Topic 3: Respiratory & ABGs Flashcards
respiratory acidosis risk factors
*Neuromuscular disorders
*CNS depression
*Hypoventilation
*Decreased respiratory rate
respiratory acidosis s/s
*Kussmaul breathing
*Chest pain
*Nausea /vomiting
*Abdominal pain
*General muscle weakness
respiratory acidosis interventions
*Bronchodilators
*Assisted ventilation
*Respiratory stimulants
metabolic acidosis risk factors
*Diabetic ketoacidosis
*Lactic acidosis
*Resp., renal, or heart failure
*Diarrhea, laxatives
metabolic acidosis s/s
*Vertigo
*Neuro changes
*Dyspnea
*Tachypnea
*Hyperpnea
metabolic acidosis interventions
*Monitor vitals
*Monitor respiratory status
*Monitor blood gases
*Correct cause
*Give bicarbonate
respiratory alkalosis risk factors
*Extended periods of hyperventilation
*Extreme anxiety
*Fever
respiratory alkalosis s/s
*Lightheadedness
*Agitation
respiratory alkalosis interventions
*Encourage patient to take slow deep breaths
*Decrease patient anxiety
*Monitor ABG
metabolic alkalosis risk factors
*Vomiting
*NG suctioning
*Hypokalemia
*Excess antacids/bicarb
*Steroids
metabolic alkalosis s/s
*Lightheaded; N/V
*Confusion; stupor
*Muscle twitching; tremors
*Numbness/tingling face or extremities
*Electrolyte imbalance, dysrhythmias
metabolic alkalosis interventions
*Monitor: Vitals, neuro status, I & O, ABGs,
*Warn/teach about taking too many antacids
what is the onset fro influenza
abrupt, usually 3-6 hours
what are the signs and symptoms of influenza
Þ Chills
Þ Fever (usually high 102-104 that lasts 3-4 days)
Þ Generalized myalgia
Þ Headache
Þ Cough
Þ Sore throat
Þ Fatigue
what are the diagnositc studies for influenza
Þ Viral cultures can be taken (throat swab, nasopharyngeal swab, sputum, ect.)
Rapid influenza diagnostic test (RIDTs)
when should antiviral drugs be given
can be given if its within 24-48 hours of onset
what can nurses instruct patients to do if they have influenza
Þ Rest
Þ Hydrate
Þ Take acetaminophen or ibuprofen for HA, aches, pain
Þ Antipyretics for fever
when should a pateint not get the flu vaccine
if they have already had it that year
or
egg allergy
prevention of influenza
Þ Hand washing
Þ Annual vaccination (best time to get the vaccine is in September or October, before flu exposure)
Þ Antiviral drugs
Avoid close contact with anyone who has the flu
what are the s/s of acute sinusitis
Þ Significant pain over affected sinus
Þ Purulent nasal drainage
Þ Nasal obstruction
Þ Congestion
Þ Fever
Þ Malaise
Þ Halitosis (bad breath)
how can sinusitis get diagnosed
X-rays or CT scan of sinuses
(sinuses are filled with fluid or thickened mucous membrane)
what are treatments for the SYMPTOMS of sinusitis
Þ Oral or topical decongestants (to promote drainage)
Þ Intranasal corticosteroids (decrease inflammation)
Þ Analgesics (reduce pain)
Þ Saline spray (relieve congestion)
what is important to teach patients when using topical decongestions
to use the medication for no longer than 4 to 5 days to prevent rebound congestion
Management of sinusitis
Þ Get plenty of rest to help body fight infection and promote recovery
Þ Hydrate to loosen secretions
Þ Take hot showers or steam inhaler
Þ Apply warm damp towels around sinuses
Þ Sleep with head elevated
what are the s/s of pneumonia
Þ Cough (can be productive or not productive)
Þ Sputum (may be green, yellow or rust colored-bloody)
Þ Fever, Chills
Þ Dyspnea, Tachypnea
Þ Pleuritic chest pain
Fine or coarse crackles may be auscultated over the affected region
what are the diagnostic tests for pneumonia
Þ Chest X-ray
Þ Sputum: Gram stain, culture and sensitivity test
Þ Pulse oximetry or ABGs
Þ CBC: WBC differential and routine blood chemistries (if indicated)
Blood cultures (if indicated)
what are some interventions for pneumonia
Þ Increased fluid intake (at least 3L/day), IV fluids
Þ Balance between activity and rest
Þ O2 therapy
Þ Physiotherapy
Þ VTE prophylaxis
Þ Critical care management, with mechanical ventilation as needed
nutritional therapy for pneumonia
Þ Hydration to prevent dehydration and to thin and loosen secretions
Þ Small, frequent meals are easier for dyspneic patients to tolerate
Þ Offer foods high in calories and nutrients
health promotion for pneumonia
Þ Frequent handwashing
Þ Proper nutrition
Þ Adequate rest
Þ Regular exercise
Þ Cough or sneeze into the elbow rather than hands
Þ Avoid cigarette smoke
when does a follow up x ray need to be done for pneumonia
in 6 to 8 weeks to evaluate resolution of pneumonia
what are the symptoms for active TB
Þ Productive cough
Þ Night sweats
Þ Afternoon temperature elevation
Þ Weight loss
Þ Pleuritic chest pain
Þ Crackles over apices of lungs
Þ Fatigue
Þ Malaise
Þ Anorexia
Þ Dyspnea (late symptom)
renal TB symptoms
dysuria and hematuria
bone and joint TB symtoms
may cause severe pain
meningitis TB symtoms
HA, vomiting, lymphandenopathy
what indicates a positive PPD (tuberculin skin test)?
