Med Surg Respiratory System
Transcript of Med Surg Respiratory System
RESPIRATORY
SYSTEM
RESPIRATORY SYSTEMRESPIRATORY SYSTEM
PRIMARY FUNCTIONSPRIMARY FUNCTIONS• Provides O2 for metabolism in the tissues • Removes CO2, the waste product of metabolism
SECONDARY SECONDARY FUNCTIONSFUNCTIONS• Facilitates sense of smell• Produces speech• Maintains acid-base balance• Maintains body water levels• Maintains heat balance
UPPER RESPIRATORY TRACTUPPER RESPIRATORY TRACT
NOSE Humidifies, warms & filters inspired air
SINUSES• Air-filled cavities within the hollow bones that surround the nasal passages• Provide resonance during speech
PHARYNX• Located behind the oral & nasal cavities• Divided into the nasopharynx, oropharynx & laryngopharynx• Passageway for both the respiratory & digestive tracts
UPPER RESPIRATORY TRACT
LARYNX• Located above the trachea & just below the pharynx at the root of the tongue• Commonly called the “VOICE BOX”• Contains 2 pairs of vocal cords, the false & true cords• The opening between the true vocal cords is the
GLOTTIS GLOTTIS - Valsalva Maneuver
EPIGLOTTIS• Leaf-shaped elastic structure that is attached along one end to the top of the larynx• Prevents the food from entering the tracheo-bronchial tree by closing over the glottis during swallowing
LOWER RESPIRATORY TRACT
TRACHEA• Located in front of the esophagus• Branches into the right & left mainstem bronchi at the carina
MAINSTREAM BRONCHI• Begin at the carina• RIGHT BRONCHUS is slightly wider, shorter, & more vertical than the left bronchus• Mainstream bronchi divide into 5 secondary or lobar bronchi that enter each of the 5 lobes of the lung• The bronchi are lined with cilia which propel mucus up & away from the lower airway to the trachea where it can be expectorated or swallowed
LOWER RESPIRATORY TRACTLOWER RESPIRATORY TRACTBRONCHIOLES Branch from the secondary bronchi & subdivide into small terminal & respiratory bronchioles• Contain no cartilage & depend on the elastic recoil of the lung for patency• Terminal bronchioles contain no cilia & don’t participate in gas exchangeALVEOLAR DUCTS & ALVEOLI•- used to indicate all structures distal to the terminal bronchiole• Alveolar ducts branch from the respiratory bronchioles• Alveolar sacs which arise from the ducts contain clusters of alveoli which are basic units of gas exchange• Cells in the walls of the alveoli secrete surfactant - phospholipid CHON the reduces the surface tension in the alveoli - without surfactant the alveoli would collapse
LOWER RESPIRATORY RACTLOWER RESPIRATORY RACTLUNGS• Located in in the pleural cavity in the thorax• Extend from just above the clavicles to the diaphragm - the diaphragm is the major muscle of respiration• RIGHT LUNG - is larger than the left; divided into 3 lobes: the upper, middle & lower lobes• LEFT LUNG - somewhat narrower than the right lung to accommodate the heart ; divided into 2 lobes• Innervation of the respiratory structures is accomplished by the PHRENIC PHRENIC NERVE, VAGUS NERVE & THORACIC NERVE, VAGUS NERVE & THORACIC NERVES NERVES • PARIETAL PLEURA PARIETAL PLEURA - lines the inside of the thoracic cavity including the upper surface of the diaphragm• VISCERAL PLEURA VISCERAL PLEURA - covers the pulmonary surfaces• A thin fluid layer produced by the cells lining the pleura, lubricates the visceral & parietal pleura
LOWER RESPIRATORY RACT
ACCESSORY MUSCLES OF ACCESSORY MUSCLES OF RESPIRATIONRESPIRATION
SCALENE MUSCLESSCALENE MUSCLES• Elevate the first 2 ribsElevate the first 2 ribs
STERNOCLEIDOMASTOID STERNOCLEIDOMASTOID MUSCLESMUSCLES• Raises the sternumRaises the sternum
TRAPEZIUS & PECTORALIS TRAPEZIUS & PECTORALIS MUSCLESMUSCLES• Fix the shouldersFix the shoulders
• the diaphragm descends into the abdominal cavity during inspiration causing (-) pressure in the lungs• the (-) pressure draws the air from the area of greater pressure (THE ATMOSPHERE)(THE ATMOSPHERE) into an area of lesser pressure (THE LUNGS)(THE LUNGS)• In the lungs, air passes thru the terminal bronchioles into the alveoli to oxygenate the body tissues• At the end of inspiration, the diaphragm & intercostal muscles relax & the lungs recoil• As the lungs recoil, pressure within the lungs becomes greater than atmospheric pressure, causing the air which now contains the cellular waste products of CO2 & H2O to move from the alveoli in the lungs to the atmosphere• Expiration is a passive process
THE RESPIRATORY THE RESPIRATORY PROCESSPROCESS
RISK FACTORS FOR RESPIRATORY DISEASE
SmokingSmoking Use of chewing tobaccoUse of chewing tobacco AllergiesAllergies Frequent respiratory illnessesFrequent respiratory illnesses Chest injuryChest injury SurgerySurgery Exposure to chemicals & Exposure to chemicals & environmental environmental pollutantspollutants Family history of infectious diseaseFamily history of infectious disease Geographic residence & travel to Geographic residence & travel to foreignforeign
countriescountries
DIAGNOSTIC TESTS
CHEST X-RAY (CXR) FILM CHEST X-RAY (CXR) FILM (RADIOGRAPH)(RADIOGRAPH) - information on the anatomic location & appearance
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE
• Remove all jewelry & other metal objects• Assess ability to inhale & hold the breath• Question regarding pregnancy of possibility of pregnancy
DIAGNOSTIC TESTS
SPUTUM SPECIMENSPUTUM SPECIMEN - - obtained by expectoration or tracheal suctioning obtained by expectoration or tracheal suctioning - identify organisms or abnormal cells- identify organisms or abnormal cells
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Determine specific purposeDetermine specific purpose• Early morning sterile specimenEarly morning sterile specimen• 15 ml of sputum15 ml of sputum• Rinse the mouth with water prior to collectionRinse the mouth with water prior to collection• Take several deep breaths and then cough forcefully Take several deep breaths and then cough forcefully • Collect the specimen before antibioticsCollect the specimen before antibiotics
DIAGNOSTIC TESTS
SUCTIONING PROCEDURE IN SUCTIONING PROCEDURE IN OBTAINING SPUTUM SPECIMENOBTAINING SPUTUM SPECIMEN• Aseptic technique• Hyperoxygenate• Lubricate the catheter with sterile water• Tracheal suctioningTracheal suctioning: 4 inches• Nasotracheal suctioningNasotracheal suctioning: insert to induce cough reflex• Don’t apply suction while inserting• Suction intermittently for 10-15 seconds• Rotate and withdraw• Hyperoxygenate & deep breaths
SPUTUM SPECIMENSPUTUM SPECIMEN
