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93 Cards in this Set
- Front
- Back
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Primary Function: Gas exchange |
1. Takes O2 from the air
2. Transport to the lungs 3. Exchanges 02 for co2 in the alveoli 4. returns CO2 to the air |
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Division of the respiratory system
Upper Respiratory tract 1. nasal cavities 2. pharnyx 3. larnyx |
Location
1. includes sinuses 2. Throat nasopharnyx oropharnyx Larngopharnyx 3. Above the trachea (voice box) Function 1. warms air 2. filters the air 3. prevent from coughing |
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LOWER RESPIRATORY TRACT
1. trachea 2. Rt. & lft. mainstem bronchi 3. segmental bronchi 4. subsegmental bronchi 5. bronchioles 6. Alveoli: Basic unit of gas exchange |
LOCATION:
1. (windpipe) Front of esophagus 2. Made of Cartilage begins at carina 3. Five segmental bronchi extending into the fice lung lobes 4. See above 5. Divisions of the secondary bronchi 6. Branch from respiratory bronchioles 7. pleural LOWER RESPIRATORY FUNCTION: 1. gas exchange 2. lubricates & protects lungs 3. prevent mucous from propels by cilia 5. allows from pressure to maintain in lungs 6. serves as a protective factor |
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LUNGS
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Right lung has 3 lobes, and the left lung has 2 lobes.
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LUNG VOLUME AND CAPACITY
lung volume Tidal volume (500ml) gas exchange |
DESCRIPTION
The amount of air inhaled and exhaled with each breath (equal) SIGNIFICANCE Cane be effective form certain type of respiratory disease. |
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INSPIRATORY RESERVE
(3000ML) |
DESCRIPTION
The maximum volume of air that can be inhale after normal exhalation SIGNIFICANCE Any condition that causes a restriction Decreases with restrictive lung disease eg. obesity, pregnancy, asicities |
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EXPIRATORY RESERVE
(1100ml) |
DESCRIPTION
(the maximum volume of air that can be exhaled forcibly after normal exhalation SIGNIFICANCE Decreases with restrictive lung disease eg. obesity, pregnancy, asicities |
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RESIDUAL VOLUME
(1200ML) always remain |
DESCRIPTION
not all air leaves the lungs on expiration-about 1,200ml always remains to support lung structures SIGNIFICANCE keep alveoli open & help with gas exchange. Help with pressure |
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LUNG CAPACITY
VITAL CAPACITY (4600ml) |
DESCRIPTION
the maximum volume of air exhaled from the point of maximum inspiration SIGNIFICANCE Decrease may indicate neuromuscular disease, generalized fatigue, atelectasis, COPD, Pulmonary edema |
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INSPIRATORY CAPACITY
(3500ML) |
DESCRIPTION
the maximum volume of air inhaled after normal respiration SIGNIFICANCE decrease may indicate restrictive disease. |
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FUNCTIONAL RESIDUAL CAPACITY
(2300ML) |
DESCRIPTION
Volume of air remaining in the lungs after normal respiration SIGNIFICANCE Residual capacity may increase with COPD and ARDS |
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TOTAL LUNG CAPACITY
(5800ml) |
DESCRIPTION
Volume of air in the lungs after maximum inspiration SIGNIFICANCE Total lung capacity may be decreased with restrictive diesease (atelactasis, pneumonia) and increased with COPD. |
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ACCESSORY ORGANS AND RESPIRATION
STRUCTURE Thorax-Rib cage |
LOCATION
12 pairs of ribs 11th and 12th ribs are floating FUNCTION protection |
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INTERCOASTAL MUSCLES
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LOCATION
between the ribs FUNCTION allow for chest expansion |
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DIAPHRAGM
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LOCATION
lower boundary of the thorax FUNCTION major muscle of inspiration |
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FACTORS THAT GOVERN AIR FLOW
Air pressure variances |
Air (gases) flow from areas of higher-->lower pressure
example: Inspiration: Diaphragm pulls down, other muscles move and increase the thoracic cavity with decreased pressure therefore, air moves in Expiration: Diaphragm relaxes, lungs recoil with the decreased size of the thoracic cavity. Alveolar pressure is greater than atmospheric pressure, therefore, air moves out. |
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RESISTANCE TO ARI FLOW
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Resistance is determined chiefly by the radius of the airway which air is flowing
