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Nursing Management of Clients with Stressors of Respiratory Function

Nursing Management of Clients with Stressors of Respiratory Function. Chronic Airflow Limitation (CAL) Pneumonia Tuberculosis. NUR133 Lecture #5 K. Burger, MSEd, MSN, RN, CNE. Chronic Airflow Limitation (CAL). Term used for Chronic lung diseases:   - Emphysema - Chronic Bronchitis

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Nursing Management of Clients with Stressors of Respiratory Function

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  1. Nursing Management of Clients with Stressors of Respiratory Function Chronic Airflow Limitation (CAL)PneumoniaTuberculosis NUR133 Lecture #5K. Burger, MSEd, MSN, RN, CNE

  2. Chronic Airflow Limitation (CAL) Term used for Chronic lung diseases:   - Emphysema - Chronic Bronchitis - Bronchial Asthma

  3. COPDChronic Obstructive Pulmonary Disease • Emphysema • Chronic Bronchitis Bronchospasm, dyspnea Non-reversible and progressive Continously symptomatic

  4. Asthma Reversible airflow obstruction d/t: • Inflammation • Airway hyperresponsiveness • Hyperresponsiveness leading to bronchospasms

  5. Asthma • stimulus or allergen- chemical mediators released. Within minutes: Dyspnea Wheezing Cough Mucus production

  6. Inflammatory process

  7. Asthma • Common agents or stimuli: -fog, smog, smoke -odors, aerosols -exercise -cold air • Allergens- dust mites, animal dander, pollen, cockroaches, foods, medicines.

  8. Asthma • FOCUSED Respiratory assessment 1. Expiratory and Inspiratory wheezing 2. Dry or moist cough 3. Dyspnea, signs of hypoxemia, anxiety 4. increased HR, BP, RR 5. Diaphoresis, Pallor 6. Cyanosis 7. Nasal flaring 8. Use of accessory muscles

  9. Asthma • Diagnostic Assessment • ABGs / PO2 low, PCO2 high, PH low • SaO2 low • Eosinophils / serum and sputum • PFTs / FEV and PERF • CXR

  10. Asthma

  11. Complications of Asthma - Respiratory infections - Status Asthmaticus - pneumothorax - respiratory arrest - cardiac arrest

  12. Asthma Nursing Diagnoses 1. Impaired Gas Exchange related to alveolar membrane changes, airflow limitation, respiratory muscle fatigue, excess production of mucus. 2. Ineffective Breathing pattern related to airflow obstruction (narrowed airways), and fatigue. 3. Ineffective Airway Clearance related to excessive secretions, fatigue and ineffective cough.

  13. Asthma Interventions • Client Education A. Identify causes B. Proper environmental changes C. Stress management, rest, and sleep D. Correct use of inhalers E. Correct use of peak flow meter and step wise approach to med management F. What to do if an attack occurs

  14. Asthma • How to use a METERED DOSE inhaler (without spacer) correctly: 1. Shake inhaler 2. Tilt head back, breathe out fully 3. Open mouth, mouthpiece 1-2” away 4. As you begin to breathe in deeply, press down and release medicine. 5. Breathe in deeply and slowly for 3-5 sec. 6. Hold your breathe for 10 sec 7. Breathe out slowly

  15. Bronchodilator Beta agonists short-acting long-acting Anti-cholinergics Methylxanthines Anti-inflammatory Corticosteroids Anti-leukotriene Mast cell stabilizers Monoclonal antibodies Inhaled agents AsthmaDrug Therapy

  16. Asthma • Pharmacologic stepped approach to treating asthma symptoms • Step 1- mild intermittent- beta 2 agonist • Step 2.- mild persistent – add cromolyn • Step 3.- moderate persistent- add inhaled corticosteroid , may add theophylline. • Step 4.- Severe persistent- add po steroids

  17. Chronic Obstructive Pulmonary Disease EMPHYSEMA • Loss of lung elasticity • Hyperinflation of lungs / air trapping • Diaphragm flattening • Increased airflow resistance • Ineffective gas exchange • Retained CO2 (hypercapnia) • Chronic respiratory acidosis

  18. Chronic Obstructive Pulmonary Disease CHRONIC BRONCHITIS • Chronic inflammation of airways • Mucosol edema • Increased # of mucous glands • Bronchial wall thickening • Impaired airflow AND gas exchange • Hypoxemia, hypercapnia, respiratory acidosis

  19. COPD • FOCUSED assessment 1. Rapid, shallow respirations & dyspnea 2. Irregular breathing patterns 3. Moist cough 4. Limited diaphragmatic excursion 5. Decreased fremitus 6. Hyperresonant percussion 7. Crackles 8. Barrel chest 9. Cyanosis 10.Clubbing 11.Orthopneic posturing

  20. COPD • DIAGNOSTIC ASSESSMENT • ABGs • SaO2 • CXR • PFT • Serum AAT • ECG • H&H, Electrolytes, WBC

  21. Complications of COPD • Respiratory infection • Cor pulmonale • Cardiac dysrhythmias

  22. Nursing Diagnoses for COPD • Impaired gas exchange • Ineffective breathing pattern • Ineffective airway clearance • Activity intolerance

  23. Interventions for COPD • Airway maintenance • Cough enhancement • Oxygen therapy • Energy conservation • Drug therapy • Surgical interventions

  24. COPD Drug Therapy • Bronchodilators • Anti-Inflammatory drugs • Inhalants AND systemic drugs • PLUS Mucolytics

  25. Pneumonia • Community acquired pneumonia (CAP) Versus • Nosocomial pneumonia • Higher incidence in:Elderly, immunocompromised, CAL, mechanically vented, chronically ill • 5th leading cause of death in US

  26. PneumoniaAssessment • Chest pain, dyspnea, tachypnea, SOB • Cough & hemoptysis • Crackles & wheezes • Tactile fremitus • Percussion • Fever and chills • Hypoxemia

  27. PneumoniaNursing Diagnoses • Impaired gas exchange • Ineffective airway clearance • Potential for sepsis • Acute pain

  28. PneumoniaInterventions • C&DB q2h/ incentive spiro • O2 therapy / Positioning HOB elevated • Maintain hydration • Medications: bronchodilators, expectorants, antibiotics • Client teaching: completion of med rx, influenza and pneumococcal vaccinnations

  29. Tuberculosis • Causative organism: Mycobacterium tuberculosis • Incidence increasing worldwide • Highest prevalence: immunocompromised, people living in crowded and or poor living conditions • Exposure versus infection versus active

  30. TuberculosisAssessment • Persistent, productive cough • Hemoptysis • Fever and night sweats • Fatigue • Anorexia • Weight loss • Progressive and persistent S & S

  31. TuberculosisDiagnostic Assessment • Purified Protein Derivative PPD Positive = 10mm induration or > general 5mm induration or > Hx HIV • CXR • Sputum for acid-fast bacillus AFB • Sputum culture; BACTEC • PCR assay • NEW: Quantiferon TB Gold Test QFT-G

  32. TuberculosisNursing Diagnoses • Impaired gas exchange • Ineffective airway clearance • Fatigue • Deficient knowledge • Ineffective therapeutic regimen maintenance

  33. TuberculosisInterventions • Combination drug therapy Isoniazid (INH) Rifampin (RIF) • Plus Pyrazinamide (PZA) Ethambutol or Streptomycin • RIFATAR = NEW med combo of INH, RIF, & PZA • LONG TERM THERAPY!!!!!6-12 months duration • CLIENT EDUCATION!!!!!

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