ü Chest X ray à painless procedure
ü Bronchoscopy
o AtSO4
§ Anticholinergic à mimics SNR
§ Decreases saliva à dry mouth
o NPO 6 to 8 hours
o Local anesthesia à check gag reflex before feeding
ü ABG
o Hyperventilation à decreased CO2 à increased blood pH à respiratory alkalosis
o Hypoventilation à increased CO2 à decreased blood pH à respiratory acidosis
o Diarrhea à decreased HCO3 à decreased blood pH à metabolic acidosis
o Vomiting gastric content à decreased HCL à increased blood pH à metabolic alkalosis
o Vomiting blood à decreased O2 à anaerobic metabolism à formation of lactic acid à decreased blood pH à metabolic acidosis
o Blood pH à normal 7.35 to 7.45 à If increased à alkalosis; If decreased à acidosis
o Partial CO2 à normal 35 to 45à If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
o Partial HCO3 à normal 22 to 26 à If increased Metabolic alkalosis; If decreased metabolic acidosis
ü Cancer of the larynx à CS, alcohol and over usage of voice (choir member)
o A - nterior neck mass
o B – urning sensation with hot beverages / Bad breath
o C - hange in the voice (hoarseness)
o D – ysphagia/dyspnea
ü Chronic Obstructive Pulmonary Disease
o Chronic Bronchitis
§ Blue bloater
§ Excessive mucus production
o Asthma
§ Periods of bronchospasm and bronchoconstriction
o Emphysema
§ Disequilibrium of elastase and antielastase
§ Pink puffer
o Manifestations
§ A – LTERATION IN
· LOC à decreased O2
· Thoracic anatomy à over distention of alveoli à TD = APD à barrel chest
· Skin
o Temperature à cool clammy skin
o Color à pale to cyanotic
· ABG à Respiratory acidosis à Increased CO2
§ B – reathing à difficulty, purse lip à expiration > inhalation à removal of excess CO2 (diet low CHO)
§ C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and SFF) à clubbing of the fingers and decreased TP to the kidneys causing polycythemia
§ D – ecreased Metabolism
· Anorexia à weight loss (high calorie diet) à fatigue à weakness
ü Bronchodilators
o Theophylline and aminophylline
§ Primary effect à stimulates beta 2 receptors à smooth muscle relaxation à bronchodilation
§ Side effect à stimulates beta 1 receptors à increases cardiac rate à need not to notify the physician
§ Adverse effect à hypotension à monitor BP à sign of toxicity
§ Evaluation à check breath sounds
ü Acute Respiratory Distress Syndrome
o Causes
§ A – spiration
§ R – espiratory trauma (embolism)
· fracture à embolism à ARDS
§ D – rug toxicity (ASA)
§ S – epsis and shock
· Vomiting, bleeding, dehydrationà hypovolemia à shock à ARDS
o Syndrome
§ Severe hypoxia
§ Bilateral infiltrates
§ Dyspnea
ü Pulmonary embolism
o Restlessness à earliest
ü Water Seal System
o Drainage Bottle ® marked the level every shift
o Water seal bottle
§ Presence of fluctuation ® normal
§ Absence of fluctuation ® lungs are fully expanded ® assess first patient (X ray ® confirm) OR presence of obstruction
§ Intermittent bubbling ® normal
· Absent ® obstruction
· Continuous ® leakage
o Suction Control ® continuous bubbling ® normal
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3 comments :
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