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Respiratory Noninvasive Procedures

1. Chest xray
2. pulse ox
3. pulomonary fxn test
4. sputum culture

Invasive Procedure- ABG

Taken via arterial puncture or arterial line. Allows the most accurate method of assessing respiratory function.
a. perform ALLEN TEST if no arterial line
b. sample is drawn into heparanized syringe
c. keep in ice an dsend to lab immediately
d. document amount and method of O2 delivery
e. apply pressure to punture site for 5-10 mins

IP- bronchoscopy

Visualize layrnx, trachea, bronchi, obtain tissue biopsy
a. informed consent
b. NPO-8-12 hours
c. local anesthesia
d. position upright
e. sedatioln
f. observe postprocedure- #1 gag reflex #2 bleeding #3 respiratory status

IP-mantoux test

Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with sputum culture for presence of acid fast bacillus (AFB)
a. admin .01 ml of purified protein derivation intradermal to upper 1/3 inner surface or forearm
b. assess for reaction 48-72 hours; 10 mm or greater induration is postitive

IP- Quantiferon- TB Gold IN-Tube test (QFT-GIT)

Identify the presence of Mycobacterium tuberculosis infection by measuring the immune response to the TB bacteria in whole blood

IV- Thoracentesis

Surgical perforation of the pleural space to obtain specimen, or to remove fluid or air
a. informed consent
b. educate client: remain still, feeling of pressure
c. position upright
d. monitor vitals
e. label specimen
f. chest tube at bedside

Asthma

Chronic inflammatory disorder of the airways resulting in intermittent and reversible airflow obstruction of the bronchioles.

Asthma contributing factors (3)

1. Extrinsic- antigen-antibody reaction triggered by food, medication, or inhaled substances
2. Intrinsic- pathophysiological abnormalities within the respiratory tract.
3. older clients- beta receptors are less responsive to agonist and trigger bronchospasm

Asthma manifestations

1. sudden, severe dyspnea, with use of accessory muscles
2. sitting up leaning forward
3. diaphoresis and anxiety
4. wheezing, gasping
5. coughing
6. cyanosis (late sign)
7. barrel chest

Asthma diagnostic procedures

1. ABG's
2. sputum culture
3. pulmonary fxn test

Asthma interventions

1. remain with the client during attack
2. position in high fowlers
3. assess lung sounds and pulse ox
4. admin O2 therapy
5. maintain iv access

Asthma Meds- Bronchodilators

1. short acting inhaled: Proventil, Ventolin for rapid relief
2. methylxanthines: theophylline (Theo-Dur): monitor therapeutic range for toxicity

Asthma Meds- Anti-inflammatory

1. corticosteroids: fluticasone (Flovent), and prednisone (Deltasone)
2. Leukotriene antagonist: montelukast (Singulair)
3. Combination agents- a) Ipratropium and albuterol (Combivent)
b) fluticasone and salmeterol (Advair)

Asthma Therapeutic measures

1. respiratory treatments
2. O2 admin

Asthma client education

1. avoid allergens
2. proper use of inhaler

Status Asthmaticus

A life threatening episode of airway obstruction that is often unresponsive to treatment.

SA manifestations

1. extreme wheexing
2. labored breathing
3. use of accessory musces
4. distended neck veins
5. high risk for cardiac and respiratory arrest
6. diminished breath sounds

SA interventions

1. Place in high fowlers
2. prepare for emergency intubation
3. admin O2, epinephrine, and systemic steroid as RX
4. emotional support

Chronic Obstructive Pulmonar Disease (COPD)

encompasses pulmonary emphysema and chronic bronchitis

Pulmonary emphysema

Destruction of alveoli, narrowing of bronchioles, and trapping or air resulting in loss of lung elasticity

PE contributing factors

1. cigarette smoking
2. advanced age
3. exposure to air pollution
4. alpha- antitrypsin deficiency (inability to break down pollutants)

PE manifestations

1. dyspnea with productive cough
2. difficult exhalation with purse lip breathing
3. wheezing, crackles
4. barrel chest with clubbed fingernails
5. shallow, rapid respirations
6. respiratory acidosis with hypoxia
7. anorexia, weight loss
8. weakness

Chronic Bronchitis

inflammation of the bronchi and bronchioles caused by chronic exposure to irritants

CB contributing factors

1. smoking
2. exposure to air pollution

CB manifestations

1. productive cough
2. thick sputum
3. hypoxemia
4. respiratory acidosis

COPD Diagnostic Procedures

1. chest xray shows consolidation
2. pulmonary fxn test: stale air remains trapped in lungs
3. pulse ox: less than 90%
4. ABG's: chronic respiratory acidosis

COPD interventions

1. assess respiratory effort
2. assess cardiac status for signs of right sided heart failure
3. position upright and lean forward
4. schedule activities to allow for frequent rest periods
5. admin low flow O2 (max is 3 L)
6. incentive spirometry
7. encourage 3 L of fluids/day
8. high calorie diet (high protein low carb)
9. emotional support

