Respritory part1

646 views

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
646
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide


  • These components are broken up into sections – Many texts discuss these sections separately because their function and diseases are specific and different
  • Ventilation – movement of air in and out (breathing)
    Respiration – gas exchange btw the atmosphere air in the alveoli and blood in capillaries
    Perfusion – process by which oxygenated blood passes through to body tissues.
  • Delivery – we need : blood, hemoglobin, a good heart, and arteries. Used for removal of wastes – blood, hemoglobin, heart and veins
    Control of acid base through ventilation – assessory muscles, diaphragm which increases depth of inspiration
    Chemo receptors in medulla and carotid bodies.
    Lungs major purpose is to breathe in O2 which combines with glucose to make energy, water and CO2
    The lungs also exhale CO2 (a waste product)
  • Diffusion or the transfer of a substance from an area of high_concentration to low concentration or pressure. This occurs at the alveolar-capillary level (external respiration) and the tissue level (internal respiration)
    Surfactant – detergent phospholipid reduces surface tension between moist membranes of alveoli. Preventing collapse. Pleural fluid acts as a lubricant and as an adhesive agent to hold lungs in expanded position (2-3 mL of fluid)
    Pressure in pleural space is negative pressure.

    Alveoli - What are their major purpose? Respiration – transfer of O2 to blood tissue and CO2 exhallation
  • The lungs do the above using the diaphragm which is the main muscle for breathing. It contracts and descends in the thorax making negative pressure. The ribs expand with the diaphragm.
    Lungs fill with air because of pressure gradients. The pressure inside the chest is < the pressure outside making it possible for air to fill the lungs until the pressure equalizes
  • Diaphragm relaxes, ribs relax, decrease in lung volume. This causes an increase in intra-pulmonic pressure which forces the air out.
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Measures volumes of inspired, expired, and retained volume of air
    Tidal volume – Volume of air inhaled and exhaled with each breath normal 0.5 L
    Total lung capacity – Max volume of air that lungs can obtain Normal 6.0 L
  • Drain fluid or air
    NPO
    Hold
  • Drain fluid or air
    NPO
    Hold
  • Drain fluid or air
    NPO
    Hold
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • Pneumothorax
    Procedure, amount fluid, where it was sent, how the patient is, pain medication
    Need consent – invasive and has risks
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
  • ABG’s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
    ABG’s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
























  • Flexible scope used to view the bronchus, remove foreign debris, take tissue specimens, laser therapy on lesions
  • Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
    Some throat swabs can be tested immediately for streptococcus.
  • Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
    Some throat swabs can be tested immediately for streptococcus.
  • Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
    Some throat swabs can be tested immediately for streptococcus.
  • Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
    Some throat swabs can be tested immediately for streptococcus.
  • 2 parts to the test

    Checking presence of a pulmonary embolism (perfusion needed to be tested for clot) Tested with a IV radioisotope
    Ventilation – breathing in a radioactive gas and then a picture taken.
    Diminished or absent uptake of radioactive substances suggest lack of perfusion and aeration (bad)
  • Exposure to tuberculosis bacilli. Intradermal injection, read 2 days later. Positive means – exposure to antigen, but does not mean that TB is present. Negative – no exposure, or have (HIV, depressed immunity) and cannot build a defence.







  • P. 517-525

  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Know this
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Blood
    Tissue
    Decrease
    Increase
  • Nasal polyps


    Deviated septum
  • Caused primarily by smoking, environmental pollutants, chemical exposure, with close association to ETOH use and smoking (promoters), radiation, beetlenut, chewing tobacco
    Metastasis to other structures due to lymphatic system except if tumor originates in the glottis
    Hoarseness > 2 weeks due to involvement of the muscles and cartilage surrounding the larynx causing fusion of the vocal cords
  • Persistent hoarseness/sore throat
    Painless neck mass, lymph nodes enlarged
    Change in voice quality – nasal, loss of voice
    Dyspnea
    Dysphagia
    Foul breath odor
    Mouth ulcer that does not heal

    Use penlight to examine oral cavity including under tongue and dentures
  • If it involves the false cord, early signs include aspiration on swallowing liquids, persistent unilateral sore throat, feeling of something “stuck” in the throat, dysphagia, weight loss, neck mass, hemoptysis and late signs include dyspnea, pain in the throat or referred to the ear
    If it is a polyp, there are usually no early signs but later the patient may have dyspnea, airway obstruction, dysphagia, weight loss & hemoptysis
  • The nasopharynx & posterior soft palate are viewed indirectly with a mirror to assess for drainage, bleeding or masses
    Assessment trhough direct visualization of the larynx looks at the base of the tongue, epiglottis and vocal cords.

