Assessment and Care of the Respiratory Patient PDF

Assessment and Care of the Respiratory Patient Inge Luce, MSN/ED, RN-C, NRP VENTILATION, PERFUSION, AND RESPIRATION  CURRENT COMPLAINTS  S/S  Region/radiates  Onset  Severity  Provokes/palliat...

Assessment and Care of the Respiratory Patient Inge Luce, MSN/ED, RN-C, NRP VENTILATION, PERFUSION, AND RESPIRATION  CURRENT COMPLAINTS  S/S  Region/radiates  Onset  Severity  Provokes/palliates  Timing  Quality  U: What do you think it is? History PAST MEDICAL HISTORY  Smoking and drug use  Family hx  Allergies  Travel, work, residence,  Medications exposures  Past medical, surgical hx Assessment  Inspect  General impression, tone, appearance, mental status  Patency of the airway, nares, neck/trachea  Rate, depth, effort of breathing, shape of thorax  Skin color, turgor, mucus membranes  Nails for clubbing, fingers for tobacco staining  Palpate  Trachea –midline  Thorax- crepitus, pain, masses, deformities, expansion  Auscultate Lung sounds  Inspiratory Stridor Adventitious W es Lung h Rhonchi ez ee Sounds he ze W s Crackles   Pulse oximetry  Estimates oxygen binding to hemoglobin  Capnography, Capnometry  Measure exhaled CO2  VBGs and ABGs  Respiratory acidosis Diagnostics  COPD, late finding in pneumonia, ARDS  Hypoventilation, respiratory failure  Respiratory alkalosis  Hyperventilation, early asthma or pneumonia, anxiety  Sputum analysis  Chest x-ray  Pulmonary function testing  AWAKE  Thoracentesis  Local anesthetic  Risks: pain, bleeding,  Position, reassurance infection  HYPOTENSION,  Evaluate VS and LS PNEUMOTHORAX Diagnostics SEDATION = NPO 8 HOURS  Bronchoscopy  Lung biopsy  Flexible  Percutaneous  Moderate sedation  Moderate sedation  Rigid  Open  General anesthesia  General anesthesia  Chest tube GAG REFLEX PRIOR TO PO Chest tube management AIRWAY Ventilation   Assessment and management  Open? AIRWAY  Position  Adjunct (NPA, OPA, ETT, BiPAP/CPAP) assessment  Patent?  Suction, FBAO maneuvers &  Adventitious sounds?  Snoring- tongue managemen  Gurgling- secretions  Stridor- glottic area t  Mucus, mucus plugs, secretions  Hydration, suction, mucolytics  Encourage TCDB, I/S  Chest PT, positioning Tracheostomy  Inner cannula  Stoma  Dressing  Ties  Document   URI  Viral  Rhinitis/ Rhinosinusitis  Allergic or viral  intranasal steroids, antihistamines, decongestants, saline  Acute bacterial rhinosinusitis  Antibiotics (>10 days, new symptoms after 5-6 days, acute URI & symptoms for more than 3-4 days) infections  Pharyngitis  Viral or bacterial (or can be from irritation)  Strep throat  Tonsillitis  Lymphatic tissue, often inflamed with pharyngitis  Tonsillectomy  Monitor airway, gag, bleeding   Obstructive sleep apnea  CPAP, weight loss, surgery Upper airway disorders  Laryngitis  Smoking cessation, URI treatment, GERD management  Screen for cancer  Laryngeal cancer  Smoking, tobacco, toxin exposures, GERD  Hoarseness for >2 weeks   Laryngotracheobronchitis  Brassy or barking cough  Stridor  Supportive care (hydration, steroids, nebs)  Bronchiolitis and RSV  Viral inflammation, leads to wheezing, dyspnea  Vaccine and an antiviral treatment Croup Syndromes  Acute epiglottitis  Tripod, sniffing position, drooling, muffled voice  Acute onset = bacterial  Antibiotics  NOTHING IN THE MOUTH/THROAT  Can cause laryngospasm and obstruct the airway   Influenza is a viral infection of the respiratory tract  It is spread through droplets PRECAUTIONS!  Antiviral agents may be started within 24-48 of onset of symptoms to decrease the severity of symptoms and shorten the duration by 1 day  The biggest concern is development of a Influenza secondary infection  Elderly, young, immunocompromised  Watch for s/s of pneumonia  Lingering cough, night time cough  Fever after getting better  Lack of energy, appetite, etc., after initial improvement BREATHING Respiration and Gas Exchange   Assessment and management BREATHING  Rate  Too fast or too slow for age? assessment  Consider current condition (pain, fear, fever, sleep/activity, meds) &  Depth  Deep, shallow, normal managemen  Is it constant or fluctuating t  Effort  Normal, increased, decreased  Adventitious sounds? Asthma  Chronic Bronchitis & Emphysema  Cystic Fibrosis Lung cancer Pneumon ia Tuberculo sis CIRCULATION Perfusion Pulmonary Embolus  PULMONARY INFLAMMATION AND EDEMA ARDS COVID-19  Chest trauma