Oxygenation Student 0324.pptx for student learning

oxygenation PowerPoint

1. Oxygenation NSG 3250

2. Pulmonary Diagnostic Tests Pulmonary function tests Arterial blood gasses Sputum tests Chest X-rays Computed tomography Magnetic Resonance Imaging Fluoroscopic studies and angiography Radioisotope procedures Endoscopic bronchoscopy or thoracoscopy Thoracentesis Biopsies

3. Allergic Rhinitis

4. Causes for Rhinitis Causes Modifiable or Not modifiable Patient teaching? Environmental – Temperature, humidity, odors Age Allergens Foreign body Infections / systemic disease Medications – antihypertensives, antidepressants, antipsychotics, anxiolytics, antiplatelets)

5. Treatment for Rhinitis Symptoms Cause of symptoms Treatment Rhinorrhea Due to release of histamine Congestion Sneezing Pruritis of nose/airway/eyes Headache Sore, dry throat Low grade fever In prior content, what did we learn about treatment from disorders which are due to histamine releases? Encourage rest and increase fluid intake. Humidifier can assist with dry throat or can use steam from hot shower.

6. Management Medications Antihistamines , such as brompheniramine/ pseudoephedrine; leukotriene inhibitors, such as montelukast; are used to block the release of chemicals from WBCs that bind with receptors in nasal tissues, which prevent edema and itching. Nursing Considerations: Older adults should be aware of adverse effects such as vertigo, hypertension, and urinary retention. Decongestants , such as phenylephrine, constrict blood vessels and decrease edema. Nursing Considerations: Encourage clients to use as prescribed for 3 to 4 days to avoid rebound nasal congestion. Intranasal glucocorticoid sprays are the most effective for prevention and treatment of seasonal and perennial rhinitis. Antipyretics are used if fever is present. Antibiotics are given if a bacterial infection can be identified.

7. Allergic Rhinitis Management Symptom relief Sprays Antihistamine / corticosteroid / decongestant Neo-synephrine (decongestant) Nasacort / Fluticasone (steroid) Cromolyn (mast cell stabilizer) Saline / “Ocean” (mild decongestant) Atrovent (bronchodilator) Oral Dimetapp (antihistamine / decongestant) Sudafed (pain reliever / antihistamine / decongestant) Diphenhydramine / Benadryl Guaifenesin / Robitussin

8. Viral Rhinitis

9. Let’s break this down Signs and symptoms Management Inflammation issues – Pain, congestion in nose and sinuses, headache Viral infection – (s/s of infection) Fever, malaise, chills NSAIDs, rest, fluids Mucous issues – Sneezing, rhinorrhea, drainage can lead to chest congestion Antihistamines, Expectorants, nasal sprays, decongestants At risk for other issues d/t overused immune system Fever

10. Why is it important not to ignore Rhinitis or Sinusitis? An immune system fighting one infection, can make people at risk for other infections Infections in the head area can lead to other infections in the head area

11. Pharyngitis - Acute

12. Causes for Causes Modifiable or Not modifiable Patient teaching? Bacteria Viruses Trauma Irritants Dehydration Tobacco ETOH

13. Let’s break this down Signs and symptoms Management Sore throat, painful or difficulty swallowing, enlarged tonsils Headache Myalgia Analgesics Painful cervical adenopathy Fever, malaise, with or without chills Purulent discharge - Bad breath Liquid or soft diet, cool or warm beverages Penicillin V, Macrolides, Cephalosporins

14. Why is it important not to ignore Pharyngitis An immune system fighting one infection, can make people at risk for other infections Infections in the head area can lead to other infections in the head area Sinusitis Mastoiditis Infections can lead to other infections in other places too Bronchitis Pneumonia Scarlet fever Acute glomerulonephritis

15. Laryngitis

16. Causes for Laryngitis Causes Modifiable or Not modifiable Patient teaching? Voice abuse Exposure to dust Chemicals Smoke Common cold

17. Let’s break this down Signs and symptoms Management Hoarseness Rest voice Severe Cough Inhaling cool steam or an aerosol Dry, sore throat Uvular edema Antibiotics if infection is present If laryngitis persists longer than 5 days needs to be reported to r/o malignancy Call primary healthcare provider if have difficulty with swallowing, hemoptysis, noisy respirations

