Respiratory

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Respiratory

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Respiratory Medical Surgical Nursing P10B Lung CA left bronchus * Correct answer: A When a problem falls outside a nurse's experience or knowledge, it is ... – PowerPoint PPT presentation

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Title: Respiratory

1
Respiratory

Medical Surgical Nursing
P10B

2
Nasal Cavity

Location
Btw mouth cranium
Function
Remove foreign bodies
Warm
Moisten
Olfactory

3
Nasal Cavity

Contains
Cilia
Hair-like
Sensitive nerve endings
Sneeze

4
Para-Nasal Sinuses

Description
4 pairs
Facial area
Continuous w/ nasal cavity
Function
Speech

5
Pharynx (throat)

Passageway
Food liquids ?
Digestive tract
Air ?
Respiratory tract
Lowest portion
Opens into 2 space

6
Pharynx (throat)

Location
Behind nasal cavity
Contains
Adenoids
Tonsils
Lymph system
Eustachian tubes

7
Larynx (voice box)

Location
Btw pharynx trachea
Function
Vocalization
Facilitates cough/sneeze

8
Larynx (voice box)

Epiglottis
Gateway / trap door
Flap of elastic cartilage
Thyroid cartilage
Adams apple

9
Larynx (voice box)

Vocal cords
Speech

10
Trachea (Windpipe)

Location
Btw larynx bronchi
Description
4-5 inches long
Palpate
Above sternal notch
C-shaped rings of cartilage

11
Trachea (Windpipe)

Function
Conduct air

12
Bronchi

Location
Below trachea
Center of chest
Behind the heart
Branches into 2 tubes
Rt
h diameter
More vertical
Shorter in length

13
Question?

Mr. Henderson had a CVA 5 days ago and is having
some difficulty swallowing. There is some
question that he may have aspirated some food and
developed pneumonia. What side pneumonia would
you except him to have?
A. Right sided
B. Left sided

14
Lungs

Location
Thoracic cage
Description
Airtight
Mult. Air sacs
Rt
3 lobes
Lf
2 lobes

15
Lungs

Bronchi
Bronchial tree
Bronchioles
No cilia
No cartilage
Patency d/t
elastic recoil of the smooth muscles
alveolar pressure

16
Lungs

Alveolar ducts
Smallest tubes
Alveoli
Functional unit
Air sacs
Gas exchange
Surrounded by pulm. Capillaries

17
Lungs

Alveoli
Thin membrane
Tendency to collapse
Alveolar Pressure
surfactant

18
Pleural membrane

Location
Surrounds surface of lung interior wall of
thorax
Function
Protects
Neg. pressure
Allows movement (i friction)

19
Pleural membrane

Pleural space/cavity
Btw
Contains fluid

20
Mediastinum

Location
Space btw lungs
Contains
Heart
Large blood vessels
Esophagus
Trachea
Bronchi

21
Diaphragm

Location
Muscle btw lungs abd. Cavity
Aids in resp

22
Skeletal System

Ribs
12 pairs
Thoracic cage
Sternum

23
Pulmonary circulation

Main function of resp. system is to deviler O2 to
the blood remove CO2 from it.
Pulm. Art.
CO2 / deoxygenated
Pulm vein
O2 / oxygenated

24
Blood flow heart and lungs

Inf/sup vena cave
Rt atrium
Tricuspid
Rt ventricle
Pulm
Pulm art
Pulm cap
Pulm vein
Lt atrium
Bicuspid / mitral
Left venticle
Aorta

25
Small Group Questions

Name the structures that air flows past on its
way to the lungs
What is the function of the epiglottis?
What are the supporting structures of the
trachea?
Where in the circulation of blood do you find
deoxygenated blood?

How many lobes do the rt and lf lungs each have?
What is the purpose of the serous fluid btw the
pleural membranes?

27
Processes of respirations

Ventilation
Movement of air in out of the the
tracheobronchial tree. Delivering O2 to the
alveoli removing CO2
Perfusion
Blood flow in the capillary bed in the lungs
Diffusion
Movement of gases (O2 CO2) across the alveoli
membrane
Flows from area of greater concentration to
lesser concentration

28
Patient airway

Choking

29
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30
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31
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32
Changes assoc. with aging

Cartilage hardens
Muscles weaker
i cough reflex
i elasticity

33
Assessment Subjective

Nasal Congestion
Sore throat
Change in voice
Difficulty breathing
Orthopnea
Pain

Cough
Sputum
Affect on ADLs

34
History

Physical problems
Function problems
Life style
Smoking
Family Hx
Occupation hx
Allergens / environment
Anxiety

