Module 1C - Gas Exchange Disorders.pdf

UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory,...

UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture [TRANS] UNIT XX: UPPER AIRWAY DISORDERS is not detectable on chest x-ray) to macroatelectasis Module 1C with loss of segmental, lobar, or overall lung volume. Gas Exchange Disorders o It can also be caused by different conditions. o Usually, atelectasis can be described when an x-ray is Outline done to the patient supported by the different clinical 1. Identify patients at risk for atelectasis and the nursing signs and symptoms that will be presented by the interventions related to its prevention and management. patient. 2. Recognize the signs and symptoms of acute Most often in the postoperative setting or in people who tracheobronchitis and the corresponding medical and are immobilized and have a shallow, monotonous nursing interventions. 3. Use the nursing process as a framework for care of the breathing pattern. patient with pneumonia. o With this, the lungs will not be able to expand. 4. Summarize the care management for patients with lung o In preoperative nursing, one of the complications of abscess. a postoperative patient is respiratory disorders. The common are atelectasis and pneumonia (infection). Gas Exchange Disorders o Preoperative teaching is important for postoperative Gas exchange disorders are diseases that occurs in the care that will promote lung expansion. Eg.: lower respiratory tract (trachea, bronchi, bronchioles, ▪ Early ambulation alveoli - what makes up the lung tissue, this is where the ▪ Deep breathing exercises and coughing. problem happens in the exchange of oxygen and carbon Splinting the incision site to prevent excessive dioxide). pressure that results to dehiscence. To mobilize also the secretions to prevent pooling of 1. Atelectasis secretions that will obstruct the air flow that Closure or collapse of alveoli. causes the air to hinder entering that will cause o Alveoli are the small sacs that make up the lungs which lungs to not fully expand. become inflated with oxygen and also dispose of ▪ Use of incentive spirometry helps in breathing of carbon dioxide during cellular metabolism. the patient. o If the alveoli collapses, there would be no gas ▪ Use of range of motion exercises (passive and exchange. active). o Atelectasis is the term when the alveoli collapses. ▪ Turning in bed to promote lung expansion and blood circulation. Normal and Collapsed Alveoli Atelectasis can also happen to patients with COPD. Excess secretions or mucus plugs may also cause obstruction of airflow and result in atelectasis in an area of the lung. Also is observed in patients with a chronic airway obstruction that impedes or blocks the flow of air to an area of the lung. Pathophysiology Reduced airflow ↓ Reduced alveolar ventilation ↓ Loss of air in the lungs ↓ Lung collapse CTTO: https://step1.medbullets.com May be acute or chronic and may cover a broad range of pathophysiologic changes, from microatelectasis (which CTTO: https://medlineplus.gov Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 1  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Reduced alveolar ventilation - entry of oxygen into the alveoli. Any blockage that obstructs the passage of air to and from the alveoli will reduce alveolar ventilation. Loss of air in the lungs - there will be no air that will be inflated on the alveoli. The part of the lungs has obstruction in the entry of air that causes the lung not to expand. Occurs in adults (post-operative) as a result of reduced ventilation when the cause is non-obstructive atelectasis. Maybe they have shallow breathing that is why the lungs are not ventilated. On the other hand, in obstructive atelectasis, there is blockage of air into the lungs. Both conditions will contribute to the loss of air into the lungs because of reduce alveolar ventilation. Causes A. An obstruction prevents air from reaching distal airways, Foreign body and alveoli collapse. The most frequent cause is blockage of Tumor or growth in an airway a bronchus by a mucus or mucopurulent (pus-filled) plug, as Altered breathing patterns might occur postoperatively. B. Accumulations of fluid, blood, or air within the pleural cavity collapse the lung. This can o The breathing is not normal (non-obstructive). occur with congestive heart failure (poor circulation leads to Retained secretions fluid buildup in the pleural cavity) or because of leakage o Deep breathing and coughing is needed to expel out. caused by a pneumothorax. Pain Alterations in small airway function Pathophysiology Prolonged supine