Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1
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Transcript of Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1
Rachel S. Natividad, RN, MSN, NPRachel S. Natividad, RN, MSN, NPN212 Medical Surgical Nursing 1N212 Medical Surgical Nursing 1
The Respiratory The Respiratory SystemSystem
Structure and FunctionStructure and Function
Gas exchangeGas exchange
Changes associated to AgingChanges associated to Aging ↓ ↓ recoil and compliancerecoil and compliance
AP diameter AP diameter
↓ ↓ functional alveolifunctional alveoli
↓ ↓ in Pa02in Pa02
Respiratory defense Respiratory defense mechanisms less effective mechanisms less effective
Altered respiratory controlsAltered respiratory controls More gradual response to More gradual response to
changes in O2 and Co2 changes in O2 and Co2 levels in bloodlevels in blood
DiagnosticsDiagnostics
Chest X-RayChest X-Ray
Computed Computed Tomography (CT Tomography (CT scan)scan)
BronchoscopyBronchoscopy
ThoracentesisThoracentesis
Pulse OximetryPulse Oximetry
Pulmonary Function Pulmonary Function TestsTests
Sputum Specimen and Sputum Specimen and CulturesCultures
Diagnostics: Pulse OximetryDiagnostics: Pulse Oximetry Measures arterial oxygen Measures arterial oxygen
saturationsaturation
Pulse oximetry probe on ears, Pulse oximetry probe on ears, nose, finger, toes, foreheadnose, finger, toes, forehead
False readingsFalse readings
Intermittent or continuous Intermittent or continuous monitoring monitoring
Ideal valuesIdeal values
When to Notify MDWhen to Notify MD
Diagnostics: Chest X-RayDiagnostics: Chest X-Ray Screen, diagnose, Screen, diagnose,
evaluate treatmentevaluate treatment
Instructions:Instructions:
Diagnostics: Chest X-Ray Cont.Diagnostics: Chest X-Ray Cont.
Posterior Anterior View Left Lateral View
Diagnostics: Sputum SpecimenDiagnostics: Sputum Specimen
To diagnose; evaluate treatmentTo diagnose; evaluate treatment Specimen: ID organisms or abnormal Specimen: ID organisms or abnormal
cellscells Culture & Sensitivity (C&S)Culture & Sensitivity (C&S) CytologyCytology Gram stains Gram stains
(e.g. Acid Fast Bacilli)(e.g. Acid Fast Bacilli)
Diagnostics: Computed Diagnostics: Computed Tomography: CT ScanTomography: CT Scan
Images in Images in cross-cross-sectionsection view view
Uses contrast Uses contrast agentsagents
Instructions:Instructions:
Right upper Lobe
Diagnostics: BronchoscopyDiagnostics: Bronchoscopy
Diagnose problems and assess Diagnose problems and assess changes in bronchi/bronchioleschanges in bronchi/bronchioles
Performed to remove foreign Performed to remove foreign body, secretions, or to obtain body, secretions, or to obtain specimens of tissue or mucus for specimens of tissue or mucus for further studyfurther study
Post-Procedure Care/Instructions:Post-Procedure Care/Instructions:
Diagnostics: Pulmonary Diagnostics: Pulmonary Function Test (PFTs)Function Test (PFTs)
Evaluate lung functionEvaluate lung function
Observe for increased Observe for increased dyspnea or dyspnea or bronchospasmbronchospasm
Instructions:Instructions:
Diagnostics: ThoracentesisDiagnostics: Thoracentesis Specimen from Specimen from
pleural fluidpleural fluid
Treat pleural Treat pleural effusioneffusion
Assess for Assess for complicationscomplications
Post-Procedure Post-Procedure care:care:
PositionsPositions•Sitting on side of bed over bedside table Sitting on side of bed over bedside table chestchest elevatedelevated•Lying on affected sideLying on affected side•Straddling a chairStraddling a chair
