1. Respiratory System Function, Assessment, and Therapeutic Measures

3.  Upper Respiratory Symptoms  Lower Respiratory Symptoms  Exposures/Smoking  Current Treatments  Family History

4.  Where Is It?  How Does It Feel?  Aggravating and Alleviating Factors  Timing  Severity  Useful Other Data  Patient’s Perception

5.  Symmetry  Dyspnea  Use of Accessory Muscles  Color  Respiratory Rate and Rhythm  Chest Shape

6.  Normal Breath Sounds  Adventitious Sounds  Compare Bilaterally

7.  Crackles—Coarse or Fine  Wheezes  Stridor  Friction Rub  Diminished  Absent

8.  CBC  ABGs  D -Dimer  C&S  Sa O 2

9.  Chest X-Ray  VQ Scan  PFTs  Angiography  Bronchoscopy

10.  Smoking Cessation ◦ Ask ◦ Advise ◦ Assess ◦ Assist ◦ Arrange  Interventions ◦ Behavior Modification ◦ Counseling ◦ Setting Quit Date ◦ Nicotine Replacement ◦ Drug Therapy ◦ Hypnosis

11.  Deep Breathing and Coughing  Breathing Exercises  Positioning ◦ Fowler’s ◦ Semi-Fowler’s ◦ Good Lung Down

12.  Nasal Cannula

13. A.B. C. D.

18.  Indications  Chest Tube Insertion  Drainage System  Nursing Care

20.  Definition  Indications  Nursing Care ◦ Suctioning ◦ Cleaning ◦ Communication ◦ Teaching

23.  Invasive ◦ Indications ◦ Nursing Care ◦ Trouble-Shooting Alarms

24. Nursing Care of Patients with Upper Respiratory Disorders

25.  Causes ◦ Trauma ◦ Hypertension ◦ Hemophilia ◦ Medications ◦ Recreational Drug Use (Cocaine)

26.  Positioning  Direct Pressure  Ice  Nasal Packing  Nasal Balloon Catheter  Vasoconstrictive Agent  Electrocautery

28.  Usually Benign  Occur More Often with Allergies  Treatment ◦ Control Allergies ◦ Surgery ◦ Avoid Aspirin Postop

29.  Symptoms ◦ Stuffy Nose ◦ Blocked Sinus Drainage ◦ Headaches  Treatment ◦ Nasoseptoplasty

30.  Monitor Vital Signs/Bleeding  Report Excess Swallowing  Monitor Dressing  Teach ◦ Avoid Activities That Increase Pressure ◦ Avoid Aspirin

31.  Inflammation of Sinus Mucosa ◦ Bacterial ◦ Allergic  Signs and Symptoms ◦ Pain Over Affected Sinus ◦ Fever ◦ Nasal Discharge

32.  Decongestants  Hot Packs  Saline Irrigation  Acetaminophen/ Ibuprofen  Humidification  Oral Fluids  Positioning  Antibiotics  Surgical Drainage  Rest

33.  Rhinitis  Pharyngitis  Laryngitis  Tonsillitis

34.  Pathophysiology ◦ Primary Tumor of Mucosal Epithelium ◦ Metastasizes to Lungs, Liver, Lymph Nodes  Etiology ◦ Associated with Smoking, Alcohol ◦ More Common in Men

35.  Hoarseness  Change in Voice  Pain  Dyspnea  Cough  Dysphagia  Airway Obstruction

36.  Laryngoscopy  CT  MRI

37.  Radiation  Chemotherapy  Laryngectomy

38.  Ineffective Airway Clearance  Acute Pain  Impaired Verbal Communication  Imbalanced Nutrition  Impaired Swallowing  Grieving  Disturbed Body Image

40. Nursing Care of Patients with Lower Respiratory Tract Disorders

41.  Pathophysiology ◦ Acute Lung Infection ◦ Inflammation and Alveolar Damage ◦ Alveoli Filled with Exudate ◦ Reduced Surface Area for Gas Exchange

