What is epistaxis?

• nose bleed
• rupture of small capillaries in the nose
• shouldnt bleed for over 30 min.(danger)

• trauma
• dry air
• hypertension
• over anti-coagulation

Teaching for epistaxis

• Pressure
• ice
• Dont tip head back
• Extreme cases:
  • cautery
  • topical cocaine
  • packing

what kind of sounds would you hear over a lung abcess?

• Abcent, dull

What is COPD

• Chronic obstructive pulmonary disease
• Any combo of asthma, bronchitis, emphysema.
• Over time>destroys alveolar walls&capillary beds

COPD

Emphysema IS?

• Most common common in copd
• Occurs frequently in men40-45 years
• takes 20-30 yrs. to develop

• Smokin most frequent
• second hand smoke
• air pollution
• chronic infection
• allergies

• progressive
• dyspnea on exertion
• chronic cough producing purulent sputum
• SOB at rest

• Barrel shaped chest>aveoli hyper inflated
• prolonged expiration
• hypercapnia
• become thin & frail cuz of inability to maintain 02 levels while eating

Hypercapnia

• cellular respiration inpaired, blood levels of O2 decrease/CO2 increases

02 for emphysema patients

• no gr8r than 2L
• If higher-can cause respiratory arrest

COPD

chronic bronchitis

• Persistence of chronic cough w/excessive production of mucus for at least 3 months of 2 consecutive years.

COPD

Chronic bronchitis characteristics

• hypersecretion of mucous by bronchial glands
• recurrent/chronic respiratory tract infection

• Projection  linining in throat and nose
• prople secretions and debri upward and out

What is stridor

• high-pitched, harsh sounds during respiration
• indicate airway obstruction

what makes the lungs inflate?

• as we inspirate the  diaphragm pulls down, the intercostal muscles push out
• Co2 triggers it

• Inflammation of mucous membranes that line the mayjor bronchi & branches
• Frequently starts as URI
• may involve trachea

• Fever
• malaise
• Dry non-productive cough leads to cough producing mucopurulent sputum
• frequent coughing attacks w/weezing
• moist inspiratory crackles heard

• Monitor breath sounds /temp
• Deep breath/cough
• humidify air
• encourage fluids
• medicate for fever/pain

Complications of acute bronchitis?

whats the precise path of 02 around the lungs

• De-O2 blood leaves R ventricle via pulmonary artery>goes to pulmonary capallaries surrounding alveoli>exchange carbon dioxide for oxygen across semipermeable membrane>oxygenated blood  returns to L atrium via pulmonary vein>oxygenated blood moves throughout the body.

• actual respiration occurs at cellular level where O2 &CO2 are exchanged.
• O2 is used for glucose metabolism at the cellular level.

How to collect a sputum specimen

• Early morning before breakfast
• No mouthwash
• sputum not spit

• Adult respiratory distress syndrome
• Complication that follows other desease process:
  • chest trauma
  • shock
  • drug over dose
  • pancreatitis
  • infections

• Sever hypoxemia& progressive loss of lung complience

• Collapse of alveoli leading to collapse of lung
• may involve small portion of lung or whole lobe

• Decreased breath sounds
• increasing level of resp.distress
• CXR reveals dense shadows

• Aspiration
• mucus plug
• fluid/air in thoracic cavity
• compression of tissue from tumor/enlarged heart

• aggressive pulmonary hygeine
• TCDB
• bronchodialaters
• humidification
• supplementary O2
• pulmonary drainage
• Clapping
• incentive sperometer

• Acute inflammation of the parietal and visceral pleura
• 2 types

• Develops from URI, TB, CA, or collagen disease
• inflammation of pleural membranes
• Knife like chest pain on inspiration
• pleural friction rub

• Treat underlying cause
• analgesia
• splint affected side with coughing

• Accumulation of fluid between pleural layers

• TB
• cardiac/renal disease
• pneumonia
• CA(50% develop)

• Dyspnea
• coughing
• chest pain
• fatigue
• sharp pain on inspiration

• same as dry pleurisy
• relieve SOB
• chest tube in need 2 drain fluid

what do chest tubes do?

