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Respiratory 4

  1. Lung cancer
      1. Definition/etiology
        1. types of lung cancer
          1. squamous cell carcinoma
          2. small-cell (oat cell) carcinoma
          3. adenocarcinoma
          4. large cell carcinoma
        2. prognosis is generally poor
        3. largely preventable if smokers stop and nonsmokers avoid second hand smoke
      2. Findings
        1. hoarse voice
        2. changes in breathing
        3. persistent cough or change in cough
        4. blood-streaked or bloody sputum
        5. chest pain or tightness in chest wall
        6. recurring pneumonia, pleural effusion
        7. weight loss
      3. Diagnostics
        1. medical imaging examinations
        2. cytological sputum analysis
        3. bronchoscopy
        4. biopsy
      1. Management
        1. nonsurgical
          1. chemotherapy
          2. radiation therapy
          3. laser therapy to de-bulk tumor
          4. thoracentesisand pleurodesis
        2. surgical
          1. thoracotomy
            • wedge resection - part of a lobe
            • segmental resection- part of a lobe
            • lobectomy - one or more lobes
            • pneumonectomy - entire right or left lung
      2. Nursing interventions
        1. post-operative care
          1. chest drainage
          2. routine post operative care
            • monitor respiratory status frequently
            • teach effective deep breathing and cough techniques
            • refer to physical therapy for exercises for shoulder on affected side
            • relieve pain
          3. optimize oxygenation
          4. provide opportunities for the client to talk about cancer; as needed, refer to support groups
          5. teach information as based on treatment plan and prognosis
          6. optimize nutritional status
    1. Cor pulmonale
      1. Definition/etiology
        1. right ventricular hypertrophyand subsequent chronic heart failure
        2. cause: heart must pump against great resistance from lung's blood vessels: called increased pulmonary vascular resistance (PVR)
        3. increased PVR results from chronic lung disease
        4. may be due to primary pulmonary hypertension as well
      1. Diagnostics
        1. pulmonary artery pressure readings via a catheter (illustration)
        2. echocardiogram
        3. chest radiograph
        4. ABG
        5. EKG
      2. Management
        1. administer oxygen as ordered
        2. if hemoglobin within normal limits (WNL), monitor oxygenation with finger or pulse oximeter
        3. bed rest, as needed
        4. monitor effects of medications
          1. cardiac glycosides
          2. pulmonary artery vasodilator
          3. diuretics
          4. restricted fluid intake as indicated
        5. nursing interventions
          1. monitor for changes in oxygenation status
          2. pace activities in clients who tire easily
    2. Respiratory failure
      1. Definition: lungs cannot maintain arterial oxygen levels or eliminate carbon dioxide
        1. PaCO2 > 50 mm Hg
        2. PaO2 < 50 mm Hg
        3. clients with chronic lung disease precautions
          1. look for drop from baseline function
          2. this is a nursing and medical emergency
          3. clients are always hypoxemic
      2. Etiology
        1. lung diseases that harden the alveolar-capillary membrane to trap O2
        2. neuro-muscular or musculoskeletal disorders
          1. respiratory drive dulled or blunted
          2. muscles too weak to breathe
      3. Diagnostics: ABG
      4. Management
        1. oxygen per mask
        2. mechanical ventilation
        3. monitor for improvement in the underlying cause for the respiratory failure
        4. Oxygen is essential for life. So, before all else, keep airways open and ease breathing effort.
  • Clients with chronic lung disease use more oxygen and energy to breathe. This can create a vicious cycle in which the client works harder, and continually requires more oxygen and more energy.
  • Nursing interventions for clients with chronic lung disease should include pacing of activities, because these clients have little reserve for exertion.
  • Quality of life for clients can be significantly improved if clients routinely use diaphragmatic breathing and pursed-lip breathing.
  • Clients with asthma must understand the different types of inhalers and when to use each type. Some rescue inhalers are for acute dyspnea. Other inhalers are for maintenance or preventative types of drugs.

  • A finger or pulse oximeter reading is simply one element of an assessment. It is not the whole picture.
  • Cyanosis, a late finding, is determined by oxygenation and hemoglobin content.
  • Clients with anemia may be severely hypoxemic and never turn blue, but rather "ashen".
  • Clients with polycythemia may be cyanotic with adequate tissue oxygenation.
  • The serious public health issue of pulmonary TB requires control and reporting of any incidence and recent contacts that the client had so prophalactic therapy for two to three months can be initiated.
  • When caring for a client after a chest tube insertion, an occlusive dressing is placed around the chest tube insertion site and the connections of the chest tube system are taped to prevent air leaks at connections. An occlusive dressing is one that is totally covered, as well as the edges with non-porous tape. This dressing is typically not changed and not expected to have any drainage on it.

  • When caring for a client on a ventilator, if an alarm sounds, first, assess the client. See if the alarm resets or if the cause is obvious. If the alarm continues to sound and the client develops distress, disconnect the client from the ventilator, use a manual resuscitation bag to ventilate with 100% oxygen and page or call the respiratory therapist immediately.
  • If the ventilator tube disconnects, the low pressure alarm will sound.
  • If the high pressure alarm sounds on the ventilator, the nurse should check for some type of obstruction or occlusion of the airway: mucous plugs, biting of the tube by the client, tube slips into right main stem bronchus, or increased secretions.
  • To maximize therapeutic effect of inhalers, the key is technique. It is critical to teach clients the right technique and observe how well they use the inhaler.
  • Smoking cessation is critical to reduce the risk and severity of lung disease. Second-hand smoke enhances the risk of children to develop asthma or other chronic lung diseases.
  • Best approach to pulmonary embolus is prevention. The use of intermittent compression stockings prevents clots in the deep veins.
  • Clients with pulmonary TB need intensive community follow up to ensure that they continue with pharmacological treatment once discharged from the hospital. Clients who stop therapy too soon are the source for the more deadly multi-drug resistant forms of pulmonary TB.

Cor Pulmonale
Cromolyn sodium
Kussmaul's breathing
Nosocomial pneumonia