Adult 2 Unit 3 Respiratory

vital signs with lung/breathing focused assessment, NPO until gag reflex or cough returns, monitor for lethargy, hypotension, tachycardia, dyspnea, and atelectasis.

• remove foreign bodies or secretions from the tracheobronchial
• tree, control bleeding, treat postoperative atelectasis, destroy and excise lesions, and provide brachytherapy (endobronchial radiation therapy)
• Some tracheal secretions are normal, excessive secretions - give Atropine(dries secretions up)

diarrhea, ASA OD, renal failure, DKA, shock

lungs aren’t expanding completely usually in the base of the lungs (fluid or something in the lungs so your lung doesn’t want to expand)

Person sits or stands leaning forward supporting upper body with their hands either on their knees or on a surface.

Helps lower diaphragm and open lung space to decrease SOB.

extended pressure on site is required.

confusion, drowsiness, N/V, low BP, clammy skin, headache, Kussmaul’s respirations (goes along with DKA), coma.

administer bicarb IV (given in its own line), if due to kidney failure, then dialysis.

increased pulse and BP, mental cloudiness

improve ventilation (BRONCHODILATORS, suctioning, hydration)

lightheadedness, numbness & tingling, tinnitus, restlessness, N/V, dysrhythmias.

attempt to calm patient down, have patient breath into a paper bag in hopes to retain CO2.

tingling in fingers & toes, dizziness, lethargy, weakness, muscle twitching, tetany, decreased BP & gastric motility.

restore fluid volume with NaCl containing fluids (kidneys absorb NaCl allowing excretion of bicarb) which flushes and dilutes bicarbonate.

• Assess lung function
• Determine the degree of damage to the lungs o Need H&P, CXR or CT, or lung biopsy
• Respiratory function
• Ventilatory Volume

• To relax diaphragm and allow lungs to fully fill for
• better image

• Positive TB, PPD/Mantoux test, quantiferon –
• TB GOLD (24 hours) elisa, Hx of BCG vaccine will give positive skin tests, chest x-ray, sputum (ONLY definitive diagnostic tool, best to get sputum first thing in the morning)

• ▪ INH (isoniazid), RIF (Rifampin) – makes you pee orange (all
• excretions become orange), SM (streptomycin, PZA (Pyrazinamide) Taken for 4-12 months although therapeutic effects may be seen 2- 3 weeks after beginning medications.

to treat or prevent bronchospasms

• nervousness or shakiness, throat or nasal irritation, muscle
• aches. Less common – rapid HR, palpitations

classic s/s may be missing such as fever and coughing. General deterioration, weakness, abdominal symptoms, confusion (infection, hypoxia), MUCH higher rate of mortality.

• “rubbing, grating sound”, inflammation of pleural spaces, can be heard on inhalation and exhalation; typically symmetrical. Louder over
• the chest wall (pleural space). Heard best over lower lateral thorax
• Call doctor if it’s a new finding.

• Dyspnea, cough, chest tightness, nasal flaring, pursed lip breathing, tripoding, expiratory wheezing, anxiety.
• Inspiratory wheezes may indicate worsening asthma!

Air enters the pleural space, disrupts negative pressure, causes lung collapse.

• sharp stabbing chest pain that worsens when trying to breath in, SOB, bluish skin due to lack of oxygen, fatigue, rapid breathing
• and heartbeat, dry hacking cough.

Chest tube, needle aspiration

Collection of pus within the lung tissue (empyema)

• patients most at risk have impaired cough reflexes (cva, seizures, drug and alcohol addicts, esophageal problems, pt’s with
• ng tube), dysphagia, fever, chills, pleuritic pain, cough, copious sputum
• (foul or bloody), decreased breath sounds.

antibiotics, therapeutic bronchoscopy, postural drainage, frequent mouth care, high calorie, high protein diet to help with healing, RARE: lobectomy (watch for hemoptysis: bloody cough)

reduce inflammation and suppress immune system

cataracts (elderly), osteoporosis, ulcers.

• maintain control of lung disease and prevent symptoms.
• check blood sugars, even in non-diabetics

• 5 lobes
• right lung 3lobes
• left lung 2 lobes

up to 6 L (non-high flow cannula)

6-10 L

10-15, but always 15L

Measures the rate of change in lung volume during forced breathing maneuvers. Helps prevent pneumonia in non-ambulating patients. Helps to identify the presence of obstructive and restrictive lung diseases.

pt inhales slowly to keep float in range to measure how much volume in liters the patient is drawing in, helps expand lungs by inhaling slowly.

