Chapter 14 Care of Patients with Disorders of the Lower Respiratory System

drainage system

-left chamber serves as suction control, water in there will bubble -middle chamber is water seal that prevents air from entering chest cavity, tidaling should occur and maybe bubbling but not persistent -collection chamber right side shows accurate measurement of drainage from chest

TB skin testing (PPD/mantoux)

0.1mL of fluid injected intradermally, if swelling is more then 5/10mm 48-72hr after test its positive, indicates person has been infected with TB but doesnt indicate if its active or inactive

A nursing student is reviewing signs and symptoms with a group of people who are at risk for lung cancer. You would intervene if the student says which of the following? 1. "Weight loss and fatigue are the first symptoms to manifest." 2. "An occasional cough or wheezing is typically the first sign." 3. "Hoarseness could occur if a tumor presses against the vocal cords." 4. "Deep bone pain could occur because the cancer may spread to the bones."

1. "Weight loss and fatigue are the first symptoms to manifest."

You admit a patient who was diagnosed with active pulmonary tuberculosis. What nursing intervention(s) would help control the spread of the disease? (Select all that apply.) 1. Implementing airborne isolation 2. Prohibiting visitors 3. Wearing a HEPA respirator mask when providing direct patient care 4. Explaining the importance of covering the mouth when smiling 5. Practicing good hand hygiene

1. Implementing airborne isolation 3. Wearing a HEPA respirator mask when providing direct patient care 5. Practicing good hand hygiene

On initial admission assessment of a patient with acute exacerbation of chronic obstructive pulmonary disease (COPD), the nurse is likely to expect which sign(s) and symptom(s)? (Select all that apply.) 1. Tensing of the shoulder muscles 2. Inability to tolerate sitting up 3. Flaring of the nostrils 4. Completes sentences with no effort 5. Sternal retraction

1. Tensing of the shoulder muscles 3. Flaring of the nostrils 5. Sternal retraction

A patient is immobilized and has been lying in bed for an extended period. What nursing intervention(s) should be done to prevent hypostatic pneumonia? (Select all that apply.) 1. Avoid immunizations because of weakened state. 2. Assist the patient to turn at least every 2 hours. 3. Instruct the patient to cough and deep-breathe. 4. Allow nothing by mouth to prevent aspiration. 5. Practice scrupulous hand hygiene

2. Assist the patient to turn at least every 2 hours. 3. Instruct the patient to cough and deep-breathe. 5. Practice scrupulous hand hygiene.

Which action is appropriate in the care of a patient who is on mechanical ventilation? 1. Instruct the respiratory therapist to check the ventilator settings and alarms. 2. Auscultate the lungs bilaterally to ensure that both lungs are being ventilated. 3. Disconnect the alarms before suctioning or before turning the patient. 4. Perform endotracheal suctioning every 15 minutes, using sterile technique.

2. Auscultate the lungs bilaterally to ensure that both lungs are being ventilated.

A 58-year-old man is admitted with bacterial pneumonia. He has high fever accompanied by chills, a cough productive of rust-colored sputum, and a general feeling of malaise. The medical diagnosis is confirmed by: 1. blood cultures. 2. chest radiographs. 3. white blood cell count. 4. bronchoscopy

2. chest radiographs.

Which patient is at greatest risk for developing a pulmonary embolism? The patient who: 1. has a central line that was started 2 days ago. 2. is 3 months pregnant with her first child. 3. has been immobile for 1 week and is mildly dehydrated. 4. is ambulating 2 days after abdominal surgery.

3. has been immobile for 1 week and is mildly dehydrated.

A person having a tuberculosis (TB) blood test would need further teaching about the test if they stated which of the following? 1. "I will only have to make one trip to have the test done." 2. "This test is okay even though I have had a BCG vaccination." 3. "This test evaluates my body's response to TB." 4. "This test will determine if I have active or inactive TB."

4. "This test will determine if I have active or inactive TB."

You are caring for a patient with signs and symptoms of influenza. What home care for this respiratory condition would be appropriate? 1. Schedule adequate periods of exercise and activity. 2. Provide warming measures. 3. Restrict fluid intake. 4. Consider analgesics and antipyretics.

