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Respiratory- Lower 2

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mattisensept's version from 2017-09-27 18:58

pulmonary embolism

Question Answer
pulmonary embolism blockage of one or more pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
treatment to reduce mortality anticoagulants
what is happening?lung is ventilated, but gas exchange is decreased as there is no blood supply to the ventilated alveoli
risk factorsobesity, ortho sx, immobility, dehydration, heart failure, smoking, clotting disorders, fractured long bones, hx of DVT, birth control
manifestationschest pain, dyspnea, tachycardia, tachypnea, restlessness, crackles, hemoptysis
pulmonary infarctionalveolar necrosis and hemorrhage, abscess, plural effusion
pulmonary HTN results from hyposemia associated w/massive recurrent emboli, right ventricular hypertrophy
diagnostic testsserum d-dimer levels, spiral CT scan, chest x-ray, ECG, troponin, BNP
prevention is keysequential compression devices, early ambulation, prophylactic anticoagulation
goals of txprevent further thrombi, prevent further embolization to pulmonary system
supportive care variableoxygen--> mechanical ventilation, pulomary toilet, fluids, duiretics, analgesics
nurse managmentsemi-fowlers position, O2 therapy, frequent assessments, IV access, monitor lab results, emotional support and reassurance
patient teaching long-term anticoagulant therapy, measures to prevent DVT, follow up exams
expected outcomesadequate tissue perfusion & respiratory function, cardiac output, increased level of comfort, prevention of further recurrence PE
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lung disease

Question Answer
risk factors for lung disease smoking, more is worse, age of smoking, depth of inhalation, tar and nicotine content, use of unfiltered, second hand smoke
other risk factorpollution, radiation, asbestos, industrial agents
patho mutated epithelial cells, 8-10 years for tumor to reach 1 cm,
non-small cell lung cancer80% of cases are more treatable
small-cell lunge cancer20% of cases and relatively deadly
squamous cellslow grower, centrally located, less likely to metastasize,
adenocarcinoma moderate grower and most common in non-smokers, usually no symtoms until it spreads, maybe sx, chemo not as effective
large-cellrapid growth, bronchi, metastasizes easily, radiation good, recurs
small-cellvery rapid growth, most malignant & metastasizes quickly, poor prognosis
lung cancer metastasize primarily bydirect extension, blood circulation, lymph system
primarily metastasize tolymph nodes, liver, brain, bones, adrenal glands
early clinical manifestations disease hypercalcemia, SIADH, adrenal hypersecretion, polycythemia, cushing syndrome
early symptomspneumonitis, persistent cough w/sputum, hemoptysis, chest pain, dyspnea, wheezing
late symotomsanorexia, fatigue, weight loss, dysphagia, N/V, hoarse voice, unilateral paralysis of diaphragm, superior vena cava obstruction, palpable lymph nodes, mediastinal involvement
diagnostics chest x-ray, sputum specimens, lung biopsy
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asthma

Question Answer
asthmachronic inflammatory disease of the airways
inflammation causesairway obstruction, recurrent episodes of wheezing, breathlessness, chest tightnees, cough (particularly @ night and in early morning)
pathoairway hyper-responsiveness is caused by bronchoconstriction in response to physical, chemical or pharmacologic agents
triggersallergen inhalation, air pollutants, viral URI, sinusitis, exercise & cold, dry air, stress, drugs, occupational exposure, food additives, hormones/menses, GERD
prominent featuesreduction in airway diameter, increase in airway resistence, consdtriction of bronchial smooth mucles, excess production of mucus
early-phase response bronchospasm, wheeze, chest tightness, dyspnea & cough
late-phase responsepeak 5-6 hrs after, hightened airway reactivity, increased airway resistence, lung hyperinflation,
textbook featuresrecurrent episodes of wheezing, breathlessness, cough, tight chest, expirations may be prolonged, between attacks--> may be asymptomatic w/normal or near-normal lung function
wheezingunreliable sign to gauge severity of attack, severe attacks can have no audible wheezing due to reduction in airflow,
manifestationshypoxia (during attack), restlessness, increased anxiety, inappropriate behavior, and increased pulse, percussion (hyperresonance), percussion (hyperresonance), auscultation (inspiratory or expiratory wheezing), diminished or absent breath sounds may indicate atelectasis of pneumonia
ABG during mild attackrespiratory alkalosis w/arterial 02 pressure near normal, trying to compensate
severe attack respiratory and metabolic acidosis
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mild, intermittent

