Pulmonary Concept in Critical Care

8/22/2019 Pulmonary Concept in Critical Care

1/21

PULMONARYCONCEPTINCRITICALCARE


2/21

PULMONARY

Pertaining to the lungs.

CRITICAL CAREContinuous and closely monitored

health care that is provided to critically ill

patients.


3/21

PNEUMONIA

An inflammatory process, involving the terminalairways and alveoli of the lung, caused by

infectious agents (viral/ bacterial).

Is the most common cause of death frominfectious diseases.

Recurring pneumonia commonly indicatesunderlying disease, such as cancer of lung,

multiple myeloma, or COPD.


4/21

PNEUMONIA

Signs/Symptoms:

1. Sudden onset; shaking chill; rapidly fever of

38.340 C .

2. Cough productive of purulent sputum.

3. Pleuritic chest pain aggravated by

respiration/coughing.

4. Dyspnea, tachypnea.5. Rapid, pounding pulse.


5/21

PNEUMONIA

Nursing Management:

1. Administer medications as prescribed (antibiotics,

antipyretics)

2. Improving gas exchange.

a. Observe for cyanosis, dyspnea, hypoxia, and

confusion.

b. Checking ABGs.c. Administer oxygen.

d. Place patient in an upright position.


6/21

PNEUMONIA3. Improving airway patency.

a. Encourage pt. to cough.

b. Suctioning.

c. Encourage increased fluid intake.

d. Humidify air or oxygen therapy.e. Chest physiotherapy.

f. Changing pt. position frequently.

4. Relieving pleuritic pain.

a. Place patient in semiFowler position.b. Administer analgesics as prescribed.

(avoid opioids in patient's with a history of COPD)

c. Avoid suppressing a productive cough.

5. Monitoring for complications.


7/21

PNEUMONIA

6. Patient education.

a. Advise smoking cessation, and excessive alcohol

intake, and heavy exercises.

b. Advise the patient to keep up natural resistance with

good nutrition, adequate rest.

c. Encourage breathing exercises.

Gerontologic Considerations:Sedatives, opioids, and cough suppressants should be used cautiously

in elderly pt.s, because their tendency to suppress cough and gag

reflexes and respiratory drive. Also , provide frequent oral care for

Pneumonia prevention.


8/21

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Includes diseases that cause airflow obstruction

1. Chronic Bronchitis

A disease of the airways, is defined as thepresence of cough and sputum production for atleast 3 months in each of 2 consecutive years.

Primarily viral etiology, but may also arisefrom bacterial agents.


9/21


2. Asthma

Chronic inflammatory disease of airways

causing airway hyper responsiveness, mucosal

edema, and mucus production.Reversible, either spontaneously or with

treatment.

Allergy is strongest predisposing factor.


10/21


3. Emphysema

A pathological term that describes an

abnormal distention of the air spaces beyond the

terminal bronchioles, with destruction of thewalls of the alveoli.


11/21


Primary Symptoms:

Cough

Sputum production

Dyspnea

Chest Pain


12/21


Nursing Management:1. Improving airway clearance

a. Encourage smoking cessation.

b. Keep patients room as dust free as possible.

c. Administer bronchodilators as prescribed.d. Use postural drainage position.

e. Encourage coughing.

f. Encourage oral fluids intake.

2. Improving breathing patterna. Encourage breathing, coughing exercises.

b. Use pursed- lip breathing at intervals and duringperiods of dyspnea.

3. Administer antibiotics as prescribed.


13/21


4. Improving gas exchange

a. Check ABGs.

b. Administer oxygen.

c. Inspiratory muscle training.

5. Improving nutrition.

a. Encourage frequent small meals if pt. is dyspneic.

b. Avoid foods producing gas and abdominal discomfort.

c. Monitor body weight.6. Increasing activity tolerance.

a. Encourage pt. to carry out regular exercise program.

b. Encourage use of portable oxygen system for

ambulation for patients with hypoxemia.


14/21

PULMONARY EMBOLISM

Refers to the obstruction of one or more

pulmonary arteries by a thrombus originating

usually in the deep veins of the legs or the right

side of the heart.Predisposing Factors:

1. Stasis, prolonged immobilization.

2. Previous heart (CHF, MI) or ling diseases.3. Coagulation disorders.

4. Advancing age, estrogen therapy.


15/21

PULMONARY EMBOLISM

Signs/Symptoms (occur suddenly):

1. Dyspnea, pleuritic pain, tachypnea.

2. Chest pain.

3. Cyanosis.

Emergency Management:

1.Anticoagulation therapy is used to prevent new

clot formation but does not dissolve previouslyformed clots.

2. Thrombolytic therapy is used to dissolve clots.


16/21

PULMONARY EMBOLISMNursing Management:

1. Administer prescribed medications.Anticoagulant (IV Heparin, followed byWarfarin) and Thrombolytic (streptokinase).Sedatives (Morphine) to relief pain.

2. Administer oxygen to relief hypoxemia,respiratory distress, and cyanosis.

3. Apply anti-embolism stockings to helpimprove venous

return.


17/21

PULMONARY EMBOLISM

4. Instruct the pt. do not do activities thatincrease venous stasis such as crossing legs,sitting or standing for long periods. Instruct

pt. to elevate the legs above the level ofheart.

5. Patient education.


18/21

PULMONARYEDEMA

Acute pulmonary edema refers to excess fluidin the lung, either in the interstitial spaces or inthe alveoli.

Most often occurs as result of cardiac disorderssuch as CHF and MI.


19/21

PULMONARYEDEMA

Signs/Symptoms:

1. Crackles.

2. Dyspnea and cough.

3. Tachycardia.4. Cyanosis, cold diaphoretic skin.

5. Restlessness.

6. Jugular venous distention. (JVD)


20/21

PULMONARYEDEMA

Nursing Management:

1. Administer medications as prescribed.

Morphine,

diuretics, cardiacglycosides,vasodilators,aminophylline.

2. Give oxygen in high concentration.

3. Position the pt. upright to decrease venousreturn and

allow maximum lung expansion.

4. Monitor vital signs and electrolytes balance.


21/21

THANK YOU FORLISTENING!

Presented By:

ANGUE, Aileen T.

CASTILLO, Ma. Princess M.PERLADO, Karen B.

BSN IV - 2

Pulmonary Concept in Critical Care

Documents

Transcript of Pulmonary Concept in Critical Care