CNN Respiratory Responses PDF

CCN: Responses to Early childhood infections alteration in ventilatory Primary complex (called tuberculosis in children) functions (lec) Meningeal tuberculosis...

CCN: Responses to Early childhood infections alteration in ventilatory Primary complex (called tuberculosis in children) functions (lec) Meningeal tuberculosis Lecturer: Bmb Magpantay Epididymal tuberculosis ( tb sa bayag ) (COPD) Chronic Obstructive Disease Clinical manifestations Type of lung disease that occur Chronic Cough (di makatulog sa due to blockage or obstruction in pag ubo) the airway. The main symptoms is Sputum production ( rusty sputum shortness of breath. cardinal sign of pneumonia, green Blockage damage the lungs mucus bacterial infection- might causes their airway to narrow. The mucus indicate what repiratory damage leads to difficulty of disease you have) breathing Dyspnea (ayaw kumain pag (Makikita ito sa mga nag smoke,nag vape) nahirapan huminga, severe use of accessory muscle, Types of lung disease - Weight loss COPD Barrel chest Emphysema Diagnosis Asthma Cystic fibrosis Spirometry ABG- obtained to assess baseline Common factors that obstruct airflow oxygenation and gas exchange and include: are especially important in Swelling and inflammation in the advance COPD airways. Chest x-ray Thick mucus. Chest CT scan Damage to the walls of air sacs Screening for alpha 1 antitrypsin deficiency, maybe perormed for Risk Factors px younger than 45 yr/old Occupational exposure: and prolonged exposure to workplace dusts, chemicals and fumes Asthma Medical management Surgical management Promoting smoking cessation Bullectomy- surgical option for Prescribing medication that selected px with bullous typically include bronchodilator emphysema: bullae are enlarge May include corticosteroids (might airspaces that do not contribute to use PPI such as omeprazole). ventilation but occupy soace in Managing exacerbations and thorax. providing supplemental oxygen Lung volume reduction surgery therapy as needed. (lubectomy) lobes of the lungs Lung transplantation Medication Nursing management Bronchodilators- (Nebulization)(standard q24hrs) Assessing the patient- obtaining - Relieve bronyhospasm by information about the current improving expiratory flow symptom as well as previous through widening of the disease manifestation. airways and promoting Achieving airway clearance Improving breathing pattern Note: brochial spasm caused by plema Improving activity tolerance Corticosteroids Monitoring and managing potential - Hydrocortisone complication. - Dexamethasone Nursing diagnosis Antibiotic agent - Cefuroxime 750mg Ineffective airway clearance - Ceftriaxone 2grams Impaired gas exchange - Piptaz Ineffective breathing pattern Mucolytic Activity tolerance - Flumucil (600mg adult, Imbalance imbalance nutrition Antitussive Knowledge deficit - Rubutussin dm Risk for infection Vaccine - Meningitis - Mmr - Meningo - Covid - Hepa b PNEUMONIA - Deep venous thrombosis prophylaxis (anti-embolic INFLAMMATION of the lungs stockings) parenchyma caused by various microorganism, Meds: - Community- acquired 0.4 or 0.6 brand: (clexane), Generic: pneumonia enoxapharine sodium / blood thinners - Health care ,sub q. - Hospital - Ventilator Signs of VAP Wbc increased Sputum production increase Community acquired pneumonia Fever Common infectious disease, occus, either in the community setting or within the first 48 hours Risk factors after hospitalization of patients Conditions that produce mucus or who do not meet the criteria for bronchial obstruction and interfere HCAP. with normal lung drainage (Pediatric community aquired Immunosuppressed patients and pneumonia) those with low neutrophil count Smoking Ventilator associated pneumonia- Prolonged immobility and shallow 48 hrs after et intubation breathing How to prevent VAP Nothing by mouth status, - Head of bed elevation placement of the NGT Orogastric - Oralcare with chloqhexidine ( or endotracheal tube. usage of dactarine ointment on Supine position inpx to protect thei lips of the px or airway - Stress ulcer prophylaxis ( PPI 40 mg omeprazole 1 od ) Advaced age because of possible - Daily sedation assessment and depressed cough and glottic reflex spontaneous breathing trials ( and nutritional depletion for conscious px., breathing Transmission of organism from trials- dapat onti onti iwean ang health care worke. px. 48-72 hrs nakatangal na ang ventilator, Turning px in ICU o 4 expectorate the raised sputum into sterile Turn px q 2hrs no pressure ulcer container Turn px q 30 mins with pressure ulcers Medical management Antibiotic Clinical manifestations Hydration - Sudden onset of chills, rapidly Antioyretic risking fever ( 38.5 deg cel to 45 Paracetamol 300 mg iv q4 hrs de cel) - Other signs of respiratory distress ( SOB and use of Complication accessory muscle, trapezius Respiratory failure and sternocleidomastoid Pleural effusion ( accumulation of muscle). fluid in the lungs) - Some px exhibits an URTI ( nasal congestion - Orthopnea ( SOB when Nursing process reclining kaya ang ibang px gusto naka ubob. Asessment - Pneumonia-Rusty sputum Clinical manifestation of pneumonia ceftriaxone 2g IV a day/ - Increased HR if px is having a Acitromycin- 500mg 1 tab a day fever Changes in temperature and pulse, Assessment and dx findings amount, odor, and color of secretion; - Physical examination frequency and severity. - Chest xray Degree of tachypnea or SOB, changes in - Blood culture physical assessment findings and - Sputum culture changes in the chest x ray older adult o Rinse mouth with water to unusual behavior. minimize contamination by Increase temperature might cause normal flora, hallucination. o 2 breathe deeply several