7. Ventilation
The Process of Breathing
z Inspiration:
the active
phase of
ventilation
z Negative
pressure
8. Ventilation
The Process of Breathing
z Expiration:
the passive
phase of
ventilation
Increase in
intrapulmonic
pressure
9. total volume= amount of
air inhaled and exhaled
with each breath=1/2L
total lung capacity=6L
10. Diagnostic Test: Pulmonary Function
Tests (PFTs) total volume= amount of
air inhaled and exhaled
with each breath=1/2L
total lung capacity=6L
11. Diagnostic Test: Pulmonary Function
Tests (PFTs) total volume= amount of
air inhaled and exhaled
with each breath=1/2L
total lung capacity=6L
z Pulmonary Function
Tests (PFTs)
12. Diagnostic Test: Pulmonary Function
Tests (PFTs) total volume= amount of
air inhaled and exhaled
with each breath=1/2L
total lung capacity=6L
z Pulmonary Function z Measures the client’s volume
of air in the lung with
Tests (PFTs) inhalation & exhalation
13. Diagnostic Test: Pulmonary Function
Tests (PFTs) total volume= amount of
air inhaled and exhaled
with each breath=1/2L
total lung capacity=6L
z Pulmonary Function z Measures the client’s volume
of air in the lung with
Tests (PFTs) inhalation & exhalation
z Nursing Responsibilities
y No bronchodilators or smoking 6 hours before
the test
y Instruction on how to inhale & exhale, reason
for the test
y Inform client that may feel short of breath (SOB)
y Provide comfort as needed
17. Diagnostic Test: Thoracentesis
z Purpose is to ___remove fluid or air from plural
space________
z Nursing Responsibilities
y Client must be _NPO__________________
y Client must not move and be able to _hold_
their breath
y Monitor VS, for dyspnea, pain and difficulty
breathing
22. Diagnostic Tests:
Thoracentesis Cont’d
z Tachypnea, dyspnea,
cyanosis, retractions
or ↓ breath sounds
may indicate a
_calapsed lung/
pneumothorax______
______
z Define what this is.
23. Diagnostic Tests:
Thoracentesis Cont’d
z What should you record
z Tachypnea, dyspnea, and where?
cyanosis, retractions
or ↓ breath sounds
may indicate a
_calapsed lung/
pneumothorax______
______
z Define what this is.
24. Diagnostic Tests:
Thoracentesis Cont’d
z What should you record
z Tachypnea, dyspnea, and where?
cyanosis, retractions how the pt tolerated it,
or ↓ breath sounds sent to lab, VS for before
and after, O2 sats,
may indicate a premeditate, education,
_calapsed lung/ amount of fluid taken out
pneumothorax______ and from where.
______
z Define what this is.
25. Diagnostic Tests:
Thoracentesis Cont’d
z What should you record
z Tachypnea, dyspnea, and where?
cyanosis, retractions how the pt tolerated it,
or ↓ breath sounds sent to lab, VS for before
and after, O2 sats,
may indicate a premeditate, education,
_calapsed lung/ amount of fluid taken out
pneumothorax______ and from where.
______ z You must obtain
_concent_ before
procedure
z Define what this is.
26. Diagnostic Tests:
Thoracentesis Cont’d
z What should you record
z Tachypnea, dyspnea, and where?
cyanosis, retractions how the pt tolerated it,
or ↓ breath sounds sent to lab, VS for before
and after, O2 sats,
may indicate a premeditate, education,
_calapsed lung/ amount of fluid taken out
pneumothorax______ and from where.
______ z You must obtain
_concent_ before
procedure
z Define what this is.
z Why?
30. Diagnostic Test: Arterial Blood Gas (ABG)
z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
z Done by doctors &/or specialized nurses/or RT
31. Diagnostic Test: Arterial Blood Gas (ABG)
z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
z Done by doctors &/or specialized nurses/or RT
z Must know amount of oxygen receiving
32. Diagnostic Test: Arterial Blood Gas (ABG)
z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
z Done by doctors &/or specialized nurses/or RT
z Must know amount of oxygen receiving
z Allen test must be completed before the procedure (what pulses
need to be assessed?)
