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Medical Therapeutic - Respiratory System
DISEASES OF RESPIRATORY SYSTEM
Bronchial
Asthma – Recurrent paroxysms of
dyspnea with wheesing – inherited allergic tendency.
Assm’t:
Dyspnea, orthopnea, wheezing, tightness in chest – feeling of suffocation,
slight dry cough, perspires freely.
Tx & Implementation
A.
Drugs : Bronchnodilators
Sedatives - Tranquilizers
-
Humidify inspired air -
O2 only if attack prolonged ro cyanosis present
- Rest
– Fowler’s or orthopneic postion
F.
Fluids: Watch
for toxic effects of drugs - Avoid
stress -
Avoid allergy foods – eggs, mild, fish, wheat, strawberries
tomatoes, pork, bacon, citrus fruits,
nuts, chocolate, pineapple,
use soybean mild as substitute for milk. Gluten is a
found in wheat (germ)
COPD
(Emphysema): Over inflated
cough, dyspnea, sputum, wt. loss, hypoxia, barrel
Chest, prolonged expiratory phase with wheezes and ronchitis
COMPLICATIONS
Pulmonary hypertension, Rt sided heart failure, spontaneous pneumo-
Thorax.
Rx/Implementation
Watch for impending Hypoxia -
Check lung sounds - Pursed
lip breathing -
O2 1- 2 4 min.
Hydratuib/Hymidification with face or aerosol masks Good nutrition
rest, breathing exercises -Chest
physiotherapy < -- > Postural drainage
*Positions:
RUL + LUL – sit up cup thorax -
RML – Left side with head slanted down, right shoulder ¼ turn onto
Pillow
Cup anterior over right nipple(mid)
LL (Lingula) – S/A Reserved – Left nipple
RLL + LLL – Trendelenburg – cup posterior
Alternating sides – or prone
O2
ADMINISTRATION
Colorless, odorless, tasteless gas
1.
NASAL CATH. – measure nose to ear.LUB
if necessary Change 8-12hrs.30-50%
2.
FACE MASK – Cover nose only or nose and mouth may have
Rebreather bag
30-65%
3.
CANNULA – Nasal prongs -
Clean q 8hrs.
TENT – Upper third abed
50-60%. Keep pt. Warm and
dry
SAFETY
No Smoking signs -
No material that produces static electricity -
No electric equipment – unless checked grounded
PT,
MANAGEMENT
Semi or high Fowler’s – adequate lung expansion
T,DB, C -
Hydrate -
Check VS, Color, LOC -
Stay with frightened/anxious pt.
O2 analyzer – 20% room air normal
DISCUSSION
1.
CORYZA – sneezing, chills, slight fever, H/A, watery eyes,
Copious
nasal dishcharge, dry, scrathy sore throat
2.
PNEUMONIA – S/S
Bacterial
– rusty color sputum
3.
PLEURISY – DRY (
with effusion – wet )
INFLUENZA – S/A coryza + muscle aches
With high fever anorexia & weakness
Rx cool vapor system inhalation
5.
T.B. – S/S -Resp.
isolation
Meds : Isoniazid (INH)
Ethambutol any combination of two if necessary
Rifampin once daily
Streptomycin
PAS
Prophylaxis INH with B6 for 1 year
Emergency drug of choice for pain – Demerol
NO
Atropine, Morphine, Barbiurates
Fx Ribs – S/S – trauma – pain at site – (intercostal nerveblock)
¨
Flail chest – resp. embarrassment (impairment)
f
rom multiple rib trauma
¨
Tx cuffed trach:
(Vent (MA – 1) -
(IPPB
Suction
Open wound of chest :Submucus
Resection – Packing – check resp.
Ice to face/eye -
Moustache/dripper drsg.
Semi Fowlers -Laryngectomy
– Lost cord club
Fed through N/G tube p.o. have permanentCommunication
– written, flip chart
*Tracheostomy
– cuf type
à
release pressure q 1hr. for 5 minutes
Hyperventilate
before and after with ambu bag humdify air (100% O2 for one-two minutes)
*Suction : Always suction nasal/oral 1st
Then deflate cuff
Change cathter – change drsg. Q 4hrs.
Clean under with H2O2
Clean inner cannula with H2O2
Rinse sterile H2O or N.S.
Cath – ½ diameter of trach.
LUB with sterile NS for each entry insert 6-10
VS-VS -> Suction left bronchus have pt.turn head to
right
i.
No suction below –10-15 sec. Max Suction on exit
j.
Rotate cath 360 degrees flush with NS between
k.
Rest 2-3 min. between suction
l.
Instill 4-5ml N.S with fresh N.S. or (use syringe no needle) if thick, stickly,
crusty material to liquidy
Order
of Procedure
resp. suctions
Lower
resp. suction
Clean around trach. With H2O2 and rinse with NS.
Remove and wash inner cannula. Dry and replace
DSD below trach
Get assistant – change ties (only one finger should fit under tie)
HEIMLICK
MANEUVER
Fist with thumb in cover with other hand – flat side on bet naval
Naval
and below sternum – 6-10 upward abd thrust can be
Done on floor or over a chair
*CPR 1 man- 2 breaths to 15 compressions (pulse 60-100)
2 man- 1 breath to 5 compressions ( if over 8 yrs old)
(The more the better)
Respiratory
Post-op Complications
Usual :
+1) Tension Pneumothorax
a.
Air leak into pleural space from incision site
b.
Mediastinal shift
2)
Pulmonary Emboli
3)
Bronchopulmonary Fistula
a.
Subcutaneous Emphysema(air
from pleural space -> into subq tissuePalpate
skin=tissue paper sound usually around
Incision
Chest Tubes
Vasoline gauze dsg. – DO NOT remove
Hemostates at B.S.
Milk chest tubes 30- 60 min. if clots or debris
Do not clamp tubes if moving pt. – keep bottle below chest
Level
*HOB
^ - Okay – affected side - ^ drainage – pillows to prevent
pinching
tubes
Bronchodilators
Drugs
Adrenalin – adult dose 0.3mg S/C
Isuprel
Tedral
Aminophylline – S/E Hypotension
Theodur
S/E:
pulse, BP
diff. Voiding
N/V
insomnia
Flushing
diaphoresis
CNS
-
tremors
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