VN 36 TEST 3 respiratory Flashcards
- Rifampin Kill, hurt, know (K,H,K) [pharm flashcard 61, pharm S.G 3)
(Treatment of TB)
Body fluids may turn red/orange (tears, urine & sweat) - NORMAL
Do not wear contacts, wear glasses
Use non hormonal back up birth control
AE: liver toxicity can develop into hepatitis (report signs of jaundice)
No alcohol during therapy
- Chest tube nursing considerations (PP slide 29)
Drain fluid, blood or air
RE-establish a negative pressure
Facilitate lung expansion
Monitor VS
Monitor Chest tube placement
Provide rest periods
Assess for abdominal distention
Monitor drainage: 70ml/within 3hrs
Assess for continual bubbling (is it on?)
- Post op sinus surgery nursing considerations (PP slide 4)
Observe for repeated swallowing: hemorrhage
Optic nerve function assessment
Temperature every 4hrs, pain over involved sinus
Administer analgesics as indicated: ice compresses
Nasal packing & dressing under nares (“moustache” or drop pad”)
- Trach suctioning nursing considerations (PP slide 12)
Risk for ineffective airway clearance : VS, breath sounds, assess skin color, LOC, mental status, airway patency
Risk for infection: Monitor stoma, provide routine trach care, position
Risk for ineffective management of therapeutic regimen
- ABGs
Acidosis Neutral Alkalosis
PH: 7.35-7.45
PCo2: 45-35
HCo3: 22-26
PaO2: 80- 100
- Emphysema client education(PG.266)
Drink extra fluids as indicated, unless fluids are restricted.
Eat a well-balanced diet.
Success of treatment depends on strict adherence to the treatment regimen.
Perform breathing exercises as prescribed.
Avoid respiratory irritants and people with respiratory infections.
Avoid dry-heated areas that can aggravate symptoms.
Take medication exactly as prescribed. Observe the time intervals between medications.
Take frequent rests during the day. Space activities to prevent fatigue and shortness of breath.
Contact the primary provider if adverse drug effects occur, drugs fail to relieve symptoms, new symptoms appear, symptoms become more severe, or signs or symptoms of respiratory infection develop.
Humidify inspired air during the winter months.
Maintain close medical supervision.
Do not skip doses or take more than what is prescribed.
- Emphysema manifestations & Nursing management (PP slide 21)
Dyspnea especially- exertional dyspnea, breathlessness at rest
Chronic productive cough, pursed-lip breathing
Expiration difficult, carbon dioxide narcosis
Use of accessory muscles; barrel – chested *
Clubbing of the fingers
Shallow respirations
Management:
Monitor: O2 and PaCO2 levels, breathing exercises- pursed lip, nutrition
- Asthma manifestations (PP slide 24)
SOB
Expiratory wheezing
Coughing
Production of thick sputum
Prolonged expiration
- Pleural effusion manifestations (PP slide 31, PG.257)
Will hear decreased breath sounds (caused by trauma)
Fever
Pain
- Thoracentesis nursing actions (PG.234 box 19-3)
Explain procedure & educate client will still receive local anesthesia but will still experience pressure like pain when needle pierces & fluid is withdrawn
Assist client to position (sitting w/arms & head on padded table or in side lying position on unaffected side
Instruct client to not move during procedure including no coughing or deep breathing
Provide comfort & maintain asepsis
Monitor VS during procedure (including pulse oximetry)
During removal of fluid monitor for respiratory distress, dyspnea, tachypnea or hypotension
Apply small sterile pressure dressing to the side after the procedure.