18. For all Upper Respiratory Infections: Elevate head Ice collar area to reduce inflammation and bleeding Hot packs to reduce congestion Analgesics for pain Gargles for sore throat Use alternative communication Encourage liquids: at least 2-3 L/day Soft bland diet Rest

19. For all Upper Respiratory Infections: Need to complete antibiotic treatment regimen Emphasize frequent had washing Annual influenza vaccine for those at risk When to contact health care provider Prevention whenever possible

20. Upper Airway Obstruction

21. Upper Airway Obstruction Life-threatening emergency in which airflow through the nose, mouth, pharynx, and larynx is interrupted and gas exchange is impaired. Leads to respiratory arrest without early treatment Causes: Tongue edema Tongue occlusion Laryngeal edema Peritonsillar/pharyngeal abscess Head/neck cancer Thick secretions Stroke/cerebral edema Smoke inhalation edema Facial trauma Foreign-body aspiration Burns Anaphylaxis

22. Management Assessment: Partial obstruction Diaphoresis Tachycardia Elevated BP Continuously assess for stridor, cyanosis, and changes in LOC Diagnostics: Chest/neck x-rays Laryngoscopic examination CT Emergency Medical Care: Abdominal thrusts to remove foreign body Cricothroidectomy Endotracheal Intubation Tracheotomy

23. LOWER AIRWAY ISSUES

24. Asthma

25. Diagnosis Diagnosis is based on symptoms and classified into one of the following four categories. Mild intermittent : s/s occur less than twice a week. Mild persistent : s/s arise more than twice a week but not daily. Moderate persistent : Daily s/s occur in conjunction with exacerbations twice a week. Severe persistent : s/s occur continually, along with frequent exacerbations that limit physical activity and quality of life.

26. Risk Factors Older adults Older adult clients are more susceptible to infections Family history of asthma Smoking Secondhand smoke exposure Environmental allergies Exposure to chemical irritants or dust Gastroesophageal reflux disease (GERD)

27. Symptoms Coughing, Wheezing (squeaky/musical) Mucus production Use of accessory muscles Prolonged exhalation Barrel chest or increased chest diameter Hypoxia (always leads to tachycardia and tachypnea) Hypoxemia (Low O2 sat)

28. Treatments Quick relief medications – Beta2 – adrenergic agonists Anticholinergics Long-acting medications Long-acting beta2 – adrenergic agonists Leukotriene modifiers Corticosteroids

29. Treatments Bronchodilators (inhalers) Short-acting beta2 agonists – albuterol-provide rapid relief of acute symptoms and prevent exercise-induced asthma. Anticholinergic medications-ipratropium-block the parasympathetic nervous system. This allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretions. These medications are long-acting and used to prevent bronchospasms. Long-acting beta2 agonists-salmeterol-primarily are used for asthma attack prevention. Nursing Considerations Albuterol: Watch for tremors and tachycardia. Ipratropium: Observe for dry mouth. Anti‑inflammatory agents (These medications are for prophylaxis and are used to decrease airway inflammation.) Corticosteroids, such as fluticasone and prednisone Leukotriene antagonists, such as montelukast

30. Complications Respiratory failure Persistent hypoxemia related to asthma can lead to respiratory failure. Nursing Actions ● Monitor oxygenation levels and acid-base balance. ● Prepare for intubation and mechanical ventilation. Status Asthmaticus This is a life-threatening episode of airway obstruction that is often unresponsive to common treatment. It involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and creates a risk for cardiac and/or respiratory arrest. Nursing Actions ● Prepare for emergency intubation. ● Administer IV fluids, oxygen, bronchodilators, and epinephrine. Initiate systemic steroid therapy

31. Metered Dose Inhalers MDI with a spacer

32. Using a Peak Flow Meter

33. Patient Education

34. Influenza

35. Influenza Seasonal influenza , or “flu,” occurs as an epidemic, usually in the fall and winter months. ● It is a highly contagious acute viral infection that occurs in children and adults of all ages. ● Influenza can be caused by one of several virus families, and can vary yearly. Adults are contagious from 24 hr before manifestations develop and up to 5 days after they begin. (Incubation is about 5-7 days) Pandemic influenza refers to a viral infection among animals or birds that has mutated and is becoming highly infectious to humans. The resulting viral infection has the potential to spread globally, such as H1N1 (“swine flu”) and H5N1 (“avian flu”).

