Revised Shortened Respiratory Review PPT Fall student.pdf

Respiratory Review Foundations of Nursing Practice Theory Course Kathryn Kushto-Reece, MSN, RN Nicole Y. Johnson, MSN, RN Shari Lynn, MSN, RN  What is our stimulus for breathing? CO2 What is the stimulus for breathing of a patient with...

Respiratory Review Foundations of Nursing Practice Theory Course Kathryn Kushto-Reece, MSN, RN Nicole Y. Johnson, MSN, RN Shari Lynn, MSN, RN  What is our stimulus for breathing? CO2 What is the stimulus for breathing of a patient with COPD? O2 What is eupnea? RESPIRATORY Normal respirations REVIEW What is bradypnea? Slow respiratory rate. Should you be concerned that your patient’s inspiratory rate to expiratory rate is 1:2. No, expiration is longer than inspiration. What is normal respiratory rate for adults? 12-20 breaths per minute. What is normal respiratory rate for infants? 30-60 breaths per minute. RESPIRATORY REVIEW How does body Upright posture position affect promotes ease of respiration? lung expansion How does the Pollution, environment allergens, affect respiration? humidity How do lifestyle Smoking, drugs, habits affect alcohol respiration?  RESPIRATORY REVIEW Your patient has increased WOB. What does WOB stand for? Work of Breathing A term used to describe the effort it takes to breathe What are two conditions that increase WOB? Restrictive lung movement Airway Obstruction  RESPIRATORY REVIEW What characterizes restrictive lung movement/diseases and how does it increase WOB? While both restrictive and obstructive conditions cause shortness of breath, restrictive lung diseases (RLD) are defined by difficulty filling the lungs with air during inhalation. RLD is characterized by the following: Decreased total volume of air and capacity. Decreased elasticity of the lungs. Decreased expansion of the chest wall during inhalation. Stiffening of the lungs (i.e., Idiopathic pulmonary fibrosis). See diagram. RESPIRATORY REVIEW Your patient is diagnosed with pneumonia? What is happening in their lungs? Accumulation of pus or fluid in the alveoli d/t inflammation, which causes consolidation. Your patient now has atelectasis. What does that mean? Airway partial/complete collapse of a lung or lobe of the lung. RESPIRATORY REVIEW What characterizes obstructive lung diseases and how does it increase WOB? obstructive lung diseases (i.e., asthma & COPD) are characterized by an obstruction in the air passages causing more difficulty with exhaling air, which causes increased residual air volume. What is happening with airway obstruction, and how does it increase WOB? The diameter of the airway is decreased, and the resistance is increased. What are the three main components of airway obstruction in a patient with Asthma? 1. Bronchoconstriction 2. Inflammation 3. Mucous production RESPIRATORY REVIEW What is COPD? Chronic Obstructive Pulmonary Disease. With COPD, the airways in your lungs become inflamed and thicken, and the tissue where oxygen is exchanged is destroyed. The flow of air in and out of your lungs decreases. Airway obstruction and resistance occurs with decreased gas exchange; CO2 retention. Your patient has COPD. What symptoms would you expect to see? SOB Cough with mucous Fatigue Frequent lung infections You have two additional patients. One has emphysema and one has bronchitis. Are these different than COPD? COPD includes both conditions. RESPIRATORY REVIEW Your patient is using accessory muscles to breath. What does that mean? Use of muscles other than diaphragm and intercostal muscles. What are the accessory muscles? Sternocleidomastoid & neck, pectoralis major (largest ant chest), trapezius muscles (largest back), intercostal muscles (between ribs), abdominal muscles (diaphragm). This patient is having difficulty breathing. What position are they in to attempt to breathe easier? Tripod Signs and Symptoms of Altered Respiratory Function A patient is admitted to the ED. What signs/symptoms would you see that indicate