positioning Increased abdominal pressure Reduced lung volumes due to musculoskeletal or neurologic disorders Restrictive defects Surgical procedures (e.g., upper abdominal, thoracic, or open-heart surgery) Pulmonary Pleurae Atelectasis CTTO: https://en.wikipedia.org Factors Why the Lungs is not Able to Expand and Leads to Atelectasis Excessive fluid in the pleural space. When air (pneumothorax), blood (hemothorax), and water (pleural effusion) enters the pleural space. CTTO: https://www.wikiwand.com Figure 12-7: Two Forms of Atelectasis Clinical Manifestations Onset is insidious (hindi agad-agad lumalabas) Dyspnea Cough Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 2  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Sputum production ▪ You can teach the significant others if there are no Tachycardia nurse available. o When there is large amount of lung tissue involved, Early mobilization / ambulation there would be marked respiratory distress that will Strategies to expand the lungs and to manage secretions cause tachycardia. o Deep breathing and coughing exercise o Tachycardia is a heart rate of over 100. o Using spirometry o There is increased heart rate because the heart is Voluntary deep breathing maneuvers (at least every 2 trying to compensate for the lack of oxygen. hours) ▪ Problem: there is obstruction. Use of incentive spirometry or voluntary deep breathing Tachypnea Secretion management techniques include directed o More than 20 breaths per minute. cough, suctioning, aerosol nebulizer treatments o There is increased breathing because the body is o Pooling of secretions causes obstruction. trying to compensate for the lack of oxygen. Followed by chest physiotherapy (postural drainage and Pleural pain chest percussion), and bronchoscopy. o Pleuritic pain (painful breathing) o Chest percussion or chest physiotherapy Central cyanosis (late sign of hypoxemia) ▪ Postural drainage - positioning the client where o Bluish discoloration of the skin. lobe has more secretions. o Hypoxemia - low oxygen levels in the blood ▪ Cupping and percussion of the back helps o Hypoxia - low oxygen level in the body tissue dislodged the secretions in the lower respiratory Difficulty breathing in the supine position and anxiety. tract. ▪ After CPT, drinking a full glass of water is Remember recommended to liquefy the secretion. In chronic atelectasis, the signs and symptoms are same as Metered-dose inhaler is used to dispense a with acute atelectasis. Their difference only is: bronchodilator rather than an aerosol nebulizer. o More vulnerable to certain infections. o May suffer from other respiratory infection Medical Management How to assess clients with atelectasis: The goal of treatment will always be to improve ventilation o In the medical examination, we are instructed to hold (to air can come in) and remove secretions (in order to our breath (in order to see the lung expansion) – prevent blockage in the lower respiratory tract) because in atelectasis, the lungs do not expand fully. For patients who do not respond to first-line measures or who cannot perform deep-breathing exercises: Assessment and Diagnostic Findings o Positive end-expiratory pressure (PEEP; a simple Characterized by increased work of breathing and mask and one-way valve system that provides varying hypoxemia. amounts of expiratory resistance - about 10-15 cm Decreased breath sounds and crackles are heard over water that will provide air to enter the lower respiratory the affected area. tract). o Decreased or diminished o Continuous positive pressure breathing (CPPB) breath sounds because Bronchoscopy there is no gas exchange o To view and it can remove the blockage. that happens in the alveoli. If cause of atelectasis is bronchial obstruction from o Crackles are the clicking, secretions, the secretions must be removed by coughing rattling, or crackling noises or suctioning to allow air to reenter that portion of the lung. that may be made by one or Chest physiotherapy both lungs of a human with a Nebulizer treatments with a bronchodilator or sodium respiratory disease during bicarbonate. inhalation. Endotracheal ▪ There is pleural intubation and effusion that cause the mechanical ventilation lungs to collapse. o After intubation, Chest x-ray. Ambu bag will be Pulse oximetry (SPO2) may demonstrate a low saturation placed on patient of hemoglobin with oxygen (less than 90%) or a lower- and it will deliver than-normal partial pressure of arterial oxygen (PaO2). oxygen manually. o Arterial blood gas analysis o Until such time the ▪ Partial oxygen is low patient will be attached to a mechanical