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  • Primary function of respiratory system is transport of O2 and CO2. This requires the four processes collectively known as respiration: 1.      Pulmonary ventilation is the movement of air into and out of the lungs (breathing). This involves gas pressures and muscle contractions.2.      External respiration is the exchange of O2 (loading) and CO2 (unloading) between blood and alveoli (air sacs). 3.      Transport of respiratory gases between lungs and tissues. 4.      Internal respiration is gas exchange between blood and tissue cells.  Cellular respiration - the includes the metabolic pathways which utilize O2 and produce CO2, which will not be included in this unit.
  • What should you expect to Notice in a patient with adequate oxygenation and tissue perfusion related to respiratory function?
  • Loss of normal pharyngeal muscle tonePharynx collapse during inspirationTongue falls against posterior pharyngeal wallAsphyxia causes brief arousal from sleepRestores airway patency & airflowMay occur 100s of times a night
  • Inflammation of the mucus membranes of sinusesFollows a upper respiratory infectionRisks high in patients with impaired immunity
  • Obstruction of sinusImpaired drainage
  • Nursing diagnosisPainImbalanced Nutrition: Less than Body Requirements
  • External sphenoethmoidectomy

Respiratory Respiratory Presentation Transcript

  • NURSING CARE OF THE CLIENT: RESPIRATORY SYSTEM
  • Nursing Dx: Respiratory Dysfunction
    Ineffective Airway Clearance
    Impaired Gas Exchange
    Ineffective Breathing Pattern
    Impaired Verbal Communication
    Activity Intolerance
    Anxiety
    Altered Nutrition: Less than body requirement
    Risk for Infection
  • Respiratory System
    Its primary function is delivery of oxygen to the lungs and removal of carbon dioxide from the lungs.
  • Respiration
    Process of gas exchange
    Supply cells with oxygen for carrying on metabolism
    Remove carbon dioxide produced as a waste by-product.
    Two types of respiration: external and internal.
  • Respiratory Assessment
  • Assessment Review
    Vital Signs
    Respiratory rate & heart rate WNL
    Oxygen saturation of 95% or higher
  • Assessment Review
    Physical Assessment
    Speak a sentence of 12 words without stopping for breath
    Walk and talk without stopping for breath
    No cyanosis, pallor, or jaundice
    Oral mucus membrane & nail beds pink with rapid capillary refill
  • Assessment Review
    Fingertips and nails normal shape, no clubbing
    Anterior & posterior diameter of chest 2/3 smaller than lateral diameter
    Space between each rib larger than breath of patient’s finger
    Breathes in through nose & out through mouth & nose
  • Assessment Review
    Breathing quiet
    Air movement heard in all lobes of both lungs
    Sputum production minimal, clear or white
    Muscle development even with no muscle loss on arms & legs
    Weight proportionate to height; not underweight
  • Assessment Review
    Psychological Assessment
    Oriented, not confused
    Energy level good, can engage in desired work, recreational & personal activities
  • Assessment Review
    Laboratory Assessment
    RBC
    Hemoglobin
    Hematocrit
    WBC
    WNL for age & gender
  • Assessment: Inadequate Oxygenation
    Resp rapid & shallow
    Respirations noisy
    Cannot speak >4 or 5 words without pausing for breath
    Change in cognition, acute confusion
    Decreased oxygen saturation by pulse ox
  • Assessment: Inadequate Oxygenation
    Skin cyanosis or pallor (lighter-skinned pts)
    Cyanosis or pallor of lips or oral mucus membranes (pts of any skin color)
    Tachycardia
    Appears to strain to catch breath
    Fatigue