• Re-expand lung after it has collapsed
• draing accumulation of fluid/air from pleural cavity

Chest tubes can be used for:

• pnemothorax_air in pleural space
• Hemothorax-Blood in pleural space

• prevent kinks\
• make sure there is patency
• document amount and color of drainage
• teach coughing and deep breathing
• ???

• Total lung capacity
• total volume of air that lungs contain when fully inflated

• Vital capacity
• volume of air a person can exhale

• Tidal volume
• total volume of air expired during normal breathing

• Residual volume
• amount of air remaining in lungs after expiration

• Acute resp. disease of short duration
• caused by several/distinct viruses
• strains: A,B,C
• transmitted through resp. tract

• fever,chills
• severe headache
• muscle aches
• anorexia
• weakness,apathy,malaise
• sneezing
• sore throat
• dry cough
• nasal discharge conjunctival irratation

• annual vaccination

• Mucopurulent possibly blood streaked sputum
• fatigue, anorexia, weight loss:later
• dyspnea chest pain:advanced

S/S of upper airway cancer

• lesion, lump, abnormality
• detected often at dentist
• later: pain bleeding

• Aspiration of excess fluid/air from pleural space
• outpatient procedure

• have signed inforemed consent
• explain procedure
• asst. into position
• tell not to move for procedure,no coughing/DB
• monitor VS during
• pos. on uneffected side after done for @ least 1 hour>remain on bedrest for several hours
• record amount, color, characteristics of fluid removed.
• monitor respiratory function

sequela

• condition following as consequence of disease

• Heimlich manuavar

• Collection of pus in pleural space

PPD

• give intracutaneously
• 0.1 mL

• report bleeding(esp w/in 1st 12-14 hrs.)
• gently gargle with warm saline or alkaline mouth wash
• maintain liquid/very soft diet 4 several days
• avoid spicy &rough textured foods
• avoid milk & its products

• frequent,brief episodes of respiratory standstill during sleep

• restless sleep
• loud/heavy snoring may B inturrupted by silence/gasps
• excessive daytime sleepiness
• morning headaches
• loss of energy
• trouble concentrating
• irratability
• forgetfullness
• mood/behavior changes
• decreased interest in sex
• systemic hypertension
• dysrythmias
• enuresis

• high pressure within pulmonary circulation
• from resistance to blood flow in pulmonary circulation

• dyspnea on exertion
• weakness
• chest pain
• fatigue
• distended neck veins
• orhopnea
• peripheral edema

• Fluid accumulation in the lungs
• interferes with gas exchange in the alveoli

• dyspnea
• orthopnea
• restlessness,
• cough(pinl frothy sputum)
• cynosis                       (DORCCWRST)
• wheezing
• respirations moist/gurguling
• severe apprehension
• tachy cardiac

• Dont let H20 enter the stoma-it will flow 2 lungs
  • avoid swimming,showers
  • take care with bathing(use hand held)
• wear scarf or gauze dressing over stoma so less obvious
• avoid fabrics or dressings that fray

liquid/soft diet

• observe for repeated swalling(hemorrhage)
• assess visual acuity(damaged optic nerve)
• monitor temp q4h
• assess for pain over area(infection)
• admn. analgesics
• apply compresses to invoved sinuses(pain/edema)
• oral hygene/ice chips(mouth breathing)
• change drip pads prn/assess drainage
• teach not to blow nose,not lift gr8r tan 5 lbs,
• "      ' stay in warm enviro. & avoid smoking

• exaggerated curve of thoracic spine

• lateral S- shaped curvature of the thoracic/lumbar spine

• chest diameter increased and rounded
• ribs horizontal

• also pectus excavatum
• sternum depressed from 2nd intercostal space

• also pectus carinatum
• sternum abnormally protrudes
• ribs are sloped backward

• Airway clearance;ineffective
• aspiration,risk for
• breathing pattern,ineffective
• gas exchange,impaired
• ventilation,impaired spontaneous
• ventilatory weaning response,dysfunctional

• Acute infectios inflammation of Larynx,trachea,bronchi

• recurrent bouts of spasmodic coughing>continues til breath is exhausted
• ending in inspiratory stridor