EXPLAIN

• Cardiopulmonary assessment of mother and pregnant clients

  1. Review

  2. Nursing diagnoses

  3. Nursing interventions integrating evidence-based practices
• External respiration


  Interchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary blood

  
• Internal respiration


  Interchange of O2 and CO2 between the circulating blood and the cells of the body tissues
• Respiration process


  1. Pulmonary ventilation or breathing

  2. Diffusion
• Pulmonary ventilation or breathing

  • Movement of air between the atmosphere and the alveoli of the lungs
  • Accomplished through inspiration and expiration
• Factors affecting adequate ventilation

  • Clear airways
  • Intact central nervous system and respiratory center
  • Intact thoracic cavity capable of expanding and contracting
  • Adequate pulmonary compliance and recoil
• Diffusion


  Movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration
• Factors affecting rate of oxygen transport from the lungs to the tissues

  • Cardiac output
  • Number of erythrocytes (RBCs) and blood hematocrit
  • Exercise
• Costal (thoracic) breathing


  Involves the external intercostal muscles and other accessory muscles
• Diaphragmatic (abdominal) breathing

  Involves the contraction and relaxation of the diaphragm
• Mechanics and regulation of breathing

  1. During inhalation

  2. During exhalation
• Factors that increase respiratory rate


  • Exercise
  • Stress
  • Increased environmental temperature
  • Lowered oxygen concentration at increased altitudes
• Factors that may decrease the respiratory rate


  • Decreased environmental temperature
  • Medications i.e. Narcotics
  • Increased intracranial pressure
• Breathing patterns


  • Eupnea
  • Tachypnea
  • Bradypnea
  • Apnea

  
• Breathing volumes


  • Hyperventilation
  • Hypoventilation
• Breathing rhythms


  • Cheyne-Stokes breathing
  • Biot's (Cluster) respirations

  
• Depth of respiration


  • Deep respirations
  • Shallow respirations
  • Normal respirations
• Breath sounds audible without amplification

  • Stridor
  • Stertor
  • Wheeze
  • Bubbling

  
• Breath sounds audible by stethoscope

  • Crackles (rales)
  • Gurgles (Rhonchi)
  • Pleural friction rub

  
• Ease or effort of breathing

  • Dyspnea
  • Orthopnea
• Secretions and coughing


  • Hemoptysis
  • Productive cough
  • Nonproductive cough
• Chest movements


  • Intercostal retraction
  • Substernal retraction
  • Suprasternal retraction
  • Tracheal tug
  • Flail chest
• Cardiac assessment


  1. Inspection of the heart

  2. Palpation of the heart

  3. Percussion of the heart

  4. Auscultation of the heart
• Electrocardiogram (ECG/EKG)


  Non-invasive painless test that measures the heart's electrical activity
• Nursing responsibilities for echocardiography

  1. Explain the procedure to the patient

  2. Ensure patient preparation

  3. Encourage patient cooperation
• Chest X-ray/Radiography


  Employs ionizing radiation in the form of x-rays to generate images of the chest
• Main regions where a chest X-ray may identify problems

  • Airways
  • Breast shadows
  • Bones
  • Cardiac silhouette
  • Costophrenic angles
  • Diaphragm
• Preparing patient for chest X-ray

  1. Empty the bladder

  2. Instruct patient to void prior and to change into a gown

  3. Encourage the patient to cooperate

  4. Advise the patient to remain still during the test because movement may distort results

  5. Inform that a conductive gel is applied to the chest area

  6. Warn him that he may feel minor discomfort because pressure is exerted to keep the transducer in contact with the skin
• Chest X-ray / Radiography employs ionizing radiation in the form of x-rays to generate images of the chest
• Main regions where a chest X-ray may identify problems

  • Airways, including hilar adenopathy or enlargement
  • Breast shadows
  • Bones, e.g. rib fractures and lytic bone lesions
  • Cardiac silhoutte, detecting cardiac enlargement
  • Costophrenic angles, including pleural effusions
  • Diaphragm, e.g. evidence of free air
  • Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
  • Extrathoracic tissues
  • Fields (lung parenchyma), being evidence of alveolar filling
  • Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions
• Normal pulmonary tissue is radiolucent and appears black on film. Thus, densities produced by tumors, foreign bodies, infiltrates, can be detected as lighter or white images
• Chest X-ray shows the position of normal structures, displacement, and presence of abnormal shadows. It may reveal pathology in the lungs in the absence of symptoms
• Nursing and Patient Care Considerations for Chest X-ray

  1. Should be taken upright if patient's condition permits

  2. Assist technician at bedside in preparing patient for portable chest X-ray

  3. Encourage patient to take deep breath, hold breath, and remain still as X-ray is taken

  4. Make sure that all jewelry, electrocardiogram (ECG) leads or metal objects in X-ray field are removed so as not to interfere with film

  5. Consider the contraindication of X-rays for pregnant patients
• Purposes of Sputum Exam

  • For culture and sensitivity to identify a specific microorganism and its drug sensitivity
  • For cytology to identify the origin, structure, function, and pathology of cells
  • For acid-fast bacillus (AFB), which also requires serial collection, often for 3 consecutive days to identify the presence of TB
  • To assess the effectiveness of therapy
• Steps for Sputum Collection

  1. Offer mouthcare

  2. Ask client to do DBE and CE, then cough up 1 to 2 tbsp, or 15-30 mL of sputum

  3. Wear gloves to avoid direct contact with the sputum. Wear a mask capable of filtering droplet nuclei

  4. Ask the client to expectorate (spit out) the sputum into the specimen container. Make sure the sputum does not contact the outside of the container. If the outside of the container does become contaminated, wash it with a disinfectant

  5. Offer mouthwash or mouthcare after sputum collection

  6. Label and transport specimen to the laboratory. Bacterial cultures should be started immediately before any contaminating organisms can grow, multiply, and produce false results
• Sputum samples are best taken early in the morning. Upon awakening, the client can cough up the secretions that have accumulated during the night
• Pulse oximetry


  A non-invasive technique that measures the arterial oxyhemoglobin saturation of arterial blood
• Oxygen saturation is determined by the amount of each light absorbed; unoxygenated hemoglobin absorbs more red light and oxygenated hemoglobin absorbs more infrared light
• Normal oxygen saturation


  95 -100%
• Partial pressure


  The pressure exerted by each individual gas in a mixture according to its concentration in the mixture