Respiratory 100131162132-phpapp01 (1)

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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 100131162132-phpapp01 (1)

    1. 1. NURSING CARE OF THE CLIENT:RESPIRATORY SYSTEM
    2. 2. Nursing Dx: Respiratory Dysfunction Ineffective Airway  Activity Intolerance Clearance  Anxiety Impaired Gas Exchange  Altered Nutrition: Less than body Ineffective Breathing Pattern requirement Impaired Verbal  Risk for Infection Communication
    3. 3. Respiratory System  Its primary function is delivery of oxygen to the lungs and removal of carbon dioxide from the lungs.
    4. 4. 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.
    5. 5. Respiratory Assessment Health History (allergies, occupation, lifestyle, health habits) Inspection (clients color, level of consciousness, emotional state)(Rate, depth, quality, rhythm, effort relating to respiration) Palpation and Percussion Auscultation (Listening for Normal and Adventitious Breath Sounds)
    6. 6. Assessment ReviewVital Signs Respiratory rate & heart rate WNL Oxygen saturation of 95% or higher
    7. 7. Assessment ReviewPhysical 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
    8. 8. 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
    9. 9. 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
    10. 10. Assessment ReviewPsychological Assessment Oriented, not confused Energy level good, can engage in desired work, recreational & personal activities
    11. 11. Assessment ReviewLaboratory Assessment RBC Hemoglobin Hematocrit WBC WNL for age & gender
    12. 12. Assessment: InadequateOxygenation 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
    13. 13. Assessment: InadequateOxygenation 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
    14. 14. 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
    15. 15. Physical Assessment:Inadequate O2 Assess presence of thick or excessive secretions Assess ability to cough and clear airway
    16. 16. Intervention: InadequateOxygenation Apply O2 & assess response Elevate HOB 30 degrees Suction if needed Notify MD Priortize & pace activities to prevent fatique
    17. 17. Assessing Lung Sounds
    18. 18. 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)
    19. 19. 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)
    20. 20. Diagnosing RespiratoryDisordersLaboratory Tests Radiologic Studies Hemoglobin  Chest X-ray  Ventilation-perfusion Arterial blood gases scan Pulmonary Function  CAT scan Tests  Pulmonary Sputum Analysis angiography
    21. 21. Respiratory DisordersOther diagnostic tests Pulse oximetry Bronchoscopy Thoracentesis MRI
    22. 22. Assessment: Upper AirwayProblems Voice changes nasal quality if above palate “breathy” or “whispery” if larynx or trachea Snoring Mouth breathing
    23. 23. Assessment: Upper AirwayProblems 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
    24. 24. Physical Assessment: Upper AirwayProblems 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
    25. 25. Physical Assessment: Upper AirwayProblems Check WBC & ABG levels Assess cognition Assess hydration status
    26. 26. Intervention: Upper AirwayProblems Suction Apply o2 & assess response Keep HOB elevated 30 degrees Notify MD Ensure venous access
    27. 27. 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
    28. 28. Obstructive Sleep Apnea
    29. 29. Obstructive Sleep Apnea Loud storing during sleep Excessive daytime drowsiness Irritability Restless sleep
    30. 30. Obstructive Sleep Apnea Restore airflow  Weight reduction Prevent adverse  Alcohol abstinence effects of disorder  Improve nasal patency  Avoid prone sleeping position
    31. 31. Obstructive Sleep Apnea  Treatment of Choice: Continous positive airway pressure (CPAP)
    32. 32. Obstructive Sleep Apnea Tonsillectomy  Adenoidectomy
    33. 33. Obstructive Sleep Apnea Uvuloplatopharyngopla sty
    34. 34. Obstructive Sleep Apnea Disturbed Sleep Pattern Fatigue Ineffective Breathing Pattern Impaired Gas Exchange Risk for Injury Risk for Sexual Dysfunction
    35. 35. Tracheostomy Bypass upper airway obstruction 1. esophagus 2. trachea 3. tracheostomy tube
    36. 36. Tracheostomy Facilitate removal of secretions
    37. 37. Tracheostomy Manage long-term mechanical ventilation
    38. 38. Assessment: Infectious RespProblems 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
    39. 39. Physical Assessment: Infections Vital signs Auscultate all lung fields Monitor O2 sat Assess cognition Assess sputum Assess ability to cough & clear airway
    40. 40. 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
