Title NCM 118 LEC MIDTERMS ✅

MIDTERMS MIDTERMS 1 Week 6 - 7: Nursing Care of Clients with Altered Ventilatory Function 2 Week 8 - 9: Nursing Care of Clients with Altered Tissue Perfusion 3 Week 11 - 12: Nursing Care of Clients with Altered Metabolic- Gastrointestinal and Liver Function 4 Week 13 - 14: Nursing Care of Clients with Altered Elimination 4 Week 15 - 16: Nursing Care of Clients with Altered Perception 4 Week 17: Nursing Care of Clients with Multisystem Problems 5 Week 18: Nursing Care of Clients in Emergency Situation 5
NCM 118 LEC MIDTERMS by TMJ (Temporomandibular Joint) WEEK 6 - 7 Week 6 - 7: Nursing Care of Clients with Altered Ventilatory Function ❖ Alterations in Ventilation (Focus Conditions) ➢ Acute and Chronic Obstructive Pulmonary Disease ■ Group of lung conditions that cause breathing difficulties which includes emphysema and chronic bronchitis. ➢ Pulmonary Embolism ■ Occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. ➢ Acute Respiratory Distress Syndrome ■ Is recognized as the most severe form of acute lung injury a condition that causes fluid to build up in your lungs so oxygen can't get to your organs ➢ Acute Lung Injury ➢ Respiratory Failure ■ Condition that happens when the respiratory system fails to maintain gas exchange ➢ Pneumonia ■ Infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus ■ Symptoms: cough, rapid & shallow breathing, fever, and shortness of breath. ■ Types: ● Community acquired ● Hospital-acquired ● Ventilator acquired ➢ Respiratory Pandemics ➢ Pulmonary Hypertension ■ Condition where there is abnormally high pressure in the blood vessels between the lungs and the heart. ➢ Pneumothorax ■ When air gets inside your chest cavity and creates pressure against your lung, causing it to collapse partially or fully. ❖ Assessment ➢ Subjective Data ■ History: Current & Past ■ Medications ■ Lifestyle ➢ Objective Data ■ Vital Signs ■ Assessment ■ Inspection, Palpation & Auscultation ➢ Diagnostic tests ■ Noninvasive Oximetry ● Non-invasive oximetry, commonly known as pulse oximetry, is a method used to measure the oxygen saturation level in your blood. it works by using a small device called a pulse oximeter ■ Invasive Oximetry ● ABG ◆ Measures the levels of oxygen (o2), carbon dioxide (co2), and the ph of blood from an artery. ● Pulmonary Wedge Pressure (PWP) ◆ AKA pulmonary arterial wedge pressure (pawp) ◆ Measurement used to estimate the pressure in the left atrium of the heart. ◆ Involves inserting a catheter with an inflated balloon into a small branch of the pulmonary artery. ● Pleural Fluid Analysis ◆ Examines the fluid collected from the pleural space, which is the area between the lungs and the chest wall. ◆ This analysis helps determine the cause of pleural effusion, which is the abnormal accumulation of fluid in this space. ● Pulmonary Angiography ◆ Involves injecting a special contrast dye into the blood vessels, typically through the groin or arm. ◆ This dye makes the blood vessels visible on X-rays, allowing doctors to see the blood flow in real-time using fluoroscopy, which is like an X-ray movie ● Ventilation-perfusion (V/Q) Scan ◆ Medical imaging test that evaluates both the airflow (ventilation) and blood flow ////(perfusion) in your lungs. ◆ Useful for diagnosing conditions like pulmonary embolism (a blood clot in the lungs). ● Capnography ◆ Provides a continuous graphical representation of CO2 levels throughout the respiratory cycle. ◆ The resulting graph, known as a capnogram, shows the CO2 concentration over time ❖ Nursing Diagnosis ➢ Ineffective Airway Clearance related to excessive and Tenacious Secretions ➢ Impaired Gas Exchange related to Activity Intolerance ➢ Anxiety related to Breathlessness ➢ Powerlessness related to Feeling of Loss of Control ➢ High Risk for Ineffective Therapeutic Regimen Management relat ed to Lack of Knowledge ❖ Planning ➢ Client Positioning ■ Tripod Position ● Sitting or standing while leaning forward that can help you breathe better. ● Common to patients with COPD ■ Lateral Decubitus Position ● This helps to prevent air from traveling through the right side of the heart into the pulmonary 1
