1. Respiratory Fundamentals Linda Winn, RN, MSN Ed., BA Ed.

3. Major Topics Anatomy http://www.argosymedical.com/Respiratory/samples/animations/Respirat ion/index.html http://www.argosymedical.com/Respiratory/samples/animations/Sherwo od%20Respiration/index.html Assessment Labs Diagnostics Meds Common Diagnoses

4. Activity Each team will be assigned one of the following topics to research and present to the entire group: –Assessment Normal assessment – what makes up a complete respiratory assessment? Abnormal findings & significance –Labs What labs are relative to respioratory status? Normals Abnormals & significance –Diagnostics What diagnostic tests are relative to pulmonary status? Normals Abnormals & significance Any significant patient care measure before, during, or after tests –Meds Major categories / actions of Respiratory meds Significant side-effects Nursing measures specific to meds

5. Respiratory Assessment

6. Assessment Screening Exam Techniques http://depts.washington.edu/physdx/pulmonary/tec h.html http://depts.washington.edu/physdx/pulmonary/de mo.html

7. Resp Assessment Breathing Pattern –I:E ratio –Kussmaul –Rate Dyspnea –Orthopnea –PND – Paroxysmal nocturnal dyspnea Cough and Sputum –Frequency –Dry / moist –Amount –Color –Thickness –Odor –Hemoptysis

8. Assessment (Cont.) Inspection –Symmetry –Skin color – lip color / finger clubbing –WOB – accessory muscles Auscultation –Adventitious sounds Chest pain History –Diagnoses –Smoking Quick, Focused Assessment

10. Breath Sounds Link Normal and Adventitious breath sounds http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/conte nts.htmlfaculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/conte nts.html

11. Diagnostics & Labs

12. Labs H/H Sputum Analysis –C&S –Gram Stain –Acid-Fast smear (AFB) –Cytology ABG’s WBC O2 Sats

13. Diagnostic Tests CXR CT Chest MRI V/Q Scan Bronchoscopy http://www.nlm.nih.gov/medlineplus/tutorials/bronchoscopy/htm/_no_50_no_0.htm Thoracentesis PFTs – Pulmonary Function Tests –Spirometry

14. Diagnostics PFR –http://www.argosymedical.com/Respiratory/samples/ animations/Peak%20Flow%20Meter/index.htmlhttp://www.argosymedical.com/Respiratory/samples/ animations/Peak%20Flow%20Meter/index.html

15. Diagnostic Tests Endoscopic Exams –Bronchoscopy: direct inspection of airways Only __________ ___________ of airways –Purposes: diagnose diseases find obstructions obtain tissue samples remove mucous plugs, foreign bodies find bleeding sources

16. Pulmonary Meds

17. Oxygen (later) Corticosteroids http://www.argosymedical.com/Respiratory/sample s/animations/Inhaled%20Corticosteroids/index.ht ml Antibiotics Beta-Agonists

18. Respiratory Med Delivery

19. How & Why Is the Spacer Used? http://www.mayoclinic.com/health/asthma/MM00608

20. Methods of Delivery

22. Respiratory Treatments Coughing and Deep Breathing (later) Incentive Spirometry (later) Oropharngeal Suctioning Inhaled Medication Oxygen Therapy (Supplementation)

23. Coughing & Deep Breathing Position for maximal lung expansion Splint with hand(s) or pillow Slow inspiration via nose, hold 3-5 seconds, exhale via mouth. Cough after 2-3 breaths. Pulmonary disease: exhale via pursed lips & cough after expiration started More frequent coughing if productive Coughing contraindicated: post-eye, ear, brain or neck surgery

24. Incentive Spirometry Prevents atelectasis & PNA –Position for maximal lung expansion –Exhale completely –Close mouth around mouthpiece –Inhale slow & deep, watching meter for flow rate –Make inspiration last for 3-5 seconds –10 X Q/hr WA