    The patient is asked to vocalize so that the movement of the cords, color of the mucous membranes and the presence of lesions are noted


    CT and MRI scans, Bxs, PFTs, kidney & LFTs, CBC/Differential, electrolytes – (surgery)
    The tumor is staged and then decisions on treatments are discussed and started

  • Radiation for early stages: If the tumor is small and caught early and is on the true vocal cord, RT may be all that is needed. Voice is preserved.
    Problems with radiation – Dry mouth, (increase fluids, chew gum) Fatigue, stomatitis, reddened skin

    Surgery to remove affected areas/tumors
    Supraglottic tumors may be treated with RT, a partial laryngectomy
    Supraglottic tumors with metastasis will entail getting a total laryngectomy with or without unilateral or bilateral radical neck dissection. Need a trach.

    Advanced lesions may require a total laryngectomy: entire larynx and preepiglottic region is removed and a permanent tracheostomy is performed
    A radial neck dissection usually accompanies total laryngectomy to decrease the risk of lymphatic spread. Multiple structures may be removed- review on p. 552
    Modified could just involve one side of the neck


    Laser - can be used for small tumors to preserve as much of the glottis and voice
  • A Total laryngectomy involves removing the entire larynx and preepiglottic region and a permanent trach is placed
  • Edema and inflammation in the airway – need for trach
    Drainage tubes (JP, hemovac)
    Frequent suctioning of airway


    1. Parenteral fluids for first 24 to 48 hours
    2. Tube feedings via NG or G tube
    3. Assess for tolerance of feedings and regulate amount, time and formula if N/V/D or distention occurs.
    4. Patient and family teaching regarding tube feeding.
    5. When able to swallow give small amounts of water in high Fowler’s position and assess closely for choking
    Have suction ready to prevent aspiration
    Removal of epiglottis – need to learn how to protect their airway
    7. Communication concerns – written, communication board,

  • arterial flow and venous outflow(may use Doppler), color, temperature, and blanching at least every hour for 24-36 hours
    ROM to shoulder because of forward rotation and dropping of the shoulder and interruption of nerve innervation to the upper trapezius muscle
  • Respritory part1

