Nursing Management of Nursing Management of Clients with Stressors Clients with Stressors of Respiratory Function of Respiratory Function Chronic Airflow Limitation Chronic Airflow Limitation (CAL) (CAL) Pneumonia Pneumonia Tuberculosis Tuberculosis NUR133 Lecture #5 K. Burger, MSEd, MSN, RN, CNE
33
Embed
Nursing Management of Clients with Stressors of Respiratory Function Chronic Airflow Limitation (CAL) Pneumonia Tuberculosis NUR133 Lecture #5 K. Burger,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Nursing Management of Clients Nursing Management of Clients with Stressors of Respiratory with Stressors of Respiratory
1. 1. ExpiratoryExpiratory and Inspiratory wheezing and Inspiratory wheezing 2. Dry or moist cough2. Dry or moist cough3. Dyspnea, signs of hypoxemia, 3. Dyspnea, signs of hypoxemia,
anxietyanxiety4. increased HR, BP, RR4. increased HR, BP, RR5. Diaphoresis, Pallor5. Diaphoresis, Pallor6. Cyanosis6. Cyanosis7. Nasal flaring 7. Nasal flaring 8. Use of accessory muscles8. Use of accessory muscles
AsthmaAsthma
Diagnostic AssessmentDiagnostic Assessment ABGs / PO2 low, PCO2 high, PH lowABGs / PO2 low, PCO2 high, PH low SaO2 lowSaO2 low Eosinophils / serum and sputumEosinophils / serum and sputum PFTs / FEV and PERFPFTs / FEV and PERF CXRCXR
Asthma Asthma
STEP SYSTEM
MILD INTERMITTENT
MILD PERSISTENT
MODERATE PERSISTENT
SEVERE PERSISTENT
Complications of AsthmaComplications of Asthma
- Respiratory infections- Respiratory infections
- Status Asthmaticus- Status Asthmaticus
- pneumothorax- pneumothorax
- respiratory arrest- respiratory arrest
- cardiac arrest - cardiac arrest
AsthmaAsthma
Nursing DiagnosesNursing Diagnoses1. 1. Impaired Gas ExchangeImpaired Gas Exchange related to related to alveolar alveolar membrane changes, airflow membrane changes, airflow limitation, respiratory muscle fatigue, limitation, respiratory muscle fatigue, excess production of mucus.excess production of mucus.2. 2. Ineffective Breathing patternIneffective Breathing pattern related related
to to airflow obstruction (narrowed airways), airflow obstruction (narrowed airways), and fatigue.and fatigue.3. 3. Ineffective Airway ClearanceIneffective Airway Clearance related related
to to excessive secretions, fatigue and excessive secretions, fatigue and ineffective cough.ineffective cough.
C. Stress management, rest, and sleepC. Stress management, rest, and sleepD. Correct use of inhalersD. Correct use of inhalersE. Correct use of peak flow meter and step wise E. Correct use of peak flow meter and step wise
approach to med managementapproach to med managementF. What to do if an attack occursF. What to do if an attack occurs
AsthmaAsthma
– How to use a METERED DOSE inhaler (without How to use a METERED DOSE inhaler (without spacer) correctly:spacer) correctly:
1. Shake inhaler1. Shake inhaler
2. Tilt head back, breathe out fully2. Tilt head back, breathe out fully
3. Open mouth, mouthpiece 1-2” away 3. Open mouth, mouthpiece 1-2” away
4. As you begin to breathe in deeply, press down and 4. As you begin to breathe in deeply, press down and release medicine.release medicine.
5. Breathe in deeply and slowly for 3-5 sec.5. Breathe in deeply and slowly for 3-5 sec.
6. Hold your breathe for 10 sec6. Hold your breathe for 10 sec
corticosteroid , may add theophylline.corticosteroid , may add theophylline. Step 4.- Severe persistent- add po steroidsStep 4.- Severe persistent- add po steroids
Loss of lung elasticityLoss of lung elasticity Hyperinflation of lungs / air trappingHyperinflation of lungs / air trapping Diaphragm flatteningDiaphragm flattening Increased airflow resistanceIncreased airflow resistance Ineffective gas exchangeIneffective gas exchange Retained CO2 (hypercapnia) Retained CO2 (hypercapnia) Chronic respiratory acidosisChronic respiratory acidosis
people living in crowded and or poor living people living in crowded and or poor living conditionsconditions
ExposureExposure versus versus infectioninfection versus versus activeactive
TuberculosisTuberculosisAssessmentAssessment
Persistent, productive coughPersistent, productive cough HemoptysisHemoptysis Fever and night sweatsFever and night sweats Fatigue Fatigue AnorexiaAnorexia Weight lossWeight loss Progressive and persistent S & SProgressive and persistent S & S
Purified Protein Derivative PPDPurified Protein Derivative PPD Positive = 10mm induration or > generalPositive = 10mm induration or > general 5mm induration or > Hx HIV5mm induration or > Hx HIV CXRCXR Sputum for acid-fast bacillus AFBSputum for acid-fast bacillus AFB Sputum culture; BACTECSputum culture; BACTEC PCR assayPCR assay NEW: Quantiferon TB Gold Test QFT-GNEW: Quantiferon TB Gold Test QFT-G