NCM 118 LEC MIDTERMS by TMJ (Temporomandibular Joint) arteries, leading to right ventricular outflow obstruction ● For patient with pulmonary embolism ■ Prone position ● Face-down position. ● This can increase your oxygen levels if they're too low due to respiratory illness. ● Preferred postion for patients with covid-19/ pneumonia ■ Fowler & Semi- Fowler’s Position. ● Full upright at 90° angle is high/full Fowler, and tilted back at 30-45° angle is semi- fowler’s position. ● Used for breathing treatments ➢ Preventing Atelectasis ■ The collapse of one or more parts of the lung. It specifically affects the small air sacs called alveoli. ■ Prevention: ● Early ambulation ● Perform breathing exercises and ● Use an incentive spirometer after surgery ● Don’t smoke/ quit smoking ➢ Preventing Desaturation Experiential Sharing ➢ Promoting Secretion Clearance ➢ Patient Education ➢ Optimizing Oxygenation and Ventilation ❖ Implementation ➢ Medical Surgical Management ■ Oxygen Therapy ● A treatment that delivers extra oxygen to the lungs when the level of oxygen in the blood is too low. ■ Mechanical Ventilation ● Involves use of a machine to help a patient breathe by providing oxygen to and removing carbon dioxide from the lungs. ■ Thoracic Surgeries ● Lung transplantation is a surgical procedure in which one or both lungs are replaced by lungs from a donor. ■ Mobilization of Secretions ■ Artificial Airway Management ➢ Pharmacological ➢ Complementary and Alternative Medicines ■ Echinacea ● A dietary supplement for common colds and other infections. ● Stimulates the immune system to more effectively fight infection ■ Goldenseal ● Herbal remedy that some people use to treat colds, hay fever, digestive problems, and other health conditions. ■ Zinc ➢ Nutritional and Diet Therapy ■ Nasogastric Tube Feeding ● Where a narrow feeding tube is placed through your nose down into your stomach. ● The tube can be used to give you fluids, medications and liquid food complete with nutrients directly into your stomach. ■ Percutaneous Endoscopic Gastrostomy (PEG) ● Feeding tube through the skin and the stomach wall intended for long term feeding ■ Fluid Therapy ■ High CHON, High Calorie Supplements ❖ Client Education ❖ Evaluation of the Outcome of Care ➢ The expected outcomes are the standards against which the nurse judges if goals have been met and if care is successful. ❖ Reporting and Documentation of Care ➢ Documentation serves as a permanent record of client information and care ➢ Reporting takes place when information is shared about client care CH 23 Chest and Lower Respiratory Tract Disorders I. ATELECTASIS - closure or collapse of alveoli A. acute or chronic; cover a broad range of pathophysiologic changes, from microatelectasis (not detectable on chest x-ray) to microatelectasis with loss of segmental, lobar, or overall lung volume. B. most common acute (occurs most often in postoperative setting or people who are immobilized and have shallow, monotonous breathing pattern) C. excess secretions or mucous plugs may cause obstruction of airflow and result in atelectasis D. observed in patients with chronic airway obstruction that impedes or blocks air flow to an area of lung (eg, obstructive atelectasis; more insidious, slower onset) E. Pathophysiology 1. Reduced ventilation or blockage that obstructs passage of air to and from alveoli → reducing alveolar ventilation → trapped alveolar absorbed into bloodstream → no additional air enter into alveoli (blockage) → affected portion becomes airless → alveoli collapse. 2. Causes: altered breathing patterns, retained secretions, pain, alterations in small airway function, prolonged supine positioning, increased abdominal pressure, reduced lung volumes due to musculoskeletal or neurologic disorders, restrictive defects, and specific surgical procedures (upper abdominal, thoracic, or open heart surgery). 3. High risk in postoperatively a) Effects of anesthesia or analgesic, supine positioning, splinting of chest wall because of pain, or abdominal distention → Monotonous, low tidal breathing pattern → small airway closure and alveolar collapse. b) Secretion retention, airway obstruction, and impaired cough reflex, reluctant to cough because of pain, impaired cough mechanisms (musculoskeletal or neurologic disorders), debilitated, bedridden→ bronchial obstruction by secretions → atelectasis. 2
