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

2. 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

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

4. 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

5. 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%

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

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

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

9. 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

10. 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

11. PFT – Pulmonary Function Tests
Patient Experience
Various Measurements

12. 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