Care of the patient with a respiratory disorder
Use of a hypertonic saline aerosol mist is indicated if___________.
the patient cannot raise sputum spontaneously, instruct the patient to take several normal breaths of the mist, inhale deeply, cough, and expectorate.
hypoventilation
the condition in which the amount of air that enters the alveoli and takes part in gas exchange is not adequate for the body's metabolic needs.
What happens in respiratory acidosis?
the kidneys attempt to compensate by reabsorbing increased amounts of HCO3−.
What happens in respiratory alkalosis?
the kidneys excrete HCO3− in increased amounts in an attempt to lower pH through compensation.
Medical management for pleural effusion:
thoracentesis - less than 1300 to 1500 mL at one time is recommended chest tubes
Indications for fluid removal for diagnostic purposes of a thoracentesis include:
(1) examining the pleural fluid for specific gravity, white blood cell count, red blood cell count, protein, and glucose (2) culturing the fluid for pathogens and checking for abnormal or malignant cells.
Objective data when assessing the patient with Legionnaires' disease include:
* A significantly elevated temperature (102° to 105° F [38.8° to 40.5° C]). nonproductive cough with difficult and rapid breathing. crackles or wheezes. Because of the high fever and extreme respiratory effort, tachycardia and signs of shock may be present. Hematuria may develop, indicative of renal impairment.
PE diagnostic tests:
* ABGs - respiratory alkalosis develops early from hyperventilation as respiratory drive diminishes. Respiratory acidosis with hypoxemia often follows. * chest x-ray; shows an enlarged main pulmonary artery. CT scan Helical/spiral scan V/Q scan Pulmonary angiography serum D-dimer test venous ultrasound
Allergic rhinitis and allergic conjunctivitis (hay fever) clinical manifestations:
* Acute ocular manifestations include edema, photophobia, excessive tearing, blurring of vision, and pruritus. * Excessive secretions or inability to breathe through the nose because of congestion and/or edema. * Otitis media symptoms can occur if the eustachian tubes are occluded.
Medical management for laryngitis:
* Antibiotics (such as erythromycin or levofloxacin [Levaquin]). * Analgesics or antipyretics for comfort * Antitussives to relieve cough (such as promethazine [Phenergan] with codeine) * throat lozenges to promote comfort and decrease irritation are useful
severe OSA nursing interventions:
* CPAP machine * BiPAP machine
Laryngeal cancer clinical manifestations:
* Progressive or persistent hoarseness is an early sign * Signs of metastasis to other areas include pain in the larynx radiating to the ear * Difficulty in swallowing (dysphagia) * Feeling of a lump in the throat * Enlarged cervical lymph nodes
Clinical manifestations for SARS:
* SARS begins with a fever greater than 100.4° F (38° C) headaches an overall feeling of discomfort muscle aches mild respiratory symptoms a dry cough (after 2 to 7 days) SOB * intubation and mechanical ventilation
Nursing interventions for SARS
* The infection control nurse must notify the local public health department. Respiratory isolation Hand hygiene
Objective data during an epistaxis episode includes:
* Vital signs * evidence of hypovolemic shock * hypotension is a late sign of shock
Medications used in tonsillitis include:
* analgesics and antipyretics (e.g., acetaminophen) * antibiotic agents (e.g., penicillin) * Warm saline gargles are also beneficial
Medical management for allergic rhinitis/hay fever:
* antihistamines * intranasal corticosteroids (nasal corticosteroids were once considered appropriate treatment they are no longer recommended because of the tolerance that is built up with continuous use) * leukotriene receptor antagonists * decongestants (Actifed, Triaminic, and Robitussin)
mild OSA nursing interventions:
* avoid sedatives and alcoholic beverages for 3 to 4 hours before sleep. * weight loss may help, since excessive weight exacerbates symptoms.
Sinusitis
* can be acute or chronic * begins as an upper respiratory infection (pneumonia or nasal polyps) * can involve the maxillary and frontal sinuses
clinical manifestations for sinusitis include:
* constant headache with pain in the sinus area involved * purulent exudate.
Nursing interventions for the patient after bronchoscopy include:
* keeping the patient on NPO (nothing by mouth) status until the gag reflex returns, usually about 2 hours after the procedure * keeping the patient in a semi-Fowler's position and turning on either side to facilitate removal of secretions (unless the health care provider specifies another position) * monitoring the patient for signs of laryngeal edema or laryngospasms, such as stridor or increasing dyspnea * monitoring sputum for signs of hemorrhage (blood-streaked sputum is expected for a few days after biopsy)
Epistaxis (nose bleed) may precede other issues such as:
* menstrual flow in women * hypertension * irritation of nasal mucosa * topical corticosteroid use * nasal spray abuse * street drug use * a disorder that results in a prolonged bleeding time or reduction in platelet counts * use of aspirin or NSAIDs
Cancer of the lung
* metastasis from the colon and kidney is common linked to cigarette smoking second hand smoking occupational exposure - such as to asbestos, radon, and uranium people who are older than 50
Clinical manifestations for lung cancer:
* metastasis may occur (to the liver, esophagus, pericardium, skeletal bone, brain) weight loss fatigue decreased stamina changes in functional status Pain is unlikely unless the tumor is pressing on a nerve or the cancer has spread to the bones.