examples: * COPD *asthma |
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LUNG COMPLIANCE
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Measure of elasticity, expandability,distensibilty of the lungs and thoracic structures
*Factors that determine compliance are: *surface tension of the alveoli *Connective tissue *examples: a. Raise Compliance loss of elasticity(seen in pts with emphysema b. lower Compliance stiff lungs; seen in pts. with pulmonary fibrosis. Atelactasis pulmonary edema. LUNGS WITH DECREASED COMPLIANCE REQUIRE GREATER EXPENDITURE OF ENERGY TO ACHIEVE NORMAL LEVELS OF RESPIRATION |
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GAS EXCHANGE
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Air is a gaseous mixture consisting mainly of Nitrogen(78%) and oxygen(20%), traces of carbon dioxide
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PARTIAL PRESSURE (PP)
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Is the pressure exerted by each gas in the mixture. PP is proportional to the gas in each mixture. Measured in mm Hg
*PaO2=partial pressure of aarterial oxygen (are at equlibrium. Look at their PO2 *PaCO2=partial pressure of arterial carbon dioxide |
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PULMONARY PERFUSION
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is the filling of pulmonary capillaries with blood
*Blood in the rgt. ventricle of the heart flows to the pulmonary artery and then to the right and left lung *Pulmonary circulation is a low pressure system *pulmonary artery pressure 20-30mm Hg systolic 5-15 mm Hg diastolic |
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VENTILATION AND PERFUSION
(V=P) |
The relationship between airlfow and perfusion determines the efficiency of gas exchange. A 1:1 ratio is desired
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FACTORS CAUSING AN IMBALANCE
INADEQUATE VENTILATION |
No ventilation to the alveolar unit, but perfusion continues a shunt develops and unoxygenated blood continues to circulate.
*Atelectasis and pneumonia can cause collapse of the alveoli |
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INADEQUATE PERFUSION
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No perfusion, but ventilation usually results in a dead space in the alveoli (no blood flow).
Pulmonary embolism will cause a perfusion defect (no gas excahnge in this area). |
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BOTH
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Neither perfusion or ventilation causes a silent unit. (no ventilation to area)
ARDS (adult respiratory distress syndrome) pulmonary embolism |
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DIAGNOSTIC TEST
Throat culture Nasal Culture with resp. problem |
PURPOSE
Identify Orgnasims * Strep *Candida (thrush) *RSV in babies eg. influenza & swine flu PROCEDURE * place is good light *depress patient tongue with balde, rotate swab firmly over areas of inflammation or exudates *swab nostril with swab over areas of secretions NURSING INTERVENTIONS *Instruct pt. culture will take 24 hours to obtain results (Pt will/suppose to gag when taking it. Eyes will tear) |
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PULSE OXIMETRY
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PURPOSE
noninvasive way to monitor SpO2(o2 saturation of hemoglobin) (Not accurate if person is anemic, in shock, dizzy or smoking cigarette) PROCEDURE * May use forehead, earlobe, or bridge of nose *Apply probe to clean area. *Monitor. Normal SpO2 is 95%-100% NURSING INTERVENTION *Instruct pts. that this a noninvasive way to monitor the O2 lvls. *Remove nailpolish on finger nail beds. *Apply probe to clean dry skin(can use toes) |
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BRONCHOSCOPY
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PURPOSE
Permits visualization of the larnyx, trachea, and bronchi with a flexible bronchoscope *biopsy-->cancer-->cytolological exam-->find hemmorrhage sites-->Remove foreign objects PROCEDURE * Local anesthetic is sprayed in the back of nose, tongue, pharnyx, and epiglottic *Flexible bronchoscope is inserted thru the mouth or nose. *Use of suctioning O2delivery, or biopsies thru ports in the scope *Time 30-40 minutes NURSING INTERVENTIONS Prior consent is signed *No food/fluid for 6 hours *Remove dentures/prothestic in mouth. *Atropine is used (decreases secretion) *Start on ice chips after post op *Observe for hypoxia & bloody sputum *confusion |
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THORACENTESIS
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PURPOSE
