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  • 1. Medical and Surgical Nursing Review The Respiratory System Nurse Licensure Examination Review
  • 2.  
  • 3. Outline Of Review Concepts:
    • Review of the relevant respiratory anatomy
    • Review of the relevant respiratory physiology
    • The respiratory assessment
    • Common laboratory examinations
  • 4. Outline Of Review Concepts:
    • Review of the common respiratory problems and the nursing management
    • Review of common respiratory diseases
      • Upper respiratory conditions
      • Lower respiratory conditions
  • 5. Respiratory Anatomy & Physiology
    • The respiratory system consists of two main parts - the upper and the lower tracts
  • 6. Respiratory Anatomy & Physiology
    • The UPPER respiratory system consists of:
    • 1. nose
    • 2. mouth
    • 3. pharynx
    • 4. larynx
  • 7. Respiratory Anatomy & Physiology
    • The LOWER respiratory system consists of:
    • 1. Trachea
    • 2. Bronchus
    • 3. Bronchioles
    • 4. Respiratory unit
  • 8. Upper Respiratory Tract
  • 9. The Nose
    • This is the first part of the upper respiratory system that contains nasal bones and cartilages
    • There are numerous hairs called vibrissae
    • There are numerous superficial blood vessels in the nasal mucosa
  • 10. The Nose
    • The functions of the nose are:
    • 1. To filter the air
    • 2. To humidify the air
    • 3. To aid in phonation
    • 4. Olfaction
  • 11. The Pharynx
    • The pharynx is a musculo - membranous tube that is composed of three parts
    • 1. Nasopharynx
    • 2. Oropharynx
    • 3. Laryngopharynx
  • 12. The Pharynx
    • The pharynx functions :
    • 1. As passageway for both air and foods (in the oropharynx)
    • 2. To protect the lower airway
  • 13. The Larynx
    • Also called the voice box
    • Made of cartilage and membranes and connects the pharynx to the trachea
  • 14. The Larynx
    • Functions of the larynx:
    • 1. Vocalization
    • 2. Keeps the patency of the upper airway
    • 3. Protects the lower airway
  • 15. The Paranasal sinuses
    • These are four paired bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium
    • Named after their location - frontal, ethmoidal, sphenoidal and maxillary
  • 16. The Paranasal sinuses
    • The function of the sinuses:
    • Resonating chambers in speech
  • 17. The Lower Respiratory System
    • The lower respiratory system consists of
    • 1. Trachea
    • 2. Main bronchus
    • 3. Bronchial tree
    • 4. Lungs- 3R/ 2L
    • The trachea  to the terminal bronchioles is called the conducting airway
    • The respiratory bronchioles  to the alveoli is called the respiratory acinus
  • 18. The Trachea
    • A cartilaginous tube measures 10-12 centimeters
    • Composed of about 20 C-shaped cartilages, incomplete posteriorly
  • 19. The Trachea
    • The function of the trachea is to conduct air towards the lungs
    • The mucosa is lined up with mucus and cilia to trap particles and carry them towards the upper airway
  • 20. The Bronchus
    • The right and left primary bronchi begin at the carina
    • The function is for air passage
  • 21. The Primary Bronchus
    • RIGHT BRONCHUS
    • Wider
    • Shorter
    • More Vertical
    • LEFT BRONCHUS
    • Narrower
    • Longer
    • More horizontal
  • 22. The Bronchioles
    • The primary bronchus further divides into secondary, then tertiary then into bronchioles
    • The terminal bronchiole is the last part of the conducting airway
  • 23. The Respiratory Acinus
    • The respiratory acinus is the chief respiratory unit
    • It consists of
    • 1. Respiratory bronchiole
    • 2. Alveolar duct
    • 3. alveolar sac
  • 24. The Respiratory Acinus
    • The respiratory acinus is the chief respiratory unit
    • The function of the respiratory acinus is gas exchange through the respiratory membrane
  • 25. The Respiratory Acinus
    • The respiratory membrane is composed of two epithelial cells
    • 1.The type 1 pneumocyte - most abundant, thin and flat. This is where gas exchange occurs
    • 2. The type 2 pneumocyte - secretes the lung surfactant
  • 26. The Respiratory Acinus
    • A type III pneomocyte is just the macrophage that ingests foreign material and acts as an important defense mechanism
  • 27. Accessory Structures
    • The PLEURA
    • Epithelial serous membrane lining the lung parenchyma
    • Composed of two parts- the visceral and parietal pleurae
    • The space in between is the pleural space containing a minute amount of fluid for lubrication
  • 28. Accessory Structures
    • The Thoracic cavity
    • The chest wall composed of the sternum and the rib cage
    • The cavity is separated by the diaphragm, the most important respiratory muscle
  • 29. Accessory Structures
    • The Mediastinum
    • The space between the lungs, which includes the heart and pericardium, the aorta and the vena cavae.