Nursing interventions and patient teaching for the patient with laryngeal cancer:
* monitor I&O * airway maintenance - suctioning * monitoring skin integrity at the tracheal opening * assists with tube feedings * Encourage communication through writing and facial and hand gestures
Other symptoms of OSA include:
* morning headaches (from hypercapnia, which causes vasodilation of cerebral blood vessels) * personality changes, and irritability * Systemic hypertension, cardiac dysrhythmias * right-sided heart failure from pulmonary hypertension caused by nocturnal hypoxemia * stroke are serious complications that may occur
medical management for septal deviations and polyps:
* nasoplasty * nasal polypectomy * corticosteroids (prednisone), which cause polyps to decrease or disappear * antihistamines for allergy signs and symptoms, and to decrease congestion in both septal deviations and polyps * Antibiotic agents (penicillin) may be used in both conditions to prevent infection * Analgesics (acetaminophen [Tylenol]) may be given to relieve the headache that occurs with septal deviation.
Lung cancer nursing interventions:
* often directed at postsurgical interventions * encourage the patient to eat a diet high in protein and calories Instruct the patient and the family regarding signs and symptoms that could indicate recurrence of metastasis, such as fatigue, weight loss, increased coughing or hemoptysis, central nervous system changes, and arm or shoulder pain.
Clinical manifestations for acute bronchitis:
* productive cough * diffuse rhonchi and wheezes dyspnea chest pain low-grade fever generalized malaise and headache
Medical management for laryngeal cancer:
* radiation therapy - if the tumor is confined * surgery - total or partial laryngectomy or a radical neck dissection * chemotherapy
Pleurisy clinical manifestations:
* severe inspiratory pain, often radiating to the shoulder or abdomen of the affected side (caused by stretching of the inflamed pleura). If pleural effusion develops, pain subsides and fever and dry cough occur. On auscultation of the lungs, a pleural friction rub is heard.
Clinical manifestation of Legionnaires' disease:
* significantly elevated temperature headache nonproductive cough diarrhea general malaise
Nursing interventions for septal deviations and polyps:
* use nasal sprays and drops judiciously because of the possible rebound effect on nasal mucous membranes * avoid nose blowing, vigorous coughing, or Valsalva's maneuver for 2 days postoperatively * Instruct the patient that facial ecchymosis and edema may persist for several days after surgery
Medical management for the common cold:
1) aspirin or acetaminophen for analgesia and reduction of temperature (aspirin is not used in infants, children, and adolescents because of the danger of developing Reye's syndrome) 2) a cough suppressant for a dry, nonproductive cough 3) an expectorant to help dislodge mucus for a productive cough 4) antibiotic agents (e.g., erythromycin) if a secondary bacterial infection is confirmed
The three types of anthrax
1. Cutaneous anthrax, the most common type, occurs after bacteria or spores enter the skin through a cut or abrasion. Within several days of exposure, a pruritic reddened macule or papule develops, followed by vesicle formation. The lesion resembles an insect bite at first, until black eschar (dead, sloughing tissue) appears at the center of the lesion and the site becomes edematous. Although a patient may develop bacteremia if the organism enters his or her bloodstream, cutaneous anthrax is rarely fatal if it is treated with antibiotics. 2. Gastrointestinal anthrax, the least common type, occurs after ingestion of the organism in contaminated, undercooked food. Spores can germinate in the mouth, the esophagus, the stomach, or the small and large intestines, causing ulcers. Inflammation of the gastrointestinal tract can cause nausea, vomiting, fever, abdominal pain, and diarrhea. Unless treated early, a patient may die from sepsis. 3. Inhalational anthrax, seen in global germ warfare, is the most deadly type. It develops when spores are inhaled deeply into the lungs. Immune cells sent to fight the lung infection carry some bacteria back to the lymph system, which spreads the infection to other organs.
Normal respiratory rate:
40 to 60 breaths/minute for a newborn 22 to 24 breaths/minute for an early school-age child 20 to 22 breaths/minute for a teenager 14 to 20 breaths/minute for an adult
chest expansion on one side only may indicate serious pulmonary complications, such as:
A collapsed lung, look for retraction of the chest wall between the ribs and under the clavicle during inspiration. This can signal late-stage respiratory distress.
TB
A common misconception about TB is that it is easily transmitted. In fact, most people exposed to TB do not become infected. The body's first line of defense, the upper airway, prevents most inhaled TB organisms from ever reaching the lungs. If the inhaled particles are small enough, the organisms can survive in the upper respiratory tract, reach the alveoli, and establish infection. Less commonly, transmission may occur by ingestion or by invasion of the skin or mucous membranes.
Medical management for massive PE:
A massive PE must be dissolved by administering thrombolytics such as the tissue plasminogen activator alteplase (Activase).
tuberculin skin test (Mantoux)
A negative reaction is less than 5 mm. If the patient is infected with TB (whether active or dormant), lymphocytes recognize the PPD antigen in the skin test and cause a local indurated reaction. Generally, the larger the reaction, the greater the likelihood that the person is infected with the TB organism (unless of course the person has had a false positive result in the past and does not have an active infection).
The nurse is caring for a patient at risk for hypoxia. What precautions does the nurse take? Select all that apply. A) Ensure that patient's airway is free. B) Administer medications for restlessness. C) Be alert to signs of shortness of breath. D) Keep an oxygen mask on the patient all the time. E) Use pulse oximetry to assess oxygen saturation levels.
A) Ensure that patient's airway is free. C) Be alert to signs of shortness of breath. E) Use pulse oximetry to assess oxygen saturation levels. Hypoxemia poses a dangerous threat to the patient. The most obvious symptom of hypoxemia is shortness of breath. The nurse should be alert to this symptom and take rapid actions to clear the patient's airway. The nurse should ensure that the patient's airway is not obstructed with secretions or fluids. This reduces the risk for hypoxia. Pulse oximetry is used to test the patient's oxygen saturation levels and verify if the patient is at risk for oxygen depletion. The primary health care provider prescribes the oxygen mask and the period for which it is to be applied. It is not administered all the time as overuse can cause physiologic changes in breathing. Restlessness is a symptom of hypoxia; if the patient is restless, the nurse takes immediate steps to supply oxygen to the patient.
