1. Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1 The Respiratory System

2. Structure and Function

3. Gas exchange

4. Changes associated to Aging ↓ recoil and compliance ↓ recoil and compliance  AP diameter  AP diameter ↓ functional alveoli ↓ functional alveoli ↓ in Pa02 ↓ in Pa02 Respiratory defense mechanisms less effective Respiratory defense mechanisms less effective Altered respiratory controls Altered respiratory controls More gradual response to changes in O2 and Co2 levels in blood More gradual response to changes in O2 and Co2 levels in blood

5. Diagnostics Pulse Oximetry Pulse Oximetry Chest X-Ray Chest X-Ray Computed Tomography (CT scan) Computed Tomography (CT scan) Bronchoscopy Bronchoscopy Thoracentesis Thoracentesis Pulmonary Function Tests Pulmonary Function Tests Sputum Specimen and Cultures Sputum Specimen and Cultures

6. Diagnostics: Pulse Oximetry Measures arterial oxygen saturation Measures arterial oxygen saturation Pulse oximetry probe on forehead, ears, nose, finger, toes, Pulse oximetry probe on forehead, ears, nose, finger, toes, False readings False readings Intermittent or continuous monitoring Intermittent or continuous monitoring Ideal values: 95-100% Ideal values: 95-100% When to Notify MD When to Notify MD < 91% < 91% 86% (Medical Emergency) 86% (Medical Emergency)

7. Diagnostics: Chest X-Ray Screen, diagnose, evaluate treatment Instructions: No metals/jewelry

8. Diagnostics: Chest X-Ray Cont. Posterior Anterior View Left Lateral View Nodule Infiltrates

9. Diagnostics: Sputum Specimen To diagnose; evaluate treatment To diagnose; evaluate treatment Specimen: ID organisms or abnormal cells Specimen: ID organisms or abnormal cells Culture & Sensitivity (C&S) Culture & Sensitivity (C&S) Cytology Cytology Gram stains Gram stains (e.g. Acid Fast Bacilli) (e.g. Acid Fast Bacilli)

10. Diagnostics: Computed Tomography: CT Scan Images in cross- section view Images in cross- section view Uses contrast agents Uses contrast agents Instructions: Instructions: Right upper Lobe

11. Diagnostics: Bronchoscopy Diagnose problems and assess changes in bronchi/bronchioles Diagnose problems and assess changes in bronchi/bronchioles Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study Procedure Care/Instructions:  NPO 6 -8 hrs prior  Sedation during procedure Post Procedure:  HOB elevated  Observe for hemorrhage  NPO until gag reflex returns

12. Diagnostics: Pulmonary Function Test (PFTs) Evaluate lung function Evaluate lung function Observe for increased dyspnea or bronchospasm Observe for increased dyspnea or bronchospasm Instructions: Instructions: No bronchodilators 6 hours prior No bronchodilators 6 hours prior

13. Diagnostics: Thoracentesis Specimen from pleural fluid Specimen from pleural fluid Treat pleural effusion Treat pleural effusion Assess for complications Assess for complications Post-Procedure care: CXR after procedure CXR after procedure Positions Sitting on side of bed over bedside table chestSitting on side of bed over bedside table chest elevated elevated Lying on affected sideLying on affected side Straddling a chairStraddling a chair

14. Assessment: Cues to Respiratory Problems DyspneaCoughSputum

15. Pneumonia: Case Study Pathophysiology

16. Pneumonia: Pathophysiology Cont.

17. Pneumonia: Etiology Cause Cause bacteria (75%) bacteria (75%) viruses viruses fungi fungi Mycoplasma Mycoplasma Parasites Parasites chemicals chemicals

18. Pneumonia: Classifications Community-acquired pneumonia (CAP) Community-acquired pneumonia (CAP) Onset in community or during 1 st 2 days of hospitalization (Strep. pneumoniae most common) Onset in community or during 1 st 2 days of hospitalization (Strep. pneumoniae most common) Hospital-acquired Pneumonia(HAP/nosocomial) Hospital-acquired Pneumonia(HAP/nosocomial) Occurring 48 hrs or longer after hospitalization Occurring 48 hrs or longer after hospitalization Aspiration pneumonia Aspiration pneumonia Pneumonia caused by opportunistic organisms Pneumonia caused by opportunistic organisms Pneumocystis Carinii Pneumocystis Carinii

19. Pneumonia: Risk Factors CAP Older adult Older adult Chronic/coexisting condition Chronic/coexisting condition Recent history or exposure to viral or influenza infections Recent history or exposure to viral or influenza infections History of tobacco or alcohol use History of tobacco or alcohol useHAP Older adult Older adult Chronic lung disease Chronic lung disease ALOC ALOC Aspiration Aspiration ET, Trach, NG / GT ET, Trach, NG / GT Immunocompromised Immunocompromised Mechanical ventilation Mechanical ventilation

20. Pneumonia: Clinical Manifestations Fevers, chills, anorexia Fevers, chills, anorexia Pleuritic chest pain Pleuritic chest pain SOB SOB Crackles/wheezes Crackles/wheezes Cough, sputum production Cough, sputum production Tachypnea Tachypnea

21. Pneumonia: Clinical Manifestations-Cont. Mycoplasma (Atypical) feeling tired or weak, headaches, sore throat, or diarrhea. feeling tired or weak, headaches, sore throat, or diarrhea. Eventually, most develop a dry cough. They can, also, develop fever, chills, earaches, chest pain Eventually, most develop a dry cough. They can, also, develop fever, chills, earaches, chest pain “walking pneumonia” “walking pneumonia”

22. Pneumonia: Diagnosis  Diagnosis →  Physical exam → crackles, rhonchi/wheezes  CXR →area of increased density (infiltrates/ consolidation) (infiltrates/ consolidation)  Sputum specimen –  Gram stain LUL Infiltrates

23. Pneumonia :Interventions/Tx  Treatment  Antibiotics → choose based on age, suspected cause & immune status  Supportive care → IV fluids, supplemental oxygen therapy, respiratory monitoring, cough enhancement  *may take 6-8 weeks for CXR to normalize

24. Nursing Diagnoses… Impaired gas exchange R/T Pneumonia Impaired gas exchange R/T Pneumonia Pain R/T infection in lung Pneumonia Pain R/T infection in lung Pneumonia

25. Pneumonia: Complications Hypoxemia Pleural effusion AtelectasisPleurisy Atelectasis Pleurisy Pleural Effusion

26. Toxic sprinkles anyone?

27. Any Questions?