Alterations in oxygenation/Pneumonia/Sleep Apnea
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. What would you like to do?
Propels mucous towards the orpharynx
phagocytize inhaled foreign particles like bacteria
decreases the surface in alveoli
collapsed or airless alveoli
Post op pt are at risk for cuz of the affects of anesthesia nd restriced breathing with pain
provides the lungs with blood for gas exchange
provides oxygen to the bronchi and other pulmonary tissues
lines the chest cavity
lines the lungs
involves inspiration and expiration
gas flows from an area of high concentration (atmosphere) to low concentration (intracostal)
passive and occurs because of elastic recoil
Is a measure of the ease of expansion of the lungs
Requires the help of the elasticity of the lungs and elastic recoil of the chest wall.
oxygen and carbon dioxide moving back and fort across the alveolar-capillary membrane
defense mechanism that's in response to the inhalation of large amounts or irritating substances
Auscultation of lungs....start where?
Where's the loudest?
Start at right apex- go over, down, over, down and over.
Loudest on the lower back
Subjective data for respiratory assessment
- past health history
- functional health (sleep, nutrition, activity, coping values)
Objective data for assessment of respiratory system
Observe respiratory rate, depth, rhythm and skin color
Inspect skin and nails, neck for position of trachea and movement of chest wall
Palpage chest and back for masses
Percuss to assess density of lungs
Auscultate to one full cycle of inspiration and expiration
What do you note when listening to breath sounds?
- duration of sound
- presence of adventitious sounds
Give an example of over compliant lungs
COPD...warn out pantyhose. Too stretchy so doesnt expand well.
Example of high compliance
when a small amount of pressure is needed to expand the lungs
individualized perception of labored or difficult breathing
dyspnea or sob
What causes dyspnea?
- disorder that causes airway resistance or constriction
- disorder that cause decreased compliance
- disoreders that later pulmonary vascular system
Ex of disorders that cause airway resistance or constriction
Example of disorders that cuase decreased compliance
Example of disorders that later the pulmonary vascular system
- pulmonary HTN
- Left sided CHF
What can cause dyspnea?
- weather (cold or santa ana's)
- paroxysmal nocturnal dyspnea
cessation of air flow thru the nose and mouth for at least 10 seconds
30 or more apneic episodes during 7 hours of sleep or 5+ apneas/hr
Sleep apnea increases a persons risk for:
- Heart disease
- depression/memory loss
- MVA risk
What can cause an obstruction in airway?
- obese neck
- nasal obstructions
S/S of sleep apnea
- loud snoring interrupted by periods of silence
- morning headache
Result of atelectasis
- loss of lung volume
- decreased perfusion
- decreased oxygenation
continuous delivery of airway pressure to keep alveoli open
continuous deliver of air, but can set inspiration and expiration at different levels
Used for patients in severe respiratory distress. It increases pressure and forces person to take a breath
How do you treat mild apnea?
- sleep on your side
- hard object under back to keep from rolling over
- band over nose
What dont you want a person with apnea to do to help sleep?
- Drink alcohol
- take hypnotics
How do you treat moderate apnea
mouth piece that holds the mandible slightly forward in an open position
How do you treat major apnea
CPAP andsleep on your back-Takes 3 months to see if it works
- remove uvula, bariatric surgery or TRACH
What is paroxysmal nocturnal dyspnea?
a sensation of shortness of breath that awakens the patient, often after 1-2 hrs of sleep and is relieved by person getting to an upright position immediately.
Feels like they are suffocating
How do you get respiration?
Must have both ventilation and perfusion
You can have__________ and not _________
BUT you cant have ___________ with out
ventilation and not perfusion
perfusion without ventilation
What do you need for ventilation?
muscles in the thorax and a change in pressure gradient
The diaphragm and intercostal muscles working to enlarge in the thorax
intrathoracic pressure decreases below atmospheric pressure and air moves in to the lungs.