Appropriate nursing care for a patient with pneumonia includes which interventions? Select all that apply. A) Help the patient conserve energy B) Encourage the patient to limit fluids C) Position the patient with the side of the "good" lung up D) Place the patient in semi-Fowler to high-Fowler position E) Educate the patient about the importance of hand washing
A) Help the patient conserve energy D) Place the patient in semi-Fowler to high-Fowler position E) Educate the patient about the importance of hand washing Appropriate nursing care for a patient with pneumonia includes helping the patient conserve energy, which will decrease oxygen demands. The nurse should allow rest periods and should facilitate optimal air exchange by placing the patient in high-Fowler position, which allows maximum lung inflation to promote air exchange. Appropriate nursing care for a patient with pneumonia includes implementing interventions to foster the ability to move secretions. This will be tailored to the individual patient and may include coughing, positioning, suctioning, and liquefying secretions. Medications, such as bronchodilators, expectorants, and mucolytic agents, may be prescribed. Hydration to 3 L/day of fluid may be encouraged, unless contraindicated. Appropriate nursing care for a patient with pneumonia includes educating the patient about the importance of hand washing to prevent spread of the disease. The patient with pneumonia should be positioned with the "good" lung down when lying in the supine position. The "good" or unaffected side benefits from improved perfusion in the dependent position, and the "bad" side or the side of the lung affected by pneumonia will benefit by being in the upright position, which allows for maximal inflation of the alveoli. This position should be alternated with the semi-Fowler position and should not be used exclusively.
An arterial blood gas sample has been drawn. What is the most important intervention by the nurse for preserving the integrity of the specimen? A) Place the specimen on ice B) Have the patient initial and sign the specimen C) Place the specimen in room-temperature water D) Place the specimen in a location from which it can be picked up within 4 hours
A) Place the specimen on ice The arterial blood gas sample must be placed on ice and taken to the laboratory immediately to preserve the integrity of the specimen. The nurse should not place the specimen in skin temperature water. Although the nurse should hold pressure at the site and chart the date and time of the procedure with the patient's response, these interventions do not apply to preservation of the specimen.
Nursing Interventions and patient teaching for pleural effusion:
Bed rest Oral care O2 Deep breathing/coughing excersises Sterile dressing changes
Medical management for SARS:
Antiviral medications (such as ribavirin) Corticosteroids * Antibiotics will not help with SARS (because it is believed to be caused by a virus) * Respiratory isolation
Adventitious breath sounds
Abnormal breath sounds such as wheezes, rhonchi, and rales.
Pleural Effusion/Empyema
Accumulation of fluid if the fluid becomes infected it becomes empyema. Which is the accumulation of pus in a body cavity, especially the pleural space.
Nursing interventions for a T&A
Advise the patient to avoid attempting to clear the throat immediately after surgery (may initiate bleeding) and to avoid coughing, sneezing, or vigorous nose blowing for 1 to 2 weeks.
Medical management for treatment of anthrax:
Antibiotics - ciprofloxacin (Cipro) has been considered the treatment of choice for all three forms of anthrax.
What happens during a chronic episodes of upper airway obstruction?
As hypoxia progresses during an upper airway obstruction, the respiratory centers in the brain (medulla oblongata and pons) are depressed, resulting in bradycardia and shallow, slow respirations.
Objective data of the respiratory assessment should include:
Assess respiratory rate and oxygen saturation. The patient's expression, chest movement, and respirations all provide valuable visual clues.
TB clinical manifestations:
fever weakness productive cough * Later in the disease, daily recurring fever with chills, night sweats, and hemoptysis is seen.
A nurse observing the dining room of a skilled nursing facility sees a patient begin choking on food. What should the nurse do first? A) Begin the Heimlich maneuver B) Ask the patient, "Are you choking?" C) Use a jaw-thrust technique to open the patient's airway D) Perform a blind finger sweep of the patient's mouth to clear the obs
B) Ask the patient, "Are you choking?" The nurse should first determine if the patient's airway is obstructed by asking the patient to speak. If the patient cannot speak, the nurse should look in the mouth to see if an obstruction can be visualized. If an obstruction is visualized, the patient can attempt to remove it. However, a blind finger sweep is never used because the obstruction can be pushed further down the airway. If the attempt at removal is unsuccessful, the nurse should perform the Heimlich maneuver. The jaw-thrust technique is not appropriate at this time.
A nurse is caring for a patient 12 hours after a lung tissue biopsy. The nurse notes streaks of blood in the patient's sputum. What should the nurse's action be at this time? A) Obtain vital signs B) Document the findings C) Prepare the patient for surgery D) Call the primary health care provider
B) Document the findings Blood streaks in the sputum are normal for several days after a lung tissue biopsy. The nurse should document the findings and be alert for increased blood in the sputum. It is not necessary to obtain vital signs, call the primary health care provider, or prepare the patient for surgery.
