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Respiratory System ATI Review

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
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
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
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
1- embolectomy
2- vena cava filter
1- preventative measures
2- dietary precautions with vitamin K
3- follow up for PT or INR
4- bleeding precautions
5- respiratory care
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
accumulation of blood in the pleural cavity
Pneumo and hemothorax Contributing factors
1- blunt chest trauma
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
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