    1. 1. Respiratory System NURS156 Kapi’olani Community College
    2. 2. CH 26 – Respiratory System Review terms, Physiology, assessment – objective and subjective Discussion Diagnostic studies: Radiologic studies biopsy, bronchoscopy thorencentesis, Cultures ABG pulmonary function tests Common assessment abnormalities
    3. 3. Respiratory Function UPPER LOWER Warm Conduction of air, filter, mucocilliary & humidify clearance, production of inspired air pulmonary surfactant
    4. 4. Principles of gas exchange
    5. 5. Major functions: z Delivery of oxygen to the blood z removal of carbon dioxide z Control of acid-base balance
    6. 6. Alveolus- site of gas exchange Diffusion
    7. 7. Ventilation The Process of Breathing z Inspiration: the active phase of ventilation z Negative pressure
    8. 8. Ventilation The Process of Breathing z Expiration: the passive phase of ventilation Increase in intrapulmonic pressure
    9. 9. total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L
    10. 10. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L
    11. 11. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function Tests (PFTs)
    12. 12. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function z Measures the client’s volume of air in the lung with Tests (PFTs) inhalation & exhalation
    13. 13. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function z Measures the client’s volume of air in the lung with Tests (PFTs) inhalation & exhalation z Nursing Responsibilities y No bronchodilators or smoking 6 hours before the test y Instruction on how to inhale & exhale, reason for the test y Inform client that may feel short of breath (SOB) y Provide comfort as needed
    14. 14. Diagnostic Test: Thoracentesis
    15. 15. Diagnostic Test: Thoracentesis z Purpose is to ___remove fluid or air from plural space________
    16. 16. Diagnostic Test: Thoracentesis z Purpose is to ___remove fluid or air from plural space________ z Nursing Responsibilities y Client must be _NPO__________________ y Client must not move and be able to _hold_ their breath y Monitor VS, for dyspnea, pain and difficulty breathing
    17. 17. Diagnostic Tests: Thoracentesis Cont’d
    18. 18. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______
    19. 19. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______
    20. 20. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______ z Define what this is.
    21. 21. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______ z Define what this is.
    22. 22. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z Define what this is.
    23. 23. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z You must obtain _concent_ before procedure z Define what this is.
    24. 24. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z You must obtain _concent_ before procedure z Define what this is. z Why?
    25. 25. Diagnostic Test: Arterial Blood Gas (ABG)
    26. 26. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
    27. 27. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT
    28. 28. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving
    29. 29. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?)
    30. 30. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?) z After the procedure, continuous pressure must be applied to the site, i.e., 5” for ___________________ arteries and 10 minutes for ____________
    31. 31. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?) z After the procedure, continuous pressure must be applied to the site, i.e., 5” for ___________________ arteries and 10 minutes for ____________ z Know normal values of the above
    32. 32. ABGs: Definitions & Normals Review p. 336-7
    33. 33. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood
    34. 34. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood
    35. 35. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood
    36. 36. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood
    37. 37. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood
    38. 38. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood
    39. 39. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood
    40. 40. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood
    41. 41. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
    42. 42. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
    43. 43. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
    44. 44. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
    45. 45. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L arterial blood z BE - Base excess
    46. 46. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L arterial blood z BE - Base excess z +2
    47. 47. Diagnostic Test: Oximetry
    48. 48. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously
    49. 49. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously
    50. 50. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign
    51. 51. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign
    52. 52. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe
    53. 53. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe
    54. 54. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70%
    55. 55. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70%
    56. 56. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70% z Movement, hypotension, hypothermia and vasocon- striction reduce arterial blood flow to the sensor
    57. 57. Diagnostic Test: Bronchoscopy z Reasons for this test: Post-procedure Dx & therapeutic x Monitor VS z Responsibilities x Assess for respiratory distress: Pre-procedure dyspnea, Δs in RR & x obtain informed consent breath sounds, use x NPO ≥ 6 hours of accessory x remove prostheses: muscles, hemoptysis dentures, contacts, etc. x topical anesthetic to x Withhold fluids till throat and IV started _gag reflex_ returns
    58. 58. Diagnostic Test: Sputum & Nose/Throat Cultures
    59. 59. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture SPUTUM NOT SPIT y Client brushes teeth first & coughs into the container y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
    60. 60. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT y Client brushes teeth first & coughs into the container y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
    61. 61. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT z Nose or throat is swabbed y Client brushes teeth with a sterile cotton swab first & coughs into and placed in a tube & the container sent to lab ASAP y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
    62. 62. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT z Nose or throat is swabbed y Client brushes teeth with a sterile cotton swab first & coughs into and placed in a tube & the container sent to lab ASAP y Best to obtain in early AM z For tubes that have fluid, y Assess for amount, the swab should not touch consistency, color, it unless it is a medium odor & contents