ventilation Safety nursing alert: tachypnea, dyspnea, and mild to (artificial respiration) moderate hypoxemia are hallmarks of the severity of If the cause of atelectasis is compression of lung tissue atelectasis. (fluids, blood, or air that causes restriction on lung expansion), the goal is to decrease the compression thru Preventive Nursing Measures thoracentesis (removal of the fluid by needle Frequent turning aspiration) or insertion of a chest tube. o Turned side to side q2h (FDAR) Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 3  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture If the atelectasis is a result of obstruction caused by lung o Often, this inflammation is caused by infection in the cancer, an airway stent or radiation therapy to shrink a upper respiratory tract – either bacterial or viral in tumor may be used to open the airways and provide nature. The mucus secretions become a very good ventilation to the collapsed area. medium for growth of bacteria. Nursing Management Bronchitis and Normal Condition in Tertiary Bronchus Change patient’s position frequently, especially from supine to upright position, to promote ventilation and prevent secretions from accumulating. Encourage early mobilization from bed to chair followed by early ambulation. o Before ambulation, dangling of the feet preventing postural hypotension. ▪ Promotes circulation of the blood also. o Assisted client with ambulation (action of FDAR). Encourage appropriate deep breathing and coughing to mobilize secretions and prevent them from accumulating. o With splinting of the incision site (if coughing is hard for the patient). CTTO: https://medlineplus.gov Causes The inflamed mucosa of the bronchi produces mucopurulent sputum, often in response to infection by: o Streptococcus pneumoniae o Haemophilus influenzae o Mycoplasma pneumoniae o Fungal infection (e.g., Aspergillus) Other causes: o Inhalation of certain irritating chemicals / gas - causes sensitivity reaction that leads to the inflammation of the bronchi (causes obstruction). Educate/reinforce appropriate technique for incentive Pathophysiology spirometry. The inflamed mucosa of the bronchi. ↓ Administer prescribed opioids and sedatives judiciously to Produces mucopurulent sputum because of bacterial / fungal prevent respiratory depression. infection. o Opioid analgesic (e.g., Morphine) has adverse ↓ effect, the first organ will be affected is the lungs A sputum culture should be obtained in order to determine (respiratory depression) – further problem that is why what is the specific causative agent for the infection. the dosage of the medication must be right. Perform postural drainage and chest percussion, if Clinical Manifestations indicated. Dry, irritating cough and expectorates a scanty amount of Institute suctioning to remove tracheobronchial mucoid sputum. secretions, if indicated (if other measures are not working). o Productive cough - there is phlegm (mamaklas) o Non-productive - there is no phlegm Take Time to Watch Sternal soreness from coughing https://www.youtube.com/watch?v=KGkeKfPHZoE Fever or chills (because of bacterial infection) 2. Acute Tracheobronchitis Night sweats Acute inflammation of the mucous membranes of the Headache trachea and the bronchial tree, often follows infection of General malaise the upper respiratory tract. Shortness of breath o Mucopurulent sputum (possible bacterial infection) Noisy inspiration and expiration (inspiratory stridor and o When the bronchi are inflamed, causes airway expiratory wheeze) obstruction (difficulty passing of air) o Stridor is noisy breathing Purulent sputum Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 4  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Medical Management Normal Alveoli and Pneumonia Antibiotic treatment o Depending on the bacteria identified – test will be done is culture and sensitivity). Fluid intake is increased o To liquefy the secretion). Suctioning and bronchoscopy Rarely, endotracheal intubation may be necessary Cool vapor therapy or steam inhalations o To moisten the respiratory tract and liquify the secretion. Moist heat to the chest. Mild analgesics may be prescribed. Nursing Management Usually treated in the home setting that encourage bronchial hygiene. Increased fluid intake. o In FDAR documentation (measurable), include the amount or volume (e.g., encouraged the patient to drink 3 liters of water per day). o Glasses is not recommended because there is a lot of glasses available there. Directed coughing → assists the patient to sit up frequently to cough effectively and to prevent retention of mucopurulent