induration; a palpable raised, hardened area of swelling (NOT REDNESS at the injebtion site
what is considered positive PPD in low risk individuals
> 15mm induration
what is considered positive PPD in immunocompromised patients
> 5mm
interferon release assays
blood test that detect INF release from T cells in response to M. tuberculosis
a TB diagnosis cannot be solely made on…
a chest x-ray alone
what are the four drugs included in TB drug therapy
isoniazid, rifampin, pyrazinamide, and ethambutol
directly observed therapy (DOT)
Þ Providing antiTB drugs to patients and watching them as they swallow to ensure adherence
Bacille Calmette-Guerin Vaccine
Þ Usually given to infants in parts of the world with high prevalence of TB
if a patient is suspected of having TB what should be done
- Be placed on airborne isolation (single occupancy room with 6-12 airflow exchanges/hour and health care worker wearing HEPA mask)
- Receive medical workup, including chest xray, sputum, smear and culture
- Receive appropriate drug therapy
what is the treatment for ADULTS who are PPD+, ghons complex on CXR, and sputum+ (latent?):
- isoniazid (INH) for 6 months
what is the treatment for CHILDREN who are PPD+, ghons complex on CXR, and sputum+ (latent?):
INH or other antibiotic for 9 months.
what is the treatment for HIX + who are PPD+, ghons complex on CXR, and sputum+ (latent?):
INH for 12 months.
What is the treatment for patients with active TB
Multidrug therapy for 12-18 months (isoniazid, rifampin, pyrazinamide, ethambutol or streptomycin), may return home/community when sputum is negative
SE of ethambutol
red-green vision loss, optic neuritis
blurred vison
N/V/D
HA
SE of isoniazid
hepatotoxicity
asymptomatic elevation of ALT and AST
hyperglycemia
visual disturbances
vomiting, confusion, HA
SE of pyrazinamide
hepatoxicity
arthralgias
hyperuricemia
photosensitivity
anemia
dysuria
SE of rifampin
Turns body fluids orange
hepatoxicity
thrombocytopenia
what are the s/s of asthma
-Weezing (on auscultation)
-Cough
-Dyspnea
-Chest tightness
-Hyperventilation (lungs responding to trapped air and airflow limitation, can cause respiratory alkalosis)
“silent chest” means
Þ Decreased breath sounds means severe airway obstruction and impending respiratory failure
Mild asthma symptoms
Dyspnea occurs with activity; may feel like they “can’t get enough air”
moderate astham symptoms
Dyspnea interferes with or limits usual activates
severe asthma symptoms
-Dyspnea at rest
-Speaks in words, not sentences because of difficulty breathing
-Feeling suffocation
life threatening asthma symptoms
-To dyspneic to speak
-May feel drowsy or confused
-Perspiring
what management is done for asthma
Þ Identify and eliminate triggers
Þ Drug therapy
Þ SaO2 monitoring
Þ ABGs
Þ O2 by nasal cannula or mask
what is mild asthma treated with
Þ Prompt relief with inhaled SABA such as albuterol (via a nebulizer or MDI with a spacer)
how often are patients with asthma instructed to take albuterol
take 2 to 4 puffs of albuterol every 20 minutes 3x to gain rapid control of symptoms
moderathe asthma treatment
- Usually requires office or ED visit
- Relief is provided with frequent inhaled SABA
- Oral systemic corticosteroids (symptoms may persist for several days even after corticosteroids are started)
severe asthma treatment
- Usually required ED visit and likely hospitalization
- Partial relief from frequent inhaled SABA
- Oral systemic corticosteroids. Some symptoms last for >3 days after treatment is begun
- Adjunctive therapy: ipratropium, IV magnesium
life threatening asthma treatment
Þ Requires ED visit/hospitalization. Possible ICU
Þ Minimal or no relief from frequent inhaled SABA
Þ IV corticosteroid
Adjunctive therapy: ipratropium, IV magnesium
how to use an inhaler
- Take off cap and shake inhaler
- Breathe out all the way
