Medical-Surgical Respiratory PDF

Medical Surgical Respiratory Early sign of cerebral hypoxia → restlessness and irritability Respiratory status Key is visualization and assessment of breath sounds If lungs sound clear and patient is blue, they are not receiving enough oxygen Asthma...

Medical Surgical Respiratory Early sign of cerebral hypoxia → restlessness and irritability Respiratory status Key is visualization and assessment of breath sounds If lungs sound clear and patient is blue, they are not receiving enough oxygen Asthma Difficulty of breathing due to the narrowing, swelling, and production of mucus in the airway S/sx: SOB, wheezing, coughing, hypoxemia, respiratory acidosis NI: Administer bronchodilators and steroids, maintain hydration, deliver oxygen or nebulizer as prescribed Avoid morphine → histamine releasing opioid can lead to exacerbation Avoid NSAID’s and aspirin - can worsen asthma symptoms COPD - characterized by bronchospasm and dyspnea Bronchitis Inflamed bronchioles, increased mucus Blue bloaters, barrel chest Emphysema Destruction of alveoli Pink puffers Encourage pursed-lip breathing (promotes CO2 Bronchitis Emphysema elimination), high-fowlers and leaning forward Normal SpO2 for COPD: 88-92%. Do NOT raise SpO2 level higher than 92% because a low SpO2 is what stimulates pt to breathe NI: offer mechanically soft foods (to save pt energy), teach pt to inject at least 3L of fluid/day (thins mucus) Empyema Pus in the pleural cavity; associated w/ pneumonia or after thoracic surgery NI: elevate HOB, abx, chest tube or thoracentesis (drainage) Acute Respiratory Distress Syndrome (ARDS) Fluid fills the alveoli in the lungs and inhibits oxygen exchange; causes severe hypoxemia First sign- increased respirations. Followed by dyspnea, retractions, cyanosis Hypoxemia is NOT responsive to O2 therapy because the fluid in the alveoli blocks the diffusion of oxygen NI: mechanical ventilation with PEEP Pulmonary Embolism (PE) Thrombus gets lodged into pulmonary artery, blocking blood flow. Other cause is fat embolism from long bone fracture First sign - chest pain. Then dyspnea, tachypnea, blood tinged sputum Body compensates by hyperventilating → respiratory alkalosis NI: elevate HOB, give O2, thrombolytic therapy, pain control, encourage ambulation (prevent venous stasis)  Respiratory Pneumonia Infection resulting in decreased gas exchange in the affected lung lobes Alveoli become blocked with purulent fluid → impairs ventilation V/Q Mismatch Alveoli continue to receive perfusion from the pulmonary Ventilation (airflow) or artery resulting in deoxygenated blood perfusion (blood flow) in Ventilation to perfusion (V/Q) mismatch or pulmonary shunt the lungs is impaired May result in hypoxia and respiratory distress Blood flow in the lungs is partially influenced by gravity, S/sx: SOB, fatigue, meaning blood flows in higher volumes to dependent parts headache, confusion, of the lung dizziness, cyanosis Unilateral pneumonia should be positioned with the unaffected (good) lung down to improve perfusion and oxygenation *Ex: pt with a left lobar pneumonia: position in the right lateral position Unaffected (good) lung down (right lung) to increase blood flow to the lung most capable of oxygenating blood Crackles heard on auscultation suggest pneumonia At risk: people 65 or older and infants under 2 years old (immune system still developing) Pneumococcal vaccine recommended for pts 65 years and older S/sx: pleuritic pain, wheezing, fever, sputum, change in LOC NI: Droplet precautions, O2 as needed, encourage deep breathing and coughing, increase fluid intake (thin mucus), abx, monitor LOC Pleural Effusion Fluid buildup between the lungs and chest; prevents lung expansion S/sx: pleuritic pain, dyspnea, dry cough, orthopnea NI: high Fowler’s, monitor breath sounds, encourage deep breathing and coughing, prep for thoracentesis Pleurisy Stabbing chest pain that usually increases on inspiration or with cough Caused by inflammation of the visceral pleura (over the lung) and the parietal pleura (over the chest cavity) The pleura space (between the 2 layers) normally contains about 10 mL of fluid to help the layers glide easily with respiration When inflamed, they rub together and cause pleuritic pain Fremitus Palpable vibration felt on the chest wall Expected finding in pneumonia Sound travels faster in solids (consolidation) than in aerated lung → increased fremitus in pneumonia Tuberculosis PPD test: skin assessed 48-72 hours post administration Positive if induration is: >15 mm in healthy pt or >10 mm in immunocompromised pts or >5 mm in high risk pts (HIV, recent contact with TB pt) Positive and no symptoms → chest x-ray Positive and symptomatic → sputum culture Anyone who has received a bacillus Calmette-Guerin (BCG) vaccine will have a positive test and needs chest x-ray Airborne precautions, pt must wear mask if leaving room Public health risk; if pt does not comply with treatment, they need supervision Teaching is very important! Drug therapy is typically 6 months or longer Med: Rifapentine (Prifin) - may cause orange colored body secretions, take w/ meals  Respiratory Pneumothorax Lung collapse due to air in pleural space (space b/w lungs and chest wall) Open pneumothorax -air circulates freely into pleural space Closed - air in pleural space does not increase Tension pneumothorax - air cannot leave pleural space; compresses lungs and shifts the mediastinum S/sx: sharp chest pain, SOB, cyanosis, tachycardia, tachypnea, hypotension NI: 3 way dressing, oxygen, chest tube, surgery (if needed) Nasopharyngeal airway Tube-like device used to maintain upper airway patency Used in alert or semiconscious patients; less likely to cause gaging NEVER insert them in a pt who may have had a head trauma (which might occur during a seizure) bc if they have a skull fracture, it may be malpositioned into structures and tissues in the brain CT must be done first to rule out fracture Size- measure tip of nose to the earlobe; select diameter smaller than naris