Question Answer
symptomsno more frequently than twice weekly, asymptomatic & normal PERF between exacerbations, exacerbations brief, intensity of exacerbations varies
nocturnal symptoms no more frequent than twice monthly
pulmonary functionFEX/PERF is at least 80% predicted , PERF variability is less than 20%
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mild persistent

Question Answer
symptomsmore frequent than 2 weekly but less than once a day, exacerbations may affect activity
nocturnal symptoms more frequent than twice monthly
pulmonary functionFEV/PERF is at least 80% of predicted, PERF variability is between 20% and 30%
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moderate persistent

Question Answer
symptomsdaily use of inhaled short-acting B2 agnoist, exacerbations affect activity, at least twice weekly and may last for days, may affect activity
nocturnal symptoms more frequent than once weekly
pulmonary functionFEV1/PERF exceeds 60% but is less than 80% of predicted. PERF variability exceeds 30%
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severe persistent

Question Answer
symptoms continual symptoms, limited physical activity, frequent exacerbations
nocturnal symptoms frequent
pulmonary function FED/PERF is no greater than 60% of predicted, PERF variability exceeds 30%
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asthma cntd

Question Answer
acute asthma episodesstart O2 immediatley & monitor w/pulse oximetry, medications (inhalers, nebulizers, corticosteroids),
status asthmaticussevere, life-threatening complication of asthma that is refractory to usual tx, places the patient @ risk for respiratory failure
causes of status asthmaticusviral illnesses, ASA or NSAIDS, stress, increased allergen exposure, abrupt discontinuation of drug therapy, abuse of aerosol medication
manis of status asthmaticusHTN, sinus tachycarida, ventricular arrhythmias
complications of status asthmaticus pneumothorax, pnesumomediastinum, acute cor pulmonale, respiratory muscle fatigue leading to respiratory arrest
management focuses on correcting hypoxemia, improving ventilation, measures similar to those for acute asthma
collaborative careIV corticosteroid, continuous monitoring
start with preventativeavoid triggers of acute attacks, pre-medicate before exercising
health promotiondesensitization can decrease sensitivity, treat URI and inusitis, adequate nutrition, adequate sleep, take short acting B-adrenergic agonist 10-20 min prior to exercising
important patient teachinglearn about medications, monitor responsiveness to medication, understand importance of continuing medication when symptoms are not present
medications termors are a common side affect of short acting B2 and not a reason to stop, all dry powder inhaled drugs must be inhaled rapidly, inhaled corticosteroids are never a fast acting drug, pt. should hold their breath 10 seconds after using an inhaler
green zone 80-100% of personal best so remain on medication
yellow zone50-80% of personal best & somthign is triggering, need fast acting bronchodilator
red zone50% of less indicates serious problem, definitive action must be taken w/health care provider, fast acting and contact provider
goalsnormal or near-normal pulmonary function, normal activity level, no recurrent exacerbations of asthma or a decreased incidence of attacks, adequate knowledge to participate in and carry out a treatment plan
diagnosisineffective airway clearance, anxiety, ineffective therapeutic regimen management
Interventionsmonitor respiratory and cardiac systems, lung sounds, VS, monitor ABG, pulse ox, PERF, work of breathing
Important nursing interventionscalm, quiet, reassuring attitude, positioned comfortably, staying w/patient , slow breathing through pursed lips, administering O2, medications
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COPD