altered respiratory function? Cough SOB/Dyspnea Sputum Bradypnea/Tachypnea/Cheyne Stokes Chest pain Use of accessory muscles Adventitious breath sounds RESPIRATORY REVIEW What is Cheyne-stokes breathing? Cheyne-stokes an increased in rate and depth of respirations followed by a period of apnea. Cyclic, end stage. What is stridor? A high-pitched sound heard on inspiration and associated with upper airway obstruction and/or edema. http://www.youtube.com/watch?v=QkaX83H31QY  RESPIRATORY REVIEW What is the condition of the patient’s fingers in picture #1? Cyanosis- Is a blue color of the skin, lips, mucous membranes, or nail beds in the periphery. What causes it? Lack of oxygen when the amount of oxygen bound to hemoglobin is very low. What is the condition of the patient’s fingers in picture #2? Clubbing- Is seen in chronic cardiac/ respiratory diseases. What causes it? Lack of oxygen from chronic tissue hypoxia. RESPIRATORY REVIEW What is a normal pulse ox reading? 95-100% Depends, some COPD pts have O2 sat in the low 90’s or less. A baseline O2 sat is needed. Refer to oxyhemoglobin curve RESPIRATORY REVIEW What are some interventions to improve respiratory function? Hydration Positioning Ambulation Deep breathing Stacked/huff cough, Incentive spirometer, & Purse lip breathing Connect the Dots a. Device used for a measured delivery of respiratory Peak Flow meter. medication to the lungs. Spacer Acapella B. Measures the peak expiratory volume with forced exhalation. Record before and after treatment Nebulizer treatment C. Uses positive expiratory pressure to force air behind the sputum and move it upward. Metered Dose Inhaler (MDI) D. Ensures patient receives all medication and decreases bad taste of medication. e. Delivers aerosolized medicine directly to the lungs.  THREE PRINCIPLES OF OXYGEN THERAPY LOWEST CONCENTRATION FOR ASSESS THE PT'S RESPIRATORY MONITOR ABG'S AND O2 SAT. THE SHORTEST PERIOD OF TIME. STATUS.  RESPIRATORY REVIEW If O2 is >3 L, how should it be delivered? Humidified, especially if > 3L What is a typical order for O2? O2 to keep sats > 95 o O2 via NC at 2L/min r​ %​ RESPIRATORY REVIEW What does low flow mean? What are some examples of Low Flow delivery system?  LOW FLOW DOES NOT NASAL CANNULA, SIMPLE FACE WHAT DOES HIGH FLOW MEAN? MEET ALL PT VENTILATORY MASK, 100% NON-REBREATHER, DEMAND, MIXES WITH RA. PARTIAL RE-BREATHER. RESPIRATORY REVIEW PREMIXES RATIO OF O2 AND AIR, HIGH FLOW NASAL CANNULA PROVIDES ALL VENTILATORY VENTURI MASK, TRACHEOSTOMY DEMANDS OF PT, PRECISE FIXED COLLAR, O2 HOOD. O2 CONCENTRATION. Low flow oxygen delivery systems Nasal cannula Partial rebreather 1-6L=24-60% O2 10-15L per min 30-60% O2 Simple Face Mask >5L – 10L per min Nonrebreather 40%-60% O2 10L-15L min 55%-90% O2 Name that high flow oxygen delivery system High flow nasal Venturi mask Tracheostomy collar Oxygen hood/tent cannula Meets entire ventilator 28%-98% O2 concentrations >60% Increases FI O2 demand for COPD High humidity High humidity Premixed air and O2 patient Generates up to 60L/ Colored valves at min flow 24%-60% Heated and Requires humidified humidification Precise and accurate  What is our normal CO2 is the normal stimulus stimulus to breath. for breathing? RESPIRATORY O2 (they have high levels of REVIEW What is a COPD CO2 retention so do patient’s normal not respond stimulus for to chemoreceptors, breathing? O2 becomes stimulu. s​  RESPIRATORY REVIEW Your patient Bobby Turner is admitted with pneumonia and his RR is 28 and pulse ox is 94% and he is not complaining of SOB. Which O₂ delivery system would you use for him? A low flow delivery system. He can meet some of his own demand is breathing somewhat normally. Elevated RR but no other signs of ↑ WOB or respiratory distress or dropping O₂ below 93%. Use NC or simple face mask, start with 2L O₂ check pulse ox RR, and WOB. RESPIRATORY REVIEW Your patient Hannah Smith is admitted with exacerbation of COPD. She is SOB, tachypneic, and extremely fatigued. Her pulse ox reading is 92%. She is on 2L of O2 at home at night per NC. What is the best O2 delivery system for her while she is hospitalized? RESPIRATORY REVIEW Hannah would benefit best with a Venturi mask. That would give us the most accurate % of oxygen she is on and prevent her from receiving excessive oxygenation. Why does this concern us knowing Hannah’s diagnosis?  