Sie sind auf Seite 1von 27

The Respiratory

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

Structure and Function

Gas exchange

Changes associated to Aging

recoil and compliance


AP diameter

functional alveoli

in Pa02

Respiratory defense mechanisms


less effective

Altered respiratory controls


More gradual response to
changes in O2 and Co2 levels
in blood

Diagnostics

Pulse Oximetry

Chest X-Ray

Computed Tomography
(CT scan)

Bronchoscopy

Thoracentesis

Pulmonary Function
Tests

Sputum Specimen and


Cultures

Diagnostics: Pulse Oximetry

Measures arterial oxygen


saturation

Pulse oximetry probe on


forehead, ears, nose, finger,
toes,

False readings

Intermittent or continuous
monitoring

Ideal values: 95-100%

When to Notify MD

< 91%
86% (Medical Emergency)

Diagnostics: Chest X-Ray

Screen, diagnose,
evaluate treatment

Instructions: No
metals/jewelry

Diagnostics: Chest X-Ray Cont.


Nodule

Infiltrates

Posterior Anterior View

Left Lateral View

Diagnostics: Sputum Specimen


To diagnose; evaluate treatment
Specimen: ID organisms or abnormal
cells

Culture & Sensitivity (C&S)


Cytology
Gram stains

(e.g. Acid Fast Bacilli)

Diagnostics: Computed
Tomography: CT Scan

Images in crosssection view

Uses contrast
agents

Instructions:

Right upper Lobe

Diagnostics: Bronchoscopy

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

Procedure Care/Instructions:
NPO 6 -8 hrs prior
Sedation during procedure
Post Procedure:
HOB elevated
Observe for hemorrhage
NPO until gag reflex returns

Diagnostics: Pulmonary
Function Test (PFTs)

Evaluate lung function

Observe for increased


dyspnea or
bronchospasm

Instructions:
No bronchodilators 6
hours prior

Diagnostics: Thoracentesis

Specimen from
pleural fluid

Treat pleural
effusion

Assess for
complications

Post-Procedure care:
CXR after procedure

Positions
Sitting on side of bed over bedside table
chest
elevated
Lying on affected side
Straddling a chair

Assessment: Cues to
Respiratory Problems
Dyspnea
Cough
Sputum

Pneumonia: Case Study


Pathophysiology

Pneumonia: Pathophysiology Cont.

Pneumonia: Etiology

Cause

bacteria (75%)
viruses
fungi
Mycoplasma
Parasites
chemicals

Pneumonia: Classifications

Community-acquired pneumonia (CAP)

Onset in community or during 1st 2 days of hospitalization


(Strep. pneumoniae most common)

Hospital-acquired Pneumonia(HAP/nosocomial)

Occurring 48 hrs or longer after hospitalization

Aspiration pneumonia

Pneumonia caused by opportunistic organisms

Pneumocystis Carinii

Pneumonia: Risk Factors

CAP
Older adult
Chronic/coexisting
condition
Recent history or
exposure to viral or
influenza infections
History of tobacco or
alcohol use

HAP
Older adult
Chronic lung disease
ALOC
Aspiration
ET, Trach, NG / GT
Immunocompromised
Mechanical ventilation

Pneumonia: Clinical
Manifestations

Fevers, chills, anorexia


Pleuritic chest pain
SOB
Crackles/wheezes
Cough, sputum production
Tachypnea

Pneumonia: Clinical
Manifestations-Cont.
Mycoplasma (Atypical)
feeling tired or weak,
headaches, sore throat,
or diarrhea.

Eventually, most develop


a dry cough. They can,
also, develop fever, chills,
earaches, chest pain

walking pneumonia

Pneumonia: Diagnosis

Diagnosis
Physical exam
crackles,
rhonchi/wheezes

CXR area of increased


density
(infiltrates/ consolidation)

Sputum specimen

Gram stain

LUL Infiltrates

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

Nursing Diagnoses

Impaired gas exchange R/T


Pneumonia

Pain R/T infection in lung


Pneumonia

Pneumonia: Complications
Hypoxemia
Pleural effusion

Atelectasis

Pleurisy

Atelectasis
Pleurisy
Pleural Effusion

Toxic sprinkles anyone?

Any Questions?