Obtain fluid from pleural cavity for cytological examination *Malignancy *inflammatory process PROCEDURE * Procedure is performed under sterile procedures *Expose entire chest, pt. placed at edge of bed with head & arms resting on the overbed table *Physician will advance thoracentesis needle with syringe into pleral space *Fluid of 300ml-1000ml removed. *Needle withdrawn, pressure applied to sterile dressing. *Bedrest and chest x-ray is obtained. NURSING INTERVENTIONS *Consent is signed. * Chk. for a chest x-ray to see where fluid is *Allergies to anesthesia* betadine *Position them Fowler/side lined in bed at 30-35 degree *Monitor post op/shorten of breath. Tighten of chest, blood tinge/frothy sputum |
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PULMONARY FUNCTION TEST
(PFT measures volume) |
PURPOSE
* Such test measures lung volume, ventilatory function, mechanics of breathing, diffusion and gas exchange *Useful in assessing pt. with known Pulmonary disease. PROCEDURE *Usually performed by Respiratory Therapist *Uses Spirometer that has a volume collecting device/time measuring device. NURSING INTERVENTION *explains to pt. that PFT'S are Non-invasive measurement of lung capacity. |
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CYTOLOGY STUDIES
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PURPOSE
* Empahsize to pt. that sputum is not saliva. *Nothing to eat/drink until sputum is collected. *C&D breath to get a good cough with sputum form bronchi *Volume of 1-3ml mucopurulent/purulent in sterile cup *Culture and Sensitivity NURSING INTERVENTION * Instruct pt. to brush teeth prior to obtaining specimen. *Rinse pt. mouth with post collection (sputum sitting on desk after 4 hours is no good. Collect in morning after they get up) |
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SPUTUM COLOR/CONSISTENCY
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Rust colored thick-->bacteria, pneumonia (illness assoc.)
Purulent, light green-->influenza & strep(illness assocaited) Thick, yellow-->staph, sinus infection(illness assoc.) Frothy, pink, streaks of blood-->pulmonary edema Dark red clots, Bright Red liquid-->pulmonary emboli (illness associated) |
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ABG'S ARTERIAL BLOOD GASES
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Measurement of blood ph and arterial oxygen, carbon dioxide tensions
1. Aid in assessing the ability of the lungs to provide adequate o2 and remove Co2 2. Ability of the kidneys to reaborp and excrete bicarbonate ions to maintain pH PURPOSE *Management of pts. with Resp. problems *Oxygen Therapy |
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PH
NORMAL VALUE 7.35-7.45 |
DEFINITION
Indicates the hydrogen ion concentration of the blood |
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PCO2
normal value: 35-45 mm Hg |
A measure of CO2 tension (also called partial pressure of blood gas CO2)
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PO2
normal value 80-100 mm Hg |
Oxygen tension of the partial pressure of oxygen
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BE
Normal Value =/- 2mmol/L |
Base excess
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HCO3
Normal Value 22-26mEq/L |
Amt. of bicarbonate or alkaline substance dissolved in blood.
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SaO2
Normal value 93%-98% |
Percentage of available hemoglobin saturated with oxygen
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PH
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ph of 7 is Neutral
pH of 7.35 or less is Acidic pH of 7.45 or greater is alkaline pH below 6.8 or above 7.8 is incompatible with life |
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HOW cO2 EFFECTS BLOOD GASES
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STEPS
*acid is produced daily in the body through the breakdown of carbon in food. *Co2 is the resulting product which combines with H2O to form Carbonic acid. *Carbonic acid is a weak molecule and breaks down into bicarbonate (HCO) and hydrogen (H+) |
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CO2 IN RELATION TO VENTILATION
Drive to breathe (resp in nature) |
When CO2 in the arterial blood is elevated, the cerebral medulla is stimulated to increase the rate of ventilation
When CO2 in the arterial blood is decreased the cerebral medulla is stimulated to decrease the rate of ventilation. (hyperventilate) |
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KIDNEYS
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1. Excrete your H= ions(bicarbonate)
{HCO3-->metabolic (think of it)} |
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OBTAINING A SAMPLE
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1. ABG specimen are usually obtained by arterial punctures.