42.  Bacteria, U usually Steptococcus pneumoniae  Virus  Fungus  Aspiration  Artificial Ventilation (VAP)  Hypostasis  Chemical

43.  Very Young  Elderly  Hospitalized  Intubated  Immunocompromised

44.  Chest Pain  Fever, Chills  Cough, Dyspnea  Yellow, Rusty, or Blood-Tinged Sputum  Crackles, Wheezes  Malaise

45.  Pleurisy  Pleural Effusion  Atelectasis  Spread of Infection

46.  Chest X-Ray  Sputum Culture  Blood Cultures

47.  Antibiotics - PO or IV  Antiviral Medication (Zovirax)  Bronchodilators  Expectorants  Oxygen  Fluids

48.  Pathophysiology ◦ AFB Implant on Bronchioles or Alveoli ◦ Tubercle Formed ◦ Immune System Keeps in Check ◦ 5%-10% Infected Become Ill ◦ May Activate with Impaired Immunity

49.  Elderly  Alcoholics  Crowded Living Conditions  New Immigrants  HIV

50.  Cough  Blood-Tinged Sputum  Night Sweats  Anorexia and Weight Loss  Low-Grade Fever  Dyspnea, Chest Pain (Late)

51.  PPD Skin Test  Chest X-Ray  Sputum Cultures  QuatifFERON-TB Gold

52.  Combination of Drugs for 6 - 24 Months ◦ INH ◦ Rifampin ◦ Streptomycin ◦ Ethambutol  Occasional Surgical Removal  Isolation

53.  Impaired Gas Exchange  Ineffective Airway Clearance  Ineffective Breathing Pattern  Activity Intolerance

54.  Monitor ◦ Lung Sounds, Respiratory Rate and Effort ◦ Dsypnea ◦ Mental Status ◦ Sa O 2, ABGs  Position ◦ Fowler’s ◦ Good Lung Down  Administer Oxygen  Teach Breathing Exercises  Discourage Smoking

55.  Monitor ◦ Lung Sounds ◦ Sputum  Encourage ◦ Fluids ◦ Deep Breathing ◦ Coughing  Administer Expectorants  Turn q2h or Ambulate  Suction prn  Consider CPT or Mucus Clearance Device

56.  Monitor ◦ Respiratory Rate, Depth, Effort ◦ ABGs, Sa O 2  Determine/Treat Cause  Position  Teach Diaphragmatic Breathing

57.  Monitor Response to Activity ◦ Vital Signs ◦ Sa O 2  Use Portable O 2 for Ambulation  Allow Rest Between Activities  Obtain Bedside Commode  Increase Activity Slowly  Refer to Pulmonary Rehabilitation

58.  Clean, Well-Ventilated Living Areas  Isolation of Patients who have Active TB  High-Efficiency Filtration Masks  Gowns, Gloves, Goggles If Contact with Sputum Likely

59.  Combination of ◦ Chronic Bronchitis ◦ Emphysema ◦ Asthma  Chronic Airflow Limitation

61. Chronic Bronchitis Chronic Inflammation Low-Grade Infection Hypertrophied Mucous Glands in Bronchi Impaired Ciliary Function Ineffective Airway Clearance Diagnosed After Ill 3 Months of Year for 2 Consecutive Years Emphysema Destruction of Alveolar Walls Loss of Elastic Recoil Damage to Pulmonary Capillaries Air Trapping Impaired Gas Exchange

62.  Smoking  Passive Smoke Exposure  Pollutants  Familial Predisposition  α 1 AT Deficiency (Emphysema)

64. Smoking!!

65.  Cough  Sputum Production  Dyspnea  Prolonged Expiration  Barrel Chest  Activity Intolerance

66.  Wheezing, Crackles  Chronic Cough  Dyspnea  Thick, Tenacious Sputum  Increased Susceptibility to Infection  Mucous Plugs

