D I S O R D E R R N 1 0 1 . N E T - rn101questionbank.com · you sop the coticosteroid if patient...

RESPIRATORY DISORDER

RN101.NET

Jim Briant Banusan

Copyright 2018 RN101 All Rights Reserved. This product is protected by copyright and distributed under licenses restricting copying, distribution, and decompilation.

ASTHMA is a chronic inflammatory disorder of the airways that causesvarying degrees of obstruction in the airways. Marked by airwayobstruction and hyperresponsiveness to a variety of stimuli or triggers.


A-sthma attack Nursing Interventions: •Position the patient in high Fowler’s or sitting •Administer oxygen asprescribed •Stay with the patient to decrease anxiety. •Administer bronchodilators as prescribed•Record the color, amount, and consistency of sputum, if any. • Administer corticosteroids asprescribed. • Auscultate lung sounds before, during, and after treatments. Patient Instructions: •Stop any activity, sit down, take a rest and do pursed lip breathing. •Takerescue inhaler (12Ventolin-blue), if no effect should call 911 (more or less after 15 mins).

S-igns and Symptoms •Restlessness •Wheezing or crackles •Absent or diminished lung sounds •Hyperresonance •Use ofaccessory muscles for breathing •Tachypnea with hyperventilation •Prolonged exhalation•Tachycardia •Pulsus paradoxus •Diaphoresis •Cyanosis •Decrease oxygen saturation •Decreasedair flow rates from pulmonary function test result •Substernal and subclavicular retractions •Audibleadventitious sound •Inability to complete a sentence •Cold and clammy skin •Nasaldischarge/obstruction •Nasal flaring• Slow capillary refill (>2sec) •Expectoration •Change in LOC oralertness

T-riggers Allergens: Animal dander, pollen, house dust mites, molds, cockroaches. Air pollutants: Fumes,perfumes, cigarette smoke, aerosol spray. Viral upper respiratory infection: Cold and Flu Physiologic:Exercise-induced asthma, cold dry air, stress, GERD. Drugs: Aspirin, NSAIDS, Beta blockers.


H-elp •Offer support groups such as the Asthma Society of Canada or The Quebec Lung Association.•Introduce support from CLSC and school. •Involve the family in care. •Have a regular doctorcheckup. •Help the patient to develop an asthma action plan.

M-edications Side effects: •Ventolin-Hyperactivity, restlessness, tremors, and tachycardia (Reassure that theseare temporary side effects for children and the medication given is based on weight.). •Atrovent-Anticholinergic effects (e.g., Dry mouth, dizziness, nausea, upset stomach.) •Flovent-Oral thrush(Encourage to rinse the mouth after using the medication.) FAQ “Frequently Asked Questions byfamily” Q1: Why not to stop corticosteroids abruptly? A1: To prevent adrenal insufficiency Q2: Canyou stop the corticosteroids if the patient signs & symptoms are gone? A2: No, the action is slow andgradual, treatment must be respected even without symptoms because there's still inflammation inthe respiratory tract, it must be completed to prevent relapse of inflammation. Q3: Do corticosteroidsinhalers influence growth? A3: No, inhaled corticosteroids have a little systemic effect, and theprescribed dose is very low and based on the patient's weight.

A-ctivity •Avoid extreme weather during activity (windy, cold, humid, very hot). •If S&S occurs, stop the activityand take the bronchodilator. •Do activities with rest periods. •No strenuous exercises. •Takemedication before activity (15 mins) . •Baseball and swimming are good sports for asthma patients.


Medication Administration: Take the bronchodilator (Ventolin) first before the corticosteroids(Flovent) to open the airways so that the corticosteroids will penetrate deeper and be more effective.

Spacers need weekly cleaning,to clean, soak in soapy warm tapwater, shake off excess waterand allow it to air dry overnight.

•Flovent effect is slow and gradual (24-48 hrs), it isused as a maintenance anti-inflammatory therapy.The treatment of choice for reducing symptoms.•Pediapred-oral prednisolone is rarely taken for morethan 5 days. Taken for a short period of time toquickly reduce the bronchial inflammation, given assoon as prescribed, then every morning for bloodcortisol levels are at their highest at this time.


CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) is a disease state characterized byairflow obstruction caused by emphysema or chronic bronchitis.

Assessment: •Cough •Exertional dyspnea •Wheezing andcrackles •Sputum production • Weight loss •Barrel chest (Emphysema) •Use of accessorymuscles for breathing •Prolong expiration•Orthopnea •Cardiac dysrhythmias •Congestion and hyperinflation are seen onchest x-ray •ABG levels that indicaterespiratory acidosis and hypoxemia•Pulmonary function test has decreased vitalcapacity

Interventions: 1. Monitor vital signs and oxygen saturation. 2. Administer a low concentration of oxygen (1-2 L or asprescribed) by a nasal prong. 3. Position the patient in high Fowler’s. 4. Administer medications as prescribed (e.g., bronchodilators,corticosteroids, mucolytic, or antibiotics). 5. Encourage pursed-lip breathing and controlled coughing. 6. Record sputum (COCA) and suction secretions as needed. 7. Provide chest physiotherapy as needed. 8. Monitor for signs and symptoms of pulmonary infections.

Patient Education: C-igarette smoking cessation C-rowded area must be avoided as well as people with infection O-xygen therapy as prescribed O-verexertion must be avoided and O-ver temperature (extremelycold/hot) P-neumococcal and Flu vaccine as recommended P-ursed lip breathing, coughing and diaphragmatic breathing used D-ilators (Bronchodilators), mucolytics, antibiotics, andcorticosteroids must be taken as prescribed D-iet, have a small frequent meal (high calorie, high protein) D-ust must be avoided such as fireplaces, pets, feather pillows,and other environmental allergens


DANGERS OF OXYGEN THERAPY 1. Physical risks •Oxygen being combustible, fire hazard and tank explosion are always there (Place an Oxygen inuse sign). •Catheters and masks can cause injury to the nose and mouth. •Dry and non-humidified gas can causedryness and crusting (Humidify the oxygen if indicated). 2. Functional risks •Patients who have lost sensitivity to CO2 and are upon the hypoxic drive are in danger ofventilatory depression as seen in patients of COPD. Hypoventilation can lead to hypercapnia and CO2 narcosis

NURSING INTERVENTIONS FOR PATIENTS ONVENTILATOR 1. Assess vital signs, lung sounds, and the ventilator. 2. Monitor skin color, chest for bilateral expansion, pulseoximetry, and ABG results. 3. Assess the level of water and temperature of humidifierbecause extremes temperature can damage the mucosa. 4. If the cause of alarm cannot be determined to ventilatethe patient manually with a resuscitation bag until theproblem is corrected. 5. Turn the patient at least every two hours 6. Haveresuscitation equipment available at all times.

LOW-PRESSURE ALARM 1. Disconnection or leak inthe ventilator or in thepatient’s airway cuff occurs.2. The patient stopsspontaneous breathing.

HIGH-PRESSURE ALARM 1. Increased secretions in the airway. 2. Wheezing or bronchospasms. 3. Displaced endotracheal tube. 4. Tube obstruction or kink 5. The patient coughs, gags, or bites the oralendotracheal tube. 6. Anxious patient or fights the ventilator


PNEUMONIA is an infection of the pulmonary tissue, including the interstitial spaces, the alveoli, andthe bronchioles. The edema associated with inflammation stiffens the lung, decreases lung complianceand vital capacity, and causes hypoxemia. A sputum culture identifies the organism.

RISK FACTORS Immunosuppression Nicotine abuse (cigarette smoking) Secretion retention Positioning, improper for CVA or Parkinson’s Influenza infection Respiratory tract infection Alcohol abuse Tracheal intubation Immobility Other diseases (Pulmonary, cardiac, liver) No swallowing (Dysphagia)

ASSESSMENT •Chills •Fever •Cough •Pleuritic pain •Tachypnea •Rhonchi •Wheezes•Use of accessory muscle for breathing •Mental status changes•Sputum production

INTERVENTIONS Position patient to semi-Fowler's. Note sputum (COCA). Encourage coughing and breathing exercises. Use antibiotics as prescribed and other medications (e.g., antipyretics). Monitor respiratory status (O2 saturation, respiratory rate, cyanosis). Mobilize patient as tolerated. Oxygen administration as prescribed. Nasotracheal suctioning as needed. Increase fluid intake, protein, calorie in the diet. Advise proper handwashing and disposal of secretion. Avoid people with a respiratory infection.


