Respiratory Exercise

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cswett
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145376
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Respiratory Exercise
Updated:
2012-04-02 22:26:13
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Respiratory Exercise
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Respiratory Exercise
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  1. Physical process of Gas Exchange
    • Ventilation-air in & out of lungs
    •  Elastic Recoil- lungs go back to original shape
    •  Diffusion-O2 & CO2 exchange by movement of gasesfrom higher concentration to lower
    •  Oxygen-Hemoglobin Dissociation Curve –affinity for hemoglobin to O2 & gives up at tissues
    •  ABG’s-measures O2, CO2 status & pH
    •  Control of Respiration -
    •  Medulla oblongata & pons
    •  Chemoreceptors (respond to CO2 & pH)
    •  Mechanical Receptors (control lung expansion)
    •  Irritant Receptors (hair, mucus, cough, macrophages)
  2. Laryngeal Cancer
    • Malignant Cancer of Larynx: (squamous cell)
    •  Risk factors: males>females; > 50 years old,tobacco, alcohol, exposure to chemicals, African Amer.

    •  S/S: Early detection important
    •  Painless growth in mouth
    •  Ulcer that does not heal/change in denture fit
    •  Hoarseness or change in voice
    •  Lump in neck
    •  Dyspnea and/or dysphagia
    •  Pain is a late symptom (sometimes earache)
    •  DX: by biopsy (TNM grading)
  3. Area of Larynx Affected
    Glottis/vocal cords – 60%, hoarseness or change in voice, well differentiated & slow growing with late metastasis as limited lymphatic supply

    Supraglottis/false vocal cords – 35%,dysphagia, lump in throat, halitosis, early metastasis as rich lymphatic supply

    Subglottis/below vocal cords – 5% asymptomatic til tumor obstructs airway
  4. Tx for Larynx CA
    • Radiation – esp. glottis
    • external or internal
    • Preserves voice

    • Chemotherapy – esp. metastasis
    • Primary with radiation v. palliative

    • Surgery –
    • Cordectomy
    • Hemilaryngectomy
    • Total Laryngectomy
    • Radical Neck
  5. Radiation Interventions for Larynx
    • Nurse can suggest interventions to reduce side effects:
    • Dry mouth (xerostomia)
    • Medication to increase production of saliva(Salagen) pilocarpine hydrochloride
    • Squirt or water bottle
    • Increase fluid intake
    • Chewing sugarless gum or candy
    • Nonalcoholic mouth rinse
    • Artificial saliva
    • Avoid commercial mouthwashes and hot or spicy foods because they are irritating
  6. Chemo for CA Larynx
    • Primary treatment with radiation for some tumors
    • Used to treat distant metastasis
    • Palliative if tumor unresectable
    • Multi-drug approach (Cisplatin, 5FU,Methotrexate, Bleomycin)
  7. Surgery for CA Larynx
    Cordectomy-superficial tumor involving one cord; voice rest

    Hemilaryngectomy-removal of one vocal cord or lateral part larynx; temporary tracheostomy-voice preserved but quality is breathy and hoarse

    Total laryngectomy- perm. separate trachea &esophagus so no aspiration; stoma or trach

    Radical neck-+ lymph nodes but no metastasis; all soft tissue from mandible to clavicle so deformity
  8. ABGs
    • pH (7.35-7.45)
    • CO2 (35-45 mm Hg)
    • HCO3 (22-26) mmol/L
    • BE –3 to +3
    • O2 (80-100 mm Hg) evaluate
    • SaO2 (95-100%) O2 status
  9. Respiratory System and Aging
    • DECREASE IN ELASTIC RECOIL OF THE LUNG
    • DECREASE IN CHEST WALL COMPLIANCE
    • INCREASE IN ANTEROPOSTERIOR DIAMETER
    • DECREASE IN FUNCTIONAL ALVEOLI
    • LOWER PaO2, HIGHER PaCO2
    • DECREASE IN CELL-MEDIATED IMMUNITY
    • DECREASE IN COUGH
    • MORE SIGNIFICANT IF SMOKER, OBESE,CHRONIC DISEASE
  10. Respiratory Acidosis
    Due to: excess CO2 or excess carbonic acid, acute& chronic lung diseases (COPD, cystic fibrosis),neuromuscular disease, chest trauma, narcotics(suppresses resp.)

