caring for individuals experiencing respiratory health challenges
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HealthTRANSCRIPT
Caring for Individuals Caring for Individuals Experiencing Respiratory Experiencing Respiratory
ChallengesChallenges
NURS2016NURS2016
Self-StudySelf-Study
Common ColdCommon Cold
Acute/Chronic SinusitisAcute/Chronic Sinusitis
RhinitisRhinitis
Acute/Chronic PharyngitisAcute/Chronic Pharyngitis
Tonsillitis and AdenoiditisTonsillitis and Adenoiditis
Clinical Manifestations & Clinical Manifestations & TreatmentTreatment
Sore throat, fever, snoring and difficulty Sore throat, fever, snoring and difficulty swallowing.swallowing.
Mouth breathing, earaches, halitosis, Mouth breathing, earaches, halitosis, frequent colds.frequent colds.AntibioticsAntibiotics
Surgical tonsillectomy (& adenoidectomy)Surgical tonsillectomy (& adenoidectomy)
Nursing Care related to T&ANursing Care related to T&A
Pre-op assessment.Pre-op assessment.
Pre-op teaching Pre-op teaching
Post-opPost-op– Assess operative siteAssess operative site– Ice collarIce collar– AnalgesiaAnalgesia– Ice chips/waterIce chips/water– No straws, no No straws, no
coughing, limit talkingcoughing, limit talking
Risk of HemorrhageRisk of HemorrhageAssess expectorantAssess expectorantAssessment Assessment swallowingswallowingAssess VSAssess VSRestlessnessRestlessness
Hemorrhage at Hemorrhage at operative site is an operative site is an
emergency.emergency.
Ostruction/Trauma of URTOstruction/Trauma of URT
Sleep apneaSleep apnea
ObstructiveObstructive
Apnea>10sec. & Apnea>10sec. & >5x/hr>5x/hr
Tx: +ve airway Tx: +ve airway pressure or surgerypressure or surgery
Nurse educate pt re tx Nurse educate pt re tx and use of oxygenand use of oxygen
EpistaxisEpistaxis
Pressure, Head tiltPressure, Head tilt
Chemical cautery or Chemical cautery or vasoconstrictorsvasoconstrictors
Assess vital signsAssess vital signs
Preventative Preventative strategiesstrategies
Cancer of LarynxCancer of Larynx
Glottic area, supraglottic area, subglottisGlottic area, supraglottic area, subglottis
Risk factors: carcinogens & othersRisk factors: carcinogens & others
Radiation treatmentRadiation treatment
Surgical treatmentSurgical treatment– Partial laryngectomyPartial laryngectomy– Supraglottic laryngectomySupraglottic laryngectomy– HemilaryngectomyHemilaryngectomy– Total laryngectomyTotal laryngectomy
Primary Nursing Interventions: Primary Nursing Interventions: LaryngectomyLaryngectomy
Pre-operative teachingPre-operative teaching
Reducing anxiety and depressionReducing anxiety and depression
Maintaining a patent airwayMaintaining a patent airway
Promoting alternative communication Promoting alternative communication methodsmethods
Promoting adequate nutritionPromoting adequate nutrition
Promoting home-based carePromoting home-based care
Primary Nursing Interventions: Primary Nursing Interventions: LaryngectomyLaryngectomy
Monitoring and managing potential Monitoring and managing potential complicationscomplications– Respiratory distress and hpyoxiaRespiratory distress and hpyoxia– HemorrhageHemorrhage– InfectionInfection– Wound breakdownWound breakdown
AtelectasisAtelectasisClosure or collapse of alveoliClosure or collapse of alveoli
Prevention: Prevention: Education and ReinforcementEducation and Reinforcement
Frequent position changeFrequent position change
Early ambulationEarly ambulation
DB&CDB&C
Incentive spirometerIncentive spirometer
AtelectasisAtelectasis
Management: Management:
Positive expiratory pressurePositive expiratory pressure
Suctioning secretions, chest physical Suctioning secretions, chest physical therapy, bronchiodilatorstherapy, bronchiodilators
ThoracentesisThoracentesis
Respiratory InfectionsRespiratory Infections(lower RT)(lower RT)
Acute tracheobronchitisAcute tracheobronchitis
PneumoniaPneumonia
Pulmonary TuberculosisPulmonary Tuberculosis
Acute TracheobronchitisAcute Tracheobronchitis
ManagementManagement
Antibiotic treatmentAntibiotic treatment
ExpectorantsExpectorants
Deep suctioning and Deep suctioning and ventilation supportventilation support
Nursing CareNursing Care
Increasing fluuid Increasing fluuid intakeintake
Breathing and Breathing and coughing exercisescoughing exercises
Encourage restEncourage rest
Education related to Education related to medicationsmedications
PneumoniaPneumoniaInflammation of Lung ParenchymaInflammation of Lung Parenchyma
Caused by microbial agent: Strep Caused by microbial agent: Strep pneumoniae, haemophilus influenzae, pneumoniae, haemophilus influenzae, legionella, pseudomonas aeruginosalegionella, pseudomonas aeruginosa
Community Aquired PneumoniaCommunity Aquired Pneumonia
Hospital Aquired Pneumonia Hospital Aquired Pneumonia
ImmunocompromisedImmunocompromised
Aspiration PneumoniaAspiration Pneumonia
Medical Managment & Medical Managment & ComplicationsComplications
ManagementManagement
Antibiotic according to Antibiotic according to sensitivity and Gram sensitivity and Gram stain.stain.
