Week 8 Respiratory Handout

PNUR 124_NOTES


RESPIRATORY HANDOUT NOTES



Normal Breath Sounds

Vesicular: Soft, low-pitched, gentle sounds (heard over all lung fields EXCEPT for the major bronchi area)

Broncho vesicular: Medium patch (heard anteriorly over the primary bronchus on both side of the
sternum and posterior: between the scapula

Bronchial: Loud, high-pitched sounds (heard mainly over the manubrium).

Abnormal/Adventitious Breath Sounds

Crackles: is a discontinuous bubbling, crackling sounds heard over lung fields, common in
pneumonias, CHF.

Wheezes is a musical sounds produced by narrowed bronchial airways; common in COPD &
Asthma.

Friction Rubs: are grating sounds over surface of thorax; indicates inflammation of pleura.

The Older Adult and Respiratory Function

 ↓ elastic recoil of lungs during expiration d/t less elastic collagen
 Alveoli are less elastic
 Loss of skeletal muscle strength in the thorax and diaphragm
 Aging and disease affect the respiratory function and airway clearance
 The number of cilia decreases
 Cough weakens
 Diminished cough and gag reflexes
 At increased risk of dehydration, which can lead to thick, viscous mucus that is difficult to
expectorate
 Immune function also declines with age (↑ risk of pulmonary infection and ability to fight the
infection processes)
 Immobility, smoking history, surgery, malnutrition, polypharmacy and existing lung disease
(COPD) also increase risk for respiratory infections.



PNEUMONIA (acute inflammation of the lungs

- Inflammatory disease of the lung with either (collection of pus (empyema), fluid (pleural effusion), or
consolidation within the pleural space.

 Caused by different infectious agents (bacteria, virus, fungal) and by inhalation of chemicals or
aspiration of gastric content.
 Types of Pneumonia include:



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- Community-Acquired (CAP)

- Hospital- Acquired (HAP)

- Aspiration Pneumonia

- Pneumonias in immunocompromised clients

RISK FACTORS

 Age (Older adults)
 Alcoholism
 Other existing respiratory disorders (COPD)
 Smoking
 Ineffective cough
 Immobility
 Endotracheal intubation
 HIV infection
 Immunocompromised
 Abdominal and thoracic surgery
 Chronic illnesses
 G-tube feedings and history of dysphagia

S&S OF PNEUMONIA

 Fever, chills
 Tachypnea
 Tachycardia
 Dyspnea
 Cough (with or without purulent sputum)
 Hypoxemia
 Chest pain
 Confusion

DIAGNOSTICS

Lab work: WBC with differentials, sputum gram stain/C&S, Chest x-ray

PNEUMONIA

Nursing Assessments Treatments Nursing Interventions
- Health History - Respiratory support (oxygen) - Monitor and ensure patent
- Physical Assessment - Medications: Specific broad airway, assess for resp. distress
(presentation, any distress, spectrum antibiotics, analgesics - Encourage ↑ fluid intake
LOC), skin color and use of for pain, Antipyretics for fever, (which help to liquefy thick
accessory muscles expectorants and secretions)
- Vital signs, breathing patterns, Bronchodilators (inhalers) ---to - O2 therapy as needed
oxygen saturation ↓bronchospasm, open tight - Incentive spirometry (to
- Color, amount and consistency and congested airways to promote deep breathing
of sputum improve ventilation (See Kozier - Suctioning as indicated

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