67.  Diminished Breath Sounds  Dyspnea  Progressive Activity Intolerance

68.  Cor Pulmonale  Weight Loss  Pneumothorax  Respiratory Failure

69.  Chest X-Ray  CT Scan  ABGs  CBC  Spirometry  Sputum Analysis

70.  Stop Smoking!!  Oxygen 1-2 L/m  Supportive Care  Pulmonary Rehab  Surgery  Mechanical Ventilation  End-of-Life Planning  Medications ◦ Bronchodilators ◦ Corticosteroids ◦ Expectorants  NMT/MDI

71.  Pathophysiology ◦ Inflammation of Bronchial Mucosa/ Bronchial Tree ◦ Spasm of Bronchial Smooth Muscles ◦ Air Trapping ◦ Reversible

72.  Smoking  Allergens  Infection  Sinusitis  Stress  GERD

73.  Dyspnea  Wheezing  Cough  Sputum  Use of Accessory Muscles  May Be Worse at Night

74.  Status Asthmaticus ◦ Severe, Sustained Asthma ◦ Worsening Hypoxemia ◦ Respiratory Alkalosis Progresses to Respiratory Acidosis ◦ May Be Life Threatening

75.  History and Physical Examination  Spirometry  ABGs  Allergy Skin Testing

76. Bronchodilators Adrenergic (Ventolin, Serevent) Leukotriene Inhibitors (Accolate, Singulair) Theophylline (Rare) Corticosteroids Inhaled, IV, PO Mast Cell Inhibitors (Exercise Induced) Antihistamines Oxygen PRN

77.  Pathophysiology ◦ Exocrine Gland Disorder ◦ Thick Tenacious Secretions ◦ Blocked Pancreatic Enzymes  Etiology ◦ Heredity

78.  Thick Tenacious Sputum  Frequent Respiratory Infections  Finger Clubbing  Malabsorption  Fatty, Foul Smelling Stools  Death From Antibiotic-resistant Infection

79. Hydration Inhaled Mucolytic Medication Bronchodilators, Corticosteroids Expectorants Chest Physiotherapy Antibiotics Prevent Infection Pancreatic Enzyme Replacement (Pancrease, Viokase) Ibuprofen May Slow Lung Deterioration Lung Transplant

80.  Pathophysiology ◦ Blood Clot in Pulmonary Artery ◦ Ventilation-Perfusion Mismatch ◦ Impaired Gas Exchange ◦ Lung Infarction

82.  DVT Most Common  Fat Emboli From Compound Fracture  Amniotic Fluid Emboli During L&D

83.  Regular Ambulation  Prompt Treatment of DVT  In High-risk Patients ◦ Warfarin (Coumadin) ◦ Heparin

84.  Sudden Onset Dyspnea  Tachycardia  Tachypnea  Cough  Crackles  Hemoptysis

85.  Small Cell Lung Cancer  Large Cell Carcinoma  Adenocarcinoma  Squamous Cell Carcinoma

86.  Smoking ◦ Smokers 13× as Likely to Develop Cancer as Nonsmokers  Environmental Tobacco Smoke  Other Carcinogens ◦ Asbestos ◦ Arsenic ◦ Pollution

87.  None Until Late  Productive Cough  Recurrent Infection  Dyspnea  Hemoptysis  Anorexia and Weight Loss  Pain  Wheezing/Stridor

88.  Pleural Effusion  Superior Vena Cava Syndrome  Ectopic Hormone Secretion ◦ ADH (SIADH) ◦ ACTH (Cushing’s Syndrome)  Actelectasis  Metastasis

89.  Chest X-Ray  CT Scan  Sputum Analysis  Biopsy  Additional Tests to Find Metastasis

91.  Stage (TNM System)  Chemotherapy (Usually Palliative)  Radiation (Usually Palliative)

93.  Pneumonectomy  Lobectomy  Resection  VATS  Transplant

94.  Monitor Respiratory Status  Teach ◦ Routine Preop Teaching ◦ What to Expect ◦ Visit SICU ◦ Include Family

95.  Intensive Care Setting  Monitor ◦ Vital Signs ◦ SaO 2, ABGs ◦ Hemodynamic Parameters ◦ Lung Sounds  Ventilator  Chest Tubes