NUR 240 ch 19 lower resp Flashcards
Atelectasis
closure of collapse of alveoli
described in relation to chest x ray findings and signs and symptoms
microatelectasis vs macroatelectasis (AKA acute atelectasis
micro- not detectable on a chest X-ray
macro- loss of segmental, lobar, and overall lung volume
acute atelectasis occurs often in the ____
postoperative setting following thoracic and upper abdominal procedure, ppl who are immobilized, and have shallow monotonous breathing pattern
Obstructive atelectasis
results from a BLOCKAGE that impedes the passage of air to and from the alveoli, reducing alveolar ventilation
most common
Obstructive atelectasis results from
reabsorption of gas (trapped alveolar air is absorbed into the blood stream)
no additional air can enter alveoli due to the blockage
Causes of Atelectasis
foreign body,
tumor or growth in an airway,
altered breathing patterns,
retained secretions,
pain,
alterations in small airway function,
prolonged supine positioning,
increased abdominal pressure,
reduced lung volumes due to musculoskeletal or neurologic disorders,
restrictive defects,
specific surgical procedures
Symptoms of atelectasis
“I’m having a hard time breathing” - increased work of breathing
low oxygen levels- hypoxia
tachycardia, tachypnea, pleural pain and central cyanosis (later stage of hypoxia)
(atelectasis) What will you hear over after area?
decreased breath sounds and crackles
diagnostic test for atelectasis
chest x ray
pulse oximetry
prevention of atelectasis
*frequent turning - SITTING UP RIGHT
*early mobilization
*incentive spirometer
*voluntary deep breathing and coughing
secretion management
pressurized meter dose inhaler
ICOUGH
Incentive spirometry
Coughing and deep breathing
Oral care (brushing teeth)
Understanding (patient and staff education)
Get out of bed at least 3 times a day
Head of bed elevation
nebulizer
aerosolizes the medication
Chest physiotherapy
movement of secretions
chest postural drainage
drainage of lung secretions using gravity
trendelenburg, hold meal for one hour
positive end-expiratory pressure (PEEP)
simple mask and one way valve system that provides varying amounts of expiratory resistance (10-15 cm H2O)
With a large pleural effusion that is compressing lung tissue and causing alveolar collapse, treatment may include thoracentesis (removal of the fluid by needle aspiration) or insertion of a chest tube
bronchoscopy (in atelectasis)
used to open an airway obstructed by lung cancer or a nonmalignant lesion
if the cause of atelectasis is compression, the goal is to
decrease the compression
possibly from a pleural effusion –> thoracentesis
Acute tracheobronchitis
inflammation of the mucous membranes of the trachea usually after a viral infection
In acute tracheobronchitis, the inflamed mucosa of the bronchi produces
mucopurulent sputum
*** very important to get a sputum culture to identify the specific causative organism
presentation of acute Tracheobronchitis
first- dry, irritating cough, small amount of mucoid sputum
As progresses, dyspnea, stridor, wheezes,
purulent sputum
management of acute Tracheobronchitis
antibiotics
analgesics
increased fluid intake
cool vapor or steam inhalation
suctioning
nursing management of acute tracheobronchitis
bronchial hygiene- increased fluids, coughing
rest
complete full course of antibiotics
Pneumonia
inflammation of the lung parenchyma (portion of the lung involved in gas exchange) caused by bacteria, myobacteria, fungi, and viruses
classifications of pneumonia (RELATED TO TIME)
o Community-acquired (CAP)
o Health care–associated (HCAP)
o Hospital-acquired (HAP)
o Ventilator-associated (VAP)
Community acquired pneumonia
acquired from the community or if diagnosed in the first 48 hours of hospital admission
rate of infection increases with age
S. Pneumoniae is the most common cause
among adults
health care associated pneumonia
often caused by multidrug-resistant organisms
early diagnosis and treatment is critical
hospital acquired pneumonia
develops after 48 hours of more I hospital
high mortality rate
colonization of multiple organisms due to overuse of antimicrobial agents
signs and symptoms of hospital acquired pneumonia
pleural effusion, high fever, tachycardia, increased respiratory rate
most common in debilitated, dehydrated patients with minimal sputum production (older adults)
ventilator associated pneumonia
received mechanical ventilation for at least 48 hours
prevention is key
pneumonia in immunocomprimised individuals
can occur with the use of corticosteroids, chemotherapy, nutrition depletion, use of broad spec antibiotics, AIDS, genetic disorders and long term advanced life support (mechanical ventilation)
Pneumonia carries a higher morbidity and mortality rate in patients who are ______ than in those who are ______
immunocompromised, immunocompetent
Aspiration pneumonia
entry of endogenous or exogenous substances into the lower airway.
some COPD patients only show these symptoms of pneumonia
purulent sputum, or slight changes in respiratory symptoms
diagnosis of pneumonia
history (antibiotics in the last 3 months?)
