Ch 29 Respiratory PT.2
(MED-SURG)
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Hemoptysis
coughing up blood from the respiratory tract
Source of bleeding:
Nose, Nasal pharynx: "sniffing", bloody sputum, blood in nose
Lung:
bright red, frothy, mixed with sputum; blood has alkaline pH (greater than 7.0)
Stomach
Stomach: blood vomited (Hematemesis) rather than coughed-up; Referred to "coffee grounds" due to dark appearance (mixed with gastric acids). This blood has an acid pH (less than 7.0)
4 different types of Pneumonia
Pneumonia
Pulmonary embolism with lung infarction
Pleurisy (inflammation of the pleura)
Late symptom: Bronchogenic carcinoma
Know pulmonary chest pain characteristics:
Cardiac Pain: usually intense and crushing. radiates to arm, shoulder or neck
Pulmonary: varies depending on cause: feels like "rubbing" on inside. Deep on inhalation or present at the end of inhalation and end of exhalation. Is not made worse by touching
Presence of Thoracic Pain
may/may not be present:
Lungs and visceral pleura lack sensory nerves
Parietal pleura: rich in sensory nerves; stimulated by inflammation and stretching - "sharp", "stabbing
Always treat chest pain like:
its cardiac FIRST
Chest Pain Assessment
Assessment includes: quality, intensity, radiation of pain, precipitating factors; positioning; relationship to inspiratory/expiratory phases
Chest Pain Relief Measures
Analgesic medication: NSAIDs
Avoid respiratory depression
Regional anesthetic blocks�severe pain
Positioning
Dyspnea
Difficult or labored breathing; shortness of breath
Common to respiratory and cardiac disorders
Associated with:
? lung compliance
? airway resistance
Right ventricle affected�pumps against resistance
Greater severity in acute lung diseases than chronic
D
S/S of Asthma attack
indigestion
reguritation
Viagra
Pulmonary Hypertension
After open heart surgery:
Amulate as soon as possible help maintain heart and lung function and speed up recovery. reduce lung secretions
COPD
is the only disease you can stop this in its process and prevent it from getting worse and it is a inflammatory
Inhaler
Shld not be using every nite. it can cause other problems.
Zopenex
give in place of albuteral
EMERGENT response to attack
KNOW YOUR ABC's
Airway
Breaths
circulation
CAB?
Questions to ask....
When did it begin?
Was the onset sudden or gradual?
What triggered the episode?
How much exertion triggers SOB? Does it occur at rest? During exercise? Walking? Climbing stairs?
Are there any other symptoms?
Does it occur/worsen at any particular time of
Paroxysmal Nocturnal Dyspnea (PND):
Intermittent dyspnea during sleep. Onset of breathing difficulty that wakens patient from sleep
Orthopnea: shortness of breath when lying down but relieved when sitting up.
Occur with Chronic Lung Disease and Left-sided heart failure.
Does it interfere with ADLs?
Table 29-2: Correlation of Dyspnea with ADLs
pg 559
Ischemia vs Infarction?
Infarction is where it dies
Ischemia is decrease blood flow
Physical Examination
Inspection
Auscultation
Percussion
Palpation
Breathing Ability
Diagnostic Testing
best way to hear bottom of lungs.... inhale quickly with pursed lips.
Tactile Fremitus
Place hand on posterior chest and flatten palm, ask patient to recite 'ninety nine' or 'one one one', repeat bilaterally and compare
Bronchophony
normal voice sounds heard when auscultating the posterior thorax. These sounds should be muffled. The clarity indicates an abnormality such as fluid.
egophony
increased resonance of voice sounds heard when auscultating the lungs. Over area of consolidation or compression, the spoken "eee" sound changes to a bleating long "aaaa" sound
what do you see when a person inhales and exhales?
chest rises and falls
Flail chest
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment.
Percussing lungs
crucial because if has hyperresonance sounds instead of dull bc designated bt hemothorax, pnemothorax. Percuss in the intercostal spaces listen for the predominant note over the lung fields
Sinus pressure
anytime there is fluid in a body cavity, you'll have pressure. Seen more in maxillary in swelling
AP to LAT Ratio LUNG Assessment
size of chest
1:2 normal
1:1 is barrel chest- COPD (using accessory muscles to breathe)
XRAYs- will see that they have lost bottom of lung function
Other Indicators of Respiratory Adequacy
Skin and mucous membrane changes
-Pallor, cyanosis: inadequate oxygenation
-Diaphorisis
-Tachycardia
General appearance
-Weight loss, loss of general muscle mass
Endurance
-Decreases. Short or breath when resting
Peripheral Cyanosis
-will not see as much as in adults
more in babies
atypical micoplasmic pneumonia
true walking pneumonia- presents with a rash around ribs and then you get the respiratory status
Cyanosis
Bluish coloring of skin
Late indicator of hypoxia
Presence or absence determined by amount of unoxygenated hemoglobin in blood (appears when there is 5g/dL of unoxygenated hemoglobin)
Not a reliable sign of hypoxia
Central cyanosis
Assess color of lips and tongue�indicates decrease in O2 in blood
Peripheral cyanosis
not a good indicator of systemic problems; decreased blood flow to certain areas of body e.g. nail beds, earlobes vasoconstrict in response to cold.
Ppl that have eaten in while or not hungry or dehydrated:
could be something pulmonary, not perfusing
i.e. pneumonia
turbinates
Three bony shelves that protrude from the lateral walls of the nasal cavity and extend into the nasal passageway, parallel to the nasal floor; serve to increase the surface area of the nasal mucosa, thereby improving the processes of warming, filtering, a
Clubbing of the Fingers- sign of lung disease
chronic hypoxia
Chronic lung infections
Malignancies
Clubbing of fingers- Initially manifested by:
Sponginess of nail bed
Loss of nail bed angle
Barrell Chest
1:1, related to lung overinflated and increase in A/P diameter
Normal is 1:2