(0) Week 3/4 General Info

What’s a Bronchoscopy? Pre-procedure considerations? Post-procedure considerations

• Bronchoscopy = An invasive procedure where a bronchoscope is inserted through the nose/mouth to VISUALIZE + EXAMINE THE LUNG TISSUE + AIRWAYS

• Pre-procedure considerations

  • STRICT NPO FOR 8 HOURS BEFORE PROCEDURE

  • IV MUST BE ESTABLISHED

  • Patient will be SEDATED to HELP TOLERATE PROCEDURE

• Post-procedure considerations

  • HIGHEST PRIORITY IN NURSING ASSESSMENT: CHECK GAG REFLEX

    • You should always check gag reflex since the pt is at high risk for aspiration because a numbing agent was used to suppress the throat reflex

      • Numbing agent causes suppression of throat reflex and loss of sensation → Pt has HIGH RISK OF CHOKING because of the numbness

  • Pt has to REMAIN NPO UNTIL RETURN OF GAG REFLEX (so they can’t eat, drink, swallow anything)

  • Check O2 stats and breath sounds

What’s a thoracentesis? Why’s it used? Post-procedure considerations? What position should the pt be when administering anesthetic?

• Thoracentesis: invasive procedure involving REMOVAL OF FLUID/AIR FROM PLEURAL SPACE.

• Used for DIAGNOSTIC PURPOSES (to identify infections, cancer, heart failure, etc) and THERAPEUTIC PURPOSES (relieve breathing + ease symptoms)

• Post-procedure considerations:

  • TOP NURSING PRIORITY: IMMEDIATE POST-PROCEDURE CHEST X-RAY to make sure this didn’t cause pneumothorax (accidental lung collapse from needle puncture)

  • MONITOR VITALS, RR, SPO2 (Oxygen)

• Pt should be SITTING UPRIGHT AND LEANING FORWARD ON AN OVER-BED TABLE

Define the following + what each may indicate:

• Orthopnea

• Wheeze

• Crackles

• Chest Percussion

• Postural Drainage

• Orthopnea: DIFFICULTY BREATHING WHILE LYING FLAT

  • Indicates FLUID BACKUP INTO THE PULMONARY SYSTEM, seen w/ patients with HEART FAILURE

• Wheeze: HIGH-PITCHED musical lung sound R/T NARROWING OF AIRWAY

  • Indicates BRONCHOCONSTRICTION, SWELLING, INFLAMMATION

• Crackles: FINE (popping/fireplace sounds) ASSOCIATED WITH FLUID IN THE LUNGS

  • Common in pneumonia or pulmonary edema

• Chest Percussion: USING VIBRATIONS to LOOSEN SECRETIONS

• Postural Drainage: POSITIONING IN TRENDELENBURG and/or ROTATE TO MOVE SECRETIONS

  • Positioning the person in Trendelenburg HELPS DRAIN LOWER LOBES OF LUNGS (bc gravity is pulling it)

Give me normal range for the following + what it could indicate if it’s TOO HIGH or TOO LOW:

• pH

• PaCO2

• HCO3 (Bicarbonate)

• pH: 7.35-7.45

  • INCREASED pH = ALKALOSIS

  • DECREASED pH = ACIDOSIS

• PaCO2: 45-35

  • RESPIRATORY INDICATOR (45-35)

• HCO3 (Bicarbonate): 22-26

Example: (using tic-tac-toe method)

• pH: 7.79

• CO2: 24

• HCO3: 21

• This would indicate RESPIRATORY ALKALOSIS (since both CO2 and pH are high).

Explain Respiratory Acidosis/Alkalosis. Why does each one happen? What s/s would show if someone was going through these?

Respiratory Acidosis: the pH is LOW (<7.35) and the PaCO2 HIGH is > 45

• This happens because of COPD or airway obstruction where The patient cannot breathe

  • Remember that if a person can't breathe, then they aren't going to be able to exhale the carbon dioxide that is in their body, which can accumulate, causing acidosis

    • If they can't breathe out the carbon dioxide, it's going to increase inside their body, making it acidic

• s/s:

  • DROWSINESS, CONFUSION, headache, fatigue, and SOB, DECREASED RR

Respiratory Alkalosis: pH is HIGH (> 7.45) and PaCO2 is LOW < 35

• This happens because there’s anxiety, panic attack, pulmonary embolism, or too much ventilation (you’re BREATHING TOO MUCH)

  • The opposite happens with alkalosis because if you're breathing too much, then the carbon dioxide is going to decrease, causing the PaCO2 to be more basic

• s/s

  • LIGHTHEADEDNESS, DIZZY, INCREASED RR, HYPERTENSION,

Explain Metabolic Acidosis/Alkalosis. Why does each one happen? What s/s would show if someone was going through these?