  • Physical Assessment: Inadequate O2
    Take vital signs
    Auscultate all lung fields
    Monitor O2 sat
    Check recent Hgb, Hct, ABGs
    Assess cognition
    Assess use of accessory muscles
  • Physical Assessment: Inadequate O2
    Assess presence of thick or excessive secretions
    Assess ability to cough and clear airway
  • Intervention: Inadequate Oxygenation
    Apply O2 & assess response
    Elevate HOB 30 degrees
    Suction if needed
    Notify MD
    Priortize & pace activities to prevent fatique
  • Assessing Lung Sounds
  • Adventitious Breath Sounds
    • Fine crackles (dry, high-pitched popping…COPD, CHF, pneumonia)
    • Coarse crackles (moist, low-pitched gurgling…pneumonia, edema, bronchitis)
    • Sonorous wheezes (low-pitched snoring…asthma, bronchitis, tumor)
  • Adventitious Breath Sounds
    • Sibilant wheezes (high-pitched, musical … asthma, bronchitis, emphysema, tumor)
    • Pleural friction rub (creaking, grating… pleurisy, tuberculosis, abscess, pneumonia)
    • Stridor (crowing…croup, foreign body obstruction, large airway tumor)
  • Diagnosing Respiratory Disorders
    Laboratory Tests
    Hemoglobin
    Arterial blood gases
    Pulmonary Function Tests
    Sputum Analysis
    Radiologic Studies
    Chest X-ray
    Ventilation-perfusion scan
    CAT scan
    Pulmonary angiography
  • Respiratory Disorders
    Other diagnostic tests
    Pulse oximetry
    Bronchoscopy
    Thoracentesis
    MRI
  • Assessment: Upper Airway Problems
    Voice changes
    nasal quality if above palate
    “breathy” or “whispery” if larynx or trachea
    Snoring
    Mouth breathing
  • Assessment: Upper Airway Problems
    Change in cognition or LOC or acute confusion
    Decreased O2 sat
    Skin cyanosis or pallor
    Cyanosis or pallor of lips or oral mucus membranes
    Tachycardia & dysrhythmia
  • Physical Assessment: Upper Airway Problems
    Take vital signs
    Monitor O2 sat
    Assess for presence of thick or excessive secretions
    Assess ability to cough and clear airway
    Assess nasal drainage & sputum for color & blood
  • Physical Assessment: Upper Airway Problems
    Check WBC & ABG levels
    Assess cognition
    Assess hydration status
  • Intervention: Upper Airway Problems
    Suction
    Apply o2 & assess response
    Keep HOB elevated 30 degrees
    Notify MD
    Ensure venous access
  • Obstructive Sleep Apnea
    Intermittent absence of airflow through mouth & nose during sleep
    Occlusion of the oropharyngeal airway
    Obstruction causes O2 sat, pO2, and pH to rise & pCO2 to rise
  • Obstructive Sleep Apnea
  • Obstructive Sleep Apnea
    Loud storing during sleep
    Excessive daytime drowsiness
    Irritability
    Restless sleep
  • Obstructive Sleep Apnea
    Restore airflow
    Prevent adverse effects of disorder
    Weight reduction
    Alcohol abstinence
    Improve nasal patency
    Avoid prone sleeping position
  • Obstructive Sleep Apnea
    Treatment of Choice:
    Continous positive
    airway pressure (CPAP)
  • Obstructive Sleep Apnea
    Tonsillectomy
    Adenoidectomy
  • Obstructive Sleep Apnea
    Uvuloplatopharyngoplasty
  • Obstructive Sleep Apnea
    Disturbed Sleep Pattern
    Fatigue
    Ineffective Breathing Pattern
    Impaired Gas Exchange
    Risk for Injury
    Risk for Sexual Dysfunction
  • Tracheostomy
    Bypass upper airway obstruction
    1. esophagus
    2. trachea
    3. tracheostomy
    tube
  • Tracheostomy
    Facilitate removal of secretions
  • Tracheostomy
    Manage long-term mechanical ventilation
  • Assessment: Infectious Resp Problems
    Resp shallow & rapid
    Decreased O2 sat
    Skin cyanosis or pallor
    Cyanosis or pallor of lips & oral mucus membranes
    Tachycardia
    Work hard to inhale & exhale
