Sputum Culture Sputum: Secretions from the lungs Contains mucus, cellular debris, microorganisms, blood and/or pus Sputum Culture A laboratory test involving cultivation of microorganisms or cells in a special growth medium Expectoration must be brought up from bronchial tree Early morning collection is best before meals Tracheal suctioning may be necessary Characteristics Color Clear, white, yellow, green, brown, red, pink tinge, blood streaked Odor None or malodorous Consistency Frothy, watery, tenacious Blood frequency All the time, occasionally, only in early morning
Hypoxia Apprehension, Anxiety, Restlessness Decreased concentration Disorientation Decreased LOC Fatigue Vertigo Behavioral changes Cardiac Dysrhythmia Pallor Cyanosis Clubbing Dyspnea First tachycardia and increase rate and depth respirations Then bradycardia with shallow slow respirations when progressed Elevated blood pressure first then drop w/o O2 correction
Arterial Blood Gases Normal Values pH 7.35 – 7.45 PaCO mmHg PaO mmHg HCO3ˉ21 – 28 mEq/L Arterial Blood Gas Below Normal Range Normal rangeAbove Normal Range pHAcidic7.35 – 7.45Alkaline PaCO2Alkaline34 – 45Acidic HCO3ˉAcidic alkaline Respiratory Acidosis: pH and PaCO2 are in acidic range Respiratory Alkalosis pH and PaCO2 are in alkaline range
Chronic Obstructive Pulmonary Disease COPD conditions: Are progressive and irreversible Have diminished inspiratory and expiratory capacity of the lungs Obstruct the flow of air to or from the patients bronchioles Includes: 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 infections Asthma: 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.
Asthma Diagnostics/Lab Pulmonary Function Test Arterial Blood Gases Chest x-ray Sputum CBC 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/S Dyspnea Chest tightness Coughing Wheezing Mucus production Use of accessory muscles Poor oxygen saturation
Nursing Diagnosis Impaired gas exchange Ineffective airway clearance Ineffective breathing pattern Anxiety Nursing Interventions MAINTAIN A CALM AND REASSURING DEMEANOR Elevate head of bed Provide rest periods Provide oxygen as prescribed Administer medications as prescribed Teaching patient and family To recognize early signs and symptoms of attack To recognize asthma triggers Effective breathing techniques Peak flow meter (personal zones) Medications Infection prevention techniques Provide referral to support groups as needed Asthma
Medical Management/Medications Maintenance therapy- to be taken on a regular basis to prevent and minimize symptoms. examples: Serevent, Flovent, Singular, Theophylline Acute (rescue) therapy- quickly relieves symptoms of an asthma attack. examples: Albuterol, Corticosteroids, Epinephrine Bronchodilators: assist in opening the airways Albuterol (Proventil, Ventolin), Ipratropium (Atrovent), Theophylline Anti-inflammatory: used to decrease inflammation Corticosteroids: Flovent and Prednisone Leukotriene antagonists: Singulair Mast cell stabilizers: Intal Monoclonal antibodies: Xolair Combination Agents: Bronchodilator and Anti-Inflammatory Combivent and Advair Recommended yearly flu shot and pneumococcal vaccine every 5 years
Pneumonia : inflammation of bronchioles and alveolar sacs Caused by infection, over sedation, inadequate ventilation, or aspiration Infection could be caused by bacteria, viruses, mycoplasma, fungi, or chemicals Currently about 50% of cases are caused by bacteria and 50% by viruses Signs and symptoms vary with the type of pneumonia Streptococcal, pneumococcal: sudden onset, chest pain, fever, headache, cough, rust colored sputum, crackles, possible plural friction rub, hypoxemia, cyanosis, visible on chest x-ray, Vaccine Available Staphylococcal: same as streptococcal with copious, salmon colored sputum Klebsiella: 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 high Haemophilus: commonly follows upper respiratory infection, low grade fever, croupy cough, malaise, arthralgias, yellow or green sputum Mycoplasmal: 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
Diagnostics/Lab Sputum for culture and sensitivity Collected before eating and before start of antibiotics Chest radiograph reveals changes in density White blood count Normal or low in viral or mycoplasmal Elevated in bacterial, Leukocytosis with a shift to the left ABGs identify altered gas exchange Pulse oximetry monitors oxygen saturation Medical Interventions Antibiotics: penicillin, erythromycin, cephalosporin, and tetracyclines depending on causative organism Analgesics – Tylenol, IBU, Vicodin, Percocet Antipyretics – Tylenol, IBU Expectorants – Guiafenesin (Robitussin) Mucolytics - Mucinex Bronchodilator – Albuterol, Atrovent, Serevent Humidification or nebulizers Oxygen if below 90% Pneumococcal Vaccine (most common bacteria pneumonia) Good for lifetime when healthy Repeat every 5 years if immunosuppressed or at risk for development of fatal infection Recommended chronic illnesses, recovering from serious illness, over age 65, or in a long term care facility Pneumonia
Pneumonia Nursing Diagnosis Ineffective breathing pattern r/t inflammatory process and pleuritic pain Impaired gas exchange r/t alveolar capillary membrane changes secondary to inflammation Nursing Interventions Help pt conserve energy with periods of rest High or Semi-Fowlers position Provide hydration at least 3L per day unless contraindicated (Heart Failure) Monitor temperature and VS Deep breathing and cough exercises Incentive spirometry Possible oxygen therapy Auscultate for crackles, wheezes, and pleural friction rub Assess ventilation Breathing rate, rhythm, depth, and chest expansion Assess for respiratory distress Dyspnea, sob, nasal flaring, pursed lip breathing, prolonged expiratory phase, and use of accessory muscles S/S Hypoxia: restlessness, irritability, and disorientation Good Hand Hygiene!
