Chest and Lower Respiratory Tract Disorders Flashcards
alveoli
- responsible for ventilation and oxygenation
- if deflated can cause infection and business problems
atelectasis
closure or collapse of alveoli caused by excessive secretions
causes of acute atelectasis
- occurs in post op settings
- immobile
- anesthesia
- supine
- abdominal/cardiac surgery
- abdominal distention
- obstruction (mucus plugs)
chronic atelectasis
- similar to acute
- pulmonary infection may be present
symptoms of atelectasis
- insidious
- increased dyspnea
- cough
- sputum production
large area of lung affected sx
- marked respiratory distress
- tachycardia
- tachypnea
- pleural pain
- central cyanosis
assessment of atelectasis
- increased work of breathing and hypoxemia
- decreased breath sounds and crackles over affected area
diagnosis of atelectasis
- chest x-ray
- pulse ox (less than 90%)
hallmarks of severity of atelectasis
- tachypnea
- dyspnea
- mild to moderate hypoxemia
preventing atelectasis
- frequent turning
- early mobilization
- incentive spirometer
- tcdb
- respiratory treatments/metered dose inhaler
- hydration
- monitor i&o, bun, cr
management of atlectasis
- improve ventilation and remove secretions
- first line measures: ICOUGH
- other measures: PEEP, CPAB, bronchoscopy, CPT, Endotracheal intubation & mechanical ventilation, thoracentesis
pneumonia
inflammation of the lung parenchyma caused by various organisms
classifications of pneumonia
- CAP: acquired outside of hospital within 48 hrs
- HCAP: 48 hours after hospital admission
- VAP: 48 hrs after intubation
causative agents of pneumonia
- s. pneumoniae: young with no comorbidities
- h. influenzae: elderly and those with comorbid ilnesses
pneumonia risk factors
- Heart failure: fluid overload that travels to the lungs
- COPD: decrease ventilation and perfusion
- Aids & diabetes: compromised immune system
- alcholism
- flu: increased risk for developing pneumonia
- cystic fibrosis: high amount of resp. secretions; recurrent pneumonia
manifestations of pneumonia caused by strep
- sudden onset of chills
- fever
- pleuritic chest pain
- tachypnea
- resp. distress (sob, tachypnea, tripod, use of accessory muscles)
manifestations of pneumonia caused by viral, mycoplasma, or legionella
relative bradycardia
pneumonia s/s
- resp. tract infection
- h/a
- low grade fever
- pleuritc pain
- myalgia
- rash
- pharyngitis
- orthopnea
- crackles
- increased tactile fremitus
- purulent sputum
assessment- history
- recent viral infections?
- comorbid conditions?
- hx of asthma?
- sputum?
- sob?
assessment- physical exam
- vital signs
- secretions: amount, consistency, odor, color
- cough: frequency, severity
- tachypnea, sob
- inspect & auscultate chest
- changes in mental status, fatigue, edema, anorexia, dehydration, concomitant HF
diagnostics for pneumonia
- chest x-ray: shows pattern of organism, rate of perfusion, fluid build up
- blood cultures: detect microorganism and type of abx needed to treat it
- sputum: rinse mouth w/ water, take several deep breaths, and cough deeply into specimen cup
- cbc: elevated if infection is present, presence of bands indicate infection
- O2 sat/abgs: assess for hypercapnia or acidosis
- bronchoscopy: retain biopsies and fluid samples
- thoracentesis: needle into pleural space and fluid drained
bronchoscopy perioperative
- preop: informed consent, iv access, pt npo for about 6 hrs before
- intraop: monitor vs, keep surgeion updated on state of pt
- postop: pt remains on O2 2-4 hours, return of gag reflux, chest x-ray to rule out pneumothorax
thoracentesis perioperative
- preop: informed consent
- intraop: upright on edge of bed, leaning forward, elbows on hard surfaces, apply dressing once drained
- postop: will need ride home, nonitor s/s of pneumothorax, s/s of infection, will need ride home
s/s of pneumothorax
- uneven respiration
- diminished breath sounds on one side
- dyspnea
- sob
medical management for pneumonia
- abx
- supportive treatment: fluids, o2 for hypoxia, antipyretics, antitussives, decongestants, and antihistamines
collaborative problems with pneumonia
- continuing sx after initiation of therapy
- sepsis and septic shock
- resp. failure
- atelectasis
- pleural effusion
- delirium
pneumonia expected outcomes
- improved breath sounds
- decreased wbc count
- rest, conserves energy then slowly increased activity
- maintains adequate hydration; adequate dietary intake
- verbalize increased knowledge about management strategies
- exhibits no complications
aspiration
inhalation of foreign material into the lungs (serious complication of pneumonia)
s/s of aspiraiton
- tachycardia
- dyspnea
- central cyanosis
- htn
- hypotension
- death
aspiration risk factors
- seizure
- brain injury
- decreased loc
- flat body position
- stroke
- swallowing disorder
- cardiac arreset
aspiration interventions
- hob greater than 30
- avoid stimulation of gag reflux with sunctioning or other procedures
- thickened fluids for swallowing problems
covid s/s
- fever
- nonproductive cough
- sore throat
- fatigue
- myalgia
- nasal congestion
- n/v
- diarrhea
- anosmia
- ageusia
conservative measures for covid
- rest
- hydrate
- take antipyretic meds
- monitor sx
self quarantine/isolate until
- 72 hours free w/ out antipyretic meds
- improvement in resp s/s
- 5 days since first noted s/s
pneumonia hospital management
- pneumonia precautions
- dvt prophylaxis
- airborne infection, isolate rooms
- lab testing
