Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1

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Rachel S. Natividad, RN, MSN, NPN212 Medical
Surgical Nursing 1

• The Respiratory System

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Structure and Function
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Gas exchange
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Changes 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

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Diagnostics

• Pulse Oximetry
• Chest X-Ray
• Computed Tomography (CT scan)
• Bronchoscopy
• Thoracentesis

• Pulmonary Function Tests
• Sputum Specimen and Cultures

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Diagnostics Pulse Oximetry

• Measures arterial oxygen saturation
• Pulse oximetry probe on forehead, ears, nose,
  finger, toes,
• False readings
• Intermittent or continuous monitoring
• Ideal values 95-100
• When to Notify MD
• lt 91
• 86 (Medical Emergency)

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Diagnostics Chest X-Ray

• Screen, diagnose, evaluate treatment
• Instructions No metals/jewelry

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Diagnostics Chest X-Ray Cont.
Nodule
Infiltrates
Posterior Anterior View
Left Lateral View
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Diagnostics Sputum Specimen

• To diagnose evaluate treatment
• Specimen ID organisms or abnormal cells
• Culture Sensitivity (CS)
• Cytology
• Gram stains
• (e.g. Acid Fast Bacilli)

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Diagnostics Computed Tomography CT Scan

• Images in cross-section view
• Uses contrast agents
• Instructions

Right upper Lobe
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Diagnostics 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

• Procedure Care/Instructions
• NPO 6 -8 hrs prior
• Sedation during procedure
• Post Procedure
• HOB elevated
• Observe for hemorrhage
• NPO until gag reflex returns

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Diagnostics Pulmonary Function Test (PFTs)

• Evaluate lung function
• Observe for increased dyspnea or bronchospasm
• Instructions
• No bronchodilators 6 hours prior

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Diagnostics Thoracentesis

• Specimen from pleural fluid
• Treat pleural effusion
• Assess for complications
• Post-Procedure care
• CXR after procedure

• Positions
• Sitting on side of bed over bedside table chest
• elevated
• Lying on affected side
• Straddling a chair

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Assessment Cues to Respiratory Problems

• Dyspnea
• Cough
• Sputum

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Pneumonia Case Study
Pathophysiology
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Pneumonia Pathophysiology Cont.
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Pneumonia Etiology

• Cause
• bacteria (75)
• viruses
• fungi
• Mycoplasma
• Parasites
• chemicals

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Pneumonia 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

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Pneumonia 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

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Pneumonia Clinical Manifestations

• Fevers, chills, anorexia
• Pleuritic chest pain
• SOB
• Crackles/wheezes
• Cough, sputum production
• Tachypnea

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Pneumonia 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

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Pneumonia Diagnosis

• Diagnosis ?
• Physical exam ? crackles, rhonchi/wheezes
• CXR ?area of increased density
• (infiltrates/ consolidation)
• Sputum specimen
• Gram stain

LUL Infiltrates
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Pneumonia 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

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Nursing Diagnoses

• Impaired gas exchange R/T Pneumonia
• Pain R/T infection in lung Pneumonia

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Pneumonia Complications

• Hypoxemia
• Pleural effusion
• Atelectasis
• Pleurisy

Atelectasis
Pleurisy
Pleural Effusion
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Toxic sprinkles anyone?
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Any Questions?