Body Fluid Compartments and Third Spacing

Body Fluid Compartments

• Intracellular fluid comprises about two-thirds of total body water and contains solutes like electrolytes and glucose.
• Extracellular fluid makes up about one-third of total body water and is divided into interstitial, intravascular, and transcellular fluids.
• Interstitial fluid is the fluid between cells, excluding blood vessels.
• Intravascular fluid is the fluid inside blood vessels, also known as blood plasma.
• Transcellular fluids are contained in epithelial-lined cavities like cerebrospinal, synovial, pleural, and peritoneal fluids.
• Distribution and composition are regulated to maintain cellular function, nutrient transport, waste removal, and internal environment optimization.

Third Spacing

• An abnormal shift of fluid from the intravascular space to the interstitial space or body cavities.
• Can occur in conditions like ascites, pleural effusions, intestinal obstructions, and severe burns.
• Leads to a relative decrease in intravascular volume, potentially causing hypovolemic shock.
• Clinically presents as edema or fluid accumulation in areas like the abdomen or extremities.

Electrolyte Normal Ranges and Abnormal Signs/Symptoms

• Sodium Normal Range: 135-145 mEq/L
  • Hyponatremia (145 mEq/L): Extreme thirst, confusion, muscle twitches, seizures.
• Calcium Normal Range: 8.5-10.2 mg/dL
  • Hypocalcemia (10.2 mg/dL): Nausea, vomiting, confusion, kidney stones.
• Potassium Normal Range: 3.5-5.0 mEq/L
  • Hypokalemia (5.0 mEq/L): Muscle paralysis, peaked T-waves on ECG, arrhythmias.
• Magnesium Normal Range: 1.8-2.4 mg/dL
  • Hypomagnesemia (2.4 mg/dL): Nausea, vomiting, lethargy, respiratory depression.
• Bicarbonate Normal Range: 22-28 mEq/L
  • Low levels: Metabolic acidosis - nausea, fatigue, Kussmaul respirations.
  • High levels: Metabolic alkalosis - confusion, arrhythmias, muscle twitching.
• Albumin Normal Range: 3.5-5.0 g/dL
  • Hypoalbuminemia (5.0 g/dL): Dehydration, rarely symptomatic.

Intravenous Solutions

• Isotonic solutions have the same osmotic pressure as blood plasma and cells, causing no fluid shift between compartments. Examples include 0.9% normal saline, Lactated Ringers and D5W.
• Hypertonic solutions have higher osmotic pressure than blood plasma and cells, pulling water out of cells and causing cellular dehydration and shrinkage. Examples include 3-5% saline solution, D10W, D5 in 0.9% NS, D5 in 0.45% NS, and D5 in LR.
• Hypotonic solutions have lower osmotic pressure than blood plasma and cells, causing water to move into cells, potentially leading to cellular rupture. Examples include 0.45% saline and LR.

Clinical Use of Intravenous Solutions

• Isotonic solutions are used to replace fluid losses and maintain intravascular volume without disrupting fluid balance.
• Hypertonic solutions treat severe hyponatremia by raising extracellular sodium concentration and pulling water out of cells, administered cautiously.
• Hypotonic solutions treat hypernatremia by diluting extracellular fluid and allowing water to move into cells, also used for fluid replacement with elevated sodium levels.

Crystalloids

• Aqueous solutions of electrolytes or water-soluble molecules.
• Used to replace fluid losses, maintain fluid balance, and deliver medications.
• Examples include normal saline, Ringer's lactate, and dextrose solutions.
• Administered for fluid resuscitation in conditions like dehydration, hypovolemia, and shock.

Colloids

• Contain larger insoluble molecules like proteins or starches suspended in a crystalloid solution.
• Used when plasma volume expansion such as in hypovolemic shock, burns, or during surgery is needed.
• Examples include albumin, dextran, and hydroxyethyl starches.
• Pull fluid into the vascular space from the interstitial space due to higher oncotic pressure.

