Respiratory Disorders
What are some signs an symptoms of asthma
- Audible wheezing initially louder on expiration, shortness of breath, tachypnea, coughing, use of accessory muscles, Hypoxia(PCO2 high)
What are the two types of pneumonia
- Community-Acquired - Hospital- Acquired
What is the chest tube size for a child or young adult
16-20 F
Hemoptysis
Blood in sputum
What is the chest tube size for most adults
24-32 F
What is the chest tube size for an infant or small child
8-12 F
Pleural Effusion
Accumulation between the pleural layers
Pneumothorax
Air accumulation in the pleural space causing the lung to collapse
Spontaneous pneumothorax
Air accumulation in the pleural space causing the lung to collapse with no evidence of trauma or lung disease
What medications are used for treatment of emergency asthma
Albuterol, Atrovent
What will we always have for a chest tube
An inclusive dressing
A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the tube was accidentally removed. What should the nurse do?
Apply sterile gauze to the insertion site
What is a sign of severe asthma
Barrel Chest
What is Asthma
Chronic, intermittent condition with reversible airway obstruction caused by: Inflammation, airway hyper responsiveness causing bronco constriction
What are allergens that can cause inflamed airway leading to asthma
Cockroaches, dust mites, mold, and pollen
FEV
Forced volume in the first second
Bronchospasm
Narrowing/Constriction of bronchial tubes
A nurse is caring for a client who is scheduled for a thoracentesis, What supplies would the nurse need?
Oxygen Equipment, Pulse ox, and Sterile Dressing
A nurse is assisting a provider with removal of a chest tube. What should the nurse instruct the client to do?
Perform the Valsalva maneuver - Breath, exhale, and bear down
A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure, what action should the nurse take?
Position the client in an upright position, leaning over the bedside table.
Tachypnea
Rapid respiratory rate
Dyspnea
Shortness of breath/difficulty breathing
What is 40% of hospital pneumonia due to
Ventilator associated pneumonia
What will you hear with a patient with asthma
Wheezing
Where does gas exchange occur
Between Alveoli and the lung capillaries
Hemothorax
Blood accumulation in the pleural cavity
A nurse is caring for a client following a thoracentesis. What would the nurse need to know is a risk for complication?
Dyspnea, Fever, and Hypotension
PEF
Fastest airflow rate at any time during expiration
What are the medications used for daily inhaler for asthma
Flovent, Serevent, Tilade
What are the severe COPD complication
Hypoxemia, Hypercarbia, Respiratory acidosis, Respiratory infection, dysrhythmias, cardiac failure
What is the most common drainage system for a chest tube
Pleur-Evac System 9 One piece disposable system with 3 chambers)
What position should you keep a patient in for a pneumothorax
Semi-Fowlers
What position should the pt be in for a hemothorax or pleural effusion
Semi-fowlers
What can happen if infectious pneumonia is left untreated?
Sepsis
Why is it important to provide good oral care for pt with pneumonia
They can aspirate on the bacteria in their mouth and then it will start to grow in their lungs
What are the symptoms of an emergency asthma attack
- Bluish color of lips/face - Decreased LOC - Extreme difficulty breathing - Extreme tachycardia - Severe anxiety due to SOB - Diaphoresis - Chest pain
What should you assess with the pt for a chest tube
-CT site, dressing, respiratory status and breath sounds, trachea alignment, and pain
What is the chest tube size for large adults
36-40 F
What are irritants that cause inflamed airways causing asthma
- Strong odors (perfume, bug spray, floor wax) - Smoke
What are the pulmonary function test we can run
- forced Vita Capacity - Forced Expiratory volume - Peak expiratory flow
What lab test do we do for asthma
ABG - Decreased PaO2, Increased PaCO2
A nurse working on a med-surg unit admits a client. 2 hours after admission, the clients SaO2 is 91% and he is exhibiting audible wheezers and use of his accessory muscles. What medication should the nurse administer?
Beta Agonist
Orthopnea
Difficulty breathing when lying down relieved by string up
A nurse is assessing a client with asthma. What risk factor is associated with the disease?
Environmental allergies
A nurse is assesing a client who is in respiratory distress. The nurse should know what can cause low pulse ox readings?
Inadequate peripheral circulation, hypothermia, decreased Hgb level, and Edema
Paroxysmal Nocturnal Dyspnea
Intermittent dyspnea during sleep causing the patient to awaken
Right lung
- Has 3 lobes, does 60-65% of the functioning
Left Lung
2 lobes
What will you see with Chronic Bronchitis
Inflammation of Bronchi or bronchioles Results in cough, mucous production, and SOB
A nurse in the ER is caring for a client who was admitted with an acute asthma attack. What indicated the clients resp status is declining?
Wheezing, Retraction of sternal muscles, and Premature ventricular complexes
What should you tell the pt to help with the chest tube
- cough, deep breathe, and use incentive spirometer - Reposition if pt is uncomfortable - Help manage pain
How much should the water seal chamber rise and fall with inhalation and exhalation
2-4 cm
A nurse is assessing a client following a bronchoscopy. What should the nurse notify the provider about?
Bronochospasms
What are ways to prevent HAP?
