rachel s natividad rn msn np n212 medical surgical nursing 1 n.
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Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1. The Respiratory System. Structure and Function. Gas exchange. Changes associated to Aging. ↓ recoil and compliance  AP diameter ↓ functional alveoli ↓ in Pa02 Respiratory defense mechanisms less effective

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Presentation Transcript
changes associated to aging
Changes associated to Aging
  • ↓ recoil and compliance
  •  AP diameter
  • ↓ functional alveoli
  • ↓ in Pa02
  • Respiratory defense mechanisms less effective
  • Altered respiratory controls
    • More gradual response to changes in O2 and Co2 levels in blood
Pulse Oximetry

Chest X-Ray

Computed Tomography (CT scan)



Pulmonary Function Tests

Sputum Specimen and Cultures

diagnostics pulse oximetry
Diagnostics: Pulse Oximetry
  • Measures arterial oxygen saturation
  • Pulse oximetry probe on forehead, ears, nose, finger, toes,
  • False readings
  • Intermittent or continuous monitoring
  • Ideal values: 95-100%
  • When to Notify MD
    • < 91%
    • 86% (Medical Emergency)
diagnostics chest x ray cont
Diagnostics: Chest X-Ray Cont.



Posterior Anterior View

Left Lateral View

diagnostics sputum specimen
Diagnostics: Sputum Specimen
  • To diagnose; evaluate treatment
  • Specimen: ID organisms or abnormal cells
    • Culture & Sensitivity (C&S)
    • Cytology
    • Gram stains
      • (e.g. Acid Fast Bacilli)
diagnostics computed tomography ct scan
Diagnostics: Computed Tomography: CT Scan
  • Images in cross-section view
  • Uses contrast agents
  • Instructions:

Right upper Lobe

diagnostics bronchoscopy
Diagnose problems and assess changes in bronchi/bronchioles

Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study

Diagnostics: Bronchoscopy

Procedure Care/Instructions:

  • NPO 6 -8 hrs prior
  • Sedation during procedure

Post Procedure:

  • HOB elevated
  • Observe for hemorrhage
  • NPO until gag reflex returns
diagnostics pulmonary function test pfts
Diagnostics: Pulmonary Function Test (PFTs)
  • Evaluate lung function
  • Observe for increased dyspnea or bronchospasm
  • Instructions:
  • No bronchodilators 6 hours prior
diagnostics thoracentesis
Specimen from pleural fluid

Treat pleural effusion

Assess for complications

Post-Procedure care:

CXR after procedure

Diagnostics: Thoracentesis
  • Positions
    • Sitting on side of bed over bedside table chest
    • elevated
    • Lying on affected side
    • Straddling a chair
pneumonia case study
Pneumonia: Case Study


pneumonia etiology
Pneumonia: Etiology
  • Cause
    • bacteria (75%)
    • viruses
    • fungi
    • Mycoplasma
    • Parasites
    • chemicals
pneumonia classifications
Pneumonia: Classifications
  • Community-acquired pneumonia (CAP)
    • Onset in community or during 1st 2 days of hospitalization (Strep. pneumoniae most common)
  • Hospital-acquired Pneumonia(HAP/nosocomial)
    • Occurring 48 hrs or longer after hospitalization
  • Aspiration pneumonia
  • Pneumonia caused by opportunistic organisms
    • Pneumocystis Carinii
pneumonia risk factors

Older adult

Chronic/coexisting condition

Recent history or exposure to viral or influenza infections

History of tobacco or alcohol use


Older adult

Chronic lung disease



ET, Trach, NG / GT


Mechanical ventilation

Pneumonia: Risk Factors
pneumonia clinical manifestations
Pneumonia: Clinical Manifestations
  • Fevers, chills, anorexia
  • Pleuritic chest pain
  • SOB
  • Crackles/wheezes
  • Cough, sputum production
  • Tachypnea
pneumonia clinical manifestations cont
Pneumonia: Clinical Manifestations-Cont.

Mycoplasma (Atypical)

  • feeling tired or weak, headaches, sore throat, or diarrhea.
  • Eventually, most develop a dry cough.  They can, also, develop fever, chills, earaches, chest pain
  • “walking pneumonia”
pneumonia diagnosis
Pneumonia: Diagnosis
  • Diagnosis →
    • Physical exam → crackles, rhonchi/wheezes
    • CXR →area of increased density

(infiltrates/ consolidation)

    • Sputum specimen –
      • Gram stain

LUL Infiltrates

pneumonia interventions tx
Pneumonia :Interventions/Tx
  • Treatment
    • Antibiotics → choose based on age, suspected cause & immune status
    • Supportive care → IV fluids, supplemental oxygen therapy, respiratory monitoring, cough enhancement
  • *may take 6-8 weeks for CXR to normalize
nursing diagnoses
Nursing Diagnoses…
  • Impaired gas exchange R/T Pneumonia
  • Pain R/T infection in lung Pneumonia
pneumonia complications

Pleural effusion



Pneumonia: Complications



Pleural Effusion