NCM 118 LEC MIDTERMS by TMJ (Temporomandibular Joint) c) pleural effusion, pneumothorax, hemothorax, pericardial effusion, tumor growth within the thorax, elevated diaphragm → excessive pressure on the lung tissue → restricts normal lung expansion on inspiration → lung collapse F. Clinical Manifestations 1. Development usually is insidious. 2. Dyspnea, cough, and sputum production. 3. Acute a) Involving large amount of lung tissue (lobar atelectasis) → marked respiratory distress b) Tachycardia, tachypnea, pleural pain, and central cyanosis (late sign of hypoxemia) c) Difficulty breathing in supine position; anxious. 4. Chronic atelectasis a) Similar to acute. b) Predisposes to infection distal to obstruction. c) S/S of pulmonary infection G. Assessment and Diagnostic Findings 1. Clinically significant atelectasis: increased work of breathing & hypoxemia. 2. Decreased breath sounds and crackles heard over the affected area. 3. Chest x-ray suggest diagnosis before clinical symptoms appear revealing patchy infiltrates or consolidated areas. 4. Depending on degree of hypoxemia, pulse oximetry (SpO2) demonstrate low saturation of HGB with O2 (<90%) or lower-than-normal PaO2 H. Prevention 1. Frequent turning, early mobilization, strategies to expand lungs and manage secretions. Position especially from supine to upright position, to promote ventilation and prevent secretions from accumulating 2. Voluntary deep-breathing maneuvers (at least q2) requires patient to be alert and cooperative. 3. Incentive spirometry or voluntary deep breathing enhances lung expansion, decreases potential for airway closure, and may generate a cough. 4. Secretion management: directed cough, suctioning, aerosol nebulizer, chest physical therapy (postural drainage and chest percussion), bronchoscopy, metered dose inhaler to dispense bronchodilator . 5. Administer opioids and sedatives judiciously to prevent respiratory depression. I. Management 1. Goal: improve ventilation and remove secretions. 2. Same with strategies to prevent atelectasis: first-line measures to minimize or treat atelectasis 3. Other: positive end-expiratory pressure (PEEP; simple mask and one-way valve system provides varying amounts of expiratory resistance 10-15 cm H2O), continuous positive pressure breathing (CPPB), or bronchoscopy 4. Before initiating more complex, costly, and labor-intensive therapies, ask: a) Has the patient been given an adequate trial of deep breathing exercises? b) Has patient received adequate education, supervision, and coaching to carry out the deep-breathing exercises? c) Have other factors been evaluated that may impair ventilation or prevent a good patient effort (lack of turning, mobilization; excessive pain; excessive sedation)? 5. If the cause is bronchial obstruction from secretions: secretions removed by coughing or suctioning or chest physical therapy 6. Nebulizer: bronchodilator or sodium bicarbonate to in the expectoration of secretions. 7. Fail to remove obstruction → bronchoscopy 8. Severe/massive atelectasis → acute respiratory failure (in patients with underlying lung disease) → Endotracheal intubation/mechanical ventilation. 9. Pleural effusion compressing lung tissue: thoracentesis or chest tube. 10. Chronic atelectasis: removing cause of obstruction or compression a) Bronchoscopy to open airway obstructed by lung cancer or a nonmalignant lesion (may involve cryotherapy or laser therapy) b) Caused by lung cancer: airway stent or radiation therapy to shrink tumor 11. Chronic, long-term collapse: may not be possible to reopen airways and reaerate the area; surgical management may be indicated. II. RESPIRATORY INFECTIONS A. Acute tracheobronchitis - acute inflammation of mucous membranes of trachea and bronchial tree, often follows URTI. ● Patients with viral infections have decreased resistance & readily develop secondary bacterial infection. ● Prevention: treatment of URTI 1. Pathophysiology a) Inflamed mucosa of bronchi produces mucopurulent sputum in response to infection (1) Streptococcus pneumoniae, (2) Haemophilus influenzae (3) Mycoplasma pneumoniae. (4) Fungal infection (eg, Aspergillus) b) Sputum culture to identify specific causative organism. c) Other: inhalation of physical & chemical irritants, gasses, or other air contaminants 2. Clinical Manifestations a) Dry, irritating cough & expectorates a scanty amount of mucoid sputum. b) Sternal soreness from coughing, fever/chills, night sweats, headache, and general malaise. c) As infection progresses: SOB, noisy inspiration & expiration (inspiratory stridor & expiratory wheeze), & purulent (pus-filled) sputum. d) Severe tracheobronchitis: blood-streaked secretions expectorated (irritation of mucosa) 3