The nurse is collecting the data of a patient who has symptoms of weakness, weight loss, and shortened breath. The nurse measures the patient's inflamed tissue as 8 mm after a Mantoux test. What immediate care would the primary health care provider prescribe to ensure the patient's safety? A) Intranasal fluticasone (Flovent) B) Isoniazid (INH) and rifampin (Rifadin) C) 100 mg of zafirlukast (Accolate) intravenous D) Theophylline (Accurbron) and para-aminosalicylate sodium (PAS)
B) Isoniazid (INH) and rifampin (Rifadin) Weakness, weight loss, and shortened breath are the characteristic symptoms of tuberculosis. The Mantoux test, or tuberculin skin test, is performed to identify the presence of mycobacterium (TB) in the blood. The tissue on the skin gets inflamed and hardened; if the tissue measures more than 5 mm, it confirms that the patient is infected with tuberculosis. The primary health care provider will immediately prescribe first line antituberculosis drugs such as isoniazid (INH) and rifampin (Rifadin) to the patient. Fluticasone (Flovent) is a corticosteroid used in treating various respiratory tract infections and also used in treating TB as second line agent. Zafirlukast (Accolate) is an anti-inflammatory agent used in the treatment of asthma. Theophylline (Accurbron) is a bronchodilator used to treat conditions like asthma. Para-aminosalicylate sodium (PAS) is a second line anti-tuberculosis agent used after treating with the first line drugs.
diagnostic tests for atelectasis:
CT scan radiographs * ABGs bronchoscopy pulse oxymetry
Ethnic groups that have a high incidence of tuberculosis include:
foreign-born people from Asia, Africa, and Latin America.
A patient returns from nasoseptoplasty for correction of a deviated septum. For which early sign of a life-threatening condition must the nurse be vigilant? A) Pallor B) Oliguria C) Hypotension D) Frequent swallowing
D) Frequent swallowing Frequent swallowing is the earliest sign of hemorrhage. Pallor, oliguria, and hypotension are all late signs of hypotension.
Which statement most accurately describes the disease tuberculosis (TB)? A) All strains of TB are resistant to antibiotic therapy. B) TB has the highest rates in the white U.S. population. C) TB is easily spread from person to person via respiratory secretions. D) Most people who become infected with the TB organism do not progress to the active disease stage.
D) Most people who become infected with the TB organism do not progress to the active disease stage. Most people who become infected with the TB organism do not progress to the active disease stage; they remain asymptomatic and noninfectious. These people will have a positive tuberculin skin test result, and chest radiograph results will be negative. These people retain a lifelong risk of developing reactivation TB if the immune system becomes compromised. A common misconception about TB is that it is easily spread—in fact, most people exposed to TB do not become infected. The body's first line of defense, the upper airway, prevents most inhaled TB organisms from ever reaching the lungs. TB rates in the white population are about half those in the nonwhite population. More than two thirds of reported cases occur in racial and ethnic minorities, particularly among Hispanic and African American populations. Not all strains of TB are resistant to antibiotic therapy. A growing percentage of new TB cases are resistant to the medications that are traditionally used to fight the disease.
Subjective data of the respiratory assessment should include:
Data should include onset; duration; precipitating factors; and relief measures, such as position and use of over-the-counter or prescribed medications.
serum radioallergosorbent test (RAST):
Done by drawing blood and then mixing the blood with various allergens. This procedure will give definitive diagnosis of allergies by the increases in allergen-specific immunoglobulin E (IgE)
A late sign of respiratory distress is___________.
Flaring nostrils
What is the antidote used for overheparinization?
In the event of overheparinization resulting in profound bleeding, the treatment is IV administration of protamine sulfate.
How does the body protect us from TB once it reaches the lungs?
In the lung, pulmonary macrophages ingest TB bacteria. Macrophages engulf the organisms, but do not kill them. Instead they surround them and wall them off in tiny, hard capsules called tubercles. Macrophages activate lymphocytes, and within 2 to 10 weeks, activated lymphocytes usually control the initial infection in the lung and nonpulmonary sites. Nonmultiplying tubercle bacilli can survive more than 50 years in human tissue.
acute follicular tonsillitis
Inflammation of the tonsils, it is the result of an airborne or food-borne bacterial infection, often streptococci. Rheumatic fever, carditis, and nephritis must be considered when streptococci is the identified as the cause.
TB medical mangement:
Isolation is indicated for patients with pulmonary TB who have a positive sputum smear or a chest radiograph that strongly suggests current (active) TB. treatment for TB is lengthy, typically 6 to 9 months, and sometimes longer for extrapulmonary disease. Treatment usually consists of a combination of at least four drugs
Pharyngitis
It is the most common throat inflammation and frequently accompanies the common cold. Pharyngitis is usually viral but can be caused by beta-hemolytic streptococci, staphylococci, or other bacteria.
Preventative measures for lung cancer include:
Many studies suggest the importance of certain antioxidant vitamins, especially vitamins A and E, to reduce the risk of developing lung cancer. Studies report that an increased intake of fruits and vegetables can lower the risk for lung cancer development
Laryngeal cancer risk factors:
Men over the age of 60 prolonged tabacco use heavy alcohol use family history chronic larygitis
Carbon Dioxide (CO2)
the chemical stimulant for regulation of respiration.
Chest tube placement
the chest tube is inserted in the fifth or sixth intercostal space, under the patient's arm [i.e., at the midaxillary line.
