Presentation is loading. Please wait.

Presentation is loading. Please wait.

Respiratory N415 Linda Winn, RN, MSN Ed., BA Ed..

Similar presentations

Presentation on theme: "Respiratory N415 Linda Winn, RN, MSN Ed., BA Ed.."— Presentation transcript:

1 Respiratory N415 Linda Winn, RN, MSN Ed., BA Ed.


3 Respiratory Assessment

4 Resp Assessment Breathing Pattern I:E ratio Kussmaul Rate Dyspnea Orthopnea PND – Paroxysmal nocturnal dyspnea Cough and Sputum Frequency Dry / moist Amount Color Thickness Odor

5 Assessment (Cont.) Inspection Symmetry Skin color – lip color / finger clubbing WOB – accessory muscles Auscultation Adventitious sounds Chest pain History Diagnoses Smoking Quick, Focused Assessment


7 Breath Sounds Link Normal and Adventitious breath sounds thsounds/ thsounds/contents.html

8 Diagnostics & Labs

9 Labs H/H Sputum Analysis C&S Gram Stain Acid-Fast smear (AFB) Cytology ABGs O2 Sats

10 Diagnostic Tests CXR CT Chest MRI V/Q Scan Bronchoscopy Thoracentesis PFTs – Pulmonary Function Tests Spirometry


12 Chronic Obstructive Pulmonary Disease Obstruction to expiratory air flow 15 million Americans have COPD 4th leading cause of death Women approaching men in incidence and surpassed men in number of deaths

13 COPD 2 Types of COPD Emphysema Chronic Bronchitis (most common) can have either or both Asthma no longer considered a type of COPD

14 COPD Etiology smoking: 90% of people with COPD only15% of smokers get COPD smokers 10 x more likely to die from COPD environmental: Pollution Toxins second hand smoke develops slowly Common Signs and Symptoms Dyspnea and Wheezing Video Clip

15 Impact of Smoking


17 COPD video clips OPD.htm (skip through the ads )

18 Emphysema - Pathophysiology Abnormal permanent enlargement of the gas exchange airways with destruction of alveolar walls bronchioles too narrow or collapse slows air movement during exhalation & traps air in lungs increases work of breathing surface area for gas exchange Blebs, Bulla

19 Chronic Bronchitis Definition chronic productive cough for 3 months in each of the last 2 years Pathophysiology hypertrophy of mucous secreting glands & chronic inflammation of small airways excessive sputum production impaired ciliary movement & excessive sputum can increase risk of infection bronchial walls can become narrowed or obstructed Thicker mucus



22 Assessment Findings Early SOB Dyspnea Activity intolerance Hypoxemia Chronic cough with sputum Prolonged expiration Wheezing on forced expiration Altered Breathing Techniques Pursed-lip breathing Tripod breathing position Later Hyperinflation of lungs barrel chest Diminished lung & heart sounds Central cyanosis (chronic hypoxemia) CO2 retention

23 Asthma

24 Asthma Videos

25 Asthma

26 Exaggerated bronchoconstriction response to stimuli Airways overreact to triggers causing narrowing Chronic inflammatory disorder of airways 1 in 20 Americans; 5000 deaths/year Common triggers: allergies: dust, mold, sulfites, dander cold, dry air exercise stress

27 Common Triggers Allergens: dust, mold, sulfites, dander Cold, dry air Exercise Stress Environmental


29 Wheezing after exposure to triggers, coughing, chest tightness Rapid, shallow respirations, dyspnea, or absent breath sounds, accessory muscle use Postural changes to aid breathing Activity intolerance Anxiety Severity of symptoms vary Changes in peak expiratory flow rate Assessment Findings



32 In the Zone Green Zone PEFR 80% of baseline no sx; meds may be by MD Yellow Zone PEFR 50-80% baseline may have Ø to mod sx having attack or meds adjusted Red Zone 50% baseline severe sx medical alert; call MD

33 Potential Nursing Diagnoses Ineffective Airway Clearance Impaired Gas Exchange Ineffective Breathing Pattern Activity Intolerance Altered Nutrition Aspiration, risk for Pain Anxiety Fear High risk for infection Pneumonia

34 Nursing Management Monitor VS LOC lung sounds sputum amount and character Maintain airway Pursed-lip breathing cough routines positioning for max lung expansion Suctioning avoid cough suppressants unless cough frequent & non- productive

35 Nursing Management Monitor activity tolerance help pt conserve energy plan rest periods O2 prn Good oral hygiene Decrease anxiety remain with patient during anxious episodes, relaxation techniques, O2 prn Nutrition Hydration

36 Collaborative Treatment Immunizations flu & pneumonia vaccinations Bronchodilators Inhaled steroids Antibiotics Oxygen therapy Pulmonary Rehabilitation Smoking Cessation

37 Patient Education Monitor color, amount, thickness of sputum Self care: at-home meds & treatments; avoid triggers Prevention Pneumococcal vaccine, flu shot Frequent oral hygiene Encourage fluids Environmental hazards altitude, smog, allergies, smoke Follow up medical care American Lung Association

38 COPD – Cor Pulmonale Long-term complication

39 Respiratory RN Diagnoses Impaired Gas Exchange Ineffective Airway Clearance Others

40 Pulmonary Tuberculosis

41 Tuberculosis Incidence Risk Factors Mode of Transmission Mycobacterium tuberculosis Development of TB htm Text copy:

42 Diagnostic Tests PPD CXR AFB Bronchoscopy WBC

43 Assessment Findings Classic Sx: Weight Loss Low-grade fever Night sweats Productive Cough

44 Treatment Medications INH – Isoniazid Rifampin (Rifadin) Ethambutol (Myambutol) Pyrazinamide (PZA) Multi-drug approach Not transmittable after 2-3 weeks of treatment

45 Nursing Care In-hospital Care Negative pressure Room Respiratory isolation N-95 mask Fit testing Transporting Patient Public Health Nurse DOT

46 O2 Levels PaO2 SaO2 Needs O2 <55 <88% May be OK 40 75% Short-term With COPD Critical <40 <75%

47 ABGs Acid – Base Balance Nursing Considerations in drawing ABGs Allens Test Ice Pressure

48 ABG Normal Values pH pCO HCO PaO mm Hg SaO2>95%

49 ABG Evaluation Step 1 – pO2 Step 2 – pH Acidotic or Alkalotic? Step 3 – pCO2 Respiratory cause? Step 4 – HCO3 Metabolic cause? Step 5 – Compensated or Uncompensated

50 ABG examples pH 7.39 pO259 pCO259 HCO331 Diagnosis? What is this typical of?

51 Group Activity 1 pH7.3 pCO225 HCO316 pO285 Interpretation: _______________

52 Group Activity 2 pH7.33 pCO247 HCO324 pO276 Interpretation: _______________

53 Group Activity 3 Create ABG for pt with Metabolic Acidosis Metabolic Alkalosis with compensation

Download ppt "Respiratory N415 Linda Winn, RN, MSN Ed., BA Ed.."

Similar presentations

Ads by Google