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What is Postural drainage positioning?

Positions that allow the force of gravity to assist in the removal of bronchial secretions.

What is the position for drainage of the Lungs anterior, lower lobes, anterior basal segments?

Laying on right side with a pillow propped up under the waist and the foot of bed elevated.

What is the position for drainage of the Lungs anterior, upper lobes, anterior segments?

Laying on back with pillows propped up under butt with knees bent.

What is the position for drainage of the Lungs anterior, lower lobes, lateral basal segments ?

Laying on the left side with a pillow propped under the waist and the foot of the bed elevated.

What is the position for drainage of the Lungs anterior, upper lobes, apical segments (anterior)?

HOB elevated 30-45 degrees with pillows propped up behind the back.

What is the position for drainage of the Lungs posterior, lower lobes, superior segments (posterior)?

Laying on stomach with pillows propped up under stomach.

What is the position for drainage of the Lungs posterior, upper lobes, posterior segments?

Sitting up in bed, leaning over a pillow.

Nasal cannula

-Flow rates from 1-6L
-O2 % 23-42
-Can be used continuous with meals and activity.
-Can cause mucosal drying
Used when the patient requires a low to medium concentration of oxygen

Partial rebreathing mask

-Flow rates from 8-11
-O2 % 50-75
-Used for moderate O2 concentrations.
-Can be warm, poorly fitting, & must be removed to eat.

Non-rebreathing mask

-Flow rate of 12
-O2 % 80-100
-Used For high O2 concentrations.
-Is poorly fitted and must be removed to eat.
Has additional valves that partial rebreathing mask does not have

Venturi mask

-Flow rate of 4-6 L
-O2 % 24,26 & 28
-Provides low levels of supplemental O2
-Must be removed to eat.
Most reliable for delivering precise concentrations of O2

Transtracheal oxygen catheter

-Flow rate of 1/4-4
-O2 % 60-100
-Concealed by clothing, less O2 Liters per minute needed than nasal cannula.
-Requires frequent cleaning & surgical intervention.
-Inserted directly into trachea

T-piece

-Flow rate of 8-10
-O2 % 30-100
-Same as a Tracheostomy collar
-Tubing is heavy
-Useful in weaning patients from mechanical ventilation.

Chest tubes

Intervention used for improving gas exchange and breathing in the postoperative period after thoracic surgery. It is placed in the pleural space to restore negative intrathoracic pressure needed for lung re-expansion after surgery or trauma resulting in pneumothorax.

What is some patient teaching after a thoracotomy?

-Coughing techniques
-Splinting with hands, pillow, or a folded towel when coughing
-Huffing

C pap (Continuous Positive Airway Pressure)

Allows the patient to breathe spontaneously while applying positive pressure throughout the respiratory cycle.
Used for sleep apnea, resp. failure, neonates and prevent the need for tracheal intubation

Bi Pap (Bi level Positive Airway Pressure)

Differs from C pap in that is provides assistance with ventilation. C Pap only provides positive pressure.
Also called non-invasive positive pressure ventilation

What do you watch for when patient is coming off a ventilator?

Signs of distress:
-Rapid or shallow breathing
-Use of accessory muscles
-Reduced LOC
-Increase in CO2 levels
-Decrease in O2 saturation
-Tachycardia

Symptoms of laryngeal cancer?

-Hoarseness that persists more than 2 weeks.
-Persistent cough or sore throat
-Pain or burning in the throat
-Lump in the neck
Later symptoms:
-Dysphagia
-Dyspnea
-Unilateral nasal obstruction or discharge
-Persistent hoarseness
-Persistent ulceration
-Foul breath

Treatments for laryngeal cancer?

-Vocal cord stripping
-Cordectomy
-Laser surgery
-Partial laryngectomy
-Total laryngectomy
-Radiation therapy

What are some complications of packing a nose bleed?

-Respiratory distress
-Slippage of packing in or out when sneezing or moving
-Blood can still trickle in the back of throat which may be the only airway.

What are some complications of Asthma?

S/S Cough,-Chest tightness, Wheezing & Dyspnea.
Complications:
-Status asthmaticus
-Resp. failure
-Pneumonia
-Atelectasis
-Hypoxemia
-Dehydration

What is some patient teaching for a patient with Asthma?

-Identify what precipitates symptoms or attacks.
-Proper use of their MDI

What are some medications used to treat Asthma?