Albumin

• It has a higher oncotic pressure than blood plasma, causing fluid from the interstitial spaces to be pulled into the vascular space, effectively expanding the plasma volume by approximately 4 times the volume of albumin infused.
• Can increase blood pressure by expanding the plasma volume with increased venous return, cardiac output, and blood pressure.
• Can potentially cause pulmonary edema if too much fluid enters the pulmonary vasculature.
• Draws fluid from the interstitial spaces into the vascular space, increasing renal perfusion, the glomerular filtration rate, and urination.

Fluid Volume Deficit - Signs and Symptoms

• Thirst and dry mucous membranes.
• Decreased skin turgor and dry skin.
• Sunken eyeballs.
• Orthostatic hypotension (dizziness upon standing).
• Oliguria (decreased urine output).
• Tachycardia (rapid heart rate).
• Fatigue and weakness.
• Headache.
• Muscle cramps.
• Concentrated urine with high specific gravity.
• Elevated BUN and hematocrit levels.
• Weight loss.
• Hypovolemic shock with cool, clammy skin, altered mental status, oliguria or anuria, and hypotension may result.

Fluid Volume Excess - Signs and Symptoms

• Weight gain.
• Edema (swelling) in the legs, feet, hands.
• Distended neck veins.
• Shortness of breath.
• Crackles or wheezing in the lungs.
• Jugular venous distension.
• Ascites (fluid accumulation in the abdomen).
• Increased blood pressure.
• Decreased hematocrit and plasma protein levels.
• Oliguria (decreased urine output).
• Pulmonary edema with pink, frothy sputum, congestive heart failure possible in severe cases.

Edema Types

• Edema is the accumulation of excessive fluid in the interstitial spaces.
• Localized edema: Swelling confined to a specific area, often due to injury, inflammation, or obstruction.
• Generalized edema: Widespread swelling throughout the body, often seen in conditions like heart, liver, or kidney disease (called anasarca).
• Pitting edema: Edema that leaves an indentation or pit after pressing on the swollen area.
• Non-pitting edema: Firm swelling that does not indent with pressure, seen in conditions like lymphedema.
• Peripheral edema: Swelling in the extremities like legs, ankles, and feet due to fluid accumulation.
• Pulmonary edema: Fluid buildup in the lungs, causing breathing difficulties.
• Cerebral edema: Excess fluid in the brain tissue, potentially life-threatening.

Hormonal Regulators

• Hormones regulate fluid intake through various mechanisms.
• ADH (Antidiuretic Hormone): Stored in and released from the posterior pituitary gland in response to changes in blood osmolarity; increases water reabsorption by the kidneys.
• Aldosterone: Released by the adrenal cortex; acts as a sodium conserver, causing the kidneys to reabsorb more sodium and water.
• RAAS (Renin-Angiotensin-Aldosterone System): Combats hypovolemia and low blood pressure by increasing sodium and water retention through angiotensin II and aldosterone effects.
• ANP (Atrial Natriuretic Peptide): Released by the heart; promotes excretion of sodium and water by the kidneys, helping reduce blood volume and blood pressure.

Hormonal Regulator Production

• Hypothalamus: Produces antidiuretic hormone (ADH) and is stored/released from the posterior pituitary gland.
• Kidneys: Release renin which converts angiotensinogen to angiotensin I, further converted to angiotensin II which stimulates aldosterone release.
• Adrenal Cortex: Releases aldosterone in response to angiotensin II, causing the kidneys to reabsorb more sodium and water.
• Heart Atria: Releases atrial natriuretic peptide (ANP) which counters RAAS.

Fluid and Electrolyte Diagnostic Test Evaluation & Assessment

• Serum electrolyte tests help measure imbalances: sodium, potassium, chloride, bicarbonate levels.
• Serum hematocrit can indicate hydration status.
• Hemoglobin: Low levels suggest anemia or fluid imbalance.
• BUN: Elevated levels indicate dehydration or kidney dysfunction.
• Creatinine: Rising levels signal impaired kidney function.
• Renal function tests: Assess kidney's ability to filter and maintain balance
• Liver function tests: Evaluate fluid regulation/protein production.
• Serum osmolality measures total solute concentration.
• Urinalysis checks for abnormalities that can alter fluid balance.
• Arterial blood gases assess acid-base status.
• Monitor Fluid intake via Diet, Fluids, and Food
• -Monitor fluid output via Urine, Stool, and Sweat