  • 30. GENERAL FUNCTIONS OF THE Respiratory System
    • Gas exchange through ventilation, external respiration and cellular respiration
    • Oxygen and carbon dioxide transport
  • 31. The Assessment
    • HISTORY
    • Reason for seeking care
    • Present illness
    • Previous illness
    • Family history
    • Social history
  • 32. The Assessment
    • PHYSICAL EXAMINATION
    • Skin- cyanosis, pallor
    • Nail clubbing
    • Cough and sputum production
    • Inspect - palpate - percuss - auscultate the thorax
  • 33. The Assessment
    • LABORATORY EXAMINATION
    • 1. ABG analysis
    • 2. Sputum analysis
    • 3. Direct visualization - bronchoscopy
    • 4. Indirect visualization - CXR, CT and MRI
    • 5. Pulmonary function test
  • 34. ABG Analysis
    • This test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample
  • 35. ABG Analysis
    • Pre-test: choose site carefully, perform the Allen’s test, secure equipments- syringe, needle, container with ice
    • Intra-test: Obtain a 5 mL specimen from the artery (brachial, femoral and radial)
    • Post-test: Apply firm pressure for 5 minutes, label specimen correctly, place in the container with ice
  • 36. ABG Analysis
    • ABG normal values
    • PaO2 80-100 mmHg
    • PaCO2 35-45 mmHg
    • pH 7.35- 7.45
    • HCO3 22- 26 mEq/L
    • O2 Sat 95-99%
  • 37. Sputum Analysis
    • This test analyzes the sample of sputum to diagnose respiratory diseases, identify organism, and identify abnormal cells
  • 38. Sputum Analysis
    • Pre-test: Encourage to increase fluid intake
    • Intra-test: rinse mouth with WATER only, instruct the patient to take 3 deep breaths and force a deep cough, steam nebulization, collect early morning sputum
    • Post-test: provide oral hygiene, label specimen correctly
  • 39. Pulse Oximetry
    • Non-invasive method of continuously monitoring the oxygen saturation of hemoglobin
    • A sensor or probe is attached to the earlobe, forehead, fingertip or the bridge of the nose
  • 40. Bronchoscopy
    • A direct inspection of the trachea and bronchi through a flexible fiber-optic or a rigid bronchoscope
    • Done to determine location of pathologic lesions, to remove foreign objects, to collect tissue specimen and remove secretions/aspirated materials
  • 41. Bronchoscopy
    • Pre-test: Consent, NPO x 6h, teaching
    • Intra-test: position supine or sitting upright in a chair, administer sedative, gag reflex will be abolished, remove dentures
    • Post-test: NPO until gag reflex returns, position SEMI-fowler’s with head turned to sides, hoarseness is temporary, CXR after the procedure, keep tracheostomy set and suction x 24 hours
  • 42. Thoracentesis
    • Pleural fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection
  • 43. Thoracentesis
    • Pre-test: Consent
    • Intra-test: position the patient sitting with arms on a table or side-lying fowler’s, instruct not to cough, breathe deeply or move
    • Post-test: position unaffected side to allow lung expansion of the affected side, CXR obtained, maintain pressure dressing and monitor respiratory status
  • 44. Pulmonary Function Tests
    • Volume and capacity tests aid diagnosis in patient with suspected pulmonary dysfunction
    • Evaluates ventilatory function
    • Determines whether obstructive or restrictive disease
    • Can be utilized as screening test
  • 45. Pulmonary Function Test
    • Lung Volumes
    • Tidal volume
    • Inspiratory reserve volume
    • Expiratory reeve volume
    • Residual volume
  • 46. Pulmonary Function Test
    • Lung capacities
    • Inspiratory capacity
    • Vital capacity
    • Functional residual capacity
    • Total lung capacity
  • 47. Pulmonary Function Test
    • Pre-test: Teaching, no smoking for 3 days, only light meal 4 hours before the test
    • Intra-test: position sitting, bronchodilator, nose-clip and mouthpiece, fatigue and dyspnea during the test
    • Post-test: adequate rest periods, loosen tight clothing
  • 48. Common Respiratory Problems and the common interventions
  • 49. Dyspnea
    • Breathing difficulty
    • Associated with many conditions- CHF, MG, GBS, Muscular dystrophy, obstruction, etc…
  • 50. Dyspnea
    • General nursing interventions:
    • 1. Fowler’s position to promote maximum lung expansion and promote comfort. An alternative position is the ORTHOPNEIC position
    • 2. O2 usually via nasal cannula
    • 3. Provide comfort and distractions
  • 51. Cough and sputum production
    • Cough is a protective reflex
    • Sputum production has many stimuli
    • Thick, yellow, green or rust-colored  bacterial pneumonia
    • Profuse, Pink, frothy  pulmonary edema
    • Scant, pink-tinged, mucoid  Lung tumor
  • 52. Cough and sputum production
    • General nursing Intervention
    • 1. Provide adequate hydration
    • 2. Administer aerosolized solutions
    • 3. advise smoking cessation
    • 4. oral hygiene
  • 53. Cyanosis
    • Bluish discoloration of the skin
    • A LATE indicator of hypoxia
    • Appears when the unoxygenated hemoglobin is more than 5 grams/dL
    • Central cyanosis  observe color on the undersurface of tongue and lips
    • Peripheral cyanosis  observe the nail beds, earlobes
  • 54. Cyanosis
    • Interventions:
      • Check for airway patency
      • Oxygen therapy
      • Positioning
      • Suctioning
      • Chest physiotherapy
      • Check for gas poisoning
      • Measures to increased hemoglobin
  • 55. Hemoptysis
    • Expectoration of blood from the respiratory tract
    • Common causes: Pulmo infection, Lung CA, Bronchiectasis, Pulmo emboli
    • Bleeding from stomach  acidic pH, coffee ground material
  • 56. Hemoptysis
    • Interventions:
    • Keep patent airway
    • Determine the cause
    • Suction and oxygen therapy
    • Administer Fibrin stabilizers like aminocaproic acid and tranexamic acid
  • 57. Epistaxis
    • Bleeding from the nose caused by rupture of tiny, distended vessels in the mucus membrane
    • Most common site- anterior septum
    • Causes
    • 1. trauma
    • 2. infection
    • 3. Hypertension
    • 4. blood dyscrasias , nasal tumor, cardio diseases
  • 58. Epistaxis
    • Nursing Interventions
    • 1. Position patient: Upright, leaning forward, tilted  prevents swallowing and aspiration
    • 2. Apply direct pressure. Pinch nose against the middle septum x 5-10 minutes
    • 3. If unrelieved, administer topical vasoconstrictors, silver nitrate, gel foams
    • 4. Assist in electrocautery and nasal packing for posterior bleeding
  • 59. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections
    • 1. Rhinitis- allergic, non-allergic and infectious
    • 2. Sinusitis- acute and chronic
    • 3. Pharyngitis- acute and chronic
  • 60. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections
    • 1. Rhinitis- Assessment findings
    • Rhinorrhea
    • Nasal congestion
    • Nasal itchiness
    • Sneezing
    • Headache
  • 61. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections
    • 2. sinusitis- Assessment findings
    • Facial pain
    • Tenderness over the paranasal sinuses
    • Purulent nasal discharges
    • Ear pain, headache, dental pain
    • Decreased sense of smell
  • 62. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections
    • 3. Pharyngitis- Assessment findings
    • Fiery-red pharyngeal membrane
    • White-purple flecked exudates
    • Enlarged and tender cervical lymph nodes
    • Fever malaise ,sore throat
    • Difficulty swallowing
    • Cough may be absent
  • 63. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections- Laboratory tests
    • 1. CBC
    • 2. Culture
  • 64. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections: Nursing Interventions
    • 1. Maintain Patent Airway
    • Increase fluid intake to loosen secretions
    • Utilize room vaporizers or steam inhalation
    • Administer medications to relieve nasal congestion
  • 65. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections: Nursing Interventions
    • 2. Promote comfort
    • Administer prescribed analgesics
    • Administer topical analgesics
    • Warm gargles for the relief of sore throat
    • Provide oral hygiene
  • 66. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections: Nursing Interventions
    • 3. Promote communication
    • Instruct patient to refrain from speaking as much as possible
    • Provide writing materials
  • 67. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infections: Nursing Interventions
    • 4. Administer prescribed antibiotics
    • Monitor for possible complications like meningitis, otitis media, abscess formation
    • 5. Assist in surgical intervention
  • 68. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • Infection and inflammation of the tonsils
    • Most common organism- Group A- beta hemolytic streptococcus (GABS)
  • 69. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • ASSESSMENT FINDINGS
    • Sore throat and mouth breathing
    • Fever
    • Difficulty swallowing
    • Enlarged, reddish tonsils
    • Foul-smelling breath
  • 70. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • Laboratory test
    • 1. CBC
    • 2. throat culture
  • 71. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • MEDICAL management
    • 1. Antibiotics- penicillin
    • 2. Tonsillectomy for chronic cases and abscess formation
  • 72. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • NURSING INTERVENTION for tonsillectomy
    • 1. Pre-operative care
    • Consent
    • Routine pre-op surgical care
  • 73. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • NURSING INTERVENTION for tonsillectomy
    • 2. POST-operative care
    • Position: Most comfortable is PRONE, with head turned to side
    • Maintain oral airway, until gag reflex returns
  • 74. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • NURSING INTERVENTION for tonsillectomy
    • 2. POST-operative care
    • Apply ICE collar to the neck to reduce edema
    • Advise patient to refrain from talking and coughing
    • Ice chips are given when there is no bleeding and gag reflex returns
  • 75. CONDITIONS OF THE UPPER AIRWAY
    • Upper airway infection: Tonsillitis
    • NURSING INTERVENTION for tonsillectomy
    • 2. POST-operative care
    • Notify physician if
    • a. Patient swallows frequently
    • b. vomiting of large amount of bright red or dark blood
    • c. PR increased, restless and Temp is increased
  • 76. Laryngeal Cancer
    • A malignant tumor of the larynx
    • More frequent in men
    • 50-70 years old
    • RISK FACTORS
    • 1. Smoking
    • 2. Alcohol
    • 3. Exposure to chemicals
    • 4. Straining of voice
    • 5. chronic laryngitis
    • 6. Deficiency of Riboflavin
    • 7. family history
  • 77. Laryngeal Cancer
    • Growth can be anywhere in the larynx
    • 1. Supraglottic- above the vocal cords
    • 2. glottic- vocal cord area
    • 3. infraglottic- below the vocal cords
    • Most tumors are found in the glottic area
  • 78. Laryngeal Cancer
    • ASSESSMENT FINDINGS
    • Hoarseness of more than TWO weeks duration
    • Cough and sore throat
    • Burning and pain in the throat especially after consuming HOT liquids and citrus foods
    • Neck lump
    • Dysphagia, dyspnea, foul breath, CLAD
  • 79. Laryngeal Cancer
    • LABORATORY FINDINGS
    • 1. Indirect laryngoscopy
    • 2. direct laryngoscopy
    • 3. Biopsy
    • 4. CT and MRI
    • Most commonly- squamos carcinoma
  • 80. Laryngeal Cancer
    • MEDICAL MANAGEMENT
    • Radiation therapy
    • Chemotherapy
    • Surgery
      • Partial laryngectomy
      • Supraglottic laryngectomy
      • Hemilaryngectomy
      • Total laryngectomy
  • 81. Laryngeal Cancer
    • NURSING MANAGEMENT: PRE-operative
    • 1. Provide the patient pre-operative teachings
    • Clarify misconceptions
    • Tell that the natural voice will be lost
    • Teach communication alternatives
    • Collaborate with other team members
  • 82. Laryngeal Cancer
    • NURSING MANAGEMENT
    • 2. reduce patient ANXIETY
    • Provide opportunities for patient and family members to ask questions
    • Referrals to previous patients with laryngeal cancers and cancer groups
  • 83. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 3. Maintain PATENT Airway
    • Position patient: Semi or High Fowler’s
    • Suction secretions
    • Encourage to deep breath, turn and cough
  • 84. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 4. Administer care of the laryngectomy tube
    • Suction as needed
    • Cleanse the stoma with saline
    • Administer humidified oxygen
    • Laryngectomy tube is usually removed within 3-6 weeks after surgery
  • 85. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 5. Promote alternative communication methods
    • Call bell or hand bell
    • Magic Slate
    • Hand signals
    • Collaborate with speech therapist
  • 86. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 6. Promote adequate Nutrition
    • NPO after operation
    • No foods or drinks per orem for 10 days
    • IVF, TPN are alternative nutrition routes
    • Start oral feedings with thick liquids, avoid sweet foods
  • 87. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 7. Promote positive body image and self-esteem