2. the specimen is collected in a heparinized syringe. 3. Firm pressure is applied to the puncture site for 5 minutes (brachial/radial) 10 minutes to femoral site. 4. Specimen sent on ice to the lab 5. An Allen test is done before radial puncture |
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pH
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ACID
<7.35 NORMAL 7.35-7.45 ALKALINE >7.45 |
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PaCO2
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ACID
>45 NORMAL 35-45 ALKALINE <35 |
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HCO3
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ACID
<22 NORMAL 22-26 ALKALINE >26 |
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ACID BASE PARAMETERS
HOW TO DIAGNOSE THE PT |
*The column that the pH is in tells if the pt. is in alkalosis or acidosis
*If the pt. and PaCO2 fall in the same column the imabalnce is repsiratory in nature. *If the pH and HCO3 fall into the same category the imabalance is metabolic in nature *If the pH is within normal limits, but other parameters are out of range the body is in complete compensation. *If the diagnosis is respiratory acidosis and the HCO3 is abnormal there is partial comepensation *If the diagnosis is respiratory acidosis and the HCO3 is normal there is no compensation |
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CAUSES OF ACID BASE IMBALANCES
METABOLIC ACIDOSIS |
* Diarrhea
*renal failure *Diabetic shock *shock *Salicylate overdose *sepsis |
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METABOLIC ALKALOSIS
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*loss of gastric secretions
*Over use of Antacids *Potassium-wasting diuretics(peeing alot) |
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RESPIRATORY ACIDOSIS (HYPOVENTILATION)
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* Decrease overdose
*Chest trauma (increase in co2) *Neuromuscular diseease *COPD *Pulmonary edema (shunt) (CO2 is going up) |
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RESPIRATORY ALKALOSIS (HYPERVENTILATION)
blowing off too much co2 |
* Anxiety
*high altitude *pregnancy *fever *pulmonary embolism * |
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ACUTE RESP ACIDOSIS V.S CHRONIC RESP ACIDOSIS SYMPTOMS
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ACUTE
Elevated pulse Elevated resp rate increased BP Fullness in head Pink in color *mental cloudiness CHRONIC (COPD) weakness headache |
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MANAGEMENT OF RESP ACIDOSIS
GOAL: IMPROVED VENTILATION AND DECREASED PaCO2 SLOWLY |
1. Bronchodilators
2.Antibiotics (get rid of mucous. do sputum sample on it) 3. Adequate hydration (loosens it up/thins it. Do c& DB 4.Position in semifowler psotion 5. Give O2 in low dose (supplemental) 6.Put them on a vent |
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SYMTPOMS CHRONIC RESP ALKALOSIS VS. ACUTE RESP ALKALOSIS
problems in brain & liver problems in pts. |
ACUTE
Carpopedal spasms/tetany (muscle spasm) Light-headedness(vasoconstriction) Decreased cerebral flow (lack of blood flow in head) Numbness tetanitits loss of consciosness CHRONIC Seen in hepatic insufficiency and cerbral tumors |
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MANAGEMENT OF RESP ALKALOSIS
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1. sedatives-
2. paper bag them/slow breathing down |
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NORMAL BREATH SOUNDS
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1. BRONCHIAL BREATH SOUNDS-->Heard over the trachea with the insp. phase shorter than the expiratory phase (Loud and hollow sounding)
2. BRONCHIAL VESICULAR BREATH SOUNDS-->heard on either side of the sternum at the 1st and 2nd intercostals space and between the scapula with the inspiratory phase equal to the expiratory phase (soft and breezy) |
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ABNORMAL BREATH SOUNDS
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1. CRACKLES (RALES)-->Usually heard at the end of insp. caused by moisture near alveoli
eg. obstructive, fluid in lungs. upper (ronchi) bases (crackle/rale) 2. SONOROUS WHEEZES (FORMELY RHONCHI)-->rattling sound usually heard during expration. Louder deeper pitch caused by secretions or fluids in larger airways. eg. striver-->see it in when babies have coup. 3. SIBILIANT WHEEZES (CREAKING/GROANING SOUNDS)-->Usually head during expiration but also inspiration which caused by constriction or obstruction of the major airway. eg. hear in anterior & posterior lungs. Heard on expiratory end. |
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DOCUMENTATION