Assessment: Assessment: Cues to Cues to Respiratory ProblemsRespiratory Problems
DyspneaDyspnea
CoughCough
SputumSputum
Pneumonia: Case StudyPneumonia: Case Study
Pneumonia: PathophysiologyPneumonia: Pathophysiology
Pneumonia: EtiologyPneumonia: Etiology
CauseCause bacteria (75%)bacteria (75%) virusesviruses fungifungi MycoplasmaMycoplasma ParasitesParasites chemicalschemicals
Pneumonia: ClassificationsPneumonia: Classifications
Community-acquired pneumonia (CAP)Community-acquired pneumonia (CAP) Onset in community or during 1Onset in community or during 1stst 2 days of hospitalization 2 days of hospitalization
(Strep. pneumoniae most common)(Strep. pneumoniae most common)
Hospital-acquired Pneumonia(HAP/nosocomial)Hospital-acquired Pneumonia(HAP/nosocomial) Occurring 48 hrs or longer after hospitalizationOccurring 48 hrs or longer after hospitalization
Aspiration pneumoniaAspiration pneumonia
Pneumonia caused by opportunistic organismsPneumonia caused by opportunistic organisms Pneumocystis CariniiPneumocystis Carinii
Pneumonia: Risk FactorsPneumonia: Risk Factors
CAPCAP Older adultOlder adult Chronic/coexisting Chronic/coexisting
conditioncondition Recent history or Recent history or
exposure to viral or exposure to viral or influenza infectionsinfluenza infections
History of tobacco or History of tobacco or alcohol usealcohol use
HAPHAP Older adultOlder adult Chronic lung diseaseChronic lung disease ALOCALOC AspirationAspiration ET, Trach, NG / GT ET, Trach, NG / GT ImmunocompromisedImmunocompromised Mechanical ventilationMechanical ventilation
Pneumonia: Clinical Pneumonia: Clinical ManifestationsManifestations
Fevers, chills, anorexiaFevers, chills, anorexia Pleuritic chest painPleuritic chest pain SOBSOB Crackles/wheezesCrackles/wheezes Cough, sputum productionCough, sputum production TachypneaTachypnea
Pneumonia: Clinical Pneumonia: Clinical Manifestations-Cont.Manifestations-Cont.
Mycoplasma (Atypical)Mycoplasma (Atypical) feeling tired or weak, feeling tired or weak,
headaches, sore throat, headaches, sore throat, or diarrhea. or diarrhea.
Eventually, most develop Eventually, most develop a dry cough. They can, a dry cough. They can, also, develop fever, chills, also, develop fever, chills, earaches, chest painearaches, chest pain
““walking pneumonia”walking pneumonia”
Pneumonia: DiagnosisPneumonia: Diagnosis
Diagnosis Diagnosis →→ Physical exam → Physical exam →
crackles, crackles, rhonchi/wheezesrhonchi/wheezes
CXR →area of increased CXR →area of increased density density
(infiltrates/ consolidation)(infiltrates/ consolidation)
Sputum specimen – Sputum specimen – Gram stainGram stain
LUL Infiltrates
Pneumonia :Interventions/TxPneumonia :Interventions/Tx TreatmentTreatment
Antibiotics → choose based on age, Antibiotics → choose based on age, suspected cause & immune statussuspected cause & immune status
Supportive care → IV fluids, supplemental Supportive care → IV fluids, supplemental oxygen therapy, respiratory monitoring, cough oxygen therapy, respiratory monitoring, cough enhancementenhancement
*may take 6-8 weeks for CXR to normalize*may take 6-8 weeks for CXR to normalize
Nursing Diagnoses…Nursing Diagnoses…
Impaired gas exchange R/T Impaired gas exchange R/T PneumoniaPneumonia
Pain R/T infection in lung Pain R/T infection in lung PneumoniaPneumonia
Pneumonia: ComplicationsPneumonia: Complications
HypoxemiaHypoxemia
Pleural effusionPleural effusion
AtelectasisAtelectasis
PleurisyPleurisy
Atelectasis Pleurisy
Pleural Effusion
Toxic sprinkles anyone?Toxic sprinkles anyone?
Any Questions?Any Questions?