    • Encourage verbalization of feelings
    • Allow independence in self-care
  • 88. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 8. Monitor for COMPLICATIONS
    • Respiratory Distress
      • Suction
      • Coughing and deep breathing
      • Humidified oxygen
      • Alert the surgeon
  • 89. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 8. Monitor for Complications
    • Hemorrhage
      • Monitor for bleeding
      • Monitor vital signs
      • Apply direct pressure over the bleeding artery
      • Summon assistance and alert the surgeon
  • 90. Laryngeal Cancer
    • NURSING MANAGEMENT: POST-op
    • 8. Monitor for COMPLICATIONS
    • Wound infection and breakdown
    • Monitor for increased temperature, purulent drainage and increased redness/tenderness
    • Administer antibiotics
    • Clean and change dressing OD
  • 91. Laryngeal Cancer
    • NURSING MANAGEMENT: HOME CARE
    • Humidification system at home is needed
    • AVOID swimming
    • Cover the stoma with hands or plastic bib over the opening
    • Advise beauty salons to avoid hair sprays, powders and loose hair near the opening
    • Oral hygiene frequently
  • 92. Acute Respiratory Failure
    • Sudden and life-threatening deterioration of the gas-exchange function of the lungs
    • Occurs when the lungs no longer meet the body’s metabolic needs
  • 93. Acute Respiratory Failure
    • Defined clinically as:
    • 1. PaO2 of less than 50 mmHg
    • 2. PaCO2 of greater than 5o mmHg
    • 3. Arterial pH of less than 7.35
  • 94. Acute Respiratory Failure
    • CAUSES
    • CNS depression- head trauma, sedatives
    • CVS diseases- MI, CHF, pulmonary emboli
    • Airway irritants- smoke, fumes
    • Endocrine and metabolic disorders- myxedema, metabolic alkalosis
    • Thoracic abnormalities- chest trauma, pneumothorax
  • 95. Acute Respiratory Failure
    • PATHOPHYSIOLOGY
    • Decreased Respiratory Drive
    • Brain injury, sedatives, metabolic disorders  impair the normal response of the brain to normal respiratory stimulation
  • 96. Acute Respiratory Failure
    • PATHOPHYSIOLOGY
    • Dysfunction of the chest wall
    • Dystrophy, MS disorders, peripheral nerve disorders  disrupt the impulse transmission from the nerve to the diaphragm  abnormal ventilation
  • 97. Acute Respiratory Failure
    • PATHOPHYSIOLOGY
    • Dysfunction of the Lung Parenchyma
    • Pleural effusion, hemothorax, pneumothorax, obstruction  interfere ventilation  prevent lung expansion
  • 98. Acute Respiratory Failure
    • ASSESSMENT FINDINGS
    • Restlessness
    • dyspnea
    • Cyanosis
    • Altered respiration
    • Altered mentation
    • Tachycardia
    • Cardiac arrhythmias
    • Respiratory arrest
  • 99. Acute Respiratory Failure
    • DIAGNOSTIC FINDINGS
    • Pulmonary function test- pH below 7.35
    • CXR- pulmonary infiltrates
    • ECG- arrhythmias
  • 100. Acute Respiratory Failure
    • MEDICAL TREATMENT
    • Intubation
    • Mechanical ventilation
    • Antibiotics
    • Steroids
    • Bronchodilators
  • 101. Acute Respiratory Failure
    • NURSING INTERVENTIONS
    • 1. Maintain patent airway
    • 2. Administer O2 to maintain Pa02 at more than 50 mmHg
    • 3. Suction airways as required
    • 4. Monitor serum electrolyte levels
    • 5. Administer care of patient on mechanical ventilation
  • 102. COPD
    • These are group of disorders associated with recurrent or persistent obstruction of air passage and airflow, usually irreversible.
  • 103. COPD
    • The most common cause of COPD is cigarette smoking. Asthma, Chronic bronchitis, Emphysema and Bronchiectasis are the common disorders.
  • 104. COPD
    • The general pathophysiology:
    • In COPD there is airflow limitation that is both progressive and associated with abnormal inflammatory response of the lungs to stimuli, usually smoke, particles and dust
  • 105. ASTHMA
    • The acute episode of airway obstruction is characterized by airway hyperactivity to various stimuli that results in recurrent wheezing brought about by edema and bronchospasm
  • 106. Asthma Pathophysiology
    • Immunologic/allergic reaction results in histamine release, which produces three main airway responses
    • a. Edema of mucous membranes
    • b. Spasm of the smooth muscle of bronchi and bronchioles
    • c. Accumulation of tenacious secretions
  • 107. Asthma Assessment Findings
    • Assessment findings
    • 1. Family history of allergies
    • 2. Client history of eczema
  • 108. Asthma Assessment Findings
    • Assessment findings
    • 3. Pulmonary signs and symptoms- Respiratory distress: slow onset of shortness of breath, expiratory wheeze , prolonged expiratory phase, air trapping (barrel chest if chronic), use of accessory muscles, irritability (from hypoxia), diaphoresis, cough, anxiety, weak pulse, diaphoresis and change in sensorium if severe attack
  • 109. Asthma Assessment Findings
    • Assessment findings
    • 4. Use of accessory muscles of respiration, inspiratory retractions, prolonged I:E ratio
    • 5. Cardiovascular symptoms: tachycardia, ECG changes, hypertension, decreased cardiac contractility, pulsus paradoxus
    • 6. CNS manifestations: anxiety, restlessness, fear and disorientation
  • 110. Emphysema
    • There is progressive and irreversible alveolocapillary destruction with abnormal alveolar enlargement causing alveolar wall destruction. The result is INCREASED lung compliance, DECREASED oxygen diffusion and INCREASED airway resistance!
  • 111. Emphysema
    • These changes cause a state of carbon dioxide retention, hypoxia, and respiratory acidosis.
  • 112. Emphysema
    • Cigarette smoking
    • Heredity, Bronchial asthma
    • Aging process
    • Disequilibrium between
    • ELASTASE & ANTIELASTASE (alpha-1-antitrypsin)
    • Destruction of distal airways and alveoli
    • Overdistention of ALVEOLI
    • Hyper-inflated and pale lungs
    • Air traping, decreased gas exchange and Retention of CO2
    • Hypoxia Respiratory acidosis
  • 113. Emphysema Assessment
    • 1. Anorexia, fatigue, weight loss
    • 2. Feeling of breathlessness, cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea
  • 114. Emphysema Assessment
    • 3. Decreased respiratory excursion, resonance to hyper-resonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus
    • 4. Diagnostic tests: pCO2 elevated or normal; PO2 normal or slightly decreased
  • 115. Chronic bronchitis
    • Chronic inflammation of the bronchial air passageway characterized by the presence of cough and sputum production for at least 3 months in each 2 consecutive years.
