Respiratory Disorders and Treatment, Exams of Nursing

Download Respiratory Disorders and Treatment and more Exams Nursing in PDF only on Docsity!

NUR2571 Exam 2 Material Note

Ventilation – physical movement of air in and out of the lungs. Perfusion – movement of gases between alveoli.

• Dead space o Smoking, PE, PNA, ARDS. IGGY Ch. 29 Sleep apnea (CV EVENTS)
• Obstructive o Overweight patients occur because of obstruction in the airway.
• Central o Respiratory drive is affected by neurological or medications affects
• Complications of sleep apnea o Heart attack, stroke, arrythmia.
• Diagnosing o Sleep study
• Treatment o Bipap, Cpap.
• Do not restrain and caution food and fluids. Upper airway obstruction
• Causes o Tongue edema, abscess, cancer, etc.
• Do not interfere with gagging, only intervene when patient is choking. Lower respiratory disorders
• Asthma o Inflammatory ▪ Airway obstruction r/t inflammation o Generalized chest pain/tightness. o Diagnosed with pulmonary function tests and ABGs. o PG 566 and 569 in IGGY (know LABAs and SABAs.)
• Know how to educate your patient for asthma related medications. o MDIs, DPIs, LABAs, SABAs.
• NO LUNG SOUNDS = CRITICAL SPACE = DEATH.
• Status Asthmaticus o Medical emergency; prepare to intubate if sudden absence of wheezing occurs. o Pneumothorax, cardiac arrest, respiratory arrest. COPD
• Emphysema + chronic bronchitis
• CO2 retainers; think respiratory acidosis.

o hypercapnia

• Wheezes not crackles. Crackles occur with fluid in the lungs.
• Exhaling too much carbon dioxide will cause breathing to speed up.
• Inhaling too much oxygen will cause breathing to slow, allowing oxygen levels to fall to normal levels.
• BE CAUTIOUS OF O2 THERAPY WITH COPD PATIENTS – REASSESS GCS IF PATIENT BECOMES DROWSY. o 89%-92% if healthy for a COPD patient. COPD – Cor Pulmonale
• Right sided heart failure as it related to respiratory disease.
• Signs and symptoms o Peripheral edema o SOB
• Education on pursed lip breathing and/or abdominal breathing. o Take frequent rest periods o Avoid working with arms raised. o Prevent weight loss, consume smaller but more frequent meals. o SABAs 30 minutes prior to a large meal. o High calorie/high protein meals. Cystic Fibrosis
• Limits the ability to breath over time in relation to a poor chloride absorption causing mucous to become thick and sticky. o Lung secretions affect tissue perfusion.
• Mucous thickening in GI affects pancreatic secretions. o Inability to gain weight regardless of intake. o GERD/Distension o Steatorrhea, bulky, foul smelling stool. o Osteoporosis and osteopenia from lack absorption.
• Daily chest physiotherapy to break up secretions. o Vibration, percussion.
• Prevention of infection.
• MECHANICAL VENTILATION IS A LAST RESORT o Increases complications.
• Respiratory drug therapy. Infection respiratory disorders
• Influenza o S/S headache, fever, fatigue, N/V/D o Treat with vaccination. o Educate patient on hand washing, get annual vaccination, droplet precautions.
• Pneumonia o Excess fluid in the lungs. o Decreases tissue perfusion, increases inflammation and mucous build up.

o Patient can easily and quickly develop sepsis. Lactate levels indicate sepsis. o May complain of chest pain – EKG and troponin to r/o cardiac. o VAP bundle ▪ Prevention of pneumonia for ventilator patients. ▪ Q2 turns ▪ Q2-Q4 hour mouth care ▪ HOB > 30 degrees ▪ Good hand hygiene ▪ Daily sedation vacations ▪ Stress ulcer prophylaxis (medications.) ▪ ORAL CARE!! o Treatment ▪ Antibiotic therapy is crucial. ▪ Weeks to months of recovery. ▪ Activity intolerance ▪ Activity avoidance to re-introduce infection. ▪ Don’t smoke! ▪ Respiratory therapies common with other respiratory malfunctions.

• Low body temperature in patient with pneumonia means sepsis.
• TB o Screening with Mantoux TB test. ▪ Healthy patient – 10mm is positive. ▪ Immunocompromised patient – 5mm is positive. o Chest X Rays are used to detect TB. ▪ Cavitasious lesions. o Latent TB ▪ TB lives in the body but does not result in active infection. ▪ Noninfectious. o S/S of TB ▪ Weight loss, nausea, night sweats, chest pain, lethargy, persistent cough with bloody sputum. o Treatment ▪ Rifampin, INH, PZA, and ethambutol. ▪ First phase is all four meds daily for 8 weeks. ▪ Second phase is two meds daily for 18 weeks. o Treatment meds are very hepatotoxic, monitor liver function. Critical lung disorders
• Pulmonary embolism o SOB, pleuritic chest pain, restlessness, tachycardia, tachypnea, hemoptysis.
• Diagnosis o D-dimer, VQ scan, CT.
• Treatment o High fowlers, O2 therapy, cardiac monitoring, continuous pulse ox, anticoagulants. o IV heparin.

• Pulmonary Empyema o Pneumonia complication – pus in the pleural space. o Thoracentesis and chest tube placement may be necessary.
• Pneumothorax o Collapsed lung, air is present in pleural space. o Rise in chest pressure o Often result of trauma (open or closed) o Tension pneumothorax ▪ Decreases blood flow from heart o Hemothorax ▪ Blood present in chest cavity. o S/S ▪ SOB ▪ Significant tachypnea ▪ Decreased breath sounds ▪ Low O2 sats ▪ Anxiety ▪ Chest pain o Diagnostic ▪ CT/X-Ray o Treatment is based on level of severity. ▪ Anything over 30% pneumothorax requires a chest tube. ▪ Keep chest tube cannister BELOW PATIENT LEVEL! o CHART 30-12 PG 592