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Respiratory Fundamentals

Respiratory Fundamentals. Linda Winn, RN, MSN Ed., BA Ed. Major Topics. Anatomy http://www.argosymedical.com/Respiratory/samples/animations/Respiration/index.html http://www.argosymedical.com/Respiratory/samples/animations/Sherwood%20Respiration/index.html Assessment Labs Diagnostics Meds

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Respiratory Fundamentals

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  1. Respiratory Fundamentals Linda Winn, RN, MSN Ed., BA Ed.

  2. Major Topics • Anatomy http://www.argosymedical.com/Respiratory/samples/animations/Respiration/index.html http://www.argosymedical.com/Respiratory/samples/animations/Sherwood%20Respiration/index.html • Assessment • Labs • Diagnostics • Meds • Common Diagnoses

  3. Activity • Each team will be assigned one of the following topics to research and present to the entire group: • Assessment • Normal assessment – what makes up a complete respiratory assessment? • Abnormal findings & significance • Labs • What labs are relative to respioratory status? • Normals • Abnormals & significance • Diagnostics • What diagnostic tests are relative to pulmonary status? • Normals • Abnormals & significance • Any significant patient care measure before, during, or after tests • Meds • Major categories / actions of Respiratory meds • Significant side-effects • Nursing measures specific to meds

  4. Respiratory Assessment

  5. Assessment • Screening Exam Techniques http://depts.washington.edu/physdx/pulmonary/tech.html http://depts.washington.edu/physdx/pulmonary/demo.html

  6. Resp Assessment • Breathing Pattern • I:E ratio • Kussmaul • Rate • Dyspnea • Orthopnea • PND – Paroxysmal nocturnal dyspnea • Cough and Sputum • Frequency • Dry / moist • Amount • Color • Thickness • Odor • Hemoptysis

  7. Assessment (Cont.) • Inspection • Symmetry • Skin color – lip color / finger clubbing • WOB – accessory muscles • Auscultation • Adventitious sounds • Chest pain • History • Diagnoses • Smoking • Quick, Focused Assessment

  8. Breath Sounds Link • Normal and Adventitious breath sounds http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/contents.html

  9. Diagnostics & Labs

  10. Labs • H/H • Sputum Analysis • C&S • Gram Stain • Acid-Fast smear (AFB) • Cytology • ABG’s • WBC • O2 Sats

  11. Diagnostic Tests • CXR • CT Chest • MRI • V/Q Scan • Bronchoscopy http://www.nlm.nih.gov/medlineplus/tutorials/bronchoscopy/htm/_no_50_no_0.htm • Thoracentesis • PFTs – Pulmonary Function Tests • Spirometry

  12. Diagnostics • PFR • http://www.argosymedical.com/Respiratory/samples/animations/Peak%20Flow%20Meter/index.html

  13. Diagnostic Tests • Endoscopic Exams • Bronchoscopy: direct inspection of airways • Only __________ ___________ of airways • Purposes: • diagnose diseases • find obstructions • obtain tissue samples • remove mucous plugs, foreign bodies • find bleeding sources

  14. Pulmonary Meds

  15. Pulmonary Meds • Oxygen (later) • Corticosteroids http://www.argosymedical.com/Respiratory/samples/animations/Inhaled%20Corticosteroids/index.html • Antibiotics • Beta-Agonists

  16. Respiratory Med Delivery Metered Dose Inhalers • deliver constant dose of drug directly to airways • requires hand-lung coordination • propellant based • compact & portable • relatively inexpensive • wait 1 minute between puffs

  17. How & Why Is the Spacer Used? Spacer • http://www.mayoclinic.com/health/asthma/MM00608

  18. Methods of Delivery Dry Powder Inhalers • no propellants used • breath activated easier to use • delivers more drug to airways than MDIs http://www.mayoclinic.com/health/asthma/MM00405

  19. Methods of Delivery Nebulizers • used at home or hospital • continuous aerosol spray with external energy source (O2) • takes longer to deliver drug • choice if patient unable to use MDIs

  20. Respiratory Treatments • Coughing and Deep Breathing (later) • Incentive Spirometry (later) • Oropharngeal Suctioning • Inhaled Medication • Oxygen Therapy (Supplementation)

  21. Coughing & Deep Breathing • Position for maximal lung expansion • Splint with hand(s) or pillow • Slow inspiration via nose, hold 3-5 seconds, exhale via mouth. Cough after 2-3 breaths. • Pulmonary disease: exhale via pursed lips & cough after expiration started • More frequent coughing if productive • Coughing contraindicated: post-eye, ear, brain or neck surgery