Lung Cancer Abnormal cell growth/overgrowth: -Oncogenes/Tumor Suppressors malfunction Two Classifications: Small-cell lung cancer 10-15% - directly related to smoking Non-small cell lung cancer 85-90% - Squamous cell carcinoma - Adrenocaricoma - Large cell carcinoma Risk Factors Genetic Smoking Occupational exposures
Signs and Symptoms Cough Weight loss Dyspnea Chest pain Hemoptysis Bone pain Clubbing Fever Hoarseness Recurring infections Neuro changes Jaundice Lumps Weakness Dysphagia Wheezing Varies depending on type/extent of disease
Diagnostics/Labs Virtual bronchoscopy Spiral CT Chest x-ray CT Scan MRI Positron emission tomography (PET) Bronchoscopy (biopsy or brushing) Scalene lymph node biopsy Bone scan Thoracentiesis Thorascopy Bone marrow aspiration Immunohistochemstry testing Sputum cytology Mediastinoscopy Fine needle aspiration
Nursing 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.
Laryngeal 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 Impacts breathing, speaking, and eating. Risk Factors Chronic exposure to harmful chemicals Tobacco/alcohol Chronic laryngitis Vocal abuse Family history
Signs and Symptoms Progressive/persistent hoarseness (2+ weeks) Referred pain to the ear Dyspnea Dysphagia Hemoptysis Mouth sores/lesions that fail to heal Lump in throat/mouth/neck Unilateral ear pain Weight loss/anorexia Enlarged cervical lymph nodes Diagnostics/Lab s X-Ray CT Scan MRI Laryngoscopy Bone scan PET scan Biopsy and microscopic study
Laryngeal 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
Nursing 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 hours Impaired 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
Sleep Apnea Symptoms of Sleep Apnea Loud snoring Choking or gasping during sleep Daytime sleepiness Morning headaches Memory or learning problems Irritability Inability to concentrate Mood swings Dry throat in the morning Three types of Sleep Apnea Obstructive Sleep Apnea Central Sleep Apnea Complex Sleep Apnea Diagnosed by a Sleep Study in a Sleep Center Causes of OSA A small jaw, or large tongue, tonsils or adenoids, large neck size Throat muscles, a tongue and uvula that relax more than normal Drinking alcohol, taking sleeping pills or other medicine at bedtime Smoking Being overweight
Sleep Apnea If left untreated sleep apnea can lead to: High blood pressure Heart disease Heart attack Stroke Congestive heart failure Memory loss Death (due to accidents while driving or working Sleep deprived bed partner Treatment Lose weight if overweight Avoid alcohol, caffeine and/or smoking Avoid medications that affect your sleep and breathing Sleep on your side instead of your back Using a mouthpiece during sleep CPAP/BiPAP Surgery to enlarge the airway CPAP: Continuous Positive Airway Pressure BiPAP: Bilevel Positive Airway Pressure used in patients that cant 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.***
Complementary & Alternative Therapies Acupuncture Allergies, asthma, colds, flu and coughing Astralagus Antiviral/ immunity enhancing properties Echinacea Multiple effects on immune system Alleviates cold/flu symptoms Eucalyptus Expectoral agent Everlast Anti-inflammatory Garlic Cancer suppressing Antibacterial/antiviral/antifungal effects Clears congestions Improves immune system function Imagery Lemon Cold/flu Licorice Bronchitis Vitamin C Yoga Zinc Cold; reduced aggravating symptoms & duration