Module 1-Oxygenation

nursebrandy17's version from 2016-10-03 18:40


Question Answer
Age of Onset40-50 years
Smokingoften long history (>10-20 pack years)
Health HistoryInfrequent allergies; exposure to enviromental polluntant
Family HistoryLung and liver disease without smoking
Clinical SymptomsSlowly progressive and persistant
DyspneaDiffculty breathing during excercise
Disease CourseProgressive worsening w/ exacerbations
ABGsBetween exacerbations in advanced COPD: LOW-NORMAL pH & PaO2; HIGH-NORMAL PaCO2 w/ HIGH HCO3 (comp. resp. acidosis)
Chest XrayHyperinflation, may have enlarged heart, flattened diaphram
Lung VolumeNever normalizes

COPD Drugs

Question Answer
Expectorantguafenesin (Robitussin)
Bronchodialatorsalbuterol, ipratropium bromid (Atrovent), fluticason-salmeterol (Advair)
Proton Pump Inhibitorsomeprazole (Prilosec)


Question Answer
Status AstmaticusAsthma Attack
Age of onsetUsually <40 years of age
SmokingNot casual
Health HistoryPresence of allergies, rhinitis, eczema
Family HistoryHistory of asthma
Clinical SymptomsIntermittent, vary day to day, at night or in early morning
DyspneaAbsent except in exacerbation's or poor control
Disease CourseStable w/ exacerbation
ABGsNormal between episodes
pHINCREASED early in exacerbation, then DECREASED if prolonged or severe exacerbation
PaCO2DECREASED early in exacerbation, the INCREASED if prolonged or severe exacerbation
Chest X-rayMay reveal hyperinflation
Lung VolumesOften normalizes

Asthma Meds

Question Answer
Short Acting Betasalbuterol (Proventil, Ventolin, Proair)
Anticholinergicsipratropium (Atrovent)
Combo Medssalmeterol + fluticasone (Advair Discus or HFA)


Question Answer
DefineAcute infection of the lung parenchyma; mucociliary mechanism impaired
3 Ways Organisms Reach LungsASPIRATION, Inhalation of microbes, hematogenous spread from primary infection elsewhere in body
CAPCommunity Acquired Pneumonia
MCAPMedical care-associated Acquired Pneumonia (ventilator associated VAP; hospital associated HAP) WITHIN 48 hours
HCAPHealth care-associated Acquired Pneumonia WITHIN 90 DAYS
Other TypesAspiration Pneumonia; Opportunisitic Pneumonia (immunosuppressed)
PCPPneumocystis jiroveci pneumonia (Associated with HIV)
CMVCytomegalovirus pneumonia (Herpes virus that causes pneumonia)
Clinical ManifestationsMost common= Fatigue; Rhonchi & crackles=loose mucus
Diagnostic TestsChest X-Ray, CBC, Sputum and Blood Cultures, ABGs
ABGsRespiratory Acidosis= pH LOW; CO2 HIGH
TreatmentStart with Broad Spectrum until sputum culture results get back; If mucus is thick=bronchoscopy
PreventionPneumonia vaccine every 5 years; Flu Vaccine-yearly can help prevent pneumonia

Chest Tubes

Question Answer
Pneumothorax(a.k.a collapsed lung) air in lungs
Hemothoraxblood in the lungs
Empyemapus in the lungs
Pleural Effusionexcess fluid in lungs r/t pneumonia, HF, PE, Cancer
Chylothoraxlymph fluid
CDUChest Drainage Unit
Rule of 2'sWater in at 2 cm mark, add water to 20 cm level, later turn dial to -20 pressure
To Drain AirInsert at 2nd ICS (doctor does this)
To Drain FluidInsert at rib cage (doctor does this)
Suction UnitTraditional-Water Seal
Gravity UnitHeimlich Valve; JP-indwelling Pleural Catheter

Nursing Management-Chest Tubes

Question Answer
Doctor OrderAlways Check Order
TubingLoosely Coiled; do not strip or milk (increases pressure)
ObserveTidaling (water) is present
ClampDO NOT CLAMP (unless changing)
UnitBelow Chest AT ALL TIMES
Upon Entering Clients RoomLook at site of chest tube placement then check patients status
Drainage<100 ml/hr is reasonable drainage (make sure you ask doctor how much to expect)
Bubblesmean an air leak is present; re-tape tubing connection
Subcutaneous Emphysemagases in tissue (Rice Krispies) In immediate area is normal
Re-Expansion Pulmonary EdemaGood Lung UP; Give diuretics
DocumentationMark output on container; note color and output on documentation
DressingXeroform=preferred petroleum gauze for occlusive dressing
SuppliesKeep 4x4 and vasoline at bedside
Assessmentv/s, lung sounds, pain, drainage amt, infection (sample), subcu emphy, encourage deep breathing, ROM, IS every hour
If Chest Tube Comes Outapply pet gauze dressing (xeroform), assess O2 status, give oxygen, GET HELP, call provider