Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1

1. Rachel S. Natividad, RN, MSN, NPN212 Medical Surgical Nursing 1 The Respiratory System

2. Structure and Function

3. Gas exchange

4. Changes associated to Aging ? recoil and compliance ? AP diameter ? functional alveoli ? in Pa02 Respiratory defense mechanisms less effective Altered respiratory controls More gradual response to changes in O2 and Co2 levels in blood

5. Diagnostics Pulse Oximetry Chest X-Ray Computed Tomography (CT scan) Bronchoscopy Thoracentesis Pulmonary Function Tests Sputum Specimen and Cultures

6. Diagnostics: Pulse Oximetry Measures arterial oxygen saturation Pulse oximetry probe on forehead, ears, nose, finger, toes, False readings Intermittent or continuous monitoring Ideal values: 95-100% When to Notify MD < 91% 86% (Medical Emergency)

7. Diagnostics: Chest X-Ray Screen, diagnose, evaluate treatment Instructions: No metals/jewelry

8. Diagnostics: Chest X-Ray Cont.

9. Diagnostics: Sputum Specimen To diagnose; evaluate treatment Specimen: ID organisms or abnormal cells Culture & Sensitivity (C&S) Cytology Gram stains (e.g. Acid Fast Bacilli)

10. Diagnostics: Computed Tomography: CT Scan Images in cross-section view Uses contrast agents Instructions:

11. Diagnostics: Bronchoscopy Diagnose problems and assess changes in bronchi/bronchioles Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study

12. Diagnostics: Pulmonary Function Test (PFTs) Evaluate lung function Observe for increased dyspnea or bronchospasm Instructions: No bronchodilators 6 hours prior

13. Diagnostics: Thoracentesis Specimen from pleural fluid Treat pleural effusion Assess for complications Post-Procedure care: CXR after procedure

14. Assessment: Cues to Respiratory Problems Dyspnea Cough Sputum

15. Pneumonia: Case Study Pneumonia is a serious infection causing inflammation to one or both lungs. The air sacs (alveoli) in the lungs fill with fluid and pus, making it difficult for the person affected to breathe. When the air sacs in the lungs' fill it impairs their main function, which is to get oxygen from the air into the bloodstream organism reaches lower resp tract Outpouring of inflammatory exudate and cells WBCs phagocytize the organisms and release enzymes Portions of the lungs fill with exudate and inflammatory cells - consolidation Pneumonia is a serious infection causing inflammation to one or both lungs. The air sacs (alveoli) in the lungs fill with fluid and pus, making it difficult for the person affected to breathe. When the air sacs in the lungs' fill it impairs their main function, which is to get oxygen from the air into the bloodstream organism reaches lower resp tract Outpouring of inflammatory exudate and cells WBCs phagocytize the organisms and release enzymes Portions of the lungs fill with exudate and inflammatory cells - consolidation

16. Pneumonia: Pathophysiology Cont.

17. Pneumonia: Etiology Cause bacteria (75%) viruses fungi Mycoplasma Parasites chemicals

18. Pneumonia: Classifications Community-acquired pneumonia (CAP) Onset in community or during 1st 2 days of hospitalization (Strep. pneumoniae most common) Hospital-acquired Pneumonia(HAP/nosocomial) Occurring 48 hrs or longer after hospitalization Aspiration pneumonia Pneumonia caused by opportunistic organisms Pneumocystis Carinii

19. Pneumonia: Risk Factors CAP Older adult Chronic/coexisting condition Recent history or exposure to viral or influenza infections History of tobacco or alcohol use HAP Older adult Chronic lung disease ALOC Aspiration ET, Trach, NG / GT Immunocompromised Mechanical ventilation

20. Pneumonia: Clinical Manifestations Fevers, chills, anorexia Pleuritic chest pain SOB Crackles/wheezes Cough, sputum production Tachypnea

21. Pneumonia: Clinical Manifestations-Cont. Mycoplasma (Atypical) feeling tired or weak, headaches, sore throat, or diarrhea.  Eventually, most develop a dry cough.� They can, also, develop fever, chills, earaches, chest pain �walking pneumonia�

22. Pneumonia: Diagnosis Diagnosis ? Physical exam ? crackles, rhonchi/wheezes CXR ?area of increased density (infiltrates/ consolidation) Sputum specimen � Gram stain *always obtain both PA & Lateral films For complicated pneumonia- gram stain and ID the infecting organism Rapid Diagnostic studies The infectious agent is the most valuable piece of information in managing a complicated pneumonia. Gram stain - bacteria Acid fast - mycobacteria DFA - Pneumocystis, influenza, legionella PCR - chlamydia, mycoplasma, mycobacteria, legionella, hantavirus EIA - influenza, RSV Treatments: hydration, proper nutrition, support 02; ABX IV, HHN tx, analgesics Treat with abx based on source of infection (com vs hosp acquired;) type of org present; and severity New antibiotics Cephalosporins Macrolides/ketolides Fluoroquinolones Route of administration Oral Intravenous Intramuscular Admission decisions related to :hypoxia, inadequate oral intake, lack of home care support Antibiotic Decision Making: Severity of disease, Microbiology environment, Patient, Host status, Individual considerations *always obtain both PA & Lateral films For complicated pneumonia- gram stain and ID the infecting organism Rapid Diagnostic studies The infectious agent is the most valuable piece of information in managing a complicated pneumonia. Gram stain - bacteria Acid fast - mycobacteria DFA - Pneumocystis, influenza, legionella PCR - chlamydia, mycoplasma, mycobacteria, legionella, hantavirus EIA - influenza, RSV Treatments: hydration, proper nutrition, support 02; ABX IV, HHN tx, analgesics Treat with abx based on source of infection (com vs hosp acquired;) type of org present; and severity New antibiotics Cephalosporins Macrolides/ketolides Fluoroquinolones Route of administration Oral Intravenous Intramuscular Admission decisions related to :hypoxia, inadequate oral intake, lack of home care support Antibiotic Decision Making: Severity of disease, Microbiology environment, Patient, Host status, Individual considerations

23. Pneumonia :Interventions/Tx Treatment Antibiotics ? choose based on age, suspected cause & immune status Supportive care ? IV fluids, supplemental oxygen therapy, respiratory monitoring, cough enhancement *may take 6-8 weeks for CXR to normalize

24. Nursing Diagnoses� Impaired gas exchange R/T Pneumonia Pain R/T infection in lung Pneumonia

25. Pneumonia: Complications Hypoxemia Pleural effusion Atelectasis Pleurisy

26. Toxic sprinkles anyone?

27. Any Questions?