Respiratory Problems - 1 Lewis finish up Chapter 26 Start at PowerPoint Outline Slide 14

Assessment - SUBJECTIVE Subjective findings: (onset, frequency, severity, pattern, assoc. symptoms, alleviating or exacerbating factors) Dyspnea Wheezing, tightness Pain upon breathing Cough: productive or unproductive Sputum: amount, color, consistency, odor Hemoptysis Voice change: acute or chronic, frequency, smoking and alcohol use history, excessive use of voice History: Smoking, environmental irritants, previous pulmonary disorder (TB, chest surgery), Genetic disorder

Assessment - OBJECTIVE See Common Assessment Abnormalities Table 26-7, p. 511 Review physical assessment steps Inspection Palpation Percussion Auscultation: normal and adventitious breath sounds

Diagnostic Studies – Table 26-10, p. 513 ABG’s Sputum culture: isolate and identify causes of pulmonary infection Usually collected by expectoration, suction Collected in sterile container

Pulse Oximetry Non-invasive measurement of saturation of arterial blood with oxygen Normal value: >95% Hospitalized patients: most acute care units set the goal to be > 92%

Diagnostic Studies Chest x-ray: PA and Lateral Standing in radiology department AP view: Portable Chest x-ray

CT scan: biopsy (pneumothorax) MRI Ventilation-perfusion scan: pulmonary embolus Compares ventilation of radioisotope to perfusion of radioisotope Pulmonary Angiography: confirm PE

CT Scanner vs. MRI Scanner CT (computed tomography) – open MRI (magnetic resonance imaging) – closed, LOUD!! magnet

Thoracentesis Collection of pleural fluid, instill medication into pleural space Position client sitting up with elbows on over-bed table May insert chest tube for continued drainage

Pulmonary Functions Tests Measure lung volumes and airflow Results used to diagnose pulmonary disease, monitor progress, evaluate disability, evaluate response to bronchodilators Verbal coaching encourages clients optimal performance

PFT – Pulmonary Function Tests Patient Experience Various Measurements

Pulmonary Functions Tests - Volumes Tidal volume (VT): volume of normal breath - .5 L (500 mL) Common tests of airflow Forced Vital Capacity – quickly exhaled after max. inhalation FEV1 - forced expiratory volume in first second of expiration PEFR – peak expiratory flow rate