25. Respiratory Diagnoses

26. Asthma COPD –Chronic Bronchitis –Emphysema Pneumonia

27. Major Pulmonary Diagnoses COPD –http://video.about.com/copd/Emphysema.htm http://video.about.com/copd/Emphysema.htm –http://video.about.com/copd/COPD.htmhttp://video.about.com/copd/COPD.htm Pneumonia –CAP vs HAP

28. Major Pulmonary Diagnoses Asthma –http://www.argosymedical.com/Respiratory/samples/animation s/Asthma%20TLC_AZ/index.htmlhttp://www.argosymedical.com/Respiratory/samples/animation s/Asthma%20TLC_AZ/index.html –http://www.argosymedical.com/Respiratory/samples/animation s/Asthma/index.htmlhttp://www.argosymedical.com/Respiratory/samples/animation s/Asthma/index.html Sleep Apnea –http://www.argosymedical.com/Respiratory/samples/animation s/CPAP%20Sleep%20Apnea/index.htmlhttp://www.argosymedical.com/Respiratory/samples/animation s/CPAP%20Sleep%20Apnea/index.html

29. Pneumonia Collaborative Care Appropriate antibiotic therapy Increased fluid-- 3 liters/day Good nutrition--  1500 cal/day analgesics Reduced activity and rest Antipyretics Supplemental oxygen Vaccine prophylaxis CORE Measure

30. Assessment Findings Fever, restlessness, fatigue, splinting painful chest (New) cough with or without sputum Shortness of breath,  RR & HR Pleuritic chest pain Infiltrates on CXR Crackles or bronchial sounds in the peripheral lung fields

31. Collaborative Care Appropriate antibiotic therapy Increased fluid-- 3 liters/day Good nutrition--  1500 cal/day Analgesics Oxygen Reduced activity and rest Antipyretics Supplemental oxygen Vaccine prophylaxis CORE Measure

32. Oxygen Medication –Requires MD order –Side Effects Highly combustible gas –Clear –Odorless Set-up is part of initial room check

33. Indications for O2 therapy Goal –Prevent or relieve hypoxia Keep SaO2 > 90% –Reduce work of breathing –Room Air / FIO2 = 21% Used with hypoxia due to: –Respiratory Disorders –Cardiovascular disorders –Central nervous system disorders

34. Safety Precautions O2 sign posted No smoking or flames Electrical equipment grounded Check tank level before transport No oil-based lubricants / lotions

35. Delivery Devices Nasal Cannula Masks –Simple face –Partial rebreathing –Non-rebreathing –Venturi (Venti Mask) Tracheostomy –Collar Ventilator Flow Meter Humidification

36. Oxygen Safety

37. Nasal Cannula Advantages –Safe, simple, tolerated well –Allows eating and drinking –Can humidify Disadvantages –Easily dislodged Check regularly –Skin breakdown Check regularly O2 Concentrations –1L/min = 24% –2L/min = 28% –3L/min = 32%

38. Simple Face Mask RA enters via side holes Advantages –Humidified Disadvantages –Imprecise FIO2 –High FIO2 needed to prevent rebreathing CO2 Concentrations –5-6L/min = 40% –6-7L/min = 50% –>7L/min = 60%

39. Non-rebreather Mask Use –Valve prevents air from flowing back into bag –Last step, usually, before intubation Advantages –High O2 concentrations –Accurate Disadvantages –Can’t use high humidity –uncomfortable

40. Venturi Mask Venti-mask –High flow –Adjustable Advantages –Very precise –Mask of choice for COPD Disadvantages –uncomfortable

41. O2 and COPD Historically… –Never give O2 >2L/min to COPD pts. However… “ There has been concern regarding the dangers of administering O2 to COPD pts and reducing their drive to breath.” “This has been a pervasive myth but is not a serious threat.” “In fact, not providing adequate O2 to these patients is much more detrimental.” Lewis, p. 643 (7 th ed.)

42. Patient Education Monitor color of sputum Self care: at-home meds & treatments; avoid triggers Prevention –Pneumococcal vaccine, flu shot Frequent oral hygiene Encourage fluids Environmental hazards –altitude, smog, allergies, smoke Follow up medical care American Lung Association –www.lungusa.org