Title: Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1
1Rachel S. Natividad, RN, MSN, NPN212 Medical
Surgical Nursing 1
2Structure and Function
3Gas exchange
4Changes associated to Aging
- ? recoil and compliance
- ? AP diameter
- ? functional alveoli
- ? in Pa02
- Respiratory defense mechanisms less effective
- Altered respiratory controls
- More gradual response to changes in O2 and Co2
levels in blood
5Diagnostics
- Chest X-Ray
- Computed Tomography (CT scan)
- Bronchoscopy
- Thoracentesis
- Pulse Oximetry
- Pulmonary Function Tests
- Sputum Specimen and Cultures
6Diagnostics Pulse Oximetry
- Measures arterial oxygen saturation
- Pulse oximetry probe on ears, nose, finger, toes,
forehead - False readings
- Intermittent or continuous monitoring
- Ideal values
- When to Notify MD
7Diagnostics Chest X-Ray
- Screen, diagnose, evaluate treatment
- Instructions
8Diagnostics Chest X-Ray Cont.
Posterior Anterior View
Left Lateral View
9Diagnostics Sputum Specimen
- To diagnose evaluate treatment
- Specimen ID organisms or abnormal cells
- Culture Sensitivity (CS)
- Cytology
- Gram stains
- (e.g. Acid Fast Bacilli)
10Diagnostics Computed Tomography CT Scan
- Images in cross-section view
- Uses contrast agents
- Instructions
Right upper Lobe
11Diagnostics Bronchoscopy
- Diagnose problems and assess changes in
bronchi/bronchioles - Performed to remove foreign body, secretions, or
to obtain specimens of tissue or mucus for
further study
- Post-Procedure Care/Instructions
-
12Diagnostics Pulmonary Function Test (PFTs)
- Evaluate lung function
- Observe for increased dyspnea or bronchospasm
- Instructions
13Diagnostics Thoracentesis
- Specimen from pleural fluid
- Treat pleural effusion
- Assess for complications
- Post-Procedure care
- Positions
- Sitting on side of bed over bedside table chest
- elevated
- Lying on affected side
- Straddling a chair
14Assessment Cues to Respiratory Problems
15Pneumonia Case Study
16Pneumonia Pathophysiology
17Pneumonia Etiology
- Cause
- bacteria (75)
- viruses
- fungi
- Mycoplasma
- Parasites
- chemicals
18Pneumonia Classifications
- Community-acquired pneumonia (CAP)
- Onset in community or during 1st 2 days of
hospitalization (Strep. pneumoniae most common) - Hospital-acquired Pneumonia(HAP/nosocomial)
- Occurring 48 hrs or longer after hospitalization
- Aspiration pneumonia
- Pneumonia caused by opportunistic organisms
- Pneumocystis Carinii
19Pneumonia Risk Factors
- CAP
- Older adult
- Chronic/coexisting condition
- Recent history or exposure to viral or influenza
infections - History of tobacco or alcohol use
- HAP
- Older adult
- Chronic lung disease
- ALOC
- Aspiration
- ET, Trach, NG / GT
- Immunocompromised
- Mechanical ventilation
20Pneumonia Clinical Manifestations
- Fevers, chills, anorexia
- Pleuritic chest pain
- SOB
- Crackles/wheezes
- Cough, sputum production
- Tachypnea
21Pneumonia Clinical Manifestations-Cont.
- Mycoplasma (Atypical)
- feeling tired or weak, headaches, sore throat, or
diarrhea. - Eventually, most develop a dry cough. They can,
also, develop fever, chills, earaches, chest pain - walking pneumonia
22Pneumonia Diagnosis
- Diagnosis ?
- Physical exam ? crackles, rhonchi/wheezes
- CXR ?area of increased density
- (infiltrates/ consolidation)
- Sputum specimen
- Gram stain
LUL Infiltrates
23Pneumonia Interventions/Tx
- Treatment
- Antibiotics ? choose based on age, suspected
cause immune status - Supportive care ? IV fluids, supplemental oxygen
therapy, respiratory monitoring, cough
enhancement - may take 6-8 weeks for CXR to normalize
24Nursing Diagnoses
- Impaired gas exchange R/T Pneumonia
- Pain R/T infection in lung Pneumonia
25Pneumonia Complications
- Hypoxemia
- Pleural effusion
- Atelectasis
- Pleurisy
Atelectasis
Pleurisy
Pleural Effusion
26Toxic sprinkles anyone?
27Any Questions?