Brush up on key concepts

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Respiratory refresher (continued)

PNEUMOCYSTIS PNEUMONIA (CONTINUED)
Monitor intake and output and daily weight. Replace fluids as
necessary.
Give antimicrobial drugs as required. Never give pentamidine
I.M. Administer the I.V. form slowly over 60 minutes.
Monitor the client for adverse reactions to antimicrobial drugs.
If hes receiving co-trimoxazole, watch for nausea, vomiting,
rash, bone marrow suppression, thrush, fever, hepatotoxicity, and anaphylaxis. If hes receiving pentamidine, watch for
cardiac arrhythmias, hypotension, dizziness, azotemia, hypocalcemia, and hepatic disturbances.
Provide nutritional supplements and encourage the client
to eat a high-calorie, protein-rich diet. Offer small, frequent
meals.
PNEUMONIA
Key signs and symptoms
Chills, fever
Crackles, rhonchi, pleural friction rub on auscultation
Shortness of breath, dyspnea, tachypnea, accessory muscle use
Sputum production thats rusty, green, or bloody with pneumococcal pneumonia; yellow-green with bronchopneumonia
Key test results
Chest X-ray shows pulmonary infiltrates.
Sputum study identifies organism.
Key treatments
O2 therapy
Chest physiotherapy and respiratory treatments
Antibiotics: according to organism sensitivity
Key interventions
Monitor and record intake and output.
Monitor laboratory studies.
Monitor pulse oximetry and assess respiratory status.
Encourage fluid intake of 3 to 4 qt (3 to 4 L)/day unless contraindicated, and administer I.V. fluids.
PNEUMOTHORAX AND HEMOTHORAX
Key signs and symptoms
Diminished or absent breath sounds unilaterally
Dyspnea, tachypnea, subcutaneous emphysema, cough
Sharp pain that increases with exertion
Key test results
Chest X-ray reveals pneumothorax or hemothorax.
Key treatments
Chest tube to water-seal drainage or continuous suction

Key interventions
Monitor and record vital signs.
Assess respiratory status.
Monitor chest tube function and drainage.
Assess cardiovascular status.
PULMONARY EDEMA
Key signs and symptoms
Dyspnea, orthopnea, tachypnea
Productive cough (frothy, bloody sputum)
Key test results
Chest X-ray shows diffuse haziness of the lung fields and, commonly, cardiomegaly and pleural effusions.
Hemodynamic monitoring shows increases in pulmonary artery
pressure, pulmonary artery wedge pressure, and central venous
pressure as well as decreased cardiac output.
Key treatments
O2 therapy: possibly intubation and mechanical ventilation
Diuretics: furosemide (Lasix), bumetanide (Bumex), metolazone
(Zaroxolyn)
Nitrates: isosorbide (Isordil), nitroglycerin
Cardiac glycoside: digoxin (Lanoxin)
Inotropic agents: dobutamine, inamrinone (Amrinone), milrinone
Vasodilator: nitroprusside (Nitropress)
Key interventions
Assess cardiovascular and respiratory status and hemodynamic variables.
Keep the client in high Fowlers position if blood pressure tolerates; if hypotensive, maintain in a semi-Fowlers position if tolerated.
PULMONARY EMBOLISM
Key signs and symptoms
Sudden onset of dyspnea, tachypnea, crackles
Key test results
ABG levels show respiratory alkalosis and hypoxemia.
Lung scan shows ventilation/perfusion (V) mismatch.
Spiral computed tomography of the chest shows central
pulmonary emboli.
Key treatments
Vena cava filter insertion or pulmonary embolectomy
O2 therapy, intubation, and mechanical ventilation, if necessary
Anticoagulants: enoxaparin (Lovenox), heparin, followed by
warfarin (Coumadin)
Fibrinolytics: streptokinase (Streptase), urokinase (Abbokinase)
(continued)

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