- As you start breathing in slowly through your mouth, press down on the inhaler one time
- Keep breathing in slowly, as deeply as you can
- Hold breath for 10 seconds, if you can
how do you clean an inhaler
Þ : rinse only the mouthpiece and cap in warm water and let them dry overnight
pursed lip breathing instructions
- Inhale slowly and deeply through nose
- Exhale through pursed-lips as if whistling, without puffing your cheeks
- Make breathing out 3 times as long as breathing in
8-10 repetitions, 3-4x a day
SABA
albuterol
SABA: albuterol use
For quick-relief or “rescue” medications
SABA: albuterol onset
within minutes and are effective for 4 to 8 hours
SABA: albuterol SE
tremors, anxiety, tachycardia, palpitations, and nausea
LABA: Salmeterol use
-Should not be the first or only drug used to treat asthma (SHOULD BE USED WITH INHALED CORTICOSTEROIDS ICSs)
-Should be added to the treatment plan only if other controller medicines do not control asthma
LABA
Salmeterol
SABA: albuterol should be limited to…
Should be limited to less than 2x weekly
what is ALWAYS used to treat sudden wheezing
SABA
Methylxanthine (Xanthine) Derivatives
theophylline
what should patietns avoid when using theophylline
Avoid caffeine to prevent intensifying adverse effects
s/s of COPD
Þ Chronic intermittent cough
Þ Sputum production
Þ May report chest heaviness
Þ Gasping, increased effort to breathe
Þ Relies on intercostal and accessory muscles
Þ Fatigue
Þ Weight loss, anorexia
Þ Decreased breath sounds in all lung fields
Þ Barrel chest
Þ Tripod position
COR PULMONALE
cor pulmonale
right-sided heart failure arising from chronic lung disease
cor pulmonale s/s
can be seen with edema in the ankles, dyspnea is the most common symptom
management of COPD
Þ Cessation of cigarette smoking
Þ Drug therapy
Þ Airway clearance techniques
Þ Breathing exercises and retraining
Þ Oxygen therapy (GOAL FOR SAO2 IS GREATER THAN 95%)
Þ Progressive plan of exercise, especially walking and upper body strengthening
Þ Chest physiotherapy
Þ Administer bronchodilators, corticosteroids
hydration recommendation for COPD pateitns
2-3 L a day
wht immunizations are recommended for COPD Patients
influenza and pneumococcal
nutritional interventions for COPD patients
Þ Rest for 30 mins and use bronchodilator before eating
Þ Avoid exercise and treatments 1 hour before and after meals
Þ Ensure O2 therapy is in use during eating
Þ Encourage activity during the day to stimulate appetite
Þ If underweight; supply with protein and calories, moderate carbs and fat
Þ 5-6 small meals a day
initial findings in infants with cystic fibrosis
meconium ileus: Þ a bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum
if patients were not diagnosed as newborns, what are other s/s of cystic fibrosis
- Acute respiratory symptoms (wheezing, coughing, frequent pneumonia)
- Failure to thrive or malnutrition
- Steatorrhea (large, oily, frequent bowel movements)
- Bronchiectasis
- Fam history
what test is done to diagnose cystic fibrosis
sweat chloride test
what is a positive sweat chloride test
swear contains 4x the normal amount of sodium and chloride
-60mmol/L is considered positive
management for the pulmoary problems of cystic fibrosis
- Aerosol and nebulization treatments to dilate airways, liquefy mucus and facilitate clearance
- CPT (postural drainage with percussion and vibration)
- Expiratory techniques: PEP devices (Flutter device)
- O2 therapy in severe disease
management for controlling infection for cystic fibrosis
-antibiotic based on sputum culture
management of pancreatic insufficiency for cystic fibrosis
-pancreatic enzyme replacement of lipase, protease and amylase, taken before each meal and snack (Pancreaze, Creon, Ultresa)
what vitamins are supplemented for cystic fibrosis patients
Fat soluble vitamins must be supplemented because they are malabsorbed (A, D, E, K)