    Restless anxious or confused
  • Physical Assessment: Infections
    Vital signs
    Auscultate all lung fields
    Monitor O2 sat
    Assess cognition
    Assess sputum
    Assess ability to cough & clear airway
  • Lab Values: Infections
    Elevated WBC
    ABG:
    pH lower than 7.35
    HCO3 at or below 24 mmHg
    PaCO2 at or below 45 mmHg
    PaO2 below 90 mm Hg
  • Interventions: Infectious Resp Problems
    Administer O2
    Upright position with arms resting on table or armrests
    Chest physiotherapy/pulmonary hygiene
    Pace activities to prevent fatigue
  • Interventions: Infectious Resp Problems
    Administer IV, oral, or inhaled drugs
    Respiratory therapy treatments
    Reassess resp status after resp therapy
    Ensure fluid intake 3 liters/day
  • Sinusitis
  • Sinusitis
    Pain & tenderness
    Headache, fever, malaise
    Nasal congestion
    Purulent nasal discharge
    Bad breath
  • Sinusitis: Medication Therapy
    Antibiotics
    Oral or topical decongestants
    Antihistamines
    Saline nose drops or sprays
    Systemic mucolytic agents
  • Sinusitis: Interdisciplinary Care
    Drain obstructed sinuses
    Control infection
    Relieve pain
    Prevent complications
  • Sinusitis
    Endoscopic sinus surgery
  • Sinus Surgery: Caldwell Luc procedure
  • Sinus Surgery: Antral irrigation
  • Sinusitis: Health Promotion
    Promote nasal drainage
    Encourage liberal fluid intake
    Judicious use of nasal decongestants
    Treat any obstructive process
  • Pneumonia
    Inflammation of lung parenchyma
    Infectious: Bacteria, viruses, fungal protozoa
    Noninfectious: aspiration of gastric contents, inhalation of toxic or irritating gases
    Can be classified as community acquired, nosocomial, or opportunistic
  • Pneumonia: Signs & Symptoms
    Primary Atypical PNA
    Fever
    Headache
    Myalgias
    Arthralgias
    Dry, hacking, non productive cough
    Viral PNA
    Flu-like symptoms
    Headache
    Fever
    Fatigue
    Malaise
    Muscle aches
  • Pneumonia: Signs & Symptoms
    Pneumocystis PNA
    Opportunistic infection
    Abrupt onset
    Fever
    Tachypnea
    SOB
    Dry, nonproductive cough
    Respiratory distress
    Intercostal retractions
    Cyanosis
  • Pneumonia
    Interdisciplinary care
    Prevention
    Pneumococcal vaccine
    Influenza vaccine
    Medications
    Antibiotics
    Bronchodilators
    Agents to liquefy mucus
  • Pneumonia
    Treatment
    Oxygen therapy
    Chest physiotherapy
    Nursing Diagnosis
    Ineffective airway clearance
    Ineffective breathing pattern
    Activity intolerance
  • Theresa
    A 20 year old college student
    Lives in a small dormitory with 30 other students.
    Four weeks into the Spring semester, she was diagnosed with bacterial pneumonia
    Admitted to the hospital
  • Teresa: High Priority Intervention
    Specimens for culture are taken prior to beginning the antibiotic
    Administering prior to cultures may make it impossible to determine the actual agent causing the pneumonia.
  • Theresa: Bacterial Pneumonia
    Sputume culture results
    most frequent strain of found in community-acquired pneumonia
    Streptococcus pneumoniae
  • Teresa: Clinical Manifestations
    Fever
    stabbing or pleuritic chest pain
    tachypnea
    Elderly
    Weakness
    Fatigue
    lethargy
    Confusion
    poor appetite without classic s & s
  • Treatment: Bacterial Pneumonia
    Started on Penicillin G
    Response between 1 & 2 days
  • Complications of Pneumonia
    Atelectasis
    Hypotension & shock
    Pleural effusion
    Impaired gas exchange
  • Pneumonia: Impaired Gas Exchange
    Results in hypoxia
    Earliest sign and symptom of which is a change in the level of consciousness.