    41. 41. Interventions: Infectious RespProblems Administer O2 Upright position with arms resting on table or armrests Chest physiotherapy/pulmonary hygiene Pace activities to prevent fatigue
    42. 42. Interventions: Infectious RespProblems Administer IV, oral, or inhaled drugs Respiratory therapy treatments Reassess resp status after resp therapy Ensure fluid intake 3 liters/day
    43. 43. Sinusitis
    44. 44. Sinusitis  Pain & tenderness  Headache, fever, mal aise  Nasal congestion  Purulent nasal discharge  Bad breath
    45. 45. Sinusitis: Medication Therapy Antibiotics  Saline nose drops or sprays Oral or topical decongestants  Systemic mucolytic agents Antihistamines
    46. 46. Sinusitis: Interdisciplinary Care Drain obstructed sinuses Control infection Relieve pain Prevent complications
    47. 47. Sinusitis Endoscopic sinus surgery
    48. 48. Sinus Surgery: Caldwell Lucprocedure
    49. 49. Sinus Surgery: Antral irrigation
    50. 50. Sinusitis: Health Promotion Promote nasal drainage Encourage liberal fluid intake Judicious use of nasal decongestants Treat any obstructive process
    51. 51. 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
    52. 52. Pneumonia: Signs & SymptomsPrimary Atypical PNA Viral PNA Fever  Flu-like symptoms Headache  Headache  Fever Myalgias  Fatigue Arthralgias  Malaise Dry, hacking, non productive cough  Muscle aches
    53. 53. Pneumonia: Signs & SymptomsPneumocystis PNA  Dry, nonproductive Opportunistic cough infection Respiratory distress Abrupt onset  Intercostal Fever retractions Tachypnea  Cyanosis SOB
    54. 54. PneumoniaInterdisciplinary care Medications Prevention  Antibiotics Pneumococcal  Bronchodilators vaccine  Agents to liquefy Influenza vaccine mucus
    55. 55. PneumoniaTreatment Nursing Diagnosis Oxygen therapy  Ineffective airway Chest physiotherapy clearance  Ineffective breathing pattern  Activity intolerance
    56. 56. 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
    57. 57. 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.
    58. 58. Theresa: Bacterial PneumoniaSputume culture results most frequent strain of found in community- acquired pneumonia Streptococcus pneumoniae
    59. 59. Teresa: Clinical Manifestations Fever Elderly  Weakness stabbing or pleuritic  Fatigue chest pain  lethargy  Confusion tachypnea  poor appetite without classic s & s
    60. 60. Treatment: Bacterial Pneumonia Started on Penicillin G Response between 1 & 2 days
    61. 61. Complications of Pneumonia Atelectasis Impaired gas exchange Hypotension & shock Pleural effusion
    62. 62. Pneumonia: Impaired GasExchange Results in hypoxia Earliest sign and symptom of which is a change in the level of consciousness.
    63. 63. 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?
    64. 64. Nasal Cannula  Low flow delivery device  2 l/min = ~28%  Higher flow rates (>5 l/min) dry nasal membranes
    65. 65. Simple Face Mask  Flow rates 6-12 l/min  Delivers 35-50% O2  Pt comfort issues (Maybe used for Mr. Howe if SOB)
    66. 66. Non-Rebreathing Mask  Delivers accurate, high concentrations of oxygen  Achieves 60-90% O2 delivery
    67. 67. Oxygen Conserving Cannula  Built in oxygen reservoir  30-50% O2 delivery  Increased comfort
    68. 68. Nebulizers/Humidifiers 02 is drying to mucous membranes Nebulizers  Bubble-through humidifier  >4 l/min Humidifiers  Heated water
    69. 69. Tuberculosis Infection of the lung tissue Mycobacterium tuberculosis
    70. 70. TuberculosisSpread through dropletnuclei: Coughing Sneezing Speaking Singing
    71. 71. Tuberculosis: Risk Factors Overcrowded, poor living  Close contact to conditions infected person Poor nutritional status  Immune dysfunction; Previous infection HIV infection Inadequate treatment of primary infection leads  LTC facilities, to multi-drug resistant Prisons organisms  Elderly  Substance abuse
    72. 72. TuberculosisCaseation necrosis Inhaled bacteria multiply Tubercle is formed Infected tissue dies Cheeselike center forms
    73. 73. TuberculosisIf patient has adequate Inadequate immuneimmune response: response Scar tissue develops  TB can develop around tubercle rapidly Walls off bacilli Infected, does not develop TB
    74. 74. Reactivation TBSuppressed immune system due to Age Disease Use of immunosuppressive drugs
    75. 75. Tuberculosis: Signs & Symptoms Fatigue  Dry cough Weight loss  Later productive, Anorexia purelent/blood tingled pm fever  Night sweats
    76. 76. Tuberculosis: InterdisciplinaryCare Early detection Tuberculin test Accurate diagnosis  Intradermal PPD Effective disease (Mantoux) test treatment  Multiple-puncture Preventing spread to (tine) testing others