Metabolic Acidosis: pH is LOW, and HCO3 is LOW ( < 22)

• Happens because of DKA (Diabetes ketoacidosis), Kidney disease or severe diarrhea

  • Kidney disease can cause metabolic acidosis because it's not able to filter out the acids or it can't produce enough bicarbonate to neutralize the acidity

  • Diarrhea can cause metabolic acidosis because you are losing a lot of the bicarbonate that comes from the gut

• s/s

  • RAPID BREATHING, WEAKNESS, FRUITY-SMELLING BREATH, CONFUSION

Metabolic Alkalosis: pH is HIGH, and HCO3 is HIGH ( < 26)

• Happens because of VOMITTING, DEHYDRATION, OVERUSE OF DIURETICS,

• s/s

  • Muscle cramps/spasms, arrhythmia (irregular heart rate), irritability, and tingling

Explain COPD:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain COPD:

• Treatment

• RN intervention

• Pt teaching

• What’s the genetic link to causing it? What can such genetic mutation cause?

How can pneumonia be diagnosed? How can post operative pneumonia be avoided?

• Diagnosed: chest X-ray, sputum/ blood culture (always obtain culture prior to administering antibiotics!).

• Avoided by USING CDB (Cough and deep breathing) OR PREVENTING ATELECTASIS

What is atelectasis? What are some interventions to help prevent atelectasis?

• This is COLLAPSED LUNG TISSUE because the ALVEOLI DEFLATED or FILLED WITH FLUID

• Interventions

  • Place the client in Fowler’s (45-60) or semi-Fowler’s (30) position to help promote chest expansion

  • Promote deep breathing exercises, such as purse lip or belly breathing

    • Doing deep breathing exercises can help prevent atelectasis because it encourages the patient to expand their lungs

  • Use the incentive spirometer

    • Remember that you should use the Incentives spirometer 10 times an hour

Explain Pneumonia:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Pneumonia:

• Treatment

• RN intervention

• Pt teaching

Explain Asthma:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Asthma:

• Treatment

• RN intervention

• Pt teaching

Explain the following medications for Asthma and their drug action:

• A rescue inhaler

• Montelukast

• Maintenance inhaler (salmeterol and fluticasone)

• Theophylline

Medications that target the lungs are Beta ____. What are the 2 types of these medications? Overall, what does it do for the lungs?

Agonists (Specifically beta-2 adrenergic agonists)

• These meds bind to receptors in the smooth muscle of the airways, ALLOWING MUSCLE RELAXATION WHICH OPENS THE AIRWAYS FOR BETTER BREATHING

2 types of beta-2 adrenergic agonists

• Short-acting beta-2 agonists

  • This is good for QUICK, TEMPORARY RELIEF DURING SUDDEN SOB or ASTHMA ATTACKS

• Long-acting beta-2 agonists

  • This is good for DAILY + LONG-TERM MAINTENANCE AND CONTROL OF CHRONIC SYMPTOMS

Explain Lung Cancer:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Lung Cancer:

• Treatment

• RN intervention

• Pt teaching

What's the difference between a lobectomy and a pneumonectomy?

Explain Tuberculosis (TB):

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Tuberculosis (TB):

• Treatment

• RN intervention

• Pt teaching

Explain Laryngeal Cancer:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Laryngeal Cancer:

• Treatment

• RN intervention

• Pt teaching

Explain Pulmonary Embolism:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Pulmonary Embolism:

• Treatment

• RN intervention

• Pt teaching

Explain Pleural Effusion:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Pleural Effusion

• ⭐ Treatment

• RN intervention

• Pt teaching

Explain Pleurisy:

• Pathophysiology (cause, how it develops, how it disrupts)

• Clinical manifestations

• Complications/Risks

Explain Pleurisy:

• Treatment

• RN intervention

• Pt teaching

Explain hypoxia. What is the S/S of it?

• Neuro: AGITATION, RESTLESSNESS, Headaches, lightheadedness, etc

• Tachycardia, Hypertension

• PALLOR, CYANOSIS, TACHYPNEA, DYSPNEA, DIGITAL CLUBBING