COPD meds

1. bronchodilators
2. methyxanthines
3. anti-inflammatory agents
4, mucolytic agents

COPD Therapeutic Measures

1. chest physiotherapy/ pulmonary drainage
2. lung reduction surgery

COPD client education

1. breathing techniques
2. portable O2 therapy
3. meds
4. nutrition
5. smoking cessation
6. avoid crowds
7. immmunizations for pneumonia and flu
8. pulmonary rehab

Cor- pulmonale and manifestations

right sided heart failure caused by pulmonary disease
1. hypoxia and hypoxemia
2. extreme dyspnea
3. cyanotic lips
4. JVD
5 dependent edema
6. metabolic and respiratory acidosis
7. pulmonary hypertension

Cor-pulmonale interventions

1. monitor for resp distress
2. monitor O2 therapy and oximetry
3. ensure adequate rest periods
4. low sodium diet

Cor-pul meds

1. diuretics
2. digoxin

Cor-pul therapeutic measures

1. mechanical ventilation

Carbon Dioxide Toxicity Contributing factors and manifestations

Stuporous secondary to increased CO2 retention 1- carbon dioxide retention 2- excessive O2 delivery
manifestations 1- drowsiness, irritability
2- hallucinations
3- convulsions with coma
4- tachycardia with dysrythmias

CO2 toxicty interventions

1- monitor pulse ox and ABG's
2- avoid excessive O2, keep below 3L (cannula 40%, mask 60%, non-rebreather 100%)
3- admin CPAP or BiPAP

Pneumonia and contributing factors

an inflammatory process in the lungs that produces excess fluid and exudate that fill the alveoli; classified as bacterial, fungal, or chemical
1- older age
2- chronic lung disease
3- immunocompromised
4- mechanical ventilation
5- postoperative
6- prolonged immobility
7- tobacco use

Pneumonia manifestations

1- tachypnea, and tachycardia
2- sudden onset of chills, fever, flushing
3- productive cough
4- dyspnea with pleuritic pain
5- crackles
6- elevated WBC
7- decreased O2 sat

Pnuemonia procedures

1- chest xray
2- pulse ox
3- sputum culture

pneumonia interventions

1- assess resp pattern and effort
2- admin o2
3- assess sputum
4- monitor vitals
5- 3 L of flluids/day
6- provide pulmonary toilet
7- encourage mouth care

pneumonia meds

1- anti-infectives
2- cough suppressants
3- bronchodilators
4- anti-inflams

pneumonia education

1- meds
2- preventative measures
3- vaccine

Tuberculosis and contributing factors

a highly communicable disease caused by M. tuberculosis and transmitted through aerosolization (airborne)
1- older and homeless population
2- lower SES
3- foreign immigrants
4- frequent contact with untreated person
5- long term care facilities
6- prisons

tuberculosis manifestations

1- cough, hemoptysis
2- postive culture for sputum AFB
3- fever with night sweats
4- anorexia, weight loss
5- malaise, fatigue

TB procedures

1- screening test: Mantoux
2- sputum culture and smear
3- serum analysis (QuantiFERON-TB Gold)
4. Chest xray

TB Interventions

1- initiate airborne precautions
2- obtain sputum sample before giving meds
3- maintain nutrition
4- avoid foods with tyramine because of meds
5- wear a particulate mask when in clients room
6- isolate in negative pressure room

TB meds and administration of meds

usually combination therapy
1- admin on empty stomach at the same time every day
2- meds taken for 6-12 months as directed
3- instruct client to watch for signs of hepatoxicity, and notify PCP of signs of nephrotoxicty and visual changes
MEDS
1- Isoniazid (INH)- avoid tyramine and alcohol
2- Rifampin- orange urine
3- Pyrazinamide
4- Streptomycin
5- Ethambutol

TB education

1- good hand hygiene, cover mouth and nose when sneezing and coughing
2- med compliance

Laryngeal cancer and contributing factors

malignant cells occuring in the mucosal tissue of the larynx; most common in men 55-70
1- smoking
2- radiation exposure-
3- chronic laryngitis and or straining of vocal cords

Laryngeal cancer manifestations

1- hoarseness longer than 2 weeks
2- dysphagia
3- dyspnea
4- cough
5- gray, dark brown or black tongue
6- hard, immobile lymph nodes in neck
7- weight loss, anorexia

Laryngeal cancer procedures

1- MRI
2- direct laryngoscopy with biopsy
3- xray and CT
4- bone scan

Laryngel C interventions

1- maintain patent airway
2- swallow precautions
3- emotional support
4- nutrition
5- pain management
6- give meds as elixir if possible

Laryngel C therapuetic measures

1- partial or total laryngectomy

Laryngeal C education

1- communication method
2- stoma care
3- swallowing
4- speech therapy

Lung cancer and contributing factors

Leading cause of cancer related deaths for both men and women in the US; primary or metastatic; common in age 45-70
1- smoking
2- radiation exposure
3- chronic exposure to inhaled irritants
4- older adult

