Respiratory - Ch 23 Flashcards
Atelectasis
S/S (both acute & chronic)
Insidious/increasing dyspnea, cough, sputum production
Acute: tachycardia, tachypnea, pleural pain, central cyanosis
Chronic: similar to acute, but pulmonary infection may be present
Atelectasis
Abnormal assessment findings
- Increased WOB, hypoxemia
- Decreased breath sounds & crackles over affected area
- CXR
- SpO2 may demonstrate low sat < 90%
ICOUGH Program
- IS
- Coughing & deep breathing
- Oral care
- Understanding (patient & staff)
- Getting out of bed at least 3x/day
- HOB elevation
Atelectasis
Management
- Improve ventilation and remove secretions —> frequent turning, early ambulation, lung vol expansion maneuvers
- ICOUGH
- PEEP, CPAP, bronchoscopy
- CPT
- ET intubation, mechanical ventilation
- Thoacentesis to relieve compression
Pneumonia, strep
S/S
Sudden onset of chills, fever, pleuritic chest pain, tachypnea, respiratory distress
Pneumonia, viral
S/S
Relative bradycardia
Pneumonia
General S/S
HA, low-grade fever, pleuritic pain, myalgia, rash, pharyngitis, ortopnea, crackles, increased tactile fremitus, purulent sputum
Pneumonia
DX
CXR
Blood culture
Sputum examination
Bronchoscopy may be used for severe infection
Pneumonia
Management
- Admin of appropriate ABX
- IVF, oxygen, antipyretics, antitussives, decongestants, antihistamines
Pneumonia
Complications
Sepsis/septic shock Respiratory failure Atelectasis Pleural effusion Delirium
Pneumonia
Nursing interventions
- Oxygen w/humidification to loosen secretions (face mask, NC)
- Coughing techniques
- Chest physiotherapy
- Position changes
- IS
- Nutrition
- Hydration
- Rest
- Activity as tolerated
Aspiration
S/S
Tachycardia, dyspnea, central cyanosis, HTN, hypotension, potential death
Aspiration
Nursing interventions
- HOB > 30
- Avoid stimulation of gag reflex w/suctioning
- Check for placement before tube feedings
- Thickened fluids for swallowing problems
Pleurisy
Inflammation of both layers of pleura
Pleurisy
Key characteristic
Pleuritic pain w/respiration
Pleurisy
Abnormal findings
- Pleural friction rub
- CXR, sputum analysis, thoracentesis
Pleurisy
Nursing interventions/TX
- TX of underlying cause
- Provide analgesia
- Teaching to splint rib cage when coughing
Pleural effusion
S/S
Fever, chills, pleuritic pain, dyspnea
Pleural effusion
Abnormal findings
- Decreased/absent breath sounds, decreased fremitus, dull/flat sound on percussion
- Tracheal deviation away from affected side
- CXR, chest CT, thoracentesis
Empyema
Accumulation of thick, purulent fluid in pleural space
Complication of bacterial PNE or lung abscess
Empyema
Abnormal findings
- Decreased or absent breath sounds over affected area
- Chest CT, diagnostic thoracentesis
Empyema
TX
Drain fluid and admin ABX for 4-6 weeks
ARDS
Risk factors
- Aspiration,
- Drug ingestion/overdoses
- Hematological disorders (DIC, massive transfusions, cardiopulmonary bypass)
- Prolonged inhalation of high concentrated O2, smoke, corrosive substances
- Localized infection
- Metabolic D/O (pancreatitis, uremia)
- Shock
- Trauma (pulmo contusion, FX, TBI)
- Major SX
- Fat or air embolism
- Sepsis
ARDS
Major S/S
Characterized by sudden, progressive pulmonary edema, increasing B/L lung infiltrates visible on CXR, absence of an elevated L-atrial pressure
HYPOXEMIA THAT DOES NOT RESPOND TO O2 THERAPY
ARDS
Management
- ID & TX underlying cause
- Intubation, mechanical vent w/PEEP to keep alveoli open
- Hypovolemia treated
- Pone position best for oxygenation, frequent repositioning to protect skin
- Nutritional support, enteral feedings preferred
- Reduce anxiety
PE
Risk factors
Trauma SX Pregnancy HF Hypercoagulability Immobility, venous stasis Dyspnea = MOST COMMON
