Respiratory

• Oxygen (O2)


  Essential for all cells to live and perform their specific job
• Carbon dioxide (CO2)


  Waste gas created by the tissues of the body from the use of oxygen
• Exchange of oxygen and carbon dioxide occurs in the alveoli
• Inhalation irritant exposure


  • Air pollution
  • Occupation
  • Home conditions
  • Hobbies
  • Tobacco use
• Smoking assessment


  • Current smoker or smoked in the past?
  • Number of cigarettes smoked daily
  • Duration of the smoking habit
  • Age of the patient when the habit began
• Passive smoking


  • Increases the risk for development of respiratory problems significantly
  • Direct exposure: Being in the same environment as a person who is smoking
  • Third-hand smoke: Indirect exposure through hair or clothing
• 1. cigarettes


  Assess use
• Smoking cessation


  1. Is patient interested in quitting?

  2. Provide education sources for quitting

  3. Drug therapies for smoking cessation
• Nicotine replacement products


  • Available in the form of patches, gums, lozenges, inhalers, and nasal sprays
  • DO NOT smoke while taking these products
  • Increases the level of circulating nicotine and increases the risk for heart attack and stroke significantly
  • Have a success rate of 50-70%
• Prescription drug therapies


  • Bupropion (Zyban): Decreases cravings and withdrawal manifestations as well as reduces the depression associated with nicotine withdrawals
  • Varenicline (Chantix): Interferes with nicotine receptors, reduces the pleasure derived from nicotine as well as the manifestation of withdrawal
  • Both drugs carry BLACK BOX warnings from the FDA, may cause manic behavior or hallucinations, may unmask serious mental health issues
• Hemoglobin


  Provides information about the transport of oxygen
• 1. Dimer


  Protein fragment the body makes as a blood clot dissolves, elevated results indicate the presence of a blood clot, most commonly collected when pulmonary emboli are suspected
• Arterial blood gases (ABGs)


  Assess gas exchange in the body
• Sputum culture and sensitivity

  Identifies bacterial infection and determines which antibiotics will be effective in treatment
• Chest X-ray findings


  • Pneumonia (PNA)
  • Atelectasis
  • Pneumothorax
  • Masses/tumors
  • Fluid accumulation
  • Endotracheal tube placement
  • Central line placement

  
• CT scan


  Assesses the soft tissue of the chest with a cross section view, can detect bones, tissues, lesions, and clots, requires a contrast agent to enhance visibility of certain structures

  
• Pulse oximetry


  Identifies blood saturation with oxygen, probe is placed on the patient's finger, toe, nose, earlobe, or forehead, can detect decrease in oxygen before manifestations begin to occur, normal range is 92% to 100%, 86% - 91% requires immediate assessment and treatment, less than 85% body tissues have a hard time becoming oxygenated, less than 70 or 80% is life threatening

  
• Capnography


  Visual assessment of a waveform and number on monitor, measures the amount of carbon dioxide present in exhaled air, normal range is 20-40 mm Hg

  
• Pulmonary function tests (PFTs)


  Noninvasive assessment of how well a patient's lungs are functioning, measures lung volume, lung capacities, flow rates, and gas exchange, results are interpreted by comparing the patient's data with expected findings for age, gender, race, height, weight, and smoking status, useful for screening patients for lung disease before manifestations occur, tests before surgery may identify patients at risk for lung complications postop

  
• Pulmonary function test procedure

  Advise patient not to smoke 6-8 hours prior to testing, bronchodilators may be held for 4-6 hours before the test, performed at bedside or in lab by respiratory therapist or technician, patient breathes through the mouth only while performing different breathing maneuvers, measurements are obtained for comparison

  
• Skin tests


  • Tuberculosis
  • Allergies
• Bronchoscopy/laryngoscopy


  Insertion of endoscopic tube into the airways to view structures, obtain tissue samples for biopsy or culture, assist with placing ET tubes, remove secretions that are not cleared with normal suctioning procedures, stent placement into trachea and bronchus to open strictures, may require general anesthesia or low-dose sedation
• Bronchoscopy/laryngoscopy patient preparation


  Obtain consent, document patient allergies, review lab work, NPO for 4-8 hours before the procedure to reduce risk for aspiration, premedicate patient to provide sedation and amnesia, numb the oropharynx with benzocaine spray
• Bronchoscopy/laryngoscopy procedure


  Scope (camera) inserted through the nose or the mouth, need continuous IV access, monitor VS continuously, apply supplemental oxygen

  
• Bronchoscopy/laryngoscopy follow-up care


  Monitor patient until sedation has resolved and patient's gag reflex has fully returned, assess vital sounds and breath sounds frequently, assess for complications such as hypoxemia, hemoptysis, or infection
• Thoracentesis


  Needle aspiration of pleural fluid or air from the pleural space, may be done to diagnose or to relieve lung compression and respiratory distress, drugs may also be instilled into the pleural space during procedure
• Thoracentesis patient preparation


  Explain procedure to patient, stinging sensation will be felt during the administration of local anesthetic, feeling of pressure when needle is advanced into the posterior chest, stress the importance of not moving, coughing, or deep breathing during the procedure to avoid puncture of the lung, assess any allergies, obtain consent, patient should be properly positioned by sitting on the side of the bed, resting arms on bedside table, and leaning slightly forward, provide pillows to make patient comfortable, stand in front of the table to prevent the table from moving and the patient falling
• Thoracentesis procedure


  Performed at the bedside or in radiology to be guided by CT or ultrasound, goggles and mask should be worn to prevent splash to eye or mouth, observe patient for shock, pain, nausea, pallor, diaphoresis, tachypnea, and dyspnea, after fluid is aspirated and needle is removed, a sterile dressing is applied or a drain may be placed through the needle insertion and left to a water seal drainage system if patient may require multiple thoracentesis
• Thoracentesis follow-up care


  Chest x-ray done immediately after to ensure a pneumothorax or mediastinal shift has not occurred, monitor VS, listen to lung sounds for absent or diminished sounds on the affected side, check puncture site for leaking or bleeding, monitor for bleeding, infection, subcutaneous emphysema, or pneumothorax

  
• Rib Fractures


  • Results from blunt chest trauma
  • Could place patient at risk for pneumothorax, hemothorax, or pulmonary contusion

  
• Rib Fractures


  • Patient may report pain with movement, deep breathing, and coughing
  • Inadequate ventilation
  • Inadequate clearance of secretions

  
• Interventions for Rib Fractures

  1. Place patient in Semi-Fowlers to High-Fowler's position

  2. Provide pain medications to maintain adequate ventilation

  3. Educate patient to self-splint with hands, arms, or pillow

  
• Pulmonary Contusion


  Interstitial hemorrhaging with intra-alveolar hemorrhage

  
• Pulmonary Contusion


  • Dyspnea
  • Hypoxemia
  • Increased secretions
  • Hemoptysis
  • Restlessness
  • Decreased breath sounds
  • Crackles and wheezes

  
• Interventions for Pulmonary Contusion

  1. Maintain patent airway

  2. Ensure adequate ventilation

  3. Place patient in Semi-Fowler's to High-Fowler's position

  4. Provide oxygen

  5. Ensure bedrest

  
• COPD


  Chronic Obstructive Pulmonary Disorder
• COPD


  • Severe tissue damage to alveoli and lung tissue
  • Non-reversible
  • Progression can be slowed by good management of the disease

  
• Emphysema


  Alveolar problem, traps carbon dioxide
• Chronic Bronchitis


  Airway problem, inflammation of airways, production of large amounts of thick mucous

  
• Asthma


  Inflammation and narrowing of the bronchioles (airways)