N233 Final Flashcards
Dyspnea causes
COPD Asthma Pregnancy MI Panic Attack Chocking/Obstruction CHF Age Pulmonary embolism Allergies Pneumothorax ...
Dyspnea
Difficult or laboured breathing
Shortness of breath
A person’s expression with dyspnea may not correlate with respiratory rate or oxygen saturation
Signs and symptoms of respiratory disease
- Dyspnea
- Sputum production
- Cough
- Chest pain
- Wheezing
- Clubbing of fingers
- Hemoptysis
- Cyanosis (late sign)
Risk factors for dyspnea
SMOKING exposure to 2nd hand smoke Family medical hx of lung disease - genetic Allergens Poor nutrition Inadequate exercise Substance abuse Stress
Dyspnea: Subjective data questions
- Complaints of chest tightness, can’s get air, air hunger
- Fatigue
- On exertion
- Cough
- When? Position? Worse when walking?
Dyspnea: Objective Data
Nasal Flaring Increased RR Chest symmetry Rate and depth of respirations Use of accessory muscles Wheeze, creackles, decreased or absent LS Vitals signs Tracheal tug (https://www.youtube.com/watch?v=xM92cP5pE_Q)
Dyspnea: diagnostic tests
Oxygen sats Hbg, RBCs, WBCs ABGs CXR CT chest Throat and sputum cultures Bronchoscopy? PFT - pulmonary function tests = aka Spirometry
Pulmonary Function Tests
Tidal volume Forced vital capacity (FVC) Forced Expiratory Volume (FEV1) Used to assess respiratory function and stage COPD (obstructive or restrictive) To determine if Tx is working
Restrictive Lung Disease
Lungs can’t move well d/t fibrosis, scoliosis, pregnancy, obesity, pulmonary edema
Obstructive Lung Disease
Narrowing of the airways (COPD, Asthma)
Palliative Nursing Interventions for Dyspnea
Decrease anxiety
Treat underlying pathology
Reduce respiratory demand
Alter perception of breathlessness
Pneumonia
Inflammation of the lung parenchyma
Caused by many microorganisms
Pneumonia causes
Bacteria Viruses Parasites Aspiration Opportunistic - immunocompromised .. Typical pneumonia - bacteria Atypical pneumonia "walking pneumonia", less severe symptoms
Community acquired pneumonia (<48h)
Hospital acquired pneumonia/ Nosocomial (>48h)
Reasons why Pts develop HAP (Hospital acquired pneumonia)
Impaired defenses (skin, immune sys)
Highly virulent
Organisms reach lower respiratory tract
Aspiration Pneumonia
Pulmonary consequences of resulting from the entry of endogenous or exogenous substances into the lower airway.
Pneumonia- Objective data
Hx Px (fever,chills, rigors, pleuritic chest pain - worsen by coughing or deep breathing, severily ill appearance) Tachypnea (25-45) SOB Use of accessory muscles Tachycardia, bounding pulse Upper resp tract infection s+s (eg. runny nose) Rash? Pharyingitis Mucoid or purulent sputum
Pneumonia diagnostics
Chest XRay CT chest CBC Blood cultures Sputum sample for C&S ABGs Oxygen saturation VS
Pneumonia: Medical Treatments
Abx (if bacterial) Bed Rest Hydration (Oral or IV) O2 & humidification ( to avoid hypoxemia and help break down sputum) Supportive medication
Pneumonia: Gerontological considerations
Difficult to treat
Higher mortality rate
symptoms: weakness, abdominal symptoms, anorexia, confusion, tachycardia, tachypnea
Breath sounds are difficult indicators of pneumonia in elderly
Pneumonia: Nursing Diagnoses
- Ineffective airways clearance r/t copious tracheobronchial secretions
- Activity intolerance r/t impaired resp fx
- Risk for deficient fluid volume r/t fever and tachypnea
- Imbalanced nutrition (less than body requirements)
- Deficient knowledge about the treatment regimen and preventive health measures
Pneumonia: Nursing Assessments
In hospitalized pts:
- fever, chills, night sweats, pleuritic plain, tachypnea, accessory muscle use, coughing purulent sputum
Once diagnosed watch for:
- VS: temp, pulse, O2 sats
- amount, odour, and colour of secretions
- tachypnea and SOB?
- XRay changes
- fatigue
- knowledge deficit?
Pneumonia: Nursing Interventions
- Improve airway patency
- Rest to conserve energy - Bed rest
- Maintenance of proper fluid volume - Hydration (2-3L per day)
- Adequate nutrition
- Positioning
- Incentive Spirometry
- Deep breathing and coughing
- NG suctioning
- Humidification via face mask
Asthma Triggers
- Respiratory infections (use of more bronchodilators for relief)
- Aiway irritants (smoke, perfume, weather changes- heat or cold)
- Exercise
- Stress
- GI reflux (GERD)
Asthma: S+S
WHEEZING COUGH DYSPNEA Chest tightness May be abrupt Increased effort with expiration tachycardia Severe hypoxia
