respiratory n415
DESCRIPTION
Respiratory N415. Linda Winn, RN, MSN Ed., BA Ed. Respiratory Assessment. Resp Assessment. Breathing Pattern I:E ratio Kussmaul Rate Dyspnea Orthopnea PND – Paroxysmal nocturnal dyspnea Cough and Sputum Frequency Dry / moist Amount Color Thickness Odor. Assessment (Cont.). - PowerPoint PPT PresentationTRANSCRIPT
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RespiratoryN415
Linda Winn, RN, MSN Ed., BA Ed.
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Respiratory Assessment
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Resp Assessment
• Breathing Pattern I:E ratio Kussmaul Rate
• Dyspnea Orthopnea PND – Paroxysmal nocturnal dyspnea
• Cough and Sputum Frequency Dry / moist Amount Color Thickness Odor
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Assessment (Cont.)
• Inspection Symmetry Skin color – lip color / finger clubbing WOB – accessory muscles
• Auscultation Adventitious sounds
• Chest pain
• History Diagnoses Smoking
• Quick, Focused Assessment
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Breath Sounds Link
• Normal and Adventitious breath sounds
http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/contents.html
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Diagnostics & Labs
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Labs
• H/H
• Sputum AnalysisC&SGram StainAcid-Fast smear (AFB)Cytology
• ABG’s
• O2 Sats
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Diagnostic Tests• CXR
• CT Chest
• MRI
• V/Q Scan
• Bronchoscopyhttp://www.nlm.nih.gov/medlineplus/tutorials/bronchoscopy/htm/_no_50_no_0.htm
• Thoracentesis
• PFTs – Pulmonary Function TestsSpirometry
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COPD
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Chronic Obstructive Pulmonary Disease
• Obstruction to expiratory air flow
• 15 million Americans have COPD
• 4th leading cause of death
• Women approaching men in incidence and surpassed men in number of deaths
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COPD
• 2 Types of COPDEmphysema Chronic Bronchitis (most common)
• can have either or both
• Asthma no longer considered a type of COPD
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COPD
•Etiologysmoking: 90% of people with COPD
•only15% of smokers get COPD•smokers 10 x more likely to die from COPD
environmental: •Pollution•Toxins•second hand smoke
develops slowly
•Common Signs and SymptomsDyspnea and Wheezing
•Video Cliphttp://www.nlm.nih.gov/medlineplus/tutorials/copd/htm/_no_50_no_0.htm
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Impact of Smoking
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COPD
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COPD video clips
http://video.about.com/copd/COPD.htm
(skip through the ads )
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Emphysema - Pathophysiology
• Abnormal permanent enlargement of the gas exchange airways with destruction of alveolar walls
• bronchioles too narrow or collapse
• slows air movement during exhalation & traps air in lungs
• increases work of breathing
surface area for gas exchange
• Blebs, Bulla
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Chronic Bronchitis
• Definitionchronic productive cough for 3
months in each of the last 2 years
• Pathophysiologyhypertrophy of mucous secreting
glands & chronic inflammation of small airways excessive sputum production
impaired ciliary movement & excessive sputum can increase risk of infection
bronchial walls can become narrowed or obstructed
Thicker mucus
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Assessment Findings• Early
SOB Dyspnea Activity intolerance Hypoxemia Chronic cough with sputum Prolonged expiration
• Wheezing on forced expiration Altered Breathing Techniques
• Pursed-lip breathing• Tripod breathing position
• Later Hyperinflation of lungs barrel chest Diminished lung & heart sounds Central cyanosis (chronic hypoxemia) CO2 retention
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Asthma
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Asthma Videos
http://www.mayoclinic.com/health/asthma/MM00001
http://www.nlm.nih.gov/medlineplus/tutorials/asthma/htm/_no_50_no_0.htm
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Asthma
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• Exaggerated bronchoconstriction response to stimuli Airways overreact to triggers causing
narrowing
• Chronic inflammatory disorder of airways
• 1 in 20 Americans; 5000 deaths/year
• Common triggers: allergies: dust, mold, sulfites, dander cold, dry air exercise stress
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Common Triggers
• Allergens: dust, mold, sulfites, dander
• Cold, dry air