    • Excessive production of mucus in the bronchi with accompanying persistent cough.
  • 116. Chronic Bronchitis pathophysiology
    • Characteristic changes include hypertrophy/ hyperplasia of the mucus-secreting glands in the bronchi, decreased ciliary activity, chronic inflammation, and narrowing of the small airways.
  • 117. Chronic Bronchitis Assessment
    • I. Productive (copious) cough, dyspnea on exertion, use of accessory muscles of respiration, scattered rales and rhonchi
    • 2. Feeling of epigastric fullness, cyanosis, distended neck veins, ankle edema
    • 3. Diagnostic tests: increased pCO2 decreased PO2
  • 118. Bronchiectasis
    • Permanent abnormal dilation of the bronchi with destruction of muscular and elastic structure of the bronchial wall
  • 119. Bronchiectasis
    • Caused by bacterial infection; recurrent lower respiratory tract infections; congenital defects (altered bronchial structures); lung tumors
  • 120. Bronchiectasis
    • 1. Chronic cough with production of mucopurulent sputum, hemoptysis, exertional dyspnea, wheezing
    • 2. Anorexia, fatigue, weight loss
    • 3. Diagnostic tests
      • a. Bronchoscopy reveals sources and sites of secretions
      • b. Possible elevation of WBC
  • 121. COPD Management
    • Independent and Collaborative Management
    • 1. Rest- To reduce oxygen demands of tissues
    • 2. Increase fluid intake -To liquefy mucus secretions
    • 3. Good oral care- To remove sputum and prevent infection
  • 122. COPD Management
    • Independent and Collaborative Management
    • 4. Diet:
    • High caloric diet provides source of energy
    • High protein diet helps maintain integrity of alveolar walls
    • Moderate fats
    • Low carbohydrate diet limits carbon dioxide production (natural end product). The client has difficulty exhaling carbon dioxide.
  • 123. COPD Management
    • Independent and Collaborative Management
    • 5. O2 therapy 1 to 3 lpm ( 2 lpm is safest )
    • Do not give high concentration of oxygen. The drive for breathing may be depressed.
  • 124. COPD Management
    • Independent and Collaborative Management
    • 6 . Avoid cigarette smoking, alcohol, and environmental pollutants-These inhibit mucociliary function.
    • 7. CPT –percussion, vibration, postural drainage
  • 125. COPD Management
    • Independent and Collaborative Management
    • 8. Bronchial hygiene measures
    • Steam inhalation
    • Aerosol inhalation
    • Medimist inhalation
  • 126. COPD Management
    • Pharmacotherapy
    • 1. Expectorants (guaiafenessin)/ mucolytic (mucomyst/mucosolvan)
    • 2. Antitussives
    • Dextrometorphan
    • Codeine
    • Observe for drowsiness
    • Avoid activities that involve mental alertness, e.g driving, operating electrical machines
    • Cause decrease peristalsis thereby constipation
  • 127. COPD Management
    • Pharmacotherapy
    • 3. Bronchodilators
    • Aminophylline (Theophylline)
    • Ventolin (Salbutamol)
    • Bricanyl (Terbutaline)
    • Alupent (Metaproterenol)
      • Observe for tachycardia
  • 128. COPD Management
    • Pharmacotherapy
    • 4. Antihistamine
    • Benadryl (Diphenhydramine)
    • Observe for drowsiness
    • 5. Steroids
    • Anti-inflammatory effect
    • 6. Antimicrobials
  • 129. Flail Chest
    • Complication of chest trauma occurring when 3 or more adjacent ribs are fractured at two or more sites, resulting in free-floating rib segments.
  • 130. Flail Chest
    • Chest wall is no longer able to provide the bony structure necessary to maintain adequate ventilation; consequently
    • the flail portion and underlying tissue move paradoxically (in opposition) to the rest of the chest cage and lungs.
  • 131. Flail Chest
    • The flail portion is sucked in on inspiration and bulges out on expiration.
    • Result is hypoxia, hypercarbia, and increased retained secretions.
    • Caused by trauma (sternal rib fracture with possible costochondral separations).
  • 132. Flail Chest
    • PATHOPHYSIOLOGY
    • During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a “paradoxical” manner
    • The chest is pulled INWARD during inspiration, reducing the amount of air that can be drawn into the lungs
    • The chest bulges OUTWARD during expiration because the intrathoracic pressure exceeds atmospheric pressure. The patient has impaired exhalation
  • 133. Flail Chest
    • This paradoxical action will lead to:
      • Increased dead space
      • Reduced alveolar ventilation
      • Decreased lung compliance
      • Hypoxemia and respiratory acidosis
      • Hypotension, inadequate tissue perfusion can also follow
  • 134. Flail Chest
    • Assessment findings
    • 1. Severe dyspnea; rapid, shallow, grunty breathing; paradoxical chest motion. The chest will move INWARDS on inhalation and OUTWARDS on exhalation.
    • 2. Cyanosis, possible neck vein distension, tachycardia, hypotension
    • 3. Diagnostic tests
      • a. PO2 decreased
      • b. pCO2 elevated
      • c. pH decreased
  • 135. Flail Chest
    • Nursing interventions
    • 1. Maintain an open airway: suction secretions, blood from nose, throat, mouth, and via endotracheal tube; note changes in amount, color, and characteristics.
    • 2. Monitor mechanical ventilation
    • 3. Encourage turning, coughing, and deep breathing.
    • 4. Monitor for signs of shock: HYPOTENSION, TACHYCARDIA
  • 136. Flail Chest
    • Medical management: SUPPORTIVE
    • 1. Internal stabilization with a volume-cycled ventilator
    • 2. Drug therapy (narcotics, sedatives)
  • 137. Pneumothorax
    • Partial or complete collapse of the lung due to an accumulation of air or fluid in the pleural space
  • 138. Pneumothorax
    • Types
    • a . Spontaneous pneumothorax : the most common type of closed pneumothorax; air accumulates within the pleural space without an obvious cause. Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.
