1. Nursing Care of the Client: Oxygenation and Perfusion
Unit 10
Nursing Care of the Client: Oxygenation and Perfusion

2. Chapter 35
Respiratory System

3. Anatomy and Physiology Review
Primary function:
Delivery of oxygen to and removal of carbon dioxide from lungs

4. Anatomy and Physiology Review

5. Anatomy and Physiology Review

6. Assessment Health history Inspection Palpation and percussion
Auscultation

7. Assessment

8. Assessment

9. Assessment

10. Assessment

11. Assessment

12. Assessment

13. Assessment

14. Assessment

15. Diagnostics

16. Diagnostics

17. Diagnostics

18. Diagnostics

19. Diagnostics

20. Diagnostics

21. Diagnostics pH 7.35 – 7.45 PO2 80 – 100 mm Hg PCO2 35 – 45 mm Hg
HCO3 22 – 26 mm Hg

22. Hgb Within Normal Limits
The client has a long history of COPD and is currently experiencing an exacerbation of COPD. The following lab work is done this morning: CBC, ABG’s and an electrolyte panel consisting of K+, Na+, Cl, CO2, BUN and FBS. Which lab data requires immediate follow up?
Increased PaO2
Increased RBC’s
Increased PaCO2
Hgb Within Normal Limits

23. A is the answer
Hypoxemia provides the stimulus for the respiratory drive in clients with COPD. Increased oxygen levels may depress the respiratory drive.
Option B and C are expected findings
Option D does not require immediate follow- up.

24. Nursing Interventions

25. Nursing Interventions

26. Nursing Interventions

27. Nursing Interventions

28. Nursing Interventions

29. General Respiratory Medications
Anti-tussive
Narcotic
Non-narcotic
Expectorant
What is the best one?
Mucolytic
Antihistamine
Decongestant

30. Infectious/Inflammatory Disorders: Upper Respiratory
Common
Self-limiting
Caused by viruses, bacteria, and allergic reactions
(continued)

31. Infectious/Inflammatory Disorders: Upper Respiratory

33. Infectious/Inflammatory Disorders: Upper Respiratory
Symptoms:
Malaise, fever, edema of affected tissues, nasal or sinus congestion, headache, sore throat, and cough
Treatment
Symptomatic

34. Pneumonia
Inflammation of bronchioles and alveoli accompanied by consolidation in lungs
Can result from bacteria, viruses, mycoplasms, fungi, chemicals, or parasite invasions
(continued)

35. Pneumonia

36. Pneumonia
Symptoms:
Sudden or high fever, productive cough with thick sputum, dyspnea, coarse crackles, diminished breath sounds, and pleuritic chest pain
(continued)

37. Pneumonia

38. Pneumonia
Treat to clear airways and maintain adequate oxygenation (postural drainage and percussion)
Treatment:
Respiratory therapy, hydration medications, and turn, cough, deep breathe (TCDB)

39. Nursing Responsibilities?
Pneumonia
Antibiotics:
Penicillins
Tetracyclines
Aminoglycosides
Cephalosporins
“Other”
Side Effects:
Allergy/Hypersensitivity
Anaphylaxis
Indirect toxicity
Direct toxicity
Nursing Responsibilities?

40. Tuberculosis Caused by inhalation of Mycobacterium tuberculosis
Symptoms:
Low-grade fever, persistent cough, hemoptysis, hoarseness, dyspnea, night sweats, fatigue, and weight loss
(continued)

41. Tuberculosis

42. Tuberculosis

43. Tuberculosis

44. Tuberculosis Treatment:
Airborne precautions and long-term multi-drug regimen

45. Tuberculosis
Medications
Nursing Responsibilities

46. Pleurisy/Pleural Effusion
Painful condition from inflammation of pleura
Symptoms:
Pain on inspiration
(continued)

47. Pleurisy/Pleural Effusion
Pleural fluid accumulation within pleural space
Symptoms depend on amount of lung tissue compressed and source of effusion
(continued)

48. Pleurisy/Pleural Effusion

49. Pleurisy/Pleural Effusion

50. Pleurisy/Pleural Effusion
Treat to eliminate underlying cause, maintain adequate oxygenation to tissues, and prevent complications
Treatment:
Oxygen, respiratory therapy, incentive spirometry, thoracentesis, thoracotomy and chest tube drainage, and medications

51. Pleurisy/Pleural Effusion

52. Pleurisy/Pleural Effusion

53. The nurse is preparing to assist with the insertion of a chest tube that will be attached to a closed-chest drainage system without suction. In monitoring the closed-chest drainage system, the nurse would expect to initially assess for:
Fluctuation of water in the water-seal chamber during respirations.
Constant fluid fluctuations in the drainage-collection chamber.
Continuous bubbling in the suction-control chamber.
Occasional bubbling in the suction-control chamber.

54. A is the answer
Fluctuations of water during inspiration and expiration in the water-seal chamber indicates normal functioning.
Option B should not be seen in the collection chamber.
Options C and D should not be seen because suction has not been applied to the suction-control chamber.

