Respiratory system Disorder medical surgical nursing

Thoracentesis :-

• Removal  of fluid or air from pleural space via transthoracic aspiration.

• Postion :– patient is positioned sitting upright with arms and Shoulder supported by a table at the bedside during the procedure

• If patient cannot sit up the patient is placed lying in bed toward unaffected side, with head of bed eleveted.

• Instruct pt not to cough and breath deeply or move during procedure.

•  Postprocedure: apply pressure  dressing and assess for bleeding and crepitus

•  Monitor signs of pneumothorax

Pulmonary function tests (PFT):-

• PFT is used to evaluate Lang mechanics gas exchange and acid-base disturbance review spirometric measurement lung volumes and ABG

• Instruct the patient to stop smoking and eating a heavy meal for 4 to 6 hours before the test

• Remove the dentures before the test

Ventilation perfusion Test:-

•  The perfusion scan evaluates blood flow to the lungs

• Postprocedure :-

• Keep the patient in  semi Fowler position and asses for return of gag reflex.

• Notify doctor if fever difficulty in breathing occurs

Pulmonary angiography :-

• It is invasive fluoroscopy procedure in which a catheter is inserted through antecubital aur femoral vein into Pulmonary artery or its branches

•  Also involves an injection of iodine and radiopaque contrast material.

• Instruct patient that he may feel in urge to Cough flushing  nausea or salty taste following the injection of dye.

• Postprocedure:- avoid taking blood pressure for 24 hours in extremity used for the injection.

•  Monitor peripheral neurovascular status of the affected extremity

Respiratory Treatment :-

1. Pursed lip breathing :-

• The patient should inhale slowly through the nose and abdomen should expand with inhalation and contract during exhalation.

•  The patient should Exhale three times longer than inhalation by blowing through pursed lip.

2. Huff coughing :-

•  It is effective coughing technique that conserve energy reduce fatigue and facilitate mobilization of secretion

•  The patient should take 3 or 4  deep breathusing pursed lip and leaning slightly forward patient should cough 3 to 4 times during exhalation

***Tectile fremitus :- detection of resulting vibration on chest wall by touch

3. Spirometry:-

•  In sitting position , teeth patient to place the mouth tightly around the mouth is of the device

•  Instruct the patient to inhale slowly to raise and maintain the flow rate indicator between 600 and 900 marks.

• Instruct the patient to hold breath for 5 seconds and then to exhalethrough pursed lip.

•  Repeat this process 10 times every hour

Supplental oxygen delivery system :–

Venti mask colour coding with% o2 flow :-

Chest physiotherapy (CPT) :-

• Percussion, vibration and postural  drainage techniques are performed over thorax to loosen secretion in affected area of lungs and move them into more central airways

•  CPT should be performed in the morning on arising, 1hr before meal or 2 to 3 hr after meal

• Administer bronchodilator 15min before procedure

• If patient is recieving tube feeding, stop feeding and aspirate the residual before begining cpt

Chest injury :-

·      Rib fracture :-

•     Results from direct blunt chest trauma and causes intrathoracic injury such as Pneumothorax or pulmonary contusion

• Assessment :- pain at injury site that increases with inspiration.

•   Client splints chest, fracture on xray

•  Intervention:-ribs usually reunites spontaneously

• Place patient in Fowler position administer pain medication.

·      Flail chest :-

·      Pulmonary Contusion:- 

·      Pneumothorax :-

                  Asthma :- 

Chronic Obstructive pulmonary disease (COPD) :-

• ·       Chracterized by airflow obstruction caused by emphysema or chronic bronchitis

• ·       Assessment :- cough, wheezing and crackles

• ·       Weight loss

• ·       Barrel chest, use of accessory muscle for breathing

• ·       ABG level indicates respiratory acidosis

• ·       Intervention:- ***administer low concentration of oxygen 1 to 2 lit/min as  prescribed