sputum. CTTO: https://www.roswellpark.org Emphasize full course of antibiotics. Normal Alveoli and Pneumonia Caution the patient from overexertion and advised to rest. Take Time to Watch https://www.youtube.com/watch?v=SGhbsD4Akpw 3. Pneumonia Inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. Pneumonitis is a more general term that describes an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion. Bronchopneumonia and Lobar Pneumonia CTTO: https://medlineplus.gov Classification of Pneumonia into Four Types A. Community-Acquired Pneumonia (CAP) Occurs either in the community setting or within the first 48 hours after hospitalization or institutionalization. CTTO: https://ksumsc.com Causative Agents Streptococcus pneumoniae (pneumococcus) → most common Haemophilus influenzae causes a type of CAP that frequently affects older adults and those with comorbid illnesses. Mycoplasma pneumoniae Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 5  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Viruses are the most common cause of pneumonia in Patients who are being brought to the hospital are sick, infants and children but are relatively uncommon causes of meaning their immune system is low, which makes them CAP in adults vulnerable to acquire the infection. Cytomegalovirus Doctors and nurses don’t only care for one patient, they Herpes simplex virus move from one patient to another. ***That is why our goal is shorter hospital stays to our Adenovirus clients as per EBP. Respiratory syncytial virus B. Healthcare-Associated Pneumonia (HCAP) Pneumonia in the Immunocompromised Host An important distinction of HCAP is that the causative Pneumocystis pneumonia (PCP) pathogens are often MDR (multi-drug resistant). Fungal pneumonias Often difficult to treat, initial antibiotic treatment must Mycobacterium tuberculosis not be delayed. Initial antibiotic treatment for HCAP is often Causative Agent different from that for CAP due to the possibility of MDR multiple drug resistant) bacteria. The organism that causes PCP is now known as o Occurring in non-hospitalized patient with extensive Pneumocystis jiroveci instead of Pneumocystis carinii. healthcare contact. Pneumonia in the Immunocompromised Host C. Hospital-Acquired Pneumonia (HAP) Occurs with: Develops 48 hours or more after admission and does not Use of corticosteroids or other immunosuppressive appear to be incubating at the time of admission. agents Chemotherapy (chemotherapy attack good and bad cells) Predisposing Factors Nutritional depletion (malnourished) Impaired host defenses Use of broad-spectrum antimicrobial agents Comorbid conditions Acquired immunodeficiency syndrome (AIDS) Supine positioning Genetic immune disorders Aspiration Long-term advanced life support technology Coma Malnutrition Aspiration Pneumonia Prolonged hospitalization Refers to the pulmonary consequences Hypotension resulting from entry of endogenous or Metabolic disorders exogenous substances into the lower airway. Exposure to potential bacteria from other sources Most common form of aspiration Causative Agents pneumonia is bacterial infection from Enterobacter species aspiration of bacteria that normally Escherichia coli reside in the upper airways. Haemophilus influenzae Causative Agents Klebsiella species Staphylococcus aureus Proteus Streptococcus species Serratia marcescens Gram-negative bacilli Pseudomonas aeruginosa Substances other than bacteria may be aspirated into the Staphylococcus aureus (MRSA) lung, such as gastric contents, exogenous chemical Streptococcus pneumoniae contents, or irritating gases. D. Ventilator-Associated Pneumonia (VAP) Pathophysiology Subtype of HAP; however, in such cases, the patient has been endotracheally intubated and has received Risk Factors mechanical ventilatory support for at least 48 hours. Altered resistance (low immune system) Most common in intensive care units. Aspiration of flora present in the oropharynx. Causative Agent Bloodborne organisms that enter the pulmonary VAP occurring within 96 hours of the onset of mechanical circulation and are trapped in the pulmonary capillary bed. ventilation is usually due to antibiotic sensitive bacteria ↓ that colonize the patient prior to hospital admission, Inflammatory reaction can occur in the alveoli, producing an whereas VAP developing after 96 hours of ventilatory exudate that interferes with the diffusion of oxygen and carbon support is more often associated with MDR bacteria. dioxide. ↓ Why patients in the hospital are prone in acquiring White blood cells, mostly neutrophils, also migrate into the pneumonia? alveoli and fill the normally air-filled spaces. The hospital is already home for pathogenic ↓ microorganisms. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 6  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Areas of the lung are not adequately ventilated because of In pneumonia, you can hear crackling sound. secretions and mucosal edema that cause partial occlusion of Tactile fremitus (percuss) in clients with pneumonia is the bronchi or alveoli, with a resultant decrease in alveolar dullness because the air does not feel the lung oxygen tension. parenchyma. ↓ In atelectasis, there would be no sound or diminished Bronchospasm may also occur in patients with reactive airway because it is already collapsed. disease. Patients in ICU has VAP bundle checklist ↓ Hypoventilation causes a ventilation perfusion mismatch in the Assessment and Diagnostic Findings affected area of the lung. History (particularly of a recent respiratory tract infection) ↓ Physical examination Venous blood entering the pulmonary circulation passes Chest x-ray (consolidation or paninigas in lung through the underventilated area and travels to the left side of parenchyma) the heart poorly oxygenated. Blood culture ↓ Sputum examination Mixing of oxygenated and poorly oxygenated blood. Bronchoscopy ↓ Arterial hypoxemia Medical Management Antibiotics Lobar Pneumonia Treatment of viral pneumonia is primarily supportive. A substantial portion of one or more lobes is involved. Hydration is a necessary part of therapy, because fever Bronchopneumonia and tachypnea may result in insensible fluid losses. Pneumonia that is distributed in a patchy fashion, having Antipyretics for headache and fever originated in one or more localized areas within the bronchi Antitussive for cough and extending to the adjacent surrounding lung Warm, moist inhalations relieve bronchial irritation parenchyma. Antihistamines (to modulate sensitive reaction, chemical mediators against allergens) Clinical Manifestations Nasal decongestants may be used; however, excessive Streptococcal (pneumococcal) pneumonia usually has a use can cause rebound nasal congestion. sudden onset of chills, rapidly rising fever (38.5° to 40.5°C Bed rest (easily fatigue) [101° to 105°F]), and pleuritic chest pain that is If hypoxemia develops, oxygen is administered. aggravated by deep breathing and coughing. Pulse oximetry or arterial blood gas analysis is used to Marked tachypnea (25 to 45 breaths/min), accompanied determine the need for oxygen and to evaluate the by other signs of respiratory distress (e.g., shortness of effectiveness of the therapy. breath, the use of accessory muscles in respiration). Administration of high concentrations of oxygen (fraction o Clients with tachypnea uses accessory muscle for of inspired oxygen [FiO2]), endotracheal intubation, and breathing. mechanical ventilation. A relative bradycardia (a pulse–temperature deficit in which the pulse is slower than that expected for a given Nursing Management temperature) Promote hydration (2 to 3 L/day), because adequate Headache hydration thins and loosens pulmonary secretions. Low-grade fever - fever increases in metabolic demand. Provide adequate nutritional support. Pleuritic pain Encourages the patient to perform effective, directed Myalgia cough, which includes correct positioning, a deep Rash inspiratory maneuver, glottic closure, contraction of the Pharyngitis expiratory muscles against the closed glottis, sudden glottic Mucopurulent sputum opening, and an explosive expiration. Flushed cheeks Chest physiotherapy with postural drainage o Chest physiotherapy is done before meals Central cyanosis (lips and nails) because of hypoxemia (nebulization also) because it will induce not only the Orthopnea - difficulty in breathing when lying down secretion but also the food eaten. After CPT, advise the Poor appetite patient to drink warm water to liquify the secretions. Diaphoresis - increased sweating Administers and titrates oxygen therapy as prescribed Tires easily (oxygen is not enough) Recommend rest and avoid overexertion Purulent sputum Observes response to antibiotic therapy Rusty, blood-tinged sputum may be expectorated with Monitor for continuing symptoms of pneumonia, and streptococcal (pneumococcal), staphylococcal, and other complications, such as septic shock, multiple organ Klebsiella pneumonia dysfunction syndrome (MODS) and atelectasis, which may Note develop during the first few days of antibiotic treatment. For any patient with respiratory disorders, one important Note: thing to do is auscultation to hear gas exchange. Pneumonia can be a complication of other conditions. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 7  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Clients in the ICU are attached to ventilator for artificial Abscess formation breathing, the risk is ventilator acquired pneumonia. VAPP bundle checklist is invented to prevent the possible Most lung abscesses are a complication of bacterial occurrence of pneumonia. pneumonia or are caused by aspiration of oral anaerobes onto o Is the patients head elevated 3-45 degrees? the lung. o Did the patient receive oral care with chlorhexidine? ↓ Abscesses also may occur secondary to mechanical or functional obstruction of the bronchi by a tumor, foreign body, or bronchial stenosis, or from necrotizing pneumonias, TB, pulmonary embolism, or chest trauma. ↓ If the pleura is involved, an empyema result. Causative Agents Staphylococcus aureus Klebsiella Other gram-negative species Clinical Manifestations Mild productive cough to acute illness. Fever and a productive cough with moderate to copious amounts of foul-smelling, sometimes bloody, sputum. Leukocytosis Pleurisy or dull chest pain CTTO: https://www.slideserve.com Dyspnea o Because there is necrotic part in the lungs. Take Time to Watch Weakness https://www.youtube.com/watch?v=tvrzQsSUnvU Anorexia 4. Lung Abscess Weight loss Necrosis of the pulmonary Lung Abscess parenchyma caused by microbial infection generally caused by aspiration of anaerobic bacteria. Abscess – there is puss that causes necrosis. Risk Factors Impaired cough reflexes who cannot close the glottis. o Cough is defense mechanism of the body to expectorate the secretion. o Medium of growth for bacteria. Swallowing difficulties. Central nervous system disorders (e.g., seizure, stroke), drug addiction, alcoholism, esophageal disease, or compromised immune function Patients without teeth Nasogastric tube feedings CTTO: https://speciality.medicaldialogues.in Altered state of consciousness due to anesthesia Assessment and Diagnostic Findings Pathophysiology Physical examination of the chest may reveal dullness Complication of bacterial pnemonia or are caused by aspiration on percussion. of oral anaerobes onto the lung Decreased or absent breath sounds with an intermittent pleural friction rub (grating or creaking sound) on Aspiration of infected material or foreign body auscultation. ↓ Crackles Pneumonitis impairs drainage of fluid or aspirated material Chest x-ray ↓ Sputum culture Inflammatory vascular obstruction Fiberoptic bronchoscopy ↓ Tissue necrosis, liquefaction Prevention ↓ Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 8  UA-CONP: C-NCM112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Lecture Appropriate antibiotic therapy before any dental procedures. o E.g., root canal or tooth extraction – window for bacterial infection. Adequate dental and oral hygiene. Appropriate antimicrobial therapy for patients with pneumonia. Medical Management Adequate drainage of the lung abscess may be achieved through postural drainage and chest physiotherapy. Insertion of a percutaneous chest catheter for long-term drainage. Diet high in protein and calorie because chronic infection is associated with a catabolic state. Surgical intervention is rare, but pulmonary resection (lobectomy) is performed if massive hemoptysis (coughing up of blood) occurs or if there is little or no response to medical management. IV antimicrobial therapy depends on the results of the sputum culture and sensitivity. Nursing Management Administer antibiotics and IV treatments as prescribed and monitors for adverse effects. o Emphasize need for compliance and check for adverse effects. Chest physiotherapy is initiated as prescribed to facilitate drainage of the abscess. Educate the patient to perform deep-breathing and coughing exercises to help expand the lung. Encourage a diet that is high in protein and calorie to support the metabolic demand of the body during chronic infections. Educate the patient or caregivers about how to change the dressings to prevent skin excoriation and odor and how to monitor for signs and symptoms of infection, and how to care for and maintain the drain or tube. Remind the patient to perform deep breathing and coughing exercises every 2 hours during the day and shows caregivers how to perform chest percussion and postural drainage. Emphasize the importance of completing antibiotic regimen and of following suggestions for rest and appropriate activity. Monitor for further complications since breathing is already compromised. Take Time to Watch https://www.youtube.com/watch?v=clw3gZJG1Qg Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 9