    63. 63. Radiological Diagnostic Tests checking for pulmonary embolism z Scans: Ventilation/ Normal X-ray Perfusion (V/Q) z V → Ventilation z Q → Perfusion z What are the implications of a V/Q scan?
    64. 64. Diagnostic Tests: Skin z PPD - What is this test used for? y Properly administered y Read when? y Implications of the test z Allergy Testing y Administered properly y Emergency equipment readily available Why?
    65. 65. Common Causes of Lung Problems
    66. 66. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke
    67. 67. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways
    68. 68. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections
    69. 69. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases
    70. 70. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases z Secondary to Other Diseases/Problems
    71. 71. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases z Secondary to Other Diseases/Problems z Cancer
    72. 72. Assessment 517-525 z Subjective Data z Objective Data z Chief complaint z Physical Assessment z Pain z Color z Pharmacology z Clubbing, Cap refill z Hx of Resp Problems z Chest symmetry z Breath sounds z Family Hx z Diagnostic Tests z Environment/ Occupation z Labs z Risk Factors z Other
    73. 73. Assessment z Normal Lung z Abnormal Lung Sounds Sounds z Bronchial z Crackles z Bronchovesicular z Wheezes z Vesicular z Rhonchi
    74. 74. absent can mean, bronchospasm, sever pneumonia, collapsed lung
    75. 75. Abnormal findings absent can mean, bronchospasm, sever pneumonia, collapsed lung
    76. 76. Abnormal findings • Bradypnea absent can mean, bronchospasm, sever pneumonia, collapsed lung
    77. 77. Abnormal findings • Bradypnea • Eupnea=normal absent can mean, bronchospasm, sever pneumonia, collapsed lung
    78. 78. Abnormal findings • Bradypnea • Eupnea=normal • Propnes absent can mean, bronchospasm, sever pneumonia, collapsed lung
    79. 79. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea absent can mean, bronchospasm, sever pneumonia, collapsed lung
    80. 80. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations absent can mean, bronchospasm, sever pneumonia, collapsed lung
    81. 81. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony absent can mean, bronchospasm, sever pneumonia, collapsed lung
    82. 82. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony absent can mean, bronchospasm, sever pneumonia, collapsed lung
    83. 83. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, bronchospasm, sever pneumonia, collapsed lung
    84. 84. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    85. 85. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    86. 86. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    87. 87. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    88. 88. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    89. 89. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    90. 90. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    91. 91. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Kussmaul • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    92. 92. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Kussmaul • Egophony • Absent sounds • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
    93. 93. TERMINOLOGY
    94. 94. TERMINOLOGY z Hypoxemia
    95. 95. TERMINOLOGY z Hypoxemia
    96. 96. TERMINOLOGY z Hypoxemia z Hypoxia
    97. 97. TERMINOLOGY z Hypoxemia z Hypoxia
    98. 98. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation
    99. 99. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation
    100. 100. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation z Hypoventilation
    101. 101. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z Hyperventilation z Hypoventilation
    102. 102. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z Hypoventilation
    103. 103. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z decrease in CO2 z Hypoventilation
    104. 104. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z decrease in CO2 z Hypoventilation z increase in CO2
    105. 105. Chapter 27 – Upper Respiratory Problems Deviated septum Nasal fracture Polyps Pharyngitis/ laryngitis Laryngeal Cancer epitaxis means nose
    106. 106. Laryngeal Cancer z Malignant tumor of larynx z Spread by local extension z Presents as malignant ulceration z Diagnosis made by laryngoscope and biopsy showing positive cytological study for cancer cells horseness over 2 weeks should be checked out
    107. 107. Laryngeal Cancer S/S z Early signs: hoarseness, voice changes, hemoptysis, z Late signs: dyspnea, obstruction, dysphagia, weight loss, pain, decreased tongue mobility
    108. 108. Laryngeal Cancer s/s Laryngeal Polyps z there are usually no early signs but later the patient may have dyspnea, airway obstruction, dysphagia, weight loss & hemoptysis Supraglottic – false vocal cord z early signs include aspiration on swallowing liquids, persistent unilateral sore throat, feeling of something “stuck” in the throat, dysphagia, weight loss, neck mass, hemoptysis and late signs include dyspnea, pain in the throat or referred to the ear
    109. 109. Diagnostic tests z Visual inspection w/laryngeal mirror or flexible nasopharyngoscope z CT, MRI, PET- shows local and regional spread z Multiple biopsy specimens to determine extent z Disease is staged based on tumor size, number and location of involved nodes, and extent of metastasis
    110. 110. Laryngeal Cancer treatment Radiation z Partial laryngectomy z Supraglottic tumors with metastasis Laser Surgery z Partial, total, and modified
    111. 111. Surgery z Total Laryngectomy y Used for large glottic tumors where there is suturing of the trachea to the neck y no risk of aspiration because the trachea and esophagus is separated permanently by the surgery
    112. 112. Postop Concerns z Postop Concerns concentration on the airway/ respiratory status, e.g., trach suctioning/care, lung sounds, complications y HIGH Risk for aspiration, infection, gas exchange y Ineffective airway clearance, y nutrition y Swallowing Techniques y Communication concerns
    113. 113. Surgery Radical Neck Dissection (en bloc) z Indicated when there is metastasis to the cervical nodes z lymphatic channels and nodes, sternocleido-mastoid muscle, spinal accessory nerve, jugular vein and submandibular tissue are removed z Complications: hemorrhage, fistulas, airway obstruction
    114. 114. Radical dissection Radical Neck Dissection y Preop- The usual with concentration on body image/self esteem concerns y Postop-↑ edema can interfere with airway usually due to inflammation or bleeding y Positioning in Semi-Fowler’s to ↓ edema y Frozen shoulder

    ×