Week 10 Mrs. Adams, In the Hospital

Nebulization

Delivery of small drops of water or particles of medications to the airways

Hypoxemia

Low oxygen in arterial blood

Angina

Chest pain due to transient myocardial ischemia

Preload

amount of blood in ventricles before contraction

Afterload

resistance the ventricles must pump against

Acute coronary syndrome

Imbalance between myocardial oxygen supply and demand

Includes unstable angina, NSTEMI, STEMI

NSTEMI

Partial coronary artery blockage

STEMI

Complete coronary artery blockage

What are some independent nursing interventions to promote oxygenation

• Position patient to maximize lung expansion

• Encourage turning, coughing, deep breathing

• Teach breathing exercises

• Promote activity as tolerated

• Encourage smoking cessation

• Support hydration when appropriate

• Reducing anxiety

• Conserving energy

What are some interdependent/dependent interventions?

• oxygen therapy

• medications

• lung inflation techniques

• chest physiotherapy

• suctioning

• respiratory therapy referral

• cardiac/pulmonary rehabilitation

Deep breathing and coughing function

Technique to prevent atelectasis and clear secretions after surgery

Pursed lip breathing function

• prevents alveolar collapse

• helps improve oxygen saturation

• especially useful in chronic pulmonary disease

Diaphragmatic breathing functions

• emphasizes diaphragmatic expansion

• reduces accessory muscle use

• decreases work of breathing

who is diaphragmatic breathing useful for

patients with pulmonary disease, postop patients, and labour relaxation

Acute bronchitis definition

Inflammation of bronchi usually due to infection

Acute bronchitis causes

• Mostly viral (rhinovirus, influenza)

• Can be bacterial (S.pneumoniae, H. influenza)

Key features of acute bronchitis

• Cough (may become productive)

• Fever, malaise (generally feeling of discomfort), dyspnea

• Wheezing possible

Management of acute bronchitis

• Fluids, rest

• Bronchodilators

• Cough suppressants

Pneumonia definition

Inflammation of lung parenchyma

Predisposing factors to pneumonia

• elderly

• smoking

• chronic disease (COPD, diabetes, heart disease)

• Immunosuppression

• Malnutrition

• Aspiration risk

• Immobilization

• Intubation

Community acquired pneumonia

Pneumonia developed outside hospital or within 48 hours of admission

Hospital acquired pneumonia

• Occurs ≥48h after hospital admission

• More severe, higher mortality

• Often caused by drug-resistant organisms

Aspiration pneumonia

From inhalation of food, fluid, or gastric contents

who is aspiration pneumonia common in?

• individuals with decreased LOC

• stroke

• tube feeding

oopportunistic pneumonia

Occurs in immunocompromised patients

4 stages of pneumonia pathophsyiology

1. congestion

2. red hepatization

3. gray hepatization

4. resolution

congestion stage

organisms enter the alveoli, fluid accumulates in the lungs

Red hepatization

Stage where alveoli fill with RBCs and neutrophils

Gray hepatization

Stage with decreased blood flow and fibrin buildup

Resolution

Macrophages clear debris and lung returns to normal

symptoms of typical pneumonia

• Sudden fever and chills

• Productive cough (mucus, sputum)

• Dyspnea

• Pleuritic chest pain

• Crackles, bronchial breath sounds

symptoms of atypical pneumonia

• gradual onset

• dry cough

• headache, fatigue, GI symptoms

severe symptoms of pneumonia

• Tachypnea, hypoxia

• Confusion (especially in the elderly)

diagnostic tests for pneumonia

• Chest x-ray to look for consolidation patterns (fluid, blood, pus, cells, etc.)

• Sputum culture

• Blood cultures

• ABGs to assess oxygenation

• Complete blood count (CBC) 

Treatments for pneumonia

• Antibiotics (based on type)

• Oxygen therapy

• Fluids

• Antipyretics, analgesics

• Rest, limited activity

health promotion for pneumonia prevention

• Teaching good health habits like proper diet and hygiene, adequate rest, regular exercise

• Vaccinations for influenza and pneumonia

• Exposure to people with URI’s should be reduced

• URI should be treated early with supportive measures

hospital prevention for pneumonia

• Reposition q2h

• Early mobilization

• Deep breathing + coughing

• Prevent aspiration through positioning (side lying, upright)

interventions for pneumonia

• Oxygen therapy

• Encourage fluids (unless contraindicated)

• Small frequent meals

• Assist with coughing/deep breathing

nutritional therapy for patients with pneumonia

• Fluid intake of at least 3 L/day is important in the supportive treatment of pneumonia

• Intake of at least 1500 calories a day should be provided energy for increased metabolic process in the patient

• Small meals are better tolerated by the patient with dyspnea

what can lack of teamwork lead to in healthcare?

• poor communication results in different perceptions of situations

• communication errors can lead to inaccurate diagnoses, incorrect treatment and medication errors

• can delay responses to deterioriating patients

key teamwork skills

• leadership

• mutual support

• situation monitoring

• communication

human factors of communication failures

• cognitive load

• cognitive failures

cognitive failures examples

Attentional tunnelling → focus on one thing, ignore others

Confirmation bias → only see what confirms belief

Memory failures → forget steps

Inaccurate mental models → wrong understanding of situation

barriers to effective communication

1. authority gradient

2. different communication styles

3. “hint and hope” communication

4. cognitive overload

strategies to improve communication

1. team briefing

2. huddles

3. debriefing

CUS tool

1. concerned

2. uncomfortable

3. safety issue

• used when patient safety risk is ignored

transaction model of comunication

Involves two or more people continuously sharing information with each other throughout their interaction to co-create meaning

closed loop communciation

Using verbal feedback including call-outs, check-backs, tech-backs to ensure recipients understand messages

check-back

Closed-loop communication strategy used to ensure that infromation shared by one team member is correctly understood by another team member

IPASS

• Preferred handoff tool for patient transitions in care in many organizations

• Stands for:

I - ILLNESS SEVERITY

P - PATIENT SUMMARY

A - ACTION LIST

S - SITUATION AWARENESS AND CONTINGENCY PLANNING

S - SYNTHESIS BY RECEIVER

what are common factors of vaccine hesitancy

• Lack of understanding about vaccines and immunization processes

• Conflicting information from various sources

• Mistrust in information sources

• Discomfort associated with injections

• Underestimation of the severity and prevalence of vaccine-preventable diseases

• Sociocultural beliefs (religious considerations)