• Cause - dec. RR and/or vol. COPD, Pneumothroax, Drug OD, Anesthesia,
• Restlessness, confusion, HA, Coma
• HYPOventilation r/t brain attempt to increase RR
• HyperK l/t muscle twitch, cardiac arrhyth.
• Tachycard, HTN

• ---

  PH low
• CO2 High
• If HCO3 high, metabolic comp.

• ---

  Improve ventilation, O2 PRN, Move secretions (pulmonary toilet), bronchodilators, treat HyperK

• Cause - increased RR and/or vol. 1:1 ratio
• HYPERventilation - dec. CO2 (blowing off), Hypoxia, exercise, high alt. r/t decreased O2 in air, high fever
• Light headed, dizzy, agitated
• Pt needs to take slow deep breaths
• HYPO K - muscle weakness
• Possible HypoCa - tetany

• ---

  PH high
• CO2 low
• If HCO3 low - metabolic Comp.

• ---

  Assess ABC's - treat underlying condition
• Admin O2, monitor O2 sats
• If r/t anxiety - give sedative
• If r/t exercise - rebreath in paper bag
• Treat for HYPO K and HYPO CA

• Cause - increased acids or dec. base, DKA, Chronic renal disease
• Renal system responds SLOW
• DKA - Kousmal's (hypervent) fruity breath
• Drowsy, confusion, HA, Incr. RR
• HYPERK - muscle twitching
• GI Upset - N/V/D

• ---

  PH down
• HCO3 down
• If CO2 down - respiratory comp.(quick)

• ---

  ABC's treat Sx
• Increase RR and VOLUME
• Montiror K and Ca
• If PH <7.1 Na Bicarb.
• Treat GI upset
• If renal failure, Dialysis

• Cause - Dec. acid or incr. vase, N/V, dehydration, excessive NG suction, excessive antacids
• Irritable, Confused, lethargy
• HYPOvent (slow and shallow)
• HypoK, HypoCa

• ---

  PH high
• HCO3 high
• If CO2 hich - respir. comp. (quick)

• ---

  Treat cause (first line of this card)
• Anti-emetic, look for diuretics and NG suct, Monitor I/O

• Starts from upper Resp.
• lasts 2-3 weeks
• Reversible, not usually caused from smoking
• Cough (starts dry, turns moist)
• Chest soarness from coughing
• Fever, chills, aching, SOB, exp. wheeze, inspir. stridor
• Increase fluids, steam/vaporizers (decrease inspir. pain)
• Anti-infective (broad spectrum), aniti-inflammitories, mucolytics (mucomist), expectorants (tussin) to thin secretions
• Can turn to Pneumonia

Rhinitis

Can l/t Sinusitis

• Cause - allergens
• Inflammation, congestion, edema, runny nose, sneezing, itching, watery eyes
• Anti-histamines (benadryl, allegra)
• Decongestants (sudafed, afrin)
• Intranasal Roids (Flonaz, nasocort)

• ---

  Cause - non allergic
• Occur anytime r/t environmental changes (temp, humidity), TB, Cocaine, abuse of nasal decongestants
• Inflammation, Congestion, Edema, Purulant nasal drainage
• Antibiotics

• ---

  Cause - Viral (common cold, 90%)
• Influenza, Adenovirus, Rhinovirus
• Inflammation, Congestion, Systemic complaints (gen. malaise, aches, sore throat, temp, cold sores)
• Highly contagious
• Increase fluids, salt water gargles, NSAIDS, anti-inflammatories, NO anti-biotics(useless for viral).
• Relief of symptoms. Caution with OTC's r/t Rx meds.

Sinusitis

Acute and Chronic

Often follows Rhinitis

• Inflammation of the sinus
• Acute:
• Cause - Viral, bacterial, fungal
• Rapid onset, inflammation, congestion, PAIN in face and ears, temp
• ABx, Decongs, Biacin and suftin

• ---

  Chronic:
• Cause - viral bacterial, fungal, environmental
• Repeated episodes of sinus infec.
• Despite Tx, Sx >3 weeks
• Inflammation, congestion, polyps in nasal and sinus cavity, cough, mouth breathing, snoring, fatigue, temp, PAIN, HA, teeth pain
• CAT scan, ABx, Decong.
• Aspiration (sinus surg), moist heat compressions
• Major Cx - BRAIN - meningitis, periorbital cellulitis, encephalitis
• Nsg Dx - Ineffective airway clear, ineff. breath. pattern, pain, fluid vol. deficit r/t temp

Pneumonia

(Infiltrate)

• Micro organism - bacteria, virus, fungus
• Must have infection to be pneumonia
• Will have inflammation
• Community aquired - includes influenza, most common in adults
• Hosp. aquired - got at hospital.  No prior s/s
• Ventilator, O2 tubes, NG tube, EDUCATE
• Aspiration - particles of something got into lungs (gastric juices, food, liquids)
• Inhaled - inhaled bacteria/virus/fungus
• Pts at risk - anything that enters airway, steroids, AIDS, HIV, COPD
• Ineffective Airaway Clearance, activity intolerance, Impaired Gas Exchange
• Fever, chills, chest pain (pinpointed), productive cough, crackles in lower lobes on auscil. purulent sputum
• Good lung down.  Good blood to good lung
• Anti-infectives, pulmonary toilet, incent spir, CXR, Labs
• V/Q shunt