  • Interventions
    Oxygen by nasal cannula
    Plan for periods of rest during activities of daily living.
    Monitor pulse oximetry readings every 4 hours.
    What oxygen delivery system would be most effective for Theresa?
  • Nasal Cannula
    • Low flow delivery device
    • 2 l/min = ~28%
    • Higher flow rates (>5 l/min) dry nasal membranes
  • Simple Face Mask
    Flow rates 6-12 l/min
    Delivers 35-50% O2
    Pt comfort issues (Maybe used for Mr. Howe if SOB)
  • Non-Rebreathing Mask
    Delivers accurate, high concentrations of oxygen
    Achieves 60-90% O2 delivery
  • Oxygen Conserving Cannula
    Built in oxygen reservoir
    30-50% O2 delivery
    Increased comfort
  • Nebulizers/Humidifiers
    02 is drying to mucous membranes
    Nebulizers
    Bubble-through humidifier
    >4 l/min
    Humidifiers
    Heated water
  • Tuberculosis
    Infection of the lung tissue
    Mycobacterium tuberculosis
  • Tuberculosis
    Spread through droplet
    nuclei:
    Coughing
    Sneezing
    Speaking
    Singing
  • Tuberculosis: Risk Factors
    Overcrowded, poor living conditions
    Poor nutritional status
    Previous infection
    Inadequate treatment of primary infection leads to multi-drug resistant organisms
    Close contact to infected person
    Immune dysfunction; HIV infection
    LTC facilities, Prisons
    Elderly
    Substance abuse
  • Tuberculosis
    Caseation necrosis
    Inhaled bacteria multiply
    Tubercle is formed
    Infected tissue dies
    Cheeselike center forms
  • Tuberculosis
    If patient has adequate
    immune response:
    Scar tissue develops around tubercle
    Walls off bacilli
    Infected, does not develop TB
    Inadequate immune
    response
    TB can develop rapidly
  • Reactivation TB
    Suppressed immune system due to
    Age
    Disease
    Use of immunosuppressive drugs
  • Tuberculosis: Signs & Symptoms
    Fatigue
    Weight loss
    Anorexia
    pm fever
    Dry cough
    Later productive, purelent/blood tingled
    Night sweats
  • Tuberculosis: Interdisciplinary Care
    Early detection
    Accurate diagnosis
    Effective disease treatment
    Preventing spread to others
    Tuberculin test
    Intradermal PPD (Mantoux) test
    Multiple-puncture (tine) testing
  • TB: Goals of Medication Treatment
    Make the disease noncommunicable to others
    Reduce symptoms of the disease
    Affect a cure in the shortest possible time
  • Tuberculosis: Nursing Diagnosis
    Deficient Knowledge
    Ineffective Therapeutic Regimem Management
    Risk for Infection
  • Mr. Howe
    c/o dyspnea
    progressive wt loss for several months
    Productive cough
    Night sweats “wringing wet”
    Dx: R/O TB
    What additional questions should you ask about Mr. Howe’s cough?
