HESI STUDY GUIDE RESPIRATORY

HESI STUDY GUIDE RESPIRATORY   HESI STUDY GUIDE RESPIRATORY Penumonia – Inflammation of the lower respiratory tact o Types:  Bacterial (gram positive / negative)  Viral  Fungal (rare)  Chemical o Reach lungs by:  Aspiration  Inhalation  Hematogenous Spread o High Risk Groups  Altered Level of Consciousness  Depressed/absent gag and cough reflexes  Susceptible to aspirating - Oropharyngeal secretions • Alcoholic, anesthetized individuals  Drug Overdose  Stroke Victims  Immunocompromised o Nursing Assessment  Tachypnea – shallow, often accessory muscles  Sudden onset of fever/shaking/chills  Productive Cough with pleuritic (lung) pain  Rapid/bounding pulse  Breath sounds - crackles o OLDER ADULTS: confusion, lethargy/malaise, anorexia, tachypnea, tachycardia o Interventions:  Assess sputum – COCA  Turn and deep breath q2hrs  Humidify room/oxygen  Chest physiotherapy  3L/day of fluids (liquefies secretions)  Monitor ABG’s • PO2 80, PCO2 45  Encourage at risk groups to get annual pneumonia and flu shots  Promote rest and conserve energy o Hydration – thins out mucus, essential for client w/ fever, 300-400mL of fluid is lost daily by lungs through evaporation o Cerebral Hypoxia – irritability and restlessness are early signs o Pneumonia Preventives  Older adults & Asplenia: flu/pneumonia shots  Comatose/immobile: elevation of HOB and for 1 hr after feeding, frequent turning. Anti-Infectives o Penicillin  AR – Anaphylaxis, diarrhea, GI distress, superinfection (sore mouth, vaginal discharge, cough), phlebitis @ IV site  NI – Observe for 30 mins following parenteral admin, Orals = empty stomach, alters birth control effectiveness o Tetracycline (-cycline)  AR- Hypersensitivity and Photosensitivity  NI- alters birth control effectiveness, NO ANTACIDS OR MILK PRODUCTS, inspect IV frequently, no 8yrs – yellow/brown teeth discoloration and growth retardation o Aminoglycosides – xxxx sulfate, Vancomycin, Metronidazole (Flagyl)  AR- Neuromuscular blockade, Nephro/Ototoxicity  NI- Renal Function Test, BUN, creatinine, I&O  Ototoxicity – headache, dizziness, hearing loss, tinnitus  Peak and Trough levels required. o Cephalosporin – (cef/ceph)  AR – Thrombophlebitis, GI distress  NI – caution if allergic to penicillin o Macrolides – Clarithromycin (Biaxin), Erythromycin, Azithromycin (Zithromax)  AR – Pseudomembranous colitis, phlebitis, dizziness, dyspnea  NI – Biaxin with food, Zithromax without food  Liver and Renal Labs  Space MAOI’s 14 days before and after Biaxin o Fluoroquinolones  CNS disturbances, Cataracts, blistering  NI- Prompt onset, Category D, Lowers seizure threshold, LIVER/RENAL/CBC, many drug-drug interactions Chronic Bronchitis: Sputum with daily cough production for 3mo-2yr consecutive, hypoxemia, cor pulmonale (enlarged R side heart - result of lung or pulmonary blood vessel disease), increased bronchial wall thickness o Factors: Higher incidence in smokers o Generalized cyanosis, BLUE BLOATERS, Right sided HF, distended neck veins, crackles, expiratory wheezes. o NI – Lowest FiO2 possible to prevent CO2 retention, S/s fluid overload, PaO2 between 55-60, teach pursed lip breathing and diaphragmating breathing, Tripod position Emphysema: Reduced gas exchange, decreased capillary network, increased air trapping o Factors: smoking, genetic, environmental/occupational exposure o PINK PUFFERS, pursed lip breathers, barrel chest, distant/quiet breath sounds, wheezes, pulmonary blebs on radiograph. o NI- Same as Bronchitis Asthma: Narrowing/closure of airway due to a stimulant o Factors: Mucosal edema, Increased work of breathing, beta blockers, respiratory infection, allergic reaction, emotional stress, exercise, environmental/occupational exposure, reflux esophagitis o Dyspnea, wheezing, chest tightness o NI- Administer bronchodilators, fluids and humidification, ABG’s, ventilatory patterns In advanced emphysema, due to the alveoli being affected, hypercarbia is a problem, rather than in bronchitis, where the airways are affected. Compensation occurs over time in clients with chronic lung diseases, and ABGs are altered. Productive cough and comfort can be facilitated by semi-Fowler (30-45) or high-fowler (90), which lessens pressure on the diaphragm by abdominal organs. o Gastric distention becomes a priority - it elevates the diaphragm and inhibits full lung expansion Pink Puffer - barrel chest, client works harder to breathe, but O2 taken in is adequate to oxygenate the tissues Blue Bloater - Insufficient oxygenation and leads to generalized cyanosis and often Right Sided Heart Failure. COPD / Asthma Interventions o Tripod position o Small frequent meals, increase calories and protein, Mg and Ca - muscle contraction and relaxation, Mg and Phosphorus - related to bone mineral density o 3L+/day - between meals rather than with Adrenergic and Sympathomimetic o Bronchodilator o AR – anxiety, increase HR, N&V, urinary retention o Monitor HR, urinary retention, may cause sleep disturbance o BRONCHODILATOR