Strict hand hygiene, oral care (every 6 hours), HOB greater than 30% incline
What does the water-seal chamber do
- Prevents air from flowing back into the patients pleural space - Should always contain 2cm of water - One way valve and will bubble as air passes through until all air ecscapes
What is the placement for a chest tube for blood or fluid
- Side placement near the base of the lung - May have more than one placed anterior an posterior after a lung or heart surgery - Covered with air tight dressing
What are the causes of COPD
- Smoking, Chemical fumes, Dust, air pollution, rare-genetic disorder called alpha 1 antitrypsin
What is the chest tube placement for air
- Typically near front of the lung apex - Covered with air tight dressing
What will you hear in a pt with pneumonia
Crackles
What is pneumonia
Excess of fluid in the lung resulting from an inflammatory process usually triggered by an infectious organism or inhaled respiratory irritant.
What populaton do we have to worry about pneumonia the most
Older adults
When are you allowed to clamp a chest tube
Only if changing out the container
What does the collection chamber do
- Collects fluid draining from the patient - measure fluid hourly for first 24 hours
What should the nurse education a patent with pneumonia about
- Complete all antibiotics - Notify if chills, fever, cough, fatigue, or dyspnea last longer than 2/3 days after going home - Rest, healthy diet, fluid intake - Quit smoking
What does the regulator chamber do
- Connected to wall suction and turned up to match physicians order (usually around 20cm of suction) - Causes continual bubbling (but should not be aggressive bubbling)
What are some forms of asthma management
- Decreased hospital admissions - Tailored to meet pt personal triggers, manifestation pattern, and drug response - Usually includes a daily asthma prevention medication and emergency relief medication
What are the three chambers for a chest Pleur-Evac
- Drainage collection chamber - Water Seal chamber - Suction regulator chamber
What are the two types of COPD
- Emphysema (alveolar) - Chronic bronchitis (airway)
What are the clinical manifestations you will see in a pt with pneumonia
- Flushed cheeks, bright eyes, anxious expression - Chest discomfort, headache, chills, tachypnea, dyspnea, tachycardia, sputum production - Chest muscle weakness - Crackles
What will test show for asthma due to allergies
- Increased WBC greater than 12 - Sputum with eosinophils, mucous plugs, and epithelial cells
What are the two major changes you will see in a pt with emphysema
- Loss of lung elasticity and lung hyperinflation results in Dyspnea, tachypnea, and barrel chest
What must you have an MD order to do for a chest tube
- Manage water seal or wall suction - CT site dressing changes
What should you never do with a chest tube
- Never milk tube (raises pressure in the lung) - Do not let tube go above the head
What will you see to diagnose pneumonia
- Sputum culture (know what organism is growing) - WBC above 12,000 - Blood cultures - ABG - Increased BUN and hypernatremia with dehydration - Pulse ox - Bronchoscopy
What are the things you should notify a MD about with a CT
- Treacheal deviation, sudden onset of dyspnea, PoX less than 90, CT drainage less than 70ml/hr, Accedental removal of CT, excessive bleeding
What are some ways to prevent getting pneumonia
- flu vaccine and yearly pneumococcal vaccine - Avoid crowds during flu season - Do not smoke - Get sleep, eat balanced diet, and drink at least 3L of fluid - Strict hand hygiene
What clients have an increased risk for developing pneumonia
Client with dysphagia, client with AIDS, Client who has a closed head injury and is receiving ventilation, and client who has myasthenia gravis.
A nurse is planning care for a client following the insertion of a chest tube and drainage system, What should be part of the plans of care
Encourage the client to cough every 2hr, Check for continuous bubbling in the suction chamber, and obtain a chest x-ray
A nurse is assessing a client who has a chest tube and drainage system in place. What are some expected findings?
Gentle constant bubbling in the suction control chamber. and rise and fall in the level of water seal chamber with inspiration and expiration
A nurse is teaching a group of clients about influenza. Which of the following statements by a client requires clarification.
I need to avoid drinking fluids if I develop symptoms
A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. What statement by a client indicates teaching is effective?
I take the mediation to prevent asthma attacks
A nurse is completing discharge teaching with a client who has a new prescription for prednisone for asthma. What statement by the client indicates need for further teaching?
I will take my medication on an empty stomach
What should you do if the CT accidentally comes out
Immediately cover the insertion site
What would cause an incorrect pulse reading on the pulse ox?
Nail Polish
What are the parts of the respiratory system?
Nose, Trachea, Right and left lungs,Right and left bronchus, Bronchioles, Alveolar ducts, and Alveoli
A nurse is caring for a client who was brought into the clinic by a partner, The partner states they woke up and the client did not recognize him or where where she was. The client reports chills and chest pain upon inspiration. What is the priority of the nurse?
Obtain a baseline VS and oxygen saturations
A nurse is preparing to care for a client following chest tube placement. What should the nurse have in the clients room?
Oxygen, Sterile Water, Enclosed Hemostat, Occlusive dressing
A nurse is caring for a client who has pneumonia. Assessment findings include temperature 37.8, resp 30, BP 130/76, HR 100, and SaO2 91% on room air. What are the priorities of the nurse in order?
Perform Sputum culture, Adminster antibiotics as prescribed, administer oxygen therapy, and administer an antipyretic medication to promote client comfort.
Who is most at risk for a spontaneous pneumothorax
Tall skinny males
Where is a chest tube inserted
Through the rib space of the the thorax into a pleural space to remove air/fluid - It is attached to a water-seal chest drainage device usually used after surgery or for a lung collapse
FVC
Volume of air exhaled from full inhalation to full exhalation
What is Atelectasis
When the alveolar collapse causing a reduction in gas exchange