Alterations in oxygenation/Pneumonia/Sleep Apnea

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foxyt14
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205777
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Alterations in oxygenation/Pneumonia/Sleep Apnea
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2013-03-28 18:43:31
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N170
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pneumonia, tb and sleep apnea
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  1. Propels mucous towards the orpharynx
    cilia
  2. phagocytize inhaled foreign particles like bacteria
    macrophages
  3. decreases the surface in alveoli
    surfactant
  4. atelactasis
    collapsed or airless alveoli

    Post op pt are at risk for cuz of the affects of anesthesia nd restriced breathing with pain
  5. Pulmonary circulation
    provides the lungs with blood for gas exchange
  6. bronchial circulation
    provides oxygen to the bronchi and other pulmonary tissues
  7. lines the chest cavity
    parietal  pleura
  8. lines the lungs
    visceral pleura
  9. ventilation
    involves inspiration and expiration
  10. Inspiration
    gas flows from an area of high concentration (atmosphere) to low concentration (intracostal)
  11. expiration
    passive and occurs because of elastic recoil
  12. 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.
    compliance
  13. Diffusion
    oxygen and carbon dioxide moving back and fort across the alveolar-capillary membrane
  14. Reflex bronchoconstriction
    defense mechanism that's in response to the inhalation of large amounts or irritating substances
  15. 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
  16. Subjective data for respiratory assessment
    • past health history
    • surgeries
    • meds
    • functional health (sleep, nutrition, activity, coping values)
  17. 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
  18. What do you note when listening to breath sounds?
    • pitch
    • duration of sound
    • presence of adventitious sounds
  19. Give an example of over compliant lungs
    COPD...warn out pantyhose.  Too stretchy so doesnt expand well.
  20. Example of high compliance
    when a small amount of pressure is needed to expand the lungs
  21. individualized perception of labored or difficult breathing
    dyspnea or sob
  22. What causes dyspnea?
    • disorder that causes airway resistance or constriction
    • disorder that cause decreased compliance
    • disoreders that later pulmonary vascular system
  23. Ex of disorders that cause airway resistance or constriction
    • asthma
    • bronchitis
    • URI
  24. Example of disorders that cuase decreased compliance
    • COPD
    • tumors
    • secretions
  25. Example of disorders that later the pulmonary vascular system
    • pulmonary HTN
    • Left sided CHF
  26. What can cause dyspnea?
    • weather (cold or santa ana's)
    • allergies
    • anxiety
    • paroxysmal nocturnal dyspnea
  27. apnea
    cessation of air flow thru the nose and mouth for at least 10 seconds
  28. sleep apnea
    30 or more apneic episodes during 7 hours of sleep or 5+ apneas/hr
  29. Sleep apnea increases a persons risk for:
    • Heart disease
    • obesity
    • stroke
    • fatigue
    • depression/memory loss
    • diabetes
    • MVA risk
  30. What can cause an obstruction in airway?
    • tongue
    • obese neck
    • nasal obstructions
  31. S/S of sleep apnea
    • loud snoring interrupted by periods of silence
    • morning headache
    • nausea
    • impotence
  32. Result of atelectasis
    • loss of lung volume
    • decreased perfusion
    • decreased oxygenation
  33. CPAP
    continuous delivery of airway pressure to keep alveoli open
  34. BiPap
    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
  35. How do you treat mild apnea?
    • sleep on your side
    • hard object under back to keep from rolling over
    • band over nose
  36. What dont you want a person with apnea to do to help sleep?
    • Drink alcohol
    • take hypnotics
  37. How do you treat moderate apnea
    mouth piece that holds the mandible slightly forward in an open position
  38. How do you treat major apnea
    CPAP andsleep on your back-Takes 3 months to see if it works