4. Consider analgesics and antipyretics.

A 55-year-old man was admitted for complaints of a recurring, irritating "smoker's" cough with small amounts of sputum and was diagnosed with chronic bronchitis. What is the most likely clinical finding? 1. Weight loss 2. Decreased white blood cells 3. Dry mucous membranes 4. Elevated hemoglobin and hematocrit

4. Elevated hemoglobin and hematocrit

pneumonia prevention

65+ years old get immunization (2nd dose 5 years after first dose), strengthen pts natural defenses, avoid infection, frequent turning, coughing, deep breathing, watch for vomiting, initiate side lying position for pts with decreased consciousness, keep HOB elevated, avoid thin liquids for pts at risk for aspiration

Asthma severe

Episodes frequent and severely limit activity, symptoms frequent at night,

Asthma intermittent

Episodes occur less then once a week, episodes are short lasting a few hours, symptoms present at night

Asthma mild

Episodes occur more then twice a week but not daily, symptoms present at night 3-4x/month

Asthma moderate

Symptoms occur daily, cause limitation to activity, episodes occur more then once a week, symptoms present at night atleast 1x/wk

The student nurse is caring for a patient with a restrictive respiratory disease. Which description demonstrates the student's knowledge of the disease? a) "The disease is characterized by increased lung volumes." b) "The disease is characterized by decreased lung expansion." c) "The disease is characterized by an obstruction in the lungs." d) "The disease is characterized by narrowed tracheobronchial tree openings."

a) "The disease is characterized by decreased lung expansion."

A patient with asthma is suddenly experiencing difficulty breathing, tachypnea, and wheezing. Which medication listed on the medication administration record, administered through an inhaler, should the nurse administer to this patient? a) Albuterol b) Cromolyn c) Salmeterol d) Formoterol

a) Albuterol

The student nurse is preparing a report about COPD. The student would be correct in including which disease(s) in the report? Select all that apply. a) Emphysema b) Bronchial asthma c) Chronic bronchitis d) Pleurisy with effusion e) Pulmonary tuberculosis

a) Emphysema a) Chronic bronchitis

The nurse notes that the respiratory symptoms of the patient with chronic obstructive pulmonary disease (COPD) have affected his nutrition. Which would most help improve the patient's nutrition? a) Eat three large meals to increase stomach fullness. b) Extra protein is required to repair damaged tissues. c) Exercise before eating each meal three times a day. d) Drink six to eight glasses of caffeinated fluids each day.

a) Extra protein is required to repair damaged tissues.

The nurse assesses a patient with emphysema and notes a barrel chest. What is the reason for this patient's chest anomaly? a) Collapse of distal alveoli b) Use of accessory muscles c) Hyperinflation of the lungs d) Long-term, chronic hypoxia

a) Hyperinflation of the lungs

A patient with COPD asks the nurse to turn his oxygen up from 3 L/min via nasal cannula to 5 L/min. The nurse explains to the patient that she cannot turn his oxygen up this high. What is the reason the oxygen cannot be increased to 5 L/min? a) Hypoxic drive is necessary for breathing. b) Hypercapnic drive is necessary for breathing. c) Higher concentrations may result in a severe headache. d) Higher levels will be required later for arterial blood gases (ABGs).

a) Hypoxic drive is necessary for breathing.

A patient who experienced high fever and chills, a productive cough, chest pain, general malaise, and aching muscles during the past week is admitted to the hospital. The nurse realizes these symptoms correspond most closely with which disease? a) Pneumonia b) Type A influenza c) Pleurisy with effusion d) Streptococcus emphysema

a) Pneumonia

The nurse is caring for a patient with viral pneumonia. Which intervention(s) should the nurse expect to be included in the care plan? Select all that apply. a) Providing adequate rest periods b) Maintaining adequate fluid intake c) Administering organism-specific antibiotics d) Monitoring vital signs and respiratory status e) Providing oral hygiene before and after meals

a) Providing adequate rest periods b) Maintaining adequate fluid intake a) Monitoring vital signs and respiratory status b) Providing oral hygiene before and after meals

A patient taking aminophylline tells the nurse that he is going to begin a smoking cessation program when he is discharged from the hospital. Why should the nurse tell this patient to notify his physician if his smoking pattern changes? a) The patient will need his aminophylline dosage adjusted. b) The patient will not derive as much benefit from inhaler use. c) The patient will require an increase in antitussive medication. d) The patient will no longer require annual influenza immunization.

a) The patient will need his aminophylline dosage adjusted.

