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