Supportive treatment Supportive treatment when viralwhen viral
Oxygen if hypoxicOxygen if hypoxic
ComplicationsComplications
Shock and respiratory Shock and respiratory failurefailure
Atelectasis and Atelectasis and pleural effusion pleural effusion (empyema)(empyema)
SuperinfectionSuperinfection
Nursing AssessmentNursing AssessmentPneumoniaPneumonia
T & PT & P
Secretions/Secretions/expectorantexpectorant
CoughCough
RespirationsRespirations
Chest assessmentChest assessment
Nursing InterventionsNursing InterventionsPneumoniaPneumonia
Improving airway Improving airway patencypatency
Promoting rest and Promoting rest and conserving energyconserving energy
Promoting fluid intakePromoting fluid intake
Maintaining nutritionMaintaining nutrition
Monitoring and Monitoring and managing potential managing potential complicationscomplications
Pulmonary TuberculosisPulmonary Tuberculosis
Infectious disease of the lung parenchymaInfectious disease of the lung parenchyma
Mycobacterium tuberculosisMycobacterium tuberculosis
Worldwide public health problemWorldwide public health problem
Common TB meds: isoniazid, rifampin, Common TB meds: isoniazid, rifampin, streptomycin, pyrazinamide, ethamutolstreptomycin, pyrazinamide, ethamutol
Nursing AssessmentNursing AssessmentTBTB
FeverFever
AnorexiaAnorexia
Weight lossWeight loss
Night sweatsNight sweats
FatigueFatigue
Enlarged and painful Enlarged and painful lymph nodeslymph nodes
CoughCough
SputumSputum
Ecophony, fremitusEcophony, fremitus
Diminished bronchial Diminished bronchial sounds & cracklessounds & crackles
Nursing DiagnosisNursing DiagnosisKnowledge deficit about tx regimen Knowledge deficit about tx regimen
& preventative health measures& preventative health measures
Medication regimen is complexMedication regimen is complexTB is highly communicable – meds are the TB is highly communicable – meds are the most effective means of preventing most effective means of preventing transmissiontransmission
Medication side effects are primary Medication side effects are primary reason for D/Creason for D/C
COPDCOPD
A disease state characterized by airflow A disease state characterized by airflow limitation that is not fully reversiblelimitation that is not fully reversible
Often include diseases such as chronic Often include diseases such as chronic bronchitis and emphysemabronchitis and emphysema
Risk factors: active and passive smoking, Risk factors: active and passive smoking, occupational exposure, air pollution and occupational exposure, air pollution and genetic abnormalitiesgenetic abnormalities
Chronic BronchitisChronic Bronchitis
Presence of cough and sputum for at least Presence of cough and sputum for at least 3 months past 2 years.3 months past 2 years.
Bronchial walls thicken and lumen narrowsBronchial walls thicken and lumen narrows
Increased susceptability to RTIIncreased susceptability to RTI
EmphysemaEmphysema
Abnormal distention of the air spaces Abnormal distention of the air spaces beyond the terminal bronchioles with beyond the terminal bronchioles with destruction of the walls of the aveoli.destruction of the walls of the aveoli.
