NU310 med surg exam 2

Respiratory + fluid balance

Respiratory system 

• Two tracts

  • Upper respiratory tract

    • Warms and filters air

  • Lower respiratory tract

    • Gas exchange

• Delivering oxygen and expelling carbon dioxide

Age changes

• Stiff

• Slow

• Thin

• Weaker 

Assessment

• Dyspena

• Cough

• Sputum production

• Pain

• Wheezing

• Hemopytsis

• Clubbing fingers

• Cyanosis
  
  

Risks

• Asthma

• Atypical mucus

• Allergies

• obesity

Lung sounds

• Crackles

  • Coarse or fine

• Rhonchi

  • Honking sound

• Wheezing

  • High pitched whistling sounds

• Stridor

  • High pitched and loud

Diagnositics

• Pulmonary function test (pft)

• Arterial blood gas (abgs)

  • Normal  paOs (partial pressure of oxygen in aterial blood

    • 80-100 mmHg

• Sputum culture

• Pulse oxy

  • Check wave form 

  • Percentage of oxygen saturation of arterial blood

  • Normal 95-100

    • 94= mild

    • 91=moderate

    • 85= severve

• En tidal carbon dioxide 

• Xray

• Ct

• Pulmonary angiography

• MRI

• Radioscopic 

• Bronchoscopy

• Thorascopa

• Thoracentesis

• biopsy

Goals of oxygen therapy

• Pao2 over 80mmhg

• Sao2 over 95% depending

• Decreasing workload of heart

ABGs

• Marching band method

Oxygen therapy

• Room air = 21% oxygen

• Add more if hypoxic, adjust HOB 

• Oxygen = medication, need order from doc

• Caution for chronic hypercapnia + copd

  • Cause of breathing for copd

  • s/s of hypercarbia restlessness, HTN, headache

• Low flow

  • Varies

• High flow

  • Consisgent

• Titrate when d/c or starting

• Use water soluble lubricant prn on nose

• Delivery devices

  • Depending on age, disease process, tolerance

  • Low flo

    • Nasal cannula 1-6L/min

    • Simple face mask 5-8L/min

    • Partial rebreather 8-11Lmin

    • Nonrebreather 10-15L

  • High flow of oxygen

    • Venturi mask 4-8L

    • Aerosol mask/tent/trach 8-10L/min

    • T piece 8-10L

Upper airway diseases

• Rhinitis

• Rhinosinusitis

• OSA sleep apnea

• Laryngitis

• Laryngeal cancer

Rhinitis

• Allergic or nonallerhic

• Acute or chronic (>12wk

• Inflammation and irritation of mucous membranes of the nose

  • Can also effect eyes throat and eyes

• Symptoms

  • Nasal itches

  • Sneezing

  • Nasal congestion

  • Rhinohera

• Treatment

  • Eliminate or avoiding cause

  • Desentitation

  • Fluid intake

  • Humidified air

  • Medication

    • Antibiotics, nasal decongestants

Rhinosinusitis

• Acute, subacute, chronic

  • Acute

    • Bacterial or viral under 4 wk

  • Subacute

    • 4-12wk

  • Chronic

    • Over 12 wks

• Infection adn inflammation of the paransal sinuses

• Reduces size of nsal passages

• Signs and symptoms

  • Purulent nsal discharge normally clear

  • Nasal obstruction

  • Facial pain fullness worse when head tipped forward

• Treatment

  • Antibiotics if bacterial

  • Saline irrigation

  • Antipyretic if fever

  • Analgesics if pain

  • Nasal decongestant

  • Hot wet packs

  • Fluid intake

    • Complications

      • Orbital cellulitis

      • Orbital abscess

      • Osteomyelitisi

      • Meningitis

      • Sepsis

      • Subdural

Pharyngitis

• Sore throat (back throat

  • Symptoms

    • Red pharyngeal membrane and tonsils

    • Lymphoid follicles that are swollen and flecked with white/purple exudate

    • Caused by virus, bacteria (sometimes fungi

    • Tender large lymph nodes

    • No cough

• Treatment

  • Bacterial = antibiotics, penicillin

Tonsilitis

• Sore throat

• Fever

• Snoring

• Dysphagia

• Txment

  • Fluids

  • Antispamoidic agents

  • Cephlosporin 

  • Salt water gargles

  • Tonsillectomy

Adenoiditis

• Mouth breathing

• Earache

• Head cold

• Bronchitis

• Foul breath

• Voice issues

• Noisy breathing

  • Txt

    • Fluids

    • Antispasmodic

    • Salt water gargles

    • Rest

    • Tonsillectomy

Peritonsil abscess

• Sore throat

• Drolling

• Trismus 

• Pus in throat

• Tx

  • Tonsillectomy

  • Needle stick

  • ABCS priority

Laryngitis

• Inflammation of the mucous membranes of the larynx 

  • Symptoms

    • Hoarseness

• Treatment

  • Screen for cancer

  • Voice rest

  • Humidifying

  • Fluids

  • No smoking

  • Antibiotics if bacterial

OSA

• Obstructive sleep apnea

• Obstcution of upper airway during sleep

• Narrowing of one of more sites of the u[pe airway resulting in intermentite breathigng patterns  and periods of apnea

  • Hypoxia, hypercanpia acidosis

  • Increased sympathetic vasoconstricive activity occur as decreased tidal volume and apnea

• Symptoms

  • Loud snoring 

  • Snorting 

  • Witnessed apnea

  • Gasping

  • Waking during sleeping

• Diagnosis

  • Polysomgraphy sleep study

• Treatment

  • CPAP continuous positive airway pressure

  • Weight management

  • Avoid supine sleeping

• Compilation

  • Cvd risk

Epistaxis

• Hemorage of nose from rupture of tiny vessels

• Nasal packing

Lower airway diseases

• Atelectasis

• Bronchitis

• Pneumonia

• Pulmonary tuberculosis

• Pleural effusion

Atelectasis

• Collapse of aleveoli diagnosed by xray

• Manfiestiations

  • Dyspnea

  • Cough

  • Sputum production

• Causes

  • Obstructive

  • Nonobstructive

    • Post sugerical

• Intervention

  • Frequent turing

  • Mobilization

  • Lung expansion (incentive spritometry)

    • Breath into it

Bronchitis

• Acute inflammation of the tracheal and bronchial tree

• Manifestation

  • Dry cough

  • Fever

  • Chills

  • Malaise

  • Sore chest

• Treatment

  • Abx

  • Increased fluid intake

  • Suctions

  • Cool vapor

  • Stream humidifying air

Pneumonia

• Inflammation fo the lung parenchyma (lung tissue) froj bacteria, virus or fungus

  • inflammation process similar to flu

  • Or aspiration of irritant

• 4 types

  • Community acquired

  • Hospital acquire

  • Ventilator associated

  • Aspiration

• Symptoms

  • Fever chills sweats

  • Tachycardia

  • Diminished breath sounds

  • Sob

  • Increased respiration

• Treatment

  • Bronchodilators to open airways

  • Antibtioics

  • antiinflmatories  ie glucocorticoids

Pleural effusion

• Fluid in pleural space

• Secondary to other diseases

• Treatment

  • Chest tube/ thoracentesis

  • Suctioning