33. Diagnostic Test: Arterial Blood Gas (ABG)
z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
z Done by doctors &/or specialized nurses/or RT
z Must know amount of oxygen receiving
z Allen test must be completed before the procedure (what pulses
need to be assessed?)
z After the procedure, continuous pressure must be applied to the site,
i.e., 5” for ___________________ arteries and 10 minutes for
____________
34. Diagnostic Test: Arterial Blood Gas (ABG)
z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
z Done by doctors &/or specialized nurses/or RT
z Must know amount of oxygen receiving
z Allen test must be completed before the procedure (what pulses
need to be assessed?)
z After the procedure, continuous pressure must be applied to the site,
i.e., 5” for ___________________ arteries and 10 minutes for
____________
z Know normal values of the above
37. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
38. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
39. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
40. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
41. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
42. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
43. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
44. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
45. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
z BE - Base excess
46. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z 7.35 - 7.45
z PaO2 - partial pressure of O2 in
arterial blood
z PaCO2 - partial pressure of CO2 in
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
z BE - Base excess
47. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z 7.35 - 7.45
z PaO2 - partial pressure of O2 in
arterial blood z 80 - 100mm Hg
z PaCO2 - partial pressure of CO2 in
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
z BE - Base excess
48. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z 7.35 - 7.45
z PaO2 - partial pressure of O2 in
arterial blood z 80 - 100mm Hg
z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg
arterial blood
z HCO3- - Amount of bicarbonate in
arterial blood
z BE - Base excess
49. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z 7.35 - 7.45
z PaO2 - partial pressure of O2 in
arterial blood z 80 - 100mm Hg
z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg
arterial blood
z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L
arterial blood
z BE - Base excess
50. ABGs: Definitions & Normals
Review p. 336-7
z pH - acidity or alkalinity of blood
z 7.35 - 7.45
z PaO2 - partial pressure of O2 in
arterial blood z 80 - 100mm Hg
z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg
arterial blood
z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L
arterial blood
z BE - Base excess z +2
54. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
55. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
56. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
z Most commonly seen on the finger, ear lobe or toe
57. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
z Most commonly seen on the finger, ear lobe or toe
58. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
z Most commonly seen on the finger, ear lobe or toe
z SaO2 closely correlates to the pulse oximetry > 70%
59. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
z Most commonly seen on the finger, ear lobe or toe
z SaO2 closely correlates to the pulse oximetry > 70%
60. Diagnostic Test: Oximetry
z Assesses oxygenation non-invasively & continuously
z Sometimes called the “5th” vital sign
z Most commonly seen on the finger, ear lobe or toe
z SaO2 closely correlates to the pulse oximetry > 70%
z Movement, hypotension, hypothermia and vasocon-
striction reduce arterial blood flow to the sensor
61. Diagnostic Test: Bronchoscopy
z Reasons for this test: Post-procedure
Dx & therapeutic x Monitor VS
z Responsibilities x Assess for
respiratory distress:
Pre-procedure dyspnea, Δs in RR &
x obtain informed consent
breath sounds, use
x NPO ≥ 6 hours
of accessory
x remove prostheses: muscles, hemoptysis
dentures, contacts, etc.