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• Transport specimen to lab stat• Mouth care
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
BRONCHOSCOPYBRONCHOSCOPY - visual examination of the larynx, trachea & bronchi with a fiber-optic bronchoscope
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Informed consent• NPO prior• Assess coagulation studies• Remove dentures or eyeglasses • Prepare suction• Sedatives as Rx• Have resuscitation equipment available
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• V/S• Fowler’s position• Assess gag reflex• NPO until gag reflex returns• Monitor for bloody sputum• Monitor respiratory status • Monitor for complications: bronchospasm, bronchial perforation, crepitus, dysrhythmia, fever, hemorrhage, hypoxemia, and pneumothorax• Notify the MD if complications occur
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHY- insertion of a flouroscopy via the antecubital or femoral vein into the pulmonary artery - it involves iodine or radiopaque or contrast material
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Informed consent• Assess for allergies to iodine, seafood & dyes• NPO prior to procedure• V/S• Assess coagulation studies• Establish an IV • Administer sedation• Client must lie still during the procedure
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHYPRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Urge to cough, flushing, nausea, or a salty taste• Emergency equipment available
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• V/S• No BP for 24 hrs in the affected extremity • Monitor peripheral neurovascular status • Assess for bleeding• Monitor dye reaction
DIAGNOSTIC TESTS
THORACENTESISTHORACENTESISPRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Informed consent• V/S• CXR or U/S prior to the procedure• Assess coagulation studies• Upright• Do not to cough, breath deeply, or move during the procedure
DIAGNOSTIC TESTS
POST-PROCEDURE POST-PROCEDURE NURSING CARENURSING CARE• V/S• Monitor respiratory status• Pressure dressing • Assess site for bleeding and crepitus• Monitor for signs of PNEUMOTHORAX, AIR EMBOLISM & PNEUMOTHORAX, AIR EMBOLISM & PULMONARY EDEMAPULMONARY EDEMA
DIAGNOSTIC TESTS
LUNG BIOPSYLUNG BIOPSY - a percutaneous lung biopsy - culture or cytologic examination - a needle biopsy - pulmonary lesions, changes in lung tissue and the cause of pleural effusion
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Informed consent• NPO prior• Local anesthetic • Pressure during insertion and aspiration • Administer analgesics & sedatives as Rx
DIAGNOSTIC TESTS
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• V/S• Pressure dressing • Monitor for bleeding• Monitor for respiratory distress• Monitor for complications: pneumothorax and air emboli • Prepare for CXR
DIAGNOSTIC TESTS
VENTILATION PERFUSION LUNG VENTILATION PERFUSION LUNG SCANSCAN - determines the patency of the pulmonary airways - a radionuclide may be injected
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Informed consent• Assess for allergies to dye, iodine, or seafood• Remove jewelry • Review breathing methods • IV access• Administer sedation • Emergency resuscitation equipment
DIAGNOSTIC TESTS
POST-PROCEDURE POST-PROCEDURE NURSING CARENURSING CARE• Monitor reaction to radionuclide
• For 24 hrs following the procedure, handle body secretions carefully, rubber gloves worn when urine is being discarded should be washed with soap & H2O before removing, then the hands should be washed after the gloves are removed
• Instruct the client to wash hands carefully with soap and H2O for 24 hrs following the procedure
DIAGNOSTIC TESTS
SKIN TESTSSKIN TESTS
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Determine hypersensitivity or previous reactions to skin tests
PROCEDUREPROCEDURE• Should be of excessive body hair & dermatitis• Upper 1/3 of inner surface • Circle, document the date, time and test site
DIAGNOSTIC TESTS
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• Do not to scratch• Do not wash• Assess for induration (hard swelling), erythema and vesiculation (small blister-like elevations)
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
PULSE OXIMETRYPULSE OXIMETRY - a non-invasive test that registers arterial O2 saturation (SaO2) - NORMAL VALUE: 95%-100%NORMAL VALUE: 95%-100%
- alert hypoxemia before clinical signs occurs
PROCEDUREPROCEDURE• A sensor is placed: finger, toe, nose, earlobe or forehead • Don’t select an extremity with an impediment to blood flow• Results lower than 91% - immediate treatment• If the SaO2 is below 85% - hypo-oxegenation• If the SaO2 is 70% - life-threatening situation
RESPIRATORY TREATMENTS
CHEST PHYSIOTHERAPY (CPT)CHEST PHYSIOTHERAPY (CPT)
NURSING CARENURSING CARE• Best time - morning upon arising, 1 hr before meals or 2-3 hrs after meals • Stop if pain occurs• Provide mouth care
RESPIRATORY TREATMENTS
CONTRAINDICATIONS OF CONTRAINDICATIONS OF CHESTPHYSIOTHERAPY (CPT)CHESTPHYSIOTHERAPY (CPT)• respiratory distress• Hx of fractures• Chest incisions
RESPIRATORY TREATMENTS
POSTURAL DRAINAGEPOSTURAL DRAINAGE - use of the gravity
NURSING CARENURSING CARE• Position the client• Best time – A.M. upon arising, 1 hr before meals, 2-3 hrs after meals • Stop if cyanosis or exhaustion occurs• Maintain position 5-20 mins after• Provide mouth care after the procedure
RESPIRATORY TREATMENTS
CONTRAINDICATIONS OF CONTRAINDICATIONS OF POSTURAL DRAINAGEPOSTURAL DRAINAGE• Unstable V/S• Increased ICP
CLIENT INSTRUCTIONS FOR CLIENT INSTRUCTIONS FOR INCENTIVE SPIROMETRYINCENTIVE SPIROMETRY• Use the lips to form seal around the mouth piece• Inspire deeply• Hold inspiration for a few seconds• Forcefully exhale• Avoid the use of spirometry at mealtimes - it may cause nausea
RESPIRATORY TREATMENTS
OXYGEN (OOXYGEN (O22) ADMINSITRATION) ADMINSITRATION
NURSING CARENURSING CARE• V/S• OXYGEN IN USEOXYGEN IN USE sign• Humidify the O2
RESPIRATORY RESPIRATORY TREATMENTSTREATMENTS
NASAL CANNULA (NASAL PRONGS)NASAL CANNULA (NASAL PRONGS) - flow rates of 1-6L/min; 24% (at 1L/min) to 44% (at 6L/min) - flow rates higher than 6L/min don’t significantly increase oxygenation NOTE: Client who retains CONOTE: Client who retains CO22 should never receive O should never receive O22 at rates at rates
higher than 2-3 L/min unless on a mechanical ventilatorhigher than 2-3 L/min unless on a mechanical ventilator
- effective O2 concentration can be delivered to both nose breathers & mouth breathers with the use of a nasal cannula