Medical management for the patient with Legionnaires' disease:
O2 therapy * May need ventilation IV fluid replacement (to maintain electrolyte balance) * dialysis due to acute kidney failure Antibiotic agents (erythromycin, rifampin) Antipyretics vasopressors (dopamine or dobutamine) Analgesics
Emphysema medical management:
O2 therapy chest physiotherapy bronchodialators - albuterol, theophylline, atrovent corticosteroids antibiotics diuretics aerobic exercise such as walking
Medical management for pulmonary edema:
O2 therapy intubation for adequate ventilation support * diuretics - furosemide [Lasix] * opioid analgesic - morphine sulfate; to decrease the respiratory rate; lower the anxiety level; reduce venous return; and dilate both the pulmonary and systemic blood vessels, thus improving the exchange of gases. ** IV nitroprusside (Nipride) is a potent vasodilator that improves myocardial contraction and reduces pulmonary congestion (drug of choice for pulmonary edema)
Medical management for a sinus infection:
Surgery - Caldwell-Luc operation for chronic sinus infection (or radical antrum operation), involves making an incision between the gum and upper lip, allowing access to the floor of the maxillary sinus. This is followed by removal of a small piece of maxillary bone. This opening allows the infected maxillary sinus to drain.
Atelectasis
the collapse of alveoli, preventing the respiratory exchange of carbon dioxide and oxygen
Clinical manifestations for pleural effusion:
Pleural effusion is generally associated with other disease processes, such as pancreatitis, cirrhosis of the liver, pulmonary edema, congestive heart failure, kidney disease, or carcinoma involving altered capillary permeability.
what happens as intrathoracic pressure increases in the pleural space in a pneumothorax:
The lung collapses because lung tissue no longer expands, the mediastinum may shift to the unaffected side (mediastinal shift), which is subsequently compressed. As the intrathoracic pressure increases, cardiac output is altered because of decreased venous return and compression of the great vessels.
Emphysema:
Primarily an alveolar disease (caused by smoking), enlargement of the alveoli occurs accompanied by the destruction of their walls.
Areas of concern with a chest tube system are the following:
Proper system function: Ensure that the water in the water-seal chamber fluctuates when suction is applied. There should not be any bubbling in the water seal, since this indicates an air leak. Potential atelectasis resulting from hypoventilation: Assess for increased dyspnea; check chest radiographic studies frequently to compare degree of lung consolidation. Increased air in the pleural space: Note any air leaks in the system; ensure tubing is secure and remains patent. Infection: Note any increase in white blood cells, elevated temperature, and presence of purulent drainage.
Diagnostic test for an episode of epistaxis may include:
Prothrombin time (PT), International Normalized Ratio (INR), and partial thromboplastin time (PTT), rhinoscopy
Diagnostic tests for pulmonary edema:
Radiographic studies * ABGs - may reveal respiratory alkalosis or acidosis Sputum cultures - to rule out a bronchopulmonary infection
Diagnostic tests for a sinus infection include:
Radiographs * Transillumination (this procedure involves shining a light in the mouth with the lips closed around it; infected sinuses will look dark, whereas normal sinuses will transilluminate) CT scans
Diagnostic test for SARS:
Radiographs (maybe normal in early stages). WBC - Initially, the patient's white blood cell count will be normal or low. * platelet counts are 50,000 to 150,000/mm3 (normal range, 150,000 to 400,000/mm3). * creatine phosphokinase levels may be as high as 3000 units/L (normal, 5 to 200 units/L)
What happens in metabolic acidosis?
The lungs attempt to compensate by "blowing off" carbon dioxide to raise the pH.
Objective data for the patient with pulmonary edema:
S/S of repertory failure HTN tachycardia restlessness disorientation * On auscultation the nurse will most likely hear wheezing and crackles * Weight gain * decreased urinary output as a result of retained fluid in the pulmonary vasculature * a productive cough of frothy, pink sputum.
Acute bronchitis
Secondary to an upper respiratory infection Related to inhaled irritants * Inflammation of the trachea and bronchial tree (causes congestion of the mucous membranes, which results in retention of tenacious secretions. These secretions can become a culture medium for bacterial growth).
Causes of pulmonary edema:
Severe left ventricular failure resulting from a weakened myocardium due to a myocardial infarction. The most common cause of pulmonary edema is left-sided heart failure Hypoalbuminemia, hepatic disease, and nutritional disorders Rapid administration of IV fluids (packed red blood cells, plasma, or fluids) Altered capillary permeability of lungs: inhaled toxins, inflammation (e.g., pneumonia), severe hypoxia, near-drowning Opioid overdose Acute pulmonary edema is found in patients with sleep apnea and can be the initial feature in the diagnosis of sleep apnea
Nursing interventions for a sinus infection:
Steam inhalation and warm, moist packs facilitate drainage and promote comfort. Assess respiratory status frequently. Elevate head of bed to promote drainage of secretions.
What happens in metabolic alkalosis?
The lungs attempt to compensate by retaining carbon dioxide to lower the pH.
Medical management for pleurisy:
The health care provider may inject an anesthetic around the vertebrae to block the intercostal nerves, thus relieving pain. antibiotics (penicillin) analgesics (meperidine [Demerol] or morphine) antipyretics (acetaminophen) O2
Objective data for a sinus infection includes:
Vital signs (* Temperature) *Purulent nasal secretions elevated temperature * facial congestion * eyelid edema
Explain a radical neck dissection for a patient with laryngeal cancer:
This surgery entails removal of the submandibular salivary gland, the sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein, which results in one-sided shoulder droop. This surgery results in a very large tracheostomy opening and no tracheostomy tube is used. The opening will narrow as the patient heals from chemotherapy.
PE medical management:
Umbrella filter anticoagulant therapy - warfarin (coumadin), heparin (lovenox), dalteparin (Fragmin)
Increase in CO2 causes____________.
a decrease in pH level (carbon dioxide level and pH are inversely proportional).
PaCO2
a measure of the partial pressure of carbon dioxide in the blood. PaCO2 is referred to as the respiratory component in acid-base determination because this value is primarily controlled by the lungs.