x topical anesthetic to x Withhold fluids till
throat and IV started _gag reflex_
returns
63. Diagnostic Test: Sputum &
Nose/Throat Cultures
z Sputum Culture
SPUTUM NOT SPIT
y Client brushes teeth
first & coughs into
the container
y Best to obtain in
early AM
y Assess for amount,
consistency, color,
odor & contents
64. Diagnostic Test: Sputum &
Nose/Throat Cultures
z Sputum Culture Nose/Throat Culture
SPUTUM NOT SPIT
y Client brushes teeth
first & coughs into
the container
y Best to obtain in
early AM
y Assess for amount,
consistency, color,
odor & contents
65. Diagnostic Test: Sputum &
Nose/Throat Cultures
z Sputum Culture Nose/Throat Culture
SPUTUM NOT SPIT z Nose or throat is swabbed
y Client brushes teeth with a sterile cotton swab
first & coughs into and placed in a tube &
the container sent to lab ASAP
y Best to obtain in
early AM
y Assess for amount,
consistency, color,
odor & contents
66. Diagnostic Test: Sputum &
Nose/Throat Cultures
z Sputum Culture Nose/Throat Culture
SPUTUM NOT SPIT z Nose or throat is swabbed
y Client brushes teeth with a sterile cotton swab
first & coughs into and placed in a tube &
the container sent to lab ASAP
y Best to obtain in
early AM z For tubes that have fluid,
y Assess for amount, the swab should not touch
consistency, color, it unless it is a medium
odor & contents
67. Radiological Diagnostic Tests
checking for
pulmonary
embolism
z Scans: Ventilation/ Normal X-ray
Perfusion (V/Q)
z V → Ventilation
z Q → Perfusion
z What are the
implications of a V/Q
scan?
68. Diagnostic Tests: Skin
z PPD - What is this test used for?
y Properly administered
y Read when?
y Implications of the test
z Allergy Testing
y Administered properly
y Emergency equipment readily available
Why?
71. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
72. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
z Irritation of the airways
73. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
z Irritation of the airways
z Infections
74. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
z Irritation of the airways
z Infections
z Chronic Diseases
75. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
z Irritation of the airways
z Infections
z Chronic Diseases
z Secondary to Other Diseases/Problems
76. Common Causes of Lung
Problems
z Inhaled pollutants such as cigarette
smoke
z Irritation of the airways
z Infections
z Chronic Diseases
z Secondary to Other Diseases/Problems
z Cancer
77. Assessment
517-525
z Subjective Data
z Objective Data
z Chief complaint z Physical Assessment
z Pain z Color
z Pharmacology z Clubbing, Cap refill
z Hx of Resp Problems z Chest symmetry
z Breath sounds
z Family Hx
z Diagnostic Tests
z Environment/
Occupation z Labs
z Risk Factors
z Other
78. Assessment
z Normal Lung z Abnormal Lung
Sounds Sounds
z Bronchial z Crackles
z Bronchovesicular z Wheezes
z Vesicular z Rhonchi
107. TERMINOLOGY
z Hypoxemia z ↓ in O2 in the lungs
z Hypoxia
z Hyperventilation
z Hypoventilation
108. TERMINOLOGY
z Hypoxemia z ↓ in O2 in the lungs
z Hypoxia z ↓ in O2 in the tissue
z Hyperventilation
z Hypoventilation
109. TERMINOLOGY
z Hypoxemia z ↓ in O2 in the lungs
z Hypoxia z ↓ in O2 in the tissue
z Hyperventilation z decrease in CO2
z Hypoventilation
110. TERMINOLOGY
z Hypoxemia z ↓ in O2 in the lungs
z Hypoxia z ↓ in O2 in the tissue
z Hyperventilation z decrease in CO2
z Hypoventilation z increase in CO2
111. Chapter 27 – Upper Respiratory
Problems
Deviated septum
Nasal fracture
Polyps
Pharyngitis/ laryngitis
Laryngeal Cancer epitaxis
means nose
112. Laryngeal Cancer
z Malignant tumor of larynx
z Spread by local extension
z Presents as malignant ulceration
z Diagnosis made by laryngoscope and
biopsy showing positive cytological
study for cancer cells horseness over 2 weeks
should be checked out
113. Laryngeal Cancer S/S
z Early signs:
hoarseness, voice changes, hemoptysis,
z Late signs:
dyspnea, obstruction, dysphagia,
weight loss, pain, decreased tongue
mobility
114. Laryngeal Cancer s/s
Laryngeal Polyps
z there are usually no early signs but later the patient may
have dyspnea, airway obstruction, dysphagia, weight
loss & hemoptysis
Supraglottic – false vocal cord
z early signs include aspiration on swallowing liquids,
persistent unilateral sore throat, feeling of something
“stuck” in the throat, dysphagia, weight loss, neck mass,
hemoptysis and late signs include dyspnea, pain in the
throat or referred to the ear
115. Diagnostic tests
