Sunday, March 6, 2011

Respiratory System Disorders

  1. ARDS -Acute Respiratory Distress Syndrome  - S/S anxiety, dyspnea, crackles, rhonchi, diminished lung sounds. Tests: ABGs - respiratory and metabolic acidosis, no change with oxygen. Chest x-ray - bil. infiltrates (early), massive consolidation bil. (late stage) Tx: O2, intubation, Vent support, antibiotics, bronchodilator, neuromuscular blocker, steroids. Interventions/Assessments - assess respiratory, cardiovascular, and neuro status, maintain prone position, CPT.
  2. - Acute Respiratory Failure - decreased respiratory excersion, accessory muxcle use, retractions, dyspnea, tachypnea, orthopnea, nail abnormalities, clubbing of the fingers. Tests -  ABG shows hypoxemia, acidosis, aldalosis, and hypercapnia. Tx - oxygen, intubation, vent support, anesthetic, anti anxiety med, bronchodilators, steroids. Interventions/Assessment - respiratory assessment, O2, bedrest, suctioning, CPT, DB and C, repositioning.
  3. Asbestosis - crackles at the bases, dry cough, exertional dyspnea, plueritic chest pain Tests - Chest xray - infiltrates, plueral thickening, calcification, enlarged heart, gallium scan, Chest CT Scan, PFT.  Tx - CPT, at least 3 liters per day fluids, oxygen, vent support (advanced cases), antibiotics,mucolytic inhalation therapy. Interventions/Assessments - CPT, O2, lung assessment, DB and Coughing exercises.
  4. Asphyxia - agitation, apnea, bradypnea, occasional tachypnea, anxiety, confusion, decreased breath sounds, coma, death. Test - ABG, o2 Sat.  Tx - determine cause, open airway, bronch, O2, narcan, trach. Intervention/Assessment - high fowlers position, oxygen, suction, encourage deep breathing,
  5. Asthma - no symptoms between attacks, expiratory wheezing, Tests; •Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin), PFT, ABG, Pulse ox,  Tx; , 3 liters fluids daily, beta adrenergic meds, epi, serevent, bronchodilators, mast cell stabilizer - cromolyn, antileukotrienes - singulair. Intervention/assessment - reduce anxiety, administer humidified oxygen, high fowlers position, lung assessment, education to know triggers and have a plan to prevent a severe attack.
  6. Atelectasis - decreased breath sound, bronchial breath sounds, dyspnea, anxiety, cyanosis, diaphoresis, substernal or intercostal retractions, tachycardia. Tests: Chest Xray, Chest CT Scan, Bronchoscopy. Tx: CPT, broncodilator, mucolytic inhalation therapy, Intervention/Assessment: position on health side to allow expansion of collapsed lung, encourage DB and Coughing, analgesics as ordered. teach splinting, humidified air, chest assessment.
  7. Bronchiectasis - chronic cough, copious foul smelling sputum, dyspnea, clubbing of fingers, cyanosis, coarse inspirational  rhonchi, wheezing, crackles, anorexia. Tests: Chest Xray, Sputum culture, gram stain, bronchoscopy. Tx: 3 liters of fluid daily, intubation, ventilation, vaccines, steroids, nebulizer, antibiotics, bronchodilator, expectorants,  oxygen, surgery, CPT. Intervention/Assessment - administer meds, teach diaphragmatic and pursed lip breathing, chest assessment, monitor secretions, maintatin fowlers position, Incentive spirommetry and suctioning.
  8. Cor Pulmonale - exertional dyspnea, edema, fatique, orhtopnea, tachypnea, weakness, ascites. Tests: ABG, Chest Xray, pulmonary artery pressure measurements, V/Q Scan, echocardiogram, BNP, blood antiboies, right heart cath. Tx: O2, dig, lasix, vasodilators, calcium channel blocker, angiotenin cnverting enzyme inhibitor. Interventions/Assessments: limit fluids to 1 - 2 liters per day, low-sodium diet, reposition every 2 hours, O2, pursed lip breathing exercises, monitor ABG, monitor vitals.
  9. Emphysema - S/S: barrel chest, dyspnea, pursed lip breathing, Tests: chest xray, PFT, spirometry. ts: CPT, fluids up to 3 liters per day, antibiotics, bronchodilators, vaccines, steroids, nebulizer. Interventiioon/Assessments: respiratory assessment, assess with diaphramic/pursed lip breathing, monitor sputum for color, consistancy, ordor. provide CPT, suction.
  10. Idiopathic Pulmonary Fibrosis - S/S: dry cough, exersional dyspnea, fatigue, rapid shallow respirations; (in late stages) cyanosis, hypoxemia, pulmonary hypertention. Tests: lung biopsy, chest xray, chest CT, PFT, Bronchoscopy, ABG. Tx: lung transplant, oxygen, corticosteroids, cytotoxic drugs. Intervention/Assessments: Respiratory assessment, monitor O2 Sats, emotional support, encourage activity to tolerance.
  11. Lung Cancer - S/S:  Cough, hemoptysis, weight loss, Tests: Chest Xray, PET scan, CT scan, cytology. Tx: Resection on the affected lobe, radiation therapy, chemotherapy. Interventions/Assessments: assess pain and medicate as ordered, suctioning, oxygen, monitor for infection, bleeding, watch labs.
  12. Pleural Effusion and Empyema - S/S: dyspnea, fever, chest pain, decreased breath sounds. Tests: Chest xray, thoracenetesis, lab studies, gram stain, culture, CT Scan of chest. Tx: thoracentesis to drain fluid, thoracotomy if not effective, antibiotics, oxygen, chest tube. Intervention/Assessment: O2, antibiotics, chest tube care, monitor and record drainage.