  • Assessing Cough
    How it feels
    How bad it is
    What makes it better or worse
    When it started
    Amount, color, odor, and consistency of sputum
  • Mr. Howe
    Diagnostic test expected for patient
    Mantoux test
    Sputum for acid-fast bacillus
    Chest X-ray
    History and Physical Examination
  • Mantoux Test
    Positive result only indicate exposure or has received BCG immunization
    BCG immunization: Eastern Europe and countries where TB is endemic
    Is not diagnostic for active TB
  • Mantoux Test
    Give upper 1/3 surface of the forearm
    Needle is inserted with bevel up
    0.1 ml of purified derivative (PPD) inserted intradermally)
    Read 48-78 hrs
    Induration 1.5 mm or greater is + (HIV or immunosuppressed pts 5 mm or greater +
  • Sputum Studies
    Sputum Samples
    Expectoration tracheal suction
    Bronchoscopy
    Used to
    identify infecting organisms
    Confirm presence of malignant cells
    early morning
    15 ml required
    Obtain prior to antibiotics
    Ask pt to rinse mouth before collecting specimen
  • Mr. Howe: Bronchoscopy ordered
    Preparation
    Informed consent
    NPO after midnight
    Explain procedure, obtain baseline vs & ABG
    Atropine may be ordered to dry secretions
  • Bronchoscopy
  • Mr. Howe: Post Bronchoscopy
    Complications
    • Aspiration
    • Infection
    • Pneumothorax
  • Mr. Howe: Post Bronchoscopy Care
    NPO until gag reflex
    • Monitor vital signs
    • Assess for dyspnea, hemoptysis, & tachycardia
    • Notify MD if fever, difficulty breathing
    • Semi-Fowler’s position
    • Give H2O as first fluid
    • Inform pt of possible expectoration of blood tingled mucus
  • Tuberculosis: Drug Therapy
  • Mr. Howe’s Medication Regime
    Chemotherapy are all Hepatotoxic
    Ethambutol
    optic neuritis
    skin rash
    Rifampicin
    n/v
    Thrombocytopenia
    turns all bodily secretions a red-orange color (tears, sweat, etc)
  • Mr. Howe’s Medication Regime
    INH
    peripheral neuritis (take Vitamin B 6 in conjunction to prevent)
    hepatotoxicity
    GI upset
    Streptomycin
    8th cranial nerve damage
    routine hearing test
    caution in renal disease
  • Mr. Howe’s Medication Regime
    Pyrazinamid
    Heptoxicity
    hyperuricemia
    monitor uric acid & hepatic function
  • Mr. Howe’s Hospital Care
    Teach handwashing, cover nose and mouth when coughing, sneezing
    Droplet Isolation-negative pressure room
    Special particulate respirator mask
    Psychosocial support-reinforce need to take medication
  • Mr. Howe’s Teaching Plan
    Preventive measures to avoid catching viral infections
    Taken drugs in combination to avoid bacterial resistance
    Take meds at the same time of day on an empty stomach
    Follow med regimen 6-12 months as prescribed
  • Mr. Howe’s Teaching Plan
    Adequate nutritional status
    Annual check-up
    Annual Check-up: liver function tests
    Notify MD if signs of hepatitis, hepatoxicity, neurotoxicity, & visual changes occur
  • Thoracentesis
    Used to obtain pleural fluid for analysis
    Needle inserted between ribs second and third intercostal spaces
    Fluid withdrawn with syringe or tubing connected to sterile vacuum bottle
  • Thoracentesis
    Pre-Procedure
    Informed consent-explained & signed
    Inform about pressure sensations that will be experienced during the procedure
    Baseline vital signs
    Make sure that a CXR has been completed
  • Thoracentesis: Positioning
    Lying on the unaffected side with the bed elevated 30 – 40 degrees
    Sitting on the edge of the bed with her feet supported and her arms and head on a padded overbed table.
    Straddling a chair with her arms and head resting on the back of the chair.
  • Post Thoracentesis
    Apply pressure to puncture site
    Assess bleeding & crepitus
    Semi-fowlers or puncture site up
    Monitor for blood-tingled mucus
    Assess for hypoxemia,
    Assess for tachycardia
    Assess breath sounds
  • Why is a chest x-ray ordered post procedure?