BEFORE STEROID!!! Corticosteroids o Anti-inflammatory o AR- cardiac dysrhythmias with long term use o ORAL CARE after use Anticholinergics o Bronchodilator & control of rhinorrhea o AR- dry mouth, blurred vision, cough, essentially can’t do shit Combination products o Fluticansone + salmeterol o Ipratromium + Albuterol Eating = less energy needed for breathing - soft diets ABC - Airway first, breathing, circulation CAB- CPR O2 Delivery - in adult, O2 must bubble through some type of water solution so it can be humidified in 4L/min or delivered directly to trachea. If 1-4L/min or by mask/nasal prongs, mucus membranes provide adequate humidification Cancer of the Larynx o Causes:  Prolonged use of combined effects of alcohol and tobacco o Contributing Factors: vocal straining, chronic laryngitis, family Hx, industrial exposure to carcinogens, nutritional deficiencies: riboflavin (Vit B group) o Men Women ; 50-70 yrs o Medical Management: radiation therapy, RT+chemo, surgery o Assess for hoarseness longer than 2wks, color changes in mouth/tongue (White, gray, dark brown, black, may appear patchy) o S/S- dysphagia, dyspnea, cough, hemoptysis (coughing up blood), weight loss, neck pain radiating to eat, enlarged cervical notes (neck), and halitosis (bad breath) o Promote Respiratory Functioning:  Assess RR and characteristics q1-2hrs  Semi fowlers at ALL times  Airway humidified at ALL times  Auscultate lung sounds ever 2-4hrs  Tracheostomy care every 2-4hrs and PRN • Cleaning inner cannula, suctioning, applying clean dressings  Encourage ambulation as early as possible Laryngectomy tube has a larger lumen and is shorter than tracheostomy tube. Observe for any signs of bleeding or occlusion - greatest risk first 24hrs Teach the glottal stop technique to remove secretions - take a deep breath, momentarily occlude the trach tube, cough, and simultaneously remove the finger from the tube. TB o Airborne - bacteria remain dormant until a later time o S/S- Fever with night sweats, anorexia/weight loss, malaise/fatigue, cough/hemoptysis, dyspnea, pleuritic chest pain with inspiration, calcification or cavitation AEB radiograph, + sputum culture, repeated upper respiratory infections o Take medications for 9-12 months o May return to work after 3 negative cultures o Promote adequate nutrition o POSITIVE TEST - induration 10mm or more in diameter 48-72hrs after skin test TB Meds o Isoniazid  S/E – N&V, ab pain, Peripheral neuritis  Rare: Neurotoxicity, optic neuritis, and Hepatoxicity  Metabolized by liver and excreted by kidneys  Drug interaction with alcohol, Antabuse, and phenytoin o Rifampin  S/E- Hepatitis, fever, GI disturbance, peripheral neuropathy, hypersensitivity, ORANGE secretions  Used in conjunction, low incidence of SE, suppresses Birth Control  Increases metabolism of digoxin and oral hypoglycemic. o Rifapentine  S/E- RED discoloration of body fluids and tissues  MANY drug interactions  Used in conjunction o Streptomycin  S/E- ototoxicity, nephrotoxicity, hypersensitivity  Cautious use in older adults, those with renal disease, and pregnant women.  Must be given parenterally o Levofloxacin and Moxifloxacin  Increased risk of tendinitis Rifampin – reduces effectiveness of oral contraceptives, Orange body fluids Isoniazid – increased phenytoin levels Ethambutol – vision check before starting therapy and monthly thereafter, may have to take for 1-2 years Lung Cancer o Neoplasm occurring in the lung o S/S – dry hacking cough (cough turns productive as progresses), hoarseness, pyspnea, hemoptysis or rust colored/purulent sputum, chest pain, diminished breath sounds - occasional wheezing, positive sputum for cytology and for pleural fluid. o Nursing interventions similar to COPD  Semi fowlers, pursed lip breathing, O2, administer analgesics PRN o Thoractomy for clients who have a resectable tumor o Pneumonectomy – removal of entire lung  Position client on operative side or back, no chest tubes  Chest tubes are not usually used because it is helpful if the mediastinal cavity, where the lung used to be, fills up with fluid to prevent shift of remaining chest organs. o Lobectomy and segmental resection  Position client on back, chest tubes are usually inserted o Chest Tubes  Below chest level with connections tight and taped  Monitor fluid drainage, and mark the time of measurement and level.  Encourage deep breathing periodically  Do NOT empty collection container, replace unit when full  If chest tube becomes disconnected, DO NOT CLAMP! Immediately place the end of the tube in a container of sterile saline/water until a new drainage system can be connected  If chest tube is removed by client, nurse should cover with dry sterile dressing. • If an air leak is noted, take the dressing on three sides only - allows air to escape and prevents a tension pneumothorax - Notify the PCP.  Fluctuations (tidaling) in the fluid will occur if there is no external suction. Should move up with inspiration and down with expiration if applied.