RESPIRATORY
Pneumonia – Inflammation of the lower respiratory tact
o Types:
Bacterial (gram positive / negative)
Viral
Fungal
... [Show More] (rare)
Chemical
o Reach lungs by:
Aspiration
Inhalation
Hematogenous Spread
o High Risk Groups
Altered Level of Consciousness
Depressed/absent gag and cough reflexes
Susceptible to aspirating -> Oropharyngeal secretions
Alcoholic, anesthetized individuals
Drug Overdose
Stroke Victims
Immunocompromised
o Nursing Assessment
Tachypnea – shallow, often accessory muscles
Sudden onset of fever/shaking/chills
Productive Cough with pleuritic (lung) pain
Rapid/bounding pulse
Breath sounds - crackles
o OLDER ADULTS: confusion, lethargy/malaise, anorexia, tachypnea, tachycardia
o Interventions:
Assess sputum – COCA
Turn and deep breath q2hrs
Humidify room/oxygen
Chest physiotherapy
3L/day of fluids (liquefies secretions)
Monitor ABG’s
PO2 >80, PCO2 <45
Encourage at risk groups to get annual pneumonia and flu shots
Promote rest and conserve energy
o Hydration – thins out mucus, essential for client w/ fever, 300-400mL of fluid is
lost daily by lungs through evaporation
o Cerebral Hypoxia – irritability and restlessness are early signs
o Pneumonia Preventives
Older adults & Asplenia: flu/pneumonia shots
Comatose/immobile: elevation of HOB and for 1 hr after feeding,
frequent turning.
Anti-Infectives
o Penicillin
AR – Anaphylaxis, diarrhea, GI distress, superinfection (sore mouth,
vaginal discharge, cough), phlebitis @ IV site
NI – Observe for 30 mins following parenteral admin, Orals = empty
stomach, alters birth control effectiveness
o Tetracycline (-cycline)
AR- Hypersensitivity and Photosensitivity
NI- alters birth control effectiveness, NO ANTACIDS OR MILK PRODUCTS,
inspect IV frequently, no <8yrs – yellow/brown teeth discoloration and
growth retardation
o Aminoglycosides – xxxx sulfate, Vancomycin, Metronidazole (Flagyl)
AR- Neuromuscular blockade, Nephro/Ototoxicity
NI- Renal Function Test, BUN, creatinine, I&O
Ototoxicity – headache, dizziness, hearing loss, tinnitus
Peak and Trough levels required.
o Cephalosporin – (cef/ceph)
AR – Thrombophlebitis, GI distress
NI – caution if allergic to penicillin
o Macrolides – Clarithromycin (Biaxin), Erythromycin, Azithromycin (Zithromax)
AR – Pseudomembranous colitis, phlebitis, dizziness, dyspnea
NI – Biaxin with food, Zithromax without food
Liver and Renal Labs
Space MAOI’s 14 days before and after Biaxin
o Fluoroquinolones
CNS disturbances, Cataracts, blistering
NI- Prompt onset, Category D, Lowers seizure threshold,
LIVER/RENAL/CBC, many drug-drug interactions
Chronic Bronchitis: Sputum with daily cough production for 3mo-2yr consecutive,
hypoxemia, cor pulmonale (enlarged R side heart -> result of lung or pulmonary blood
vessel disease), increased bronchial wall thickness
o Factors: Higher incidence in smokers
o Generalized cyanosis, BLUE BLOATERS, Right sided HF, distended neck veins,
crackles, expiratory wheezes.
o NI – Lowest FiO2 possible to prevent CO2 retention, S/s fluid overload, PaO2
between 55-60, teach pursed lip breathing and diaphragmating breathing, Tripod
position
Emphysema: Reduced gas exchange, decreased capillary
network, increased air trapping
o Factors: smoking, genetic,
environmental/occupational exposure
o PINK PUFFERS, pursed lip breathers, barrel chest,
distant/quiet breath sounds, wheezes, pulmonary
blebs on radiograph.
o NI- Same as Bronchitis
Asthma: Narrowing/closure of airway due to a stimulant
o Factors: Mucosal edema, Increased work of breathing,
beta blockers, respiratory infection, allergic reaction,
emotional stress, exercise,
environmental/occupational exposure, reflux
esophagitis
o Dyspnea, wheezing, chest tightness
o NI- Administer bronchodilators, fluids and humidification, ABG’s, ventilatory
patterns
In advanced emphysema, due to the alveoli being affected, hypercarbia is a problem,
rather than in bronchitis, where the airways are affected.
Compensation occurs over time in clients with chronic lung diseases, and ABGs are
altered.
Productive cough and comfort can be facilitated by semi-Fowler (30-45) or high-fowler
(90), which lessens pressure on the diaphragm by abdominal organs.
o Gastric distention becomes a priority -> it elevates the diaphragm and inhibits full
lung expansion
Pink Puffer -> barrel chest, client works harder to breathe, but O2 taken in is adequate to
oxygenate the tissues
Blue Bloater -> Insufficient oxygenation and leads to generalized cyanosis and often
Right Sided Heart Failure.
COPD / Asthma Interventions
o Tripod position
o Small frequent meals, increase calories and protein, Mg and Ca -> muscle
contraction and relaxation, Mg and Phosphorus -> related to bone mineral
density
o 3L+/day -> between meals rather than with
Adrenergic and Sympathomimetic
o Bronchodilator
o AR – anxiety, increase HR, N&V, urinary retention
o Monitor HR, urinary retention, may cause sleep disturbance
o BRONCHODILATOR BEFORE STEROID!!!
Corticosteroids
o Anti-inflammatory
o AR- cardiac dysrhythmias with long term use
o ORAL CARE after use
Anticholinergics
o Bronchodilator & control of rhinorrhea
o AR- dry mouth, blurred vision, cough, essentially can’t do shit
Combination products
o Fluticansone + salmeterol
o Ipratromium + Albuterol
Eating = less energy needed for breathing -> soft diets
ABC -> Airway first, breathing, circulation CAB-> CPR
O2 Delivery -> in adult, O2 must bubble through some type of water solution so it can be
humidified in >4L/min or delivered directly to trachea. If 1-4L/min or by mask/nasal
prongs, mucus membranes provide adequate humidification
Cancer of the Larynx [Show Less]