pleural effusion

a collection of fluid in the pleural space

empyema

occurs when the fluid within the pleural cavity becomes infected and the exudate becomes thick and purulent

-collection of pus in pleural space

-usually caused by an infection which leads to the build up of pus

bronchiectasis

chronic respiratory disorder in which one or more bronchi are permanetly dilated

-thought to occur as a result of frequent infections in childhood

cystic fibrosis

-genetic disease

-excessive mucous production: due to exocrine gland dysfunction & lung scars

cystic fibrosis diagnosis

History and physical

genetic testing

positive sweat test

treatment: agressive respiratory treatment and antibiotics

COPD

a combination of pulmonary emphysema and chronic bronchitis

IRREVERSIBLE

Emphysema

• alveolar damage
• narrowing of bronchioles
• loss of lung elasticity due to air tapping (loose the ability to stretch)

chronic bronchitis

• inflammation of bronchi and bronchioles
• hyper secretion of mucus in bronchi snd bronchioles

risk factors of COPD

smoking and exposure to environmental irritants or air pollution

-clinical manifestations: productive cough, SOB, respiratory acidosis, hypoxemia ( low oxygen levels), wheezing, and difficulty with exhalation- use of pursed lip breathing

COPD diagnostics

• chest x-ray
• pulmonary function tests- air may remain trapped in lungs
• pulse oximetry- typically less than 90% (late finding)
• ABG'S- respiratory acidosis( could be chronic)
• CT of chest

COPD nursing interventions

• monitor respiratory and cardiac status
• allow frequent rest periods
• administer oxygen therapy as ordered
• teach breathing and coughing technique's
• encourage oral fluids if not contraindicated
• encourage a high-calorie diet

asthma pathophysiology

chronic airway inflammation resulting in intermittent airflow obstruction of the bronchioles

asthma etiology

allergens, viruses, occupational and environmental toxins, exercise, perfumes, genetics, obesity, and emotional stress

asthma

you will have increased mucous production and make it harder to breath

-if you don't hear wheezing anymore-thats bad! the bronchioles are so narrow it cut off air

nebulizers

want to teach them to breath in and out of their mouth, if they breath through the nose Scilla (nose hairs) can stop the particles from going in properly

status asthmaticus

does not respond to typical tretaments. runs a risk of cardiac arrest

• unrelieved asthma attacks
• often may result in intubation

Chest tubes complications

if you seee bubbling , there may be a leak. you'll have to trouble shoot for an air leak.

• air leak- continuous rapid bubbling in water seal chamber
• if you dont see any movement in the water seal chamber you have to check for kinks or blockage

cor pulmonale

occurs when the blood pressure in the pulmonary artery- which carries blood from the heart to the subsequent failure of the right aide of the heart.. it can also can occur with chronic low oxygen levels due to conditions like chronic obstructive pulmonary disease

as this enlarges, it functions less and less

pulmonary hypertension

a type of high blood pressure that affects the arteries in the lung and the right side of the heart

- the blood vessels in the lungs are narrowed, blocked or destroyed

-the heart must work harder to pump blood through the lungs, the extra effort eventually causes the heart muscle to become weak and fall.

in some people, pulmonary hypertension slowly gets worse. it can be life-threatening. there's no cure for pulmonary hypertension

pulmonary edema

an abnormal collection of fluid in the interstitial space of the lung and inside the alveoli (air sacs)

-pink, frothy sputum (very specific assessment for PE

pulmonary edema

happens rapidly; becomes a medical emergency

-if non-cariogenic it maybe somewhere else

adult acute respiratory distress syndrome (ARDS)

an acute lung injury that results from pulmonary changes that occur with sepsis, major trauma, major surgery or critical illness

-alveoli fill with fluid -respirations will be up

acute bronchitits treatment

• humidification(thin out secretions)
• cough suppressions(with caution, can potentially make symptoms worse)
• bronchodialators
• nutrition and fluid balance
• rest
• antibiotics (only if bacterial)

influenza

an acute, highly infectious disease of the upper and lower respiratory tracts

long smoking history, barrel chest, chronic productive cough

COPD

Sudden pleuritic chest pain, dyspnea after immobility

pulmonary embolism

absent breath sounds one side after trauma

pheumothorax

purulent pleural fluid needing drainage

empyema

severe wheezing unrelieved by inhaler

asthmaticus

COPD s/s

barrel chest and clubbing of fingers

Asthma s/s

chest tightness, respiratory distress without wheezing

pulmonary embolism

tachypnea, chest pain-sharp pain on inspiration

pleural effusion (around the lung)

orthopnea, fever &chills, diminished breath sounds

pulmonary edema (in the lungs)

pink/ frothy sputum, crackles

severe dyspnea &low sp02

high fowlers, recheck reading, airway support

suspected pulmonary embolism

remain calm, high fowlers

chest tube present

check for leaks, tubing kinks, lung sounds, how much fluid?

acute asthma attack

inhaler, deep breathing

pulmonary edema

oxygen , postion (high fowler)

why does high fowlers improve breathing?

promotes lung expansion (open airways)

why avoid lying flat after meals in COPD

increase pressure on the lungs

why elevate HOB in ventilated clients?

open up the airways, preventing ventilated- acquired pneumonia

keep system BELOW chest level to promote drainage

T/F

true

t/f

continuOUS bubbling may indicate air leak

TRUE

if disconnected place in sterile water

t/f

true

if pulled out cover with inconclusive dressing, three sides

t/f

true

why weight loss risk?

difficult to eat due to increased pressure on lungs, its hard to eat trying to breath &eat @ the same time.

why oxygen cautious?

body gets used to lower oxygen level

why pursed-lip breathing ?

prevents airway collapse

most concerning change in air movement (asthma judgement)

why? airways becoming more constricted

ventilation problem

movement of air can't happen (narrowing)

perfusion probelm

blood flow problem

asthma

ventilation

PE

Perfusion

hypoxia despite oxygen

high fowlers, pursed lip breathing , recheck equipment

fluid in alveoli

chest tube, postition- posterol drainage- allow the fluid to exit easier, incentive spirometer, administer diuretic