Diseases that are considered to be obstructive pulmonary disorders that cause chronic airflow limitations (CAL) include a) emphysema. b) acute bronchitis. c) pleurisy. d) pulmonary tuberculosis.

a) emphysema.

Nutritional therapy for the patient with chronic obstructive pulmonary disease (COPD) should include increasing fluid intake to keep mucus thin, resting before eating, eating four to six small meals a day, and a) ensuring sufficient calcium intake to prevent osteoporosis from use of steroid medications. b) increasing the intake of caffeine in order to boost energy levels. c) lying down immediately after meals to allow for adequate rest. d) increasing sodium intake.

a) ensuring sufficient calcium intake to prevent osteoporosis from use of steroid medications.

Common signs and symptoms that should alert the nurse to the possibility of pneumonia include a) fever and chills. b) nonproductive cough. c) night sweats. d) clubbed fingers.

a) fever and chills.

pulmonary edema

abnormal collection of fluid in the interstitial spaces of the lungs and inside the alveoli, left ventricular heart failure is common cause, place pt in high fowlers, o2 started immediately, CPAP given, intubation may be necessary, give furosemide (diuretic), give morphine to reduce anxiety -causes: neurogenic pulmonary edema drowning, acute glomerulonephritis, inhalation injury, allergic reaction and ARDS

influenza

acute, highly infectious disease of the upper and lower respiratory tracts, caused by types A,B,C, spread by direct and indirect contact, affects respiratory mucosa, causes inflammation in lungs, pharynx, sinuses and eustachian tubes, causes destruction of tissue, -s/s: appear 2-3 days after exposure, headache, fever, chills, muscle aches, sore throat, hacking cough, runny nose, congestion, n/v, diarrhea, sensitivity to light -tx: antiviral meds, increase fluids, analgesics, saline gurgles, cough meds, perform mouth care before meals, antipyretics, humidify air, splint chest and abdomen with pillows when coughing, apply vaseline to lips and nostrils, clear nostrils, adequate rest, prevent infection, hand hygiene -dx: chest xray, auscultation and WBC are normal, give antiviral meds

influenza type D

affects cattle

spontaneous pneumothorax

alveoli rupture, tall thin people and smokers are more prone to this type, cases have occurred after scuba diving, flying or mountain climbing

acute bronchitis

an extension of a URI involving the trachea, usually viral, may be caused by inhaling dust, car exhaust, industrial fumes and tobacco -s/s: cough with sputum, sore throat, runny stuffy nose, headache, muscle aches, fatigue -tx: humidification with warm or cool moist air, cough mixtures, bronchodilators, rest, nutrition, fluids

A patient with emphysema may lose weight despite having an adequate caloric intake. What advice should the nurse give the patient regarding ways to maintain an optimal weight? a) Increase activity level to stimulate appetite. b) Increase calories, protein, vitamins, and minerals. c) Continue the same caloric intake but increase fat intake. d) Increase amounts of complex carbohydrates and decrease fats.

b) Increase calories, protein, vitamins, and minerals.

The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccinations for which group? a) Children younger than 2 years b) People of any age with certain chronic conditions c) People younger than the age of 50 years d) People who have symptoms of influenza

b) People of any age with certain chronic conditions

Nursing management of a patient with the diagnosis of pulmonary tuberculosis would include a) placing a patient in contact precautions. b) health care personnel in contact with the patient using HEPA respirator masks. c) ensuring that meal trays have disposable utensils. d) increasing the activity level of the patient as much as possible during the active phase of the illness.

b) health care personnel in contact with the patient using HEPA respirator masks.

If a patient is exhibiting sudden chest pain or tightness, dyspnea, increased pulse and respirations, decreased blood pressure, and the absence of normal chest movements and breath sounds, the patient is probably experiencing a(n) a) myocardial infarction (MI). b) pneumothorax. c) acute tonsillitis. d) acute asthma attack.

b) pneumothorax.