  • 139. Pneumothorax
    • Types
    • b. Open pneumothorax : air enters the pleural space through an opening in the chest wall; usually caused by stabbing or gunshot wound.
  • 140. Pneumothorax
    • Types
    • c. Tension pneumothorax : air enters the pleural space with each inspiration but cannot escape; causes increased intrathoracic pressure and shifting of the mediastinal contents to the unaffected side (mediastinal shift ).
  • 141. Pneumothorax
    • Assessment findings
    • 1. Sudden sharp pain in the chest, dyspnea, diminished or absent breath sounds on affected side , tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift)
    • 2. Weak, rapid pulse; anxiety; diaphoresis
  • 142. Pneumothorax
    • Assessment findings
    • 3. Diagnostic tests
      • a. Chest x-ray reveals area and degree of pneumothorax
      • b. pCO2 elevated
      • c. pH decreased
  • 143. Pneumothorax
    • Nursing interventions
    • 1. Provide nursing care for the client with an endotracheal tube: suction secretions, vomitus, blood from nose, mouth, throat, or via endotracheal tube; monitor mechanical ventilation.
  • 144. Pneumothorax
    • Nursing interventions
    • 2. Restore/promote adequate respiratory function.
    • a. Assist with thoracentesis and provide appropriate nursing care.
    • b. Assist with insertion of a chest tube to water- seal drainage and provide appropriate nursing care.
    • c. Continuously evaluate respiratory patterns and report any changes.
  • 145. Pneumothorax
    • Nursing interventions
    • 3. Provide relief/control of pain.
    • a. Administer narcotics/analgesics/sedatives as ordered and monitor effects.
    • b. Position client in high-Fowler’s position.
  • 146. Atelectasis
    • Collapse of part or all of a lung due to bronchial obstruction
    • May be caused by
      • intrabronchial obstruction
      • tumors, bronchospasm
      • foreign bodies
      • extrabronchial compression (tumors, enlarged lymph nodes); or
      • endobronchial disease (bronchogenic carcinoma, inflammatory structures)
  • 147. Atelectasis
    • Assessment findings
    • 1. Signs and symptoms may be absent depending upon degree of collapse and rapidity with which bronchial obstruction occurs
    • 2. Dyspnea, decreased breath sounds on affected side, decreased respiratory excursion, dullness to flatness upon percussion over affected area
  • 148. Atelectasis
    • Assessment findings
    • 3. Cyanosis, tachycardia, tachypnea, elevated temperature, weakness, pain over affected area
  • 149. Atelectasis
    • Assessment findings
    • 4. Diagnostic tests
    • a. Bronchoscopy: may or may not reveal an obstruction
    • b. Chest x-ray shows diminished size of affected lung and lack of radiance over atelectatic area
    • c. pO2 decreased
  • 150. Pleural Effusion
    • Defined broadly as a collection of fluid in the pleural space
    • A symptom, not a disease; may be produced by numerous conditions
  • 151. Pleural Effusion
    • General Classification
      • Transudative effusion: accumulation of protein-poor, cell-poor fluid
      • Exudative effusion: accumulation of protein rich fluid
  • 152. Pleural Effusion
    • Assessment findings
    • 1. Dyspnea, dullness over affected area upon percussion, absent or decreased breath sounds over affected area, pleural pain, dry cough, pleural friction rub
    • 2. Pallor, fatigue, fever, and night sweats (with empyema)
  • 153. Pleural Effusion
    • Assessment findings
    • 3. Diagnostic tests
    • a. Chest x-ray positive if greater than 250 cc pleural fluid
    • b. Pleural biopsy may reveal bronchogenic carcinoma
    • c. Thoracentesis may contain blood if cause is cancer, pulmonary infarction, or tuberculosis; positive for specific organism in empyema.
  • 154. Pleural Effusion
    • Nursing interventions: In general:
    • 1. Assist with repeated thoracentesis.
    • 2. Administer narcotics/sedatives as ordered to decrease pain.
    • 3. Assist with instillation of medication into pleural space (reposition client every 15 minutes to distribute the drug within the pleurae).
    • 4. Place client in high-Fowler’s position to promote ventilation.
  • 155. Pleural Effusion
    • Medical management
    • 1. Identification and treatment of the Underlying cause
    • 2. Thoracentesis
    • 3. Drug therapy
      • a. Antibiotics: either systemic or inserted directly into pleural space
      • b. Fibrinolytic enzymes: trypsin, streptokinase-. streptodornase to decrease thickness of pus and dissolve fibrin clots
    • 4. Closed chest drainage
    • 5. Surgery: open drainage
  • 156. Pneumonia
    • An inflammation of the alveolar spaces of the lung, resulting in consolidation of lung tissue as the alveoli fill with exudates
    • The various types of pneumonias are classified according to the offending organism.
    • Pneumonia can also be classified as COMMUNITY Acquired Pneumonia (CAP) and Hospital acquired pneumonia (HAP)
  • 157. Pneumonia
    • PATHOPHYSIOLOGIC FINDINGS ARE:
    • HYPERTROPHY OF MUCOUS MEMBRANE
      • Increased sputum production
      • Wheezing
      • Dyspnea
      • Cough
      • Rales
      • Ronchi
  • 158. Pneumonia
    • PATHOPHYSIOLOGIC FINDINGS ARE:
    • INCREASED CAPILLARY PERMEABILITY
      • Increased Fluid Exudation
      • Consolidation-tissue that solidifies as a result of collapsed alveoli
      • Hypoxemia
  • 159. Pneumonia
    • PATHOPHYSIOLOGIC FINDINGS ARE:
    • INFLAMMATION OF THE PLEURA
    • Chest pain
    • Pleural effusion
    • Dullness
    • Decreased Breath sounds
    • Increased tactile fremitus
  • 160. Pneumonia
    • PATHOPHYSIOLOGIC FINDINGS ARE:
    • HYPOVENTILATION
    • Decreased Chest expansion
    • Respiratory acidosis
    • Depressed PROTECTIVE MECHANISM
    • Increased WBC (leukocytosis)
    • Increased RR and Fever
  • 161. Pneumonia
    • Assessment findings
    • Cough with greenish to rust-colored sputum production
    • rapid, shallow respirations with an expiratory grunt
    • nasal flaring; intercostal rib retraction; use of accessory muscles of respiration
    • rales or crackles (early) progressing to coarse (later).
