Respiratory

• Respiratory Acidosis


  Excess CO2 - lungs can't remove all the carbon dioxide that your body produces, so your blood pH is lower (more acidic) than normal
• Causes of Respiratory Acidosis


  • Hypoventilation
  • Lung disease
  • Problem with gas exchange
• Respiratory Alkalosis


  Decreased CO2 - hyperventilation prevents your lungs from removing excess carbon dioxide, so your blood pH is higher (more basic) than normal
• Causes of Respiratory Alkalosis


  • Hyperventilation
  • Anxiety
  • High altitude before RBC increase
• Respiratory system can compensate for metabolic acidosis or alkalosis by changing rate and depth of breathing
• PaO2


  75-100mm Hg (increase in hyperventilation, decrease in impaired respiratory function)
• PaCO2


  35-45mm Hg (increase in impaired gas exchange, decrease in hyperventilation)
• 1. Dimer


  Measures fibrin degradation products, which will be present if there is a blood clot in the body. Indicates presence of a blood clot in a pulmonary artery if above 0.5
• Sputum culture collection


  Deep breath and cough, in am after oral care
• Purpose of sputum culture


  To identify if there's any pathogens in the sputum
• Oxygen delivery goal


  Maintain saturations >95% in most patients (exception COPD)
• Low flow oxygen devices


  • Nasal cannula (1-6L/min, 24-44%)
  • Simple face mask (5-10L/min, 40-60%)
  • Non-rebreather mask (10-15L/min, 80-95%)
• Venturi mask


  High flow oxygen device used for patients who require precise percentages of oxygen, patients with chronic lung disease with CO2 retention (2-15L/min, 24-60%)
• Incentive spirometer use


  Use 10 times each hour they are awake
• Purpose of incentive spirometer

  To encourage deep breathing in patients at risk for collapse of lung tissue (atelectasis)
• Chest physiotherapy


  Includes postural drainage (head down) to help move secretions out from deep inside the lungs
• Patients who benefit from chest physiotherapy


  Patients who have a weak or ineffective cough and are at risk for retaining secretions (e.g. COPD, cystic fibrosis, bronchiectasis, ventilated patients)
• Deep breathing and coughing


  Take a deep breath and hold for a few seconds, exhale slowly

  2. Repeat 5 times

  3. Brace incision if present and cough deeply

  4. Repeat every 1 to 2 hours
• Purpose of deep breathing and coughing


  To clear secretions and prevent atelectasis and pneumonia
• Pursed lip breathing


  Breathe in through nose for 2 seconds

  2. Breathe out from mouth for 4 seconds
• Purpose of pursed lip breathing


  To relieve shortness of breath, encourage relaxation, and help keep airway open longer. For patients with COPD, pulmonary fibrosis, breathlessness, stressful situations.
• Chest tube care


  • Drainage device must remain below level of chest

  Assess for bubbling in water seal chamber (good if pneumothorax present, bad if no pneumothorax)

  If suction ordered, fill chamber to ordered amount and turn on suction to achieve gentle bubbling

  Keep occlusive dressing and padded clamp at bedside

  Reinforce dressings if needed
• What to do if chest tube falls out


  Apply occlusive dressing, immediately notify nurse and healthcare provider
• Chest tube patient care


  Observe respiratory rate, effort and symmetry

  2. Ask about shortness of breath, pain, anxiety, and other discomforts

  3. Auscultate lung sounds

  4. Confirm dressing is intact, observe for drainage, reinforce dressing if needed (do not change dressing unless ordered)

  5. Palpate around insertion site for crepitus

  6. Keep occlusive dressing and padded clamp at bedside

  7. Check tubing for kinks, breaks or disconnections

  8. Ensure no dependent loops of tubing, coil excess

  9. Verify drainage system is below patient chest

  10. Check drainage system for cracks or leaks

  11. Check water seal chamber for correct water level and for tidaling

  12. Check suction control chamber for gentle bubbling, add water if needed

  13. Check and mark drainage amount every 8 hours, report any increase in bloody drainage
• Notify nurse or healthcare provider if patient suddenly reports increasing dyspnea, there is a change in patient status, or the drainage chamber is full and needs to be changed
• Epistaxis (nosebleed)


  • Risk factors: trauma, hypertension, hemophilia, medications

  Symptoms: bloody bleeding

  Treatment: positioning, pressure, ice packs, nasal packing, vasoconstrictive agents, electrocautery

  Prevention: avoid nose blowing, picking, bending over, nasal sprays/humidifiers for 48 hours
• Obstructive sleep apnea


  • Risk factors: obesity, high palate, sleeping on back, receded mandible, smoking

  Increased risk for: heart disease, hypertension, stroke, diabetes, atrial fibrillation

  Symptoms: snoring, daytime sleepiness, headache, memory/attention problems

  Treatment: avoid sedatives/alcohol, weight loss, mandibular advancement device, NIPPV, surgery

  Prevention: lose weight, exercise, moderate drinking, quit smoking, avoid sleeping on back, avoid anti-anxiety meds/sleeping pills
• Influenza


  • Infection spread through droplets and physical contact

  Increased risk for complications in certain groups
• Obstructive Sleep Apnea


  Periods of apnea during sleep
• Risk factors for Obstructive Sleep Apnea


  • Obesity
  • High Palate
  • Sleeping on back
  • Receded Mandible
  • Smoking
• Increased risk for Obstructive Sleep Apnea


  • Heart disease
  • Hypertension
  • Stroke
  • Diabetes
  • A.Fibrillation
• Signs and Symptoms of Obstructive Sleep Apnea


  • Snoring
  • Daytime Sleepiness
  • Headache
  • Memory and Attention Problems
• Treatments for Obstructive Sleep Apnea


  • Avoid HS Sedatives/ ETOH
  • Lose Weight
  • Mandibular advancement device
  • Nasal Patch
  • NIPPV
  • Surgery
• Prevention for Obstructive Sleep Apnea


  • Lose weight if needed
  • Exercise regularly
  • Drink moderately
  • Quit smoking
  • Avoid sleeping on back
  • Avoid taking anti anxiety meds or sleeping pills
• Influenza


  Infection spread through droplets and physical contact with person or object with virus
• Increased risk for Influenza complications


  • Obesity
  • Cardiovascular disease
  • Young children
  • Chronically ill
  • Immunocompromised pts
  • Older adults
• Prevention for Influenza


  • Annual flu shot vaccine
  • Yearly Vaccination > 6 mos. of age
  • Takes a couple of weeks to develop antibodies
  • Covers for about 4 months
  • Handwashing
  • Avoidance of Infected People
• Signs and Symptoms of Influenza


  • Abrupt onset
  • Fever, Chills, Myalgia
  • Sore Throat Cough
  • Headache
  • Malaise- weeks
• Therapeutic interventions for Influenza


  • Acetaminophen
  • Avoid Aspirin
  • Antiviral Agents
  • Rest
  • Fluids
• Atelectasis


  Collapse of alveoli