RESPIRATORY RESPIRATORY TREATMENTSTREATMENTSFFII0022 DELIVERED VIA DELIVERED VIA NASAL CANNULANASAL CANNULA
24% at 1L/min 28% at 2L/min 32% at 3L/min 36% at 4L/min 40% at 5L/min 44% at 6L/min
NURSING CARE NURSING CARE • Add humidification• Monitor humidifier• Assess RR • Assess the mucosa - high flow rates have a drying effect & increase mucosal irritation• Assess the skin integrity - O2 tubing can irritate the skin•Provide water-soluble jelly
RESPIRATORY TREATMENTS
RESPIRATORY TREATMENTS
SIMPLE FACE MASKSIMPLE FACE MASK - 40%-60% for short term O2 therapy or to deliver O2 in an emergency - minimal flow rate of 5L/min - to prevent the rebreathing of exhaled air
NURSING CARENURSING CARE• Be sure the mask fits • Provide skin care - pressure & moisture under the mask may cause skin breakdown• Monitor for aspiration - the mask limits the client’s ability to clear the mouth esp if vomiting occurs • Provide emotional support to decrease anxiety in the client who feels claustrophobic
PARTIAL REBREATHER MASKPARTIAL REBREATHER MASK - 70%-90% with flow rates of 6-15L/min - the client rebreathes 1/3 of the exhaled tidal volume
NURSING CARENURSING CARE• Make sure that the reservoir does not twist or kink • Keep the reservoir bag inflated 2/3 full during inspiration - deflation results in decreased O2 delivered & rebreathing of exhaled air
RESPIRATORYRESPIRATORY TREATMENTSTREATMENTS
NON-REBREATHER MASKNON-REBREATHER MASK - 90% - most frequently deteriorating respiratory status requiring intubation - has a one-way valve between the mask & reservoir and two flaps over the exhalation ports - entire quantity of O2 from the reservoir bag - the flaps prevent room air from entering thru the exhalation ports
RESPIRATORY TREATMENTS
RESPIRATORY TREATMENTS
NON-REBREATHER MASKNON-REBREATHER MASK FFIOIO22 DELIVERED: 60% to 100% DELIVERED: 60% to 100% FFIOIO22 at a liter flow that maintains at a liter flow that maintains the bag 2/3 fullthe bag 2/3 full
NURSING CARENURSING CARE
• Remove the mucus or saliva from the mask • Assess the client• Ensure the valve & flaps are functional• Valves should open during expiration & close during inspiration• Monitor for kinks & twisting
RESPIRATORY TREATMENTSRESPIRATORY TREATMENTS
HIGH-FLOW OXYGEN DELIVERY SYSTEMHIGH-FLOW OXYGEN DELIVERY SYSTEM - 24% to 100% at 8-15L/min
- high-flow systems include the Venturi mask, aerosol mask, face tent, tracheostomy collar, and T-piece - deliver a consistent and accurate O2 concentration
VENTURI MASKVENTURI MASK - give accurate O2 concentration - an adapter is located between the bottom of the mask & the O2 source - the adapter contains holes of different sizes that allow only specific amounts of air to mix with the O2
- the adapter allows selection of the amount of O2 desired
RESPIRATORY TREATMENTS
VENTURI MASKVENTURI MASK FFIOIO22 DELIVERED: 24% to 55% DELIVERED: 24% to 55% FFIOIO22 with flow rates of 4-10L/min with flow rates of 4-10L/min
NURSING CARENURSING CARE• Monitor closely to ensure an accurate flow rate• Keep the orifice for the Venturi adapter open uncovered to ensure adequate oxygen delivery • Ensure the mask fits snugly & that tubing is free of kinks • Monitor mucous membranes
RESPIRATORY TREATMENTS
FACE TENTFACE TENT - fits over the client’s chin, with top extending halfway across the face - the O2 concentration varies - useful for the client who has facial trauma or burns because it is not tight
AEROSOL MASKAEROSOL MASK - used for the client who has thick secretions
TRACHEOSTOMY COLLAR OR T-PIECETRACHEOSTOMY COLLAR OR T-PIECE - the tracheostomy collar can be used to deliver high humidity & the desired O2 to the client with a tracheostomy - a special adapter, called T-piece can be used to deliver any desired FIO2 to the client with a tracheostomy, laryngectomy or endotracheal tube
RESPIRATORY TREATMENTS
FACE TENT, AEROSOL MASK, TRACHEOSTOMY FACE TENT, AEROSOL MASK, TRACHEOSTOMY COLLAR & T- PIECECOLLAR & T- PIECE FFIOIO22 DELIVERED: 24% to 100% DELIVERED: 24% to 100% FFIOIO22 with flow rates of at least with flow rates of at least 10L/min10L/min
NURSING CARENURSING CARE• Change to nasal cannula during meals• Empty condensation • Monitor water in the canister & change the aerosol water container as needed• Keep the exhalation port in the T-piece open • Position the T-piece so that it does not pull on the tracheostomy or endotracheal tube - it may cause erosion of the skin at the tracheostomy insertion site
ARTIFICIAL AIRWAY
A.Endotracheal TubePurpose: 1. Tracheal Suctioning2. Positive Pressure Breathing
Nsg. Care:1. Humidify air2. Suction PRN3. NGT4. Promote Communication5. Confirm placement6. Monitor the cuff
ARTIFICIAL AIRWAY
B. TRACHEOSTOMY TUBE
PURPOSE: SAME AS ET
TYPES:1. Plastic2. Metal
PARTS:
1. Outer Cannula2. Inner Canula3. Obsturator
ARTIFICIAL AIRWAY
NSG. CARE:1. Asepsis2. No sedative3. Suction PRN4. Hemostats5. NGT, TPN & Oral nutrition6. Wash the stoma7. Tub bath8. Avoid swimming9. Weaning
ADULT ADULT RESPIRATORRESPIRATOR
Y Y DISORDERSDISORDERS
CHEST CHEST INJURIESINJURIES
A. RIB FRACTUREA. RIB FRACTURE - results from blunt chest trauma - causes a potential for intra-thoracic injury: pneumothorax or pulmonary contusion
ASSESSMENTASSESSMENT Pain Tenderness Shallow respirations Client splints chest Fractures noted on CXR
RIB RIB FRACTURFRACTUR
EENURSING CARENURSING CARE Note that ribs unite spontaneously Fowler’s Pain medications Monitor for respiratory distress Instruct the client to self-splinting Prepare for possibble intercostal nerve block
CHEST CHEST INJURIESINJURIES
B. FLAIL CHESTB. FLAIL CHEST - a blunt chest trauma associated w/ accidents - resulting to loose chest wall
ASSESSMENTASSESSMENT Paradoxical respirations Severe chest pain Dyspnea Cyanosis Tachycardia Hypotension Tachypnea Diminished breath sounds
FLAIL FLAIL CHESTCHEST
NURSING CARENURSING CARE Fowler’s Humidified O2
Monitor respiratory distress Coughing & deep breathing Pain meds Bed rest Prepare for intubation with mechanical ventilation with positive end-expiratory pressure ( PEEP ) for severe respiratory failure
CHEST INJURIES
C. PULMONARY CONTUSIONC. PULMONARY CONTUSION - intra-alveolar hemorrhage resulting to ADULT ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)RESPIRATORY DISTRESS SYNDROME (ARDS)
ASSESSMENTASSESSMENT Dyspnea Hypoxemia bronchial secretions Hemoptysis Restlessness Decreased breath sounds Rales & wheezes
PULMONARY CONTUSION
NURSING CARENURSING CARE Maintain airway Fowler’s O2 as Rx Monitor respiratory distress Maintain bed rest Prepare for mechanical ventilation with positive end- expiratory pressure ( PEEP ) if required