Inspiration and is an ACTIVE process
the inspiratory muscles relaxing and the elastic recoil of the lung tissues, along with the increased intrathoracic pressure, causing air to move out of the lungs
Exhalation...which is passive
Major muscle of respiration
These assist in the inspiratory phase of ventilation
These muscles dont function during normal ventilation, but only work when forced ventilation is needed
Which side of the lungs will you have aspiration of fluids and gastric contents
right main bronchus....cuz it is most vertical
Vesicular breath sounds
Where do you hear them?
- peripheral part of the lungs
- Soft, swish and low
Bronchovesicular breath sounds
Where do you hear them?
- over mainstream bronchi and between scapulae
- inspiration and expiration
Louder and higher pitched than vesicular sounds and softer and lower pitched than bronchial sounds
Bronchial breath sounds
Where do you hear them?
- over the trachea and anterior chest wall
- inspiration and expiration
- sounds like air passing thru a tube-loud, high pitched, hollow and harsh
Ratios for vesicular, bronchovesicular and bronchial breath sounds:
- Bronchovesicular 1:1
- Bronchila 2:3
- Vesicular 3:1
heard during inspiration sounds like air bubbling and popping from collapsed alveoli
CHF-starts at base and works up.
snore like sound from the throat or bronchial tube from partial obstruction by secretions
secretions in the lungs-start high and work down
high pitched whistle generated by air flowing thru narrowed airways, heard during inspiration and expiration
airway constriction (asthma)
4 Gerontological changes in respiratory and their causes
- Barrel chest-reduced chest wall compliance and decreased elastic recoil
- Decreased oxygenation-small airways, reduced functional alveoli
- Decreased ability to clear secreations-dehydrated cilia and decreased force of cough
- Lower resistance to infections-decreased immune system response
Dry cough vs. moist
doesnt produce sputum and one does
gentle stimulation of larynx
Harsh or barking cough is indicative of ....
Hoarse cough is from
inflammation of the larynx
Hacking cough is from
an irritation of the larynx by postnasal drip
entraps debris that has entered the airway
When does a cough occur?
as a response to an irritant when the capabilities of the mucous blanket and cilia are exceeded
Pleural chest pain
happens with inspiration and expiration and is because of fluid in the pleural space-starlings forces
- from:left ventricular failure
- renal and hepatic failure
- cirrhosis of the liver
thick or gelatenous
bubbly pink as in pulmonary edema
clear, thing to moderately thick and contains mucous
thick creamy, hellow, green= infection
What is pneumonia?
- INFLAMMATION of the bronchioles and alveoli caused by:
- virus or any invading organism causing inflammation
What is a result of the inflammation of pneumonia?
- impaired gas exchange
collection of exudate in the pleural space
Why are the young and old at high risk for PA
- decreased defense mechanisms
- young-not developed yet
- olddecreased hydration, stiff chest walls and medications (steroids)
Who's at risk to get PA
- post op-anesthesia
- smokers, malnourished,
- POOR hand washing
S/S of PA
- pleuritic chest pain
- cough hemoptysis
- sputum production
Staphylococcal sputum color
pseudomonas sputum color
klebsiella sputum color
Streptococcal/pneumococcal sputum color
What's the physiological result of PA?
- increased RR in an attempt to supply sufficient O2 to the body.
- the increased work of breathing tires the PT with chronic conditions and minimal resp. reserve....result= HYPOVENTILATION
increased pc02 and decreased p02
Most common community acquired
Follows the flu
Treated with penicillin
Acquired thru blood or by aspiration
At risk-drug abusers, diabetics and pt on hemodialysis
Also seen in people with chronic debilitating diseases and alcoholism
acquired outside the hospital....HIGH MORTALITY RATE
Pseudomonas aeruginosa PA
causes colinization in wounds, burns, trachs and UTI's
- transmitted by droplets
- treated symptomatically
- predisposes to secondary bacterial infection
treat symptoms-breathing treatments
occur after extended antibiotic use.
common in immunosuppressed and are not transmitted person to person
Primary intervention for PA
- hand hygiene
- good nutrition
- oral hygiene
Secondary interventions for PA
- Respiratory treatments
Tertiary interventions for PA
- stop smoking
- adequate nutrition
How is TB transmitted?
airborne-aerosolization by droplet nuclei when a person coughs, laughs, sneezes or sings
In order for pulmonary infection of TB to occur....
the inhaled organism must resist the lungs defense mechanisms and penetrate the lung tissues.
