Module 3: Altered Ventilatory Function PDF

FAR EASTERN UNIVERSITY INSTITUTE OF HEALTH SCIENCES AND NURSING DEPARTMENT OF NURSING NUR 1219 MEDICAL-SURGICAL NURSING 3...

FAR EASTERN UNIVERSITY INSTITUTE OF HEALTH SCIENCES AND NURSING DEPARTMENT OF NURSING NUR 1219 MEDICAL-SURGICAL NURSING 3 ACUTE BIOLOGIC CRISIS MODULE 3 ALTERED VENTILATORY EMPHYSEMA FUNCTION Two Types of Emphysema Topic Outline 1. Panlobular Emphysema 1. Acute/Chronic Obstructive Pulmonary 2. Centrilobular (Centroacinar) Emphysema Diseases 2. Acute Respiratory Distress Syndrome Manifestations 3. Pneumonia Pink puffer 4. Pneumothorax Mild production of Sputum 5. SARS-CoV 2/ Covid-19 Disease Barrel Chest Dyspnea, OVERVIEW Cough may be present This module tackles various discussions on the clinical manifestations involved in the selected diseases of the CHRONIC BRONCHITIS Respiratory System. Acute and Chronic Obstructive Manifestations Pulmonary Diseases, Acute Respiratory Distress Blue bloater Syndrome, Pneumonia, Pneumothorax, and the recent Productive Cough COVID-19 Disease will be discussed thoroughly Thick, gelatinous sputum highlighting the nature of the disease, pathophysiology, Wheezing might be present defining characteristics, management, and relevant Notable dyspnea nursing care. Diagnostic Procedures: The respiratory diseases mentioned above entail Spirometry immediate management to prevent serious health ABG levels complications. Death may arise if nurses will not Chest X-ray immediately respond to the needs of the patients thus, Alpha1-antitrypsin assay thorough understanding on all the principles involved is a must to achieve the intended preservation of life. Early MEDICAL MANAGEMENT detection on the important defining characteristics will pave way on the recovery of patients. Drugs Bronchodilators to relieve bronchospasm The care of patients with respiratory diseases will Inhaled and systemic corticosteroids include health care collaboration. Nurses must be aware Alpha1-antitrypsin augmentation therapy that other members of the health care team will be Antibiotic Agents involved to help various clients recover faster. Multi- Mucolytic agents therapies will be instituted uniquely based on the Antitussive agents individual needs of the patients. With the complexity of Vasodilators and various health care management as planned, Nurses Narcotics must execute these complex interventions in a precise and competent manner. Surgical Management Bullectomy Though secondary and tertiary level of care are usually Lung Volume Reduction Surgery involved in emergency cases, primary level of prevention must still be included to as part of the NURSING CARE MANAGEMENT Teaching-coaching and helping role of Nurses. 1. Pulmonary rehabilitation to reduce symptoms, Mastering the basic tenets on the care of critically-ill improve quality of life, and increase physical patients with respiratory diseases using the nursing and emotional participation in everyday process will be end point of this module. activities 2. Pursed-lip breathing helps slow expiration, ACUTE/CHRONIC OBSTRICTIVE prevents collapse of small airways, and helps PULMONARY DISEASES the patient control the rate and depth of A disease characterized by airflow limitation that is not respiration fully reversible.  3. Instruct the patient to coordinate diaphragmatic Supportive drugs includes surfactant breathing with activities such as walking, replacement therapy, pulmonary bathing, bending, or climbing stairs antihypertensive agents and antisepsis agent 4. Provide small frequent meals and offer liquid nutritional supplements to improve caloric NURSING INTERVENTIONS intake and counteract weight loss Requires close monitoring in the intensive care 5. Administer low flow of oxygen (1-2L/min) as unit ordered Assess the patient’s status frequently to 6. Administer bronchodilator as prescribed evaluate the effectiveness of the treatment 7. Adequately hydrate the patient Turn the patient frequently to improve 8. Instruct the