CHEST INJURIESCHEST INJURIESD. PNEUMOTHORAXD. PNEUMOTHORAX - accumulation of atmospheric air in the pleural space - may lead to lung collapse
KINDSKINDS1. SPONTANEOUS PNEUMOTHORAX1. SPONTANEOUS PNEUMOTHORAX
2. OPEN PNEUMOTHORAX2. OPEN PNEUMOTHORAX
3. TENSION PNEUMOTHORAX3. TENSION PNEUMOTHORAX
PNEUMOTHOPNEUMOTHORAXRAX
ASSESSMENTASSESSMENT DyspneaDyspnea TachycardiaTachycardia TachypneaTachypnea Sharp chest painSharp chest pain Absent breath sounds Absent breath sounds chest expansion unilaterallychest expansion unilaterally CyanosisCyanosis HypotensionHypotension Sucking soundSucking sound Tracheal deviation to the unaffected side Tracheal deviation to the unaffected side with tension pneumothoraxwith tension pneumothorax
PNEUMOTHOPNEUMOTHORAXRAX
NURSING CARENURSING CARE Apply dressing over an open chest wound O2 as Rx Fowler’s Chest tube placement Monitor for chest tube system Monitor for subcutaneous emphysema
CHEST TUBE DRAINAGE CHEST TUBE DRAINAGE SYSTEMSYSTEM
- returns (-) pressure to the intra-pleural space - remove abnormal accumulation of air & fluids - serves as lungs while healing is going on
A. COLLECTION CHAMBERA. COLLECTION CHAMBERB. WATER SEAL CHAMBERB. WATER SEAL CHAMBERC. SUCTION CONTROL C. SUCTION CONTROL CHAMBER CHAMBER
CHEST TUBE DRAINAGE CHEST TUBE DRAINAGE SYSTEMSYSTEM
PRINCIPLES:PRINCIPLES: 1. a. Gravity1. a. Gravity b. Suctionb. Suction c. Watersealc. Waterseal 2. Drainage2. Drainage 3. Waterseal3. Waterseal 4. Suction4. Suction 5. Bottle should be below the chest5. Bottle should be below the chest 6. Hemostats6. Hemostats 7. If chest tube removed from the chest7. If chest tube removed from the chest 8. If chest tube removed from the bottle8. If chest tube removed from the bottle 9. Don’t strip9. Don’t strip
NURSING CARENURSING CARE• Occlusive dressing A CXR assesses the position of the tube & determines re-expansion Assess respiratory status Monitor for signs of remissions Keep the drainage system below the chest Ensure secure connections Coughing &DBE Change client’s position q 2
CHEST TUBE DRAINAGE CHEST TUBE DRAINAGE SYSTEMSYSTEM
ADULT RESPIRATORY ADULT RESPIRATORY DISTRESS SYNDROME DISTRESS SYNDROME
(ARDS(ARDS) - - caused by a lung injury leading to extravascular lung caused by a lung injury leading to extravascular lung fluidfluid - interstitial edema- interstitial edema - respiratory acidosis & hypoxemia- respiratory acidosis & hypoxemia - the CXR film shows interstitial edema - the CXR film shows interstitial edema
ADULT RESPIRATORY ADULT RESPIRATORY DISTRESS SYNDROME DISTRESS SYNDROME
(ARDS)(ARDS)ASSESSMENTASSESSMENT Tachypnea Dyspnea breath sounds Deteriorating blood gas O2
ADULT RESPIRATORY ADULT RESPIRATORY DISTRESS SYNDROME DISTRESS SYNDROME
(ARDS)(ARDS)NURSING CARE Identify & treat the cause O2 as Rx Fowler’s Restrict fluid Respiratory ttt Administer diuretics, anticoagulants, or corticosteroids as Rx Prepare the client for intubation & mechanical ventilation using (+) end-expiratory pressure (PEEP)
CHRONIC CHRONIC OBSTRUCTIVE OBSTRUCTIVE
PULMONARY DISEASE PULMONARY DISEASE (COPD)(COPD) - a group of diseases that includes EMPHYSEMA, EMPHYSEMA,
ASTHMA, BRONCHIECTASIS & CHRONIC ASTHMA, BRONCHIECTASIS & CHRONIC BRONCHITISBRONCHITIS
- COPD leads to pulmonary insufficiency, pulmonary hypertension & cor pulmonale
CHRONIC BRONCHITIS
Bronchial Inflamation mucus cilia r.acidosis
Causes:• Smoking
• Pollution
• Allergens
CHRONIC BRONCHITIS
Assessment:1. Chronic Cough
2. Blue Bloater: cyanotic edema
chronic cough exertional dyspnea,RR
hypoxia polycythemia- RBC
hypercapnia cor pulmonale-RVH &
resp. acidosis dilatation
incidence in heavy cigarette smokers
EMPHYSEMA
Destruction and Overdistension of the Alveoli
Air Trapping
Respi. Acidosis
EMPHYSEMA
CAUSES:1. Smoking, Pollution and Allergens
2. alpha-antitrypsin – causes expansion of the
alveoli
- strengthens the walls of the
alveoli(blebs)
EMPHYSEMA
Assessment:•pink puffer:
mucus speaks in short & jerky sentence
coughing anxious
orthopneic pos. Frequently develop URTI
barrelled chest Prolonged expiratory time
SOB digital clubbing
wheezing
EMPHYSEMA
ASSESSMENT:1. Exertional Dyspnea
2. Barrelled chest
3. Hyperesonance
4. Spontaneous pneumothorax
ASTHMA
- Characterized by recurring episodes of paroxysmal dyspnea, wheezing on inspiration/expiration caused by constriction of the bronchi and viscous mucus secretions.
TYPES:
1. Extrinsic
2. Intrinsic – asthma w/ physiological cause
3. Status Asthmaticus – severe form of constriction & inflamation despite treatment; may lead to respiratory or cardiac failure.
ASTHMA
ASSESSMENT:1. Severe dyspnea
2. Wheezing
3. Anxiety
4. Fever - grade fever
5. Orthopneic position
BRONCHIECSTASISPermanent dilation & distension of the bronchi; may lead to
mucus production respi. Acidosis
CAUSES:1. Infection2. Atelectasis3. Aspiration
ASSESSMENT:1. Mucupurelent mucus2. Dyspnea3. Fever4. Orthopneic position5. Anxiety
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
1. Bronchodilators: Xanthines, aminophyline, theophyline2. Adrenergics: Isoproterenol(Isuprel), Terbutaline,(Brethine), Metaproterenol(Aluputent)3. Expectorants: Guaifenessin(Robitusin)4. Mucolytics: Acetylcysteine(Mucomyst)5. Steroids: Prednisone6. Propylaxis (anti-allergy): Cromolyn Na(Intal)
NURSING CARENURSING CARE V/SV/S O2 conc. (2-3L/min) as Rx O2 conc. (2-3L/min) as Rx Monitor pulse oximetryMonitor pulse oximetry Respiratory ttt & chest physiotherapyRespiratory ttt & chest physiotherapy Pursed-lip breathing Pursed-lip breathing Record the color, amount & consistency of sputumRecord the color, amount & consistency of sputum Suction Suction Daily wt.Daily wt. Small, frequent feedings Small, frequent feedings
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
NURSING CARENURSING CARE calorie & CHON diet with supplements Encourage fluids Fowler’s Stop Smoking Activity as tolerated Avoid powerful odors
PNEUMONIA
ASSESSMENTASSESSMENT grade feverChillsChest pain Grating soundRusty SputumRales or crackles on auscultationDullness or hyperesonanceDx test: x-ray gram-staining sputum culture & sensitivity
NURSING CARE for NURSING CARE for PNEUMONIAPNEUMONIA Fluids Chest Physiotherapy Chest splinting Incentive Spirometer calorie & CHON diet Small frequent meals Rest & activity as tolerated Administer antibiotics as Rx – Penicillin DOC Administer antipyretics, bronchodilators, cough suppressants, mucolytic agents & expectorants as Rx Handwashing & proper disposal of secretions Thoracentesis – POC
.