In caring for a patient with a chest tube, it is essential that the nurse a) secure the tubing to the bedclothes with tape and a safety pin. b) carefully empty the drainage container every 8 hours and each night. c) keep the system below the patient's chest level at all times. d) change chest tube dressings at least every 4 hours and each night.

c) keep the system below the patient's chest level at all times.

Two of the most prevalent causative factors for the development of COPD are cigarette smoking and a) high serum alpha-antitrypsin (AAT) levels. b) exposure to Mycobacterium tuberculosis. c) rising levels of air pollution. d) frequent upper respiratory infections.

c) rising levels of air pollution.

restrictive pulmonary disorders

caused by decreased elasticity or compliance of the lungs or decreased ability of the chest wall to expand, CNS and neuromuscular disorders can cause restrictive lung disorder, myasthenia gravis and arthritis are extrapulmonary causes

fungal infections

caused by inhalation of fungus or spores by overgrowth of organisms found normally in the body, most common fungal lung infections are coccidiomycosis, aspergillus and histoplasmosis -s/s: cough, fever, pleuritic chest pain, muscle aches, joint stiffness, flat red rash with dark red papules

influenza type C

causes a mild respiratory illness and doesnt cause epidemics

obstructive pulmonary disorders

characterized by problems with moving air out of the lungs, causes air trapping (asthma, emphysema, bronchiectasis, CF, chronic bronchitis), caused by smoking, inhalation of irritants, chemicals, particles from air pollution, agricultural chemicals, volcanic eruptions, fumes, dusts

lung cancer dx & tx

chest xray, sputum cytology, CT scan, PET scan, cytology of specimens, bronchoscopy, electromagnetic navigation, thoracentesis, fine needle biopsy of tumor, video assisted thoracoscopic surgery -tx: surgery (wedge resection, segmental resection, lobectomy, pneumonectomy), chemo, radiation

people at high risk for influenza related complications

children ages 6 mo-4years, pregnant women, people older then 50 years, people of any age with chronic medical conditions

asthma

chronic lung disease characterized by airway obstruction, airway edema, increased airway hypersensitivity to stimuli, caused by allergens, viruses, infectious agents, occupational and environmental toxins, exercise, perfumes, genetics, obesity, emotional stress

bronchiectasis

chronic respiratory disorder when one or more bronchi are dilated, occurs from frequent respiratory infections in childhood, CF or frequent aspiration of food particles

chronic bronchitis s/s

cigarette cough, sputum cough, hypoxia, resistance to airflow, mucous membranes red blue color, hct and hgb elevated, increased RBC

occupational lung disorders

coal dust from hemp, flax and cotton processing, exposure to silica in air, asbestos exposure (can cause cancer of chest called mesothelioma)

pleural effusion

collection of fluid in pleural space -tx: thoracentesis -transudative: occurs in noninflammatory conditions, result of CHF, chronic liver failure or renal disease, transudate is a thin fluid containing no protein that passes from cells into interstitial spaced or through a membrane, causes change in chest pressure -exudative: thick, contains cells, proteins, from pleural and lung inflammation

complications of COPD

cor pulmonale (large right side of heart), acute respiratory failure, peptic ulcer, GERD, pneumothorax, pulmonary htn

TB s/s, dx, tx

cough, fever, anorexia, weight loss, fatigue, night sweats, hemoptysis, tight or dull chest pain, mucopurulent sputum -dx: TB skin test, blood test (quantiferon and tspot), sputum culture, xrays -tx: rifamate (RIF, INH and PZA), vitamin d

Early symptoms of acute bronchitis include a) large amounts of mucopurulent sputum. b) high fever. c) muscle soreness. d) dry, hacking cough.

d) dry, hacking cough.