    • Tactile fremitus is INCREASED!
  • 162. Pneumonia
    • Assessment findings
    • Fever, chills, chest pain, weakness, generalized malaise
    • Tachycardia, cyanosis, profuse perspiration, abdominal distension
    • Rapid shallow breathing
  • 163. Pneumonia
    • Diagnostic tests
    • a. Chest x-ray shows consolidation over affected areas
    • b. WBC increased
    • c. pO2 decreased
    • d. Sputum specimen- culture reveal particular causative organism
  • 164. Pneumonia
    • 1. Facilitate adequate ventilation.
    • a. Administer oxygen as needed and assess its effectiveness.
    • b. Place client in Fowler’s position .
    • c. Turn and reposition frequently clients who are immobilized/obtunded.
    • d. Administer analgesics as ordered to relieve pain associated with breathing
    • e. Auscultate breath sounds every 2—4 hours.
    • f. Monitor ABGs.
  • 165. Pneumonia
    • GENERAL Nursing interventions
    • 2. Facilitate removal of secretions
    • general hydration
    • deep breathing and coughing
    • Suctioning
    • Expectorants
    • aerosol treatments via nebulizer, humidification of inhaled air
    • chest physical therapy
  • 166. Pneumonia
    • GENERAL Nursing interventions
    • 3. Observe color, characteristics of sputum and report any changes; encourage client to perform good oral hygiene after expectoration.
  • 167. Pneumonia
    • GENERAL Nursing interventions
    • 4. Provide adequate rest and relief/control of pain.
    • a. Provide bed rest with limited physical activity.
    • b. Limit visits and minimize conversations.
    • c. Plan for uninterrupted rest periods.
    • d. Institute nursing care in blocks to ensure periods of rest.
    • e. Maintain pleasant and restful environment
  • 168. Pneumonia
    • GENERAL Nursing interventions
    • 5. Administer antibiotics as ordered. Monitor effects and possible toxicity.
    • 6. Prevent transmission (respiratory isolation may be required for clients with staphylococcal pneumonia).
    • 7. Control fever and chills: monitor temperature and administer
      • antipyretics as ordered, maintain increased fluid intake, provide frequent clothing and linen changes.
  • 169. Pneumonia
    • GENERAL Nursing interventions
    • 8. Provide client teaching and discharge planning concerning prevention of recurrence.
      • a. Medication regimen/antibiotic therapy
      • b. Need for adequate rest,
      • c. Need to continue deep breathing and coughing
  • 170. Pneumonia
    • GENERAL Nursing interventions
    • 8. Provide client teaching and discharge planning concerning prevention of recurrence.
      • d. Availability of vaccines
      • e. Techniques that prevent transmission (use of tissues when coughing, adequate disposal of secretions)
      • f. Avoidance of persons with known respiratory infections
      • g. Need to report signs and symptoms of respiratory infection
  • 171. Lung Cancer
    • Primary pulmonary tumors arise from the bronchial epithelium and are therefore referred to as bronchogenic carcinomas.
    • FACTORS: Possibly caused by inhaled carcinogens (primarily cigarette smoke but also asbestos, nickel, iron oxides, air silicone pollution; preexisting pulmonary disorders PTB, COPD)
  • 172. Lung Cancer
    • Assessment findings
    • Persistent cough (may be productive or blood tinged)
    • chest pain
    • dyspnea
    • unilateral wheezing, friction rub, possible unilateral paralysis of the diaphragm
    • Fatigue, anorexia, nausea, vomiting, pallor
  • 173. Lung Cancer
    • Diagnostic tests.
    • a. Chest x-ray may show presence of tumor or evidence of metastasis to surrounding structures
    • b. Sputum for cytology reveals malignant cells
    • c. Bronchoscopy: biopsy reveals malignancy
    • d. Thoracentesis: pleural fluid contains malignant cells
    • e. Biopsy of lymph nodes may reveal metastasis
  • 174. Lung Cancer
    • 1. Provide support and guidance to client as needed.
    • 2. Provide relief/control of pain.
    • 3. Administer medications as ordered and monitor effects/side effects.
    • 4. Control nausea: administer medications as ordered, provide good oral hygiene, provide small and more frequent feedings.
  • 175. Lung Cancer
    • 5. Provide nursing care for a client with a thoracotomy.
    • 6. Provide client teaching and discharge planning concerning
      • a. Disease process, diagnostic and therapeutic interventions
      • b. Side effects of radiation and chemotherapy
      • c. Realistic information about prognosis
  • 176. Lung Cancer
    • Medical management
    • 1. Radiation therapy
    • 2. Chemotherapy: usually includes cyclophosphamide, methotrexate, vincristine, doxorubicin, and procarbazine; concurrently in some combination
    • 3. Surgery: when entire tumor can be removed
  • 177. Lung Cancer
    • Quick Notes on Bronchogenic Cancer
    • Predisposing factors
    • Cigarette smoking
    • Asbestosis
    • Emphysema
    • Smoke from burnt wood
    • Types
    • Squamous cell Ca- with good prognosis
    • Adenocarcinoma- with good prognosis
    • Oat cell Ca- with good prognosis
    • Undifferentiated Ca- with poor prognosis
  • 178. Lung Cancer
    • Quick Notes on Bronchogenic Cancer
    • Nursing Interventions
    • Patent airway
    • O2 / Aerosol therapy
    • Deep breathing exercises
    • Relief of pain
    • Protection from infection
    • Adequate nutrition
    • Chest tube management
  • 179. Lung Cancer
    • Quick Notes on Bronchogenic Cancer
    • Surgery
    • Pneumonectomy= Removal of a lung (either left or right)
    • Lobectomy =Removal of a lobe.
    • Segmentectomy= Removal of a segment.
    • Wedge resection =Removal of the entire tumor regardless of the segment.