• ·       Provide respiratory treatment and CPT

• ·       Provide high calorie high protein diet with supplement

• ·       Increase fluid intake up to 3,000 ml per day to keep secretion thin

• ·       Position :fowler position and leaning forward to aid in breathing

Severe acute respiratory syndrome (SARS) :-

• ·       Respiratory illness caused by coronavirus covid SARS associated coronavirus

• ·       Syndrome begins with fever and overall feeling of discomfort body ache and mild respiratory symptom

• ·       Infection is spread by close person to person contact by direct contact with infectious material

            Pneumonia :-

• ·       Infection of Pulmonary tissue including interstitial space, the alveoli and the bronchioles

• ·       WBC count and erythrocytes sedimentation rate (ESR) are elevated

• ·       ASSESSMENT :- chills ,elevated temperature and tachypnea

• ·       Pleuritic pain, sputum production

• ·       Intervention :- administer oxygen encourage coughing and deep breathing exercise

• ·       Place patient in semi father position

• ·       Provide CPT

• ·       Increase fluid intake up to 3 litre per day to lossen  the secretion

            Pleural Effusion :-

• ·      It is the collection of fluid in the pleural space

• ·      Assessment :– pleuritic pain that is sharp and increase with inspiration

• ·      Tachycardia and elevated temperature

• ·      Decreased breath sound over affected area

• ·      Xray shows mediastinal shift away from fluid if effusion is more than 250 ml

• ·      Intervention:- place the patient in Fowler position increase coughing and deep breathing exercise

• ·      Prepare the patient for thoracentesis

• ·      Pleurecdectomy surgical stripping parietal pleura away from visceral pleura

• ·      Pleurodesis involves instillation of sclerosing agent into pleural space via thoractomy tube

         Empyema:-

• ·       Collection of pus within pleural cavity

• ·       The fluid is thick opaque and foul smelling

• ·       Most common cause is pulmonary infection and lung abscess

• ·       Assessment :-

• ·       Recent febrile illness, chest pain, cough, malaise

• ·       **Night swaet

• ·       Intervention :– fowler position or semi fowler

• ·       Encourage coughing and deep breathing exercises

• ·       Assist for thoracentesis or  chest tube insertion to promote drainage and lung expansion

      Pleurisy :– 

• ·       Inflammation of visceral and parietal membrane

• ·       Can be due to pulmonary infarction or pneumonia

• ·       **Pleurasy usually occurs on one side of the chest usually in lower lateral portion of chest wall

• ·       Assessment :-  knife like pain aggravated on Deep breathing and coughing

• ·       Dysonea, pleural friction heard on auscultation

• ·       Intervention :-

• ·       Analgesics administration, encourage coughing and deep breathing exercises

• ·       Instruct patient to lie on affected side

        Pulmonary Embolism :-

• ·       Pulmonary embolism occurs when thrombus forms most commonly from deep vein and travel to the right side of the heart and loadges  into Pulmonary artery

• ·       Risk factor DVT, prolonged immobilization, pregnancy and heart failure

• ·       Assessment :- apprehension and restlessneaa

• ·       Blood tinged sputum

• ·       Cough, chest pain

• ·       Crackles and wheezes on auscultation

• ·       Feeling of impending doom

• ·       Hypotension

• ·       Intervention :-

• ·       Reassure patient and elevate head of bed

• ·       Administer oxygen   and prepare for ABG

          Tuberculosis :-

• ·       Communicable disease caused by Mycobacterium tubercul6

• ·       Assessment :-

• ·       Fatigue, lethargy, anorexia

• ·       Weight loss, low grade fever

• ·       Chills and night sweat

• ·       Persistant cough and production of mucoid sputum

• ·       Chest xray shows presence of multinodular infiltrates with calcifaicationin upper lobe suggests tb

• ·       Sputum culture confirm tb(sputum for AFB acid fast bacilli)

·       Classification of tuberculin skin test :-

Tuberculin skin test:-

• ·       **Apply injection at upper third of inner surface of usually left arm

• ·       Injection is given intradermally

• ·       Circle and mark the injection site

• ·       Document date, time and site

• ·       Interpret reaction after 24 hr to 72 hrs later