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Respiratory Assessment
Respiratory Assessment
Assessment of the Respiratory System Anatomy and physiology review Upper respiratory tract Lower respiratory tract Lungs Accessory muscles of respiration Respiratory changes associated with aging
Physical assessment Lungs and thorax Other indicators clubbing, weight loss, unevenly developed muscles, skin & mucous membrane changes, general appearance, and endurance
Psychosocial Stress level Chronic issues family support, social activity, financial constraints, disability Coping mechanisms Access to support services
Care of Patients with Noninfectious Lower Respiratory Problems Chronic Airway Limitations (CAL) Asthma Chronic bronchitis Pulmonary emphysema Chronic Obstructive Pulmonary Disease (COPD) Emphysema & Chronic bronchitis Characterized by bronchospasm & dyspnea (what is this term?) Tissue damage is not reversible & increases in severity, eventually leading to respiratory failure
Pathophysiology Bronchial asthma is an intermittent and reversible airflow obstruction affecting only the airways, not the alveoli Airway obstruction occurs by: o Inflammation o Airway hyper-responsiveness Etiology Classified based on trigger events Inflammation response to specific o Allergens o General irritants o Microorganisms o Aspirin Hyper-responsiveness occurs with o Exercise o URI o Unknown reasons Genetic Genetic variation of a gene controls synthesis and activity of betaadrenergic receptors Inflammation caused by allergen binding to immunoglobulin E (IgE) Bronchospasm as a result of airway hyper-responsiveness ASA & other NSAIDS can trigger asthma in some people
Older adults Change in sensitivity of beta-adrenergic receptors Teach how to prevent asthma attacks Women 35% higher incidence Teach correct use of preventive and rescue drugs Collaborative management Assessment History Physical & clinical manifestations o Audible wheeze and increased resp rate o Increased cough o Use of accessory muscles o Barrel chest from air trapping o Long breathing cycle o Cyanosis o Hypoxemia Laboratory Assessment ABGs o Arterial oxygen level may be decreased in acute attack o Arterial carbon dioxide may decrease early in attach and increase later, indicating poor gas exchange Pulmonary Function Tests (PFTs) o Most accurate measures using spirometry Forced vital capacity (FVC) Forced expiratory volume in the first second (FEV1) Peak expiratory flow rate (PEFR) Interventions Patient education disease often intermittent; guided self-care to co-manage disease with goal of increasing symptom free periods and decreasing the number & severity of attacks Peak flow twice daily Personal drug therapy plan Drug therapy Based on the step category for severity and treatment Preventive Rx used daily regardless of symptoms Rescue drugs stop attack once it has started
Bronchodilators o Short-acting beta2 agonists o Long-acting beta2 agonists o Cholinergic antagonists o Methylxanthines
Other treatments Exercise and activity recommended Oxygen therapy acute attacks Status asthmaticus Life-threatening; acute May lead to pneumothorax, cardiac or respiratory arrest Treatment: IV fluids, potent systemic bronchodilator, steroids, epi, and O2 Emphysema
Pathophysiology loss of lung elasticity & hyperinflation of the lung Airtrapping caused by loss of elastic recoil in the alveolar walls, overstretching, & enlargement of the alveoli into bullae, and collapse of small airways (bronchioles) Dyspnea; increased respiratory rate
Chronic Bronchitis Inflammation of bronchi and bronchioles caused by chronic exposure to irritants (i.e. tobacco smoke) Inflammation, vasodilation, congestion, mucosal edema, and bronchospasm Airway only affected, not the alveoli Thick mucus production
Complications Hypoxemia Acidosis Respiratory infections Cardiac failure Cardiac dysrhythmias Physical assessment & clinical manifestations History General appearance Respiratory changes Cardiac changes
Laboratory assessment ABGs Sputum samples CBC/Hemoglobin & Hematocrit Serum electrolytes Serum AAT Chest X-ray PFTs Nursing dx Impaired Gas Exchange
Anxiety
Activity Intolerance
Surgical management
Health teaching
Care of Patients with Infectious Respiratory Problems Influenza highly contagious acute illness
Pneumonia Pathophysiology Excess fluid, inflammatory process Inflammation triggered by infectious organisms & inhalation of irritants Community acquired infections pneumonia (types of individuals most at risk?) Nosocomial (hospital-acquired) (types of patients most at risk?) Atelectasis Hypoxemia
Community-based Care Home care management Health teaching Health care resources
Severe Acute Respiratory Syndrome (SARS) Infection of cells of the respiratory tract, triggers inflammatory response No known effective treatment Prevention Avian Influenza Bird Flu Virus Prevention
Pulmonary Tuberculosis Highly communicable Transmitted via aerosolization HIV high risk individuals on developing TB
Clinical manifestations Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks
Diagnostics Manifestations of signs and symptoms Positive smear for acid-fast bacillus Confirmation of dx by sputum culture of M. tuberculosis Mantoux test (PPD) Induration of 10 mm or greater, indicative of exposure Does not mean active disease is present Interventions Combination drug therapy with strict adherence (education important) Negative sputum culture indicative of patient no longer being infectious (need results of three as negative)
Community-based Care Home care management Health teaching Health care resources