PN 113 respiratory conditions

Anatomy and Phisiology

\-Nose/nasal cavities

\-Pharynx

\-Larynx

\-Trachea

\-Bronchi

\-Bronchioles

\-Alveoli

cause of respiratory acidosis

hypoventilation

cause of respiratory alkalosis

hyperventilation

Assessment of Respiratory System

\--Symptoms

\--Exposures

\--Treatments

\--History, including smoking

Inspection of Respiratory System

\-Symmetry

\-Dyspnea

\-Use of accessory muscles

\-Color

Excursion

The extent of movement of a part such as the extremities or eyes

percussion

producing sounds by tapping on specific areas of the body with fingers, hands, or small instruments, allows evaluation of the size, consistency, and borders of the body organs, and the presence or absence of fluid in body areas.

Crepitus

a crackling or grating sound usually of bones

normal auscultation

quiet, no sounds

crackles on auscultation

Brief, fine, high pitched Rice crisps

Wheezes (auscultation)

High pitched, musical wheezing

Disease in lower airways

Stridor on auscultation

Stridor is an abnormal, high-pitched, musical breathing sound. It is caused by a blockage in the throat or voice box

CBC

complete blood count

D-dimer

• 0.43 - 2.33 mcg/mL

• 0 to 250 ng/mL

\-Measured blood clotting

sputum culture and sensitivity (C&S)

testing sputum by placing it on culture medium and observing any bacterial growth; specimen tested to determine selection of effective antibiotic

throat culture

test used to identify pathogens, especially group A streptococci

Nasal samples

A nasopharyngeal swab or a nasal wash can be used to identify flu or other respiratory viruses. To be accurate, it must be done in the first few days a person has symptoms. The sample may be obtained by swabbing the nasal passages or pharynx or by using a small amount of saline to wash out the nose, depending on the type of test ordered.

capnography

A noninvasive method to quickly and efficiently provide information on a patient's ventilatory status, circulation, and metabolism; effectively measures the concentration of carbon dioxide in expired air over time.

chest x-ray

radiographic image of the thoracic cavity (CXR)

Radiographic exams for respiratory systems

MRI

CT

bronchoscopy

the visual examination of the bronchi using a bronchoscope

pulmonary function tests

a group of tests that measure volume and flow of air by utilizing a spirometer

ABGs

arterial blood gases

Ph normal levels

7\.35-7.45

Normal PaCO2

35-45

Normal PaO2

75-100

Normal HCO3

22-26

Normal SaO2

95-100

Therapeutic measures for the respiratory system

\-Smoking cessation

\-Positioning

\-Chest physiotherapy

\-Mucous clearing devices

breathing exercises

\-Cough, deep breath

\-diaphragmatic breathing

\-Pursed lip breathing

\-Incentive spirometer

nasal cannula

1-6 L/min

Oxygen into nares

Simple Face Mask

5-10 L/min

Oxygen into nose and mouth

Nonbreather mask

6-15 L/min

Prevents patient from rebreathing exhaled air

Venturi mask

24-80%

Can deliver precise percentage of Oxygen

tracheostomy collar

4-10L/min

Humidified oxygen which rests over trach

High flow nasal cannula

7-15 L/min

Rules for nasal cannula

Apply humidity for 4L or more

Oxymask

1-15 L/min

NEBULIZED MIST TREATMENTS

Assess breath sounds prior to and shortly after administering a neb treatment

reason for chest tube insertion

Inserted in pleural space to drain fluid or air

Nursing role in chest tube insertion

\--Assist with procedure

\--Prepare drainage system

\--Administer prescribed analgesics

\--Ensure secure connections

\--Reinforce dressings

\--Clamps at bedside

Chest tube drainage system

\-Creates a one-way valve

\-Water seal chamber

\-Suction chamber

\-Drainage chamber

\--Shouldn't have bubbling

\--Tidaling is normal

Nursing assessment for chest tube drainage system

\--patient

\--tubing

\--drainage system

\-Drainage system upright and below level of chest

what if your patient with a chest tube has a hemothorax and the chest tube begins bubbling

check for leaks

what if your patient with a chest tube has a pneumothorax and the chest tube is bubbling

check for leaks

what if your patient with a chest tube has tideling in the water seal chamber

This is normal

what if your patient with a chest tube has no output to the drainage chamber and suddenly has 500 ml sanguineous drainage in the chamber

asses pt and notify provider. Check vitals

tracheostomy

Tube inserted into opening in the trachea to maintain airway

Nursing care for a patient with a tracheostomy

\--Communication

\--Suctioning

\--Keep site free from pollutants

Intubation

Endotracheal tube (ET)

Nursing care for an intubated patient

\--Assessment

\--Suctioning

\--Ventilator-associated pneumonia (VAP) prevention

\---oral cares

\---HOB>30 degrees

\--Communication

\--Monitor ABGs

mechanical ventilation

Assist and/or control patient's respirations for patients unable to breath on own