    77. 77. TB: Goals of MedicationTreatment Make the disease noncommunicable to others Reduce symptoms of the disease Affect a cure in the shortest possible time
    78. 78. Tuberculosis: Nursing Diagnosis Deficient Knowledge Ineffective Therapeutic Regimem Management Risk for Infection
    79. 79. Mr. Howe c/o dyspnea  Dx: R/O TB progressive wt loss  What additional for several months questions should you Productive cough ask about Mr. Howe’s cough? Night sweats “wringing wet”
    80. 80. 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
    81. 81. Mr. Howe Diagnostic test  Mantoux test expected for patient  Sputum for acid-fast bacillus  Chest X-ray  History and Physical Examination
    82. 82. 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
    83. 83. 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 +
    84. 84. Sputum Studies Sputum Samples  early morning  Expectoration tracheal  15 ml required suction  Obtain prior to  Bronchoscopy antibiotics Used to  Ask pt to rinse mouth  identify infecting before collecting organisms specimen  Confirm presence of malignant cells
    85. 85. Mr. Howe: BronchoscopyorderedPreparation Informed consent NPO after midnight Explain procedure, obtain baseline vs & ABG Atropine may be ordered to dry secretions
    86. 86. Bronchoscopy
    87. 87. Mr. Howe: Post BronchoscopyComplications Aspiration Infection Pneumothorax
    88. 88. Mr. Howe: Post BronchoscopyCare 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
    89. 89. Tuberculosis: Drug Therapy
    90. 90. Mr. Howe’s Medication Regime Chemotherapy are Rifampicin all Hepatotoxic  n/vEthambutol  Thrombocytopenia optic neuritis  turns all bodily skin rash secretions a red- orange color (tears, sweat, etc)
    91. 91. Mr. Howe’s Medication RegimeINH Streptomycin peripheral neuritis  8th cranial nerve (take Vitamin B 6 in damage conjunction to  routine hearing test prevent)  caution in renal hepatotoxicity disease GI upset
    92. 92. Mr. Howe’s Medication RegimePyrazinamid Heptoxicity hyperuricemia monitor uric acid & hepatic function
    93. 93. 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
    94. 94. 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
    95. 95. 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
    96. 96. 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
    97. 97. ThoracentesisPre-Procedure  Baseline vital signs Informed consent-  Make sure that a explained & signed CXR has been Inform about completed pressure sensations that will be experienced during the procedure
    98. 98. 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.
    99. 99. Post Thoracentesis Apply pressure to  Monitor for blood- puncture site tingled mucus Assess bleeding &  Assess for crepitus hypoxemia, Semi-fowlers or  Assess for puncture site up tachycardia  Assess breath sounds
    100. 100. Why is a chest x-ray ordered postprocedure?
    101. 101. Assessment: Lower RespProblems Resp shallow and rapid Decreased oxygen saturation Skin cyanosis or pallor Cyanosis or pallor of lips & mucus membranes Tachycardia Work hard to inhale & exhale
    102. 102. Assessment: Lower RespProblems 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
    103. 103. Physical Assessment: Lower RespProblems Take vital signs Monitor O2 sat Assess cognition Assess sputum Assess ability to cough & clear airway
    104. 104. Lab Values: Lower RespProblems Elevated RBC, HCT, HGB Elevated WBC ABGs ph <7.35 HCO3 > 24mm Hg PCO2 > 45 mm HG PaO2 < 80 mm Hg
    105. 105. Interventions: Lower RespProblems 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
    106. 106. Bronchitis Common in adults  Acute bronchitis follows a viral URIRisk factors  Chronic bronchitis is a component of Impaired immune COPD defenses Cigarette smoking
    107. 107. Bronchitis Viral, bacterial or inflammatory Irritants cause increased mucus production and mucosal irritation
    108. 108. Acute Bronchitis
    109. 109. Bronchitis: Signs & Symptoms Non-productive cough  Chest pain Later becomes  Moderate fever productive Paroxysmal cough  General malaise
    110. 110. BronchitisTreatment Medications Symptomatic  ASA or tylenol Rest  Broad spectrum Increased fluid intake antibioticNursing Intervention  Cough expectorant teaching
    111. 111. Asthma Chronic inflammatory disorder of the airways Brief (acute asthma fatal) Persistent irritation of the airways
    112. 112. Asthma: Risk Factors Allergies Family history occupational exposure Respiratory viruses Exercise in cold air Emotional stress
    113. 113. Asthma: Triggers Allergens Resp tract infection Exercise Inhaled irritants Secondhand smoke Medications