A 35 -year-old patient is admitted to the ED and is suspected of having a panic attack. She is light-headed, short of breath, and complaining of tingling and numbness around her mouth. Her respiratory rate is 40 bpm. What is happening to the patient What is your treatment plan?  ​ ?​  The patient is hyperventilating most likely having a panic attack. They are decreasing the levels of CO₂ in their blood. RESPIRATORY REVIEW Patient needs a partial/ rebreather to re-breathe some of their own CO₂ and provide additional O₂. She also needs to take slow deep breaths in though their nose and out through pursed lips (like blowing out a candle).  RESPIRATORY REVIEW Patient is admitted to the ED with pneumonia and ARD (Acute Respiratory Distress). Symptoms includ : SOB and cough RR 38, HR 106 Chest pain Course and diminished breath sounds Pulse ox 89-90% RA e​ RESPIRATORY REVIEW What is the treatment plan/O2 delivery system? Non re-breather mask with bag. Flow rate 10-15L (all the way up to inflate bag). Delivers approximately 55-90% O2.  A 45- year- old female had abdominal hernia repair and is on O2, 3L via NC. The doctor ordered that the patient be weaned from her O2. How would you attempt to do this? What assessment and interventions are necessary when weaning a patient from Oxygen?  ​ RESPIRATORY REVIEW When you wean a patient from oxygen you do it incrementally. So maybe begin by changing patient O2 from 3L to 2.5 or 2 Liters. Reduce as patient tolerates. Monitor patient and continue as tolerated. You need to monitor the patients O2 sats, work of breathing, color RR etc. while weaning. RESPIRATORY REVIEW What is the purpose of tracheal suctioning?  RESPIRATORY REVIEW Removal of secretions through a tube in place in a surgical opening (stoma). Maintains a patent airway. RESPIRATORY REVIEW How do we assess the need for suctioning? RESPIRATORY REVIEW Assessments Audible upper Adventitious breath indicating the need airway noise/ sounds. for suctioning are: gurgling. Decreased PaO₂ or Restlessness, Cyanosis decrease pulse ox. agitation. Increased WOB; retractions, nasal flaring, tachypnea, SOB. What are the principles of suctioning? RESPIRATORY REVIEW Suction to end of tracheostomy tube or max, 1cm. beyond. (measure length tube). Apply suction only on way out of airway, intermittently or continuously. Rotate the catheter as you apply suction Do not suction longer than 10-15 secs. (5-10 seconds for infant/young child) Hyper oxygenate the patient before and between passes. No more than 3 passes with catheter at one session. RESPIRATORY REVIEW What are some complications of suctioning? RESPIRATORY REVIEW Edema, obstruction (secretions, foreign Hypoxia/bronchospasms body). Expulsion of trach/ Infection decannulation Hemorrhage Skin Breakdown Great job with the respiratory system. Take a moment to….. Before we move on to this week’s NCLEX NEXTGEN question. Next Gen Questions Patient Roberts was admitted with SOB, an increased respiratory rate and WOB. His O2 sats are 93% and he is coughing and complaining of chest pain, 5/10. Normal Abnormal RR 28 O2 Sats 93% Accessory muscle use Temp 37.9 C Pain rating 5/10 NexGen Based upon your data for patient, RR 28, O2 sats 93%, coughing, use of accessory muscles and chest pain, what do you suspect? Foreign body aspiration MI (Myocardial Infarction) Pneumonia Scoliosis  Next Gen You perform an updated assessment on your patient. His RR is 26, O2 sats 94%, cont. use of accessory muscles, and his pain rating a 5/10. Please indicate the thing that improved or stayed the same. Improved Same RR O2 sats Accessory muscle use Pain rating