z Visual inspection w/laryngeal mirror
or flexible nasopharyngoscope
z CT, MRI, PET- shows local and
regional spread
z Multiple biopsy specimens to
determine extent
z Disease is staged based on tumor
size, number and location of involved
nodes, and extent of metastasis
117. Surgery
z Total Laryngectomy
y Used for large glottic tumors where there
is suturing of the trachea to the neck
y no risk of aspiration because the trachea
and esophagus is separated permanently
by the surgery
118. Postop Concerns
z Postop Concerns
concentration on the airway/ respiratory
status, e.g., trach suctioning/care, lung
sounds, complications
y HIGH Risk for aspiration, infection, gas
exchange
y Ineffective airway clearance,
y nutrition
y Swallowing Techniques
y Communication concerns
119. Surgery
Radical Neck Dissection (en bloc)
z Indicated when there is metastasis to the
cervical nodes
z lymphatic channels and nodes,
sternocleido-mastoid muscle, spinal
accessory nerve, jugular vein and
submandibular tissue are removed
z Complications: hemorrhage, fistulas, airway
obstruction
120. Radical dissection
Radical Neck Dissection
y Preop- The usual with concentration on
body image/self esteem concerns
y Postop-↑ edema can interfere with airway
usually due to inflammation or bleeding
y Positioning in Semi-Fowler’s to ↓ edema
y Frozen shoulder
Notas del editor
These components are broken up into sections – Many texts discuss these sections separately because their function and diseases are specific and different
Ventilation – movement of air in and out (breathing)
Respiration – gas exchange btw the atmosphere air in the alveoli and blood in capillaries
Perfusion – process by which oxygenated blood passes through to body tissues.
Delivery – we need : blood, hemoglobin, a good heart, and arteries. Used for removal of wastes – blood, hemoglobin, heart and veins
Control of acid base through ventilation – assessory muscles, diaphragm which increases depth of inspiration
Chemo receptors in medulla and carotid bodies.
Lungs major purpose is to breathe in O2 which combines with glucose to make energy, water and CO2
The lungs also exhale CO2 (a waste product)
Diffusion or the transfer of a substance from an area of high_concentration to low concentration or pressure. This occurs at the alveolar-capillary level (external respiration) and the tissue level (internal respiration)
Surfactant – detergent phospholipid reduces surface tension between moist membranes of alveoli. Preventing collapse. Pleural fluid acts as a lubricant and as an adhesive agent to hold lungs in expanded position (2-3 mL of fluid)
Pressure in pleural space is negative pressure.
Alveoli - What are their major purpose? Respiration – transfer of O2 to blood tissue and CO2 exhallation
The lungs do the above using the diaphragm which is the main muscle for breathing. It contracts and descends in the thorax making negative pressure. The ribs expand with the diaphragm.
Lungs fill with air because of pressure gradients. The pressure inside the chest is < the pressure outside making it possible for air to fill the lungs until the pressure equalizes
Diaphragm relaxes, ribs relax, decrease in lung volume. This causes an increase in intra-pulmonic pressure which forces the air out.
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Measures volumes of inspired, expired, and retained volume of air
Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L
Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
Drain fluid or air
NPO
Hold
Drain fluid or air
NPO
Hold
Drain fluid or air
NPO
Hold
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
Pneumothorax
Procedure, amount fluid, where it was sent, how the patient is, pain medication
Need consent &#x2013; invasive and has risks
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot.
ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
Flexible scope used to view the bronchus, remove foreign debris, take tissue specimens, laser therapy on lesions
Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
Some throat swabs can be tested immediately for streptococcus.
Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
Some throat swabs can be tested immediately for streptococcus.
Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
Some throat swabs can be tested immediately for streptococcus.
Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs.
Some throat swabs can be tested immediately for streptococcus.