LUNG CANCER
- Tumor in the Bronchial Epithelium; men 40 &
TYPES:1. Epidermoid/Squamous:
2. Adenocarcinoma
3. Small cell(Oat cell)
4. Large cell
LUNG CANCER
CAUSES:1. Genetics
2. Carcinogens
3. Infection
4. Smoking
LUNG CANCER
ASSESSMENT:1. Respiratory Pattern Changes2. Hemoptysis3. Dyspnea4. Chest Pain5. Fatigue6. Anorexia7. Persistent Dry Cough8. Dx Test: Sputum cytology Lung biopsy Bronchoscopy
LUNG CANCERLUNG CANCER
NSG. RESPONSIBILITIES:
1. Early detection2. Radiation – Cobalt3. Chemotheraphy – does not distinguish normal from abnormal4. Surgery – ttt of choice a. Pneumonectomy b. Lobectomy * Segment resection * Wedge resection
PULMONARY TUBERCULOSIS
Highly communicable disease caused by a gram + acid-fast bacili (mycobacterium tuberculosis)
Causes/ Risk groups:
1. Imunosuppression2. Overcrowding3. 3rd world country4. Children 5 yrs.old 5. Alcoholics6. Smoking
PULMONARY TUBERCULOSIS
ASSESSMENT:1. Asymptomatic2. Anorexia3. Wt. Loss4. Fatigue5. Low grade P.M. fever6. Night sweats7. Sputum – yellow green8. Hemoptysis9. Chest pain10. tactile fremitus
PULMONARY TUBERCULOSIS
11. Dx Test: Sputum test Sputum Culture – TOC Tuberculin test – Check for the presence of antibodies due to exposure a. Mantoux test b. Multiple puncture test(Tine or Monovac)
PULMONARY TUBERCULOSIS
NSG. CARE:1. Chemoprophylaxis – only indicated in primary infection2. Multi-drug theraphy 1st line drug: 2nd line drugs: Rifampicin Kanamycin INH Capneomycin Streptomycin Para aminosalycilic acid Pyrazinamid Etambutol
PLEURAL EFFUSION
- the collection of fluid in the pleural space
ASSESSMENTASSESSMENT Sharp pleuritic pain Dyspnea Dry non-productive cough Tachycardia temperature breath sounds CXR shows pleural effusion & a mediastinal shift away from the fluid
PLEURAL EFFUSION
NURSING CARENURSING CARE Identify & treat underlying cause Monitor breath sounds Monitor pulse oximetry Fowler’s Coughing & DBE Thoracentesis If pleural effusion is recurrent, prepare the client for pleurectomy or pleurodesis
PLEURECTOMY & PLEURODESIS
PLEURECTOMYPLEURECTOMY - surgically stripping the parietal pleura
- PLEURODESISPLEURODESIS - involves instillation of a sclerosing substance into the pleural space via a thoracotomy tube
EMPYEMA - pus within the pleural cavity
- fluid is thick, opaque & foul smelling
ASSESSMENTASSESSMENT Fever & chills Chest pain Cough Dyspnea Anorexia & wt. loss Malaise Night sweats Diminished chest wall movement on the affected side Pleural exudate on chest CXR
EMPYEMANURSING CARENURSING CARE
Monitor breath sounds Fowler’s Coughing & DBE Antibiotics as Rx Chest splinting If marked pleural thickening occurs, prepare the client for decortication, if Rx
PLEURISY
- inflammation of the visceral & parietal membranes - may be caused by pulmonary infarction or pneumonia
ASSESSMENTASSESSMENT Knife-like pain Dyspnea Pleural friction Apprehension
PLEURIPLEURISYSY
NURSING CARENURSING CARE Identify & treat cause Monitor lung sounds Analgesics as Rx Apply hot & cold applications as Rx Coughing & DBE Instruct the client to lie on affected side to splint chest
PULMONARY EMBOLISM
- Dislodgement of thrombus to the pulmonary artery - Caused by thrombus & pulmonary emboli - Other risk factors: deep vein thrombosis, immobilization, surgery, obesity, pregnancy, CHF, advanced age, prior history of thromboembolism
ASSESSMENTASSESSMENT DyspneaDyspnea Chest painChest pain Tachypnea & tachycardiaTachypnea & tachycardia HypotensionHypotension Shallow respirationsShallow respirations Rales on auscultationRales on auscultation CoughCough Blood-tinged sputumBlood-tinged sputum Distended neck veinsDistended neck veins CyanosisCyanosis
PULMONARY EMBOLISM
PULMONARY EMBOLISM
NURSING CARENURSING CARE O2 as Rx Fowler’s Maintain bed rest Incentive spirometry as Rx Pulse oximetry Prepare for intubation & mechanical ventilation IV heparin (bolus) Warfarin (Coumadin) Monitor PT & PTT closely Prepare the client for embolectomy, vein ligation, or insertion of an umbrella filter as Rx
CARBON MONOXIDE CARBON MONOXIDE POISONINGPOISONING
- Carbon monoxide is a colorless, odorless & tasteless gas
ASSESSMENT LEVELS OF CARBON MONOXIDEASSESSMENT LEVELS OF CARBON MONOXIDE
LEVELLEVEL ASSESSMENT FINDINGASSESSMENT FINDING
5% to 10% Impaired visual acuity11% to 20% Flushing21% to 30% Nausea & impaired dexterity31% to 40% Vomiting, dizziness, & syncope41% to 50% Tachypnea & tachycardia 50% Coma & death
CARBON CARBON MONOXIDE MONOXIDE POISONINGPOISONING
NURSING CARENURSING CARE Remove victim from exposure Administer O2
Assess for basic life support V/S Monitor carbon monoxide levels
HISTOPLASMOHISTOPLASMOSISSIS
- Fungal infection caused by spores of Histoplasma capsulatum - Transmitted by inhalation of spores, which are commonly located in contaminated soil - Found in bird droppings
ASSESSMENTASSESSMENT Dyspnea Chills Fever Chest pain Pulmonary infiltrates on CXR Elevated WBCSplenomegaly & hepatomegaly
HISTOPLASMOSIS
NURSING CARENURSING CARE O2 as Rx Monitor breath sounds Antiemetics, antihistamines, antipyretics & corticosteroids as Rx Fungicidal medications Coughing & DBE Fowler’s V/S Monitor for nephrotoxicity
SARCOIDOSIS
- Epitheloid cell tubercles in lung - cause is unknown
ASSESSMENTASSESSMENT Night sweats Fever Weight loss Cough Skin nodules Polyarthritis (+) KVEIM TEST(+) KVEIM TEST
SARCOIDOSIS
NURSING CARENURSING CARE Corticosteroids Monitor temperature Increase fluid intake Provide frequent periods of rest Encourage small, frequent meals
OCCUPATIONAL LUNG DISEASE : SILICOSIS
- Known as ASBESTOSISASBESTOSIS and COAL WORKER’S COAL WORKER’S PNEUMONIAPNEUMONIA - caused by the inhalation of inorganic dusts - common in miners & sandblasters - Tuberculosis (PTB) is a frequent complications
ASSESSMENTASSESSMENT Frequent respiratory infections Bloody sputum Cough CXR: Nodular lesions of the lungsCXR: Nodular lesions of the lungs
OCCUPATIONAL LUNG DISEASE :
SILICOSISNURSING CARENURSING CARE Administer antitussive Administer medication for TB as Rx Eliminate the toxic substances Administer O2 as Rx Encourage coughing & DBE
ACID-BASE BALANCE
Ph – 7.35 – 7.45ph – acidosis ( H ion conc.)ph – alkalosis( H ion conc.)