Medications Causing Electrolyte Disturbances

• Diuretics: Hypokalemia or hyperkalemia and metabolic alkalosis.
• Steroids: Metabolic alkalosis.
• Potassium Supplements: Gastrointestinal upset, ulcers, or diarrhea.
• Respiratory Depressants: Respiratory acidosis.
• Antibiotics: Nephrotoxicity, hyperkalemia, or hypernatremia.
• Calcium Carbonate Antacids: Mild metabolic alkalosis.
• Magnesium Hydroxide Laxatives: Deplete potassium.
• Stimulant Laxatives disturb fluid/electrolyte balance if overused.

Specific Medications and Nursing Interventions

Diuretics (Furosemide/Lasix)

• Loop diuretic class. Increases excretion of sodium, chloride, and water; inhibits reabsorption in kidney tubules.
• Causes hypokalemia, hyponatremia, dehydration, and metabolic alkalosis.
• Monitor intake/output, weight, electrolytes; encourage fluid/electrolyte replacement; educate the patient about daily weight monitoring, reporting excessive thirst/urination, and potassium supplements.

Steroids (Prednisone)

• Glucocorticoid class; anti-inflammatory, immunosuppressive.
• Causes fluid retention, hypokalemia, hyperglycemia, and osteoporosis.
• Monitor weight, blood glucose, and potassium levels; administer potassium supplements if ordered; educate the patient about reporting swelling, muscle weakness, diet and increased thirst/urination.

Calcium Carbonate Antacids (Tums)

• Antacid class; neutralizes stomach acid.
• Causes constipation, metabolic alkalosis, and hypercalcemia.
• Monitor bowel movements, encourage fluids, and check calcium levels; educate the patient to take it with food/milk and to report signs of nausea or vomiting.

Laxatives (Kayexalate)

• Sodium polystyrene sulfonate class; binds potassium in intestines for elimination.
• Causes hypokalemia, constipation, and intestinal impaction.
• Monitor potassium levels and bowel movements; encourage fluids; educate the patient to take with plenty of water and to report constipation or pain.

Nursing Assessments Related to Abnormal Electrolyte Values

• Respiratory Assessment: Monitor RR, SpO2, breath sounds for signs of respiratory distress.
• Circulatory Assessment: Monitor heart rate, BP, peripheral pulses for signs of hypovolemia or hypervolemia.
• Integumentary Assessment: Check skin turgor, edema, mucous membranes for hydration status.
• Assessment Considerations: Hypo or hypervolemia, labs, I&O, medication, elimination, and nutrition.

Acidosis and Alkalosis Causes

Acidosis

• Metabolic Causes: Diabetic ketoacidosis, lactic acidosis, renal failure, ingestion of acidic substances.
• Respiratory Causes: Hypoventilation and carbon dioxide retention.

Alkalosis

• Metabolic Causes: Vomiting, diuretic use, hypokalemia, excessive bicarbonate intake.
• Respiratory Causes: Hyperventilation and excessive carbon dioxide loss.

Acidosis - Signs and Symptoms

• Headache, lethargy, confusion, coma.
• Kussmaul respirations.
• Anorexia, nausea, vomiting, diarrhea, abdominal discomfort.
• Dysrhythmias, hypotension.
• Muscle weakness, cramping.
• Fatigue, restlessness.

Alkalosis - Signs and Symptoms

• Dizziness, headache, confusion, seizures, Tetany (muscle twitching/cramping).
• Shallow, slow breathing.
• Arrhythmias, hypotension.
• Nausea, vomiting
• Muscle cramps, weakness, hyperreflexia.
• Paresthesias (numbness/tingling around mouth and extremities).

Interpreting Arterial Blood Gases

• Compensated: pH is normal.
  • PaCO₂ and HCO₃⁻ are BOTH abnormal.
• Uncompensated: HCO3- NORMAL RANGE
  • pH is abnormal (acidic < 7.35 or alkaline > 7.45). One system (respiratory or metabolic) is abnormal.
• Partially Compensated Acidosis: pH is low, PaCO2 is low, HCO3 is low
• Partially Compensated Alkalosis: pH is high, PaCO2 is high, HCO3 is High .