Quick relief:
Short acting beta2-adrenergic agonists (Albuterol , Proventil, Xopenex & Alupent)
Anticholinergics (Atrovent; for those who don't tolerate beta2 adrenergics)
Long acting:
-Corticosteroids (QVAR, Flovent, Medrol, & Prednisone)
-Long-acting Beta2-adrenergic agonists
-Methylxanthines (Theophylline/ TheoDur & SloBid)
-Leukotriene Receptor antagonists (Singulair)
-Combo meds (Advair & Symbicort)
-Cromolyn & Nedocromil (Intal & Tilade)
-5-Lipoxygenase Inhibitor (Zyflo)
-Immunomodulators (Xolair)

What does smoking do to people with lung disease?

-Loss of elasticity in lungs & alveoli
- Inflammation
-Mucus clogs the lining in the throat due to tar on cilia.
-Decreased filtration of the cilia lining the nasal passages and throat.
-Cell degeneration in the lungs due to tar deposits.

What is a complication of an NG?

A sinus infection

What causes exacerbation with COPD?

-Tracheobronchial infection
-Air pollution
An event in the natural course of the disease where there is an acute change in the patient's baseline dyspnea, cough, or sputum production beyond normal day to day variations.

Respiratory distress syndrome

Is a life-threatening reaction to injuries or acute infection to the lung.

Pulmonary emboli

*s/sx:Sob, Chest pain,Wheezing,Leg swelling(usually one leg),clammy, bluish colored skin,Weak pulse,Fainting, Anxiety,Tachypnea,Tachycardia,Rapid or irregular heartbeat
*risk factors:Venous stasis,Hypercoagulabilty,Venous endothelial disease,Certain disease states: heart disease, trauma, postoperative/postpartum, diabetes mellitus, COPD
*prevention:Exercises to avoid venous stasis,Early ambulation, Anticoagulant therapy,Sequential compression devices (SCDs)
*TX: Measures to improve respiratory, CV status, Anticoagulation, thrombolytic therapy

When the chest is flared and the ribs are broken in two spots, what has happened?

a. 2-3 ribs broken in one place and is confirmed by x-ray
b. Brusing, discoloration, pain, difficulty drawing a breath

Pleural effusion

a.collection fluid in pleural space usually secondary to another disease process
b.Large effusions impair lung expansion, cause dyspnea

VQ scan

Checks for ventilation capacity.

What is the continuous & non continuous breath sounds?

Continuous- Wheezing, stridor, rhonchi & inspiratory gap.
Non-continuous- Rales, crackles, or crepitus sounds

Wheezing

To breathe with hoarse whistling sound: to breathe with an audible whistling sound and with difficulty, usually because of a respiratory disorder such as asthma.

Rales/ Crackles

A symptomatic chest sound: an intermittent crackling or bubbling sound produced by fluid in the air passages and air sacs of the lungs and heard through a stethoscope.
Crackles can be heard in patients with pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis, or post thoracotomy or metastasis ablation.
Pulmonary edema secondary to left-sided congestive heart failure can also cause rales

Rhonchi

A coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Rhonchi are breathing sounds indicative of an airway obstruction. A generalized obstruction is due to conditions such as asthma or chronic obstructive pulmonary disease, while a localized obstruction is due to a tumor, mucous, or foreign body.

Pleural rub

It's a medical sign, audible by listening to the internal sounds of the body, usually using a stethoscope on the lungs, that is used in the diagnosis of pleurisy and other conditions affecting the chest cavity.
Pleural friction rubs are the squeaking or grating sounds of the pleural linings rubbing together and can be described as the sound made by treading on fresh snow

Stable angina

heart works a little harder than normal; usually occurs with activity or stress.

Unstable angina

can lead to a very severe heart attack; chest pain my last for hours; troponin wont show; doesn't get enough blood flow or 02.

Valve replacement

a.Mechanical valves:
-Do not deteriorate
-Do not become infected easily
-Are thrombogenic
-Require life-long anticoagulation therapy.
b.Tissue (biologic) valves
-Xenograft (heterograft): pig or cow valve
-Homograft (allograft): human valve
-Autograft: patient's own valve

Pericarditis

a.Inflammation of the pericardium
b.Nursing diagnosis: pain
c. can lead to :
-Pericardial effusion
-Cardiac tamponade: fluids or blood collect around the heart in the sac; squeezes the heart and the heart cant work properly(could be fatal)
-Pulsus paradoxical: pt takes deep breath and blood pressure drops
f.DX:Chest xray, mri, cardiogram