BUFFER SYSTEM:Bicarbonate : Carbonic acidHCO3 : CO3Strong base : Weak acid 20 : 1
ACID-BASE BALANCE
A. Respiratory System: CO2 (acid) Metabolic acidosis – (Lungs) excrete CO2 Metabolic alkalosis – (Lungs) retain CO2B. Renal or Metabolic System: H ion(acid) ; HCO3(base) Respi. acidosis – (Kidney) excrete H+ ; retain HCO3 Respi. alkalosis – (Kidney) retain H+ ; excrete HCO3
Normal ABG Values:Ph : 7.35 – 7.45PCO2 : 35 – 45 mgHGHCO3 : 22-26 meq/LPO2 : 80-100 mgHgBase excess : (+2 or –2)
ARTERIAL BLOOD GAS
SITE: Radial Artery
TEST: Allens Test
Ph - acidosis alkalosisPCO2 - alkalosis acidosisHCO3 - acidosis alkalosis
ARTERIAL BLOOD GAS
1. Assess ph, PCO2 & HCO32. Identify imbalance. If ph is normal use 7.4 7.4 – acidosis 7.4 – alkalosis3. Identify if compensated or uncompensated uncompensated- if one component is normal & the other is abnormal compensated – if both PCO2 & HCO3 are abnormal in opposite directions4. If compensated, identify if partially or fully partially – if ph is abnormal fully - if ph is normal
Pediatric RESPIRATOR
Y DISORDERS
EPIGLOTEPIGLOTTITISTITIS
- a bacterial croup - caused by Haemophilus influenzae type B or Streptococcus pneumoniae - age group 2-5 yrs. old - onset is abrupt - often occurs in winter - EMERGENCY SITUATIONEMERGENCY SITUATION
EPIGLOTTITISASSESSMENTASSESSMENT
fever Sore, red and inflamed throat Spontaneous cough Drooling Dysphagia Muffled voice Inspiratory stridor Agitation TRIPOD POSITIONINGTRIPOD POSITIONING
EPIGLOTTIEPIGLOTTITISTIS
NURSING CARENURSING CARE Airway Assess respiratory status Assess temperature Do not visualize Prepare for lateral neck films NPO status Don’t leave the child unattended fowlers
EPIGLOTTITISNURSING CARENURSING CARE
Don’t restrain IV fluids Antibiotics Analgesics & antipyretics Cool-mist O2
humidification Resuscitation equipment available Immunization (Haemophilus type B)
BRONCHIOLITIS/RESPIRATORY
SYNCYTIAL VIRUS (RSV) - an inflammation of the bronchioles
- mucus production - RSV
ASSESSMENTASSESSMENT Rhinorrhea & fever Lethargy Poor feeding Irritablity Tachypnea Dyspnea Nasal flaring WheezingDiminished breath sounds
BRONCHIOLITIS/RESPIRATORY
SYNCYTIAL VIRUS (RSV)
NURSING CARENURSING CARE Airway fowler’s Cool, humidified O2
Oral & IV fluids Assess for signs of dehydration
NURSING CARE with NURSING CARE with RSVRSV Private room Hand washing Avoid contamination to others Gowns Ribavirin (Virazole) Pregnant health care providers should not care for a child receiving Ribavirin
BRONCHIOLITIS/RESPIRATORY
SYNCYTIAL VIRUS (RSV)
PNEUMONIA
- inflammation of the alveoli caused by a virus mycoplasmal agents, bacteria or the aspiration of foreign substances
TYPESTYPESA. VIRAL PNEUMONIAA. VIRAL PNEUMONIAB. PRIMARY ATYPICAL B. PRIMARY ATYPICAL PNEUMONIAPNEUMONIA (MYCOPLASMA PNEMONIAE)(MYCOPLASMA PNEMONIAE) - Ages 5 - 12 y.o. - occurs primarily in the fall & winter months and is more prevalent in crowded living conditions
PNEUMONIA
TYPESTYPESC. BACTERIAL PNEUMONIAC. BACTERIAL PNEUMONIA - hospitalization is indicated when pleural effusion or emphyema - staphylococcal pneumonia
D. ASPIRATION PNEUMONIAD. ASPIRATION PNEUMONIA - occurs when food, secretions, liquids, or other materials enter the lung & cause inflammation
VIRAL PNEUMONIA
ASSESSMENTASSESSMENT Whitish sputum Fever,cough ,malaise and prostration WheezIng
NURSING CARENURSING CARE O2 with cool mist fluid Antipyretics Chest physiotherapy Antimicrobial / anti-viral
PRIMARY PRIMARY ATYPICAL ATYPICAL
PNEUMONIAPNEUMONIAASSESSMENTASSESSMENT Fever Malaise Headache Rhinitis Sore throat Cough Nonproductive cough initially then produces seromucoid sputum that becomes mucopurulent or bld. streaked
NURSING CARENURSING CARE Nursing care: SYMPTOMATICSYMPTOMATIC
BACTERIAL BACTERIAL PNEUMONIAPNEUMONIA
ASSESSMENTASSESSMENT FeverINFANT: INFANT: irritabilty, lethargy, poor feeding, abrupt fever, respiratory distress OLDER CHILD: OLDER CHILD: headache, chills, abdominal pain, chest pain, meningeal symptoms Hacking, nonproductive cough Diminished breath sounds or scattered crackles Purulent sputum
BACTERIAL PNEUMONIA
NURSING NURSING CARECARE Antimicrobial therapy Administer O2 Mist tent Suction PRN Chest physiotherapy Bed rest Lie on the affected side Oral & IV Antipyretics Isolation precaution Anti-tussives Thoracenthesis
ASTHMA - is commonly caused by physical & chemical irritants
- bronchial obstruction - coughing at night
STATUS ASTHMATICUSSTATUS ASTHMATICUS - child displays respiratory distress despite vigorous treatment - may result in respiratory failure & death if untreated
ASTHMA
ASSESSMENTASSESSMENT Wheezing Dyspnea Chest tightness Exacerbations - air is trapped behind occluded or narrow airways and hypoxemia can occur
ASTHASTHMAMA
ASSESSMENTASSESSMENTASTHMATIC EPISODEASTHMATIC EPISODE Irritability Restlessness Headache Chest tightness Non productive cough Later stage: productive, frothy, gelatinous sputum
ASTHMANURSING CARENURSING CARE
Airway Humidified O2 Monitor respiratory status Oral & IV fluids Nutrition & electrolyte Prepare the child for a CXR Prepare to obtain ABG & serum electrolytes
ASTHMA
MEDICATIONSMEDICATIONS 1.1. BB22 agonists agonists - Albuterol (Proventil HFA, Ventolin) - Metaproterenol sulfate (Alupent ) - Terbutaline sulfate (Brethaire, Brethine, Bricanyl) 2.2. ANTICHOLERGENICSANTICHOLERGENICS - Atropine sulfate, Ipratropium bromide (Atrovent) 3. SYSTEMIC CORTICOSTEROIDS3. SYSTEMIC CORTICOSTEROIDS
ASTHMAMEDS. for MEDS. for MAINTENANCEMAINTENANCE 1.1. CORTICOSTEROIDSCORTICOSTEROIDS 2.2. CROMOLYN SODIUM (INTAL)CROMOLYN SODIUM (INTAL) 3. NECOCROMIL SODIUM (TILADE)3. NECOCROMIL SODIUM (TILADE) 4. LONG-ACTING B4. LONG-ACTING B22 AGONISTS AGONISTS - for the prevention of exercise-induced bronchospasm (EIB) - Albuterol (Proventil HFA, Ventolin) - Metaproterenol sulfate (Alupent) - Terbutaline sulfate (Brethaire, Brethine, Bricanyl)
ASTHMAMEDS for MAINTENENCEMEDS for MAINTENENCE 5. METHYLXANTHINES5. METHYLXANTHINES 6. LEUKOTRIENE MODIFIERS6. LEUKOTRIENE MODIFIERS - Zafirlukast (Accolate) and Zileuton (Zyflo) - used in children older than 12 years 7. LONG-ACTING BRONCHODILATOR7. LONG-ACTING BRONCHODILATOR - Salmeterol (Serevent)
ASTHMAASTHMAHOME CARE MEASURESHOME CARE MEASURES - Allergens control - Avoid extremes of temperature - Avoid exposure to viral respiratory infection - Recognize early symptoms - Instruct the child in the administration of medications as Rx - Adequate rest, sleep, and a well-balanced diet - Adequate fluid intake - Exercise as tolerated
CYSTIC FIBROSIS - a multi-system disorder (autosomal recessive trait