One of the objectives of Healthy People 2020 for patients with asthma is to a) increase hospitalizations of asthma patients. b) increase hospital emergency department visits for asthma patients. c) decrease the proportion of persons with asthma who receive formal education about the disease. d) reduce activity limitations among persons with asthma.

d) reduce activity limitations among persons with asthma.

emphysema

destruction of alveolar walls, causes large inflated alveolar air spaces, inhaled air becomes trapped and exhaling air is harder, lung elasticity decreases

nutritional suggestions for COPD

drink 6-8 glasses of noncaffeinated fluids per day to keep mucus thin, rest before eating, avoid overeating, avoid foods that cause gas or bloating, eat 4-6 small meals per day, eat protein and well balanced diet, avoid lying down for 1hr after eating, take small bites, chew slowly, eat foods easy to chew, use o2 while eating, eat calcium

emphysema s/s & tx

dyspnea, coughing, mucus sputum, barrel chest, use of accessory muscles to breathe, hypercapnia, hypoxemia, respiratory acidosis -tx:bronchodilators, steroids, oxygen

ARDS s/s, dx, tx

dyspnea, tachypnea, tachycardia, hypoxemia, fine scattered crackles, respiratory alkalosis, pulmonary edema, lung stiffness, increased fluid accumulation, decrease lung compliance -tx: vent, treat underlying causes, CPAP, fluid and electrolyte management -dx: physical presentation, hx of disorder causing ARDS, ABGs, chest xray (will show whiteout/bilateral infiltrates)

preventing ventilator acquired pneumonia

elevate HOB 30-45 degrees, remove secretions continuously, change vent circuit no more often then Q48h, wash hands before and after contact with every pt, check residual volume in NG tube, provide oral care, DVT prophylaxis, peptic ulcer prophylaxis

COPD

emphysema, asthma and chronic bronchitis. firefighters, welders, farmers and others who have repeated exposure to dust are at high risk -tx: bronchodilators, antiinflammatory agents, smoking cessation, respiratory rehab, nutrition, CAM therapy -dx: h&p, spirometry reading

chronic bronchitis

excess secretion of thick tenacious mucus, decreases ciliary function, interferes with airflow, inflammatory damage to bronchial mucosa, airway becomes edematous and narrows, air trapping occurs, recurrent cough is present for 3 months of each year for 2 years, respiratory infections frequent

pulmonary fibrosis s/s, dx, tx

exertional dyspnea, nonproductive cough, inspiratory crackles, clubbed fingers -tx: antifibrotic meds, lung transplant -dx: CT scan, PFT

pneumonia

extensive inflammation of the lung with consolidation of lung tissue that fills with exudate or interstitial inflammation and edema, bacteria, viruses or inhalation of irritating gases cause pneumonia, pneumonia can occur when resistance is lowered by chronic disease, alcoholism, debilitation, physical inactivity or extreme age (hypostatic pneumonia caused by lying in bed for extended periods because of lack of physical exercise)

cystic fibrosis/CF

genetic disease where excess mucus is produced because of exocrine gland dysfunction, occurs most often in Caucasians. lungs, intestines, sinuses, reproductive tract, sweat glands and pancreas are effected, dx by h&p and positive sweat test, thick mucus, impairment ciliary action, airway obstruction and repeated infections cause scarring -tx: bronchodilators, albuterol, expectorants, oral pancreatic enzymes, fat soluble vitamins, mucolytics, high calorie , moderate fat diet, breathing exercises, chest physiotherapy, flutter valve, lung transplant

CAM therapy for emphysema

ginger, cinnamon, small doses of chili or garlic

pneumonia s/s, tx and dx

high fever, chills, cough with rust or blood flecked sputum, sweating, chest pain, malaise, aching muscles, crackles or wheezing in lungs, n/v, delirium, develop CHF -dx: chest xray -tx: antibiotics, antivirals, bactrim, promote oxygenation, control temp, maintain fluids and nutrition, rest, monitor vitals and respiratory status, relieve pain, oral hygiene, prevent irritation of lungs, avoid infection, deep breathe and cough 5-10x Qhr, barberry root bark (dont use during pregnancy can cause abortion)

pulmonary hygiene

includes administering prescribed drugs, humidifying inhaled air, med therapy via nebulizer, DPI or MDI, chest physiotherapy, breathing exercises

atelectasis

incomplete expansion or collapse of alveoli, occurs from compression of the lungs from outside, decrease surfactant or bronchial obstruction, breath sounds diminish, o2 sat decreases -tx: coughing, deep breathing, incentive spirometer

