4Sputum Culture Sputum: Sputum Culture Characteristics Secretions from the lungsContains mucus, cellular debris, microorganisms, blood and/or pusSputum CultureA laboratory test involving cultivation of microorganisms or cells in a special growth mediumExpectoration must be brought up from bronchial treeEarly morning collection is best before mealsTracheal suctioning may be necessaryCharacteristicsColorClear, white, yellow, green, brown, red, pink tinge, blood streakedOdorNone or malodorousConsistencyFrothy, watery, tenaciousBlood frequencyAll the time, occasionally, only in early morning
5Hypoxia Apprehension, Anxiety, Restlessness Decreased concentration DisorientationDecreased LOCFatigueVertigoBehavioral changesCardiac DysrhythmiaPallorCyanosisClubbingDyspneaFirst tachycardia and increase rate and depth respirationsThen bradycardia with shallow slow respirations when progressedElevated blood pressure first then drop w/o O2 correction
6Arterial Blood Gases Normal Values pH 7.35 – 7.45 PaCO2 34 - 45 mmHg Respiratory Acidosis:pH and PaCO2 are in acidic rangeRespiratory AlkalosispH and PaCO2 are in alkaline rangeNormal ValuespH – 7.45PaCO mmHgPaO mmHgHCO3ˉ 21 – 28 mEq/LArterial Blood GasBelow Normal RangeNormal rangeAbove Normal RangepHAcidic7.35 – 7.45AlkalinePaCO234 – 45HCO3ˉalkaline
7Chronic Obstructive Pulmonary Disease COPD conditions:Are progressive and irreversibleHave diminished inspiratory and expiratory capacity of the lungsObstruct the flow of air to or from the patient’s bronchiolesIncludes:Emphysema: Loss of lung elasticity and hyperinflation of lung tissue. Causes destruction of the alveoli leading to decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis.Chronic Bronchitis: Bronchial inflammation and excessive mucous secretion result in airway obstruction. Caused by smoking or chronic lung infectionsAsthma: A chronic inflammatory disorder of the airways. Intermittent periods of bronchospasm resulting in wheezing and difficulty breathing. Triggered by stimuli.Bronchiectasis: Chronic dilation of bronchi that eventually destroys bronchial elastic and muscular elements. Muscle tone is gradually lost after one or more pulmonary infections.
8Asthma S/S Diagnostics/Lab Dyspnea Chest tightness Coughing Wheezing A chronic inflammatory disorder of the airways. It is an intermittent and reversible airflow obstruction that affects the bronchioles and is caused by either an internal or external factor.S/SDyspneaChest tightnessCoughingWheezingMucus productionUse of accessory musclesPoor oxygen saturationDiagnostics/LabPulmonary Function TestArterial Blood GasesChest x-raySputumCBC
9Asthma Nursing Diagnosis Nursing Interventions Impaired gas exchange Ineffective airway clearanceIneffective breathing patternAnxietyNursing InterventionsMAINTAIN A CALM AND REASSURING DEMEANORElevate head of bedProvide rest periodsProvide oxygen as prescribedAdminister medications as prescribedTeaching patient and familyTo recognize early signs and symptoms of attackTo recognize asthma triggersEffective breathing techniquesPeak flow meter (personal zones)MedicationsInfection prevention techniquesProvide referral to support groups as neededAsthma
10Medical Management/Medications Maintenance therapy- to be taken on a regular basis to prevent and minimize symptoms.examples: Serevent, Flovent, Singular, TheophyllineAcute (rescue) therapy- quickly relieves symptoms of an asthma attack.examples: Albuterol, Corticosteroids, EpinephrineBronchodilators: assist in opening the airwaysAlbuterol (Proventil, Ventolin), Ipratropium (Atrovent), TheophyllineAnti-inflammatory: used to decrease inflammationCorticosteroids: Flovent and PrednisoneLeukotriene antagonists: SingulairMast cell stabilizers: IntalMonoclonal antibodies: XolairCombination Agents: Bronchodilator and Anti-InflammatoryCombivent and AdvairRecommended yearly flu shot andpneumococcal vaccine every 5 years