55. The client has a chest tube connected to a closed-chest drainage system attached to suction and is being prepared to transfer to another room on a stretcher. To safely transport the client, it is most important for the nurse to:
Clamp the chest tube during the transport.
Get a portable suction before transferring the client.
Keep the closed-chest drainage system below the level of the chest.
Place the closed-chest drainage system next to the client on the stretcher.

56. C is the answer
Keeping the closed-chest drainage system below the level of the chest allows for continuous drainage and prevents any back flow pressure.
Options A and D should not be done because they will increase pressure in the pleural space.
Option B is not the most important.

57. Pleurisy/Pleural Effusion

58. The physician is preparing to remove the client’s chest tube
The physician is preparing to remove the client’s chest tube. Just before removing the chest tube, the physician tells the client to take a deep breath and hold it. This intervention is done primarily to:
Distract the client during the chest tube removal.
Minimize the negative pressure within the pleural space.
Decrease the degree of discomfort to the client.
Increase the intrathoracic pressure temporarily during removal.

59. D is the answer
This is done to decrease the risk of atmospheric air entering the pleural space during removal.
Options A and C are not the primary reasons for this intervention.
Option B is not correct since negative pressure is desired within the lung.

60. Severe Acute Respiratory Syndrome (SARS)
Viral illness with flu-like symptoms
Spread by close personal contact or contact with infectious material
Treatment:
Supportive care

61. Acute Respiratory Tract Disorders: Atelectasis
Collapse of lung or portion of lung
Signs of respiratory distress proportional to amount of lung tissue involved
Treatment:
Respiratory therapy, postural drainage and percussion, suctioning, oxygen, bronchoscopy, thoracentesis, thoracotomy and chest tube drainage, and medications

62. Atelectasis

63. Pulmonary Embolism
Develops when substance (emboli, fat, or amniotic fluid) lodges in branch of pulmonary artery and obstructs flow
Symptoms:
Abrupt anxiety, restlessness, inspiratory chest pain, dyspnea, cough, and hemoptysis
(continued)

64. Pulmonary Embolism
Treatment:
Medications and embolectomy

65. Pulmonary Edema Life-threatening condition Symptoms:
Rapid shift of fluid from plasma into alveoli
Symptoms:
Hemoptysis, dyspnea, orthopnea, cyanosis, anxiety, significant airway obstruction, and increased HR and respiratory rate (RR)
(continued)

66. Pulmonary Edema

67. Pulmonary Edema

68. MAD DOG Pulmonary Edema Treatment:
Oxygen, medications, and ventilation
MAD DOG

69. Acute Respiratory Distress Syndrome (ARDS)
Life-threatening condition
Dyspnea, hypoxemia, and diffuse pulmonary edema
Symptoms:
Severe dyspnea, tachypnea, cyanosis, crackles, wheezes, and hemoptysis
Treatment is intensive, supportive, and includes many body systems

70. Acute Respiratory Distress Syndrome (ARDS)

71. Acute Respiratory Distress Syndrome (ARDS)

72. Acute Respiratory Failure
Occurs as result of client literally becoming too tired to continue “work” of breathing
Mechanical ventilatory support required during acute phase

73. Chronic Respiratory Tract Disorders: Asthma
Intermittent airway obstruction in response to variety of stimuli
Symptoms:
Sudden inspiratory and expiratory wheezing, increasing dyspnea, and chest tightness
Treatment:
Taking medications and avoiding known allergens

74. Asthma

75. Asthma

76. Chronic Bronchitis
Inflammation of bronchial tree with hypersecretion of mucus
Symptoms:
History of recurrent respiratory infections, dyspnea, cyanosis, productive cough, and adventitious breath sounds
(continued)

77. Chronic Bronchitis

78. Chronic Bronchitis Treatment:
Respiratory therapy, medications, and immunizations

79. Emphysema Complex and destructive lung disease
Airflow impeded as it leaves lungs
Results in alveoli distention
First symptom:
Morning cough
(continued)

80. Emphysema

81. Emphysema

82. Emphysema

83. Emphysema

84. Emphysema

85. Emphysema

86. Emphysema Later symptoms: Treatment: Dyspnea upon exertion or at rest
Smoking cessation, low levels of oxygen, and medications

87. Bronchiectasis Chronic dilation of bronchi Symptoms: Treatment:
Chronic productive cough, dyspnea, weight loss, fatigue, thick sputum, crackles, and use of accessory muscles
Treatment:
Percussion and postural drainage, respiratory therapy, suctioning, bronchoscopy, and medications

88. Bronchiectasis

89. Medications Bronchodilators: Corticosteroids Adrenergic Xanthine
Anticholinergic
Corticosteroids

90. Get an order to increase the oxygen. Place in semi-Fowler’s position.
The nurse is caring for a client who was admitted with an exacerbation of COPD. The client’s respirations are 28 with dyspnea on exertion. The client is receiving 2L of oxygen per nasal cannula. The morning pulse oximetry is 92%. Which nursing intervention is of priority?
Monitor the client.
Notify the physician.
Get an order to increase the oxygen.
Place in semi-Fowler’s position.