  • Assessment: Lower Resp Problems
    Resp shallow and rapid
    Decreased oxygen saturation
    Skin cyanosis or pallor
    Cyanosis or pallor of lips & mucus membranes
    Tachycardia
    Work hard to inhale & exhale
  • Assessment: Lower Resp Problems
    Restless & anxious
    Thin compared to height
    Muscles of neck appear thick
    Arm & leg muscles appear thin
    Clubbed fingers
    Chest is barrel shaped
    Rib space more than a finger breath apart
  • Physical Assessment: Lower Resp Problems
    Take vital signs
    Monitor O2 sat
    Assess cognition
    Assess sputum
    Assess ability to cough & clear airway
  • Lab Values: Lower Resp Problems
    Elevated RBC, HCT, HGB
    Elevated WBC
    ABGs
    ph <7.35
    HCO3 > 24mm Hg
    PCO2 > 45 mm HG
    PaO2 < 80 mm Hg
  • Interventions: Lower Resp Problems
    Upright position
    Chest Physiotherapy
    O2 low to maintain resp of 16 breaths minute
    Pace activities
    Administer inhaled drugs
    Respiratory therapy
    Fluid intake at least 3L daily
  • Bronchitis
    Common in adults
    Risk factors
    Impaired immune defenses
    Cigarette smoking
    Acute bronchitis follows a viral URI
    Chronic bronchitis is a component of COPD
  • Bronchitis
    Viral, bacterial or inflammatory
    Irritants cause increased mucus production and mucosal irritation
  • Acute Bronchitis
  • Bronchitis: Signs & Symptoms
    Non-productive cough
    Later becomes productive
    Paroxysmal cough
    Chest pain
    Moderate fever
    General malaise
  • Bronchitis
    Treatment
    Symptomatic
    Rest
    Increased fluid intake
    Nursing Intervention
    teaching
    Medications
    ASA or tylenol
    Broad spectrum antibiotic
    Cough expectorant
  • Asthma
    Chronic inflammatory disorder of the airways
    Brief (acute asthma fatal)
    Persistent irritation of the airways
  • Asthma: Risk Factors
    Allergies
    Family history occupational exposure
    Respiratory viruses
    Exercise in cold air
    Emotional stress
  • Asthma: Triggers
    Allergens
    Resp tract infection
    Exercise
    Inhaled irritants
    Secondhand smoke
    Medications
  • Asthma: Acute/early response
    Vasoconstriction
    Edema
    Mucus production
  • Asthma: Patho
    Inflammatory mediators released
    Activation of inflammatory cells
    Bronchoconstriction
    Airway edema
    Impaired mucus clearing
    SOB
    trapping of air impairs gas exchange
  • Asthma: Signs & Symptoms
    Chest tightness
    Cough, dyspnea, sheezing
    Tachycardia, tachypnea, prolonged expiration
    Fatigue, anxiety apprenhension
    Respiratory failure
    Breath sounds may improve right before failure
  • Asthma: Treatment
    Control symptoms
    Prevent acute attacks
    Restore airway patency
    Restore alveolar ventilation
    Long term control
    Anti-infammatory agents
    Long acting bronchodialators
    Leukotriene modifiers
  • Asthma: Treatment
    Quick relief
    Short acting adrenergic stimulants
    Anticholinergic drugs
    Methylxanthines
    Administration methods
    Metered-dose inhaler (MDI)
    Dry powder inhaler (DPI)
    Nebulizer
  • Chronic Obstructive Pulmonary Disease
    A collective term used to refer to chronic lung disorders
    Air flow into or out of the lungs is limited
  • John
    Emphysema for 25 years
    H/O smoking
    Diagnosis: Bronchitis
  • John: Cigarette Smoking
    Major causative factor in the development of respiratory disorders
    lung cancer
    cancer of the larynx
    Emphysema
    chronic bronchitis
  • During assessment you note the presence of a “barrel chest”.
    “air trapping” in the lungs
  • Barrel Chest
    Slow progressive obstruction of airways
    Airways narrow
    Resistance to airflow increase
    Expiration slow and difficult
    Result: mismatch between alveolar ventilation and perfusion, leading to impaired gas exchange
  • Major symptoms to assess John for
    You should be alert for the following
    presenting symptom of COPD?