    • S/S:
    • Acute: HA, warm flushed skin, blurred vision,irritable, cardiac arrest (hypercapnia and increasedICP);
    • Chronic: weakness, impaired memory, personalitychanges, daytime sleepiness

    Tx: bronchodilators, antibiotics if infection,narcan to reverse opioids, O2 & ventilatorysupport, pulmonary hygiene (chest PT)
  11. Metabolic Acidosis
    Due to: increase in metabolic acids (DM, renal failure, lactic acid, ASA toxicity), loss of HCO3-(diarrhea, intestinal suction), increase in K+ & Cl-

    S/S: Kussmauls resp., weakness/fatigue, N/V,anorexia, decreased LOC (stupor/ coma),dysrhythmias, warm flushed skin; high K & Cl with low Mg levels

    Tx: underlying cause (DM ketoacidosis give insulin & fluids, correct cause of diarrhea),alkalizing solutions (NaHCO3)
  12. Respiratory Alkalosis
    Due to: anxiety or hyperventilation, fever, early ASA toxicity, thyrotoxicosis, pregnancy

    S/S: hightheaded, panic, paresthesia of extremities, chest palpitations, Chvosteksign/Trousseau sign (tetany), seizures

    Tx: underlying cause (antianxiety meds,rebreather mask/paper bag, reduce ventilator settings)
  13. Metabolic Alkalosis
    Due to: loss of acids (N/V, NG suction) or excess bicarb. (antacids, NaHCO3), low K+

    S/S: confusion, hype rreflexia, tetany,dysrhythmias, resp. failure, Trousseau sign,hypotension

    Tx: replace fluid & electrolyte balance esp. KCl, if severe acidifying solutions (hydrochloric acid orammonium chloride), teach risks of antacids
  14. ACUTE BACTERIAL PNEUMONIA
    • Streptococcus pneumoniae
    • Sudden onset
    • Chills/fever
    • Tachycardia & tachypnea
    • Productive cough (purulent or rust-colored)
    • Pleuritic chest pain (worse with coughing &deep resp.)
    • Pulmonary consolidation
    • Dullness of percussion
    • ↑ fremitus
    • Bronchial breath sounds
    • Crackles/Rhonchi
    • Elderly with fever, tachypnea &altered mentation (agitation)
  15. PRIMARY ATYPICAL PNEUMONIA
    • (Mycoplasma Pneumoniae or Viral; “Walking” Pneumonia)
    • More gradual onset
    • Dry hacking nonproductive cough
    • Headache
    • Myalgia (muscle aches)
    • Sore throat (pharyngitis)
    • Lack of alveolar exudate & consolidation
  16. NURSING INTERVENTIONS FOR PNEUMONIA
    • Push Fluids/monitor IV’s
    • Monitor VS esp. respirations
    • Provide humidified O2
    • Postural Drainage
    • Suction PRN
    • Encourage Rest
    • Administer Meds (antibiotics,bronchodilators)
    • High Fowlers to present aspiration
    • Check gag reflex
    • Do not overmedicate with Narcotics