tuberculosis/TB

infectious disease of the lung characterized by lesions within lung tissue, lesions degenerate and become necrotic, spread airborne, people more at risk are american indians, alaska natives, asian pacific islanders, black non hispanics and hispanics

asthma s/s, tx, dx

inflamed airways, bronchospasm, edema, cough, dyspnea, mucosal edema, excessive secretion of mucus, plugged small airways, bronchoconstriction, obstruction and narrowing of airways, limited airflow, wheezing, chest tightness -dx: h&p, PFT, chest xray -tx: bronchodilator, oxygen, mucolytics, antibiotics, anticholinergics, peak flow meter

pleuritis

inflammation of pleura, TB, pneumonia, meds, lupus, rheumatoid arthritis, neoplasm and pulmonary infarction can cause pleurisy, pain is sharp and abrupt on inhalation, pain causes shallow breathing, pleural friction rub may be heard -tx: lie pt on affected side, splint side during coughing, intercostal nerve block

metered dose inhaler/MDI

inhaler should be held 1-2in from mouth, slow deep breath inhaling med at room air

lung cancer s/s

initially cough and wheezing, later chest pain, exertional dyspnea, bloody sputum, dysplasia, tumor grows moving to brain, bone and liver, hoarseness, paralysis of vocal cords, fatigue, anorexia, weight loss

respiratory failure tx

intrathoracic surgery, med admin, humidification, pulmonary hygiene, o2 therapy, mechanical vent, reduce and remove secretions, bronchodilators, correction of acidosis, turn, deep breathe, cough, monitor fluid balance

lung cancer

leading cause of cancer deaths worldwide, non small cell lung cancer includes adenocarcinoma, squamous cell and large cell carcinoma, small cell or oat cell tumors, risk factors are air pollution, asbestos exposure, COPD, radon exposure, smoking primary cause (90%)

sarcoidosis

lung disease characterized by granulomas in lungs and lymph nodes, causes fibrotic changes in lung tissue over time, cause is unknown, affects other tissues in body, more common in african americans, usually occurs between ages 20-40

major concerns in care of pts with chest injuries

maintain airway, ensure adequate ventilation, ensure circulation of oxygenated blood

chest injuries

major complication of chest trauma involve lungs and air passages or heart and major blood vessels, fractured ribs, flail chest (two or more rib fractures with two or more breaks per rib), penetrating wounds, pneumothorax, hemothorax

pneumothorax

occurs from blunt nonpenetrating or penetrating injury to chest wall, causes total or partial collapse of one or both lungs -pneumothorax: threat in chest injury, present in period after thoracic surgery, requires rest, o2, needle aspirate, one way chest valve, chest tube

pulmonary fibrosis

occurs from severe infection, environmental pollutants, meds, intertitial lung disease repeated infection or inflammation that causes scarring of the lung tissue, scarring decreases functional lung tissue -risk factors: occupational inhalation of lung irritants, smoking, radiation tx to chest

empyema

occurs when fluid within the pleural cavity becomes infected and exudate becomes thick and purulent, caused by staphylococci or streptococci, secondary to pneumonia, complications of thoracic surgery, chest tube insertion or thoracentesis -tx: chest tube, antibiotics

hemothorax

presence of blood within the pleural cavity caused by laceration of the lung, heart or blood vessels within the thorax, causes impaired venous return to heart and mediastinal shift, use chest tube

drainage system purpose

provide drainage of air and blood from pleural cavity, allow for gradual re expansion of lung

pulmonary embolism

pulmonary vessel is plugged with mass or clot

directly observed therapy/DOT

recommended for pts who are known to be noncompliant with therapy, visual observation of the ingestion of each required dose of meds for the entire course of tx, follow up visits for 12 months after completion of therapy