FLU Main problem: An infectious or contagiousdisease caused by influenza type virus A,B, C Signs and symptoms: Generally, appear s in 4-5 days when infected Usual S&S: High fever, Headache, Hacking, and non-productive cough Prevention: •Vaccination •Proper Handwashing •Covering cough and sneeze (proper disposal ofused tissue [Kleenex]) •Avoid crowded areas •Keep immune system strong (Eating well, gettingenough sleep, and exercise)

COLD Main problem: Upper respiratory infectioncaused usually by rhinovirus Signs and symptoms: Generally, appears in 2 days when infected Usual S&S: Sneezing, Nasal congestion/discharge, Sorethroat Prevention: •Proper Handwashing •Covering cough and sneeze (proper disposal ofused tissue [Kleenex]) •Avoid crowded areas •Keep immune system strong (Eating well, gettingenough sleep, and exercise)

TREATMENT FOR FLU AND COLD W-ater increase A-cetaminophen or antipyretics, antivirals as prescribed R-est (stay home) D-iet adequate and balanced (nutritious foods) S-igns & symptoms of severe flu, notify physician (e.g., shortness of breath, chest pain, seizures, cyanosis, andsevere vomiting)


People who are at high risk of contracting the flu: 1. ≥65 years old, ≤5 years old 2. People with a medical condition (Pulmonary,immunocompromised, and diabetic patients) 3. Pregnant women (Note: Safe to give flu shot-encourage patient) 4. Living in a home care facilities 5. Hospitalization

Frequently Asked Questions Regarding Influenza Q1: What is the flu vaccine? A1: It’s an inactivated dead virus, to prevent flu. Q2: Who are the people who can’t get the flu shot? A2: Children younger than 6 months old. People withsevere allergies to the flu vaccine or any ingredient in the vaccine. People with egg allergies. If you everhad Guillain-Barré Syndrome. If you are not feeling well (febrile). Q3: Why it is offered in the residence? A3: Elderly are more susceptible to catch flu due to decreaseimmune response. Q4: Why the whole population is not vaccinated? A4: People has the right to choose to be vaccinated.Q5: For how long it is effective? A5: One year. Q6: Why does a person must be vaccinated yearly? A6: Every year there is a different strain of flu virus.

Occulorespiratory syndrome (ORS) is consists of one or more of the following: red eyes, acuterespiratory symptoms (including respiratory distress, throat tightness and/or chest discomfort), and facialedema. There may or may not be associated with systemic symptoms, including high fever. Symptomsvary from mild to severe, resolving fully within 48 hours. (Follow “WARDS” for treatments).


TUBERCULOSIS is a contagious disease caused by Mycobacterium tuberculosis, an acid-fast bacillus.Non-compliance to treatment can cause Multi-drug resistant strain of Mycobacterium tuberculosis.Transmission is via the airborne route by droplet infection. Incidence: Increase in urban low-incomeareas, nonwhites or ethnic groups, and first-generation immigrants from the endemic country. Risk factors 1. Child younger than 5 years old. 2. Drinking unpasteurized milk if the cow is infected with bovine tuberculosis. 3. Homeless individuals or those from a lower socioeconomic group, minority group, or refugee group. 4. Individuals in constant, frequent contact with an untreated or undiagnosed individual. 5. Individuals living in crowded areas, such as long-term care facilities. 6. Older patients 7. Individuals with malnutrition, infection, immune dysfunction or human immunodeficiency virus infection, orimmunosuppressed as a result of medication therapy. 8. Individuals who abuse alcohol or is an intravenous drug user. Assessment •The patient may be asymptomatic •Malaise •Low-grade fever •Cough •Weight loss •Anorexia •Lymphadenopathy•Asymmetrical expansion of the lungs •Decrease breath sounds •Crackles •Dullness on percussion •Night sweats•Chills Note: Some symptoms are specific to the site of infection (e.g., lungs, brain, bones).