11Pneumonia : inflammation of bronchioles and alveolar sacs Caused by infection, over sedation, inadequate ventilation, or aspirationInfection could be caused by bacteria, viruses, mycoplasma, fungi, or chemicalsCurrently about 50% of cases are caused by bacteria and 50% by virusesSigns and symptoms vary with the type of pneumoniaStreptococcal, pneumococcal: sudden onset, chest pain, fever, headache, cough, rust colored sputum, crackles, possible plural friction rub, hypoxemia, cyanosis, visible on chest x-ray, Vaccine AvailableStaphylococcal: same as streptococcal with copious, salmon colored sputumKlebsiella: many same as streptococcal with gradual onset, more bronchial pneumonia, and if treatment is delayed beyond second day of onset patient becomes critically ill and mortality highHaemophilus: commonly follows upper respiratory infection, low grade fever, croupy cough, malaise, arthralgias, yellow or green sputumMycoplasmal: gradual onset, headache, fever, malaise, chills, severe nonproductive cough, decreased breath sounds and crackles, x-ray will be clear and white blood count normal.Viral: generally mild, cold symptoms, headache, anorexia, myalgia, irritating cough, mucopurulent or bloody sputum, bronchopneumonic type infiltration on chest x-ray, white blood cell count usually high with rise in antibody titers
12Pneumonia Diagnostics/Lab Sputum for culture and sensitivity Collected before eating and before start of antibioticsChest radiograph reveals changes in densityWhite blood countNormal or low in viral or mycoplasmalElevated in bacterial, Leukocytosis with a shift to the leftABG’s identify altered gas exchangePulse oximetry monitors oxygen saturationMedical InterventionsAntibiotics: penicillin, erythromycin, cephalosporin, and tetracyclines depending on causative organismAnalgesics – Tylenol, IBU, Vicodin, PercocetAntipyretics – Tylenol, IBUExpectorants – Guiafenesin (Robitussin)Mucolytics - MucinexBronchodilator – Albuterol, Atrovent, SereventHumidification or nebulizersOxygen if below 90%Pneumococcal Vaccine (most common bacteria pneumonia)Good for lifetime when healthyRepeat every 5 years if immunosuppressed or at risk for development of fatal infectionRecommended chronic illnesses, recovering from serious illness, over age 65, or in a long term care facility
13Pneumonia Good Hand Hygiene! Nursing Diagnosis Nursing Interventions Ineffective breathing pattern r/t inflammatory process and pleuritic painImpaired gas exchange r/t alveolar capillary membrane changes secondary to inflammationNursing InterventionsHelp pt conserve energy with periods of restHigh or Semi-Fowler’s positionProvide hydration at least 3L per day unless contraindicated (Heart Failure)Monitor temperature and VSDeep breathing and cough exercisesIncentive spirometryPossible oxygen therapyAuscultate for crackles, wheezes, and pleural friction rubAssess ventilationBreathing rate, rhythm, depth, and chest expansionAssess for respiratory distressDyspnea, sob, nasal flaring, pursed lip breathing, prolonged expiratory phase,and use of accessory musclesS/S Hypoxia: restlessness, irritability, and disorientationGood Hand Hygiene!
14Lung Cancer Abnormal cell growth/overgrowth: Two Classifications: -Oncogenes/Tumor Suppressors malfunctionTwo Classifications:Small-cell lung cancer10-15%- directly related to smokingNon-small cell lung cancer85-90%- Squamous cell carcinoma- Adrenocaricoma- Large cell carcinomaRisk FactorsGeneticSmokingOccupational exposures
15Signs and Symptoms Varies depending on type/extent of disease HoarsenessRecurring infectionsNeuro changesJaundiceLumpsWeaknessDysphagiaWheezingCoughWeight lossDyspneaChest painHemoptysisBone painClubbingFever
18Nursing Diagnoses/Interventions Ineffective airway clearance r/t lung surgery.-Facilitate optimal breathing by placing patient in a sitting position.-Assist with position changes frequently.-Encourage early ambulation to mobilize secretions.-Encourage I.S.Fear, related to cancer, treatment, and prognosis.-Monitor changes in communication patterns-Listen/accept without personalizing reaction-encourage to identify problem, redefine situation, obtain needed information, generate alternatives, and focus on solutions.