Causes of Fluid and Electrolyte Imbalance

• Excessive fluid losses from vomiting, diarrhea, fistulas, sweating, burns, or polyuria.
• Inadequate fluid intake due to nausea, dysphagia, altered mental status, or limited access to fluids.
• Kidney disease impairing the regulation of fluid and electrolyte levels.
• Endocrine disorders like diabetes insipidus, SIADH, or Addison's disease that disrupt homeostasis.
• Medications such as diuretics, chemotherapy, or steroids that cause fluid/electrolyte shifts.
• Severe injuries or illnesses such as major trauma, pancreatitis, or sepsis that increase needs.
• Liver disease, which impairs the regulation of fluid balance and protein production.

Nurse's Procedures for Determining a Patient's Fluid Balance

1. Measure and record accurate intake and output
2. Weigh the patient daily
3. Assess skin turgor
4. Monitor vital signs
5. Review laboratory values
6. Inspect for edema
7. Collaborate with the healthcare team and patient/family

Fluid and Electrolyte Balance in Older Adults

• Older adults are at increased is risk for fluid and electrolyte imbalances due to age-related physiologic changes
• Potential health outcomes:
  • Dehydration: Decreased thirst perception, dehydration symptoms, cognitive impairment, medications, and falls.
  • Hypernatremia: Impaired kidney function and hormonal regulation can cause lethargy and sz.
  • Hypokalemia: Diuretic use, poor dietary intake, lead to arrhythmia risk and increases muscle weakness.
  • Fluid Overload: Heart failure, liver and kidney diseases can manifest as peripheral edema, pulmonary edema, and exacerbate underlying conditions.
• Monitoring intake/output, daily weights, and early intervention are imperative.

Fluid Deficit and Fluid Volume Excess

• Older adults develop fluid deficits due to decrease in thirst, reducing kidney function, insensible fluid loses, and inadequate fluid intake.
• Fluid volume excess occurs due to heart, liver and kidney diseases leading to sodium and water and edema.

Body Systems - Compensation for Altered Arterial Blood Gasses

• The respiratory system compensates faster for altered arterial blood gases.

Lung Sounds - Types

• Vesicular (Normal)
• Crackles (Rales) (Fluid)
• Rhonchi (Mucus)

Lung Sounds - Explanations

• Vesicular (Normal)
  • Soft, low-pitched, rustling sounds heard over most lung areas during inhalation and exhalation.
  • Indicates air is moving freely through the airways.
• Crackles (Rales) (Fluid)
  • Popping, crackling sounds (like rice crispy cereal) caused by fluid in the lungs, which is heard more during inspiration.
  • Discontinuous, interrupted sounds that can be fine or coarse.
  • Fine crackles sound like hair rubbing together, while coarse crackles are louder, lower-pitched popping sounds.
  • Indicates airway secretions or abnormal opening of small airways.
• Rhonchi (Mucus)
  • Low-pitched, snoring or gurgling sounds caused by mucus or secretions in larger airways.
  • Continuous, low-pitched, snoring or wheezing sounds caused by air moving through obstructed or compressed larger airways.
  • Can clear with coughing but often indicate mucus plugging or bronchospasm.

Pneumothorax, Tension Thorax, and Hemothorax

• Pneumothorax: Air entering the pleural space
  • Intervention: Inserting a chest tube in order to have the air removed, thus re-expanding the lung.
• Tension pneumothorax: Air enters the space but becomes trapped and cannot escape
  • Emergent decompression: Needle thoracostomy or chest tube needed.
• Hemothorax: Bleeding into the pleural space
  • Intervention: Chest tube needs to be inserted in order to drain the blood, thus re-expanding the lung.