Mediastinoscopy
a surgical endoscopic procedure in which an incision is created in the suprasternal notch (the base of the neck), allowing the endoscope to be passed into the upper mediastinum. A biopsy is then performed, in which a sample of lymph nodes is gathered and subsequently examined for the presence of a tumor.
Allergic rhinitis and allergic conjunctivitis (hay fever):
allergic conditions that result from antigen-antibody reactions in the nasal membranes, nasopharynx, and conjunctiva from inhaled or contact allergens.
cor pulmonale:
an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation. Cor pulmonale results in edema in the lower extremities and in the sacral and perineal area, distended neck veins, and enlargement of the liver with ascites.
Pulmonary edema (PE):
an accumulation of serous fluid in interstitial lung tissue and alveoli
Anthrax
an infectious disease caused by the spore-forming bacterium Bacillus anthracis. In nature, anthrax most commonly infects wild and domestic hoofed animals. It is spread through direct contact with the bacteria and its spores—dormant, encapsulated bacteria that become active when they enter a living host. In humans, anthrax gains a foothold when spores enter the body via the skin, intestines, or lungs. It is not contagious by person-to-person contact
Pleurisy
an inflammation of the visceral and parietal pleura. Pleurisy can be caused by either a bacterial or viral infection. frequently is a complication of: pneumonia pulmonary infarctions viral infections trauma to the chest, ribs, or intercostal muscles early stages of TB lung tumor
Nursing Interventions and Patient Teaching:
antiembolism stockings elevating the lower extremities Check peripheral pulses measure bilateral calf circumference slightly elevating the head of the bed administer oxygen by mask or nasal cannula cough and deep breathing bed rest assessing for signs of bleeding * avoid crossing the legs while sitting or lying down and avoid standing in one place for a long time since these activities increase venous pooling
Pulmonary function test (PFT)
assess the presence and severity of disease in the large and small airways.
Nursing interventions for pulmonary edema:
assessment of respiratory status monitoring of cardiac status, I&O, vital signs, ABGs, pulse oximetry, and electrolyte values oral and tracheostomy care for the intubated patient high fowlers position * patency of IV line (IV fluids are usually withheld to prevent adding even more fluid to the overloaded patient)
Nursing interventions and patient teaching for the Legionnaires' disease:
bed rest, with the head of the bed elevated at least 30 degrees for ease of respiratory effort. monitor I&Os
Chest X-ray
can confirm pneumothorax, pneumonia, pleural effusion, and pulmonary edema.
Legionnaires' Disease
causative microorganism of legionnaires' disease is Legionella pneumophila. * This organism thrives in water reservoirs, such as in air conditioners, humidifiers, and whirlpool spas. * It is transmitted through airborne routes. * It is a life-threatening pneumonia that causes lung consolidation and alveolar necrosis. * The disease progresses rapidly (less than 1 week) and can result in respiratory failure, renal failure, bacteremic shock, and ultimately death.
Failure of the respiratory system/cardiovascular system
causes rapid cell death from oxygen starvation.
Complication of an untreated sinus infection:
cavernous sinus thrombosis * spread of infection to bone, brain, or meninges, which can result in meningitis, osteomyelitis, or septicemia.
Causes of upper airway obstruction:
choking, aspiration, laryngeal spasm caused by tetany resulting from hypocalcemia. Another cause may be laryngeal edema caused by injury.
COPD can lead to a condition known as____________.
cor pulmonale (late manifestations of emphysema)
Medication regimen for acute bronchitis:
cough suppressants (codeine and dextromethorphan [Pertussin]) antipyretics (acetaminophen) bronchodilators (albuterol [Ventolin, Proventil]) Antibiotics (ampicillin)
Objective data on atelectasis include:
crackles on auscultation * tachycardia and hypertension followed by bradycardia and hypotension assessment of v/s ALOC (due to hypoxia)
Clinical manifestations for pharyngitis
dry cough tender tonsils enlarged cervical lymph gland the throat appears erythematous soreness dysphagia
Clinical manifestations for PE include:
dyspnea hemoptysis chest pain * sudden, sharp, constant, NONRADIATING, pleuritic chest pain that WORSENS WITH INSPIRATION. tachypnea elevated temperature elevated WBC * diminished lung sounds and wheezing diaphoresis
Clinical manifestations for atelectasis:
dyspnea tachypnea pleural friction rub restlessness hypertension elevated temperature
Pulmonary edema clinical manifestations:
dyspnea labored respirations tachypnea tachycardia cyanosis * pink (or blood-tinged), frothy sputum are the most obvious signs restlessness or agitation hypoxia respiratory failure.
Emphysema clinical manifestations:
dyspnea with exertion and rest barrel chest little sputum production use of accessory muscles for breathing pursed lip breathing weight loss
Second-line drugs against TB include:
ethionamide para-aminosalicylate sodium (PAS) cycloserine capreomycin kanamycin amikacin levofloxacin ofloxacin ciprofloxacin
TB is a multisystem infectious disease that may also affect other systems of the the body such as:
gastrointestinal and genitourinary tracts bones and joints nervous system lymph nodes Integumentary
Subjective data for a sinus infection includes:
generalized malaise headache decreased appetite nausea * diminished sense of smell * increased pain in the sinus region when bending forward or when gentle pressure is applied over the infected sinus region
Risks associated with a thoracentisis include:
intravascular fluid shift resulting in pulmonary edema; fluid removal is traditionally limited to 1300 mL.
