70

Respiratory system

heet

ts
Chea

Respiratory refresher
ACUTE RESPIRATORY DISTRESS SYNDROME
Key signs and symptoms
Anxiety, restlessness
Crackles, rhonchi, decreased breath sounds
Dyspnea, tachypnea
Key test results
Arterial blood gas (ABG) levels show respiratory
acidosis, metabolic acidosis, hypoxemia that
doesnt respond to increased fraction of oxygen.
Chest X-ray shows bilateral infiltrates (in early
stages) and lung fields with a ground-glass
appearance and, with irreversible hypoxemia,
massive consolidation of both lung fields (in
later stages).

Because the
major function of
the respiratory
system is gas
exchange, focus
on keeping airways
clear and facilitating
breathing.

Key treatments
Oxygen (O2) therapy: intubation and
mechanical ventilation using positive endexpiratory pressure (PEEP) or pressurecontrolled inverse ratio ventilation
Antibiotics: according to infectious organism
Bronchodilator: Albuterol (Ventolin HFA)
Neuromuscular blocking agents: pancuronium,
vecuronium
Steroids: hydrocortisone (Solu-Cortef), methylprednisolone (Solu-Medrol)
Key interventions
Assess respiratory, cardiovascular, and neurologic status.
Maintain bed rest, with prone positioning if
possible.
Provide chest physiotherapy.
ACUTE RESPIRATORY FAILURE
Key signs and symptoms
Decreased respiratory excursion, accessory
muscle use, retractions
Difficulty breathing, shortness of breath, dyspnea, tachypnea, orthopnea
Fatigue

Key treatments
O2 therapy, intubation, and mechanical ventilation (possibly with PEEP)
Anesthetic: propofol (Diprivan)
Antianxiety agent: lorazepam (Ativan)
Bronchodilators: terbutaline, aminophylline,
theophylline (Theochron); via nebulizer: albuterol
(Proventil-HFA), ipratropium (Atrovent)
Steroids: hydrocortisone (Solu-Cortef), methylprednisolone (Solu-Medrol)
Key interventions
Assess respiratory status.
Administer O2.
Provide suctioning; assist with turning, coughing, and deep breathing; perform chest physiotherapy and postural drainage.
Maintain bed rest.
ASBESTOSIS
Key signs and symptoms
Dry crackles at lung bases
Dry cough
Dyspnea on exertion (usually first symptom)
Pleuritic chest pain
Key test results
Chest X-rays show fine, irregular, and linear
diffuse infiltrates; extensive fibrosis results in a
honeycomb or ground-glass appearance.
X-rays may also show pleural thickening and
pleural calcification, with bilateral obliteration
of costophrenic angles and, in later stages, an
enlarged heart with a classic shaggy heart
border.
Key treatments
Chest physiotherapy
Fluid intake: at least 3 qt ( 3 L)/day unless contraindicated
O2 therapy or mechanical ventilator (in advanced
cases)

Key test results

ABG levels show hypoxemia, acidosis, alkalosis, and hypercapnia.

313419NCLEX-RN_Chap04.indd 70

4/8/2010 6:46:13 PM