Tracy Petleski, MSN Altered Respiratory Function

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Tracy Petleski, MSNAltered Respiratory Function

• Unit III

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Oxygen therapy

• Must have a physicians order!
• The goal of O2 therapy is to provide adequate
  transport of oxygen in the blood while decreasing
  the the work of breathing and reducing the stress
  on the myocardium
• Concentration of O2 in the environment is 21

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Oxygen therapy

• O2 is considered when there is a change in
• Respiratory pattern
• Respiratory rate
• Hypoxia
• hypoxemia

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Oxygen therapy- Assessment

• Mental status agitation, confusion lethargy
• Coma
• Dyspnea
• Inc. BP, changes in HR, dysrythmias
• Diaphoresis
• Central cyanosis

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Oxygen therapy- Assessment

• May mimic alcohol intoxication
• Lack of coordination
• Fatigue
• Drowsiness
• Apathy
• Delayed reaction
• COPD

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Types of hypoxia

• Hypoxemic hypoxia
• Circulatory hypoxia
• Anemic hypoxia
• Historic hypoxia

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Oxygen toxicity

• Can it happen?
• O2 concentration is greater than 50
• Signs symptoms
• Substantial discomfort
• Paresthesias
• Dyspnea
• restlessness

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O2 Toxicity

• Signs symptoms
• Fatigue
• Malaise

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Chest physiotherapy

• Goal normal respiration, can mobilize secretions
  and has normal breath sounds
• Goal is confirmed by normal chest x-ray

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Chest physiotherapy

• Postural drainage
• Chest percussion and vibration
• Usually performed by respiratory therapist

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Postural drainage

• 2-4x day
• At HS
• Conjunction w/ HHN, bronchodilators and or saline
  nebs
• Dilate bronchioles, reduce spasms, decrease
  thickness of secretions, combat edema in
  bronchiole walls

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Postural drainage

• Position drain LOWER lobes first
• Drain upper lobes last
• Patient has to be capable of tolerating
  positioning
• If the pt. Cannot cough, the nurse may suction

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Nursing Management

• Pt. Comfort
• Non-restrictive clothing
• Avoid eating before
• Medicate for pain
• Splint incisions

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Nursing Management

• Maintain each position for 10-15 minutes
• Breath in SLOWLY through NOSE
• EXHALE through PURSED LIPS

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Nursing Management

• STOP if c/o pain
• STOP hemoptysis
• STOP SOB
• DOCUMENT procedure and patients tolerance to
  postural drainage

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Chest percussion and Vibration

• Percussion is carried out by cupping hands and
  lightly striking the chest wall
• Perform 3-5 minutes in each area

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Chest percussion and Vibration

• Vibration manual compression during exhalation
• Increases velocity of air expired from small
  airways

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Nursing management- percussion and vibration

• Avoid eating
• Comfort
• Avoid restrictive clothing
• Medicate
• Splint for comfort
• STOP c/o pain

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Teaching

• Physiotherapy can be done at home
• Family
• Home health nurse
• RRT
• Breathing retaining breathing exercises

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Airway management

• Usually an EMERGENCY!
• Airway is narrowed or blocked
• Airway management can be chronic as seen in
  ventilator dependent pt.s

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Upper airway management

• Obstruction food, emesis, blood clots, and or any
  FB
• Tissue swelling in the laryngeal edema,
  epiglottitis, laryngeal carcinoma, abscess or
  thicken secretions

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Upper airway-nursing management

• QUICK ASSESSEMENT!!
• Inspection
• Palpation
• auscultation

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Endotracheal intubation

• Airway into mouth or nose into trachea
• GOAL PATENT AIRWAY
• IMMEDIATE relief of respiratory distress
• Can be an EMERGENCY or a CONTROLLED event

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Nursing management of endotracheal tubes

• NPO
• Cuff pressure low/high
• Secretions- suction
• Aspiration
• Hypoxia
• Sedation and paralysis
• Extubation
• Long-term trach

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Surgical intervention

• Thoracic surgery
• Pneumonectomy
• Lobectomy
• Wedge resection
• Thoracoscopy
• Lung volume reduction

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Pneumonectomy

• Removal of entire lung.
• Primary reason is cancer
• lung abscesses, lesions or extensive tuberculosis
• removal of the right lung is more dangerous

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Nursing responsibilities with pneumonectomy

• Cardiovascular surgery
• post-op pneumothorax
• post-op bleeding
• no chest tube with pneumonectomy potential for
  pneumothorax on unaffected side

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Lobectomy

• Removal of a portion of the lung
• cancer bengin or malignant
• emphysema
• fungus
• bronchiectasis

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Wedge resection

• removal of a well circumscribed lesion
• performed for diagnostic purposes
• pleural space is usually drained to prevent
  intra-operative pneumothorax

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Nursing considerations with a wedge resection

• Possible chest tube placement
• thoracic surgery potential for pneumothorax
• respiratory distress
• hemorrhage into operative space
• chest drainage

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Thoraoscopy

• Endoscopic video
• prevent large surgical incision
• can obtain specimen or tissue biopsy
• diagnostic tool for recurrent pneumothorax
• alternative treatment for mediastinal treatments
• benefits rapid diagnosis, treatment of some
  conditions and minimal post-op complications.
  Decreased hospital stay.

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Nursing management surgical procedures

• Teaching
• Relieving anxiety
• Post-op care
• Chest drainage chest tube
• Ventilator support
• Relieving pain and discomfort
• Positioning