Common Problems Common Problems related to related to

Oxygen-RespiratoryOxygen-Respiratory

Megan McClintockMegan McClintock

Spring 2008Spring 2008

Lower Respiratory ProblemsLower Respiratory Problems

Acute bronchitisAcute bronchitis PneumoniaPneumonia

Community-acquiredCommunity-acquired Hospital-acquiredHospital-acquired Fungal Fungal AspirationAspiration OpportunisticOpportunistic

Acute BronchitisAcute Bronchitis

DefinitionDefinition

SymptomsSymptoms

TreatmentTreatment

PneumoniaPneumonia

Results when the normal defense mechanisms Results when the normal defense mechanisms become incompetent or are overwhelmedbecome incompetent or are overwhelmed Filtration of airFiltration of air Warming and humidification of inspired airWarming and humidification of inspired air Epiglottis closure over the tracheaEpiglottis closure over the trachea Cough reflexCough reflex Mucociliary escalator mechanismMucociliary escalator mechanism Secretion of Immuglobin ASecretion of Immuglobin A Alveolar macrophagesAlveolar macrophages

Organisms spread by:Organisms spread by: AspirationAspiration InhalationInhalation Spread from a primary infection elsewhereSpread from a primary infection elsewhere

Types of PneumoniaTypes of Pneumonia

Community Acquired (CAP)Community Acquired (CAP)

Hospital Acquired (nosocomial)Hospital Acquired (nosocomial)

Aspiration Aspiration

OpportunisticOpportunistic

AssessmentAssessment

Sudden onset of fever, chillsSudden onset of fever, chills Cough with purulent sputumCough with purulent sputum Confusion or stupor (in the elderly)Confusion or stupor (in the elderly) Breath sounds – increased fremitus, Breath sounds – increased fremitus,

bronchial breath sounds, cracklesbronchial breath sounds, crackles

Question 9Question 9

The nurse notes new onset confusion in The nurse notes new onset confusion in an 89-year-old patient in a long-term an 89-year-old patient in a long-term care facility; the patient is normally alert care facility; the patient is normally alert and oriented. Which action should the and oriented. Which action should the nurse take next?nurse take next? A. Check the patient’s pulse rateA. Check the patient’s pulse rate B. Obtain an oxygen saturationB. Obtain an oxygen saturation C. Notify the health care providerC. Notify the health care provider D. Document the changeD. Document the change

ComplicationsComplications

PleurisyPleurisy Pleural effusionPleural effusion AtelectasisAtelectasis Lung abscessLung abscess EmpyemaEmpyema PericarditisPericarditis ArthritisArthritis MeningitisMeningitis EndocarditisEndocarditis

Health Promotion Health Promotion InterventionsInterventions

If URI symptoms > 7 days, seek medical careIf URI symptoms > 7 days, seek medical care Influenza and pneumococcal vaccines if at riskInfluenza and pneumococcal vaccines if at risk If decreased level of consciousness:If decreased level of consciousness:

Position side-lying, upright to prevent aspirationPosition side-lying, upright to prevent aspiration Turn q 2 hrsTurn q 2 hrs

If difficulty swallowing:If difficulty swallowing: Assist with eating and drinkingAssist with eating and drinking Take meds to prevent aspirationTake meds to prevent aspiration

Strict medical asepsis and handwashingStrict medical asepsis and handwashing Strict sterile technique with tracheal suctioningStrict sterile technique with tracheal suctioning

Acute Care Acute Care InterventionsInterventions

Question 8Question 8

To promote airway clearance in a To promote airway clearance in a patient with pneumonia, the nurse patient with pneumonia, the nurse instructs the patient to:instructs the patient to: A. Splint the chest when coughingA. Splint the chest when coughing B. Maintain fluid restrictionsB. Maintain fluid restrictions C. Wear the nasal oxygen cannulaC. Wear the nasal oxygen cannula D. Try the pursed-lip breathing D. Try the pursed-lip breathing

techniquetechnique

Ambulatory/Home Care Ambulatory/Home Care InterventionsInterventions

TBTB

Not just the lungsNot just the lungs ResurgenceResurgence

HIV patientsHIV patients MDR strainsMDR strains

Poor compliancePoor compliance No follow-upNo follow-up Ineffective drug therapyIneffective drug therapy