Airborne


1. Mantoux test, Tuberculin Skin Test (TST) A 0.1 mL of tuberculin, or Purified Protein Derivative (PPD)intradermally is given creating a wheal. The tests should be read between 48-72 hours and should be measured inmillimeters of the induration (palpable, raised, hardened area or swelling), DO NOT read/measure the erythema(redness), measured across the forearm (perpendicular to the long axis). The standard method of determining whethera person is infected with Mycobacterium tuberculosis. Note: A positive reaction does not confirm the presence of activedisease (exposure vs. presence). •Once react positive – it will always react positively. •A positive reaction in apreviously negative patient indicates that the patient has been infected since the last test. Cannot be done at the sametime as measles immunization (viral interference from the measles vaccine may cause a false-negative result (wait 4-6weeks).

DIAGNOSTIC TEST

Correct Wrong

Get TB testchecked in2-3 days


2. Chest X-ray Supplemental to sputum culture and are not definitive alone or does not provide conclusive evidenceof tuberculosis, but the presence of multinodular infiltrates with calcification in the upper lobes suggest tuberculosis.3. Sputum culture A definitive diagnosis is made by demonstrating the presence of mycobacteria in aculture. After medications are started, sputum samples are obtained again to determine theeffectiveness of therapy. Most patients have negative cultures after 3 months of treatment.

is considered positive in: •HIV-infected persons •A recent contact of a personwith TB disease •Persons with fibrotic changeson chest radiograph consistentwith prior TB •Patients with organ transplants•Persons who areimmunosuppressed for otherreasons (e.g. taking theequivalent of >15 mg/day ofprednisone for 1 month)

is considered positive in:•Recent immigrants (≤ 5 years)from high prevalence countries•Injection drug users •Residents and employees (usnurses) of high-risk congregatesettings •Mycobacteriologylaboratory personnel •Persons with clinical conditionsthat place them at high risk •Children < 4 years of age

is considered positive in anyperson, including persons withno known risk factors for TB.However, targeted skin testingprograms should only beconducted among high-riskgroups.

Mantoux Test Interpretation: An induration of15 or more millimeters10 or more millimeters 5 or more millimeters


INTERVENTIONS 1. Medications: RIPES (Rifampin (RMP), Isoniazid (INH), Pyrazinamide (PZA), Ethambutol (EMB), Streptomycin)taken for a 9-months course (INH) or 12 months for a patient with HIV. •Isoniazid: Body fluids may turn orange(normal) •Rifampin: Urine may turn orange-red (normal) •Advise to take the full course as directed to prevent drug-resistant. •Direct Observed Treatment program: Done for patient’s compliance to medication, watch the patient taketheir medication, look for side effects and answer their questions. 2. Isolation: Negative pressure room, Airborne Infection Isolation Room (AIIR). 3. Use personal protective equipment: N-95 is a special individually fitted mask, done prior to entry and removedafter exiting. Gloves gown and goggles/face shield if possible contamination exists. 4. If the patient needs to leave the room, they are required to wear a mask. 5. Handwashing before and after touching the patient. 6. Stress the importance of adequate rest and diet. 7. Instruct patient about measures to prevent transmission of tuberculosis. 8. Respiratory isolation is discontinued when the patient is no longer considered infectious. 9. Two to three weeks of taking the TB medications, the risk of transmission will greatly reduce. 10. Case finding and follow-up with known contacts are critical to decreasing the number of cases of individuals withactive TB.

DRUG ADVERSE EFFECTS MONITORING

Isoniazid-Hepatotoxicity, lupus-like syndrome,peripheral neuropathy. -Monoamine toxicity.

-LFT, flushing, tinglingin hands & feet.