  22. Incentive Spirometry • Prevents atelectasis & PNA • Position for maximal lung expansion • Exhale completely • Close mouth around mouthpiece • Inhale slow & deep, watching meter for flow rate • Make inspiration last for 3-5 seconds • 10 X Q/hr WA

  23. Respiratory Diagnoses

  24. Asthma • COPD • Chronic Bronchitis • Emphysema • Pneumonia

  25. Major Pulmonary Diagnoses • COPD • http://video.about.com/copd/Emphysema.htm • http://video.about.com/copd/COPD.htm • Pneumonia • CAP vs HAP

  26. Major Pulmonary Diagnoses • Asthma • http://www.argosymedical.com/Respiratory/samples/animations/Asthma%20TLC_AZ/index.html • http://www.argosymedical.com/Respiratory/samples/animations/Asthma/index.html • Sleep Apnea • http://www.argosymedical.com/Respiratory/samples/animations/CPAP%20Sleep%20Apnea/index.html

  27. Appropriate antibiotic therapy Increased fluid-- 3 liters/day Good nutrition--1500 cal/day analgesics Reduced activity and rest Antipyretics Supplemental oxygen Vaccine prophylaxis CORE Measure Pneumonia Collaborative Care

  28. Assessment Findings • Fever, restlessness, fatigue, splinting painful chest • (New) cough with or without sputum • Shortness of breath, RR & HR • Pleuritic chest pain • Infiltrates on CXR • Crackles or bronchial sounds in the peripheral lung fields

  29. Appropriate antibiotic therapy Increased fluid-- 3 liters/day Good nutrition--1500 cal/day Analgesics Oxygen Reduced activity and rest Antipyretics Supplemental oxygen Vaccine prophylaxis CORE Measure Collaborative Care

  30. Oxygen • Medication • Requires MD order • Side Effects • Highly combustible gas • Clear • Odorless • Set-up is part of initial room check

  31. Indications for O2 therapy • Goal • Prevent or relieve hypoxia • Keep SaO2 > 90% • Reduce work of breathing • Room Air / FIO2 = 21% • Used with hypoxia due to: • Respiratory Disorders • Cardiovascular disorders • Central nervous system disorders

  32. Safety Precautions • O2 sign posted • No smoking or flames • Electrical equipment grounded • Check tank level before transport • No oil-based lubricants / lotions

  33. Delivery Devices • Nasal Cannula • Masks • Simple face • Partial rebreathing • Non-rebreathing • Venturi (Venti Mask) • Tracheostomy • Collar • Ventilator • Flow Meter • Humidification

  34. Oxygen Safety

  35. Nasal Cannula • Advantages • Safe, simple, tolerated well • Allows eating and drinking • Can humidify • Disadvantages • Easily dislodged • Check regularly • Skin breakdown • Check regularly • O2 Concentrations • 1L/min = 24% • 2L/min = 28% • 3L/min = 32%

  36. Simple Face Mask • RA enters via side holes • Advantages • Humidified • Disadvantages • Imprecise FIO2 • High FIO2 needed to prevent rebreathing CO2 • Concentrations • 5-6L/min = 40% • 6-7L/min = 50% • >7L/min = 60%

  37. Non-rebreather Mask • Use • Valve prevents air from flowing back into bag • Last step, usually, before intubation • Advantages • High O2 concentrations • Accurate • Disadvantages • Can’t use high humidity • uncomfortable

  38. Venturi Mask • Venti-mask • High flow • Adjustable • Advantages • Very precise • Mask of choice for COPD • Disadvantages • uncomfortable

  39. O2 and COPD • Historically… • Never give O2 >2L/min to COPD pts. • However… “There has been concern regarding the dangers of administering O2 to COPD pts and reducing their drive to breath.” “This has been a pervasive myth but is not a serious threat.” “In fact, not providing adequate O2 to these patients is much more detrimental.” Lewis, p. 643 (7th ed.)

  40. Patient Education • Monitor color of sputum • Self care: at-home meds & treatments; avoid triggers • Prevention • Pneumococcal vaccine, flu shot • Frequent oral hygiene • Encourage fluids • Environmental hazards • altitude, smog, allergies, smoke • Follow up medical care • American Lung Association • www.lungusa.org

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