35
Inspection

Normal chest
2x as wide as deep
Anterior/posterior diameter
12

36
Inspection

Barrel chest
D/t over inflation of lungs
anterior-posterior diameter
22

37
Inspection

Kyphosis
AKA
Hunchback
Abnormal curvature of the thoracic spine

38
Inspection

Lordosis
AKA
Sway-back
Abnormal curvature of the lumbar spine

39
Inspection

Uniform expansion of the chest
Intercostal spaces

40
Inspection

Shoulder rise
Accessory muscles
Posture

41
Inspection

Trachea
midline
Color
LOC
Emotional state

42
Inspection Breathing patterns

Rate
Eupnea
Normal
12-20 / min
Tachypnea
h rate
Bradypnea
i rate

43
Inspection Breathing patterns

Depth
Hyperventilation
h depth rate
Hypoventilation
i depth rate

44
Auscultation

Purpose
Asses air flow through bronchial tree
Procedure
Diaphragm of stethoscope
Superior ? inferior
Compare rt to lf

45
Auscultation Results

Normal
Vesicular
Lung field
Soft and low
Bronchial
Trachea bronchi
Hollow

46
Auscultation Results

Adventitious
Crackles
air ? bronchi with secretions

Fine crackles
Air ? suddenly reinflated
Course Crackles
Moist

47
Auscultation Results

Wheezes
Sonorous wheezes
Deep low pitched
Snoring
Caused by air ? narrowed passages
D/t h secretions

Sibilant Wheezes
High pitched
Whistle-like
Caused by air ? narrowed passages
D/t constriction
Asthma

48
Early late signs of hypoxia

Anxiety
Bradycardia
Cyanosis
Depressed respirations
Diaphoresis
Disorientation
Dyspnea

Restlessness
Headache
Agitation
Poor judgment
Retraction
Tachycardia
Tachypnea

49
Dyspnea

Definition
SOB
SOB, flat affect, BS x 4

50
Dyspnea

Significance
Common with cardiac resp. disease

51
Dyspnea

Orthopnea
Sit up to breath
COPD
CHF

52
Dyspnea

Right ventricle
If chronic airway resistance ?
h pressure ?
Rt ventricle h work ?
Rt. Vent damage

53
Dyspnea

Nrs Management
Find cause
Give O2
HOB h
Communication
KISS

54
Cough

Definition
To expel air from the lungs suddenly
Irritation of mucous membrane

55
Cough

Significance
Infection
Irritants
Protective mechanism

56
Cough

Nrs management
Assess
Describe
Directed
Pain control
Splinting
Infection control
Suppressants / Anti-tussives

57
Sputum Production

Definition
Matter discharged from resp. track that contains
mucus and pus, blood, fibrin, or bacteria

58
Sputum Production

Significance
Purulent
Thick, yellow/green
Bacteria

59
Sputum Production

Nrs Management
Thick
Hydrate
h water
Nebulizer
Humidifier
TCDB
No smoking
Oral care
h Appetite

60
Do You Know?????

What breath sound would you expect to hear on a
patient with increased sputum production?
Vesicular
Crackles
Sonorous wheezes
Sibilant wheezes

61
Obtaining a sputum specimen

Explain
From lungs
Sterile cup
Deep breath x 3 ?
Cough deeply
Expectorate
Best time for specimen collection?
AM

62
Chest pain

Significance
Cardiac or pulmonary

63
Chest pain

Nrs Management
Assess
Analgesics OK, but
Position for pain
Affected side
Splint

64
Hemoptysis

Definition
Expectoration of blood from the respiratory tract

65
Hemoptysis

Significance
Pulm or cardiac

66
Hemoptysis

Hemoptysis
Definition?
Coughed up blood
From?
Pulm hemorrhage
Description
Pink, red, mixed with sputum

Hematemesis
Definition?
Vomited blood
From?
Stomach / GI
Description
Coffee ground

67
Hemoptysis

Nrs Management
Determine source
Serious

68
Cyanosis

Definition
Bluish coloring of skin

69
Dx tests
70
Pulse Oximeter

Purpose
Noninvasive O2 Sat
Normal
95-100
lt85 ?
Tissue is not receiving enough O2

71
Pulse oximeter

Not reliable in
Cardiac arrest
Dyes
Anemia

72
Radiographic exams

Chest x-ray
CT scan
Angiography
Bronchoscopy
Thoracoscopy
Thoracentesis

73
Chest x-ray

Description
2-d image
Purpose
Fluid
Tumor
Foreign bodies

74
Chest X-ray

Nrs management
Normal heart size clear lung field

75
CT Scan

Description
Computerize Tomography
With or without contrast medium
Purpose
Tissue
Tumor
Foreign bodies
Fluid

76
CT scan

Nrs management
Without contrast medium
No prep
With contrast medium
NPO 6 hrs
Assess for allergies