    • Client Education
    • Teach prevention
    • Emphasize need to finish all meds
    • Adequate rest
    • Encourage vaccine
    • Deep breathing exercises(X 6 wk after Hosp. Discharge)
    • Return to M.D. if fever, SOB,dyspnea, sleepiness, confusion
  17. TUBERCULOSIS HIGH RISK FOR INFECTION
    • Close contact
    • IV drug users
    • Alcoholics
    • Living in crowded,substandard housing
    • Immigrants from areas with high incidence
    • Medically underserved
    • Institutionalized
    • Health care workers
    • Immunocompromised
    • Preexisting medical conditions:
    • diabetes
    • chronic renal failure
    • silicosis
    • malnourishment
  18. TUBERCULOSISSIGNS / SYMPTOMS
    • low grade fever
    • fatigue
    • anorexia
    • weight loss
    • night sweats
    • chest pain
    • persistent cough(purulent to blood tinged/rusty)
  19. TUBERCULOSIS NURSING INTERVENTIONS
    • Promote airway clearance & hygiene
    • Good nutrition
    • Advocate adherence and prevention
    • Monitoring & manage complications
    • Report to health department
    • TB Screening(Mantoux test/PPD)
  20. ASTHMA PATHOPHYSIOLOGY
    • Early Phase: stimulus/trigger causes release of chemical mediators (histamine, prostaglandins,& leukotrienes)
    • Increase parasympathetic system causing bronchoconstriction & spasm
    • Increase capillary permeability with edema & mucus production

    Late Phase: 4-12 hrs. after trigger, basophils & eosinophils activated with increased bronchoconstriction, air trapping and decreased oxygen exchange resulting in resp. alkalosis
  21. ASTHMA NURSING INTERVENTIONS
    • Monitor resp. & breath sounds
    • Encourage fluids
    • Breathing exercises (pursed-lip & abd.breathing)
    • Chest physiotherapy/postural drainage
    • O2 – monitor O2 sat. & ABG’s
    • Keep calm (relaxation exercises)
    • Pt. education (triggers & how to controlwith medications)
  22. COPD/CHRONIC BRONCHITIS PATHOPHYSIOLOGY
    • Hyperplasia of mucous cells
    • Absence of cilia
    • Chronic inflammation
    • Narrowing of airways
    • Increased bronchial infections
    • Eventual scarring of bronchial walls
  23. COPD/CHRONIC BRONCHITIS SIGNS & SYMPTOMS
    • Productive cough (thick tenacious sputum)
    • Cyanosis
    • Rhonchi & wheezes
    • Right sided heart failure
    • +JVD (jugular venous distension)
    • Pitting edema
    • Enlarged heart on CXRay
    • Liver engorgement
    • Clubbing (late sign hypoxia)
  24. COPD/EMPHYSEMA PATHOPHYSIOLOGY
    • Obstructed airways
    • Over inflation
    • Loss of elasticity
    • Alveoli dilate & fuse together/”bulla”
    • increased ­dead space
    • decreased gas exchange
    • Lungs chronically hyper expanded
  25. COPD:EMPHYSEMA
    S & S
    • Signs & Symptoms:
    • ­ SOB (dyspnea on exertion vs.at rest)
    • Barrel chest
    • Use of accessory muscles
    • Pursed lip breathing
    • Retractions
    • Tripod position
    • Orthopnea
    • Hyperresonance percussion
  26. COPD NURSING INTERVENTIONS
    • Breathing exercises (abd., purse lip, or huffing)
    • Nutrition (low dairy & low Na, high protein, high fat with min. carbohydrates & freq. small meals)
    • Exercise program (6 min. walk for ADL)
    • Rest periods
    • Pulmonary hygiene/postural drainage
    • Encourage plan to stop smoking
    • LOW FLOW O2
  27. Breath Sounds
    Vesicular
    Bronchavesicular
    Bronchial
    Vesicular - soft, heard over most of lung 3:1

    Bronchvesicualr - medium - heard over bronchial tree 1:1

    Bronchial - loud, high pitch - heard over manubrium 2:3
  28. Postop Laryngectomy
    • Monitor airways
    • encourage deep breathing & coughing
    • Elevate HOB - reduces edema & swelling
    • Humidifier - with tracheostomy humidification is lost
    • Maintain adequate fluid intake
    • Suction via trach -sterile technique - clears secretions
    • Provide trach care
    • instruct to support head when moving in bed
    • call light in reach - answer prompt
    • Encourage family visists
    • Spend time with patient - establish trust

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