Asthma - Initial Signs and Symptoms

• Wheezing
• Dyspnea
• Coughing
• Increased sputum/mucus
• Increased respiratory rate
• Rapid breathing
• Elevated heart rate
• Nasal flaring
• Chest Tightness
• SOB

Asthma Medical Management

• Medical Management - Diagnosis
  • Medical history
  • Pulmonary function tests,
  • Chest x-ray
  • Pulse oximetry
  • Arterial blood gases
• Medical Management - Treatment
  • Assessment of respiratory status.
  • Monitoring for complications -Control of environmental factors -Pharmacological treatment: Anti-inflammatories & Bronchodilators(Albuterol and corticosteroids), and Anticholinergics
• Medical Management-Non-Pharmacological: Breathing exercises, incentive spirometry use, and adequate hydration, Emotional support, and Education.
• Nursing Management-Assessment and analysis: Vitals Signs, Oxygen saturation, Arterial Blood Gases, Level of Consciousness, ect...

Patient Education for Asthma

• Self-Management: Monitor respiratory status, recognize symptoms, and adjust medication, track peak flow monitoring and symptoms.
• Teaching: Correct inhaler technique and having the patient demonstrate.
• Trigger Avoidance: ID triggers, decrease exposure, environmental measures.
• Self-Management, Teach about Asthma action plans
• Lifestyle Guidance: Encourage exercise strategies to prevent exercise-induced symptoms.

Medications for Asthma

• A SABA short-acting beta-agonist (SABA) like albuterol always; provides quick relief.

Asthma and Inflammation

• Inhaled corticosteroids (ICS) reduce airway inflammation
• Combination inhalers: Breo Ellipta (fluticasone/vilanterol)

Status Asthmaticus - Signs and Symptoms

• Breathlessness at rest, unable to speak in full sentences
• Respiratory rate > 30 breaths/minute
• Unresponsive to typical rescue treatment with bronchodilators
• Bronchospasm, inflammation, mucus plugging
• Chest tightness, wheezing, dry cough, shortness of breath
• Use of accessory muscles
• Distended neck veins
• Decreasing oxygen saturation levels
• Rising PaCO2 levels, potential respiratory acidosis
• Silent chest with no audible air movement

Types of Medications used to treat Asthma

Prednisone (Steroid)

• Reduces airway inflammation.
• Causes: Weight gain, fluid retention, mood changes, hyperglycemia.
• How to help pt: Take with food, do not stop abruptly, watch for signs of infection.

Albuterol (Bronchodilator)

• Relaxes airway muscles.
• Causes: Tremors, rapid heartbeat, headache. -How to help pt: Use before exercise, do not exceed recommended doses.

Ipratropium Inhalant (Anticholinergic)

• Blocks acetylcholine effects, dilates airways.
• Causes: Dry mouth, constipation, urinary retention.
• How to help pt: Use with bronchodilator for better effect, rinse mouth.
• Can also use: Tiotropium (Long acting muscarinic antagonist)

Theophylline (Xanthine)

• Anti-inflammatory (Bronchodilator)
• Causes: Nausea, vomiting, insomnia, seizures with high levels.
• How to help pt: Have levels monitored, avoid certain foods/drugs.

COPD Oxygenation Complications in Older Adults

• Hypoxemia
• Hypercapnia.
• Pulmonary hypertension
• Polycythemia
• Respiratory Failure

Emphysema - Oxygen Delivery Equipment

• Delivery equipment:
  • Oxygen tanks with an H cylinder (stationary) or E tanks (portable).
  • Portable containers liquid oxygen, oxygen concentrators with back up oxygen options.

COPD - Risk Factors

• 80-90% of COPD cases exposure to tobacco smoke (Active or passive)
• Occupational exposure.
• Elderly (Pneumonia, immune system, physiological changes, medications,)
• HIV
• Air pollution.
• Deficiency of alpha1-antitrypsin enzyme.

