5_NUSC 1F18 Resp system_brightspace.pdf

Respiratory System 1F18 – Experiencing Illness and Hospitalization – Anatomy – Physiology Objectives – Factors affecting oxygenation – Alterations in respiratory functioning – Nursing knowledge – Nursing process (ADPIE) Anatomy & Physiology Respiratory Control – Chemoreceptors in brain in peripherie...

Respiratory System 1F18 – Experiencing Illness and Hospitalization – Anatomy – Physiology Objectives – Factors affecting oxygenation – Alterations in respiratory functioning – Nursing knowledge – Nursing process (ADPIE) Anatomy & Physiology Respiratory Control – Chemoreceptors in brain in peripheries (carotid & aortic arch) monitor CO2 +pH in blood – Increase or decrease RR http://bit.ly/2DgFSG6 Pulmonary circulation – Function: move blood to and from alveolocapillary membrane – Acts as a filter – removes small thrombi before reaching vital organs – Begins at the pulmonary artery *deoxygenated* – Travels to alveolocapillary membrane and exchanges gases Travels back to LA, then LV, then to body (perfusion), then back to RA and RV (Potter et al., 2014; 2019) Factors Affecting Oxygenation Physiological factors (Potter et al., 2014;2019) Pregnancy Obesity Conditions Affecting Chest Wall Movement Musculoskeletal abnormalities Trauma Neuromuscular diseases CNS alterations (Potter et al., 2014;2019) Hyperventilation Excessive ventilation than what is needed to eliminate the normal venous carbon dioxide produced by cellular metabolism Caused by anxiety, infection, drugs, acid-base imbalances Alterations in Respiratory Function Hypoventilation Alveolar ventilation is inadequate to meet the body's oxygen demands or eliminate sufficient carbon dioxide Can be caused by severe atelectasis Hypoxia Inadequate tissue oxygenation at the cellular level Can be caused by decreased hemoglobin level, diminished concentration of inspried oxygen, inability of the tissues to extract oxygen from the blood (cyanide posioning), decreased diffusion (pneumonia), poor tissue perfusion with oxygenated blood, and impaired ventilation (Potter et al., 2014;2019) Infants and toddlers Developmental Factors School-aged and adolescents Young and middle-aged adults Older persons (Potter et al., 2014;2019) Lifestyle Risk Factors POOR NUTRITION INADEQUATE EXERCISE SUBSTANCE ABUSE SMOKING STRESS (Potter et al., 2014; 2019) Where you live... urban versus rural Environmental Risk Factors Workplace and occupational pollutants Exposure to second-hand smoke (Potter et al., 2014) Assess Diagnose Nursing Process ADPIE Plan Implement Evaluate (Potter et al., 2014; 2019) Assessment HEALTH HISTORY PHYSICAL EXAMINATION (Potter et al., 2014;2019) Health History What are the things you want to know about someone's health history in relation to the respiratory system? (Potter et al., 2014) – Pain (chest) - PQRSTUV – Fatigue – Smoking – Dyspnea You want to ask about... – Cough – Wheezing – Environmental or geographical exposures – Respiratory infections – Allergies – Health risks – Medications (Potter et al., 2014) – Skin and mucous membrane colour – General appearance – Level of consciousness (LOC) – Adequacy of systemic circulation Inspection – Breathing patterns – Any abnormalities should be further assessed during palpation, percussion, and auscultation – Look for clubbed nails (this indicates prolonged oxygen deficiency) – Chest wall movement (retraction, sinking of skin between intercostal spaces) – Note the anteroposterior diameter of the chest wall (Potter et al., 2014) Tenderness Palpation Tactile fremitus, heaves Abnormal masses or lumps in axilla or breast tissues (Potter et al., 2014) Used to detect the presence of fluid or air in the lungs Resonance (hollow, air filled) Percussion Hyper-resonance (emphysema, hyperinflated) Flat (bone) Dull (organ) (Potter et al., 2014) Identify normal and abnormal lung sounds Auscultation Listening for air movement in all lung fields (posterior, anterior, lateral) Adventitious breath sounds heard with collapsed lung segment, fluid in the lungs, or narrowing or obstruction of airway (Potter et al., 2014) – Activity intolerance – Risk for activity intolerance Examples for Cardiopulmonary Systems Risk for imbalanced fluid volume – Ineffective airway clearance Impaired gas exchange – Anxiety Ineffective health maintenance – Ineffective breathing pattern Risk for infection – Decreased cardiac output Deficient knowledge – Impaired comfort – Impaired verbal communication – Ineffective individual coping – Fatigue – Fear Risk for impaired skin integrity Disturbed sleep pattern Ineffective tissue perfusion Impaired spontaneous ventilation (Potter et al., 2014) – Integrate individual patient needs – Goals and outcomes – Patient's lungs are clear to auscultation – Patient coughs productively – Tissue oxygenation improves Planning – Setting priorities – – – – Maintaining patient's airway Improve exercise tolerance Pain control Modifiable risk factors – Collaborative care – PT, nutritionists, etc. (Potter et al., 2014) Focus on health promotion Vaccinations Implementation Influenza Pneumococcal Healthy lifestyle behaviour Diet, reduce stress, reduce anxiety, exercise Eliminate cigarettes, reduce exposure to pollutants, secondhand smoke Encourage exercise 3 to 4 times a week for 20 to 30 minutes Watch for risk of infection – especially during winter months (Potter et al., 2014) Dyspnea management Airway maintenance Suctioning techniques Implementation Artificial airways Maintenance and promotion of lung expansion Maintenace and promotion of oxygenation (Potter et al., 2014) – The underlying cause of dyspnea? – Pharmacological measures Dyspnea Management – Bronchodilators, steroids, mucolytics and anti-anxiety medications – Oxygen therapy – Physical techniques – Breathing techniques, exercise, cough control – Psychosocial techniques – Relaxation, meditation (Potter et al., 2014) –Trachea, bronchi and large airways –Mobilization of pulmonary secretions Airway Maintenance – Humidification – Nebulization – Chest physiotherapy – Postural drainage – Chest percussion – Vibration (Potter et al., 2014) –Oropharyngeal and nasopharyngeal suctioning Suctioning Techniques –Orotracheal and nasotracheal suctioning – –Tracheal suctioning (Potter et al., 2014) Artificial Airways Endotracheal (ET) airway Oral Airway https://medical-dictionary.thefreedictionary.com/Endotracheal+tube https://www.sciencephoto.com/media/1026938/view/tracheostomy-airway-tube-illustration https://clinical.stjohnwa.com.au/clinical-skills/airway/basic-airway-management/oropharyngeal-airway Tracheal (ET) airway Maintenance and Promotion of Lung Expansion –Positioning –Incentive spirometry –Chest tubes - invasive (Potter et al., 2014) Maintenance and Promotion of Oxygenation http://www.louisvillelectures.org/the-ll-blog-1/2021/oxygen-devices Breathing Exercises –Pursed-lip breathing –Diaphragmatic breathing (Potter et al., 2014) –Patient care – Objective and subjective data –Patient expectations Evaluation – For care management – "Do you feel like you will be able to practice the breathing techniques we have practiced at home?" – Ask patient if all their questions and needs have been met (Potter et al., 2014) Thank you!