Rachel S. Natividad, RN, MSN, NP N 212

Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1 The Respiratory System

Structure and Function

Gas exchange

Changes associated to Aging ↓ recoil and compliance  AP diameter ↓ functional alveoli ↓ in Pa02 Respiratory defense mechanisms less effective Altered respiratory controls More gradual response to changes in O2 and Co2 levels in blood

Diagnostics Pulse Oximetry Chest X-Ray Computed Tomography (CT scan) Bronchoscopy Thoracentesis Pulmonary Function Tests Sputum Specimen and Cultures

Diagnostics: Pulse Oximetry Measures arterial oxygen saturation Pulse oximetry probe on forehead, ears, nose, finger, toes, False readings Intermittent or continuous monitoring Ideal values: 95-100% When to Notify MD < 91% 86% (Medical Emergency)

Diagnostics: Chest X-Ray Screen, diagnose, evaluate treatment Instructions: No metals/jewelry

Diagnostics: Chest X-Ray Cont. Posterior Anterior View Left Lateral View Nodule Infiltrates

Diagnostics: Sputum Specimen To diagnose; evaluate treatment Specimen: ID organisms or abnormal cells Culture & Sensitivity (C&S) Cytology Gram stains (e.g. Acid Fast Bacilli)

Diagnostics: Computed Tomography: CT Scan Images in cross-section view Uses contrast agents Instructions: Right upper Lobe

Diagnostics: Bronchoscopy Diagnose problems and assess changes in bronchi/bronchioles Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study Procedure Care/Instructions: NPO 6 -8 hrs prior Sedation during procedure Post Procedure: HOB elevated Observe for hemorrhage NPO until gag reflex returns

Diagnostics: Pulmonary Function Test (PFTs) Evaluate lung function Observe for increased dyspnea or bronchospasm Instructions: No bronchodilators 6 hours prior

Diagnostics: Thoracentesis Specimen from pleural fluid Treat pleural effusion Assess for complications Post-Procedure care: CXR after procedure Positions Sitting on side of bed over bedside table chest elevated Lying on affected side Straddling a chair

Assessment: Cues to Respiratory Problems Dyspnea Cough Sputum

Pneumonia: Case Study Pathophysiology

Pneumonia: Pathophysiology Cont.

Pneumonia: Etiology Cause bacteria (75%) viruses fungi Mycoplasma Parasites chemicals

Pneumonia: Classifications Community-acquired pneumonia (CAP) Onset in community or during 1st 2 days of hospitalization (Strep. pneumoniae most common) Hospital-acquired Pneumonia(HAP/nosocomial) Occurring 48 hrs or longer after hospitalization Aspiration pneumonia Pneumonia caused by opportunistic organisms Pneumocystis Carinii

Pneumonia: Risk Factors CAP Older adult Chronic/coexisting condition Recent history or exposure to viral or influenza infections History of tobacco or alcohol use HAP Older adult Chronic lung disease ALOC Aspiration ET, Trach, NG / GT Immunocompromised Mechanical ventilation

Pneumonia: Clinical Manifestations Fevers, chills, anorexia Pleuritic chest pain SOB Crackles/wheezes Cough, sputum production Tachypnea

Pneumonia: Clinical Manifestations-Cont. Mycoplasma (Atypical) feeling tired or weak, headaches, sore throat, or diarrhea. Eventually, most develop a dry cough. They can, also, develop fever, chills, earaches, chest pain “walking pneumonia”

Pneumonia: Diagnosis Diagnosis → Physical exam → crackles, rhonchi/wheezes CXR →area of increased density (infiltrates/ consolidation) Sputum specimen – Gram stain LUL Infiltrates

Pneumonia :Interventions/Tx Treatment Antibiotics → choose based on age, suspected cause & immune status Supportive care → IV fluids, supplemental oxygen therapy, respiratory monitoring, cough enhancement *may take 6-8 weeks for CXR to normalize

Nursing Diagnoses… Impaired gas exchange R/T Pneumonia Pain R/T infection in lung Pneumonia

Pneumonia: Complications Hypoxemia Pleural effusion Atelectasis Pleurisy Atelectasis Pleurisy Pleural Effusion

Toxic sprinkles anyone?

Any Questions?