77
Angiography

Purpose
Visualize Pulm. Circulation
Description
Dye
Femoral vein ?
Heart ?
Pulm Arteries

78
Angiography

Nrs. Management
Pre-op
NPO
Check Allergies
Shellfish/iodine
Post-op
Lie flat 8 hrs
Sandbag
Check pedal pulses
Assess hemorrhaging
Push fluids

79
Bronchoscopy

Description
Direct inspection of larynx, trachea bronchi
via flexible tube (fiberoptic)
Purpose
Examine
Tissue sample

80
Bronchoscopy

Nrs Management
Pre-op
NPO 6-8 hrs
Sedation

Lung CA obstruction

81
Bronchoscopy

Nrs management
Post-op
Side-ling until gag back
NPO till gag back
Check gag
Check bleeding

Glottis stenosis

http//video.search.yahoo.com/search/video_yltA0
oGdXBnY59OcnwAuNNXNyoA?eiUTF-8pbronchoscopyfr2
tab-webfrmoz2-ytff-

83
Thoracentesis

Purpose
Remove fluid

84
Thoracentesis

Nrs Management
Position patient
Support
Post-op
Vital signs q 15

http//video.search.yahoo.com/search/video_yltA0
oGdWeLZJ9OvQsAZ1lXNyoA?eiUTF-8pthoracentesisfr
2tab-webfrmoz2-ytff-

86
Sputum studies

Check for
Pathogens
CS

87
White Blood Cell Count

Normal
5,000 10,000 cell/mm3
Elevated
Bacterial infection
Decreased
Viral infection

88
Hemoglobin

Normal
Female 12-16 g/dl
Male14-18 g/dl
Elevated
COPD
Dehydration
Decreased
Anemia
Hemorrhaging

89
Hematocrit

Normal
Female 37-47
Male 42-52
Elevated
Dehydration
Burns
COPD
Decreased
Anemia
Leukemia

90
PTT/PT Partial Thromboplastin Time

Prolonged
Anticoagulant

91
Quiz?

The main function of platelets is to
Provide oxygen to tissue
Fight viral infections
Fight bacterial infections
Form a blood clot
Platelets adhere to one another and play a very
important role in coagulation

92
Deep Breathing Coughing

Airway clearance
Nrs Dx
Ineffective airway clearance
h fluids
Splinting
Infection Control

93
Oxygen therapy

Goal
Provide adequate transport of O2
i work
i stress to myocardium
Need for O2 based on
ABGs
Clinical assessment

94
Oxygen therapy

Cautions on O2 tx
Med!
Except in an emergency situation is administered
only with Dr. order
Give O2 only to bring the pt back to baseline
COPD
WHY?

95
Oxygen therapy

COPD O2
Normal - CO2 indicator to breath
COPD O2 indicator to breath
d/t h CO2 levels burned medulla sensor for CO2
Medulla uses O2 to initiate breath

96
COPD O2

COPD h O2 ?
i Resp

97
Oxygen therapy

Precautions
Catalyst for combustion
No smoking sign
Tanks ? missiles
No friction toys

98
Smoker's home destroyed and neighbor injured

Kalispell MO, 15 July 2004 A home on Kalispell's
west side was extensively damaged Wednesday
morning by a fire that was probably started by a
cigarette and was accelerated by oxygen from
medical oxygen tanks. A neighbor, who was trying
to help was knocked down by the explosion of one
oxygen tank, which also caused temporary hearing
loss for a police officer.
A report by F. Ray Ruffatto of the fire
department's prevention division said that while
the exact cause of the fire is still
undetermined, "initial investigation indicates
the fire may be the result of carelessly
discarded smoking materials."

99
Smoker dies in house fire

Hudson MA 21 July 2004
The victim of yestrerday's fire died after
suffering second- and third-degree burns from a
devastating blaze at her Manning Street home
Sunday.
The resident was a smoker, according to State
Fire Marshal Stephen Coan, and he said the
combination of cigarettes and the multiple oxygen
tanks in the home either caused or exacerbated
the fire.
She was in critical condition after being pulled
from the house by a neighbor and then died
yesterday at UMass Memorial Medical Center,
University Campus in Worcester.
The combination of oxygen tanks and cigarettes
have sparked fires that since 1997 have killed 16
people in the state and caused severe burns or
smoke inhalation in 20, said Coan.

100

The nurse is to teach a client with Chronic
Obstructed Pulmonary Disease safety precautions
for using oxygen at home. The nurse knows that
the client understands the safety principles
discussed when he says the following
"Smoking is permitted when oxygen is in use."
"Fire extinguishers do not need to be stored."
"Acetone, oil, and alcohol are appropriate
substances to use with clients who are using
oxygen."
"Avoid materials that generate static
electricity."

