Lower Respiratory Flashcards
Nutrition
- adequate hydration
- high calorie, small, frequent meals
Prevent Pneumonia
- elevate HOB 30 degree
- reposition every 2 hr
- strict adherence to ventilator bundle
- early mobilization
- twice daily oral hygiene
Tuberculosis symptoms
- chronic productive cough
- malaise, fatigue
- weight loss
- advanced: hemoptysis
- afternoon fever
Tuberculosis care
Airborne isolation
- 6-12 airflow exchanges/hr
- HEPA masks
Tuberculosis Ambulatory Care
- can go home with positive cultures
- monthly cultures
- minimize cultures
- negative cultures = not infectious
- smoking cessation
Pneumothorax manifestations
- mild tachycardia and dyspnea to severe respiratory distress
- absent breath sounds
- X-rays
Spontaneous pneumothorax
- rupture of blebs
- can occur in healthy or chronically ill
- risk factors
Iatrogenic pneumothorax
Caused by medical procedures
Tension pneumothorax
- accumulation of air in pleural space
- causes mediastinal shift and hemodynamic instability
- open or closed
Hemothorax and Pneumothorax treatment
Chest tube to water seal drainage
- surgery for spontaneous repeated pneumothorax
- urgent needle decompression for tension pneumothorax
Chylothorax
Lymphatic fluid in pleural space
-treat with meds, surgery, or pleuridesis
Penetrating chest wound
Air enters during inspiration
-vent dressing used (secured on 3 sides)
Rib fractures
Most common ribs 5-9
- pain, splinting, shallow respiration’s
- acetectasis and pneumonia
Rib fractures treatment
- no strapping or binding
- deep breathing or coughing
- incentive spirometer
- analgesics
Flail chest treatment
- adequate airway and ventilation
- oxygen therapy
- analgesia
- surgical fixation
Cardiac tamponade
Secondary to collection of blood in pericardial sac, prevent ventricular filling
- muffled, distant heart sounds, hypotension, neck vein distention, increased CVP
- emergent pericardiocentesis
Chest Trauma Emergency Management
- assess for signs of respiratory distress
- assess for cardiovascular compromise
- ABC
- O2
- IV
- semi-Fowler’s position or on injured side
Chest tubes and pleural drainage
Remove air or fluid
- reestablishes negative pressure
- reexpands lungs
- bubbling = air leak
- tidaling = changes in pressure
Flutter Heimlich Valve
One way valve
- opens when intrathoracic pressure > atmospheric pressure
- emergency transport and small-moderate pneumothorax
- increased patient mobility
- vent any attached drainage bag
Water suction control
- excess suction from source vented
- adjust until gentle bubbling in 3rd chamber
Dry suction
- no water
- dial in desired negative pressure
- must vent when decreasing pressure
Chest tube and drainage complications
- reexpansion pulmonary edema
- vasovagal respinse
- emphysema
If the following occurs within the first hr notify the HCP
- drainage > 200 ml
- subcutaneous emphysema
- respiratory distress
Chest tubes and drainage management
- don’t elevate above chest
- report > 100 ml/hr
- overturned: exhale and cough
- don’t clamp
- break: place distal end in sterile water
