Respiratory Issues week 4

o2 percentage of room air

21%

what percentage of o2 is added with each liter of oxygen

4%

PE background

old age, surgery, smoking, pregnancy, CA, VTE, immobility, hormones

PE patho

clot embolizes to pulmonary artery

PE s/s

dyspnea, chest pain, hemoptysis, fever, tachycardia, hypotension, syncope

PE dx

CTPA, V/Q scan, LE ultrasound, d-dimer

PE tx

heparin, lovenox, DOACs, IVC filter, fibromyolytics

PE NI

VS, PTT/INR, SCDs, d-dimer, bleeding s/s, fall risk, prevention & meds teaching

small cell lung CA background

smoking, radiation, asbestos, genetics, air pollution

lung CA patho

cell mutation dysplasia from repeated exposure/damage/gene activation

lung CA s/s

brain fog, cachexia, hypoxia, fever, fatigue, lymph node involvement, dyspnea

lung CA dx

CXR, CT, bronchoscopy/biopsy

lung CA tx

chemo, radiation, surgical resection

lung CA NI

BICAP for bronchoscopy/surgery, chemo/radiation: infection s/s, n/v/d, mucositis

sarcoidosis background

african american, female 20-40, inherited

sarcoidosis patho

type III hypersensitivity causes granulomas on skin & lungs -> fibrotic tissue formation

sarcoidosis s/s

lung CA s/s plus: granulomas, erythema nodosum, uveitis, joint pain, dysrhythmias

sarcoidosis dx

CXR, CT, bronchoscopy with lavage/biopsy

sarcoidosis tx

corticosteroids, immunomodulators, SABA/LABA

sarcoidosis NI

BICAP, corticosteroids monitoring,

monitor: lungs, eyes, joints, heart, neuro/psych

corticosteroids monitoring

infection s/s, cushings s/s, taper off

COPD background

second hand/smoking, pollution, AAT deficiency, low socioeconomic status, low birth weight/preterm

chronic bronchitis patho

irritants cause epithelial cell damage, chronic inflammation, mucus overproduction, and decreased lumen of bronchioles

emphysema patho

antitrypsin deficiency or irritant damage to alveolar walls cause alveoli to enlarge and combine causing decreased gas exchange, ineffective recoil, respiratory acidosis

COPD s/s

barrel chest, DOE then rest, hypoxia s/s, chronic productive cough, retractions, wheezing, loc/mood changes, clubbing

COPD dx

CXR, PFT, C/S, resp panel, ABG for acidosis, CBC for infection

COPD tx

asthma meds: beta agonists, steroids, mucolytics, anticholinergics, methylxanthines, possibly diuretics

COPD NI

worsening s/s, breath sounds, loc changes, VS, PEEP, use spacer

asthma background

unknown; genetics, decreased early exposure, environmental factors

asthma patho

allergens cause cytokine release -> increased mucus and vascular permeability -> time builds up edema, scarring, fibrosis -> decreased airway diameter

asthma s/s

mucus plugs, needle shaped crystals, productive cough, dyspnea, wheezing

asthma tx

bronchodilators, anticholinergics, long acting meds, o2 therapy

asthma NI

PREVENTION; identify triggers: common: pets, dust, pollen, chemicals from fragrances, cleaning products, smoke, etc.

CF background

caucasian, autosomal recessive gene, male

CF patho

CFTR gene mutation causes Cl channel dysfunction -> decreased Na & water in secretions

CF s/s

thick resp secretions, floater stools, frequent URI, SOB, dyspnea, salty skin, mucus plugs -> pneumonia

CF dx

CFTR testing, Cl sweat test, PFT, CXR

CF tx

trikafta, fluticasone, albuterol, prednisone, mucolytics, chest physiotherapy, pancreatic enzymes, supplements

CF NI

increase calories & protein, reverse isolation, steroid monitoring, medication effects

PEEP

positive end expiratory pressure; prevents alveoli collapse, helps alveoli recruitment, helps co2 out, reduces atelectasis/pulmonary edema

FEV

forced expiratory volume