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Acute Respiratory Disorder
NP02L029
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Terminal Learning Objective
Given a patient with an acute respiratory
disorder, determine approaches for patient
care by correctly responding to written,oral and experiential assessment measures.
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Enabling Learning Objectives
A: Examine the etiology/pathophysiology, clinicalmanifestations, assessment diagnosis, medical
management and nursing interventions of a
patient with a pneumothorax.
B: Describe the pathophysiology, clinical
manifestations, assessment diagnosis, medical
management and nursing interventions of lungcancer.
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Enabling Learning Objectives
C: Describe the pathophysiology, clinical
manifestations, assessment diagnosis, medical
management and nursing interventions of
pulmonary edema.
D. Examine the etiology/pathophysiology,
clinical manifestations, assessmentdiagnosis,
medical management and nursing
interventions of
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Enabling Learning Objectives
E: Describe the etiology/pathophysiology,
clinical manifestations, assessment diagnosis,
medical management and nursing interventions of
a patient with Acute Respiratory DistressSyndrome.
F. Explain the pharmacological and nursingimplications of mucolytic agents
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Pneumothorax
Etiology/Pathophysiology Air or gas in the pleural space, causing the lung
to collapse
Causes
Chest trauma
Ruptured bleb
Pleural lining injury
Spontaneous
Interrupts the normal negative pressure, keeping thelung from remaining inflated
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Pneumothorax
Tension pneumothorax
Build up of air in the pleural space, causing
interference with the ability of the heart and lungs
to fill
Life threatening
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Pneumothorax
Clinical Manifestations- patient may present with arecent chest injury
Decreased breath sounds on affected side
Sharp pleuritic pain, dyspnea
Diaphoresis, tachycardia
Tachypnea
Abnormal chest movement
Possible sucking chest wound on inspiration Hypoxia
Shifting of mediastinum
Hypotension
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Pneumothorax
Assessment
Inquire to a recent injury or coughing
episode
May c/o shortness of breath, anxiety,
hypoxia
Breath sounds unequal, or diminished
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Pneumothorax
Assessment (cont)
Penetrating or blunt wounds to the chest,unequal movement with flail segements
Assess respiratory and cardiac, rate andrhythm
Monitor vital signs frequently
Note color characteristics, and amount of sputum
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Pneumothorax
Diagnostic tests
Chest x-ray
ABG
Medical management
Needle thoracostomy
Chest Tube
Heimlich valve/water-seal suction
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Pneumothorax
Nursing interventions- maintain airway
patency and oxygenation
Assess and document patency of chest tube
Provide analgesics
Assist with coughing and deep breathing
Splint or support Observe
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Pneumothorax
Nursing interventions(cont)
Patient teaching
Increase fluid intake
Avoid fatigue
Report signs and symptoms of recurrence
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Pneumothorax
Nursing diagnosis
Breathing pattern ineffective r/tnonfunctioning lung
Fear related to feeling of air hunger
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Check on Learning
List three signs of a pneumothorax:
a.----------------------
b.----------------------
c.----------------------
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Check on Learning :
List three signs of a pneumothorax:
Decreased breath sounds on
the affected side
Sharp, pleuritic pain withdyspnea
Diaphoresis, tachycardia
Tachypnea
Hypoxia
Abnormal chest movement
If penetrating injury may
hear sucking sounds on
inspiration
Shifting of the mediastinum
to the unaffected side with
compression of the great
vessels
Hypotension - due to
decrease in venous return to
the heart and poor cardiac
filling
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Lung Cancer
Etiology/Pathophysiology Leading cause of cancer related death in men and