patient to avoid bronchial irritants ventilation and perfusion in the lungs and 9. If indicated, perform CPT in the morning and at enhance drainage secretions night as prescribed Rest is essential for patient to limit oxygen 10. Encourage alternating activity with rest periods consumption and reduce oxygen needs 11. Teach relaxation technique or provide a Adequate nutritional support is vital, 35 to 45 relaxation tape for patient kcal/kg/day is required to meet caloric 12. Enroll patient in pulmonary rehabilitation requirements program where available Identify problems with ventilation that may 13. Monitor respiratory status, including rate and cause anxiety reaction to the patient pattern of respirations, breath sounds, and signs and symptoms of acute respiratory distress PNEUMONIA Inflammation of the lung parenchyma ACUTE RESPIRATORY DISTRESS Two types: SYNDROME o Community Acquired Pneumonia Is a severe form of acute lung injury. This clinical (CAP) syndrome is characterized by a sudden and progressive o Ventilatory Acquired Pneumonia pulmonary edema, increasing bilateral infiltrates on (VAP) chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of MANIFESTATIONS: Patients often demonstrate reduced lung compliance Sudden onset, rapidly rising fever of 38.3° C to 40.5° C MANIFESTATIONS Cough productive of purulent sputum Typically develops over 4 to 48 hours Pleuritic chest pain aggravated by deep severe dyspnea, severe hypoxemia respiration/coughing Arterial hypoxemia that does not respond to Dyspnea, tachypnea accompanied by supplemental oxygen respiratory grunting, nasal flaring, use of chest x-ray are similar to those seen with accessory muscles of respiration, fatigue cardiogenic pulmonary edema Rapid, bounding pulse increased alveolar dead space Orthopnea Severe crackles and rhonchi heard on Rusty, blood-tinged sputum auscultation Poor appetite Labored breathing and tachypnea Diaphoresis DIAGNOSTIC PROCEDURES DIAGNOSTIC PROCEDURES Clinical presentation and history of findings Chest X-ray shows presence/extent of Hypoxemia on ABG despite increasing inspired pulmonary disease, typically consolidation. oxygen level Gram stain and culture and sensitivity tests of Chest x-ray shows bilateral infiltrates sputum may indicate offending organism. Plasma Brain Natriuretic Peptide (BNP) Blood culture detects bacteremia (bloodstream Echocardiography invasion) occurring with bacterial pneumonia. Pulmonary Artery Catheterization MANAGEMENT MANAGEMENT Administration of the appropriate antibiotic as Treatment of the underlying condition determined by the results of a Gram stain Optimize oxygenation pneumoniae - macrolide antibiotic Intubation and mechanical ventilation (azithromycin, clarithromycin, or Sedation may be required erythromycin) Paralytic agents may be necessary Pseudomonas infection – anti pneumococcal, Antibiotics, as indicated antipseudomonal beta-lactam PEEP usually improves oxygenation  Treatment of viral pneumonia is primarily Surgical intervention by pleurodesis or supportive thoracotomy with resection of apical blebs is advised Oxygen therapy if patient has inadequate gas for patients with recurrent spontaneous pneumothorax exchange Tension Pneumothorax NURSING INTERVENTIONS Immediate decompression to prevent Encourage coughing and deep breathing after cardiovascular collapse by thoracentesis or chest-physio therapy, splinting the chest if chest tube insertion to let air escape necessary Chest tube drainage with underwater-seal Maintain semi-Fowler’s position suction to allow for full lung expansion and Monitor pulse oximeter healing Promote hydration(2-3L/day) to liquefy secretions Open Pneumothorax Teach effective coughing techniques to Close the chest wound immediately to restore minimize energy expenditure; plan rest periods adequate ventilation and respiration Suction if necessary Patient is instructed to inhale and exhale gently Instruct client to cover nose and mouth when against a closed glottis (Valsalva maneuver) as