At Risk for TBAt Risk for TB

TBTB

EtiologyEtiology

Clinical manifestationsClinical manifestations

Diagnostic studiesDiagnostic studies

ComplicationsComplications

TreatmentTreatment

Question 10Question 10

T he nurse recognizes that the goals of T he nurse recognizes that the goals of teaching regarding the transmission of TB teaching regarding the transmission of TB have been met when the patient with TB:have been met when the patient with TB:

A. Demonstrates correct use of a A. Demonstrates correct use of a nebulizernebulizer

B. Reports daily to the public health B. Reports daily to the public health departmentdepartment

C. Washes dishes and personal items C. Washes dishes and personal items after use.after use.

D. Covers the mouth and nose when D. Covers the mouth and nose when coughingcoughing

Question 7Question 7

The nurse has received change-of-shift The nurse has received change-of-shift report about these respiratory report about these respiratory patients. Which patient should the patients. Which patient should the nurse assess first?nurse assess first? A. A patient with loud expiratory wheezes.A. A patient with loud expiratory wheezes. B. A patient who has a cough productive B. A patient who has a cough productive

of thick, green mucusof thick, green mucus C. A patient with oxygen sats of 91%C. A patient with oxygen sats of 91% D. A patient with a respiratory rate of 38D. A patient with a respiratory rate of 38

CANCER OF THE LUNG - CANCER OF THE LUNG - etiologyetiology

Cigarette smoking most important risk Cigarette smoking most important risk factorfactor

Mortality risk reduced 30-50% after 10 Mortality risk reduced 30-50% after 10 years of smoking cessationyears of smoking cessation

Sidestream smoking contains same Sidestream smoking contains same carcinogens found in mainstream smokecarcinogens found in mainstream smoke

Environmental tobacco smoke inhaled Environmental tobacco smoke inhaled by nonsmokers and children – 35% by nonsmokers and children – 35% riskrisk

CANCER OF THE LUNGCANCER OF THE LUNG Clinical ManifestationsClinical Manifestations

Asymptomatic until late in the disease processAsymptomatic until late in the disease process Persistent pneumonitis, productive coughPersistent pneumonitis, productive cough

Hemoptysis not common early in diseaseHemoptysis not common early in disease Anorexia, fatigue, wt. Loss, N/V, hoarsenessAnorexia, fatigue, wt. Loss, N/V, hoarseness

Diagnostic StudiesDiagnostic Studies Chest X-RayChest X-Ray Computerized Tomography (CT)Computerized Tomography (CT) Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) Fiberoptic BronchoscopeFiberoptic Bronchoscope MediastinoscopyMediastinoscopy Pulmonary Angiography – fine needle Pulmonary Angiography – fine needle

aspirationaspiration

NURSING MANAGEMENTNURSING MANAGEMENT& COLLABORATIVE CARE& COLLABORATIVE CARE

Radiation TherapyRadiation Therapy ChemotherapyChemotherapy Surgery – Lobectomy or Surgery – Lobectomy or

PneumonectomyPneumonectomy DiagnosisDiagnosis

Ineffective airway clearanceIneffective airway clearance AnxietyAnxiety Acute PainAcute Pain Imbalanced NutritionImbalanced Nutrition Ineffective health MaintenanceIneffective health Maintenance Ineffective Breathing patternIneffective Breathing pattern

PREDOMINANT SITE OF TYPES PREDOMINANT SITE OF TYPES OF LUNG CANCERSOF LUNG CANCERS

PNEUMOTHORAXPNEUMOTHORAX DefinitionDefinition Types of PneumothoraxTypes of Pneumothorax

Closed Closed OpenOpen TensionTension HemothoraxHemothorax ChylothoraxChylothorax

Clinical ManifestationsClinical Manifestations Collaborative CareCollaborative Care

PNEUMOTHORAX PNEUMOTHORAX

CHEST TUBESCHEST TUBESChest tube placement Chest suction system - common

PULMONARY EMBOLIPULMONARY EMBOLI

Thrombi in venous Thrombi in venous circulation or right circulation or right side of the heart side of the heart occlude pulmonary occlude pulmonary arterial blood flow arterial blood flow to parts of lungto parts of lung