Usually long history of smokingUsually long history of smoking
Dyspnea becomes the major symptomsDyspnea becomes the major symptoms
Nursing CareNursing CareCOPDCOPD
Nursing AssessmentNursing Assessment
Focus on symptomsFocus on symptoms
Disease historyDisease history
Become familiar with Become familiar with chart pg 578chart pg 578
Nursing DiagnosisNursing DiagnosisImpaired gas exchangeImpaired gas exchange
Ineffective airway Ineffective airway clearanceclearance
Ineffective breathing Ineffective breathing patternpattern
Self-care deficitSelf-care deficit
Activity intoleranceActivity intolerance
Ineffective copingIneffective coping
Knowledge deficitKnowledge deficit
Nursing InterventionsNursing InterventionsCOPDCOPD
Breathing exercisesBreathing exercisesInspiratory muscle trainingInspiratory muscle trainingActivity pacingActivity pacingSelf-care activitiesSelf-care activitiesPhysical conditioningPhysical conditioningOxygen therapyOxygen therapyNutritional therapyNutritional therapyCoping measuresCoping measures
Therapeutic ApproachTherapeutic ApproachCOPDCOPD
Treatment to improve ventilation and Treatment to improve ventilation and decrease work of breathing.decrease work of breathing.
Prevention & tx of infectionPrevention & tx of infection
Improve energy conservation techniquesImprove energy conservation techniques
Proper environmental conditionsProper environmental conditions
Psychological supportPsychological support
Ongoing educationOngoing education
Oxygen therapy and COPDOxygen therapy and COPD
Because hypoxemia, rather than high Because hypoxemia, rather than high carbon dioxide, drives respiration in carbon dioxide, drives respiration in COPD, andCOPD, and
Because oxygen therapy can raise oxygen Because oxygen therapy can raise oxygen levels in the bloodlevels in the blood
COPD patient receiving oxygen tx may COPD patient receiving oxygen tx may experience decreased stimulation to experience decreased stimulation to breath breath
AsthmaAsthma
Inflammatory disease of airwaysInflammatory disease of airways– Hyper-responsivenessHyper-responsiveness– Mucosal edemaMucosal edema– Mucous productionMucous production– Reversible processReversible process
*Prevention: identify substances that precipitate *Prevention: identify substances that precipitate symptomssymptoms
Nursing CareNursing CareAsthmaAsthma
Assess resp statusAssess resp status
Severity of symptomsSeverity of symptoms
Breath soundsBreath sounds
Peak flowPeak flow
Pulse oxymetryPulse oxymetry
Vital signsVital signs
Hx of allergy to medsHx of allergy to meds
Current med regimenCurrent med regimen
Admin and monitor Admin and monitor medicationmedication
Ensure hydrationEnsure hydration
Monitor S&S infectionMonitor S&S infection
Provide psychological Provide psychological supportsupport
Pulmonary EmbolismPulmonary Embolism
Obstruction of Obstruction of pulmonary artery by a pulmonary artery by a thrombusthrombus
Can also be air, fat, or Can also be air, fat, or amniotic fluid emboliamniotic fluid emboli
Risk factors (p.472)Risk factors (p.472)
Venous stasisVenous stasis
HypercoagulabilityHypercoagulability
Venous endothelial Venous endothelial diseasedisease
Certain disease stateCertain disease state
Other: age, obesity, Other: age, obesity, clothing, pregnancy.clothing, pregnancy.
Nursing CareNursing CarePulmonary EmbolismPulmonary Embolism
Minimize the risk (know the risks)Minimize the risk (know the risks)
Prevent thrombus formationPrevent thrombus formation
Monitor thrombolytic therapyMonitor thrombolytic therapy
Manage painManage pain
Oxygen therapyOxygen therapy
Pulmonary EmbolismPulmonary Embolism
Often suddenOften sudden
Painful: ischemiaPainful: ischemia
Immediate SOBImmediate SOB
ReminderReminder
Self study upper respiratory trackSelf study upper respiratory track
Focus on promoting health throughFocus on promoting health through– Preventative approachesPreventative approaches– Facilitate quality of life while living with chronic Facilitate quality of life while living with chronic
respiratory challengesrespiratory challenges