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Nurses should indicate
1. Crackle, type of wheeze 2. Anterior/psoterior 3. Upper, Middle, Lower lobe example: Crackles heard anteriorly in he anteriorly in the upper lobe |
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COPD
Is a broad classification for pulmonary conditions associated with chronic obstruction of air flow in and out of the lungs. |
SPECIFIC DISORDER
1. Chronic bronchitis 2. Pulmonary emphysema 3. Asthma (restrictive & reversible inflammation) |
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CHRONIC BRONCHITIS
DEF: as a productive cough that lasts 3 months a year for 2 consecutive years |
CAUSES
i. Exposure to pollution ii. Smoking PATHOPHYSIOLOGY i. Irritation of airway-->pollution or smoke ii. hyper secretion of mucous and inflammation iii. mucus secreting glands and goblet cells are increased in number iv. cilia function reduced v. more mucus is produced. vi. bronchioles become narrowed and clogged vii.Adjacent alveoli may be come damaged and fibrosed with macrophages viii. in crease susceptibility to infection CLINICAL MANIFESTATIONS(s/s) * coughing-->shortness of breath (dyspnea)on excretion. *mucous production-->fever-->wheezing MEDICAL MANAGEMENT 1. bronchodilators-->corticoids steroids-->sputum sample-->antibiotics-->quit smoking--->chest x-ray-->monitor ABG'S post op, V.S NURSING MANGEMENT *C&DB them-->semifowler position-->hydration-->incentive spirometer-->decrease room temp.-->smoking education |
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PULMONARY EMPHYSEMA
Def: Abnormal distention of the air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli {as the walls of the alveoli are destroyed, the alveolar surface that comes into contact with the pulmonary capillaries decreases, causing an increase in dead space{no gas exchange can occur}, resulting in impaired oxygen diffusion. As the alveolar walls breakdwon, pulmonary capillary beds decrease in size. Pulmonary blood flow is increased and the rght. ventricle is forced to maintain a higher blood pressure in the pulmonary artery |
CAUSES
1. smoking-->alfantitripsen-->genetic disorder. Common in Caucasian race. 2. Occupational pollutants PATHOPHYSIOLOGY 1. Inflammation and swelling of the bronchi 2. Excessive mucus production 3. loss of elastic recoil of airways leads to collapse of bronchioles 4. Redistribution of air to the functional alveoli. TYPES 1. Centrilobular-->Chgs. Rght side of heart failure. Corpulmonale empysema. Periphereal edema in pts. clubbing of fingers & toes 2. Paniobular-->Destruction of resp. bronchioles. Alveoli duct due to hyperinflation CLINICAL MANISFESTATION dyspnea-->barrel chest-->pursed lip breathing-->lung sounds reveal decreased breath sounds with crackles, rhonchi and prolonged expiration-->anorexia(becomes short of breath when eating)-->cor pulmonale-->hypoxia MEDICAL MANAGEMENT slow progression-->treat obstructed airway to decrease hypoxia-->bronchodilators-->aerosol therapy-->treatment of infections-->corticosteroids-->low concentration 02 |
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asthma
Definition: Is an intermittent, reversible, restrictive airway disease in which the trachea and bronchi respond in a hyperactive way to certain stimuli |
PATHOPHYSIOLOGY
1. Constriction of the muscles surrounding the bronchi, which narrows the airway. 2. Swelling of the membranes that line the bronchus. 3. Filling of the bronchi with thick mucus (related to swelling). TYPES 1. Sports induced, emotions, pts. will become upset 2. Respiratory infections. Allergic, known allergens, pets, dander, dust pollen, airborne/seasonal 3. Mixed (both) |
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Asthma
Clinical manisfestation |
cough-->dyspnea-->wheezing-->attacks frequently occur at night-->chest tightness--> Coughs up thick mucus with difficulty
MEDICAL MANAGEMENT *Medications 1. Beta agonists(dilate the smooth muscle) a. short acting-->Albuterol, Xopenex b. Long acting-->Serevent 2. Corticosteroids (decrease inflammation) a. Oral for severe attacks (predinose) b. Inhaled for maintenance (solevent, advair) 3. Mast Cell Inhibitors(Decrease inflammation and increase bronchodilation) a. Cromolyn 4. Leukotriene modifiers a. Singulair 9acts an allergy medication) 5. Methylxanthine (Bronchodilator)Seldom used due to side effects. a. Aminophylline(oral bronchodilator) |
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Describe the Nursing process for Patients with COPD
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ASSESSMENT