Medical management for atelectasis:
intubation IS O2 therapy chest physiotherapy suctioning physical therapy deep cough excercises * bronchodilators (e.g., albuterol) to facilitate secretion removal antibiotics to prevent infection * mucolytic agents (e.g., acetylcysteine [Mucomyst]) to reduce the viscosity of secretions
Tuberculosis (TB):
is a chronic pulmonary and extrapulmonary (outside of the lung) infectious disease acquired by inhalation of a dried droplet nucleus containing a tubercle bacillus, coughed or sneezed into the air by a person whose sputum contains virulent (capable of producing disease) tubercle bacilli, and inhaled into the alveolar structure of the lung.
HCO3
is a measure of the metabolic (renal) component of the acid-base equilibrium. As the HCO3− level increases, the pH also increases (the relationship of bicarbonate to pH is directly proportional).
Severe acute respiratory syndrome (SARS)
is an infection caused by a coronavirus. The virus spreads by close contact between people, most likely via droplets in the air. It is possible that SARS may also be spread by touching contaminated objects.
Pulmonary embolism (PE)
is caused by the passage of a foreign substance (blood clot, fat, air, tumor tissue, or amniotic fluid) into the pulmonary artery or its branches, with resulting obstruction of the blood supply to lung tissue and subsequent collapse.
Acute respiratory distress syndrome (ARDS):
is not a disease but a complication that occurs as a result of other disease processes. It can be viral or bacterial, the most common precursors of ARDS is sepsis.
What isinternal respiration?
is the exchange of oxygen and carbon dioxide at the cellular level.
First-line drugs against TB include:
isoniazid (INH) rifampin (rifampicin) rifampin and isoniazid (Rifamate) pyrazinamide ethambutol streptomycin
acute rhinitis (or acute coryza):
known as the common cold, is an inflammatory condition of the mucous membranes of the nose and accessory sinuses.
Pneumothorax
like atelectasis, is a collapsed lung; but it is due to a collection of air or other gas in the pleural space, causing the lung to collapse. * It can be caused by a penetrating chest injury that punctures the pleural lining, fractured ribs, or injury to the pleura from insertion of a subclavian catheter.
Nursing interventions for a pneumothorax:
maintain airway patency monitor blood pressure monitor secretions and observe characteristics fowler's position avoid kinks on the chest tube drainage system analgesics * avoid the use of respiratory depressants such as Demerol (meperidine), Dilaudid (hydromorphone), and Lortab (acetaminophen with hydrocodone) * Instruct the patient to limit exposure to people who may have infections avoid smoking encourage proper fluid intake
Lung biopsy
may be done transbronchially or as an open-lung biopsy. Transbronchial lung biopsy involves passing a forceps or needle through the bronchoscope to obtain a specimen.
QuantiFERON-TB Gold test
more specific for Mycobacterium tubercle bacillus than the PPD skin test. Its another blood test that aids in the diagnosis of TB. Results can be readily available within 24 hours.
Medical management for epistaxis:
nasal packing with cotton saturated with 1 : 1000 epinephrine to promote local vasoconstriction. Cautery can be either electrical (burning [cauterizing] the bleeding vessel) or chemical (applying a silver nitrate stick to the site of the bleeding).
Another way to obtain a sputum sample is through___________.
nasotracheal suctioning with a catheter or by transtracheal aspiration. Take care to ensure that the suction catheters remain sterile. A health care provider's order must be obtained for endotracheal suctioning.
Helical (also called spiral or volume-averaging) CT scanning
obtains images continuously. This produces faster and more accurate images. Because the helical CT can scan the abdomen and chest in less than 30 seconds, the entire study can be performed with one breath-hold.
Laryngitis
occurs secondary to other respiratory infections. Laryngeal inflammation is a common disorder that can be either chronic or acute. Acute laryngitis may cause severe respiratory distress in children. Acute laryngitis often accompanies viral or bacterial infections. Other causes include excessive use of the voice or inhalation of irritating fumes. Chronic laryngitis is usually associated with inflammation of the laryngeal mucosa or edematous vocal cords.
Risk factors associated with SARS:
older age (over 65) diabetes chronic hepatitis B chronic obstructive pulmonary disease (COPD) atypical symptoms renal failure
A patient with a chest tube in place is usually positioned on what side:
on the unaffected side to keep the tube from becoming kinked; however, the patient may assume any position of comfort in bed.
Secondary infections related to hay fever include:
otitis media, bronchitis, sinusitis, and pneumonia.
Obstructive sleep apnea (OSA):
partial or complete upper airway obstruction during sleep, causing apnea and hypopnea. Airflow obstruction occurs when the tongue and the soft palate fall backward and partially or completely obstruct the pharynx. Often, patients are unaware of sleep apnea until pulmonary edema develops or when the patient needs general anesthesia.
Clinical manifestations of a pneumothorax:
recent chest injury decreased breath sounds on the affected side sudden, sharp, pleuritic chest pain with dyspnea diaphoresis (perspiring) increased heart rate, tachypnea, and dyspnea a sucking sound is heard on inspiration (with a staving wound)
medulla oblongata and pons of the brain
responsible for the basic rhythm and depth of respiration.
Nursing interventions and patient teaching for acute bronchitis include:
rest periods between activities * limit exposure to others (who may spread the infection) avoid smoking or other irritating fumes
Emphysema risk factors:
smoking inhaling irritants * genetic (inheritid) - caused by a difficiency of alpha antitrypsin (ATT), a lung protective protein produced by the liver.
Signs and symptoms of acute follicular tonsillitis include:
sore throat, fever, chills, and anorexia, general muscle aching. * Enlarged, tender cervical lymph nodes * Elevated WBC (commonly the abnormal is 10,000 to 20,000) * purulent exudate
carotid and aortic bodies (chemoreceptors)
specialized receptors when stimulated by increasing levels of blood carbon dioxide (CO2), decreasing levels of blood oxygen (O2), or increasing blood acidity, these receptors send nerve impulses to the respiratory centers (the medulla oblongata and pons), which in turn modify respiratory rates.