Question Answer
COPDairway obstruction resulting from chronic bronchitis or emphysema, generally progressive, may be partially reversible, often accompanied by airway hyperactivity
etiologysmoking, recurring respiratory tract infections, urban air pollution,
h & phistory of smoking, decreased elasticity of lung tissue & thoracic cage, barrel chest, increased difficulty clearning secretions, more infections
pathosurface area decreases, compensates by increasing RR, may develop during exercise, pt. may benefit from supplemental O2, hypercapnia and respiratory acidosis do not develop until late in disease process
COPD w/bronchitis excess bronchial mucus w/cough for at least 3 months during 2 successive years, airway colonized w/increased infections, eventually, scarring of the bronchial walls, alveolar structure & capillaries are normal
emphysema progressive dyspnea, underweight, later (secondary chronic bronchitis may develop)
chronic bronchitis frequent, productive cough during winter, frequent respiratory infections, dyspnea on exertion, bluish-red color of skin, normal weight or heavy set w/ruddy appearance
cor pulmonale can resultright sided cardiac hypertrophy w/ or w/o heart failure, results from HTN
manis of cor pulmonale jugular venous distention, hepatomagaly w/ right upper quadrant tenderness, ascites, epigastric distress, peripheral edema, weight gain
management of cor pulmonale continuous low-flow O2, digitalis not indivated except when it is used when CHF is present, salt restriction, diuretics
COPD complicationsRTI, peptic ulcer, GERD, pneumonia
collaborative careimprove ventilation, promote secretion removal, prevent complications & progression of symptoms, promote pt. comfort and participation in care, improve quality of life, annual influenza vaccine, treat infections, quit smoking, bronchodilator, O2 therapy, respiratory care
goalsreturn to baseline respiratory function, ability to perform ADLs, relief from dyspnea, no complications r/t COPD, knowledge and ability to implement long-term regimen, overall improved quality of life
health promotionstop smoking, avoid or controlling exposure to occupational & environmental pollutants and irritants, early detection of small-ariway disease, early diagnosis of RTI
nursing implementationupright, orthopenic or tripod positioning, teach pt. how to achieve optima capabiity in carrying out ADLS, activity considerations
alternative ADL sit up when doing activities, slow pursed lip breathing
pulmonary function testsno bronchodilators for 6 hours before in order to get an accurate assessment
sleepnasal saline sprays, decongestants, nasal steroid inhalers, long-acting theophylline
psychosocial considerationsguilt, depression, anxiety, social isolation, denial, dependence, use relaxation techniques & support groups
discouragemoving above 4000 feet
expected outcomesnormal breath sounds, effective coughing, return of Pa02 to normal range, improved mental status, normal serum protein levels, feeling of being rested, improved sleep patterns, awareness of need to seek medical attention, no infection
drug thoughtsnebulizers, bronchodilators (expect tremors, teach and prepare patient, use before exercise)
postural drainage & chest physiotherapy through gravity & chest physiotherapy, uses gravity & percussion
best result for chest physiotherapy use bronchodilator before, work after to cough up and loosen secretions, remain in postural position for 5 min, no meals around.
nutritionalsmall frequent snacks, more calories a day, rest before meals. fiber (maybe not so good, more energy to eat) high calorie and protein
pursed lip breathinginhale slowly through nose. goal is 3:1 ration of inspiration to expiration
abdominal breathingobstructive diseases are air trapping, expiratory disease, patients feel better if they can free this trapper air, train the abdominal muscles to assist in expiration, have pt. lie down and place a paperback book on upper abdomen, on expiration have abdominal muscles contract, book is postive feed back as these muscles get trained to new thing
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cystic fibrosis

Question Answer
cystic fibrosisa autosomal recessive disease, altered exocrine gland function, involving lungs, pancrease and sweat glands.
characterized byabnormal, thick, abundant secretions leading to a chronic diffuse obstruction pulmonary disorder
in newbornsmaconium ileus, failure to grow, clubbing of fingers, persistent cough w/mucous production, tachypnea, large frequent bowl movements
in adultscough (first sign) productive w/purulent green mucous, increasingly recurring lung infections w/periods of stabilization, can have distal bowl obstruction
diagnosticssweat chloride test
collaborative carepromote secretion clearance, control infection, provide adequate nutrition
nursing management relief of respiratory symptoms, chest PT, antibiotics, 02 therapy, steroids, psycho-social support, family support, agency referral (financial burden)
hot weathercan be challenging, increased sweating, thicker secretions--> weakness, add fluid and salt to diet
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