Helps expand the lungs, have patient hold breath for 3 seconds and exhale slowly.

Pleural space only, not the actual lung

Surgical puncture to remove fluid from pleural space

Remove fluid and very rarely remove air from the pleural cavity, aspiration of pleural fluid for analysis, pleural biopsy, and installation of medication into the pleural space.

infection, stridor, decreased breath sounds on tested side could result in pneumothorax and treatment with chest tube to reinflate lung would have to be done.

• Alterations in cardiac contractions
• Decreased vascular response to catecholamines (adrenal hormones)
• Decreased response to certain medications
• Decreased or LOC

• Impaired neuro function
• Impaired muscular function
• Muscle twitching, tingling sensations, nervousness

• Helps determine source of acidosis.
• Open=commonly DKA
• closed=DKA

• occurs in community or within the first 48hrs of admission
• Under 60 – pneumococcus
• Over 60 – H. influenzae

• occurs more than 48hrs after admission
• E. coli
• Klebsiella
• Methicillin-resistant Staphylococcus aureus (MRSA)

• INFLAMMATION OF THE BRONCHIAL TREE
• OFTEN FOLLOWS UPPER RESPIRATORY TRACT INFECTION

• Mucopurulent (colorful) sputum & noisy
• inspirations (because swelling of the whole nasal cavity and esophagus)
• Sternal soreness from coughing
• Fever
• General malaise

• Type of COPD (“CHRONIC OBSTRUCTIVE PULMONARY DISEASE”)
• INCLUDES CHRONIC BRONCHITIS and EMPHYSEMA

• Productive cough lasting minimum of three months to a year for two or more consecutive years (chronic flare ups)
• History of frequent respiratory infections
• Common to have a history of cigarette smoking or pollution exposure.

often a thin patient (exerts energy just to breath and don’t eat) tripoding, anterior/posterior chest diameter enlarged (barrel chest) uses accessory muscles, pursed lip breathing (short inhalation and long exhalation)

• Patient o2 is often in the high 80s and thats “ok”
• Too much supplemental oxygen will threaten breathing incentive.

Inflammation of both layers of the pleura. May see with pneumonia or URI, chest trauma, pulmonary infarction or PE, primary or metastatic cancer, or after a thoracotomy.

• Inhaled Q4 or nebulized (typically RT)
• Albuterol (proventil)
• Ipratropium (ventolin)
• Metaproteranol (alupent)-PObymouth2-3xaday
• Aminophylline (PO - old med)
• Theophylline (PO - old med)

• Vistaril
• Atropine - dries up secretions
• Benadryl
• Prometazine (Phenergan) anti nausea/motion sicknes
• epinephrine

Mucinex(guaifenesin)- need water! 8oz but carefule with CHF ask Dr if you can give 4oz

• Raise cough threshold. May be contraindicated if patient has productive cough
• Codeine
• Robitussin (Dextromethorphan)

• Diflucan
• Amphotericin B

• Hydrocortisone- IV
• Prednisone- PO
• Dexamethasone - inhaler
• Take PO steroids with food
• Don't alter doses - no skipping, doubling up
• Don’t stop taking suddenly(seizure can occur, have to taper off)
• Long term problems cataracts, osteoporosis, ulcers

• IV, PO Topical
• Will use if resp infection is related to bacteria
• Generally start with a broad spectrum, narrow after culture/sensitivity study.
• Sputum culture DONE FIRST before prescribing
• Usually prescribed for 7-10 days - tell client to finish all doses even if they feel better
• ***overuse of ABX/s is harmful and won't be prescribed without verifying the need for it
• Ciprofloxacin

crepitus

popping sound

harsh sounds

high pitched musical sound

grading sounds or like putting leather together

high pitched wheeze on respiration

hollow; normal sound

booming sound

drum like

thudding noise on percussion

“extreme” dullness, heard in pleural effusions

• 7.35-7.45
• less than<7.4 acidosis
• greater than>7.4 alkalosis

• 35-45
• less than <35 alkalosis
• Greater than >45 acidosis

• 22-26
• <22 acidosis="" br="">>26 alkalosis