115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

72 Respiratory system

Respiratory refresher (continued)

ATELECTASIS (CONTINUED) Teach the client how to use an incentive spirometer and encourage him to use it every 1 to 2 hours, while awake. Humidify inspired air and encourage adequate fluid intake. Per-form postural drainage and chest percussion. Assess breath sounds and ventilatory status frequently and be alert for any changes.

BRONCHIECTASISKey signs and symptoms Chronic cough that produces copious, foul-smelling, mucopu-rulent secretions, possibly totaling several cupfuls daily Coarse crackles during inspiration over involved lobes or segments, rhonchi, wheezing Exertional dyspnea Anorexia

Key test results Chest X-rays show peribronchial thickening, areas of atelecta-sis, and scattered cystic changes. Sputum culture and Gram stain identify predominant organisms.

Key treatments Bronchoscopy (to mobilize secretions) Chest physiotherapy and incentive spirometry O2 therapy Antibiotics: according to sensitivity of causative organism Bronchodilator: albuterol (Proventil-HFA)

Key interventions Assess respiratory status. Provide supportive care and help the client adjust to the permanent changes in lifestyle that irreversible lung damage necessitates. Perform chest physiotherapy, including postural drainage and chest percussion designed for involved lobes, several times per day. Encourage use of incentive spirometer every 1 to 2 hours while the client is awake.

CHRONIC BRONCHITISKey signs and symptoms Dyspnea Increased sputum production Productive cough

Key test results Chest X-ray shows hyperinflation and increased bronchovas-cular markings.

PFTs may reveal increased residual volume, decreased vital capacity and forced expiratory volumes, and normal static com-pliance and diffusion capacity.

Key treatments Fluid intake up to 3 qt (3 L)/day, if not contraindicated Endotracheal intubation and mechanical ventilation if respiratory status deteriorates Antibiotics: according to sensitivity of infective organism Bronchodilators: terbutaline, aminophylline, theophylline (Theochron); via nebulizer: albuterol (Proventil-HFA), ipratropium (Atrovent) Influenza and Pneumovax vaccines Steroids: hydrocortisone (Solu-Cortef), methylprednisolone (Solu-Medrol) Steroids (via nebulizer): beclomethasone (Beconase AQ), triamcinolone (Azmacort)

Key interventions Administer low-flow O2. Assess respiratory status, ABG levels, and pulse oximetry. Assist with diaphragmatic and pursed-lip breathing. Monitor and record the color, amount, and consistency of sputum. Provide chest physiotherapy, postural drainage, incentive spi-rometry, and suction.

COR PULMONALEKey signs and symptoms Dyspnea on exertion Edema Fatigue Orthopnea Tachypnea Weakness

Key test results ABG analysis shows decreased PaO2 (< 70 mm Hg). Chest X-ray shows large central pulmonary arteries and sug-gests right ventricular enlargement by rightward enlargement of cardiac silhouette on an anterior chest film. Pulmonary artery pressure measurements show increased right ventricular and pulmonary artery pressures as a result of increased pulmonary vascular resistance.

Key treatments O2 therapy as necessary by mask or cannula in concentra-tions ranging from 24% to 40%, depending on PaO2 and, in acute cases, endotracheal intubation and mechanical ventilation

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