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

Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1. The Respiratory System. Structure and Function. Gas exchange. Changes associated to Aging. ↓ recoil and compliance  AP diameter ↓ functional alveoli ↓ in Pa02 Respiratory defense mechanisms less effective

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

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

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

  8. Diagnostics: Chest X-Ray Cont. Nodule Infiltrates Posterior Anterior View Left Lateral View

  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: Right upper Lobe

  11. 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 Diagnostics: Bronchoscopy Procedure Care/Instructions: • NPO 6 -8 hrs prior • Sedation during procedure Post Procedure: • HOB elevated • Observe for hemorrhage • NPO until gag reflex returns

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

  13. Specimen from pleural fluid Treat pleural effusion Assess for complications Post-Procedure care: CXR after procedure Diagnostics: Thoracentesis • Positions • Sitting on side of bed over bedside table chest • elevated • Lying on affected side • Straddling a chair

  14. Dyspnea Cough Sputum Assessment: Cues to Respiratory Problems

  15. Pneumonia: Case Study Pathophysiology

  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. 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 Pneumonia: Risk Factors

  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 LUL Infiltrates

  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. Hypoxemia Pleural effusion Atelectasis Pleurisy Pneumonia: Complications Atelectasis Pleurisy Pleural Effusion

  26. Toxic sprinkles anyone?

  27. Any Questions?

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