Rifampin

-Hepatotoxicity, GI upset, flu-likesyndrome, hemolytic anemia,thrombocytopenia, renal failure, orangediscolouration of body fluids.

-LFT, CBC

Pyrazinamide -Hepatotoxicity, hyperuricemia, rash,GI upset, arthralgia.

-LFT, uric acid ifsymptomatic

Ethambutol -Optic neuritis, hyperuricemia -Visual acuity, colorvision


PATIENT EDUCATION 1. Provide the patient and family with information about TB and allay concerns about the contagious aspect of theinfection. 2. Instruct the patient to follow the medication regimen exactly as prescribed and always to have a supply of themedication on hand. 3. Advise the patient of the side effects of the medication and ways of minimizing them to ensure compliance. 4. Reassure the patient that after 2-3 weeks of medication therapy, it is unlikely that the patient will infect anyone. 5. Inform the patient to resume activities gradually 6. Instruct the patient about the need for adequate nutrition and awell-balanced diet to promote healing and to prevent recurrence of the infection. 7. Instruct the patient to increase the intake of foods rich in iron, protein, and vitamin C. 8. Inform the patient and family that respiratory isolation is not necessary because family members already have beenexposed. 9. Instruct the patient to cover the mouth and nose when coughing or sneezing and to put used tissues into plasticbags. 10. Instruct the patient and family about thorough handwashing. 11. Inform the patient that a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 12. Inform the patient that when the results of three sputum cultures are negative, the patient is no longer consideredinfectious and usually can return to former employment. 13. Advise the patient to avoid excessive exposure to silicone or dust because these substances can cause furtherlung damage. 14. Instruct the patient regarding the importance of compliance with the treatment, follow-up care, and sputumcultures, as prescribed.

Note: Rifampin: Monitor liver or renal function, complete blood count, and ophthalmologic exam. Isoniazid (INH)–Liver function test should be done before therapy. Administer with Vitamin B6 to prevent peripheral neuropathy


PULMONARY EMBOLISM occurs when a thrombus detaches, travels to the right side of the heart,and then lodges in a branch of the pulmonary artery.

RISK FACTORS 1. Patients at risk for DVT2. Prolongedimmobilization 3. Surgery4. Obesity 5. Pregnancy6. Congestive heart failure7. Advanced age

ASSESSMENT 1. Blood-tinged sputum 2. Chest pain 3. Cough 4. Hypotension, tachycardia, tachypnea 5. Distended neck veins 6. Wheezes on auscultation 7. Cyanosis

INTERVENTIONS 1. Administer oxygen and position the patient in high Fowler’s. 2. Monitor lung sounds, pulse oximetry, and INR, PT, aPTT if on an anticoagulant. 3. Maintain bed rest and do active-passive ROM exercises as prescribed. 4. Encourage use of incentive spirometry as prescribed. 5. Intubation and mechanical ventilation for severe hypoxemia. 6. Administer anticoagulation therapy (Heparin IV plus Coumadin oral after). 7. Prepare for embolectomy, vein ligation or insertion of umbrella filter as prescribed.

Fat emboli can occur as a complication following fracture of a long bone.


Normal Lungs Sounds: •Bronchial breath sounds: Loud, harsh, high-pitch (heard over the trachea, bronchi –between clavicles and midsternum and over the main bronchus.) •Bronchovesicular breath sounds: Blowing sounds,moderate intensity, and pitch. (Heard over large airways, on either side of the sternum, at the Angle of Louis, andbetween scapulae.) •Vesicular breath sounds: soft, breezy quality, low-pitched.SOUNDS Crackles Rhonchi Wheezes Pleural Friction Rub

CHARACTERISTICS Popping, crackling, bubbling, moist sounds on inspiration Rumbling sound on expiration. High-pitched musical sound on inspiration and expiration Dry grating sound on both inspiration and expiration.

LUNG PROBLEMS Pneumonia, pulmonary edema, pulmonary fibrosis, CHF Pneumonia, emphysema, bronchitis, bronchiectasis Emphysema, asthma, foreign bodies, anaphylaxis, pulmonary embolism Pleurisy, pneumonia, pleural infarction.

