Assessment of the Respiratory System

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• Assessment of the Respiratory System

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Patient History

• Collect history of patient data on family,
  personal, smoking, drug use, allergies, travel,
  place of residence, dietary history, occupational
  history, and socioeconomic level.
• Pack-years of smokingnumber of packs smoked per
  day multiplied by the number of years the patient
  has smoked.
• Assess current health problems such as cough,
  sputum production, chest pain, dyspnea, PND, and
  orthopnea.

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Diagnostic Studies

• Blood studies
• Sputum studies
• Radiographic examinations including standard
  chest x-rays, CT (computed tomography), MRI
• Ventilation and perfusion scanning
• Pulse oximetry

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Other Invasive Diagnostic Tests

• Endoscopic examinations
• Thoracentesisaspiration of pleural fluid from
  the pleural space
• Patient preparation for stinging sensation and
  feeling of pressure
• Correct position
• Motionless patient
• Follow-up assessment for complications

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Thoracentesis
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Lung Biopsy

• Performed to obtain tissue for histologic
  analysis, culture, or cytologic examination.
• Patient preparation.
• May be performed in patients room.

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Lung Biopsy (Contd)

• Follow-up care
• Assess vital signs and breath sounds.
• Assess for respiratory distress.
• Report reduced or absent breath sounds
  immediately.
• Monitor for hemoptysis.

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Artificial AirwaysEndotracheal Tube
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Preparing for Intubation

• Maintain a patent airway through positioning and
  the insertion of an oral or nasopharyngeal airway
  until the patient is intubated

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Verifying Tube Placement

• End-tidal carbon dioxide levels
• Chest x-ray
• Assess for breath sounds bilaterally, symmetrical
  chest movement.

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Endotracheal Tubes Nursing Care

• Assess tube placement, proper cuff inflation,
  breath sounds, chest wall movement
• Maintain tube patency
• Providing oral care and maintaining skin
  integrity
• Fostering comfort and communication

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Tracheostomy

• Tracheotomy is the surgical incision into the
  trachea for the purpose of establishing an
  airway.
• Tracheostomy is the stoma, or opening, that
  results from the procedure of a tracheotomy.
• Procedure may be temporary or permanent.

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Tracheostomy
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Interventions

• Preoperative care
• Operative procedures
• Postoperative careensure patent airway
• Possible complications assessment
• Tube obstruction
• Tube dislodgmentaccidental decannulation

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Tracheostomy Tubes

• Disposable or reusable
• Cuffed tube or tube without a cuff for airway
  maintenance
• Inner cannula disposable or reusable
• Fenestrated tube

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Tracheostomy Tubes
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Head and Neck Cancer

• History
• Phonation
• Psychosocial assessment
• Diagnostic studies

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Head and Neck Cancer Interventions

• Radiation therapy
• Brachytherapy
• Cordectomy
• Laryngectomy

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Total Laryngectomy Postoperative Care

• The first priorities after head and neck surgery
  are airway maintenance and ventilation
• Closed suction drains
• Wound breakdown
• Pain management
• Nutrition
• Voice rehabilitation

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Communication After Laryngectomy

• Voice prosthesis
• Esophageal speech
• Electrolarynx

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Ambulatory and Home Care

• Health teaching
• Stoma care
• Communication
• Smoking cessation
• Psychosocial preparation
• Health care resources

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Lung Cancer

• A leading cause of cancer deaths in the United
  States
• Poor long-term survival because of late-stage
  diagnosis
• Etiology and genetic risk

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Lung Cancer (Contd)

• Clinical Manifestations
• History
• Pulmonary manifestations
• Nonpulmonary manifestations
• Psychosocial assessment
• Diagnostic Studies

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Lung Cancer Nonsurgical Management

• Chemotherapy
• Targeted therapy
• Radiation therapy
• Photodynamic therapy

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Lung Cancer Surgical Management

