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Purposes:
Inspect parts of
respiratory tract
d. Do biopsy
Prep – consent,
topical anesthesia,
MAJOR FUNCTION: Gas Exchange NPO 6-8 hours,
atropine sulfate,
• During gas exchange, air is
sedation
taken into the body by
inhalation and travels through Post – head of bed
respiratory passages to the elevated, lateral
lungs. In the lungs, O2 diffuses position, , check
into the blood and CO2 is gag reflex and
removed by exhalation hoarseness,
Respi-threeBPage 1
saturation (SaO2) of pCO2 pCO2
arterial blood (uses pulse Normal 24 Normal HCO3
oximeter) HCO3
B. Spirometry – measures
lung capacity, volumes ABG PROFILE IN METABOLIC ACIDOSIS
and flow rates with the or ALKALOSIS
use of an instrument ACIDOSIS MET ALKALOSIS
called spirometer. Decreased pH <7.4> Increased pH
Decreased <24> Increased
. Arterial Blood Gases – provides HCO3 HCO3
objective determination of Decreased BE <0> Increased BE
arterial blood oxygenation, gas Normal pCO2 40 Normal pCO2
exchange, alveolar ventilation
and acid-base balance;
Signs and Symptoms of Acid-
use heparinized 2ml syringe. Base Imbalances:
Sites: radial, brachial, femoral artery Acidosis – increased CO –
depression of CNS – decrease in
PaO2 – measures O2 dissolved in blood
mental capacity –delirium, coma
– shows efficiency of gas exchange
or death
ventilation and perfusion
Alkalosis – increased O2 –
PaCO2 – determines the adequacy of
overexcitability or irritability of
ventilation; depends upon the amount
CNS – extreme nervousness,
of O2 produced and ability of lungs to
over excitability, tetany or
eliminate; shows effectiveness of
convulsions
ventilation
Respi-threeBPage 2
Causes:
1. Viral – influenza,
adenovirus,
staphylococcus aureus
2. Bacterial – streptococcus
pneumonia, haemophilus
influenzae
3. Allergic – seasonal
Nursing Management:
Respi-threeBPage 3
upper lip to treat chronic maxillary 1. Rest and increase fluid
sinusitis intake
Post-op Care:
Respi-threeBPage 4
No coughing, sneezing, vigorous nose Head of bed
bleeding and vigorous exercise for one elevated 45o
to two weeks
Assist patient in
Drink fluids two to three liters a day communicating –
provide writing
Avoid hard and scratchy foods such as
materials, etc
popcorn and pretzels
Post partial
Expect stools to be black or dark for a
laryngectom
few days
y – patient
Laryngitis will be able
to talk
Inflammation and swelling of
mucous membrane of larynx Post total
laryngectom
Cause: Infection, improper use y – no voice;
of voice, smoking artificial
larynx now
Manifestations: available
Hoarse voice, throat irritation, Practice swallowing
dry, non-productive cough
Chronic Obstructive Pulmonary
Treatment:
Disease
ATB
disease state characterized by
Stop smoking airflow limitation that is
progressive and associated with
Removal of cause an abnormal inflammatory
response of the lungs to noxious
CANCER OF THE LARYNX
particle or gases ( smoking)
Risk factors – Carcinogens – smoking, that is not fully reversible
alcohol, cement/ wood
• Chronic Bronchitis
dust,petrol/paint fumes
Respi-threeBPage 5
Smoking and pollutants irritants, control of
environmental
Viral or bacterial temperature, proper
infections nutrition, adequate
hydration
EMPHYESEMA
Predisposing factors:
• Smoking
• Alpha1 antitrypsin
deficiency( enzyme
inhibitor that protects the
lung parenchyma from
injury) – for Caucasians
• Familial tendency
S/S Chronic Bronchitis
• the stimulus to breathe is
• Chronic productive cough
a low pO2 instead of an
“cigarette cough”
increased pCO2
• Grayish white sputum
Signs and symptoms:
• Dyspnea
• Uses accessory muscles
• Cyanosis, tachycardia to breathe
• Supportive measures –
avoid smoking, inhaled
Respi-threeBPage 6
• Fluid intake to 3L/day if not
contraindicated (What
condition?)
• O2 @ 2-3L/min
Nursing Management
Respi-threeBPage 7
Influenza and pneumococcal Environmental factors –
vaccination change in temperature or
humidity
Oxygen therapy
Atmospheric pollutants –
Medications cigarettes, industrial
smoke
- Bronchodilators- Salbutamol
and theophylline- Instruct on the use
Strong odors – perfume,
of both oral and inhalant medications
insecticides
- Steroids- to reduce
Allergens – feathers,
inflammation Pred.
dust, food, pollens,
- mast cell stabilizers (Cromolyn laundry detergents
Na)
Exercise
- Mucolytics- to thin secretions
Carbocysteine Stress or emotional upset
- Antibiotics,
SURGICAL MNGMT
Respi-threeBPage 8
Corticosteroids –
solumedrol,
dexamethanol
BRONCHIECTASIS
Respi-threeBPage 9
crackles, rhonchi, pleural
friction rub on auscultation,
cough, malaise
restlessness (hypoxia)
Diagnostic exam:
Respi-threeBPage 10
DX Chest X Ray,Sputum
MC&S,FOB
Pleural Conditions
Pleurisy – inflammation of
visceral and parietal pleura
DX – CXR, Ausculation
EMPYEMA
Assessment:
Accumulation of thick, purulent
fluid withing the pleural space. - Pleuritic chest pain that is sharp
and increases with inspiration
2 to lung abscess/bacterial
pneumonia - Dyspnea, decreased breath
sounds, fever, malaise
s/s of pneumonia/ chest
infection - Dry, non-productive cough
caused by bronchial irritation or
DX – Chest CT, ausc – dec mediastinal shift to unaffected
breath sounds, thoracentesis side
TX – drain fluid( home on chest Treatment of Pleural Effusion
drain), IV antibiotics(4-6wks)
- Thoracentesis – UTZ guided
PLEURAL EFFUSION
- Thoracotomy with chest drain
• Excess of fluid in the pleural insertion- drain and re expand
space the lungs
Respi-threeBPage 11
asked to change positions to Nursing Management
promote distribution of the talc -Pneumothorax
and maximize contact with
pleural space. ( promote Apply dressing over open chest
adhesion of visceral and parietal wound
pleura)
Position in high fowler’s position
Respi-threeBPage 12
• Malignant tumor of the lungs
(primary/ metastatic)
• #1 type of cancer
Causes:
ASSESSMENT
- Maintain the drainage system Non small cell 75%– Squamous cell
below chest level to maintain central, Adenocarcinoma – peripheral
water seal and prevent reflux (most common)
Respi-threeBPage 13
Treatment/Mngmt Anticoagulation therapy –
Heparin iv
• Provide activity with rest
periods ACUTE RESPIRATORY FAILURE
Respi-threeBPage 14
DX – CXR, D dimer assay,
Doppler UTZ
Emergency management
Thrombolytic therapy –
Streptokinase iv then ---
PAH Meds Anticoagulation therapy –
Heparin iv
Bosentan- vasodilator of
pulmonary artery.
Prostacyclin- Epoprostenol
(Flolan) – relaxes vascular
smooth muscle(lungs),plt
deagregator
EPOPROSTENOL
Trepostinil (Remodulin) –
prostacyclin analogue. Longer
half life than Flolan-
PULMONARY EMBOLISM
Respi-threeBPage 15