2 parts to the test
Checking presence of a pulmonary embolism (perfusion needed to be tested for clot) Tested with a IV radioisotope
Ventilation &#x2013; breathing in a radioactive gas and then a picture taken.
Diminished or absent uptake of radioactive substances suggest lack of perfusion and aeration (bad)
Exposure to tuberculosis bacilli. Intradermal injection, read 2 days later. Positive means &#x2013; exposure to antigen, but does not mean that TB is present. Negative &#x2013; no exposure, or have (HIV, depressed immunity) and cannot build a defence.
P. 517-525
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Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Blood
Tissue
Decrease
Increase
Nasal polyps
Deviated septum
Caused primarily by smoking, environmental pollutants, chemical exposure, with close association to ETOH use and smoking (promoters), radiation, beetlenut, chewing tobacco
Metastasis to other structures due to lymphatic system except if tumor originates in the glottis
Hoarseness > 2 weeks due to involvement of the muscles and cartilage surrounding the larynx causing fusion of the vocal cords
Persistent hoarseness/sore throat
Painless neck mass, lymph nodes enlarged
Change in voice quality &#x2013; nasal, loss of voice
Dyspnea
Dysphagia
Foul breath odor
Mouth ulcer that does not heal
Use penlight to examine oral cavity including under tongue and dentures
If it involves the false cord, early signs include aspiration on swallowing liquids, persistent unilateral sore throat, feeling of something &#x201C;stuck&#x201D; in the throat, dysphagia, weight loss, neck mass, hemoptysis and late signs include dyspnea, pain in the throat or referred to the ear
If it is a polyp, there are usually no early signs but later the patient may have dyspnea, airway obstruction, dysphagia, weight loss & hemoptysis
The nasopharynx & posterior soft palate are viewed indirectly with a mirror to assess for drainage, bleeding or masses
Assessment trhough direct visualization of the larynx looks at the base of the tongue, epiglottis and vocal cords.
The patient is asked to vocalize so that the movement of the cords, color of the mucous membranes and the presence of lesions are noted
CT and MRI scans, Bxs, PFTs, kidney & LFTs, CBC/Differential, electrolytes &#x2013; (surgery)
The tumor is staged and then decisions on treatments are discussed and started
Radiation for early stages: If the tumor is small and caught early and is on the true vocal cord, RT may be all that is needed. Voice is preserved.
Problems with radiation &#x2013; Dry mouth, (increase fluids, chew gum) Fatigue, stomatitis, reddened skin
Surgery to remove affected areas/tumors
Supraglottic tumors may be treated with RT, a partial laryngectomy
Supraglottic tumors with metastasis will entail getting a total laryngectomy with or without unilateral or bilateral radical neck dissection. Need a trach.
Advanced lesions may require a total laryngectomy: entire larynx and preepiglottic region is removed and a permanent tracheostomy is performed
A radial neck dissection usually accompanies total laryngectomy to decrease the risk of lymphatic spread. Multiple structures may be removed- review on p. 552
Modified could just involve one side of the neck
Laser - can be used for small tumors to preserve as much of the glottis and voice
A Total laryngectomy involves removing the entire larynx and preepiglottic region and a permanent trach is placed
Edema and inflammation in the airway &#x2013; need for trach
Drainage tubes (JP, hemovac)
Frequent suctioning of airway
1. Parenteral fluids for first 24 to 48 hours
2. Tube feedings via NG or G tube
3. Assess for tolerance of feedings and regulate amount, time and formula if N/V/D or distention occurs.
4. Patient and family teaching regarding tube feeding.
5. When able to swallow give small amounts of water in high Fowler&#x2019;s position and assess closely for choking
Have suction ready to prevent aspiration
Removal of epiglottis &#x2013; need to learn how to protect their airway
7. Communication concerns &#x2013; written, communication board,
arterial flow and venous outflow(may use Doppler), color, temperature, and blanching at least every hour for 24-36 hours
ROM to shoulder because of forward rotation and dropping of the shoulder and interruption of nerve innervation to the upper trapezius muscle