Lung Sounds Stridor: Signifies the trachea is narrowing. Er\Respiratory Fundamentals Review Oxygen Delivery Devices Nasal cannula: 1-6 Oxygen Considerations Humidify: >4L Rhonchi: Signifies mucus in the airways. Wheezing: Signifies constriction in the bronchi/bronchioles. Crackles: Signifies fluid in the alveoli. Simple Face Mask: __ 5-10 Venturi Mask: _4-10 Nonrebreather: 6-10 PARTIAL, NON 10 Pad these areas to prevent skin breakdown: behind ears Lubricate with nonpetroleum lubricant. Teach patient to clean devices with soap and water. Breathing Techniques Incentive Spirometry: Patient will wrap their lips around the device's mouthpiece and inhale slowly and deeply. Helps open the patient's alveoli. Purse-lipped breathing: Patient should breathe in for two seconds and out for four, pursing their lips as they exhale. This helps create back-pressure during exhalation that helps open the airways. Diaphragmatic Breathing: Patient should lay on their back and place their hands on their abdomen. They should focus on moving their hands up and down as they breathe. This retrains the patient to use their diaphragm to breathe.
Obstructive Sleep Apnea Patho/Risk Factors: Soft tissue in the throat and pharyngeal area becomes too relaxed and collapses over the upper airway. Risks: Obesity (BMI Smoking Large uvula Family history Enlarged tonsils. 1 Assessment/ Complications: Daytime: -Feels sleepy/fatigued -Mood: irritable -Pain: headaches -Memory loss Nighttime: -Loud snoring -Sleep activity: restless -Breathing activity: choking/gasping Treatments: Nursing Considerations: BiPAP/CPAP: helps by creating positive pressure in the airway keeping it open. Teach patient about weight loss and avoidance of alcohol and sedatives. Positioning: HOB elevated or side-lying. Oral appliances: help by pulling the jaw and soft tissue forward away from the airway. Medications: -Modafinil: decreases daytime sleepiness. Complications: Weight gain Cardiac dysrhythmias Diabetes Surgery Diagnosis: Polysomnogram
Asthma Patho /Risk Factors /Causes Bronchoconstriction due to inflammation and immune hyperresponsiveness. Triggers: Many vary per patient. Cold air. Exercise GERD Infections Medications: 1) NSAIDS 2) Beta blockers Assessment: Lab: Elevated eosinophils. Exacerbation symptoms: -Lung sounds: wheezing -Respiratory rate: elevated -Cough -Tight feeling in chest. -Shortness of breath. Complication: Status asthmaticus and respiratory failure. Watch for wheezing decreasing but O2 sat stays same. Treatments: Rescue Medications: Albuterol (SABA) - helps by stimulating the fight or flight to bronchodilate. Ipratropium bromide - works by relaxing airway muscles. Preventative Medications: Salmeterol (LABA) Fluticasone (steroid). Decreases airway inflammation. During exacerbation: Use SABA, IV steroids, magnesium sulfate, and O2. Nursing Considerations: Medication Considerations: Albuterol (SABA): Teach patient that they may feel jittery, anxious, shaky, etc. Fluticasone (steroid): Teach patient to rinse mouth after use to avoid thrush. Also watch for bruising, thinning skin, and weight gain. Other Considerations: Teach patient to develop a trigger diary. Teach patient to follow the action plan the MD prescribes.