N 295 lecture 7 respiratory student copy


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  • Suggested Interview Questions : Environmental Exposure : Have you been exposed to environmental or occupational materials that have affected your breathing? What are they? S/S of resp. dysfunction : Have you had allergies, asthma, bronchitis, emphysema, bronchitis, TB or other lung problems? How often do you cough? Describe sputum? Impact on ADLS: Do any of your breathing problems limit your activities? Adaptive Measusee: What position do you assume for sleeping? When Interviewing keep in mind these important respiratory symptoms: COUGH: Do you have a cough?If so, How long? Suddenly or gradually? does it waken you at night?what does it sound like/ describe it? Acute illness=cough throughout the day environmental exposure=occurs at time in relation to exposure post nasal drip/ sinusitis=at night sound= dry, mois,t wet, hacking, hoarse,productive, nonproductive pneumonia, -hacking, congested cough, croup- barking,HF dry cough SPUTUM: Nl sputum is thin, clear white in color, tasteless odorless, rust colored=pneumonia, yellow-green-bacterial infection DYSPNEA/SOB; Does SOB occurs @ restorw/activity? problems breathing @ night? PND=paraoxysmal nocturnal dyspnea, orthopnea=SOB while lying flat, Ask about the # of pillows. HEMOPTYSIS: produces alarm in pt, Coughing up clots--> serious illness CA, tumor PE. Blood tinged= associated w/ smoking, minor infectionsn and serious diseas. H/o TB, bronchitis recent travel? (prolonged sitting--> DVT--->PE, medication HX (anticoagulants, birth control pills). At times it may be difficult to ascertain if patient coughed up or vomited blood. Chest pain (pleuritic Pain): inflammed parietal pleura, nerves are abundant in this area. Sharp, stabbing pain usually during inspiration. may be localized (client splinting to avoid pain) WHEEZING: asthma is associated w/ wheezing but not all wheezing is asthma. CYANOSIS: central cyanosis occurs w/ inadequate gas exchange. bluish discoloration bets seen in the mucous membrane of the mouth & lips. clubbing of the nail bed is associated w/ this
  • N 295 lecture 7 respiratory student copy

    1. 1. Assessment of the Thorax and Lungs spring 2012
    2. 2. Review of Respiratory Function <ul><li>Pleura </li></ul><ul><li>Bronchi </li></ul><ul><li>Alveoli </li></ul><ul><li>Diaphragm </li></ul><ul><li>Accessory Muscles </li></ul>spring 2012
    3. 3. HEALTH HISTORY <ul><li>History of Disease </li></ul><ul><li>Common Respiratory Symptoms </li></ul><ul><li>Self Care Behaviors </li></ul><ul><li>Environmental Exposure </li></ul><ul><li>Smoking History </li></ul><ul><li>Functional Health Patterns </li></ul>spring 2012
    4. 4. <ul><li>INSPECTION </li></ul><ul><li>1. Shape of Thorax </li></ul><ul><ul><ul><li>2. Symmetry of Chest Wall </li></ul></ul></ul><ul><ul><ul><li>3. Accessory Muscle Use </li></ul></ul></ul><ul><ul><ul><li>4. Rate </li></ul></ul></ul><ul><ul><ul><li>5. Pattern </li></ul></ul></ul><ul><ul><ul><li>Depth </li></ul></ul></ul><ul><ul><ul><li>Patient Position / Mode </li></ul></ul></ul>spring 2012
    5. 5. Costal Angles spring 2012
    6. 6. Respiratory Patterns spring 2012