101

A client is being discharged and will receive
oxygen therapy at home. The nurse is teaching
the client and family oxygen safety measures.
Which of the following statements by the cleint
indicated the need for further teaching?
I realize that I should check the oxygen level of
the portable tank on a consistent basis
I will keep my scented candles within 5 feet of
my oxygen tank
I will not sit in front of my wood-burning
fireplace with my oxygen on.
I will call the physician if I experience any
shortness of breath

102

A cyanotic client with an unknown diagnosis is
admitted to the emergency room. In relation to
oxygen, the first nursing action would be to
Wait until the clients lab work is done (ABGs)
Not administer oxygen unless ordered by the
physician
Administer oxygen at 2 Liters flow per minute
Administer oxygen at 10 Liters flow per minute
and check the clients nail beds frequently

103
Oxygen

Side effects
O2 ?
Hyper or hypo ventilation?
Hypoventilation ?

104
Method of O2 Administration

Nasal Cannula
Flow rate
1-6 L/min
FiO2
20-40
Nrs
Talk eat
Comfort
Nose breather

105
Method of O2 Administration

Simple Mask
Flow rate
6-10 L/min
FiO2
40-60
Nrs
Higher flow rate

106
Method of O2 Administration

Partial Re-breather Mask (Reservoir)
Flow rate
6-10 L/min
FiO2
60-100
Nrs
Uses reservoir to capture some exhaled gas for
rebreathing
Vents allow room air to mix with O2

107
Method of O2 Administration

Non-rebreather Mask
Flow rate
6-10 L/min
FiO2
70-100

108
Method of O2 Administration

Nrs
Side vents closed
Reservoir vent closed for I, open for E
Reservoir bag stores O2 for I but does not allow
E air in
Reservoir never collapse to lt½

109
Method of O2 Administration

Venturi
Flow rate
4-8
FiO2
20-40
Nrs.
Precise of O2
i.e. COPD

110

Which one of the following conditions could lead
to an inaccurate pulse oximetry reading if the
sensor is attached to the clients ear?
Artificial nails
Vasodilation
Hypothermia
Movement of the head

111

A nurse is having difficulty setting up
humidified oxygen at 40 per Venturi mask and
does not know how many liters of flow she should
use. Which of the following actions is most
appropriate to ensure safe oxygen administration?
Consult with a respiratory therapist.
Look at the package directions and try to figure
it out.
Ask the nursing assistant how to set it up.
Use a regular oxygen mask.

112
When oxygen therapy via nasal cannula is ordered
for a patient, the first action by the nurse is
to

Post an oxygen in use sign on the door to the
room
Adjust the oxygen level before applying the
cannula
Explain the rules of fire safety and oxygen use
Lubricate the nares with water-soluble jelly

113
The nurse is beginning the shift and is assessing
the oxygen exchange on a neonate. The nurse
reviews the chart for pulse oximetry reading for
the last 8 hours.
Time 7am 9am 11am 1am 3am
Reading 95 90 90 85 80
114

The pulse oximetry reading at 330 PM is 75.
What should the nurse do first?
Administer oxygen via mask
Swaddle the neonate in heated blankets
Reassess the oximetry reading in 30 minutes
Draw blood gases for oxygen and carbon dioxide
levels.

115
Nebulizer Mist Treatment

Deliver Moisture OR medication directly into the
lungs
Topical i systemic S/E
Indications
Must be able to deep breath

116
Nebulizer Mist Treatment

Meds
Bronchodilators
Albuteral (ventolin)
Corticosteroids
Mucolytic agents
Acetylcysteine
Antibiotics

117
Metered Dose Inhaler

Admin. Topical meds directly into the lungs
i systemic S/E
Meds
Corticosteroids
Bronchodilators
Mast cell inhibitors

118
Metered Dose Inhaler

Procedure
Canister into unit correctly
Shake gently
Hold inhaler breath out slowly (not into
inhaler)

119
Metered Dose Inhaler

Place mouthpiece into your mouth
Close lips around it
Tilt head back
Keep tongue out of way
Press top of the canister firmly breath in
through your mouth

120
Metered Dose Inhaler

Remove inhaler from mouth
Hold breath for several seconds
Breath out slowly

121
Metered Dose Inhaler

Rinse your mouth afterward to help reduce
unwanted side effects

122

The nurse is teaching a client with asthma about
the proper use of a metered-dose inhaler. Which
statement by the client indicates that the
teaching was effective?
"I'll flex my head forward and breathe out
forcefully before inhaling the drug."
"As I press down on the canister, I'll inhale
slowly over 10 seconds."
"I'll hold my breath for 5 seconds after inhaling
the drug to allow the drug to reach my lungs."
"I'll wait one minute between puffs."

123
Incentive Spirometry