Miss M. N. PRIYADARSHANIE ( BSc . Nursing ) NURSING MANAGEMENT OF A CLIENT WITH IMPARED GAS EXCHANGE. How to Manage a client with pulmonary embolism ?
( BSc . Nursing )
NURSING MANAGEMENT OF A CLIENT WITH IMPARED GAS EXCHANGE
Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream.
Provide Education to prevent of a PE
Assess signs of hypoxia
Monitor pulse oximetry values
(swelling of the face and or neck with fixed elevation of jugular venous pressure)
Sputum cytology should only be used in patients with large central lesions, where bronchoscopy or other diagnostic tests are deemed unsafe.
VIDEO-ASSISTED THORACOSCOPY (VAT)
1.VIDEO-ASSISTED THORACIC SURGERY (STAGE I AND II)
2.Lung resection should be as limited as possible without compromising cancer clearance.
PALLIATIVE THORACIC RADIOTHERAPY IN PATIENTS WITH SYMPTOMATIC, LOCALLY ADVANCED LUNG CANCER
■Oxygen through nasal cannula based on level of dyspnea.
■Enteral or total parenteral nutrition for malnourished patient who is unable or unwilling to eat.
■Removal of the pleural fluid (by thoracentesis or tube thoracostomy)
■Radiation therapy in combination with other methods.
■Expectorants and antimicrobial agents to relieve dyspnea and infection.
■Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control.
■Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated.
1.Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome).
2.Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing.
3.Augment the patient’s ability to cough effectively by splinting the patient’s chest manually.
4.Instruct the patient to inspire fully and cough two to three times in one breath.
5.Provide humidifier or vaporizer to provide moisture to loosen secretions.
6.Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair
7.Encourage the patient to conserve energy by decreasing activities.
8.Ensure adequate protein intake such as milk, eggs, oral nutritional
supplements; and chicken, fowl, and fish if other treatments are not tolerated
- to promote healing and prevent edema.
9.Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals.
10.Suggest eating the major meal in the morning if rapid satiety is the problem.
11.Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy.
12.Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient’s sense of control.
13.Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction.
It is opening in the chest wall large enough to allow air to pass freely in and out of the thoracic cavity with respiration.
Sings and symptoms
PaO2<60mmHg or PaCO2>45mmHg