•Crackles-Fluid •Rhonchi-Secretions/mucus •Wheezing-Narrowing/blockage •Pleural friction rub-inflamed pleura

UNIVERSAL PRECAUTION: Standard precautions used for all clients regardless of the diagnosis.

Gloves: Required whenever contact with body fluids is likely. Blood,secretions, excretions, mucous membrane, non-intact skin (except sweats) Gown: Required if soiling is likely Mask: Required if splashes of blood or body fluids are likely Handwashing: ALWAYS Before and after contact with the clients.Immediately after gloves are removed/exposure to body fluids. Beforetouching non-contaminated surface or item. After contact with patient’ssurrounding.Donning Personal Protective Equipment (PPE) 1. Gown 2. Mask or Respirator 3. Goggles or Face shields 4. Gloves Removing Personal Protective Equipment (PPE) 1. Gloves 2. Goggles or Face Shields 3. Gown 4. Mask or Respirator


7 Steps In Response To Needlestick Injuries 1. Provide care to exposure site by washing wound and skin with soap and water and flushing mucous membranes with water (for ablood splash or other potentially infectious material exposure incident). 2. Immediately seek evaluation and treatment for the injury from the emergency department or your employee health center. 3. Report the incident to your supervisor and document it according to employer policy, including the type and brand of the devicecausing injury, the department where the injury occurred, and an explanation of the incident. 4. Identify and document source patient (if known) who should be tested for HIV and hepatitis C and hepatitis B (depending on knownimmunity of healthcare worker). The hospital may have to seek consent. 5. Be tested immediately and confidentially for HIV and hepatitis B (if immunity uncertain or unknown) and C. 6. Get post-exposure prophylaxis (PEP) when source patient is unknown. (See source patient tests positive for:) 7. Get follow-up testing, counseling, and monitoring of post-exposure prophylaxis toxicity.

Source Patient Test Positive For: HIV:Then start prophylaxis within two hours of exposure. Hepatitis B: Then get the hepatitis B Immune Globulin (HBIG) injection and initiate the hepatitis B vaccine series if you areunvaccinated; no treatment necessary if you are vaccinated with known immunity. Hepatitis C: Then no customary prophylaxis; but consult your physician or another care provider about experimental post-exposureprophylaxis (PEP).

Incentive Spirometry 1. Instruct the patient to assume a sitting or upright position. 2. Instruct the patient to blow slowly first away from the mouthpiece. 3. Instruct the patient to place his/her mouth tightly around the mouthpiece. 4. Instruct the patient to inhale slowly to raise and maintain the flow rate indicator (ball) between 600 and 900 marks or as farthe patient can do. 5. Instruct the patient to hold his/her breath 5 seconds, and then exhale through pursed lips. 6. Instruct the patient to repeat this process 10 x every hour.

Deep Breathing Exercises 1. Position the patient in a sitting position (best for lung expansion and DBE). 2. Instruct the patient to breathe deeply 3x, inhaling through the nostrils and exhaling slowly through pursed lips.3. Instruct the patient that the 3rd breath should be held for 3 seconds, then, cough deeply 3x. Perform exerciseq1-2 hours.

KEYS TO SUCCESS #3

-ORGANIZE A STUDY GROUP (MAX 3) 1. YOU MAY HAVE QUESTIONS THAT THEY HAVE THEANSWERS TO AND VICE VERSA. 2. BENEFITS: LEARN FASTER (MORE IDEAS) PROCRASTINATION SOLUTION GET NEW PERSPECTIVE FILL IN LEARNING GAPS TIP: CHOOSE YOUR COMPANION CAREFULLY

03Note: "Please don't disregard the old

materials and blog posts. Check also forany downloadable on our private

Facebook group and the website." -Jim

Date post:	30-May-2019
Category:	Documents
Upload:	dinhdien
View:	213 times
Download:	0 times

D I S O R D E R R N 1 0 1 . N E T - rn101questionbank.com · you sop the coticosteroid if patient...

Documents