Brush up on key concepts

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Respiratory refresher (continued)

ASBESTOSIS (CONTINUED)
Antibiotics: according to susceptibility of infecting organism
(for treatment of respiratory tract infections)
Mucolytic inhalation therapy: acetylcysteine
Key interventions
Perform chest physiotherapy techniques, such as controlled coughing and segmental bronchial drainage, with chest
percussion and vibration.
Administer O2 by cannula or mask (1 to 2 L/minute), or by
mechanical ventilation if arterial oxygen cant be maintained
above 40 mm Hg.
ASPHYXIA
Key signs and symptoms
Agitation
Altered respiratory rate (apnea, bradypnea, occasional
tachypnea)
Anxiety
Central and peripheral cyanosis (cherry-red mucous membranes in late-stage carbon monoxide poisoning)
Confusion leading to coma
Decreased breath sounds
Dyspnea
Key test results
ABG measurement indicates decreased partial pressure of
arterial oxygen (PaO2) < 60 mm Hg and increased partial pressure
of arterial CO2 (PaCO2) > 50 mm Hg.
Pulse oximetry reveals decreased hemoglobin saturation with
oxygen.
Key treatments
Bronchoscopy (for extraction of a foreign body)
O2 therapy, which may include endotracheal intubation and
mechanical ventilation
Opioid antagonist: naloxone (for opioid overdose)
Key interventions
Assess cardiac and respiratory status.
Position the client upright, if his condition tolerates.
Suction carefully, as needed, and encourage deep breathing.
ASTHMA
Key signs and symptoms
Lack of symptoms between attacks (usually)
Wheezing, primarily on expiration but also sometimes on
inspiration

Key test results

Pulmonary function tests (PFTs) during attacks show
decreased forced expiratory volumes that improve with therapy
and increased residual volume and total lung capacity.
Key treatments
Fluids to 3 qt (3 L)/day unless contraindicated
Beta-adrenergic drugs: epinephrine, salmeterol (Serevent)
Bronchodilators: terbutaline, aminophylline, theophylline
(Theochron); via nebulizer: albuterol (Proventil-HFA), ipratropium
(Atrovent)
Mast cell stabilizer: cromolyn (Intal)
Antileukotrienes: zafirlukast (Accolate), montelukast
(Singulair)
Key interventions
Administer low-flow humidified O2.
Assess respiratory status.
Keep the client in high Fowlers position.
ATELECTASIS
Key signs and symptoms
Diminished or bronchial breath sounds
Dyspnea
In severe cases
Anxiety
Cyanosis
Diaphoresis
Severe dyspnea
Substernal or intercostal retraction
Tachycardia
Key test results
Chest X-ray shows characteristic horizontal lines in the lower
lung zones and, with segmental or lobar collapse, characteristic
dense shadows associated with hyperinflation of neighboring
lung zones (in widespread atelectasis).
Key treatments
Bronchoscopy
Chest physiotherapy
Bronchodilator: albuterol (Proventil-HFA)
Mucolytic inhalation therapy: acetylcysteine
Key interventions
Encourage postoperative and other high-risk clients to cough
and deep breathe every 1 to 2 hours.
Teach the splinting technique.
Encourage ambulation.
Administer adequate analgesics.
(continued)

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4/8/2010 6:46:13 PM