physical exam
chest x ray
blood culture
sputum examination
bronchoscopy
Pneumonia prevention
pneumococcal vaccination (two types)
1. PCV-13 - covers 13 strains (rec. for 65+, HIV, immunosuppressive, organ transplant, leukemia, asplenia, CKD)
2. one year and one day later PPSV-23
Older adults usually have ___ symptoms of pneumonia
vague
COVID-19 related Pneumonia signs and symptoms
fatigue, myalgia, congestion, sore throat, diarrhea
COVID-19 related Pneumonia increases risk for
thromboembolism which can lead to shock and respiratory failure
complications of patients with bacterial pneumonia
sepsis, respiratory failure, atelectasis, pleural effusion, delirium
pneumonia nursing diagnosis
decreased activity intolerance
ineffective airway clearance
impaired gas exchange
ineffective health management
fraction of inspired oxygen [FiO2]
more aggressive respiratory support measure, administration of high concentrations of oxygen
aspiration
inhalation of foreign material into the lungs leads to inflammatory reaction, hypoventilation, and ventilation-perfusion mismatch
aspiration can cause
broncho or lobar pneumonia
aspiration prevention
swallowing screen
HOB elevated (intubated- endotracheal cuff elevated)
avoid stimulation of gag reflex with suctioning
check placement of tube feeding
soft diet, small bites, no straws
pulmonary tuberculosis s/s
low-grade fever
cough, nonproductive or mucopurulent, hemoptysis, NIGHT SWEATS , fatigue, weight loss
pulmonary tuberculosis tranmission
Spreads by airborne transmission through droplets then
moves to other parts of the body such as the kidneys,
bones, and cerebral cortex.
TB diagnostic tests
history and physical
TB skin test: Mantoux method
TB blood test
sputum culture
sputum testing
TB test and what are they looking for
Mantoux method (positive= palpable, a bump)
primary concern for medical management tof tuberculosis
drug resistance
treatment of TB and drugs to treat it
anti-TB agents for 6-12 month
Isoniazid
treatment of TB and drugs to treat it
anti-TB agents for 6-12 month
Isoniazid
Rifampin
rifapentine
pyrazinamide
ethambutol
isoniazid + rifampin
nursing management of TB
promoting airway clearance (copious secretion interfere with gas exchange)
promoting adherence to treatment regimen
promote activity and adequate nutrition
prevent transmission of TB (N95)
lung abscess
localized collection of pus caused by microbial infection
lung abscess is generally caused by
aspiration of anaerobic bacteria
lung abscess physical exam
dullness on percussion
decreased or absent breath sounds with an intermittent pleural friction rub on auscultation
pleural friction rub
grating or cracking sound
lung abscess can lead to
empyema (pocket of pus) and bronchopleural fistula (with collection of fluid in the pleura)
lung abscess s/s
mild productive cough to acute illness, FOUL-SMELLING SPUTUM, leukocytosis, pleurisy, dyspnea, weakness, anorexia, an d weight loss
management tof lung abscess
chest physiotherapy to drain excess fluid
sarcoidosis
type of interstitial lung disease that is also an inflammatory, multi-system, granulomatous disease of unknown eitology
walking pneumonia
mycoplasma pneumoniae
correct use of incentive spirometer
the patient inhales slowly from the device until no longer able and then holds breath for 6 seconds and exhales
vancomycin can cause
ototoxicity
pluerisy
Inflammation of both layers of pleurae
Key characteristic of pleuritic pain is its relationship to respiratory movement
plueral effusion
fluid collection in pleural space usually secondary to heart failure, TB, Pneumonia, pulmonary infections
empyema
accumulation of thick purulent fluid in pleural space often with fibrin development, patient will be acutely ill
sings and symptoms similar those of acute pneumonia
pulmonary edema
pleural effusion s/s
fever, chills, pleuritic pain, dyspnea
decreased or absent breath sounds, decreased fremits and dull/flat sound on percussion
empyema is a complication of
bacterial pneumonia or a lung abscess
acute respiratory failure
deterioration of the gas exchange of the lungs and indicates their failure to provide adequate oxygenation of ventilation for the blood
visceral pleura
membranes covering the lungs
parietal pleura
membranes covering the chest wall
Acute respiratory failure causes
hypoxemia (decrease in arterial oxygen)
hypercapnia (increase in arterial CO2)
respiratory acidosis
impaired ventilation and perfusion mechanisms
early and late signs of acute respiratory failure
early: restlessness, tachycardia, hypertension, fatigue, headache
late: confusion, lethargy, central cyanosis, diaphoresis, respiratory arrest
clinical manifestations of acute respiratory failure
accessory muscles, decreased breath sounds
medical and nursing management of ARF
intubation, mechanical ventilation (depending on severity)
enteral feedings
reduce anxiety
endotracheal intubation (why do we use the oral route?)
involves passing an endotracheal intubation tube through the nose or mouth into the trachea
oral intubation is preferred because its less risk for infection and trauma, and can accommodate a larger diameter
Intubation provides…
a patent airway when the patient is in respiratory distress and cannot maintain an adequate airway on their own
endotracheal intubation can be left in for
14-21 days.
after that, a tracheostomy is required
tracheotomy
is a surgical procedure in which an opening is made into the trachea
immediately after intubation the nurse should
check symmetry of chest expansion
auscultate breath sounds anterior and lateral
obtain chest x-ray and capnography
ARF is defined as a decrease in arterial oxygen tension (PaO2) to less than 60 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to >50 mm Hg (hypercapnia), with an arterial pH less than 7.35.
decreased PaO2 less than 60mmHg (hypoxemia)
increased PaCO2 over 50mmHg (hypercapnia)
decreased pH less than 7.35
5mm induration
positive for those at risk.
people with HIV, those who have been around someone with HIV,
10 mm induration or greater
considered significant in people who have normal or mildly impaired immunity.
A significant (positive) reaction does not necessarily mean that active disease is present in the body. More than 90% of people who are tuberculin-significant reactors do not develop clinical TB
sputum specimen for TB
if positive for AFB, MAY indicate disease but does not confirm diagnosis
key characteristic of pleurisy
its relationship to respiratory movement.
Taking a deep breath, coughing, or sneezing worsens the pain