COPD - Signs and Symptoms

• Main Symptoms* (C=cough, S=sputum, D=Dyspnea)

1. Cough.
2. Sputum.
3. Dyspnea

Definitions of Terms

• Pleuritis - Inflammation of the lining around the lungs with causing pain.
• Cyanosis - Bluish skin or lips due to low oxygen levels in the blood.
• Pleuritic - Pain - Sharp chest pain, with breathing or due to pleuritis.
• Hemoptysis - Coughing up blood from the lungs.
• Pleural Effusion - Fluid buildup between the lungs and chest wall.
• Atelectasis - Collapsed lung.
• Lung Abscess - Pocket of pus in the lung due to infection.
• Empyema - Pus buildup between the in lungs from infection .
• Thoracentesis - Procedure to remove fluid
• Dyspnea - SOB

Thoracentesis Treatment

• Thoracentesis procedure used to remove excess fluid.
  • It may treat: Pneumonia, Tuberculosis, Pleurisy, Emyema.

Thoracentesis Complications

• Pneumothorax (3-30%)
• Hemopneumothorax
• Hemorrhage, Vasovagal response
• Hypotension, Pulmonary edema
• Spleen, liver puncture
• Air embolism
• Introducing an infection

Chronic Bronchitis - Signs and Symptoms

• Persistent coughing with large amounts of sputum.
• Purulent (pus-containing) Sputum
• Hemoptysis
• Cyanosis
• Obese
• Mild dyspnea initially

Emphysema - Signs and Symptoms

• Dyspnea with minimal coughing.
• Pink skin coloring
• Barrel Chest
• Weight Loss
• Minimal cough, increased minute ventilation. Pursed-lip breathing
• Cachexia, Accessory muscle use
• Tachypnea with hyperinflation

Cor Pulmonale -Signs and Symptoms

• Enlarged tender liver, warm feet cyanotic hands
• Distended neck veins, enlargement.
• Hypoxia, & increasing dyspnea

Findings and Interventions for Chronic Bronchitis and Emphysema

Lab Results

• Increased WBC count during exacerbations.
• Sputum cultures to identify bacterial infections.
• ABG (Arterial Blood Gases) may show hypoxemia and hypercapnia.
• Sputum Gram Stain, testing, Complete blood count, Serology testing.

Diagnostic Results

• Pulmonary function tests to measure airflow limitation (hx spirometry)
• Chest X-ray assess lung hyperinflation
• CT scan/ MRI, ECG.

Medications

Bronchodilators is theophylline) & Inhaled corticosteroids/glucocorticoids), Mucolytics antibiotics. (Same as asthma but add azithromycin)

Nursing Interventions

• Oxygenate and encourage to quit smoking
• Teach breathing excersies
• Advocate rehab programs.
• Suplimental oxigen

Patient Education

• Regular exercise
• Encourage, explain the disease,
• explain medication use. provide info on oxigen when perscribed.

Special Note About Anti-Infective - Azithromycin

• Classification = semisynthetic macrolide antibiotic.
• Patients teachings need to include taking with or without food / Complete the dose and report allergies.
• Notify provider about diarrhea that is severe or doesn't resolve.
• Disclose use of herbal products or dietary supplements.

Asthma - Signs and Symptoms

• Wheezing, Cough.

Nursing Note

• Elevated heart rate due to compensation for diminished oxygen perfusion, nasal flaring =SOB

Pneumonia signs and symptoms

• Fever and chills/skin skin clammy and cyanosis.
• Malaise, fatigue
• SOB/Hemoptysis
• Productive cough

Chronic Bronchitis - Sign and Symptoms repeat information

• Chronic, productive cough.
• mild dyspnea
• Obese
• Cyanosis
• purulent spetum
• Cracckles/weezes

Emphysema-Sign&Symptoms * repeat information*

• Tachypnea/Dyspena
• Pink skin and purses lips
• Barrel chest
• Increase minute ventilation
• Decreased breath sounds

Obstructive Sleep Apnea - causes

• Central nervous system control dysfunction
• Upper airway collapse increases air flow resistance/sleep causes muscles to relax with no air movement. Also, there is hypoxemia and hypercapnia present.
• Factors include soft tissue and craniofacial: obesity, genetics narrow jaw , nose polops/septums enlarged

Prevention of airway obstruction by interventions for Sleep Apnea.

