Respiratory System Function & Measures Student Notes PDF

Respiratory System Function, Data Collection, and Therapeutic Measures CHAPTE R 29  LEARNING OUTCOMES Describe the normal structures and functions of the respiratory system. Identify how aging affects the respiratory sy...

Respiratory System Function, Data Collection, and Therapeutic Measures CHAPTE R 29  LEARNING OUTCOMES Describe the normal structures and functions of the respiratory system. Identify how aging affects the respiratory system. List data to collect when caring for a patient with a respiratory disorder. Recognize expected findings when inspecting and auscultating the chest. Identify common diagnostic tests performed to diagnose disorders of the respiratory system. Assist in planning nursing care for patients undergoing each of the diagnostic tests. Discuss therapeutic measures used to help patients with respiratory disorders. REVIEW OF ANATOMY AND PHYSIOLOGY REVIEW OF ANATOMY AND PHYSIOLOGY REVIEW OF ANATOMY AND PHYSIOLOGY  Respiratory acidosis Hypoventilation ACID- BASE BALANCE Respiratory alkalosis Hyperventilation EFFECTS OF AGING WHAT’S UP? Where is it? How does it feel? Aggravating and alleviating factors Timing Severity Useful other data Patient’s perception  INSPECTION Symmetry Dyspnea Use of accessory muscles Color Respiratory rate and rhythm Chest shape  Normal breath sounds  Adventitious sounds  Compare bilaterally AUSCULTATION  Crackles: Coarse or fine Wheezes ADVENTI Stridor TIOUS BREATH Friction rub SOUNDS Diminished Absent Adventitious breath sounds  LABORATORY TESTS Complete blood count Arterial blood gases D-dimer Culture and sensitivity Oxygen saturation Capnography DIAGNOSTIC TESTS Chest x-ray Computed tomography (CT) Ventilation-perfusion scan Pulmonary function studies Pulmonary angiography Bronchoscopy QUESTION #1 You are visiting Mrs. Harper who is at home recovering from a knee replacement. Today she reports chills and a cough. What do you do? THERAPEUTIC MEASURES Smoking Cessation  Behavior modification  Counseling  Setting quit date  Nicotine replacement  Drug therapy  Hypnosis  Physical activity  E-cigarettes SMOKING CESSATION- AFTER QUITTING 20 min-HR will drop back to normal 2 hours-HR and B/P will decrease to healthy levels 12 hours-Carbon monoxide decreases and blood O2 increases to normal 24 hours-Risk for MI have begun to drop 3 days-Nicotine is gone from the body 1-9 mon.-lungs begin to regenerate 1 year-risk of heart disease lowered by 50% and continues to lower each year 15 years-Risk of heart disease now that of a non-smoker  Deep breathing and coughing Huff coughing Breathing exercises THERAPE UTIC MEASURE S  THERAPEUTIC MEASURES Positioning Fowler Semi-Fowler “Good lung down OXYGEN THERAPY NASAL OXYGEN CANNULA MASKS  OXYGEN MASKS A. Simple mask B. Partial rebreather mask C. Nonrebreather mask D. Venturi mask  RISK OF OXYGEN THERAPY Patients with COPD  No more than 1-2 liters via nasal cannula if CO2 retainers Oxygen toxicity  At risk if oxygen delivered for more than 24 hours at high flow rates  S/S include dry cough, chest pain, numbness in extremities, lethargy or nausea  METERED-DOSE INHALER Medications directly administered into lungs What types of medications? Spacer Teaching What to do with 2 or more inhalers?? INCENTIVE SPIROMETER  QUESTION #2 Mr. Lopez, a recent immigrant from Honduras, has come to the clinic today to report that his new inhaler does not help his shortness of breath. What do you do?  A tube inserted into the opening of the trachea to maintain. Nursing care  Suctioning  Cleaning TRACHEO  Communication STOMY  Teaching Things to think about  Communication  Suctioning  Infection Tracheostomy ca re TRACHEO STOMY TRACHEOSTOMY Nursing diagnoses  Ineffective Airway Clearance  Risk for Infection  Impaired Verbal Communication  Disturbed Body Image  Deficient Knowledge CPAP AND BIPAP CPAP BIPAP Indications Nursing Care Nursing concerns CPAP- How does it work?  CASE STUDY #1 Mr. Granger is a 67-year-old with a history of COPD who visits his primary care office today for increased shortness of breath the past 3 days. He states that he has a cold that just won’t go away. His wife reports that he has felt feverish, but she has not checked his temperature. Mr. Granger has crackles throughout his lower lung fields. Vital signs: BP 140/86, Temp. 101.8°F (38.8°C), P 102, R 32, O2 saturation 86% on room air. Per the HCP’s order, you apply oxygen at 2 L per nasal cannula and his 0 2 sat increases to 92%. The HCP decides to send Mr. Granger to the emergency room (ER) and calls an ambulance. You are preparing to give a hand-off report to the HCP. Think about the information you should include in the hand-off report. Now turn to your neighbor and communicate a hand-off report using ISBARR.  QUESTIO N #3 What occurs in response to negative pressure in the thoracic cavity? 1. Pneumothorax 2. Dyspnea 3. Inhalation 4. Exhalation  QUESTIO N #4 Which acid–base imbalance results from decreased respiratory function? 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Metabolic acidosis  QUESTIO N #5 Which adventitious breath sound is generated by narrowed inflamed airways? 1. Stridor 2. Friction rub 3. Crackles 4. Wheezes