    114. 114. Asthma: Acute/early response Vasoconstriction Edema Mucus production
    115. 115. Asthma: Patho Inflammatory  Impaired mucus mediators released clearing Activation of  SOB inflammatory cells  trapping of air Bronchoconstriction impairs gas Airway edema exchange
    116. 116. Asthma: Signs & Symptoms Chest tightness  Fatigue, anxiety Cough, dyspnea, apprenhension sheezing Tachycardia, Respiratory failure  Breath sounds may tachypnea, prolonged expiration improve right before failure
    117. 117. Asthma: Treatment Control symptoms Long term control Prevent acute  Anti-infammatory attacks agents Restore airway  Long acting patency bronchodialators Restore alveolar  Leukotriene ventilation modifiers
    118. 118. Asthma: TreatmentQuick relief Administration Short acting methods adrenergic  Metered-dose inhaler stimulants (MDI) Anticholinergic drugs  Dry powder inhaler Methylxanthines (DPI)  Nebulizer
    119. 119. Chronic Obstructive PulmonaryDisease A collective term used to refer to chronic lung disorders Air flow into or out of the lungs is limited
    120. 120. John Emphysema for 25 years H/O smoking Diagnosis: Bronchitis
    121. 121. John: Cigarette Smoking Major causative factor in the development of respiratory disorders lung cancer cancer of the larynx Emphysema chronic bronchitis
    122. 122. During assessment you note the presence of a“barrel chest”. “air trapping” in the lungs
    123. 123. 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
    124. 124. Major symptoms to assess JohnforYou should be alert for the followingpresenting symptom of COPD? Increased dyspnea Sputum production
    125. 125. EmphysemaJohn is medicated with a bronchodilator to reduceairway obstruction. Assess for Dysrhythmias Central nervous system excitement Tachycardia
    126. 126. Purse Lip BreathingRecommended for John to: Decrease respiratory rate Increase alveolar ventilation Reduce functional residual capacity
    127. 127. Venturi Mask is prescribed for Johnbecause:  Moderate Oxygen Flow  Delivers precise, high-flow rates  24%-50%  Humidification available  Requires face mask
    128. 128. BronchiectasisA chronic dilation of thebronchi caused by: pulmonary TB infection chronic upper respiratory tract infections complications of other respiratory disorders
    129. 129.  Obstruction of a pulmonary artery by a bloodborne substance
    130. 130. Pulmonary Embolism:Common Cause: Deep vein thrombosis
    131. 131. Pulmonary Embolism
    132. 132. Other sources of PulmonaryEmboli Fat Emboli  From fractured long bones Air Emboli  From IVs Amniotic fluid Tumors
    133. 133. Mrs. Perkins Mrs Perkins is suspected of having a pulmonary embolus. What diagnostic test confirms this diagnosis?
    134. 134. 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?
    135. 135. Clinical Manifestations of PulmonaryEmbolus Sudden, unexplained dyspnea, tachypnea or tachycardia Cough Chest pain Hemoptysis Sudden changes in mental status (hypoxia)
    136. 136. Diagnosing Pulmonary Embolism Ventilation-Perfusion Scan  Nuclear imaging test  Determines percentage of each lung that is functioning normally Pulmonary Angiography
    137. 137. Pulmonary EmbolismMrs. Perkins pulse oximetry has decreasedto 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
    138. 138. Pulmonary EmbolismWith a diagnosis of PE, what intervention is crucial forMrs. Perkins? Institute and maintain bedrest Bedrest reduces metabolic demands and tissue needs for oxygen.
    139. 139. 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
    140. 140. Mrs. PerkinsMrs. Perkins is receiving a heparin drip.The bag hanging is 20,000 units/500 ml ofD5W infusing at 22 ml/hr. How many units ofheparin is Mrs Perkins receiving each hour?
    141. 141. Heparin Infusion 880 units20,000 divided by 500 = 40 unitsIf 22 ml are infused per hour, then 880 unitsof heparin are infused each hour40 x 22 = 880
    142. 142. Heparin TherapyWhat nursing interventions should you implement forMrs 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
    143. 143. Pulmonary EmbolismMrs Perkins PT is 12.9 and PTT is 98. What are yourimplications 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.
    144. 144. Pulmonary EmbolismThe doctor has ordered Coumadin for Mrs.Perkins. PT = 22 PTT = 39 INR = 2.8What action should you implement Give the Coumadin because the theurapeutic INR level is 2-3. What is the antidote for Coumadin?
    145. 145. 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.
    146. 146. 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)
    147. 147. IVC Filters  Greenfield  Bird’s Nest Filter Filter

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