Patient history --> If they smoke --> allergies -->Where they work --> cleaning supplies --> medications they are on f. Any current infections --> eating habits --> If they use O2-->antriprisinic disorder--> sleeping habits-->short of breath-->tolerate exercise OBSERVATION/EXAMINATION Dyspnea-->clubbing of toes/fingers-->diophretic-->cyanosis-->barrel chest-->pheripereal edema-->listen to lung sounds-->Can't complete a sentence-->prolonged expration NURSING DIAGNOSIS Impaired gas exchange d/t constriction s/s Ineffective airway clearance d/t mucus Inadequate nutrition intake Knowledge deficit |
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Planning and Implementation for patients with COPD
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GOALS
*Improvement *Acheivement of airway clearance *Improvement in breathing pattern *Independence in self-care activities *Improvement in activity tolerance *Improvement in coping ability *Adherence to therapeutic program/home care *Absence of complications |
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Nursing Interventions for COPD pts
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IMPROVING GAS EXCHANGE
O2 apply Assess lung sounds Bronchodilator C & DB REMOVING BRONCHIAL SECRETIONS * Increase fluids *C &D.B *Chest patient *Flutter valve *humidifier PREVENTING BRONCHOPULMONARY INFECTIONS *wash hands-->wear a mask-->maintenance drugs-->quit smoking->tissue disposal-->vaccine-->nutrition-->small but space out their activities PERFORMING SELF-CARE ACTIVITIES Occupational therapy: Get adaptive devices |
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NURSING INTERVENTIONS FOR COPD PTS
(CONT'D) |
PROMOTING PHYSICAL CONDITIONING
a. incentive spirometer-->breathing exercise-->depression PROMOTING COPING MEASURES a. Support group b. antidepressants c. Monitor for any suicidal attendancies d. Assistive living e. Public health PT. EDUCATION AND HOME CARE CONSIDERATIONS a. O2 teacing (not with it on) for smoking. b. medications c. Avoid temperature changes d. Home care referral |
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DISCUSS INSTRUCTIONS FOR BREATHING EXERCISES
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GENERAL INSTRUCTIONS FOR BREATHING EXERCISES
*Breathe slowly and rhythmically to exhale completely and empty the lungs completely. *inahle through the nose to filter, humididty, and warm the air before it enters the lungs *If you feel out of breathe, breathe more slowly by prolonging the exhalation time *Keep the air moist with a humidifier DIAPHRAGMATIC BREATHING Goal: To use and strengthen the diaphragm during breathing a. Place one hand on the abdomen (just below the ribs) and the other on the middle of the chest to increase the awareness of the diaphragm and its function in breathing. b. Breathe in slowly and deeply through the nose, letting the abdomen protrude as far as possible. c. Breathe out through pursed lips while tightening (contracting) the abdominal muscles. d. Press firmly inward and upward on the abdomen while breathing out. e. Repeat for 1 minute; follow with a rest period of 2 minutes f. Work up to 5 minutes, several times a day (before meals and at bedtime) |
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PURSED LIP BREATHING
goal: To prolong exhalation and increase airway pressure during expiration, thus reducing the amount of trapped air and the amt of airway resistance |
a. Inhale through the nose while counting to 3 the amt. of time needed to say "smell a rose"
b. Exhale slowly and evenly against pursed lips while tightening the abdominal muscles (pursing lips increases intratracheal pressure; exhaling through the mouth offers less resisitance to expired air) d. Count to 7 while prolonging expiration through pursed lips-the lght. of time to say "Blow out the candle" |
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While sitting in a chair
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Fold arms over the abdomen
inhale through the nose while counting to 3 bend forward and exhale slowly through pursed lips while counting to 7 WHILE WALKING Inhale while walking two steps Exhale through pursed lips while walking four or five steps Bend forward and exhale slowly through pursed lips while counting to 7 |
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PNEUMONIA
definition: An inflammatory process of the lung parenchyma that is commonly caused by infectious agents {community acquired(1st 24 hours & hosp. acquired (more than 24 hours} |
Types (Classification)
1. Bacterial 2. Atypical pneumonia LOBAR PNEUMONIA When 1 or more lobes are involved |
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BRONCHO PNEUMONIA
When it is distributed in patchy fashion, one or more areas within bronchi (also called "walking pneumonia" |
WHO IS AT RISK?
