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Respiratory system

Respiratory refresher (continued)

ATELECTASIS (CONTINUED)
Teach the client how to use an incentive spirometer and
encourage him to use it every 1 to 2 hours, while awake.
Humidify inspired air and encourage adequate fluid intake. Perform postural drainage and chest percussion.
Assess breath sounds and ventilatory status frequently and be
alert for any changes.
BRONCHIECTASIS
Key signs and symptoms
Chronic cough that produces copious, foul-smelling, mucopurulent secretions, possibly totaling several cupfuls daily
Coarse crackles during inspiration over involved lobes or
segments, rhonchi, wheezing
Exertional dyspnea
Anorexia
Key test results
Chest X-rays show peribronchial thickening, areas of atelectasis, and scattered cystic changes.
Sputum culture and Gram stain identify predominant
organisms.
Key treatments
Bronchoscopy (to mobilize secretions)
Chest physiotherapy and incentive spirometry
O2 therapy
Antibiotics: according to sensitivity of causative organism
Bronchodilator: albuterol (Proventil-HFA)
Key interventions
Assess respiratory status.
Provide supportive care and help the client adjust to the
permanent changes in lifestyle that irreversible lung damage
necessitates.
Perform chest physiotherapy, including postural drainage and
chest percussion designed for involved lobes, several times per
day. Encourage use of incentive spirometer every 1 to 2 hours
while the client is awake.
CHRONIC BRONCHITIS
Key signs and symptoms
Dyspnea
Increased sputum production
Productive cough
Key test results
Chest X-ray shows hyperinflation and increased bronchovascular markings.

313419NCLEX-RN_Chap04.indd 72

PFTs may reveal increased residual volume, decreased vital

capacity and forced expiratory volumes, and normal static compliance and diffusion capacity.
Key treatments
Fluid intake up to 3 qt (3 L)/day, if not contraindicated
Endotracheal intubation and mechanical ventilation if
respiratory status deteriorates
Antibiotics: according to sensitivity of infective organism
Bronchodilators: terbutaline, aminophylline, theophylline
(Theochron); via nebulizer: albuterol (Proventil-HFA), ipratropium
(Atrovent)
Influenza and Pneumovax vaccines
Steroids: hydrocortisone (Solu-Cortef), methylprednisolone
(Solu-Medrol)
Steroids (via nebulizer): beclomethasone (Beconase AQ),
triamcinolone (Azmacort)
Key interventions
Administer low-flow O2.
Assess respiratory status, ABG levels, and pulse oximetry.
Assist with diaphragmatic and pursed-lip breathing.
Monitor and record the color, amount, and consistency of
sputum.
Provide chest physiotherapy, postural drainage, incentive spirometry, and suction.
COR PULMONALE
Key signs and symptoms
Dyspnea on exertion
Edema
Fatigue
Orthopnea
Tachypnea
Weakness
Key test results
ABG analysis shows decreased PaO2 (< 70 mm Hg).
Chest X-ray shows large central pulmonary arteries and suggests right ventricular enlargement by rightward enlargement of
cardiac silhouette on an anterior chest film.
Pulmonary artery pressure measurements show increased
right ventricular and pulmonary artery pressures as a result of
increased pulmonary vascular resistance.
Key treatments
O2 therapy as necessary by mask or cannula in concentrations ranging from 24% to 40%, depending on PaO2 and, in acute
cases, endotracheal intubation and mechanical ventilation

4/8/2010 6:46:13 PM