care of pt with chest tube and closed drainage

regular and frequent monitoring of respiratory status, site which tube is inserted, length of tube for kinks, amount and character of drainage, assess for ease of breathing, pain, level of consciousness, orientation, anxiety, restlessness, note character of respirations and breath sounds, assess site for unusual drainage, infection, integrity of sutures, presence of subQ emphysema, all connections must remain air tight and taped, dont allow tubing to be kinked or obstructed by weight of pt, dont pin tubing to bedclothes, dont empty drainage containers it must remain closed, replace unit when full, remain below pts chest, find out how much drainage is expected, dont clamp tube if detached place it in sterile water, persistent bubbling in water seal chamber indicates air leak, fluid in chamber should fluctuate with breathing, occasional bubbles may appear with breathing, coughing, sneezing, if pneumothorax is present bubbling will occur with inspiration, look for puffed up appearance of pts chest or neck indicating subQ emphysema, reinforce dressings but dont change except by order of surgeon, dressings must be occlusive and nor allow air in around chest tube, medicate 30-60mins before removal of chest tube

PE nursing management

remain calm, stay with pt, HOB high fowlers, begin o2 therapy, maintain o2 above 92%, assess vitals, start IV, notify provider about s/s, give subQ heparin, prepare pt for dx tests and tx, DVT prophylaxis, bed rest, turn, cough, deep breathe

intrathoracic surgery

resection of lung tissue and other pulmonary structures, requires opening chest wall and entering pleural cavity -preop: assess respiratory status, health hx, subjective and objective assessment data, improve respiratory status, special exercises prescribed to strengthen chest, shoulder and accessory muscles, remove secretions, teach arm and leg exercises, teach to improve lung ventilation and prepare for chest tube, suctioning, mechanical ventilation and incentive spirometer -postop: routine positioning, turning, coughing, deep breathing, attention to chest tubes and drainage, ambulate asap, pain management, watch for signs of pneumothorax and hemothorax, respiratory distress, auscultate and palpate upper chest and neck for swelling, look for air leak in chest tube, assess for signs of infection, assess for abdominal distention, position for comfort, optimal ventilation and adequate drainage, lie pt on back not on unaffected side

PE s/s, dx, tx

respiratory distress, dyspnea, chest pain, cough, hemoptysis, anxiety, hypotension, tachycardia, confusion -dx: symptoms and risk factors, d dimer test, CTPA, chest xray, ECG, ABGs -tx: oxygen, heparin, thrombolytic therapy, embolectomy, IVC filter

influenza type A&B

responsible for seasonal disease epidemics each year

first signs of decreased oxygenation

restless, confusion accompanied by increased respiratory rate, flaring of nostrils, retraction of intercostal muscles (cyanosis late sign)

respiratory failure s/s

restlessness, agitation, confusion, increased RR, pulse and bp, have to sit upright and bend forward and unable to speak without pausing for breath, diaphoresis, retraction of accessory respiratory muscles, cyanosis, cardiac arrest, respiratory acidosis

respiratory failure

result of insufficient oxygen or excessive carbon dioxide,

acute respiratory distress syndrome/ARDS

results from pulmonary changes that occur with sepsis, major trauma, major surgery or any critical illness

instructions for pts with COPD

see nutritionist, changes in sputum needs to be reported, when exerting breathe through pursed lips, breathing exercises daily, avoid crowds during cold and flu season, dont take OTC meds unless directed, dont smoke, smoking cessation, psychosocial care

peak flow meter

set pointer to 0, stand, take deep breath, put mouthpiece in mouth and clamp lips firmly, blow as hard and fast as possible, rest, repeat 3 times, record highest reading. if a reading is 60% below pts best tx should be adjusted, when reading is in green zone airflow is normal ,when reading is in yellow zone usual airflow has decreases and routine meds should be increased, red zone rescue meds are needed

TB nursing management

standard and airborne precautions, put pt in negative pressure room, wear HEPA respirator mask, hang hygiene, cover mouth when sneezing and coughing, dispose of used tissues, evaluate sputum cultures, support, control infection, promote immunity

pneumothorax and hemothorax s/s

sudden angina, tightness of chest, increased pulse and respirations, decreased bp, absence of normal chest movement, absent or diminished breath sounds on affected side

extrapulmonary TB

tubercle bacillus attacks and damages parts of the body other then the lungs, areas most frequently affected are lymph nodes, bones, meninges, digestive system, urinary system and reproductive system. TB of the spine is called Pott disease (kyphosis common),