    • Surgery
    • Tonsilectomy
    • remove uvula, bariatric surgery or TRACH
  39. 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
  40. How do you get respiration?
    Must have both ventilation and perfusion
  41. You can have__________ and not _________
    BUT you cant have ___________ with out
    ___________.
    ventilation and not perfusion

    perfusion without ventilation
  42. What do you need for ventilation?
    muscles in the thorax and a change in pressure gradient
  43. 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
  44. 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
  45. Major muscle of respiration
    diaphragm
  46. These assist in the inspiratory phase of ventilation
    Intercostal muscles
  47. These muscles dont function during normal ventilation, but only work when forced ventilation is needed
    • parasternal
    • sternocleomastoid
    • trapezes
    • pactoralis
  48. Which side of the lungs will you have aspiration of fluids and gastric contents
    right main bronchus....cuz it is most vertical
  49. Vesicular breath sounds
    Where do you hear them?
    When?
    Sound?
    • peripheral part of the lungs
    • Inspiration
    • Soft, swish and low
  50. Bronchovesicular breath sounds
    Where do you hear them?
    When?
    Sound?
    • over mainstream bronchi and between scapulae
    • inspiration and expiration

    Louder and higher pitched than vesicular sounds and softer and lower pitched than bronchial sounds
  51. Bronchial breath sounds
    Where do you hear them?
    When?
    Sound?
    • over the trachea and anterior chest wall
    • inspiration and expiration
    • sounds like air passing thru a tube-loud, high pitched, hollow and harsh
  52. Ratios for vesicular, bronchovesicular and bronchial breath sounds:
    • Bronchovesicular 1:1
    • Bronchila 2:3
    • Vesicular 3:1
  53. Fine Crackles/Rales
    Describe
    Causes
    heard during inspiration sounds like air bubbling and popping from collapsed alveoli

    CHF-starts at base and works up.
  54. Coarse crackles/rhonchi
    Describe
    Caused by
    snore like sound from the throat or bronchial tube from partial obstruction by secretions

    secretions in the lungs-start high and work down
  55. Wheezing
    Describe
    Caused by
    high pitched whistle generated by air flowing thru narrowed airways, heard during inspiration and expiration

    airway constriction (asthma)
  56. 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
  57. Dry cough vs. moist
    doesnt produce sputum and one does
  58. Tickling cough
    gentle stimulation of larynx
  59. Harsh or barking cough is indicative of ....
    viral infection
  60. Hoarse cough is from
    inflammation of the larynx
  61. Hacking cough is from
    an irritation of the larynx by postnasal drip
  62. Mucous blanket
    entraps debris that has entered the airway
  63. When does a cough occur?
    as a response to an irritant when the capabilities of the mucous blanket and cilia are exceeded
  64. 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
  65. viscous secretions
    thick or gelatenous
  66. tenacious secretions
    sticky
  67. frothy secretions
    bubbly pink as in pulmonary edema
  68. Mucoid secretions
    clear, thing to moderately thick and contains mucous
  69. Mucopurulent secretions
    thick creamy, hellow, green= infection
  70. Hemoptysis secretions
    bloody
  71. What is pneumonia?
    • INFLAMMATION of the bronchioles and alveoli caused by:
    • bacteria
    • virus or any invading organism causing inflammation
  72. What is a result of the inflammation of pneumonia?
    • impaired gas exchange
    • hypoxemia
    • effusion
  73. effusion
    collection of exudate in the pleural space
  74. 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)
  75. Who's at risk to get PA
    • alcoholics
    • COPD
    • Influenza
    • tracheostomy
    • post op-anesthesia
    • immunosuppressed
    • smokers, malnourished,
    • POOR hand washing
  76. S/S of PA
    • fever
    • chills
    • diaphoresis
    • pleuritic chest pain
    • cough hemoptysis
    • dyspnea
    • headache
    • fatigue
    • sputum production
  77. Staphylococcal sputum color
    creamy yellow
  78. pseudomonas sputum color
    green
  79. klebsiella sputum color
    currant jelly
  80. Streptococcal/pneumococcal sputum color
    rust
  81. 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
  82. What's hypoventilation
    increased pc02 and decreased p02
  83. Streptococcal PA
    Most common community acquired