    • Decortication= Stripping off of fibrinous membrane enclosing the lung
    • Thoracoplasty= Removal of rib/s. Usually done after pneumonectomy, to reduce the size of the empty thorax thereby prevent mediastinal shift.
  • 180. Pulmonary Embolism
    • This refers to the obstruction of the pulmonary artery or one of its branches by a blood clot (thrombus) that originates somewhere in the venous system or in the right side of the heart.
    • Most commonly, pulmonary embolism is due to a clot or thrombus from the deep veins of the lower legs.
  • 181. Pulmonary Embolism
    • Causes
    • Fat embolism. Air embolism
    • Multiple trauma
    • PVD’s
    • Abdominal surgery
    • Immobility
    • Hypercoagulability
  • 182. Pulmonary Embolism
    • PATHOPHYSIOLOGY
    • The thrombus that travels from any part of the venous system obstructs either completely or partially . Then the lungs will have inadequate blood supply, with resultant increase in dead space in the lungs
    • Gas exchange will be impaired or absent in the involved area
  • 183. Pulmonary Embolism
    • PATHOPHYSIOLOGY
    • The regional pulmonary vasculature will constrict causing increased resistance, increased pulmonary arterial pressure and then increase workload of the right side of the heart.
  • 184. Pulmonary Embolism
    • PATHOPHYSIOLOGY
    • When the work of the right side of the heart exceeds its capacity, right ventricular failure will result, leading to a decrease in cardiac output followed by decreased systemic perfusion and eventually, SHOCK
  • 185. Pulmonary Embolism
    • Assessment
    • Restlessness (cardinal initial sign)
    • Dyspnea
    • Stabbing chest pain
    • Cyanosis
    • Tachycardia
    • Dilated pupils
    • Apprehension/ fear
    • Diaphoresis
    • Dysrhythmias
    • Hypoxia
  • 186. Pulmonary Embolism
    • Diagnostic Tests:
    • Ventilation-perfusion scan
    • Pulmonary arteriography
    • CXR
    • ECG
    • ABG
  • 187. Pulmonary Embolism
    • Nursing Interventions
    • Oxygen therapy STAT
    • Early ambulation postop
    • Monitor obese patient
    • Do not massage legs
    • Relieve pain- analgesics
    • HOB elevated
    • Heparin (2 weeks) then Coumadin (3-6 months)
  • 188. Pulmonary Embolism
    • Patient Teaching for prevention of Pulmonary Embolism
    • Active leg exercises to avoid venous stasis
    • Early ambulation
    • Use of elastic compression stockings
    • Avoidance of leg-crossing and sitting for prolonged periods
    • Drink fluids
  • 189. Surgical Aspect of Respiratory Care
    • Thoracic Surgery
    • a. Exploratory thoracotomy : anterior or posterolateral incision through the fourth, fifth, sixth, or seventh intercostal spaces to expose and examine the pleura and lung
  • 190. Surgical Aspect of Respiratory Care
    • Thoracic Surgery
    • b. Lobectomy : removal of one lobe of a lung; treatment for bronchiectasis, bronchogenic carcinoma, emphysematous blebs, lung abscesses
  • 191. Surgical Aspect of Respiratory Care
    • Thoracic Surgery
    • c. Pneumonectomy : removal of an entire lung; most commonly done as treatment for bronchogenic carcinoma
  • 192. Surgical Aspect of Respiratory Care
    • Thoracic Surgery
    • d. Segmental resection : removal of one or more segments of lung; most often done as treatment for bronchiectasis
  • 193. Surgical Aspect of Respiratory Care
    • Thoracic Surgery
    • e. Wedge resection : removal of lesions that occupy only part of a segment of lung tissue; for excision of small nodules or to obtain a biopsy
  • 194. Surgical Aspect of Respiratory Care
    • Nursing interventions: PREOPERATIVE
    • 1. Provide routine pre-op care.
    • 2. Perform a complete physical assessment of the lungs to obtain baseline data.
    • 3. Explain expected post-op measures: care of incision site, oxygen, suctioning, chest tubes (except if pneumonectomy performed)
  • 195. Surgical Aspect of Respiratory Care
    • Nursing interventions: PREOPERATIVE
    • 4. Teach client adequate splinting of incision with hands or pillow for turning, coughing, and deep breathing.
    • 5. Demonstrate ROM exercises for affected side.
    • 6. Provide chest physical therapy to help remove secretions.
  • 196. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • 1. Provide routine post-op care.
    • 2. Promote adequate ventilation.
    • a. Perform complete physical assessment of lungs and compare with pre-op findings.
    • b. Auscultate lung fields every 1—2 hours.
    • c. Encourage turning, coughing, and deep breathing every 1—2 hours after pain relief obtained.
  • 197. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • 2. Promote adequate ventilation.
    • d. Perform tracheobronchial suctioning if needed.
    • e. Assess for proper maintenance of chest drainage system (except after pneumonectomy).
    • f. Monitor ABGs and report significant changes.
    • g. Place client in semi-Fowler’s position
  • 198. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • If pneumonectomy is performed, follow surgeon’s orders about positioning, often on back or OPERATIVE SIDE
    • If Lobectomy , patient is usually positioned on the UNOPERATIVE SIDE
  • 199. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • 3. Provide pain relief.
    • a. Administer narcotics/analgesics prior to turning, coughing, and deep breathing.
    • b. Assist with splinting while turning, coughing, deep breathing.
  • 200. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • 4. Provide client teaching and discharge planning concerning
    • a. Need to continue with coughing/deep breathing for 6—8 weeks post-op and to continue ROM exercises
    • b. Importance of adequate rest with gradual increases in activity levels
  • 201. Surgical Aspect of Respiratory Care
    • Nursing interventions: POSTOPERATIVE
    • 4. Provide client teaching and discharge planning concerning
    • c. High-protein diet with inclusion of adequate fluids
    • d. Chest physical therapy
    • e. Good oral hygiene
    • f. Need to avoid persons with known upper respiratory infection
    • g. Adverse signs and symptoms
    • h. Avoidance of crowds and poorly ventilated areas.