critical care respiratory exam

what is epistaxis

nosebleed

first aid for epistaxis

DO NOT LEAN BACK, pinch bridge of nose and lean forward

cancer of the larynx manifestations

cough, change in voice, difficulty swallowing

diagnostics of larynx cancer

smoking, vaping, chewing tabacco

nursing considerations for larynx cancer

smokers will most likely already have a the s/s so tell them to keep an eye out for if anything changes

management of larynx cancer

chordectomy(striping vocal cords-changes voice)

laryngectomy(partial or total)- pt. will never be able to talk without help, worried about swelling and loss of airway, worried about pt. imagine of "self"

what must you have first to have COPD

2/3

emphysema

chronic bronchitis

asthma

what do we teach for COPD

teach pursed lip breathing

what is pulmonary hypertension

happens where gas exchange occurs and the buildup of scar tissue makes the heart pump more leading the right side heart failure

what is emphysema

CO2 becomes trapped in the alveoli making it blow up like a balloon, permanent enlargement of alveoli

nursing considerations for emphysema

lung sounds-wheezing

pt might be tripoding and have a barrel chest along with clubbing fingers

need to look at the heart to make sure damage has not occurred

what is chronic bronchitis

Bronchi swell and become clogged with mucus leading to a cough that has lasted over half of the time in a 2 year period

pt. teaching for chronic bronchitis

turn sides while sleeping a night

must use bronchodilator before steroids

nursing considerations for chronic bronchitis

we do not want to over oxygenate them (not their homeostasis)

someone with limited finger movements will have a hard time using a spacer bronchodilator

have pt. show you they can use the treatment before leaving

management of chronic bronchitis

exercise- should be based on what the pt. can/willing to do

chest physiotherapy- hitting your chest to help break apart the mucous to make it easier to release

monitor ABG's

what are acute exacerbations

medical emergencies

exacerbations are usually caused by infections and air pollution/ exposure to irritants

common is people with copd, may need to be ventilated and it is hard to get them off the vent

complications of acute exacerbations

cor pulmonale (hytropathy of right side of heart)

pneumonia

pneumothorax

bronchiectasis

what is bronchiectasis

permanent dilation and destruction of cartilage-containing airways

cannot move lung

what is asthma

chronic inflammatory disorder

episodes associated with variable airflow obstruction

bronchial tubes become inflamed during episode

what are the 2 phases of asthma

1.acute phase- episode happens immediately after exposure to whatever activated the episode, lasts several hours

2. late-phase- typically occurs 2-6 hours after exposure and lasts longer

manifestations of asthma

wheezing breath sounds

cough

SOB

chest tightness

reversible airflow obstruction

use of accessory muscles

thick sputum production

what is status asthmaticus

severe and life threatening asthma attack that does not respond to normal treatment

increases mucous production ---> bronchospasm--> cannot breathe

ventilators ( + or - system)

uses a + pressure to force air into the lungs because the lungs are a - pressure system

nursing interventions for ventilation

suction and ambu-bag in room at all times

oral care- minimum 2x a day

move tube from left -right side

do neuro assessments

assess GCS by asking pt. to follow commands

ventilator alarms

DO NOT TURN OFF

D.O.P.E

D-displacement of tubes

O-obstruction of tube

P-pneumothorax

E- equipment failure

what is atelectasis and how does it happen

collapse of alveoli

post-surgical complication from not taking enough deep breathes

how to prevent atelectasis

teach incentive spirometry (pre/post OP)

ICOUGH program (deep breathe in and cough)

ventilator acquired pneumonia (VAP)

occurs 48 hours after admission on a ventilator

nursing assessment for pneumonia

breath sounds are crackling

increased or decreased breathing

pt. subjective history

pneumonia complications

ARD (acute respiratory distress)

ARF (acute respiratory failure)

pulmonary TB risk factors, nursing management, manifestations, treatment

risk factors- immunocompromised

management- N-95 mask, isolation in a negative pressure room, PPE, ambulating, proper diet

manifestations- night sweats, cough, malaise

treatment- 6-9 months of medications(rifampin), pt. need to comply

nursing consideration for pulmonary tb testing

normal testing- skin test, quantiferon (blood test), sputum culture

people born in other countries/ got vaccinated in other countries cannot do skin test or blood test

what is pleurisy and what are s/s and management

infected/ inflamed pleura

s/s- squeaking sound in lungs, breathing is painful

management- antibiotics, antiinflammator, identify cause, turn pt. on side

what is pleural effusion, assessments, and management

lung space has increased with fluid or air in size because a lung has decreased in size

assessments- chest will not rise symmetrically, hallow sound in empty space

management- chest tube

what is empyema, assessments, and management

loculated puss pocket in pleural space

assessment- pain in breathing in one spot

management- removing puss pocket

what happens in ARF acute respiratory failure

medical emergency

pt. CO2 has climbed so high there is a problem, pt. needs O2 mask to help maintain homeostasis

ARF assessment and management

assessment- lung sounds go with what caused the issue

management- intubation

what is ARDS

fluid immune response

when there is damage to alveoi-barrier the cell wall becomes more permiable increasing fluid

tissue now becomes fibrotic and cannot stretch

ARDS goals and management

goal- decrease fluid in lungs

management- ventilate and increase pt. protein intake

pulmonary embolism manifestation, assessment

manifestation- bed bound, surgery, pregnancy, birth control

assessment- size of embolism matters or saddle

nursing steps for pulmonary embolism

1. throw o2 on them (anxiety)

2. stabilize HR

3. put in an IV for contrast CT

4. cardiac monitoring

5. give them blood thinners or thrombolytics

lung cancer- common group?

common in smokers and has a high morbidity rate because it creeps up on you

what is flail chest

rib breaks in a circle and now when pt. inhales lung goes into the new hole

what is pneumothorax and different types

air in collapsed lung space

simple- spontaneous pneumo

traumatic- car accident

tension- medical emergency in which the air is going in but not leaving putting pressure on your heart causing tracheal deviation

medication for TB and nursing teaching

rifampin

orange urine

medication for pneumonia and nursing consideration

zosyn

check for penicillin allergies

flu prevention

flu vaccine and hand hygiene

what happens if you use too much nasal spray, how many days should you use it?

rebound congestion, epistaxis

3 days