RESPIRATORY
DISORDERS
(ADULT HEALTH
II)
TOPICS:
1. ABGs
2. Pulmonary
Embolus
3. Lung Cancer
1. INTERPRETATION OF ARTERIAL BLOOD
GASES(SEE ABG
PAGE)
2. PULMONARY EMBOLUS
A. Most common acute disease of
hospitalized patients
B. Major risk factors:
1) Surgery
2) Immobilization--"venous
stasis"
3) Obesity
4) Advancing age
5) Hypercoagulability(Cancer,
sepsis)
6) Previous PE
7) Smoking
8) CHF, stroke, trauma
9) BCP
10) Pregnancy
C. Prevention:
D. Physical Assessment:
1) S&S: sudden dyspnea, tachypnea,
tachycardia, pleuritic chest pain, dry cough, hemoptysis, possible
crackles, high anxiety, low grade fever, syncope, hypotension, JVD,
S3, S4 or altered S2 heart sounds; dysrhythmias
2) Manifestations of right heart failure
due to pulmonary hypertension:
V/Q mismatch---- >hypoxemia----
>decreased production of surfactant---- >collapsed
alveoli---->shunting----> pulmonary hypertension----
>increased workload of right ventricle
3) ABGs: normal or respiratory alkalosis,
hypoxemia
4) Other tests: V/Q scan(shows V/Q
mismatch); pulmonary angiography(most definitive)
E. Management:
1) Oxygen Therapy
2) Pain control
2) Thrombolytics and
Anticoagulants
3) Surgery: Embolectomy OR
Placement of Vena Cava filter--"IVC
Interruption"--bird's nest filter and Greenfield filter( 3rd. edition
of text, chp. 38, p. 875)
F. Nursing Care--review
responsibilities for patients on anticoagulants
3. LUNG CANCER TREATED WITH THORACOTOMY
& RESECTION:
A. FOUR TYPES OF LUNG CANCER:
Surgery is treatment of choice in 2, 3, & 4 if at Stage I or
Stage II in order to achieve a cure:
1) Small cell or oat cell
2) Squamous cell
3) Adenocarcinoma
4) Large cell
B. TYPES OF RESECTIONS:
1) Segmental, Wedge Resection or
Lobectomy
2) Pneumonectomy
C. NURSING CARE:
PRE-OP CARE: Pulmonary function tests,
ABGs, CBC, Chest films, CT scans, EKG, PT, PTT, Blood
chemistries
TEACHING: Chest tube setup; Info about
Epidural or PCA pain control, orientation to ICU, use of triflow, arm
exercises, placement of incision
POST-OP CARE: NURSING DIAGNOSES:(see care
plan, 3rd. edition of text, chp. 32, pp. 650-653)
1. Thoracotomy and Partial Resection of the
Lung--Lobectomy, Segmental Resection,
Wedge Resection,etc.(causes an open pneumothorax-- see Care of
Pt. with Chest
Tubes)
2.
Pneumonectomy--total removal of a
lung(20% of surgeries):
Usually no chest tubes, but may have J-P
drain or Hemovac; sometimes one tube left in to gravity drainage, but
not to water seal.
According to the text, do not immediately
position patient on affected side as this can put undue pressure on
the internal sutures holding the bronchial stump
together.
Other differences: Slower I.V. rates(chance
of pulmonary edema) and prophylactic digoxin to prevent the
complication of atrial fibrillation.
Teaching: May include site care, use and
purpose of medications, need for rest, activity restriction,
avoidance of people with infections. If adjunctive treatment such as
radiation is to be done, support and teaching regarding this is
needed.
or