1. Elderly(deep cough) aspirate pneumonia. 2. Immune suppress pts (HIV pts, children) 3. Alcoholics (poor nutrition, resp depression) 4. Smokers 5. bedridden pts |
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BACTERIAL PNEUMONIAS
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TYPES
1. Streptococcal (most common) 2. Staphylococcal{immune compromise, IV drug users} 3.Klebsiella {elderly alcoholics pts, lung abscess} 4.Pseudomonas {vent pts.(noscomial infections)} 5. Haemophilus influenza {population that doesn't get immunization. HIV vaccine} |
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ATYPICAL PNEUMONIAS
{viral in nature] |
* Legionnaire's disease
*Mycoplasma (most common) in children & young adults *Viral *Pneumocystis Carini Pneumonia (PCP){aids pts.} *Fungal {immune compromise} *TWAR (chlamydial pneumonia) newborn, college students *Tuberculosis {immigrants, HIV, health care workers, homeless} |
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BACTERIAL PNEUMONIA
pathophysiology |
*The penumococci cause an imflammation in the alveoli and produce an exudate (pus) which interferes with the movement and diffusion of O2 and Co2.
*WBC (neutropils) migrate to the alveoli and fill the spaces. *Areas of lung are not adequately ventialted because of secretions, edema of the mucosa and bronchospasm-->partial occulsion of bronchi and alveoli with lower in alveolar O2 tension. *Venous blood-->passes through the underventilated area and exits to left side of heart without being oxygenated. Blood is essentiall shunted from right-->left side of heart. *Mix of oxygenated and unoxygenated blood-->arterial hypoxemia |
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ATYPICAL PNEUMONIA
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*The mycoplasm are the smallest free-living agents of disease in man.
*They invade primarily the interstitial rather than the alveolar space. *Spreads throughout entire resp. tract including the bronchioles. Generally has caracteristics of bronchopneumonia *Can create some of the same problems in both ventialtion and diffusion as in bacterial penumonia |
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CLINICAL MANIFESTATION
{CLASSIC S/S} |
BACTERIAL
*Typical starts with sudden onset of shaking chills *Rapidly rising fever (101-105 degree f), perspires perfusley *Stabbing chest pain,aggravated by breathing and coughing *Marked tachypnea (25-45 breaths/min) *Respiratory grunting, nasal falring, use of accessory muscles *Pulse rapid and bounding *Cheeks red, lips and nail beds cyanotic *Sputum is purulent (sometimes only sign in COPD or elderly pts) |
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CLINICAL MANISFESTATION
{atypical} Mycoplasma may follow URI |
*earache {follow up resp infection}
*Occurs frequently in older children and young adults{decreased immune systems} *Most prominent symptom is a cough-->violent attacks *Chills and fever are early symptoms/signs, some of have NV *Heartbeat is often slow, may have breathlessness and cyanotic lips and nail beds |
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HOW IS DIAGNOSIS OF PNEUMONIA MADE?