Lung C manifestations

1- chronic cough
2- chronic dypnea
3- hemoptysis
4- hoarseness
5- unilateral wheezing
6- fatigue, weight loss, anorexia
7- clubbing of fingers
8- chest wall pain

Lunc C diagnostics

1- chest xray with CT
2- bronchoscopy with biopsy
3- TNM staging Tumor, Nodes, Metastasis

Lung C interventions

1- maintain patent airway
2- suction PRN
3- monitor vitals and pulse ox
4- monitor nutrition
5- high fowlers
6- emotional supp
7- assess and treat stomatitis
8- ensure protection for immunocompromised client

Lung C meds and therapeutic measures

MEDS 1- chemo agents 2- opiod narcotics
Therapeutic 1- Palliative care- medication, thoracentesis
2- surgical- tumor excision, pneumonectomy, lobectomy, wedge resection

Lung C education

1- meds
2- constipation
3- mouth care
4- nutrition
5- respiratory services
6- radiology
7- rehab
8- nutrition
9- hospice

Pulmonary Embolism

A life threatening hypoxic condition caused by a collection of particulate matter (blood clot, air, fat) that enters venous circulation and lodges in the pulmonary vessels causing pulmonar blood flow obstuction

P Embolism contributing factors

1- chronic atrial fibrillation
2- hypercoagulability
3- long bone fracture
4- long termo immobility
5- oral contraception or estrogen therapy
6- obesity
7- postoperative
8- PVD
9- sickle cell anemia

P embolism manifestations

1- tachypnea
2- tachycardia
3- diaphoresis
4- decreased SaO2
5- pleural effusion
6- crackles and cough
7-pleurisy
8- petechial rash with fat embolism

P embolism diagnostics

1- abg's
2- d-dimer- rules out presence of thrombus
3- chest xra
4- V/Q scan-test the circulation and flow of air and blood in peoples lungs.
5- pulmonary angiography

P embolism interventions

1- provide O2 therapy
2- high fowlers
3- initiate IV access
4- emotional support

P embolism meds

1- thrombolytics
2- anticoags

P embolism therapeutic measurs and education

Therapeutic
1- embolectomy
2- vena cava filter
Education
1- preventative measures
2- dietary precautions with vitamin K
3- follow up for PT or INR
4- bleeding precautions
5- respiratory care

Pneumothorax

A collection of gas or air in the chest or pleural spave that causes part or all of a lung to collapse due to a loss of negative pressure

Hemothorax

accumulation of blood in the pleural cavity

Pneumo and hemothorax Contributing factors

1- blunt chest trauma
2- COPD
3- closed or occluded chest tube
4- older adults
5- penetrating chest wound

Pneum/Hemo thorax manifestations

1- respiratory distress
2- tracheal deviation to unaffected side (tension pneumothorax)
3- reduced or absent breath sounds on affected side
4- asymmetrical chest wall movement
5- hyperressonance on percussion due to trapped air (pneumo)
6- subcutaneous emphysema

P/H thorax diagnostics

1- chest xray
2- thoracentesis (hemo)

P/H thorax interventions and

1- admin o2
2- high fowlers
3- monitor chest tube and dressing
4- emotional support

PH thorax Therapeutics

1- chest tube insertion; inserted into pleural space for draining fluid, blood, air, reestablishes a negative pressure; facilitates lung expansion- 1- POSTION SUPINE OR SEMIFOWLERS
2- informed consent signed
3- prepare chest drainage system prior to insertion
4- admin pain and sedation meds
5- apply dressing to insertion site
6- maintain chest tube system
7- monitor resp status and pulse ox
8- monitor complication

Chest tube complications and interventions

page 27 ATI

Early signs of need of O2 therapy

1- tachypnea
2- tachycardia
3- restlessness
4- pale skking and mucouse membranes
5- elevated BP
6- use of accessory mm, nasal flaring, adventitious lung sounds

Late signs of need of O2

1- bradypnea
2-bradcardia
3- confusion and stupor
4- cyanotic skin and mucous membranes
5- hypotension
6- cardiac dysrythmmias

Suctioning needs and manifestations of need

Use of a suction machine and catheter to remove secrestions from the airway
1- restlessness
2- tachypnea
3- tachycardia
4- decreased SaO2
5- adventitious breath sounds
6- see secrections
7- absence of sponteneous cough

Suctioning procedure

1- hand hygiene
2- don required PPE
3- semi or high fowlers
4- obtain baseline breath sounds VS, and SaO2
5- medical asceptic technique (oral suction)
6- surgical asceptic for all others
7-hyperoxygenate patient
8- suction 10-15 seconds (rotating motion); limit to 2-3 attempts
9- allow recovery between attempts (20-30s)

Tracheostomy procedure

1- explain procedure
2- semi to high fowlers
3- at all times keep tracheostomy tubes (one clients size and one smaller) at bedside for accidental decannulation
4- suction only as clinically indicated (never routine)
5- assess for resp distress
6- trach care every 8 hours
7- change trach tubes every 6-8 weeks

Trach education

1- trach care
2- prevention of respirator infections
3- nutrition
4-home health care
5- community support group

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