NONINVASIVE POSITIVE-PRESSURE VENTILATION (NIPPV)

\-Alternative to intubation/mechanical ventilation

\-For patients able to breath on own, but unable to maintain normal ABGs

\-Mask fits over nose and/or mouth

Continuous positive airway pressure (CPAP)

treats sleep apnea

Bilevel positive airway pressure (BiPAP)

helps with COPD

oropharyngeal airway

a curved device inserted through the patient's mouth into the pharynx to help maintain an open airway

nasopharyngeal airway

a flexible breathing tube inserted through the patient's nostril into the pharynx to help maintain an open airway

MODES OF RESPIRATORY MEDICATION ADMINISTRATION

\-Nebulizers

\-Metered-dose inhalers (MDI)

\-Dry powder inhaler (DPI)

Medications used for respiratory treatments

\-Bronchodilators

\-Anticholinergics

\-Glucocorticoids

\-Antitussives

\-Expectorants

\-Mucolytics

\-Antibiotics

\-Antipyretics

\-Anti-tubercular drugs

Action of bronchodilators

relax smooth muscles of the bronchi

Uses for bronchodilators

\--COPD

\--Bronchitis

\--Asthma

Side effects of bronchodilators

\--Nervousness, restlessness

\--Hand tremors

\--Palpitations

\--Tachycardia

Nursing implications for bronchodilators

\--Teach patient use of inhaler

\--Assess lung sounds

Examples of bronchodilators

\--Albuterol inh (proair, Proventil, Ventolin)

\--Levalbuterol (Xopenex)

\--Salmeterol (serevent diskus)

Action of anticholinergics

block muscarinic receptors in bronchi which causes bronchodilation

uses of anticholinergics

\--COPD--Asthma

\-Side effects

\--Dry mouth

\--Throat irritation

\--Tachycardia

Nursing implications for anticholinergics

Used to prevent bronchoconstriction, not treat acute exacerbations

examples of anticholinergics

\--Ipratropium Inh (Atrovent)

\--Tiotropium (Spiriva)

action of glucocorticoids (corticosteroids)

decrease inflammation & edema in airway

use for glucocorticoids (corticosteroids)

\--Asthma

\--COPD

side effects of glucocorticoids (corticosteroids)

\--Fluid retention

\--Lower resistance to infection

\--Hyperglycemia

\--Impaired healing

\--Osteoporosis

nursing implications of glucocorticoids (corticosteroids)

Instruct to not stop abruptly

Examples of glucocorticoids (corticosteroids)

\--Prednisone (PO)

\--Dexamethasone (PO,IM,IV)

\--Solucortef (IV)

\--Solumedrol (IV,PO)

\--Pulmicort

\--Flovent diskus

Action of Antitussives

suppress cough

use of Antitussives

\--irritating cough

\--Dry, nonproductive cough

side effects of antitussives that are narcotics

constipation

dry mouth

hypotension

sedation

respiratory

depression

side effects of antitussives that aren't narcotics

drowsiness

examples of narcotic antitussives

codeine (PO liquid)

examples of non narcotic antitussives

Dextromethorphan (DM) (PO liquid)

Action of Expectorants

aids in secretion removal by reducing viscosity and liquefying secretions

use of expectorants

\--Cough with thick secretions

\--Dry, non-productive cough

Side effects of expectorants

\--Drowsiness

Nursing implications of expectorants

Drink lots of fluids

Examples of expectorants

\--Robitussin (PO liquid)

\--Robitussin DM (PO liquid)

\--Mucinex (PO)

Action of Mucolytics

liquefies secretions

use of mucolytics

\--COPD

\--Bronchitis

side effects of mucolytics

\--Bronchospasm

\--GI irritation

nursing implications of mucolytics

\--Foul smell, like rotten eggs

\--Rinse mouth after use

\--Don't mix with other meds

Examples of Mucolytics

Mucomyst (nebulizer)

Action of antibiotics

destroys microorganism

use of antibiotics

\--Bacterial pneumonia

\--Pharyngitis

\--Bronchitis

\--COPD

side effects of antibiotics

\--Rash

\--Diarrhea

\--Nausea

nursing implications of antibiotics

\--Obtain sputum specimen first, then start antibiotics

\--Take all doses, don't stop when feeling better

examples of antibiotics

\--Ciprofloxacin (PO,IV)

\--Penicillin (PO,IV,IM)

\--Amoxicillin/Augmentin

\--Rocephin (IM,IV)

action of antipyretics

lowers temperature

use of antipyretics

\--Elevated temperature

\--Often these are also analgesics (relieve pain)

side effects of antipyretics

\--Tylenol: hepatotoxicity

\--Aspirin/ibuprofen: GI upset, prolonged clotting time

examples of antipyretics

\--Tylenol (PO, Supp, IV)

\--Aspirin (PO, Supp)

\--Ibuprofen (PO)

action of anti-tubercular drugs

destroys tubercle bacilli

use of anti-tubercular drugs

Treat active TB