36. Assessment Expected Findings ● Severe headache and muscle aches ● Chills ● Fatigue, weakness ● Severe diarrhea and cough (avian flu) ● Fever ● Hypoxia (avian flu) Diagnostic Tests: AV Advantage A/H5N1 Flu Test Nursing Care ● Maintain droplet and contact precautions. ● Provide saline gargles. ● Monitor hydration status, I&O’s. ● Administer IVF as prescribed. ● Monitor respiratory status. Antivirals- Amantadine, rimantadine , and ribavirin Patient Education: Encourage clients to begin antiviral medications within 24 to 48 hr after s/s

37. Prevention & Education Influenza vaccines ● Quadrivalent/Trivalent vaccines are prepared yearly depending upon the suspected strain of influenza Vaccination is encouraged for everyone older than 6 months of age. Clients who have a history of pneumonia, chronic medical conditions, and those over age 65, pregnant women, and health care providers are at higher risk and require vaccination. ● H1N1 vaccine is available for the general population. ● H5N1 vaccine is stockpiled for distribution if a pandemic occurs Live Attenuated Influenza Vaccine Intranasal spray Live virus Some people may develop flu s/s Only for healthy people up to age 49 yrs.

38. Patient Education ● Encourage annual influenza vaccination ● Reduce the risk for spreading viruses ● Avoid places where people gather ● If flu manifestations develop, increase fluid intake, rest and stay home from work or school ● Avoid travel to areas where pandemic influenza is identified ● Be aware of public health announcements and activation of the early warning system Patient Education

39. Pneumoconiosis

40. Causes for Silicosis - Glass manufacturing, foundry work, stone cutting Symptoms: Acute- dyspnea, fever, cough, weight loss Chronic- progressive symptoms of hypoxemia, severe airflow obstruction, and right sided heart failure Asbestosis - Shipbuilding, building demolition Symptoms: Progressive dyspnea, persistent/dry cough, chest pain Anorexia, weight loss, malaise, clubbing of fingers

41. Role of Nurse Employee advocate Provide health education There is no treatment. There is only supportive care for symptoms and try to prevent complications. Therefore, main key is prevention of issue in the first place.

42. Let’s break this down Signs and symptoms Management Chronic cough – often discolored from dust Dyspnea Bronchioles and alveoli become clogged with dust. Lesions occur, then leads to localized emphysema, cor pulmonale and respiratory failure

43. For all Upper Respiratory Infections: Elevate head Ice collar area to reduce inflammation and bleeding Hot packs to reduce congestion Analgesics for pain Gargles for sore throat Use alternative communication Encourage liquids: at least 2-3 L/day Soft bland diet Rest

44. Triggers for Asthma Triggers Modifiable or Not modifiable Patient teaching? Hypersensitivity Upper respiratory infection Exercise Air pollutants GERD Familial tendency

45. NON-INFECTION/INFLAMMATION AIRWAY ISSUES

46. Obstructive Sleep Apnea

47. Risk factors Obesity Asthma Chronic nasal congestion Smoking Diabetes Male Family history HTN Each risk factor increases likelihood. So more risk factors, more at risk.

48. Do you remember benefits of sleep and rest? Sleep helps reset the system Helps with memory Helps with immune system

49. Symptoms of Sleep Apnea Symptoms while awake Exhaustion Irritability Headache when waking up Memory loss Symptoms while asleep Loud snoring Restless, disturbed sleep Gasping Choking Apneic events HTN

50. Sleep Apnea Assessment Patients are often unaware that they have sleep apnea Suspect Apnea if: Persistent daytime sleepiness or “waking up tired” Heavy snoring Irritability Personality changes Diagnostic Testing- Overnight sleep study- pt is directly observed while wearing a variety of monitoring equipment to evaluate- Depth of sleep Type of sleep Resp effort 02 sat Muscle movement

51. Obstructive sleep apnea: Treatment 51