Lecture 5: Assessment of the Respiratory System

med-surg notes Lecture 5: January 29 Assessment of the Respiratory System and Acute Infectious Respiratory Conditions Anatomy & Physiology Respiratory Assessment Arterial Blood Gas Upper respiratory tract: Nose, sinuses, pharynx, larynx Cnspection Arterial puncture/line Palpation zeparini'ed syringe Lower respiratory tract: Trachea, main-stem bronchi, lobar, segmental/subsegmental bronchi, alveolar ducts, alveoli Percussion AllenMs test Auscultation Education: Pain 5 sites on the Iront/bac4 Lungs: Alveolar air sacs Place sample on ice/iced water zold direct pressure 8onitor Ior bleeding/hematoma Pneumonia Pathophysiology Excess Ruid in lungs fesult oI inRammatory process Causes of PNA CnRammation caused by inIectious organisms or inhalation oI irritating agents 3acteria &iruses: 1oronavirus, f0&, inRuen'a CnRammation oI interstitial space, alveoli, and bronchioles 1linical Progression 8ycoplasmas .2 Penetrate mucosa Hungi W2 B31 migration fic4ettsiae Healthcare Associated/Acquired (HCAP) k2 1apillary wea4 Proto'oa PNA associated with a hospital stay or occurs shortly aIter 52 Edema F2 Hluid collection zelminths >worms< 8ore li4ely to be resistant to antibiotics fis4 Hactors Aspiration Pneumonia Any pt with PNA within k days oI discharge Irom any healthcare Iacility Community-Acquired Pneumonia (CAP) Not within 5V hours oI being in the hospital 1hronic dialysis within past k9 days 3acteria: Streptococcus pneumoniae zospitali'ed Ior 6 W5 hours within past 79 days &iral: Haemophilus inzuen ae or inRuen'ae A O 3 during the proper season zome wound care within past k9 days fesidence in a nursing home or extended care Iacility Ior any amount oI time within past 79 days fis4 Hactors (lder adult >6 )F< C& therapy or chemotherapy within past k9 days No Ru or PNA vaccine S )F has a chronic health problem or other coexisting condition Uses tobacco or alcohol or is exposed to high amounts oI secondhand smo4e PNA Signs & Symptoms Ventilator-Associated Pneumonia/Event (VAP/VAE) Asplenia: Absence oI a spleen, more li4ely to contract in inIection due to role in immunity Associated with endotracheal intubation and mechanical ventilation Cmmunocompromised state: 8alignancy, chronic renal Iailure, zC&, immunosuppressive drugs (ccurs within 5V-GW hours oI mechanical ventilation zypoxemia--A3D: 1hee4s Rushed, lips/nail beds cyanotic 1ough with/without sputum Hever Altered mental status: Xelirium, conIusion, anxious appearance Tachycardia zypotensive and/or orthostatic Diagnosing PNA ROS Findings Assessment Xiagnostic evaluation 0treptococcus PNA Cnspection W sets oI pre-treatment blood cultures 1hest/pleuritic pain Tachypnea >WF-5F< or dyspnea zigh Iever iI abrupt onset >bacterial< Position: Upright or tripod (ther PNA Xyspnea and cough Anxiety (lder Adult 1hest °f: fevealing an opacity consistent with presence oI acute PNA Hremitus increased with consolidation Hatigue Pharyngitis Antibiotics should not be withheld while trying to obtain sputum Palpation Nausea and anorexia 8yalgias and headache 0putum gram stain/culture iI pt has productive cough At least two clinical qndings: Lung expansion Temperature 6 kV; 1 Percussion Productive cough Xull 1hest pain Auscultation Bea4ness, Iatigue, lethargy 1onIusion Poor appetite Abdominal pain 8ay not have Iever/cough 0hortness oI breath Xecreased breath sounds Altered breath sounds CI 6 )F, tachypnea, tachycardia, conIusion Bhee'ing, crac4les, rhonchi Egophony: zollow-sounding PNA Prevention Nursing & Collaborative Management Nursing Diagnoses Oxygen Therapy Cmplement preventive strategies Cne%ective breathing pattern Elevate z(3 feduce contamination Cne%ective airway clearance 1ombustion 0wallow evaluation Cmpaired gas exchange (xygen toxicity Assess L(1 Administer and encourage Ruids unless contraindicated Alteration in comIort r/t Iever Absorptive atelectasis Xysphagia diet >thic4ened li→uids< Administer antipyretics Xeqcient Ruid volume (ral care 8anage pain Cnade→uate nutrition Xrying oI mucous membranes Assist with meals 8onitor respiratory status+ humidiqed (W as indicated >loosen secretions< Activity intolerance CnIection Aspiration Precautions Xry swallow aIter bites No straws 3ronchial hygiene: Turn, cough, deep breathe, incentive spirometry Li→uids with spoon 0mall bites za'ards Low-Hlow Xelivery Nasal cannula Hace mas4s: 0imple, partial rebreather, nonrebreather Artiwcial Air1ay: Tracheostomy Pneumococcal &accination zigh-Hlow Xelivery Adults 6 )F People S )F with concurrent disease and booster when 6 )F zigh-Row nasal cannula Positioning Pt with cochlear implants &enturi mas4s Air rises Noninvasive positive-pressure ventilation Hluid is dependent Hunctional/anatomic asplenia Cmmunocompromised people 0pread oI CnIection zand hygiene Abvoid sic4 contacts >esp iI immunocompromised< fecogni'ing 0/0 oI PNA and seeing P1P early Avoid pollutants Medications: HCAP 1lean respiratory e→uipment properly C& beta lactam with antipseudomonal activity >ceIepime/unasyn< antipseudomonal Ruoro→uinolones >1ipro< Avoid crowds during cold/Ru season 0mo4ing cessation C& beta lactam with antipseudomonal activity >ceIepime/unasyn< aminoglycosides C& atypical coverage Medications: CAP Nursing Considerations of Medications (utpatient and previously healthy macrolides >a'ithromycin< Try to obtain sputum Ior culture prior to initiating therapy, but donMt delay antibiotic tx Present oI comorbidities Ruoro→uinolones >moxiRoxacin< or C& beta lactam >ceItriaxone< Establish C& access Cnpatient, non-C1U Ruoro→uinolones >moxiRoxacin< or antipneumococcal Ruoro→uinolones >1ipro< Xetermine previous hypersensitivities (btain blood cultures beIore antibiotics CI 8f0A, add vancomycin 1hec4 C& compatibilities 8aintain therapeutic serum drug levels 8onitor 131, liver Iunction, renal Iunction Assess Ior Iungal super-inIections NotiIy healthcare proIessional immediate iI diarrhea, abdominal cramping, Iever, or bloody stools Xo not treat with anti-diarrhea without consult COVID- 9 Flu 1an cause lung complications: A common contagious viral inIection that attac4s the respiratory system Pneumonia Cn severe cases, acute respiratory distress >AfX0< About .5 oI cases are severe, with an inIection a%ecting both lungs As swelling worsens, lungs qll with Ruid and debris Air sacs qll with mucus, Ruid, and cells qghting inIection Prevention Avoid being around sic4 people Dood hand hygiene 8as4ing 3eing vaccinated 0ymptoms include: Hever oI .9925; H or higher Aching muscles 1hills/sweats zeadache Tx: fest, drin4ing Ruids, (T1, antivirals