Mitral stenosis

a. fatigue, swollen feet
b. the valve does not open completely
c. blood flow through the valve is reduced
d. Causes; aging, bacterial infection, endocarditis, high bp

What are some complications of Aortic Regurgitation?

a. valve does not close properly
b. blood backflows through the valve
c. Causes; aging, bacterial infection, endocarditis, high bp

Endocarditis

a.Rheumatic:
-Typically seen in school aged children
-Post group A beta-hemolytic streptococcal pharyngitis.
-Need to promptly recognize and treat "strep" throat to prevent rheumatic fever.
b.Ineffective:
-A microbial infection of endothelial surface
-Vegetative growths occur and may embolize to tissues throughout the body.
-Usually develops in people with
-prosthetic heart valves
-structural cardiac defect
-patients who are IV drug abusers
-debilitating diseases, indwelling catheters, or prolonged IV therapy.

What are some treatments for an MI?

a.Obtain diagnostic tests including ECG within 10 minutes of admission to the ED
b.Oxygen
c.Aspirin, nitroglycerin, morphine, beta-blockers
d.Angiotensin-converting enzyme inhibitor within 24 hours
e.Evaluate for percutaneous coronary intervention or thrombolytic therapy
f.As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor
g.Bed rest
h.MONA

Nitroglycerin

A vasodilator used to reduce preload, afterload and reduce O2 demand of the heart.

PAD S/S

A thickening or hardening of the arterial wall which restricts blood flow.
The most common symptom of PAD is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising (Intermittent claudication!!!) It goes with rest.
-The patient may also experience cool and pale extremities when elevated and ruddy and cyanotic when in a dependent position.
-Skin may be shiny, atrophic, dry, and with sparse hair growth.
-Nails may be thickened and opaque.
-Ulcerations, gangrene, muscle atrophy, bruits, and diminished or absent pulses may be present also.

PVD

It is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. The legs and the feet are the most affected.
*Includes atherosclerosis, DVT, varicose veins, Thrombophlebitis, Raynaud's phenomenon, Buerger's disease (thromboangiitis obliterans) & Chronic venous insufficiency.

Pulmonary edema

a.Acute event in which the LV cannot handle an overload of blood volume.
b.Results in hypoxemia.
c.Clinical manifestations:
-restlessness
-anxiety
-dyspnea
-cool and clammy skin
-cyanosis
-weak and rapid pulse
-cough
-lung congestion (moist, noisy respirations)
-increased sputum production (sputum may be frothy and blood-tinged)
-decreased level of consciousness
d.prevention:
-Place patient upright and dangle legs
-Minimize exertion and stress
-Oxygen
-Medications:Morphine
-Diuretic: furosemide
-Aspirate fluids

Ace inhibitors (pril)

-Decreases BP
-Decrease afterload
-Relieves S/S of HF
-Prevents progression of HF
Observe for symptomatic hypotension, increased serum K+, cough and worsening renal functioning
----Major SE: Hyperkalemia, Cough, Hypotension & Hypovolemia----

Beta blockers (lol)

-Dilates blood vessels and decreases afterload
-Reduces S/S of HF
-Improves exercise capacity
*Observe for decreased HR, symptomatic hypotension, and fatigue.
----Major SE: Dizziness, hypotension & bradycardia-----

Calcium channel blockers (pine)

-Causes Vasodilation and reduction of systemic vascular resistance.
Observe for symptomatic hypotension, drowsiness, or dizziness.
-----Major SE -CONSTIPATION-----

Digoxin

-Improves contractility
-Reduces S/S of HF
Observe for bradycardia digitalis toxicity

S/S of Digoxin toxicity

-Anorexia, N, V, Fatigue, Depression, & malaise.
-Changes in HR or rhythm
-ECG changes indicating SA or AV block, ventricular dysrhythmias, atrial tachycardia w/block, Junctional tachycardia, and ventricular tachycardia.
Digoxin immune FAB (Digibind) is the reversal agent

How would you test for PAD?

-Using a Doppler and ABI's
-Compare extremities bilaterally
-Treadmill testing for claudication
-Duplex ultrasonography

What meds are used to TX PAD?

-Pentoxifylline (Trental)
-Cilostazol (Pletal)
-Antiplatelets such as Aspirin & Clopidogrel (Plavix)

Stridor

Is a high-pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrowed or obstructed airway path. It can be inspiratory, expiratory or biphasic. It can be indicative of serious airway obstruction.

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