Common Problems related to Oxygen-Respiratory Megan McClintock Megan McClintock Spring 2008

Lower Respiratory Problems Acute bronchitis Acute bronchitis Pneumonia Pneumonia Community-acquired Community-acquired Hospital-acquired Hospital-acquired Fungal Fungal Aspiration Aspiration Opportunistic Opportunistic

Acute Bronchitis Definition Definition Symptoms Symptoms Treatment Treatment

Pneumonia Results when the normal defense mechanisms become incompetent or are overwhelmed Results when the normal defense mechanisms become incompetent or are overwhelmed Filtration of air Filtration of air Warming and humidification of inspired air Warming and humidification of inspired air Epiglottis closure over the trachea Epiglottis closure over the trachea Cough reflex Cough reflex Mucociliary escalator mechanism Mucociliary escalator mechanism Secretion of Immuglobin A Secretion of Immuglobin A Alveolar macrophages Alveolar macrophages Organisms spread by: Organisms spread by: Aspiration Aspiration Inhalation Inhalation Spread from a primary infection elsewhere Spread from a primary infection elsewhere

Types of Pneumonia Community Acquired (CAP) Community Acquired (CAP) Hospital Acquired (nosocomial) Hospital Acquired (nosocomial) Aspiration Aspiration Opportunistic Opportunistic

Assessment Sudden onset of fever, chills Sudden onset of fever, chills Cough with purulent sputum Cough with purulent sputum Confusion or stupor (in the elderly) Confusion or stupor (in the elderly) Breath sounds – increased fremitus, bronchial breath sounds, crackles Breath sounds – increased fremitus, bronchial breath sounds, crackles

Question 9 The nurse notes new onset confusion in an 89-year-old patient in a long-term care facility; the patient is normally alert and oriented. Which action should the nurse take next? The nurse notes new onset confusion in an 89-year-old patient in a long-term care facility; the patient is normally alert and oriented. Which action should the nurse take next? A. Check the patient’s pulse rate A. Check the patient’s pulse rate B. Obtain an oxygen saturation B. Obtain an oxygen saturation C. Notify the health care provider C. Notify the health care provider D. Document the change D. Document the change

Complications Pleurisy Pleurisy Pleural effusion Pleural effusion Atelectasis Atelectasis Lung abscess Lung abscess Empyema Empyema Pericarditis Pericarditis Arthritis Arthritis Meningitis Meningitis Endocarditis Endocarditis

Health Promotion Interventions If URI symptoms > 7 days, seek medical care If URI symptoms > 7 days, seek medical care Influenza and pneumococcal vaccines if at risk Influenza and pneumococcal vaccines if at risk If decreased level of consciousness: If decreased level of consciousness: Position side-lying, upright to prevent aspiration Position side-lying, upright to prevent aspiration Turn q 2 hrs Turn q 2 hrs If difficulty swallowing: If difficulty swallowing: Assist with eating and drinking Assist with eating and drinking Take meds to prevent aspiration Take meds to prevent aspiration Strict medical asepsis and handwashing Strict medical asepsis and handwashing Strict sterile technique with tracheal suctioning Strict sterile technique with tracheal suctioning

Acute Care Interventions

Question 8 To promote airway clearance in a patient with pneumonia, the nurse instructs the patient to: To promote airway clearance in a patient with pneumonia, the nurse instructs the patient to: A. Splint the chest when coughing A. Splint the chest when coughing B. Maintain fluid restrictions B. Maintain fluid restrictions C. Wear the nasal oxygen cannula C. Wear the nasal oxygen cannula D. Try the pursed-lip breathing technique D. Try the pursed-lip breathing technique

Ambulatory/Home Care Interventions

TB Not just the lungs Not just the lungs Resurgence Resurgence HIV patients HIV patients MDR strains MDR strains Poor compliance Poor compliance No follow-up No follow-up Ineffective drug therapy Ineffective drug therapy

At Risk for TB

TB Etiology Etiology Clinical manifestations Clinical manifestations Diagnostic studies Diagnostic studies Complications Complications

Treatment

Question 10 T he nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB: T he nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB: A. Demonstrates correct use of a nebulizer A. Demonstrates correct use of a nebulizer B. Reports daily to the public health department B. Reports daily to the public health department C. Washes dishes and personal items after use. C. Washes dishes and personal items after use. D. Covers the mouth and nose when coughing D. Covers the mouth and nose when coughing

Question 7 The nurse has received change-of-shift report about these respiratory patients. Which patient should the nurse assess first? The nurse has received change-of-shift report about these respiratory patients. Which patient should the nurse assess first? A. A patient with loud expiratory wheezes. A. A patient with loud expiratory wheezes. B. A patient who has a cough productive of thick, green mucus B. A patient who has a cough productive of thick, green mucus C. A patient with oxygen sats of 91% C. A patient with oxygen sats of 91% D. A patient with a respiratory rate of 38 D. A patient with a respiratory rate of 38

CANCER OF THE LUNG - etiology Cigarette smoking most important risk factor Cigarette smoking most important risk factor Mortality risk reduced 30-50% after 10 years of smoking cessation Mortality risk reduced 30-50% after 10 years of smoking cessation Sidestream smoking contains same carcinogens found in mainstream smoke Sidestream smoking contains same carcinogens found in mainstream smoke Environmental tobacco smoke inhaled by nonsmokers and children – 35% risk Environmental tobacco smoke inhaled by nonsmokers and children – 35% risk

CANCER OF THE LUNG Clinical Manifestations Clinical Manifestations Asymptomatic until late in the disease process Asymptomatic until late in the disease process Persistent pneumonitis, productive cough Persistent pneumonitis, productive cough Hemoptysis not common early in disease Hemoptysis not common early in disease Anorexia, fatigue, wt. Loss, N/V, hoarseness Anorexia, fatigue, wt. Loss, N/V, hoarseness Diagnostic Studies Diagnostic Studies Chest X-Ray Chest X-Ray Computerized Tomography (CT) Computerized Tomography (CT) Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI) Fiberoptic Bronchoscope Fiberoptic Bronchoscope Mediastinoscopy Mediastinoscopy Pulmonary Angiography – fine needle aspiration Pulmonary Angiography – fine needle aspiration

NURSING MANAGEMENT & COLLABORATIVE CARE Radiation Therapy Radiation Therapy Chemotherapy Chemotherapy Surgery – Lobectomy or Pneumonectomy Surgery – Lobectomy or Pneumonectomy Diagnosis Diagnosis Ineffective airway clearance Ineffective airway clearance Anxiety Anxiety Acute Pain Acute Pain Imbalanced Nutrition Imbalanced Nutrition Ineffective health Maintenance Ineffective health Maintenance Ineffective Breathing pattern Ineffective Breathing pattern

PREDOMINANT SITE OF TYPES OF LUNG CANCERS PREDOMINANT SITE OF TYPES OF LUNG CANCERS

PNEUMOTHORAX Definition Definition Types of Pneumothorax Types of Pneumothorax Closed Closed Open Open Tension Tension Hemothorax Hemothorax Chylothorax Chylothorax Clinical Manifestations Clinical Manifestations Collaborative Care Collaborative Care

PNEUMOTHORAX

CHEST TUBES Chest tube placementChest suction system - common

PULMONARY EMBOLI Thrombi in venous circulation or right side of the heart occlude pulmonary arterial blood flow to parts of lung Thrombi in venous circulation or right side of the heart occlude pulmonary arterial blood flow to parts of lung