Respiratory System

	1) apply pressure over puncture sit until it stops bleeding (5 mins.) 2) Gently rotate sample 3) Keep cool 4) Transport immediately
	Intradermal Interpretation-- Read 48-72 hours, positive test is 10mm or more, + means that you have presence of antibodies, anyone with vaccine will be positive
	Purpose is to visualize trachea and bronchial tree; BEFORE: No fluids 6-12 hours, Insert IV; AFTER: vasovagal response- at risk for bradycardia, check cough/gag reflex (NPO until it returns), Assess sputum, care for patient receiving conscious sedation
	BEFORE: position upright at side of bed, lean on overbed table, baseline vital signs, teach patient not to cough, move, or talk during procedure; DURING: monitor VS & cardiac rhythm, monitor respiratory status & pulse ox.; AFTER: breath sounds, place on affected side for at least 1 hr.
	POSTURAL DRAINAGE: percussion & vibration performed 1st= loosen, Position changes- promote drainage of secretions; SCHEDULE CHEST PT: early in the AM, before antibiotic therapy, between meals, bedtime
	avoid things that could produce flames, anything about 3L should be humidified
	PATHO: increase in bronchiole activity to various stimuli, episodic bronchospasm and airway obstruction w/ mucus; ASSESSMENT: -sudden severe dyspnea -use of accessory muscles -diaphoresis -wheezing -cyanosis -anxiety TREATMENT: fluids (3L/day) -Epinephrine -Bronchodilators such as aminophylline; NURSING: -low flow humidified Oxygen, -Assess resp. status -High Fowler's to promote airway expansion
	PATHO: chronic abnormal dilation of bronchi & destruction of bronchial walls; ASSESSMENT: -chronic cough- foul smelling mucopurulent secretions, -coarse crackles, -exertional dyspnea, paroxymal cough; TREATMENT: -bronchoscopy, -chest PT, -antibiotics, -Albuterol; NURSING: supportive care, fluid intake
	PATHO: excessive mucus production w/ cough for at least 3 months a year for two successive years; ASSESSMENT: -DOE, -cough, -hypoxemia, -rales, rhonchi, -pulmonary hypertension --> cor pulmonale; TREATMENT: -Aminophylline, -Steroids; NURSING: -Low- flow oxygen, -respiratory status, ABG, -diaphragmatic, purse- lipped breathing, -color, amount, & consistency of sputum, -Chest PT
	PATHO: Excessive inflation of air spaces distal to terminal bronchioles, alveolar ducts, & alveoli; Emphysema and Chronic Bronchitis; ASSESSMENT: SOB, -difficult exhalation, -wheezing, rales, -barrel chest, -productive cough, - respiratory acidosis; TREATMENT: -Epinephrine & aminophylline, -Antibiotics, -Steroids, - Mucolytics, -Supportive Care, -lung transplant; NURSING: -pursed lip breathing, rest, hygiene, increased calorie and protein diet, low oxygen level
	PATHO: Mycobacterium TB; ASSESSMENT: -Anorexia, weight loss, -Malaise, fatigue, -chest pain, - cough w/ blood, -low grade fever followed by night sweats; DIAGNOSIS: -AFB, -Chest X-Ray, TREATMENT: -INH, -multiple drugs, -9-12 months; TOXICITY: -Peripheral Neuritis (Vitamin B6), -Liver- Monitor LFTs, -Rifampin- red body fluids, -Streptomycin- auditory and renal toxic, -Ethambutol- red-green blindness; NURSING: respiratory isolation d/c with 3 sputum are negative for AFB
	PATHO: Fungal, symptoms similar to TB; DIAGNOSIS: Chest X-ray, Histoplasmin skin test; MANAGEMENT: -Amphtericin B; TOXICITY: - local phlebitis, -renal, - anaphylaxis, - decrease in bone marrow; TO DECREASE TOXICITY: -Tylenol, -Steroids, -Benadryl
	PATHO: Inflammation of alveolar spaces of lung resulting in consolidation of lung tissue; ASSESSMENT: -productive cough, -shallow respiration, -nasal flaring, -rib retractions, -rales, -fever, -sputum is rusty; MANAGEMENT: oxygen, Semi to high Fowler's, Hydration, Antipyretics, Codeine, Antibiotics; NURSING: -I/O, -Fluid intake
	Removal of one lung-- Post- op= semi-fowler's but not on either side; Life Threatening Complication: Mediastinal shift
	Partial or complete lung collapse; ASSESSMENT: -decrease or bronchial breath sounds, -anxiety, -dyspnea, -pulmonary crackles, -cyanosis; TREATMENT: -Bronchoscopy, -chest PT, Albuterol, - Mucolyst; NURSING: TCDB, -Incentive Spirometer, -Splinting, - Encourage Ambulation, -Analgesics, - Humidify inspired air, - Breath sounds & ventilatory status
	Hypertrophy of R. Ventricle from diseases affecting the lungs ASSESSMENT: -DOE, -Edema, -Fatigue, -Orthopnea, -Tachypnea, -Weakness; TREATMENT: -restrict fluid, decrease Na, - Oxygen Therapy= 24-40%, -ACE Inhibitor- Catopril, -Ca Channel Blocker- Cardizem, -Digoxin; NURSING: -small frequent meals, -limit fluid, -potassium and digoxin level, -reposition q2h, -Respiratory care, -ABG
	excess fluid in pleural space; ASSESSMENT: -decrease breath sounds, -dyspnea, -pleuritic chest pain; TREATMENT: -Thoracentesis, -Thoracotomy; NURSING: -Tell client to alert if feel SOB during thoracentesis, -reassure, - watch for resp. distress, - Administer oxygen, -chest tube care, - chest tube patency, -color, amount, consistency of drainage
	loss of negative intrapleural pressure; ASSESSMENT: -decreased breath sounds, -dullness of chest percussion, -dyspnea, tachypnea, -sharp pain on exertion; TREATMENT: -chest tube; NURSING: -monitor VS, - Resp. status, -chest tub functioning, -CV status
	PURPOSE: 1) Remove fluid or air from pleural space 2) Re-establish normal negative pressure 3) Promote re- expansion of the lung TYPES: - One Bottle System= water seal & drainage; Bubbles= intermittent; No bubbles= re-expansion or obstruction; Two Bottle System- Air & H20 in 1st, suction in 2nd; Collection bottle= intermittent bubbles; suction= continuous; No Bubbles= check to see if suction is on then check or air leaks; Three Bottle- Air and fluid in 1st, water seal in 2nd, suction in 3rd; H2O seal= intermittent; suction= continuous