• Possible vascular overload pushes fluid into lungs
• V/Q - Silent Unit
• Abnormal cardiac function - Left Vent. HF
• Complication of pneumonectomy because remaining lung will be overwhelmed with fluid
• Hypervolemia (IV fluids with renal failure)
• Early signs - dyspnea, crackles, frothy sputum, tachycardia, increased RR.
• Late signs - Labored RR, increased Tachycardia, crackles moved up from bases to become ronchi (wet in upper), frothy PINK sputum, central cyanosis
• Before calling MD - elevate HOB, O2, turn down IV fluids, vitals w/ O2 sats, I/O for diuretics.
• MD may order - Diuretics, Foley, O2, CXR (pleural effusion/cardiomegaly), Labs, ABGs (hypoxemia)

• Cause - Hypertrophy or Right Vent. from changes in lungs from pulmonary HTN from endstage COPD (poor prognosis)
• Funnel chest, Pigeon chest (increased pressure)
• Chronic hypoxemia will cause pressure in vascualar system
• W/o HF, pt experiences Resp. s/s - dyspnea on exertion, chronic cough, chest pain, fatigue, paroxysmal nocturnal dyspnea (PND - wakes them up at night)
• With HF, all plus cardiac s/s - edema, ascites (late sign), weight gain, JVD, Bounding pulses.
• Goal - Improve ventilation w/ 24hr O2
• ABGs - severe respir. acidosis
• Meds - bronchodilators
• Symptom mgmt - diuretic, low Na diet, Cardiac meds, fluid restrictions (education and compliance), bedrest (risk for DVT), daily weights
• Polycythemia - increased RBC's - may get therapeutic phlebotomy

• Pneumothorax - air in pleural space
• Hemothorax - blood in pleural space
• Tension - mediastinal shift. BAD - pressure keeps building up.  Decreased cardiac output
• Open (trauma) - something penetrated chest wall (trauma).  Chest tube.
• Closed - spontaneous, blister inside lung.  Needle aspiration or chest tube.
• Traumatic closed - blunt trauma
• Sucking chest wound - tape 3 sides of dressing
• Pleural effusion - stuff in pleural space with NO lung collapse
• Dyspnea, absent breath sounds, pain
• CXR to show air in pleural space and possible mediastinal shift
• ABGs - hypoxemia, resp. acidosis
• Give O2 - monitor sats

COPD

Emphysema and Chronic Bronchitis

General Info

• Limited airflow that is not fully reversible and is progressive
• Leading cause - SMOKING
• 4th leading cause of death
• Don't know they have it until an acute episode
• Some are genetically predisposed, don't smoke
• Develops slowly
• Prevents pts from basic ADL's
• NO CURE
• Surgery - last resort - lung volume reduction, bullectomy (remove enlarged air sac), transplant (risk rejection and infection)

Emphysema

Can't get air OUT

Pink Puffer

• CXR shows overinflation of lung. Damage to wall l/t...
• Inflammation damaged cilia (can't move secretions)
• Decreased elasticity, less surface area for gas exchange
• Barrel chest, pink ruddy appearance, fatigue,
• Diminished breath sounds
• Air does not conduct sound, fluid does
• Respiratory Acidosis (CO2 retained)
• Pulmonary Function Tests (PFT) show:
• Decreased Expiratory Volume
• Increased Residual Volume
• Increased Expiratory Capacities
• Balance activity with rest, diaphragmatic breathing (while inactive), pursed lip breathing (while active)
• Semi-Fowler's, small frequent meals, increased calories
• Education on smoking cessation
• O2 Therapy:
• Early stage - when active
• Later stage - continuous
• PO2 < 60 (80-100) intermittent O2
• PO2 <55 - continuous O2

Chronic Bronchitis

Can't get air IN

Blue Bloaters

• Chronic productive cough for 3 months for two consecutive years
• Mucus, mucus mucus, damaged cilia, can't get secretions out.
• Increase in number of mucus glands
• Peripheral cyanosis, central if worse, edema
• Crackles (low amount of mucus)
• Ronchi on inspiration and expiration (high amount of mucus)
• Productive cough, chest tightness
• ABGs - respiratory acidosis, hypoxemia
• Polycythemia, CXR - congestion, cardiomegaly.  V/Q - shunt
• Activity balanced with rest
• Airway clearance - pulmonary toilet, postural drainage if tolerated
• Low Na diet, Semi-Fowler's, smoking cess, avoid lung irritants
• Flu and Pneumonia vaccine, anti-inflammatory, anit-infective (prevent pneumonia), bronchodilator (albutoral and atrovent), O2, Expectorants, mucolytics

Asthma

Can't get air IN or OUT

• NOT COPD b/c it is reversible
• Smooth muscles constrict
• Early - wheeze on expiration, increased mucus production, inflammation, ?cough?
• Late - wheeze on inspir and expir, diaphoresis, tachycardia, central cyanosis
• Status Asthmaticus - severe and prolonged attack - bad, no breath sounds.  Can l/t respiratory failure
• Chest tightness, possible productive cough, allergies (trigger), CXR - show hyperinflation,
• PFTs - dec. inspi/expi function
• If improvement after bronchodilator = asthma instead of COPD
• V/Q - Shunt