disorder) - Common symptoms: pancreatic enzyme deficiency - duct blockage chronic lung disease – infection sweat gland dysfunction - increased NaCl sweat concentrations - SWEAT CHLORIDE TESTSWEAT CHLORIDE TEST
CYSTIC FIBROSIS
RESPIRATORY SYSTEMRESPIRATORY SYSTEM - Stagnation of the mucus in the airway - Emphysema & atelectasis - Chronic hypoxemia - Pneumothorax - Wheezing & dry non-productive cough - Dyspnea - Cyanosis - Clubbing of the fingers & toes - Repeated episodes of bronchitis & pneumonia
CYSTIC FIBROSIS
GASTROINTESTINAL GASTROINTESTINAL SYSTEMSYSTEM - Meconium ileus in the neonate - Intestinal obstruction S/S:S/S: pain, abdominal distention N&V - Stearrhea - Deficiency of A,D, E & K - Malnutrition & failure to thrive - Rectal prolapse
CYSTIC FIBROSIS
INTEGUMENTARY SYSTEMINTEGUMENTARY SYSTEM - of Na & Cl in sweat - Dehydration & electrolyte imbalances during weather
REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM - Delayed puberty in females - Infertility - Sterility
CYSTIC FIBROSIS
DIAGNOSTIC TESTSDIAGNOSTIC TESTS1. Sweat Chloride Test1. Sweat Chloride Test2. Chest X-ray2. Chest X-ray3. Pulmonary function test3. Pulmonary function test4. Stool / fat or Enzyme analysis 4. Stool / fat or Enzyme analysis
CYSTIC FIBROSIS
NURSING CARE FOR THE NURSING CARE FOR THE RESPIRATORY SYSTEMRESPIRATORY SYSTEM A. Preventing pulmonary infection B. Antimicrobial meds. C. Chest Physiotherapy D. Bronchodilators E. Flutter Mucus Clearance Device F. Therapy Vest Device G. Recombinant Human Deoxyribonuclease (DNASE)
NURSING CARE NURSING CARE (RESPIRATORY SYSTEM)(RESPIRATORY SYSTEM) - Do not give cough suppressants - Forced expiratory technique (huffing) - Physical exercise - Antibiotics prophylactically - O2 as needed - Monitor for hemoptysis - Possible lung transplant
CYSTIC FIBROSIS
CYSTIC FIBROSISNURSING CARE FOR THE GIT NURSING CARE FOR THE GIT
SYSTEMSYSTEM - Pancreatic enzymes - Encourage a well-balanced - Monitor for failure to thrive - Monitor for constipation & intestinal obstruction - Supplement salt during extremely hot weather
SUDDEN INFANT ‘s DEATH SYNDROME
(SIDS) - unexpected death of an apparently healthy infant under the age of 1year - unknown
MATERNAL RISK FACTORSMATERNAL RISK FACTORS Maternal smoking Substance abuse Younger mothers
BIRTH RISK FACTORSBIRTH RISK FACTORS Prematurity Low-birth-weight infants Multiple births Infants with CNS problems
SUDDEN INFANT DEATH SYNDROME (SIDS)
TIME OF YEAR - TIME OF YEAR - winter
TIME OF DEATH - TIME OF DEATH - during sleep
AGE - AGE - 2 months to 4 months of life; less than 1 year
SEX & RACESEX & RACE - males - native Americans & blacks
SLEEP RISK FACTORSSLEEP RISK FACTORS Prone position Use of soft bedding Overheating (thermal stress) Possibly: sleeping with an adult
SUDDEN INFANT DEATH SYNDROME
(SIDS)APPEARANCE WHEN FOUNDAPPEARANCE WHEN FOUND Apneic & blue Frothy blood-tinged fluid in the nose & mouth Typically found in a disheveled bed, with blankets over the head, and huddled in a corner Diaper is wet & full of stool
SUDDEN INFANT DEATH SYNDROME
(SIDS)PREVENTIONPREVENTION Supine position for sleep If with gastroesophageal reflux – side lying Avoid mattresses & bedding Avoid pillows Stuff toys should be removed
THE ENDYOU CAN MAKE IT, OUR GOAL IS TO TAKE IT ONE TIME.
GOOD LUCK & MAY GOD BLESS YOU ALL
BY: JUN PEÑAFLORCGFNS/NCLEX INSTRUCTOR
DIAGNOSTIC TESTS
PULMONARY FUNCTION TEST PULMONARY FUNCTION TEST (PFTs)(PFTs) - include a number of different tests used to evaluate lung mechanics, gas exchange, & acid-base disturbance thru spirometric measurements, lung volumes, and arterial blood gases
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Determine if an analgesic that may depress the respiratory function is being administered
• Consult with MD regarding holding bronchodilators prior to testing
• Instruct the client to void prior to procedure and to wear loose clothing
• Remove dentures
• Instruct the client to refrain from smoking or eating a heavy meal for 4- 6 hrs prior to the test
DIAGNOSTIC TESTS
POST-PROCEDURE POST-PROCEDURE NURSING CARENURSING CARE• Resume normal diet and any bronchodilators & respiratory treatments that were held prior to the procedure
DIAGNOSTIC TESTS
ARTERIAL BLOOD GASES ARTERIAL BLOOD GASES (ABGs)(ABGs) - measure the dissolved O2 & CO2 in the arterial blood and renal acid- base state & how well the O2 is being carried to the body - the ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation - a radionuclide may be injected for the procedure
PRE-PROCEDURE NURSING PRE-PROCEDURE NURSING CARECARE• Perform Allen’s test prior to drawing radial artery specimens
• Have the client rest for 30 mins prior to specimen collection
• Avoid suctioning prior to drawing ABGs
• Don’t turn off O2 unless the ABGs are ordered to be drawn at room air
DIAGNOSTIC TESTS
POST-PROCEDURE NURSING POST-PROCEDURE NURSING CARECARE• Place the specimen on ice
• Note the client’s temperature on the laboratory form
• Note the O2 & type of ventilation that the client is receiving on the laboratory form
• Apply pressure on the puncture site for 5-10 mins & longer if the client is on anticoagulant therapy or has bleeding disorder
• Transport the specimen to the laboratory within 15 mins
RESPIRATORY TREATMENTS
FFII0022 DELIVERED VIA DELIVERED VIA SIMPLE FACE MASKSIMPLE FACE MASK
40% at 5L/min 45% to 50% at 6L/min 55% to 60% at 8L/min
NOTE: NOTE: PYRAMID POINTPYRAMID POINT:Flow rate must be set to at least 5L/min to flush the mask of CO2
RESPIRATORY RESPIRATORY FAILUREFAILURE
- - occurs when the client can’t eliminate COoccurs when the client can’t eliminate CO22 from the alveoli from the alveoli
- the CO- the CO22 retention results in hypoxemia retention results in hypoxemia
- O- O22 reaches the alveoli but can’t be absorbed or used properly reaches the alveoli but can’t be absorbed or used properly
- the lungs can move air sufficiently but can’t oxygenate the - the lungs can move air sufficiently but can’t oxygenate the pulmonary blood properlypulmonary blood properly
- occurs as a result of a mechanism abnormality of the lungs or - occurs as a result of a mechanism abnormality of the lungs or chest chest wall, a defect in the respiratory control center in the brain, or an wall, a defect in the respiratory control center in the brain, or an impairment in the function of the respiratory muscles impairment in the function of the respiratory muscles
- the PaCO- the PaCO22 level is greater than 45 mm Hg level is greater than 45 mm Hg
RESPIRATORY RESPIRATORY FAILUREFAILURE
ASSESSMENTASSESSMENT DyspneaDyspnea HeadacheHeadache RestlessnessRestlessness ConfusionConfusion TachycardiaTachycardia CyanosisCyanosis DysrhythmiasDysrhythmias