19Laryngeal Cancer Squamous cell carcinoma - Slow growing if only involving true vocal cords- Faster elsewhere in larynx- Men 3x more likely to be affected than women.- Most occur after age 60.- Impacts breathing, speaking, and eating.Risk FactorsChronic exposure to harmful chemicalsTobacco/alcoholChronic laryngitisVocal abuseFamily history
20Signs and Symptoms Diagnostics/Labs Progressive/persistent hoarseness (2+ weeks)Referred pain to the earDyspneaDysphagiaHemoptysisMouth sores/lesions that fail to healLump in throat/mouth/neckUnilateral ear painWeight loss/anorexiaEnlarged cervical lymph nodesDiagnostics/LabsX-RayCT ScanMRILaryngoscopyBone scanPET scanBiopsy and microscopic study
21Laryngeal Cancer Treatment Treatment is determined by the extent of tumor growth*Radiation- if limited to true cords* Surgery- tumor affixed to cord(s)* Partial Laryngectomy- temporary tracheostomy*Total Laryngectomy- permanent tracheostomy-Tracheoesophageal fistulas, esophageal speech,electorlarynxes* Radical neck dissection- in conjunction with total laryngectomy- shoulder droop
22Nursing diagnoses/Interventions Ineffective airway clearance, r/t secretions/obstruction- Suction as needed- Tracheostomy care- Small, frequent feedings/liquid or pureed food- Teach stoma protection- Turn, CDB q 2-4 hours- Maintain HOB 30 degrees or higher- Respiratory rate q 1-2 hours- Auscultate lungs and monitor O2 q 4 hoursImpaired communication, verbal, r/t removal of larynx- Provide implements for communication- Keep call light in reach at all times- Ask yes/no questions when possible- Refer to local support groups
23Sleep Apnea Three types of Sleep Apnea Symptoms of Sleep Apnea Loud snoringChoking or gasping during sleepDaytime sleepinessMorning headachesMemory or learning problemsIrritabilityInability to concentrateMood swingsDry throat in the morningThree types of Sleep ApneaObstructive Sleep ApneaCentral Sleep ApneaComplex Sleep ApneaDiagnosed by a Sleep Study in a Sleep CenterCauses of OSAA small jaw, or large tongue, tonsils or adenoids, large neck sizeThroat muscles, a tongue and uvula that relax more than normalDrinking alcohol, taking sleeping pills or other medicine at bedtimeSmokingBeing overweight
24Sleep ApneaIf left untreated sleep apnea can lead to:High blood pressureHeart diseaseHeart attackStrokeCongestive heart failureMemory lossDeath (due to accidents while driving or workingSleep deprived bed partnerTreatmentLose weight if overweightAvoid alcohol, caffeine and/or smokingAvoid medications that affect your sleep and breathingSleep on your side instead of your backUsing a mouthpiece during sleepCPAP/BiPAPSurgery to enlarge the airwayCPAP: Continuous Positive Airway PressureBiPAP: Bilevel Positive Airway Pressureused in patients that can’t tolerate exhaling against the continuous pressure and patients with COPD.***If you encounter a patient that is having a difficult time tolerating the CPAP/BiPAP, refer them to their medical equipment company. There are many types of masks that can be trialed, desensitization programs, and adjustments that can be made to the machine.***
25Complementary & Alternative Therapies AcupunctureAllergies, asthma, colds, flu and coughingAstralagusAntiviral/ immunity enhancing propertiesEchinaceaMultiple effects on immune systemAlleviates cold/flu symptomsEucalyptusExpectoral agentEverlastAnti-inflammatoryGarlicCancer suppressingAntibacterial/antiviral/antifungal effectsClears congestionsImproves immune system functionImageryLemonCold/fluLicoriceBronchitisVitamin CYogaZincCold; reduced aggravating symptoms & duration