Position client on unaffected side, and instruct them to stay in this position for at least 1hr & to remain on bed rest for several hrs
Check that chest X-ray is done after procedure
Record amount, color & other characteristics of fluid removed
Monitor signs:
-increased respiratory rate, asymmetry in respiratory movement
-syncope/vertigo
-chest tightness
-uncontrolled cough or blood tinged/frothy mucus cough or both
-tachycardia & hypoxemia
- COPD nursing interventions (PP slide 20)
Vaccination against complicating illnesses (influenza & pneumonia)
Bronchodilators
Raising Head of bed
Humidifiers in dry settings
Can lead to right sided heart failure
Increase water intake to thin secretions
High protein diet
Cough every 2hrs to clear secretions
- Nosebleed nursing interactions (PP slide 32)
Tilt head forward
Apply pressure & ice pack
If unable to stop can insert tampon
Cauterization if needed
- Salmeterol K,H,K
(Treatment of asthma/COPD)
Not rescue med
Never used alone
Tachycardia
Headaches
Tremors
Restlessness (don’t take at night)
- Pulmonary embolism manifestations and nursing actions (PP slide 27)
Manifestations:
Immediate onset: pain
Tachycardia & dyspnea
Fever
Cough
Blood streaked sputum
Cyanosis
Irregular HR
Wheezing
FOID
Nursing Actions:
Prevention of DVT to prevent PE
PRIORITY always O2
- Cystic Fibrosis client education (PP slide 26)
Engage in daily aerobic exercise
- Pyrazinamide K,H,K (Pg.262)
(First line of treatment for primary active pulmonary TB)
Initial Phase: 2mos, continuing phase 4-7mos
AE: N/V, epigastric distress, myalgia, rash, peripheral neuropathy
Take on empty stomach
Hepatotoxic at routine doses (monitor liver enzymes frequently)
- Pneumonia nursing interventions (PP slide 16)
Respiratory assessment: Lung Sounds, pulse oximetry, ABG’S
Cough & sputum assessments (position – semi fowlers, raise HOB)
Pneumococcal vaccine
- Fractured ribs nursing interventions (PP slide 32)
Airway management
Emergency treatment
Pain management
Incentive spirometer
Splinting devices like pillows w/deep breathing & coughing (want to maintain expansion so no devices that constrict)
- Trach care/cleaning (clinical skills book pg.861)
Gather supplies & put on gloves
Remove oxygen source if necessary
Dip cotton tipped applicator or gauze sponge in cup or basin w/sterile saline & clean stoma under faceplate.
Use each applicator or sponge only once, moving from stoma site outward
Pat skin gently dry 4x4 gauze sponge
Slide non cotton 4x4 dressing under the faceplate
Change the trach collar
Make sure to always hold faceplate when inserting the tabs of the collar
Check the fit of the trach collar (should be able to fit one finger between the neck & collar), also make sure client can flex neck comfortably
Reapply oxygen source if necessary
Reassess the patients respiratory status (RR, respiration effort, oxygen sat & lung sounds)
- Isoniazid (INH) K,H,K
(Treatment of TB)
AE: hepatoxicity (jaundice of the skin & eyes, dark urine, vomiting, fatigue)
Peripheral neuropathy (numbness & tingling of the extremities)
Contraindications: clients w/severe liver damage, hepatic & renal impairment
Remember INH interferes w/absorption of B6, client may need to take supplements 25-50mg (neuropathy numbness, hepatoxicity)
NO ALCOHOL
- Lung Cancer early manifestations (PP slide 31)
Chronic cough
Dyspnea
Hemoptysis
Shoulder or chest pain
Intermittent temperature
Reoccurring respiratory infections
- Lung Cancer late manifestations (PP slide 31)
Bone pain
Chest pain
Dysphagia
Blurred vision
Weight loss
Pleural effusion (will hear decreased breath sounds)
- Tracheostomy suctioning (Funds flashcard)
Turn on suction to regular or ordered setting & verify tubing is attached & within arm’s reach
Open suction catheter kit & don sterile gloves
Moisten catheter by dipping the tip into sterile water
Prepare non-dominant hand to control the suction by placing thumb near the suction hole but not over it yet!
Insert catheter into trachea & thread gently down until you meet resistance, now pull back slightly
Place thumb over suction hole for 10 secs max & wait 1-2 mins between (patient cant breath during these 10 secs)
Slowly remove while suctioning, working inner to outer & twirling around the edges to remove mucous buildup
Administer oxygen to patient to reoxygenate
Dip tip of catheter into sterile water & apply thumb over suction hole to wash out the catheter of mucous
Repeat suction of trach until mucous is cleared, dispose catheter
Monitor oxygenation status (if this was helpful oxygenation should improve)