Brief exposure to TB doesnt cause infection.
Must have repeated close contact with an infected person
4 factors that increase the risk for contrcting TB
- # of viable bacilli in the infected sputum
- concentration of TB contaminating the air
- length of time the exposed person breathes contaminated air
- susceptibility of the exposed person
presence of mycobacteria in the tissue of a host who is free of clinical symptoms and who demonstrates the presence of antibodies agains the mycobacteria
presence of mycobacteria and has smptoms indicating destructive activity to the lungs
Only way to truly dx TB
sputum test for bacterium
S/S of TB
- slow onset and even asymptomatic
- low grade fever
- weight loss
- night sweats
- irregular menses
HIV and TB
will probably have a negative test result
TB skin test
- sub dermal
- 48-72 hrs. after skin test recheck and it is positive if the site has an induration of over 10mm is elevated over 1mm
What does mantoux test detect?
- past and present disease or infection....
- but CANT distinguish between active and inactive TB
Can only mean the person was a past infection of the person was exposed to another mycobacterium strain
How do you get a person out of TB isolation
3 negative sputum results 3 days in a row
will use gram stain test cuz can be done in 24 hours as opposed to a culture which takes 3-8 weeks
CDC precautions for TB pt:
- ISOLATION of suspected pt immediately
- teach pt to use paper tissues to cover mouth when sneezing/coughing
- notify infection control
- N95 mask
- Negative flow isolation rooms with ultraviolet irradiation
- BCG immunization to high risk individuals
- employees get skin tests regularly
NANDAS for TB
- Impaired gas exchange
- Self care deficit
Greatest risk factor for reactivation of TB
Treatment for TB
treated if exposed and infected
combo of 3 drugs for 6-12 months
Why 3 drugs to treat TB
- cuz hits it from many different angles so the number of bacilli in body is decreased and
- decreasing the chance of drug resistant bacilli
How long does it take for the bacilli to disappear from the sputum once drug treatment starts?
a few days
- Take on an empty stomach
- can cause Hepatitis-limit alcohol
- Need v. B supplement
- Monitor renal and liver fxn
- no alcohol
- turns body fluids orange
- decreases effects of BCP's
Which TB drug diminishes effects of Digoxin
- Given with Rifampin or INH for the first 1-2 months
- Drink 2000cc of water
Who should take PZA cautiously?
Diabetics and people with liver and renal disease
Given with Rifampin and INH for first 1-2 months
Can cause rash
Which TB Drug shouldnt be used on kids
Once treatment for TB is done what is the follow up?
sputum and xray tests every 3-6 months for 1st two years
How do you evaluate the results of pt teaching for a TB pt
- client states they will use kleenex to catch droplets from sneeze and cough
- pt will comply with drug treatment
- teach why compliance is important
Why's it important to be compliant?
- treatment failure
- drug resistance TB strains
Primary intention intervention for TB
- vaccine high risk
- ID high risk patients and wear a mask
Secondary intention interventions for TB
take drugs until they are done
Tertiary intention interventions for TB
- dont spend time in stuffy enclosed room with anyone with active TB
- wear a mask if you do
- if you live with someone with active TB make sure they take their RX
What is the focus of community health nursing?
In community health both secondary and tertiary prevention focus on
What's a community?
a group of people living in close proximity who share a bond, interact with each other and are dependent on each other
What does a community encompass?
wher you live, work, raise kids and carry on activities of daily life
What would you like to do?
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