Respiratory Nursing 232 - Exam (Graded A+ actual test)

Treatment of Emphysema - ️️(1) stop smoking (2) pulmonary rehab program (3) oxygen, 1-2L/min through nasal prongs (4) bronchodilators (5) anticholinergics Clinical Manifestations of Chronic Bronchitis - ️️Copious amounts of sputum Hypoxemia Hypercapnia-increase amount CO2respiratory acidosis Productive cough Decreased exercise tolerance Wheezing SOB Prolonged expiration parietal pleura - ️️outer layer of pleura lying closer to the ribs and chest wall visceral pleura - ️️covers the lungs pleural fluid - ️️liquid that surrounds the lungs diffusion - ️️Movement of molecules from an area of higher concentration to an area of lower concentration. what area of the brain controls respiration - ️️medulla gas signal for primary level of respiration - ️️CO2 or O2 what does the diaphragm do? - ️️contracts inhale relaxes exhale gas exchange affects Condition of alveoli- why? - ️️Interstitial edema: O2 unable to come in Ex: bronchitis, pneumonia gas lungs are surround by what - ️️pleura exchange affects Surfactant- why? - ️️? Lipid substance that lines alveoli and when it collapses prevents it from sticking together Two types of respiratory disorders: - ️️Restrictive-COPD Obstructive- cancerFactors increasing risk of respiratory infection - ️️Smoking, obesity, age( very young, very old), environmental, allergies, immunocompromised ***Arterial Blood Gases (ABG's) - ️️PCO2 - partial pressure of CO2 PO2 partial pressure of O2 O2 saturation, percentage of Hgb carrying oxygen pH: acidity or alkalinity of blood Bronchoscopy - ️️visual examination of the Visualize inside of trachea and bronchi Remove foreign bodies Biopsy Specimen collection Prep: NPO after midnight Consent Topical anesthesia (xylocaine) Bronchoscopy post operative - ️️Post Op NPO until gag reflex returns Keep head turned to side Watch for edema, bleeding - report hematoemesis immediately Temporary hoarseness to be expected Thoracentesis - ️️Removal of pleural fluid to enhance lung function or obtain fluid for diagnostic purposes Usually light colored straw Sputum sample - ️️Fresh specimen - early AM From lower respiratory - not saliva or sinus drainage Observe color, quantity, quality, blood, other contents Can diagnose TB, allergens, cancer laryngectomy - ️️Partial or total removal of larynx Larynx connects the pharynx (upper airway) to trachea (lower airway) Partial Laryngectomy - ️️Surgical removal of a portion of the larynx. Total Laryngectomy - ️️When removed a permanent opening is made by suturing the trachea to the neck. The esophagus remains attached to the pharynx No risk of aspiration as the esophagus and trachea are permanently separated by surgery (tracheostomy) Radical Neck Dissection - ️️Usually on the same side as lesion Even if lymph nodes negative as metastasis to cervical node is commonNursing Management of laryngectomy - ️️Risk for aspiration R/T excessive secretions and edema (partial laryngectomy) Place semi fowlers to high fowlers to decrease edema, improve comfort, facilitate breathing Ensure patent airway Ineffective airway clearance R/T physical alteration in airway - ️️Cough - deep breath Suction trach - careful to avoid irritation to soft tissue Clean inner cannula PRN Chest physiotherapy, nebulizer, aerosol administration, humidity Risk for impaired gas exchange R/T pain, sedation or increase mucus production - ️️Administer oxygen- keep pulse oximetry values > 90 % Administer analgesics Encourage cessation of smoking Altered Nutrition R/T swallowing difficulties - ️️Supplement with NG tube feedings until edema subsides and suture line healing Progress from fluid to soft Total Laryngectomy Considerations - ️️loss of voice, difficulty swallowing, difficulty breathing Esophageal speech - ️️proper technique client can swallow and hold air speaking up to 10 words sphenoectmoidectomy - ️️If constant swallowing check for bleeding (COPD) 3 most common - ️️asthma, emphysema, obstructive bronchitis Asthma (Reactive Airway Disease) - ️️Recurring episodes of paraxysmal dyspnea, intermittent airflow obstruction, constriction, coughing, viscous mucoid bronchial secretions Interstitial Lung Disease - ️️Thickened fibrotic alveolus become nonfunctional status asthmaticus - ️️-severe bronchospasm one following the other. Usually leads to pneumothorax; respiratory/cardiac arrest may occur Ineffective airway clearance R/T increase production of secretions - ️️Suctioning Assist to coughHumidity- break up secretions Postural drainage Lung percussion or vibration- shake to get secretions out Oral care 2-3 hrs for bad taste Encourage fluids gas exchange affects HGB, RBC- why? Hemoglobin, red blood cell count - ️️Ability to carry O2 and CO2 Impaired gas exchange R/T air trapping - ️️cyanosis is a late sign Asthma management - ️️Steroids - reduce inflammation Vanceril - inhaled Solu-Medrol - injectable Prednisone - oral