Medsurge 3

• Atelectasis


  Collapse or closure of the alveoli. Acute or chronic.
• Signs and Symptoms of Atelectasis

  • Insidious - increasing dyspnea, cough, and sputum production. Often occurs due to trauma (surgery), or from medications. Characterized by increased work of breathing and hypoxemia. Also decreased breath sounds and crackles over affected area.
• Acute Atelectasis


  • Tachycardia, tachypnea, pleural pain (pain on inspiration), and central cyanosis if large portion of lungs is affected.
• Chronic Atelectasis


  • Similar to acute, pulmonary infection might be present. COPD, lung cancer, older age.
• Nursing Interventions for Atelectasis

  Continuous pulse oximetry.
• Prevention of Atelectasis


  Early mobilization, frequent turning, strategies to expand lungs/manage secretions, incentive spirometer, voluntary deep breathing, secretion management, inhaler.
• Treatment of Atelectasis


  Improve ventilation and remove secretions.
• First Line Measures for Atelectasis

  Frequent turning (every 2 hours), early ambulation, lung volume expansion maneuvers and coughing.
• Other Treatments for Atelectasis

  PEEP, CPAP, bronchoscopy, Chest physiotherapy, Endotracheal intubation and mechanical ventilation, Thoracentesis to relieve compression
• Tuberculosis (TB)


  Airborne respiratory disease spread via droplets
• Signs & Symptoms of TB

  • Hallmark Symptom - coughing up blood! Hemoptysis. Low‐grade fever, Cough; nonproductive or mucopurulent, Night sweats, fatigue, weight loss.
• Treatment of TB


  Treated for 6 to 12 months, Drug resistance is primary concern, Initiate treatment with four or more medications, Complete all therapy, Initial treatment phase (8 weeks), Continuation phase (4 to 7 months).
• Nursing Interventions for TB

  • Promoting airway clearance, Advocating adherence to the treatment regimen, Promoting activity and nutrition, Preventing transmission.
• Negative pressure room


  Vacuum which does not allow bacteria to escape room.
• Isolation Precautions for TB

  Mycobacterium tuberculosis bacillus (TB). Spreads by airborne transmission through droplets then moves to other parts of the body such as the kidneys, bones, and cerebral cortex. Need N95 mask!
• Acute Respiratory Failure


  Rapid deterioration to hypoxemia, hypercapnia, and respiratory acidosis. Impaired ventilation of perfusion mechanisms.
• Signs and Symptoms of Acute Respiratory Failure

  • Early Signs: restlessness, tachycardia, hypertension, fatigue, headache. Later Signs: confusion, lethargy, central cyanosis, diaphoresis, respiratory arrest. Clinical Manifestations: use of accessory muscles, decreased breath sounds, decreased mental status due to respiratory acidosis.
• Treatment of Acute Respiratory Failure

  Identification and treatment of underlying cause, Intubation, mechanical ventilation, Nutritional support, enteral feedings preferred, Reduce anxiety, Provide patient a form of communication, Prevent complications (turning, ROM, mouth care, skin care).
• Acute Respiratory Distress Syndrome (ARDS)


  Usually affects people who are already critically ill. Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x-ray, and absence of an elevated left atrial pressure, hypoxemia unresponsive to oxygen.
• Signs and Symptoms of ARDS

  • Rapid onset of severe dyspnea, Crackles on auscultation, "Air hunger", Tachycardia, tachypnea, hypoxemia, Cyanosis, Altered mental status, Chest retractions.
• Nursing Interventions/Plan of Care for ARDS


  Identification and treatment of underlying cause, Intubation, mechanical ventilation with PEEP to keep alveoli open, Treat hypovolemia to keep hemodynamically stable, Prone positioning is best for oxygenation, frequent repositioning to safeguard integumentary system, Nutritional support, enteral feedings preferred, Reduce anxiety, sedation, paralysis, Supportive care.
• Aspiration


  Inhalation of foreign material into the lungs leads to inflammatory reaction, hypoventilation, and ventilation-perfusion mismatch. Serious Complication - pneumonia.
• How to Prevent Aspiration

  Keep HOB elevated and endotracheal cuff elevated (if intubated), Avoid stimulation of gag reflex with suctioning or other procedures.
• Causes of Respiratory Failure

  • Drug overdose, drowning, Sepsis, Stroke, Pneumonia.
• Treatment of Respiratory Failure


  Intubation, mechanical ventilation, Adjust vent settings, Promote adequate oxygenation, Suction to remove secretions, Give medications to reduce anxiety and hypoxia.
• Pulmonary Embolism


  Sudden onset chest pain, tachycardia, SOB. Caused by a traveling blood clot (usually originating in legs or somewhere else in body) that goes into the lungs.
• Treatment of Pulmonary Embolism

  Blood thinners, anticoagulants.
• Prevention of Pulmonary Embolism


  Don't sit for long periods of time, wear compression stockings if indicated, avoid risk factors for DVT.
• Chest Tubes


  Used for drainage. Used in removal of air and fluid from the pleural space and re-expansion of the lungs.
• Nursing Interventions for Chest Tubes

  Monitoring chest tube & patient, Keep drain below patient chest, Document I/Os, Check the seal, Check for occlusions and kinks, Frequently assess patient and tubes, Position patient in semi-fowlers, Encourage early ambulation, Should be intermittent bubbling.
• Chambers of Chest Tube System

  A suction source, A collection chamber for pleural drainage, And a mechanism to prevent air from reentering the chest with inhalation.
• Emergencies with Chest Tubes

  Have a three sided occlusive bandage and silk tape at the bedside. If the tube dislodges, want to cover it with the bandage!
• Chest Trauma


  • Blunt Trauma: Sternal, rib fractures - can puncture lungs. Flail Chest - 3 or more broken ribs in 2 different places. Issues with lung tissue compliance. Pulmonary contusion - bleeding/edema into lungs that causes damage to pleural membranes. Penetrating Trauma: Pneumothorax - collapsed lung, air leaks into space between lung and chest. Hemothorax - blood in the lung, penetrating wounds, stab wounds, gunshot wounds.
• Simple or Spontaneous Pneumothorax

  Collapsed lung from activity.
• ut plurivax


  Always write
• plurivax system

  1. for chest tubes

  2. Label with Date and time 3. drainage collection system

  4. removes fluid
• Guid from chesttube


  1. Nurses to see

  2. Make sure tubing is secure

  3. Also how much is coming out
• Water seal chamber


  Consistent bubbling may indicate air leak so check tubes and notify provider
• Place occlusive gauze over insertion site


  Tape it on 3 sides
• Chest tubes should routinely be open