women Accounts for 28% of all cancer deaths
Tumors, 80-90% r/t cigarettes
Second hand smoke, asbestos and air pollution
Mortality
Treatment
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Lung Cancer
Types of lung cancer
Small cell
Non-small cell
Squamous cell carcinoma
Large cell
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Lung Cancer
Assessment
Chronic hoarseness
Chronic cough
History of smoking or environmental
exposure
Weight loss
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Lung Cancer
Assessment(cont) Hemoptysis
Shortness of breath, wheeze Pleural effusion
Edema of face or neck
Friction rub Clubbing of fingers
Pericardial effusion
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Lung Cancer
Diagnostic tests Chest X-Ray
CT
MRI Bronchoscopy
Needle aspiration
Biopsy Mediastinoscopy
Scalene lymph node biopsy
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Lung Cancer
Medical management- depends on type and
stage of lung cancer
Estimated 1/3 of patients inoperable when first
diagnosed
Another 1/3 found inop during exploratory
thoracotomy Surgical treatment-1/3 experience tumor
spread
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Lung Cancer
Surgical treatment Pneumonectomy
Lobectomy
Segmental resection
Video assisted thorascopic surgery
Radiation and chemotherapy
SCLC chemotherapy
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Lung Cancer
Nursing interventions- directed at improvingquality of life
General nursing measures Monitor antineoplastic side effects
Reduce exertion
Maintain body weight
Relieve pain, administer analgesics
Encourage patient to stop smoking
American Cancer Society resourses
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Lung Cancer
Nursing diagnosis and interventions Airway clearence ineffective r/t lung
surgery Facilitate optimal breathing
Encourage ambulation
Position changes Cough deep breathe
Assess breath sounds
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Lung Cancer
Nursing diagnosis and interventions(cont) Fear r/t cancer treatment and prognosis
Explain treatments and procedures
Listen to the patient, accept feelings of anger
Encourage verbalization of feelings Supportive services
Monitor for signs and symptoms of worthlessness,anxiety, powerlessness
Prognosis-10-15% live 5 years or longer Survival rate- 40% for cancers identified in localstage
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Pulmonary Edema
Etiology/Pathophysiology Accumulation of serous fluid in interstitial lung
tissue and alveoli Results from Severe left ventricular failure
Inhalation of irritating gases
Rapid administration of I.V. fluids
Barbiturate and opiate overdose
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Pulmonary Edema
Serous fluid forced into alveoli
Gas diffusion severely affected
Acute
Can lead to death if untreated
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Pulmonary Edema
Clinical manifestations Dyspnea
Tachypnea Tachycardia
Hypoxia, cyanosis
Pink frothy sputum
Restlessness, agitation
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Pulmonary Edema
Assessment Note c/o dyspnea
May express feeling of impending death Assess for signs and symptoms of resp distress
Wheezing and crackles
Weight gain Decreased urinary output
Productive cough with frothy pink sputum
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Pulmonary Edema
Diagnostic tests
CXR
ABG
Medications
Oxygen therapy
Lasix
Morfine sulfate
Nipride
Digoxin
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Pulmonary Edema
Nursing interventions
Assess respiratory status frequently
O2 therapy
Volume status
Patient teaching
Prognosis
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Pulmonary Embolus
Clinical manifestations Chest pain
Dyspnea
Tachypnea
Hemoptosis
Diminished lung sounds
Elevated temperature
Hypotension
Regional bronchoconstriction, Atelectasis
Pulmonary edema, decreased surfactant
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Pulmonary Embolus
Diagnostic tests ABG’s
CXR CT angiogram
V/Q scan
Pulmonary arteriogram
D-dimer
Venous ultrasound
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Pulmonary Embolus
Nursing interventions Assess sensorium
Monitor cardiorespiratory status DVT treatment
Assess for signs of bleeding
Patient teaching
Prognosis- 30% mortality rate if untreated.
