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:
1
, PNUR 124_NOTES
- 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
2
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:
1
, PNUR 124_NOTES
- 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
2