• Exercise
• Stress
• Environmental
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• Wheezing after exposure to triggers, coughing, chest tightness
• Rapid, shallow respirations, dyspnea, or absent breath sounds, accessory muscle use
• Postural changes to aid breathing
• Activity intolerance
• Anxiety
• Severity of symptoms vary
• Changes in peak expiratory flow rate
Assessment Findings
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In the Zone
•Green ZonePEFR 80% of baselineno sx; meds may be by MD
•Yellow ZonePEFR 50-80% baselinemay have Ø to mod sxhaving attack or meds adjusted
•Red Zone 50% baselinesevere sxmedical alert; call MD
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Potential Nursing Diagnoses
•Ineffective Airway Clearance
•Impaired Gas Exchange
•Ineffective Breathing Pattern
•Activity Intolerance
•Altered Nutrition
•Aspiration, risk for
•Pain
•Anxiety
•Fear
•High risk for infection
Pneumonia
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Nursing Management
•Monitor VS LOClung soundssputum amount and character
•Maintain airwayPursed-lip breathingcough routinespositioning for max lung expansionSuctioningavoid cough suppressants unless cough frequent & non-productive
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Nursing Management• Monitor activity tolerance
help pt conserve energy plan rest periods O2 prn
• Good oral hygiene
• Decrease anxiety remain with patient during anxious episodes,
relaxation techniques, O2 prn
• Nutrition
• Hydration
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Collaborative Treatment
• Immunizations flu & pneumonia vaccinations
• Bronchodilators
• Inhaled steroids
• Antibiotics
• Oxygen therapy
• Pulmonary Rehabilitation
• Smoking Cessation
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Patient Education
• Monitor color, amount, thickness of sputum
• Self care: at-home meds & treatments; avoid triggers
• Prevention Pneumococcal vaccine, flu shot
• Frequent oral hygiene
• Encourage fluids
• Environmental hazards altitude, smog, allergies, smoke
• Follow up medical care
• American Lung Association www.lungusa.org
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COPD – Cor Pulmonale
• Long-term complication
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Respiratory RN Diagnoses
• Impaired Gas Exchange
• Ineffective Airway Clearance
• Others
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Pulmonary Tuberculosis
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Tuberculosis
•Incidence
•Risk Factors
•Mode of TransmissionMycobacterium tuberculosis
•Development of TB
http://www.nhs.uk/Conditions/Tuberculosis/Pages/Introduction.aspx
http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/_no_50_no_0.htm
Text copy:
http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/id359106.pdf
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Diagnostic Tests• PPD
• CXR
• AFB
• Bronchoscopy
• WBC
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Assessment Findings
• Classic Sx:Weight LossLow-grade feverNight sweatsProductive Cough
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Treatment
• Medications INH – IsoniazidRifampin (Rifadin)Ethambutol (Myambutol)Pyrazinamide (PZA)
• Multi-drug approach
• Not transmittable after 2-3 weeks of treatment
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Nursing Care
• In-hospital Care Negative pressure Room Respiratory isolation N-95 mask
• Fit testing Transporting Patient
• Public Health Nurse DOT
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O2 Levels
PaO2 SaO2• Needs O2 <55 <88%
• May be OK 40 75%
Short-termWith COPD
• Critical <40 <75%
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ABG’s
• Acid – Base Balance
• Nursing Considerations in drawing ABG’sAllen’s Test IcePressure
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ABG Normal Values
• pH 7.35-7.45
• pCO2 35-45
• HCO3 22-26
• PaO2 80-100 mm Hg
SaO2 >95%
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ABG Evaluation
• Step 1 – pO2
• Step 2 – pH Acidotic or Alkalotic?
• Step 3 – pCO2 Respiratory cause?
• Step 4 – HCO3 Metabolic cause?
• Step 5 – Compensated or Uncompensated
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ABG examples
• pH 7.39• pO2 59• pCO2 59• HCO3 31
• Diagnosis?• What is this typical of?
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Group Activity 1
• pH 7.3• pCO2 25• HCO3 16• pO2 85
• Interpretation: _______________
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Group Activity 2
• pH 7.33• pCO2 47• HCO3 24• pO2 76
• Interpretation: _______________
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Group Activity 3
• Create ABG for pt with
Metabolic AcidosisMetabolic Alkalosis with compensation