coughing a pressure dressing (petroleum gauze secured Teach the need to continue entire course of with elastic adhesive) is applied. This maneuver antimicrobial therapy which is usually seven to helps to expand collapsed lung ten days Chest tube is inserted and water-seal drainage Teach the patient about proper administration set up to permit evacuation of fluid/air and of antibiotics and potential side effects. produce re-expansion of the lung Teach that findings are expected to be less Surgical intervention may be necessary to within 48 to72hours of initial therapy repair trauma Nutritionally enriched drinks or shakes maybe helpful in maintaining nutrition NURSING INTERVENTIONS 1. Apply petroleum gauze to sucking chest wound PNEUMOTHORAX 2. Assist with emergency thoracentesis or occurs when the parietal or visceral pleura is thoracostomy breached and the pleural space is exposed to 3. Position patient upright if condition permits to positive atmospheric pressure allow greater chest expansion 4. Maintain patency of chest tubes TERMINOLOGIES 5. Assist patient to splint chest while turning or Simple/Spontaneous Pneumothorax coughing and administer pain medications as Traumatic Pneumothorax needed Open pneumothorax 6. Monitor oximetry and ABG levels to determine Tension Pneumothorax oxygenation. 7. Provide oxygen as needed MANIFESTATIONS Hyperresonance Diminished breath sounds. SARS-COV 2/ COVID-19 DISEASES Reduced mobility of affected half of thorax. Newly discovered Corona Virus originated Tracheal deviation from Wuhan, China (December 2019). This Air hunger, agitation, hypotension, cyanosis serious disease attacks the respiratory system and profuse diaphoresis that may lead to imminent death. Mild to moderate dyspnea and chest discomfort Incubation period: 2-14 days may be present with spontaneous pneumothorax PREDISPOSING FACTORS The Host (Individual) MANAGEMENT Age (Older Population) Spontaneous Pneumothorax Smokers Treatment is generally nonoperative if pneumothorax is Immunosuppressed individuals not too extensive. Existing Comorbidities (Serious Medical 1. Observe and allow for spontaneous resolution Condition) for less than 50% pneumothorax in otherwise 1. Heart Disease healthy person. 2. Diabetes 2. Needle aspiration or chest tube drainage may be 3. Lung Disease necessary to achieve re-expansion of collapsed Family Life and Culture (wild life diet lung if greater than 50% pneumothorax. practices)  Lack of Discipline and Education References Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, The Environment K. H. (2013). Brunner and Suddarth’s textbook of Population Density (crowded) medical-surgical nursing (13th ed.). Philadelphia: High level exposure to wet market with Lippincott Williams & Wilkins. wildlife animal trading Sole, M. L., Klein, D. G., & Moseley, M. J. (2013). Introduction to critical care nursing. St. The Agent Louis, Mo: Elsevier/Saunders. k.a: SARS-CoV-2 World Health Organization E-Manual attaching protein spikes in the lungs Centers for Disease Control and Prevention E-Manual Phases of Attack 1. Viral Replication 2. Hyperactivity of Pulmonary System 3. Pulmonary Destruction MANIFESTATIONS Cough Sore Throat Headache Diarrhea Fever Loss of Smell Loss of Taste Difficulty of Breathing Shortness of Breath Haziness and tiny white spots in the X-ray Result DIAGNOSTIC TEST SWAB TEST: rt-PCR (Real-Time Polymerase Chain Reaction) MANAGEMENT Drugs Tocilizumab Remdesivir Baricitinib+Remdesivir Low dose Heparin or Enoxapin Management: Supportive Care Providing fluids Providing oxygen Ventilatory support (Mechanical Ventilator) if indicated General Measures to Prevent COVID-19 1. Educate the general public regarding the disease 2. Encourage people to practice healthy lifestyle 3. Vaccination Specific Measures to Prevent COVID-19 1. Hand washing 2. Alcohol based Sanitizers 3. Avoid crowded places 4. Avoid travelling to high risk places 5. Avoid touching eyes, nose, and mouth 6. At least 1ft away from a person with symptoms