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*Assessment (pt. history)
*physical exam *x-ray *ABG's *Bacterial (blood culture) *Sputum exam *Bronchoscopy |
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MEDICAL MANAGEMENT
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*Appropriate antibiotic therapy determined by gram stain
*bed rest *warm, moist inhalations relieve bronchial irritation *hypoxemia form ABG's-->O2 therapy **High concentration of O2 is contraindicated in pts with COPD. In COPD pts. the stimulus for respiration is a lower blood o2 rather thabn an raised CO2. High concnetration of O2 will remove the respiratory drive that has been created by the pts' chronic low o2 tension. Result can be lower alveolar ventilation--> raised arterial Co2 pressure-->death from Co2 narcosis and acidosis |
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NURSING ASSESSMENT
{diagnosis} |
Ineffective airway clearance related to copious tracheobronchial secretions
Activity intolerance related to altered respiratory fucntion Risk for fluid volume deficit from fever and dyspnea knowledge deficit about treatment regimen and preventive health measures |
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PLANNING AND IMPLEMENTATION
{Goals} |
1. Improving airway patency
2. Obtaning adequate rest to conserve energy 3. Maintaining proper fluid volume 4. Treatment protocol and preventive measures 5. Absence of complications |
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NURSING INTERVENTIONS
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1. Improving Airway Patency
a. Remove secretions *Humidifiers C & D.B *Increase fluids & hydration (2L) *incentive spirometer *cupping (chest pts) *flutter valve B. Chest physiotherapy *Chest percussion on possible drainage *Flutter valve c. Oxygen *maintain SPO2 > than 92% *Monitor pulse oximetry 2. Promoting Rest and Conserving energy * Assist with ADL's *Chgs postion every 2 hours (semifowlers) 3. Promoting fluid intake *Increase fluids to 2L (per day) 4. Pt education and home care consideration *Prevent penumonia *pneumonia vaccine *avoid highly pop. areas * Keep taking meds *Home care referrals |
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MONITORING AND MANAGING POTENTIAL COMPLICATIONS
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a. PERSISTENT SYMPTOMS
*Deterioration *acute resp. distress *Chgs in chest x-ray b. SHOCK AND RESPIRATORY FAILURE{raised V.S lower Bp} *lvl. of consciousness lowers c. ATELECTASIS AND PLEURAL EFFUSION *Become short of breath *retractions in chest* Need thorancentesis if fluid in chest * Hypoxia. d. DILERIUM fever & dehydration e. SUPERINFECTION MERSA, ORSA'S, & URA |
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EVALUATION (IN RELATION TO GOALS) EXPECTED OUTCOMES
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1. P & O2 >92% Pure o2)
2. Blood gases (look at them) within normal limits 3. Lung sounds 4. Maintain adequate hydration 5. See what the pt. verbalize to you on what you taught them |
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PULMONARY EMBOLISM
definition: The obstruction of one or more pulmonary arteries by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart CONSIDERED AN MEDICAL EMERGENCY |
PATHOPHYSIOLOGY
* Thrombus completely or partially obstructs a pulmonary artery, the alveolar dead spaces lowers because the area, while continuing to be ventialted, receives little or no blood flow. *Substances are released from the clot and cause the blood vessels and bronchioles to constrict. this reaction compounds the ventilation-perfusion imabalance, causing some blood to be shunted (no gas exchange occurs) and results in lower O2 and raised Co2 lvls. *Consequences are raised pulmonary vascular resistances due to the lower size of the pulmonary vascular bed, resulting in an raised in pulmonary arterial pressure, and -->raised in right ventricular work to maintain pulmonary blood flow. When work requirements exceed capacity, have right ventricular failure--> lower cardiac output -->lower systemic blood pressure and the devlopment of shock |
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CLINICAL MANIFESTATIONS
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* chest pain {most common}
*Dyspnea (2nd most common symptoms){tyoo much co2} *Tachypnea *Fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis and syncope. |
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PREVENTION
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* Prevent deep vein thrombosis is most effective approach
*Active leg exercises *Use of elastic stockings *anticoagulant therapy *Intermittent pneumatic compression devices *advise against habits that raised venous stasis *Avoid leaving IV catherers in veins for prolonged periods if possible (develop a clot) *Elevate legs above heart to raise venous return *Early ambulation |
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WHO IS AT RISK?
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* Trauma patients
*Surgery (orthopedic, pelvic, gynecologic) *Pregnancy {end up with DVT's} *Congestive heart failure {right sided heart failure} *Advanced age {circulation decreased} * Prolonged immobility *Empysema pts. |
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EMERGENCY MANAGEMENTS
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* Make sure they have )2
*Iv started (18 gauge) *CT scan needed (spiral Ct) *Blood test (d-diners) *ABG's *anticoagulation therapy (hep IV) *catheter *small doses morphin *TPA sometimes admin to break up a clot |
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EMPYSEMA
a collection of purulent liquid (pus) in the pleural cavity. Thin pleural fluid--> progresses to fibro pururlent stage-->encloses lung with a thick exudate membrane |
CLINICAL MANISFESTATION
8 Short of breath *dimnish lung sounds *fever *pain on a affective side DX * x-ray *thorancentesis |
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MEDICAL TREATMENT
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* pleural catheter if fluid not thick
*closed-chest drainage with H2O seal drainage *open drainage by rib section and removal of debris and diseased pulmonary tissue |