    Increased dyspnea
    Sputum production
  • Emphysema
    John is medicated with a bronchodilator to reduce
    airway obstruction. Assess for
    Dysrhythmias
    Central nervous system excitement
    Tachycardia
  • Purse Lip Breathing
    Recommended for John to:
    Decrease respiratory rate
    Increase alveolar ventilation
    Reduce functional residual capacity
  • Venturi Mask is prescribed for John because:
    Moderate Oxygen Flow
    Delivers precise, high-flow rates
    24%-50%
    Humidification available
    Requires face mask
  • Bronchiectasis
    A chronic dilation of the
    bronchi caused by:
    pulmonary TB infection
    chronic upper respiratory tract infections
    complications of other respiratory disorders
  • Obstruction of a pulmonary artery by a bloodborne substance
  • Pulmonary Embolism:
    Common Cause:
    Deep vein thrombosis
  • Pulmonary Embolism
  • Other sources of Pulmonary Emboli
    Fat Emboli
    From fractured long bones
    Air Emboli
    From IVs
    Amniotic fluid
    Tumors
  • Mrs. Perkins
    Mrs Perkins is suspected of having a pulmonary embolus.
    What diagnostic test confirms this diagnosis?
  • Pulmonary Embolism
    The plasma D-dimer test is highly specific for the presence of a thrombus.
    An elevated d-dimer indicates a thrombus formation and lysis.
    What assessment data would support that Mrs. Perkins has experienced a pulmonary embolus?
  • Clinical Manifestations of Pulmonary Embolus
    Sudden, unexplained dyspnea, tachypnea or tachycardia
    Cough
    Chest pain
    Hemoptysis
    Sudden changes in mental status (hypoxia)
  • Diagnosing Pulmonary Embolism
    Ventilation-Perfusion Scan
    Nuclear imaging test
    Determines percentage of each lung that is functioning normally
    Pulmonary Angiography
  • Pulmonary Embolism
    Mrs. Perkins pulse oximetry has decreased
    to 90%. What does this indicate?
    The normal pulse oximeter reading is 93% - 100%.
    A reading of 90% indicates Mrs Perkins has an
    arterial oxygen level of about 60
  • Pulmonary Embolism
    With a diagnosis of PE, what intervention is crucial for
    Mrs. Perkins?
    Institute and maintain bedrest
    Bedrest reduces metabolic demands and tissue needs for oxygen.
  • Management: Pulmonary Emboli
    Anticoagulation therapy
    Heparin
    Coumadin for ~6 months
    Thrombolytic therapy
    Use very cautiously only for acute, massive PE
    Urokinase, Streptokinase & tPA
    Inferior Vena Cava filter
  • Mrs. Perkins
    Mrs. Perkins is receiving a heparin drip.
    The bag hanging is 20,000 units/500 ml of
    D5W infusing at 22 ml/hr. How many units of
    heparin is Mrs Perkins receiving each hour?
  • Heparin Infusion
    880 units
    20,000 divided by 500 = 40 units
    If 22 ml are infused per hour, then 880 units
    of heparin are infused each hour
    40 x 22 = 880
  • Heparin Therapy
    What nursing interventions should you implement for
    Mrs Perkins receiving Heparin?
    Keep protamine sulfate readily available
    Assess for overt & covert signs of bleeding
    Avoid invasive procedures and injections
    Administer stool softeners as ordered
  • Pulmonary Embolism
    Mrs Perkins PT is 12.9 and PTT is 98. What are your
    implications for administering heparin to Mrs Perkins?
    A normal PTT is 39 seconds
    58-78 is 1.5 to 2 times the normal value and is within the normal therapeutic range
    A PTT of 98 means Mrs Perkins is not clotting; medication should be held.
  • Pulmonary Embolism
    The doctor has ordered Coumadin for Mrs.
    Perkins. PT = 22 PTT = 39 INR = 2.8
    What action should you implement
    Give the Coumadin because the theurapeutic INR level is 2-3.
    What is the antidote for Coumadin?
  • Pulmonary Embolism: Teaching
    Use a soft bristle toothbrush to reduce the risk of bleeding
    Avoid aspirin
    Aspirin is an antiplatlet which may increase bleeding tendencies.
  • Pulmonary Embolism: Teaching
    Wear a medic alert band
    Increase fluid intake to 2-3L day (increases fluid volume which prevents DVT the common cause of PE)
  • IVC Filters
    Greenfield Filter
    Bird’s Nest Filter