Decreased level of consciousnessDecreased level of consciousness Alterations in respirations & breath soundsAlterations in respirations & breath sounds
RESPIRATORY RESPIRATORY FAILUREFAILURE
NURSING CARENURSING CARE Identify & treat the cause of respiratory failure
Administer O2 to maintain the PaO2 level above 60-70 mm Hg
Position the client in high Fowler’s Encourage DBE Administer bronchodilators as Rx Prepare the client for mechanical ventilation if supplemental O2 can’t maintain acceptable PaO2 levels
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)ASSESSMENT Cough Exertional dyspnea Wheezing & crackles Sputum production Weight loss Barrel chest (EMPHYSEMA) Use of accessory muscles for breathing Cyanosis Clubbing of fingers Orthopnea Cardiac dysrhythmias Congestion & hyperinflation on CXR ABGs indicate respiratory acidosis & hypoxemia PFts demonstrate decreased vital capacity
LARYNGOTRACHEOBRLARYNGOTRACHEOBRONCHITISONCHITIS
- inflammation of the larynx, trachea, & bronchi
- most common type of croup & may be viral or bacterial
- has gradual onset & may be preceded by URTI
ASSESSMENTASSESSMENT Fever, low-grade to high Irritability & restlessness Hoarse voice Seal bark & brassy coughSeal bark & brassy cough Inspiratory stridor & suprasternal retractions Use of accessory muscle for breathing Crackles & wheezing on lung auscultation\ Anorexia, nausea & vomiting Signs of anoxia & CO2 retention Cyanosis
LARYNGOTRACHEOBRONCHITIS
NURSING CARENURSING CARE Maintain a patent airway Assess respiratory status, monitoring for nasal flaring, sternal retractions & inspiratory stridor Monitor for pallor or cyanosis
Elevate the head of the bed & provide bed rest
Provide humidified O2 via cool-mist tent for the hospitalized child
Instruct the parents to use cool-air vaporizer or humidifier at home - other measures include: having the child breathe in the cool night air or the air from an open freezer, or taking the child to a cool basement or garage Provide & encourage fluid intake; IVs may be Rx - to maintain hydration status if the child is unable to take oral fluids
LARYNGOTRACHEOBRLARYNGOTRACHEOBRONCHITISONCHITIS
NURSING CARENURSING CARE Administer Acetaminophen (Tylenol) as Rx
- to reduce fever Avoid cough syrup & cold medicines - may dry & thicken secretions Administer bronchodilators if Rx - to relax smooth muscle & relieve stridor Administer corticosteroids if Rx - for its anti-inflammatory effect Administer nebulized epinephrine (racemic epinephrine) as Rx - indicated for children with severe disease, stridor at rest, retractions or difficulty breathing Administer antibiotics as Rx - Note: they are not indicated unless a bacterial infection is Note: they are not indicated unless a bacterial infection is presentpresent Have resuscitation equipment available
BRONCHITIS
- infection of the major bronchi that may be referred to as TRACHEOBRONCHITISTRACHEOBRONCHITIS
ASSESSMENTASSESSMENT Fever Dry, hacking & non-productive cough that is worse at night & becomes productive in 2-3 days
NURSING CARENURSING CARE Monitor for respiratory distress Provide cool, humidified air Monitor for signs of dehydration - such as sunken fontanel, poor skin turgor, decreased & concentrated urinary output Increase fluid intake Administer Acetaminophen (Tylenol) for fever as Rx
BRONCHIOLITIS/RESPIRATORY
SYNCYTIAL VIRUS (RSV)
NURSING CARE with NURSING CARE with RSVRSV The nurse wearing contact lenses should wear goggles when coming in contact with Ribavirin
- the mist may dissolve the lenses
Prepare for the administration of respiratory syncytial virus immune globulin (RSV-IGIV or RespiGam)
- used prophylactically to prevent RSV in high-risk infants - RespiGam is an IV preparation of immunoglobulin G & is administered before the RSV epidemic season (Nov-Apr) - subsequent doses are given every month to maintain protection - not administered to infants or children with congenital heart disease (CHD) or with cyanotic CHD
ASTHMAASSESSMENTASSESSMENTASTHMATIC EPISODEASTHMATIC EPISODE Restlessness, apprehension and diaphoresis occur
Younger children assume the TRIPOD POSITIONTRIPOD POSITION - older children sit upright with the shoulders in a hunches-over position with the hands on the bed or chair and the arms braced to facilitate the use of accessory muscles of breathing (child refuses to lie down)(child refuses to lie down) Child speaks in short, broken phrases Retractions Hyper-resonance on percussion of the chest Breath sounds are coarse & loud with crackles & coarse rhonchi and inspiratory & expiratory wheezing Expiration are prolonged
ASTHMA
ASSESSMENTASSESSMENTEXERCISE-INDUCED BRONCHOSPASM (EIB)EXERCISE-INDUCED BRONCHOSPASM (EIB) Cough
Shortness of breath Chest pain or tightness Wheezing Endurance problems during exercise
ASTHMA
ASSESSMENTASSESSMENTSEVERE SPASM OR OBSTRUCTIONSEVERE SPASM OR OBSTRUCTION Breath sounds & crackles may become inaudible
Cough is ineffective - represents a lack of air movement
VENTILATORY FAILURE & ASPHYXIAVENTILATORY FAILURE & ASPHYXIA Shortness of breath, with air movement in the chest restricted to the point of absent breath sounds accompanied by a rise in the respiratory rate
ASTHMACHEST PHYSIOTHERAPYCHEST PHYSIOTHERAPY - includes breathing exercises and physical training
- not recommended during an acute exacerbation
ALLERGEN CONTROLALLERGEN CONTROL - prevents & reduces exposure to airborne allergens
- skin testing to identify allergens
- immunotherapy is not recommended for allergens that can be eliminated effectively
- DUST MITES:DUST MITES: Maintain the humidity in the house under 50%
- COCKROACHES:COCKROACHES: Exterminating, cleaning the kitchen floors and cabinets, putting food away quickly after eating, taking the trash out in the evening
CYSTIC FIBROSIS
NURSING CARE NURSING CARE (RESPIRATORY SYSTEM)(RESPIRATORY SYSTEM) - Monitor for HEMOPTYSISHEMOPTYSIS - 300 ml/24 hrs for the older child & lesser for a younger child needs to be treated immediately
- Hemoptysis can be controlled thru bed rest, cough suppressants, antibiotics & vitamin K
- If it persists, the site of bleeding may be cauterized or embolized
- LUNG TRANSPLANTATIONLUNG TRANSPLANTATION is the final therapeutic option for the end-stage child
CYSTIC FIBROSISHOME CAREHOME CARE
- Instruct the parents about the prescribed treatment measures and their importance
- Instruct the parents to be sure immunizations are up to date
- Inform the parents that the child should be vaccinated yearly for pneumococcus & influenzae
- Inform the parents about the Cystic Fibrosis Foundation