  13. Pleurisy -S/S:  friction rub, sharp chest pain with breathing. Tests: US of Chest, Chest Xray, Chest CT, Thorencentesis, Chest assessment. Tx: bed rest, analgesic, anti inflammatories. Interventions/Assessment: stress importants of bedrest, administer antiussives and pain medicaitons as ordered, incourage Deep Breathing and Coughing, show splinting technique.
  14. Pneumocystis Pneumonia: S/S: generalized fatigue, low grade fever, non-productive cough, dyspnea, weight loss. Tests: Chest Xray, histologic studies Tx: oxygen, , antibiotics, antipyretics Intervention/Assessment: monitior I and O, antimicrobial meds, montior for adverse reaction, nutritional supplements, encouage to eat hight calorie, protiein rich diet.
  15. Pneumonia: S/S; chills, fever, crackles, rhonchi, friction rub, dyspnea, SOB, accessory muscle use, sputum - rusty, green, or bloody with pneumococcal pneumonia; yellow-green with brochopneumonia.  Tests: Chest xray, sputum gram stain and cultures, CBC, chest CT Scan. Tx: oxygen, antibiotics, nebulizer treatments. CPT.  Intervention/assessments: monitor intake and output, encourage fluids of 3 - 4 liters per day, monitor O2 saturation, lung assessment, encourage deep breathing and coughing, monitor labs.
  16. Pneumothorax and Hemothorax: S/S - diminished or absent breath sounds unilaterally, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increases with exertion. Tests - chest xray. Tx: chest tube to drainage or suction. Intervention/Assessment: monitor and record vital signs, chest assessment, chest tube drainage, cardiovascular status.
  17. Pulmonary Edema - S/S: anxiety, pale, sweaty, restless, dyspnea, orthopnea, tachypnea, productive cough, frothy, bloody sputum. Tests: chest x-ray - cardiomegaly, plural effusions, diffuse haziness of the lung fields; hemodynamic monitoring - incresase in pulmonary artery pressure, pulmonary artery wedge pressure, and central venous pressure and decreased cardiac output. Tx: oxygen, diuretics, nitrates, dig, inotropic agents, vasodilator. Interventions/Assessments: assess hemodynamics, cardiac and respiratory assessment, high fowlers position, O2 sats.
  18. Pulmonary Embolism - S/S: sudden onset of dyspnea, tachypnea, crackles, chest pain. Tests: ABG, V/Q Scan, Spiral CT of chest Tx: Vena cava filter or pulmonary embolectomy, oxygen, intubation, ventilation, anticoagulant, fibrinolytics. Interventions/Assessments: assess respiratory, and  cardiovascular status, oxygen.
  19. Respiratory Acidosis - causes the blood to become too acid due to inability to remove the carbon dioxide. S/S: tachycardia, hypertension, atrial and ventricular arrhythmias, in severe acidosis hypotension with vasodilation. Tests: ABG Paco2 greater than 45 and pH is less than 7.35, in acute stage bicarb is normal in chronic stage it is elevated, PFT, Chest xrays Tx: oxygen, bronchodilator, CPAP, BiPAP, Vent, treat cause, bicarb in severe cases. Causes: asthma, COPD, Smokiong, Obesity. Interventions/Assessments: closely monitor blood pH levels, watch for changes in respiratory, CNS, and cardiovascular functions, monitor ABG, and electrolytes, maintain hydration, maintain vent and suction if severe case.
  20. Respiratory Alkalosis: low levels of carbon dioxide. Causes - anxiety, hyperventilation S/S: agitation, arrhythmias that fail t respond to conventional treatment, circumoral or periphera paresthesia, deep, rapid breathing, exceeding 40 bpm, lightheadedness or dizziness. Tests: ABG - Paco2 is less than 35 and pH is wlwvated in proprotion to the dall in Paco2 in the acute stage but drops toward normal in the chronic stage, Bicarb in normal in acute, but lower in chronic. PFT, Chest xray. Tx: treat cause, increasin CO2 levels by having patient breathin a paper bag. Intervention/Assessment: assess  neurologic, neuromuscular and cardiovascular functions, monitor ABGs and electrolye levels.
  21. Sarcoidosis: Initial S/S - Arthralgia n the wrists, ankles, and elbows; fatigue, malaise, weight loss; Respiratory - Breathlessness, substernal pain; Cutaneous -  erythema nodosum, subcutaneous skin nodules with maculopapular eruptions; Ophthalmic - anterior uveitis; Musculoskeletal - muscle weakness, pain; hepatic - granulomatous hepatitis; Genitorurinary - Hypercalciuria; Cardiovascular -  arryhythmias; CNS - cranial or peripheral nerve palsies, basilar meningitis Test: a positive Kveim-Siltzbach skin test. Tx: low calcium diet, avoid direct sun, oxygen, systemic or topical steroid Intervention/Assessment: high calorie diet, plenty of fluids, low calcium if hypercalcemia, oxygen.
  22. Severe Acute Respiratory Syndrome (SARS) S/S: Chills, Fever, general discomfort, headache, short of breath. Test: cell culture. Tx: possible vent support, oxygen, CPT, antibiotics, antivirals, high dose cortcosteroids. Interventions/Assessment: treat symptoms, maintain patent airway, airborne precautions, monitor vital signs and respiratory status.
  23. Tuberculosis: S/S: prolonged cough, bloody sputum, fever at night, night sweats, weight loss. Test: TST, Chest x-ray, AFB and cultures. Tx: antituberculars, airborne precautions. Intervention/Assessment: maintain positive pressure room, assess respiratory status, oxygen.

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