Clinical manifestations of nasal septal deviations and polyps:
stertorous (characterized by a harsh snoring sound) respirations, dyspnea, and sometimes postnasal drip.
Saturation (SaO2) refers to:
the amount of oxygen bound to hemoglobin binding sites. Oxygen is carried in the blood in two forms: as oxygen dissolved in the plasma, and as oxygen bound to hemoglobin. Oxygen must first dissolve in blood (PaO2) before it can bind to hemoglobin (SaO2).
PaO2 refers to:
the amount of oxygen dissolved in the plasma expressed as millimeters of mercury (mm Hg). Oxygen is carried in the blood in two forms: as oxygen dissolved in the plasma, and as oxygen bound to hemoglobin.
Medical management for a pneumothorax:
thoracotomy with a chest tube insertion Heimlich valve - The one-way valve attaches to a catheter and is inserted into the chest. As the patient exhales, air and fluid drain through the valve into a plastic bag. When the patient inhales, however, the flexible tubing in the valve collapses, preventing secretions and air from reentering the pleura.
Risk factors for PE include:
thrombophlebitis surgery pregnancy, or given birth contraceptives on a long-term basis history of CHF obesity immobilization from fracture Atelectasis develops, and pulmonary vascular resistance increases. Arterial hypoxia is the result.
Nasal polyp
tissue growths on the nasal tissues that are frequently caused by prolonged sinus inflammation; allergies are often the underlying cause.
Medical management for acute follicular tonsillitis:
tonsillectomy and adenoidectomy (T&A) * Post T&A the health care provider may be able to control minor postoperative bleeding by applying a sponge soaked in a solution of epinephrine to the site. hemostasis is of the utmost importance
Emphysema nursing interventions:
use of a humidifier rest periods in between activities * small frequent meals (5-6 a day), drink fluids between meals encouraging adequate fluid intake decreasing anxiety elevating HOB * avoiding respiratory depressants ** O2 (1-2L nasal canula) - This is extremely important for patients with COPD because a higher flow of oxygen delivery can be dangerous, since it diminishes the responsiveness of the brain's respiratory (regulatory) center, leading to decreased respiratory drive and respiratory failure. * Immunization (influenza and pneumococcal vaccine is recommended)
Ventilation-perfusion (V/Q) scanning
used primarily to check for a PE. Ventilation (V) refers to the air reaching the alveoli; perfusion (Q) refers to the blood that reaches the alveoli. A radioisotope is given intravenously for the perfusion portion of the test, and an image of the pulmonary vasculature is obtained. For the ventilation portion of the test, the patient inhales a radioactive gas, and an image of the outlines of the alveoli is obtained.
Pulmonary angiography (pulmonary arteriography)
uses a radiographic contrast material injected into the pulmonary arteries to visualize the pulmonary vasculature. Angiography is used to detect pulmonary embolism (PE) and lesions of the pulmonary vessels. * When PE is suspected, lung scanning is performed first.
cardiogenic pulmonary edema
usually accompanies underlying cardiac disease in which the failure of the left ventricle causes pooling of fluid, which backs up into the left atrium and into the pulmonary veins and capillaries.
Objective data (pneumothorax):
vital signs * changes in respiratory and cardiac rate and rhythm respiratory distress * Hemoptysis and cough may be present unequal breath sounds (on auscultation)
Signs and symptoms of hypoxia:
• Apprehension, anxiety, restlessness • Decreased ability to concentrate • Disorientation • Decreased level of consciousness • Increased fatigue • Vertigo • Behavioral changes • Increased pulse rate; bradycardia as hypoxia advances • Increased rate and depth of respiration; shallow, slow respirations as hypoxia progresses • Elevated blood pressure; with continuing oxygen deficiency, decreased blood pressure • Cardiac dysrhythmias • Pallor • Cyanosis (may not be present until hypoxia is severe) • Clubbing • Dyspnea
Risk factors for OSA:
• Male gender: About twice as many men as women have OSA. • Older age: the incidence increases with age over 60 years, probably because loss of pharyngeal muscle strength. • Obesity: An obese person's pharynx may be infiltrated with fat, and the tongue and soft palate may be enlarged, crowding the air passages. An obese individual may also have a short, thick neck increasing susceptibility to obstruction. • Nasal conditions: Nasal allergies, polyps, or septal deviation decrease the diameter of the pharynx. • Receding chin: A person with a receding chin may not have enough room in the pharynx for the tongue, thus contributing to obstruction. • Pharyngeal structural abnormalities: A person with OSA may have enlarged tonsils, an elongated uvula, an especially long tongue, or a soft palate that rests on the base of the tongue.
Medications used to treat sinusitis include the following:
• Saline nasal irrigation • Nasal corticosteroids: fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex), and beclomethasone (Beconase AQ). • Oral or injected corticosteroids: also help if the patient has nasal polyps (prednisone and methylprednisolone. Oral corticosteroids can cause serious side effects when used long term, so they're used only to treat severe symptoms). • OTC decongestants: Sudafed, Actifed nasal spray oxymetazoline (Afrin). These medications are generally taken for a few days at most; otherwise they can cause the return of more severe congestion (rebound congestion). OTC analgesics: aspirin, acetaminophen (Tylenol, others), and ibuprofen (Advil, Motrin IB, others). * Because of the risk of Reye's syndrome—a potentially life-threatening illness—never give aspirin to anyone younger than age 18 years.
