Med Surge 2 - RESP SYSTEM NOTES
Med Surge 2 - RESP SYSTEM NOTES
Med Surge 2 - RESP SYSTEM NOTES
PLEURISY:
- Edema and congestion of the pleura. Pleura is inflamed
and stretched. ** KEY SYMPTOM= PAIN stabbing
sensation made worse by beathing. Confirmation of Dx
by chest X-Ray
ASTHMA:
- WHAT IS IT ??:CHRONIC INFLAMMATION OF THE AIRWAY.
narrowing of the airway, caused by constriction of
smooth muscle of the bronchioles and bronchi,
excessive mucus production, edema of the resp tract.
- S/S: wheezing, chest tightness, SOB, cough
EXTRINSIC: aggrevated by inflammatory response to
allergens
INTRINSIC: chemicals ( infection, air pollution, exercise,
stress) interact with the ANS and cause reacton.
INTERVENTION: beta 2 adrenergic agonist, antibiotics,
bronchodilators, expectorants, inhaled steroids to
prevent edema. Oxygen
- DIAGNOSTIC TESTS: ABG’s, resp acidosis in chronic
asthma
MED SURGE II: RESP SYSTEM
ATELECTASIS:
- What is it??? : incomplete expansion of the
alveoli or collapse of
- PATHO/ETIOLOGY: bronchiole obstruction of the
lungs due to the accumulations of secretions
( e.g post op), excess pressure on lung tissue
e.g with PLEURAL effusion.
- S/S: nasal flaring, hypoxia, asymetrical chest
wall expansion, hypoventilation
- INTERVENTION: incentive spirometrey, TCDB,
turn patient on the unaffected side to promote
drainage, hydration, encourage ambulations.
MED SURGE II: RESP SYSTEM
ASTHMA:
STATUS ASTHMATICUS:
- NPO, IV FLUIDS FOR HYDRATION, IV
BRONCHODILATORS & STEROIDS.
- * INABILITY TO HEAR WHEEZING IN A
PATIENT WITH ASTHMA INDICATES RESP
OBSTRUCTION.
- * WATCH FOR SUPRASTERNAL
RETRACTION IN INHALATION.
- CAN CAUSE CARDIAC OR RESP ARREST.
- * RESP ALKALOSIS.
PNEUMONIA
ETIOLOGY: Viral in infants and young children
fungal in the immunocompromised
Bacterial: ( pneumonoccocus, klebsiella, strep,
staph aureus.
S/S: older patients may present with confusion
at first. Primary symptoms, dyspnea, high WBC
and fever chest pain cough with sputum:-
SPTUM COLORS & CASUATIVE AGENT:
- STAPH : yellow
- PNEUMOCCOCAL: rusty, blood streaked
- Klebsiella: gel red
INTERVENTIONS: TCDB, semi fowlers, increase
fluids * wash hands sepsis ( tachy, elevated
WBC, increase HR), * do not start antibiotics
before culture sensitivity testing has been done.
* drug resistance probs in the elderly.
TB
PATHO: resp droplets, inhaled and make their
way to the bronchioles and alveoli. AGENT:
MYCOBACTERIUM TUBERCULOSIS.
S/S: low fever, night sweats, productive or non
productive cough. primary infection: may be
asymptomatic and infection lies dormant
Latent Infection: granulomas form, lesions
formed on primary infection are encased.
Post Primary: lesions rupture, active and
infectious stage. (+) smear = contagious.
Complications of TB: * cardiac tamponade,
renal and liver failure
DIAGNOSTICS: CXR, sputum culture,
Mantoux test ( not 100% reliable because if
immunocompromised it gives you a false
positive).
TB
INTERVENTION:
- Oxygen
- Anticoaggulants ( Warfarin to prevent more
clots)
- Heparin – PTT ( antidote *protamine sulfate)
prevents the conversation of prothrombin
into thrombin
- Coumadin- PT/INR ( antidote * vitamin K) 2.0-
3.5 prevents the formation of new clots.
Interfers with clotting by inhibiting the
activity of Vitamin K.
- THROMBOLYTIC ENZYMES: * STREPTOKINASE
( dissolves existing thrombi).
MED SURGE II: RESP
DYSPNEA:
SYSTEM
- measured by level of daily activity @ the point
when the patient feels the SOB.
BREATH SOUNDS:
- CRACKLES: = air passing through fluid, heard on
the lung bases, heard on INSPIRATION.
- RHONCHI ( SONOROUS): heard on expiration, air
passing through fluid in the upper airway; sounds
like snoring.
- SIBILIANT ( WHEEZING) = airway obstruction,
musical sound.
- PLEURAL FRICTION RUB= inflammation of the
pluera. Harsh rubbing sound heard with both ins
& expiration.
MED SURGE II: RESP
SYSTEM
CHEST PAIN:
- Associated w? : fever, chills, cough, pleuratic
( sharp stabbing pain).
HEMOPTYSIS: blood in sputum. Assess
whether it is coming from the lungs or the
nose. Blood from lungs = bright red; OLD
BLOOD= dark brown.
CENTRAL CYANOSIS = discoloration of the
mouth and lips and the buccal mucosa
PERIPHERAL CYANOSIS= earlobes,
extremities and nail beds (clubbing, spongy
spoon like fingernails. Angel > 180 degrees)
MED SURGE II: RESP
SYSTEM
MEASUREMENTS OF PULMONARY FUNCTION:
- TOTAL LUNG CAP= volume of air in the lungs after
max inspiration
- VITAL CAPACITY= max volume of air exhaled
from the point of max inspiration.