    Follows the flu

    Treated with penicillin
  84. Staphylococcal PA
    Acquired thru blood or by aspiration

    At risk-drug abusers, diabetics and pt on hemodialysis
  85. Haemophilus influenza
    • common in kids
    • URI

    Also seen in people with chronic debilitating diseases and alcoholism
  86. Klebsiella PA
    acquired outside the hospital....HIGH MORTALITY RATE
  87. Pseudomonas aeruginosa PA
    hospital acquired

    causes colinization in wounds, burns, trachs and UTI's
  88. Viral PA
    • transmitted by droplets
    • treated symptomatically
    • predisposes to secondary bacterial infection

    treat symptoms-breathing treatments
  89. Fungal PA
    occur after extended antibiotic use.

    common in immunosuppressed and are not transmitted person to person

    Candida, Aspergillosis
  90. Primary intervention for PA
    • immunization
    • hand hygiene
    • good nutrition
    • oral hygiene
  91. Secondary interventions for PA
    • oxygen
    • TCDB
    • Respiratory treatments
    • antibiotics
    • suctioning
    • rest
    • hydration
  92. Tertiary interventions for PA
    • stop smoking
    • adequate nutrition
    • rest
  93. How is TB transmitted?
    airborne-aerosolization by droplet nuclei when a person coughs, laughs, sneezes or sings
  94. 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
  95. 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
  96. TB infection
    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
  97. TB Disease
    presence of mycobacteria and has smptoms indicating destructive activity to the lungs
  98. Only way to truly dx TB
    sputum test for bacterium
  99. S/S of TB
    • slow onset and even asymptomatic
    • low grade fever
    • fatigue
    • weakness
    • anorexia
    • weight loss
    • night sweats
    • irregular menses
  100. HIV and TB
    will probably have a negative test result
  101. TB skin test
    • Mantoux
    • 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
  102. 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
  103. 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
  104. 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
  105. Immunization for TB
    BCG
  106. NANDAS for TB
    • Noncompliance**
    • Impaired gas exchange
    • Self care deficit
  107. Greatest risk factor for reactivation of TB
    HIV infection
  108. Treatment for TB
    treated if exposed and infected

    combo of 3 drugs for 6-12 months
  109. 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
  110. How long does it take for the bacilli to disappear from the sputum once drug treatment starts?
    a few days
  111. INH-Isoniazid
    • Take on an empty stomach
    • can cause Hepatitis-limit alcohol
    • Need v. B supplement
    • Monitor renal and liver fxn
  112. Rifampin
    • no alcohol
    • turns body fluids orange
    • decreases effects of BCP's
  113. Which TB drug diminishes effects of Digoxin
    Rifampin
  114. Pyrazinamide (PZA)
    • Given with Rifampin or INH for the first 1-2 months
    • Drink 2000cc of water
  115. Who should take PZA cautiously?
    Diabetics and people with liver and renal disease
  116. Ethambutol (Myambutol)
    Given with Rifampin and INH for first 1-2 months

    Can cause rash
  117. Which TB Drug shouldnt be used on kids
    Ethambutol
  118. Once treatment for TB is done what is the follow up?
    sputum and xray tests every 3-6 months for 1st two years
  119. 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
  120. Why's it important to be compliant?
    • treatment failure
    • relapse
    • drug resistance TB strains
  121. Primary intention intervention for TB
    • vaccine high risk
    • ID high risk patients and wear a mask
  122. Secondary intention interventions for TB
    take drugs until they are done
  123. 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
  124. What is the focus of community health nursing?
    PREVENTION
  125. In community health both secondary and tertiary prevention focus on
    ????
  126. 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
  127. What does a community encompass?
    wher you live, work, raise kids and carry on activities of daily life

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