• Lobectomy
• Pneumonectomy
• Segmental or wedge resection procedures

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Chest Trauma and Thoracic Injuries

• Most common thoracic emergencies
• Pneumothorax
• Tension pneumothorax
• Hemothorax
• Rib fracture
• Flail chest

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Pneumothorax

• Air in the pleural space

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Tension Pneumothorax

• Air in pleural space that does not escape
• Continued increase in amount of air shifts
  intrathoracic organs and increases intrathoracic
  pressure

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Hemothorax

• Accumulation of blood in the pleural space

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Rib Fracture

• Chest is usually not splinted by tape or other
  materials
• Main focusdecrease pain so that adequate
  ventilation is maintained

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Flail Chest

• Paradoxical chest movementsucking inward of
  the loose chest area during inspiration and
  bulging out of the same area during expiration

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Chest Tube Placement
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Chest Tube Drainage System
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Chest Tube Chambers

• Chamber 1 collects the fluid draining from the
  patient
• Chamber 2 water seal that prevents air from
  entering the patients pleural space
• Chamber 3 suction control of the system
• Nursing management of chest drainage

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Chest SurgeryCommon Locations for Thoracic
Incisions
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Nursing Care After Thoracotomy

• Pain management
• Respiratory management
• Pneumonectomy care
• VATS

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Pneumonia

• Acute inflammation of the lung parenchyma most
  frequently caused by a microorganism
• Inflammation triggered by infectious organisms
  and inhalation of irritants
• Community-acquired pneumonia (CAP)
• Hospital-acquired pneumonia (HAP)

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Pneumonia

• History
• Physical assessment
• Clinical manifestations

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Diagnostic Studies

• Gram stain, culture, and sensitivity testing of
  sputum
• Complete blood count
• Pulse oximetry or ABGs
• Imaging assessment

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Pneumonia Collaborative Care

• Appropriate antibiotic therapy
• Increased fluid intake
• Limited activity and rest
• Antipyretics
• Analgesics
• Oxygen therapy

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Pulmonary Embolism

• A collection of particulate mattersolids or
  airenters venous circulation and lodges in the
  pulmonary vessels
• In most people with pulmonary embolism, a blood
  clot from a deep vein thrombosis breaks loose
  from one of the veins in the legs or the pelvis
• Most common risk factors for PE include
  immobility and surgery within the last three
  months

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Pulmonary Embolus
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Pulmonary Embolus Etiology

• Prolonged immobilization
• Central venous catheters
• Surgery
• Obesity
• Advancing age
• History of thromboembolism
• Heavy cigarette smoking

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Pulmonary Embolus Health Promotion and Illness
Prevention

• Stop smoking
• Reduce weight
• Increase physical activity
• If traveling or sitting for long periods, get up
  frequently and drink plenty of fluids
• Refrain from massaging or compressing leg muscles
• Prevention of PE begins with prevention of DVT
• Sequential compression devices
• Early ambulation
• Prophylactic use of anticoagulant medications

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Pulmonary Embolus Clinical Manifestations

• Assess the patient for
• Respiratory manifestationsdyspnea, tachypnea,
  tachycardia, pleuritic chest pain, dry cough,
  hemoptysis
• Cardiac manifestationsdistended neck veins,
  syncope, cyanosis, hypotension, abnormal heart
  sounds, abnormal electrocardiogram findings
• Low-grade fever, petechiae, symptoms of flu

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Pulmonary Embolus Diagnostic Studies

• Imaging assessment
• Spiral (helical) CT scan
• VQ scan

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Pulmonary Embolus Nonsurgical Management

• Oxygen therapy
• Continual patient monitoring
• Drug therapy
• Fibrinolytics
• Anticoagulants

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Pulmonary Embolus Surgical Management

• Embolectomy
• Inferior vena cava filter

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Pulmonary Embolus Nursing Management

• Acute intervention
• Ambulatory and Home Care