    7. 7. Patient Positions and Modes <ul><li>… Orthopnea </li></ul><ul><li>… .Paroxysmal Nocturnal Dyspnea </li></ul><ul><li>… ..Tripod position </li></ul><ul><li>…… Normal mode </li></ul><ul><li>…… ..Pursed lip </li></ul><ul><li>……… .Stomal </li></ul>spring 2012
    8. 8. Auscultation <ul><li>HOW to USE Stethoscope </li></ul><ul><li>WHERE on Chest </li></ul><ul><li>WHAT Instructions </li></ul><ul><li>FOR What Length of Time </li></ul><ul><li>WHICH Pattern </li></ul><ul><li>EXPECTED Findings </li></ul>spring 2012
    9. 9. An Individual Breath . spring 2012 Bronchial Bronchovesicular Vesicular
    10. 10. <ul><li>Factors Affecting Auscultation </li></ul><ul><ul><ul><li>. Chest Hair </li></ul></ul></ul><ul><ul><ul><li>. Clothing </li></ul></ul></ul><ul><ul><ul><li>. Ventilator tubing </li></ul></ul></ul><ul><ul><ul><li>. Shivering </li></ul></ul></ul><ul><ul><ul><li>. Shallow breaths </li></ul></ul></ul>spring 2012
    11. 11. Voice Sounds <ul><li>Normal Voice Transmission </li></ul><ul><li>Bronchopony </li></ul><ul><li>Egophony </li></ul><ul><li>Whispered Pectoriloquy </li></ul>spring 2012
    12. 12. <ul><li>Palpation </li></ul><ul><li>1. Tracheal Position </li></ul><ul><ul><ul><li>2. Tactile Fremitus </li></ul></ul></ul><ul><ul><ul><li>3. Thoracic Expansion (3-5) </li></ul></ul></ul><ul><ul><ul><li>4. Thoracic Tenderness </li></ul></ul></ul><ul><ul><ul><li>5. Crepitus </li></ul></ul></ul><ul><ul><ul><li>6. Masses </li></ul></ul></ul>spring 2012
    13. 13. <ul><ul><li>www.rale.ca/Repository.htm </li></ul></ul>spring 2012
    14. 14. <ul><li>Adventitious Breath Sounds </li></ul><ul><ul><li>Rales </li></ul></ul><ul><ul><li>Rhonchi </li></ul></ul><ul><ul><li>Wheezes </li></ul></ul><ul><ul><li>Pleural Friction Rub </li></ul></ul><ul><ul><li>Stridor </li></ul></ul><ul><li>What would these patients look like? </li></ul>spring 2012
    15. 15. Assessing Patients with Respiratory Assistive Devices <ul><ul><li>Oxygen </li></ul></ul><ul><ul><li>Incentive Spirometer </li></ul></ul><ul><ul><li>Endotracheal tube (ETT) </li></ul></ul><ul><ul><li>Tracheotomy Tube </li></ul></ul><ul><ul><li>Mechanical Ventilation </li></ul></ul><ul><ul><li>Pulse Oximeter </li></ul></ul>spring 2012
    16. 16. Developmental Considerations <ul><li>Older Adults </li></ul><ul><li>Children </li></ul><ul><li>Infants </li></ul>spring 2012
    17. 17. Common Abnormalities <ul><li>Asthma </li></ul><ul><li>Atelectasis </li></ul><ul><li>Bronchitis </li></ul><ul><li>COPD </li></ul><ul><li>Croup </li></ul><ul><li>Emphysema </li></ul><ul><li>Pneumonia with Lobar consolidation </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Lung Cancer </li></ul><ul><li>Pneumothorax </li></ul>spring 2012
    18. 18. Nursing Diagnoses <ul><li>Ineffective airway clearance </li></ul><ul><li>Ineffective breathing pattern </li></ul><ul><li>Impaired gas exchange </li></ul><ul><li>Anxiety </li></ul>spring 2012
    19. 19. Cultural Considerations Health Promotion spring 2012
    20. 20. Risk for Pneumonia <ul><li>Smoking </li></ul><ul><li>Advance age </li></ul><ul><li>Underlying lung disease </li></ul><ul><li>Malnutrition </li></ul><ul><li>Intoxication </li></ul><ul><li>Bedridden </li></ul><ul><li>Postoperative status </li></ul><ul><li>Immunosuppressed status </li></ul><ul><li>Decreased cough reflex </li></ul><ul><li>Sedated or decreased consciousness </li></ul><ul><li>Oxygen therapy that is harboring bacteria </li></ul>spring 2012