5% mortality with early diagnosis and treatment
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ARDS
Etiology/Pathophysiology Also called non-cardiogenic pulmonary edema
Secondary to an acute disease process, asyndrome of pulmonary shunting , hypoxemia,reduced lung compliance and parenchymal lungdamage
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ARDS
Pathophysiology
Surface of alveolar capillary membrane becomes
altered Fluid leaks into the interstitial space and alveoli
Results in pulmonary edema and hypoxia
Alveoli lose elasticity and collapse Pulmonary artery hypertension
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ARDS
Clinical manifestations
Usually manifests in 12-24 hours post surgery
Respiratory distress with altered breath sounds
within 5-10 days
Altered sensorium
Tachycardia
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ARDS
Assessment
Obtain background information
Observe changes in patients condition Assess respiratory rate rhythm and effort
Assess for nasal flaring, retractions, or cyanosis
Assess for crackles and wheezing
Assess level of consciousness
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ARDS
Diagnostic tests
Pulmonary functions tests
ABG’s CXR
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ARDS
Medical management – focuses on supportave
treatment by maintaining adequate
oxygenation and treating the cause
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ARDS
Medications
Diuretics
Morphine sulfate
Digoxin
Antibiotics
Ventilatory support
Nitric oxide
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ARDS
Nursing interventions and patient teaching
Goal: Provide adequate oxygenation and
ventilation and treat multi system response to
ARDS Monitor respiratory status
Assess vital signs
Position patient to facilitate optimal ventilation Turn cough deep breath
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ARDS
Nursing diagnosis
Gas exchange impaired r/t tachypnea
Nursing interventions
Monitor ABG’s
Monitor for restlessness
Administer oxygen
Report v/s changes and L.O.C.
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ARDS
Nursing diagnosis Breathing pattern, ineffective r/t respiratory
distress Nursing interventions
Assess respiratory rate rhythm and effort
Proper positioning Maintain airway patency and promote
C/DB
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Mucolytics A mucolytic is a drug that loosens
respiratory secreations.
Use: Bronchitis.
Cystic Fibrosis.
COPD. Atelectasis.
Acetaminophen toxicity.
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Mucolytics Con’t
Actions:
Decreases viscosity of secretions by breakingdisulfide links of mucoproteins.
Serves as a substrate in place of glutathione,which is necessary to inactivate toxicmetabolites in acetaminophen overdose.
Example: acetylcysteine (Acetadote, Mucomyst).
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Mucolytics Con’t
Contraindications:
Hypersensitivity.
Increased intracranial pressure.
Status asthmaticus.
Precautions:
Pregnancy.
Hypothyroidism.
Addison’s Disease.
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Mucolytics Precautions Con’t
CNS depression. Brain tumor.
Asthma.
Renal / heptic disease.
COPD.
Psychosis.
Alcoholism. Convulsive disorders.
Breastfeeding.
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Mucolytics Side Effects
CNS: dizziness, drowsiness.
CV: hypotension.
EENT: rhinorrhea. GI: nausea, stomatitis, constipation, vomiting,
anorexia, hepatotoxicity.
Integ: urticaria, rash, fever, clamminess, pruritus.
Resp: bronchospasm, hemoptysis, chesttightness.
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Mucolytics Con’t
Interactions:
Do not use with iron, copper, rubber.
Do not mix with antibiotics. Increases the effects of nitrates.
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Mucolytics Nursing Implications
Assessment: Cough: type, frequency, character, including
sputum.
VS: resp rate, rhythm, increased dyspnea.
CV: dysrthythmias.
Lab Tests: ABGs (increased CO2: asthma).
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Mucolytics Nursing Implementation
Administration (PO):
Mix with soft drinks to disguise taste. (Give
within one hour). Give ½ - 1 hour before meals for better
absorption and to decrease nausea.
Assistance with inhaled dose: bronchodilator if
bronchospasm occurs.
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Mucolytics Nursing Implementation Con’t
Antidotal: within 24 hours.
Store in refrigerator (up to 96 hours after
opening).
Gum, hard candy, frequent rinsing of mouth for
dryness of oral cavity.
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Mucolytics Patient Teaching
About mucolytic use.
Unpleasant odor will decrease after repeated use.
Discoloration of solution after opening, does notaffect effectiveness of medication.
Report vomiting, since dose may need to berepeated.
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Mucolytics Evaluation
Absence of purulent secretions.
Absence of hepatic damage in
acetaminophen toxicity.
View:videos.howstuffworks.com/discover
y-health/14598-human-atlas-mucolytics-video.htm
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Check on Learning
Question: What is the action of
Mucolytics?
Answer:
Loosens respiratory secretions.
Reduces the viscosity of respiratory secretions by direct action on the mucus.
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REVIEW
Pneumothorax
Lung cancer
Pulmonary edema
Pulmonary embolus
ARDS
Mucolytics