• Use of an oral appliance, called maxillomandibular advancement & Noninvasive positive-pressure ventilation via continuous positive airway pressure (CPAP).
• Manage weight/ Administer Medications

Sleep Apnea- Signs and Symptoms for Air Obstruction

• Insomnia.
• Hypoxia Hyercapnia, Gasps of air,
• Head aches and dry mouth,
• Depression and irritability, fatigue,
• Decreased libido/ Difficulty concentrating/ Nighttime waking with gasping or choking sensation

Positioning of a SNoring -Sleep Apnea Victim?

1 Teach the patient to elevate the head of the bed and use a side or prone position for sleep. 2 - Use pillows to prevent a supine position/elevate head of bed

Continuous Positive Airway Pressure CPAP)Machine VS Bilevel Positive Airway BiPAP Machine

• CPAP- set pressure throughout breathing
• BiPAP.- two levels-high pressure breath vs low
• BiPAP alternating pressure improves lung air volume reducing SOB than PAP.

Nurse Intervention Using CPAP/BIPAP ON PATIENT.

• Maintain a tight face to mouth seal during breathing over device/ Explain purpose feelings when used/ Provide the patient time to breathe before turning switch power on/ monitor, set pressure , comfort, tubing,oxygen saturation/ adjust bed head angle with pillows for comfort

Paitent Education CPAP/BIPAP

• Teach clean compressor

• teach clean mask and t tubes to prevent infection,

• use distilled water only and

• do not share equipment/ report signs of irritations.

• Emphasize consist,nightly use a perscribed sleep.

• Bring Home PAP, BIPPa Equipment when hospitalized with correct setup.

Tuberculosis - Spread of infection

• Mycobacterium cough aerosolized. ( bacteria in active PT from coughs, sneezes) can invade lungs spreading infection immunity in health bodies prevents further development, initial spread infects upper lungs Cell mediated immunity against TB results in pos reaction 2-10 weeks later. Pt not conatgious until symptoms occur.

Main Body System Affected By Tuberculosis

• The upper lungs are mostly affected/ the granuloma formation is how bacteria is spread by breathing the air causing droplet infection from coughs and sneezes.

Tuberculosis - Signs and Symptoms

• Fatigue
• night sweats
• cough with blood
• Low grade fever
• Chest Tightness
• Lethargy Anorexia/ Weight Loss

Isolation Precaustions For Tuberculosis

• Air- Borne contact = use filter mask

Pneumonia Signs

• 2 Types skin test/ Blood rest results as ( Mantoux & Acid Fast Bacilli Smear)

• Diagnostic = Chest X-Rays and Testing on blood

Treatment For Diagnosed Tuberculosis

• Meds = [ Isoniazid and rifampin.] also combination is ETHAMBUTOL AND PYRAZINAMIED

• Patient teaching / Home precautions=

• Test Family Mbrs and teach use and covering for hygene.

• Remind family not needed avoid infection.

• Teach skin results meds , hygene with support systems around.

Pneumonia - Different ways to transfer

• Spread from airborne through coughs/sneezes with weakened immune systems. Pneumonia is from all types of germs like bacterium & can also be spread by aspariation inhalation.

Kinds of Pneumonia for Categories

• Community Based: (spread tru coughs from contaminated surfaces )

• Hospital Based: ( VAP =Ventilator)

Risk of developing Pheumonia

• Being young [under 2yrs ], Old [over 64years] and immunity diseases with lungs

• Smoking as well as other pollution

Elderly Pneunomias - 1st Signs

• Confusion then fatigue
• elevated heart rate
• only small temp changes

Complications of pneumonia

• ARDS failure and Sepsis
• Hypotension: and bronchitis

Diagnostics And Pneumonia

• LAB TESTS platelets and CAT scan (pt & INR)

• Oximeter (blood test) (ABG and LACTATE)

Complications Of Bronchoscopy

• Bleeding and cardic stressers

HYPOXIC is a lung that collapses

What Are Nursing Diagonostics With Pneumonia

• Disturbed Air and obstruction
• Deficient lung voume and nutritional deficiency

Overview of body fluid compartments including intracellular and extracellular fluids. Discussion of third spacing, its causes such as ascites and burns, and its impact on intravascular volume. Focus on distribution, composition, and regulation.