Nursing Care of the Patient with Lower Respiratory Problems – Flashcards
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Atelectasis
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Collapsed airless alveoli; most common cause is obstruction of small airways with secretions
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Clinical manifestations of Atelectasis?
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Decreased breath sounds Signs of hypoxemia (restless)
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Nursing interventions for Atelectasis?
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Prevention! (Ambulate, TCDB, pulmonary toilet) Supplemental O2 Address the source of the problem (pain?)
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Patient teaching with incentive spirometer
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Inhale slowly ( good, better, best marker for speed )
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Pleural Effusion
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Fluid in the pleural cavity CXR will note volume/location of effusion
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Common causes of PE
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CHF, hypoalbuminemia, pulmonary malignancies & infections
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What is an infected PE?
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Empyema
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Clinical Manifestations of PE?
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If large (>250 mL) will be seen on CXR, if smaller it will not Decreased breath sounds Signs of hypoxemia
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Treatment of PE
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Thoracentesis Pleurodesis Chest tube Address the cause
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Pleurodesis
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Inject irritant (talc or Bleomycin) into pleural cavity Creates inflammation & tacks the 2 pleura together Meaning that there is no space for fluid to collect. Like when you put grout in between tiles, you are keeping water/fluid from accumulating between
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Pneumonia
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Inflammation/infection of alveoli and bronchioles. Common AE of influenza
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Organisms that cause pneumonia reach the lung by what 3 methods?
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Aspiration Inhalation Blood
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What are pneumonia clinical manifestations?
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Usually sudden onset of sx: Fever, shaking chills, SOA, purulent sputum, adventitous breath sounds, pleuritic chest pain, confusion (elderly) More gradual dry cough, fever, h/a, n/v viral vs. bacterial
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What are pneumonia diagnostic studies?
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CXR (consolidation vs. infilatrates) Sputum C&S
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Pneumonia Nursing Diagnosis
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Ineffective breathing pattern Impaired gas exchange Ineffective airway clearance Activity intolerance Acute pain Risk for deficient fluid volume Risk for imbalanced nutrition: less than body requirements
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Pneumonia Prevention
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Patient education! (Stop smoking, adequate rest/sleep & balanced diet) If hospitalized: Know who is at risk (including aspiration), keep em movin', good handwashing habits, strict medical asepsis
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Smoking Cessation 5A's
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Ask, advise, assess, assist, arrange
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Pneumonia Acute Intervention
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VS/ Pulse ox Lung ausculatation & compare to baseline Supplemental O2 as ordered Pulmonary toilet/chest PT FF Ambulation Energy conservation Drug therapy Teaching needs
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Core Measure
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Established in 2000 by CMS, tracks a variety of evidence based scientifically researched standards of care which have been shown to result in improved clinical outcomes for patients
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What are some core measures currently?
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Pneumonia, HF, AMI, VTE, Stroke, surgical care improvement project
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Pneumonia Core Measures
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Pneumococcal vaccine Influenza vaccine Blood cultures drawn w/in 24H after hospital arrival Blood cultures in ED prior to initial abx received in hospital Initial abx received w/in 6H of hospital arrival Abx timing Initial selection for CAP in immunocomprmised patient/immunosuppressed ICU patient/non-ICU patient Adult smoking cessation advice/counseling
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What causes TB?
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Mycobacterium tuberculosis
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TB Clinical Manifestations
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Latent : + TB skin test, may or may not have ghon nodule on CXR, asymptomatic Active: + sputum for AFB, weight loss, malaise, low-grade fever, night sweats
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TB Diagnostic Test
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TB skin test CXR Sputum for AFB (culture take up to 8 weeks)
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TB Nursing diagnosis
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Ineffective breathing pattern Imbalanced nutrition: less than body requirements Ineffective health maintenance Ineffective therapeutic regimen management Activity intolerance
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TB Nursing Management
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Health promotion- ultimate goal is eradication Interpret diagnostic study results Identify contacts Drug Therapy (DOT, assess for adverse effects)
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Isoniazid (INH)
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Hepatotoxicity; peripheral neuropathy Abstain from alcohol Gold standard tx for + TB skin test
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rifampin (Rifadin)
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Red/orange discoloration of excretions. Think R...red...rifampin
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ethambutol (Myambutol)
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Decrease visual acuity; inability to differentiate b/w red and green. Think e...eyes..ethambutol
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TB Prevention of Transmission Acute Care
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Airborne precautions Private room (Negative pressure ventilation) HEPA Mask Monitor health care workers TB status- annually Preventative drug therapy to high-risk contacts
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TB Prevention of Transmission Home Care
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Preventative drug therapy to high-risk contacts Airborne precautions not necessary Cover mouth/nose Wear mask in crowds Sputum for AFB q2weeks (3 negative cultures= no longer infectious)
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COPD
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Asthma Emphysema Chronic Bronchitis
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Emphysema
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Alveolar damage
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Chronic Bronchitis
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Excessive secretion production
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Most common cause of COPD exacerbations is?
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Respiratory infections
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COPD Diagnostic studies?
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PFT's ABG's
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COPD Nursing Diagnosis
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Activity Intolerance Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange Anxiety Imbalanced nutrition: Less than body requirements Ineffective therapeutic regimen
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COPD Nursing Implications
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Early detection of respiratory infection (why?) Smoking cessation (5A's) Drug therapy - primarily bronchodilators O2 administration CO2 narcosis O2 toxicity (>50% O2 for >24H potentially toxic) Respiratory therapy Pursed-lip breathing Effective coughing Huff coughing Chest PT (percussion, vibration, postural drainage) Flutter valve Nebs
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Flutter Valve
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Positive Expiratory Pressure Device Creates vibrations to release secretions
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Home Oxygen Therapy
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Nursing measures directed toward teaching r/t decreasing risk for infection and safety issues Oxygen is highly combustible
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Why is nutritional therapy important in COPD patients?
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They need a high calorie diet, that is nutrient dense b/c they use so much energy to breathe
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Activity considerations for COPD
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Energy conservation Muscle strengthening Prioritize day Walking encouraged SOA should return to baseline within 5 minutes after cessation of exercise Rest periods prior to sex
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COPD Psychosocial
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May be anxious, edgy, grumpy How would you feel if you were chronically short of air?
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Lung Cancer Clinical Manifestations
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10% of time simply found on CXR w/o symptoms Clinically silent for majority of the course Nonspecific & late in disease Often marked by chronic underlying cough Most common sx: Persistent cough that produces sputum The N in CAUTION "Nagging cough"
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Lung Cancer Dx studies
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CXR: Mass/Infiltrate CT Scan/MRI: Assess for metastasis Sputum for cytology (20-30% are +) Biopsy (Percutaneous, bronchoscopy, video-assisted thoracoscopy)
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Percutaneous
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Fine-needle aspiration of the lung
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Lung Cancer Nsg Dx
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Ineffective airway clearance Anxiety Acute pain (if pressing tumor) Imbalanced nutrition: Less than requirements Ineffective self-health management Ineffective breathing pattern
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Lung Cancer Collaborative Care
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Health promotion- smoking cessation! Anxiety reduction Surgical therapy (pneumonectomy - removal of entire lung, lobectomy, segmental/wedge resection) Radiation Chemotherapy Biologic targeted therapy
