Respiratory Assessments and Oxygen Therapy

Respiratory Assessments

• Assessments include history of present illness, physical assessment, and laboratory tests
• Physical assessment includes:
  • Clubbing of fingernails
  • Mucous membranes
  • Position of trachea (is it midline?)
  • Breathing (are they using accessory muscles? Is their breathing even?)
  • Vital signs
  • Sputum
  • ESR & CRP
  • Chest x-ray
  • CBC & CMP

Oxygen Therapy Management

• Oxygen therapy requires a doctor's order and is considered a medication
• Noninvasive oxygen delivery methods:
  • Nasal Canula (1-6L, can titrate)
  • Simple Mask (6-10L, can titrate)
  • Venturi Mask (0-55% O2, "titrate" varies on the valve used)
  • Non-Rebreather (100%, no titration)
  • Continuous positive airway pressure (CPAP)
  • Bi-level positive airway pressure (BIPAP)
  • Tracheostomy (indicated if mechanical ventilation is required, max 2 weeks)
• Complications of oxygen therapy:
  • Oxygen toxicity: symptoms include nonproductive cough, nasal congestion, substernal pain, headache, N/V, fatigue, sore throat, dry mucous membranes, infection
  • Hypoxia: early signs include restlessness, irritability, use of accessory muscles, nasal flaring, tachycardia, tachypnea, hypertension; late signs include decrease in level of consciousness, increase in lactic acid, dysthymias, bradypnea, bradycardia, hypotension, cyanosis
  • Hypoxemia: insufficient oxygen in the arterial blood

Infectious Respiratory Disorders

• Influenza:
  • Highly contagious acute viral respiratory infection
  • Symptoms: fever, chills, malaise, muscle aches, HA, rhinorrhea, cough, sore throat
  • Diagnosis: rapid flu test
  • Treatment: saltwater gargles, increase fluids, Tamiflu (first 48 hours), analgesics
  • Nursing interventions: handwashing, vaccinations, avoiding close contact with infected people
• Pneumonia:
  • Excess fluid in the lungs due to inflammation
  • Symptoms: fever, SOB, chest pain, cough, dyspnea, crackles/wheezes
  • Laboratory tests: increased WBC, decreased O2/increased CO2
  • Diagnosis: chest x-ray (consolidation)
  • Treatment: antibiotics, bronchodilators, oxygen therapy, Guaifenesin (Mucinex)
  • Nursing interventions: high fowlers, oxygen therapy, cough and deep breath, incentive spirometer, increase fluid intake
• Tuberculosis:
  • Upper airway disorders:
  • Rhinitis/Rhinosinusitis:
    • Nasal inflammation/sinus inflammation (allergies)
    • Symptoms: nasal itching, runny nose
    • Treatment: nasal spray, decongestants, antihistamine
    • Nursing interventions: medication compliance, avoiding triggers
  • Obstructive sleep apnea:
    • Breathing disruption that occurs during sleep
    • Causes: upper airway blockage
    • Risk factors: overweight, birth defects, smoking
    • Symptoms: persistent daytime sleepiness, irritability
    • Treatment: C-pap, smoking cessation, weight loss
  • Laryngitis:
    • Inflammation of the larynx
    • Laryngeal cancer:
      • Cancerous growth on the vocal cords
      • Symptoms: hoarseness, persistent sore throat, pain with swallowing, SOB
      • Diagnosis: barium swallow, MRI, PET scan
      • Treatment: chemotherapy, radiation, surgery, trach
  • Laryngeal trauma:

Lower Airway Disorders

• Asthma:
  • Chronic inflammation disorder of the airway
  • Intermittent and reversible
  • Triggered by allergen
  • Symptoms: dyspnea, wheezing, chest tightness, coughing, tachypnea, prolonged expiration, increased sputum
  • Diagnosis: pulmonary function test, ABG's
  • Treatment: bronchodilators (can cause an increase in HR)
  • Albuterol: short-acting bronchodilator for acute asthma attacks (reliever drug)
  • Solumedrol (control therapy)
  • Corticosteroids
  • Nursing interventions: avoid triggers, pursed lip breathing, smoking cessation, track asthma with a peak flow meter (3 times and record the highest number)
• Status Asthmaticus:
  • Life-threatening asthma attack
  • Airway obstruction that is unresponsive to usual therapy
  • Symptoms: extremely labored breathing, gasping, decreased level of consciousness, cyanosis, neck vein distention, pulsus paradoxes
  • Treatment: bronchodilators, epinephrine, corticosteroids
  • Nursing interventions: administer oxygen to the patient, prepare for emergency intubation and mechanical ventilation

Chronic Obstructive Pulmonary Disease (COPD)

• Combination of emphysema and chronic bronchitis
• Airway obstruction irreversible
• Emphysema:
  • Destruction of the alveoli
  • Decreases lung elasticity
  • Hyperinflation and air trapping in the lungs
• Chronic bronchitis:
  • Inflammation of the airways
  • Hypersecretions of mucous
• Risk factors: smoking, air pollution, occupational
• Symptoms: cough, excess sputum, crackles/wheezes, barrel chest, red/blue skin, clubbing of nails, cyanosis, increased work of breathing, tripod position, SOB
• Laboratory tests:
  • Decreased SpO2 (less than 90)
  • ABG: 50/50 club
  • PFT
  • Chest x-ray
• Treatment: bronchodilators, corticosteroids, anticholinergics, oxygen therapy
• Nursing interventions: place patient in upright position, administer oxygen, monitor for R-sided HF, smoking cessation, pursed lip breathing, incentive spirometer, increase fluid and protein intake

Cystic Fibrosis

• Genetic disorder (autosomal recessive disorder)
• Severely impairs lung function and other organ functions
• Abnormally thick sticky mucous (plugs organ ducts)
• Can lead to organ failure
• Symptoms:
  • Respiratory: wheezing, coughing, dyspnea, mucous plugs, cyanosis, clubbing, barrel chest, chronic respiratory infection
  • Gastrointestinal: steatorrhea (fatty, malodorous stool), delayed growth, ADEK deficiencies
  • Integumentary: abnormally high NaCl in sweat, saliva, tears
• Diagnosis: sweat Cl test, PFT, DNA testing, stool analysis
• Treatment: bronchodilators, anticholinergics, antibiotics, pancreatic enzymes
• Nursing interventions: chest physiotherapy, administer oxygen as ordered, increase fluid, protein, and calorie intake, supplement fat-soluble vitamins

Lung Cancer

• No specific notes provided in the text