times, Dehydration o 3 cough deeply, and Children- sunken eyes Adult dry mouth, and skin turgor (ARDS) ACUTE RESPIRATORY DISTRESS SYNDROME page1705 Nursing diagnosis Magging ards pag hindi nagamot Ineffective airway clearance ang pneumonia related to copious tracheobrachial Severe version of other respiratory secretions. disease Fatigue and activity intolerance Severe inflammatory process related to impaired respiratory function Risk factors Risk for deficient fluid volume Aspiration related to fever and a rapid RR Drug ingestion and overdose Imbalanced nutrition: less than Hematologic disorder body requirements (might caused Prolonged inhalation of high atrophy in the muscle, concentration of oxygen, smoke or Knowledge deficit about the corrosive substances treatment regimen and preventive measures Note: hindi kaya ng alveoli ng sobrang daming oxygen. Localized infection Goal Metabolic disorders The major goal may include Shock Improve airway patency Trauma, fat, or air embolism sepsis Increased activity Manifestation Maintenance of adequate nutrition Repid onset of severe dypnea that Understanding of the treatment usually occurs less than 72 hrs protocol and preventive measures after the precipitating event. and absence of complication Sevre hypoxemia Nursing Intervention Improving airway patency Assessment and DX Promoting rest and conserving energy Intercoastal retractions and Promoting fluid intake crackles may be present ( kita ang Maintaining nutrition ribs sa baba pag nag inhale Promoting px knowledge commonly nakkita sa baby pag respiratory distress)  Brain natriuritic peptides BNP preventing rest. Rest is essential to levels limit oxygen consumption and Endocardiography reduces oxygen level. Pulmonary artery herterization Ventilator considerations Transthoracic enchocardiography may be used if bnp is not - Important to identify problem conclusive. with ventilation Pulmonary hypertention Medical management - Characterized by elevated pulmonary arterial pressure Identification and treatment and and secondary right heart treatment of the underlying venticular failure condition - Substernal pressure , fatigue, Supplemental oxy syncope, occational Intubation/ mechanical ventilation hemoptysis and sign of right Inotropic or vasopressor sided heart failure. (inotropes= dobutamine, Assessment DX dopamine, nore-epinephrine,) vasopressors=, epinephrine and Physical Examination vasopresins Chest X-ray Additional support treatment may Ecg include prone sitting positioning Echocardiogram sedation, paralyisis, and Medications nutritional support Calcium channel blockers Prostanoids ( oral trespostinil ) Nursing Management Endothelin antagosnist Require close monitoring in an ICU Phosphodieterase-5 inhibitor ( Position is important the nurse sildenafil) viagra pang pababa ng turns the px frwquently to improve BP ventilation and perfusion in the Nursing management lungs and enhance secretion damage. Idetify px at highrisk for ph such as It is important to reduce thepx those with COPD, PE, congenital anxiety because of anxiety heart disease, mitral valve disease increase oxygen expenditure by ( walking time bomb) Pulmonary embolism Surgical management - Thrombus na nag lodge sa - Surgical embolectomy pulmonary artery/ vein ng Nursing mangement patient. Minimizing the risk of pulmonary Clinical manifestation embolism - Sabay sabay na; Prevent thrombus formation - Dypnea Assess potential for pulmonary - Chest pain embolism - Anxiety Monitor thrombolytic therapy - Fever Managing pain - Tachy cardia Managing oxygen therapy - Diaphoresis Relieving anxiety - Tachypnea Monitor for complication Providing post operative nursing care Assessment and findings PNEUMOTHORAX Chest xray Nalagyan ng air sa lungs Ecg Abg Types of pneumothorax VQ scan ( ventilation perfusion scan – tawag pag extremities ang na scan) Simple- air enters the pleural space Prevention Traumatic – gun shot wounds Active leg ( pede mag lagay ng Tension pneumothorax- air is drawn into machine sa ilalim or hilot sa paa). the pleural space from a lacerated lung, Early ambulation use of (pwedeng dahil sa broken ribs tas na antiembolic stockings lacerate and lungs) Pharmacology Cause: Low molecular weight heparin- Gunshot trauma enoxaparin Mechanical trauma Thrombolytic therapy (1.5 million units, streptokinase, hook px on monitor cause the ,eds might cause arrythmia) Clinical manifestation o Gauge 16 ( grey ) o Use lidocaine Pain is usually sudden and may be o Use of ultrasound or dapat utz pleuritic. ( commonly pneumonia) guided. Minimal respiratory distress with o Everytime na gaga slight discomfort and tachypnea o Clamp mag ambulate ang patient … o Pleurodesis- medical management S/s ( types of pneumothorax) alternative kung hindi pede ang patch/ VATS ( oxytetracycline, color Simple pneumothorax- trachea in the yellow na medication 1 hr supine, midline, w 1 hr left side( nuvain, NSAID/pain Tension pneumothorax- Trachea shifts killer na ginagamit jaan away from the affected site. precautionnary measure bp )/ pag acls 90 systolic pede pa mag bigay ng furosemide. Medical management o VATS VIDEO ASSISTED THORACIC SURGERY Goal of treatment is to evacuate o Color of fluid ( amber, with tinge of the air from the lungs blood) CTT – use for pneumothorax, pleural effusion , hemothorax( dapat mag 300 cc of sterile water befor mag start. Document after procedure kung ilan ang nadrain pag pleural effusion. - Make sure na naka clamp yung ctt tube, kasi gradual lang ang pag kuha ng fluid sa lungs - Intermittent drain of 200 cc of pleural fluid , continous draining tangal ng clamp Others: o Less than 1L can use thoracentesis o Cytology cell block – test done to check for pleural fluid to know if Lung mass, ptb