91. A is the answer
The client is manifesting signs and symptoms consistent with COPD. Clients with COPD experience some degree of hypoxia.
Options B and C are not appropriate at this time.
Option D is not the best position for a client with COPD.

92. The client is admitted with an acute exacerbation of COPD
The client is admitted with an acute exacerbation of COPD. Which assessment finding is most indicative of a potential complication?
Respirations 32, increasingly anxious and restless.
Using accessory muscles during respiration.
Pulse oximetry 92%, pursed-lip breathing.
Expectorating copious amounts of white phlegm.

93. A is the answer
Increasing anxiousness and restlessness are signs indicating hypoxemia.
Options B, C and D are expected findings for a client with an exacerbation of COPD.

94. It’s time for report…

95. Prioritize the five nursing interventions as you would do them initially:
A – Auscultate lung sounds.
B – Assess pulse oximeter, O2 and NC.
C – Retake the vital signs.
D – Check theophylline level.
E – Place in high-Fowler’s position.

96. Pneumothorax/Hemothorax
Air in pleural space
Hemothorax
Blood in pleural space
May be traumatic, spontaneous, or tension
Symptoms determined by severity of injury and amount of lung tissue affected
(continued)

97. Pneumothorax/Hemothorax

98. Pneumothorax/Hemothorax
For affected lung to re-expand, air and/or blood must be removed from pleural space
Thoracotomy tube inserted to drain fluid and air
Allows lung to re-expand
Analgesics given for pain

99. It’s time for report…

100. Prioritize the five nursing interventions as you would do them initially:
A – Check the pulse oximetry.
B – Assess for fluctuation in the water-seal chamber and bubbling in the suction-control chamber.
C – Check for the previous shift’s fluid level marking on the tape.
D – Assess chest tube patency and drainage.
E – Ask Mr. G to cough and deep breathe.

101. Lung Cancer May originate in lung or result from metastasis
Symptoms develop late
May include cough, dyspnea, hemoptysis, and pain
Treatment:
Surgery, chemotherapy, and radiation

102. Lung Cancer

103. Laryngeal Cancer Relatively asymptomatic
May include hoarseness, difficulty speaking, difficulty swallowing, and laryngeal pain
Treatment determined by extent of tumor growth:
Surgery, chemotherapy, and radiation

104. Epistaxis Hemorrhage of nares or nostrils
May stem from dry nasal mucosa, local irritation, trauma, or hypertension
Treat to maintain airway, stop bleeding, identify cause, and prevent recurrence
Treatment:
Firm pressure on nares or nasal packing

105. Infants with Special Needs: Birth to 12 Months
Chapter 60
Infants with Special Needs: Birth to 12 Months
105

106. Laryngotracheobronchitis
Viral illness causing welling of upper airway
Symptoms:
Stridor, “barking” cough, and hoarseness
Treat to maintain patent airway and improve respiratory effort
(continued)

107. Laryngotracheobronchitis
Treatment:
Cool mist and medications
E.g., bronchodilators, corticosteroids

108. Pneumonia
Inflammation of bronchioles and alveoli spaces often preceded by upper respiratory infection (URI)
Symptoms:
Abrupt onset of fever, flaring nostrils, circumoral cyanosis, chest retractions, cough, and increased pulse and respirations
(continued)

109. Pneumonia
Treatment:
Oxygen, cool mist hydration, respiratory therapy, and medications

110. Respiratory Distress Syndrome (RDS)
Most often found in pre-term infants
Symptoms:
Tachypnea, retractions, grunting, crackles, pallor, cyanosis, hypothermia, edema, flaccid muscle tone, GI shutdown, jaundice, and acidosis
(continued)

111. RDS First 96 hours critical to recovery Treatment:
Surfactant and supportive care

112. Cystic Fibrosis Genetic dysfunction of exocrine glands
Affects lungs, pancreas, liver, and reproductive organs
Symptoms:
Meconium ileus, intussusception, problems gaining and maintaining weight, pulmonary problems, and salty taste on skin
(continued)

113. Cystic Fibrosis

114. Cystic Fibrosis
Treat pulmonary problems and nutrition

115. Sudden Infant Death Syndrome (SIDS)
Also known as crib death
Sudden unexpected death of apparently healthy infant
No single cause identified
Provide empathic support to family
Inform family that autopsy must be done

116. Common Problems: 1–18 Years
Chapter 61
Common Problems: 1–18 Years

117. Respiratory System Upper-respiratory infections Allergic rhinitis
Tonsillitis
Asthma
Foreign-body aspiration

118. Tonsillitis

119. Epiglottitis

120. Epiglottitis

121. Bronchiolitis