Professional Documents
Culture Documents
71 y/o smoking Hereditary- Asthma 41 y/o I Precipitating Factors - History of Cigarette (starts at 17 y/o and stop at pack per day) -Occupational Exposure -Low immune system
Stimulation and activation of B-lymphocytes Medication: Hydrocortisone B-lymphocytes produces Immunoglobulin E(IgE) (solu cortet) 100mg IV q6 IgE and antibodies attached to mast cells and basophils in the bronchial walls
Histamine
bradykinin
prostaglandins
Fluid shifting from the Deposition vasculature and to the collagen alveoli below the
basement membrane
(Bronchospasm)
of
Hyperinflation of alveoli
Decreased
S/Sx: weakne ss -cough
Diagnostic Exam: -Chest X-Ray Impression: Pulmonary emphysema bilateral, atherosclero sis, thrombus aorta Bronchiectas is, both bases
Ventilation-Perfusion V/Q Mismatch shunt Inadequate exchange of Oxygen and Carbon dioxide
Diagnostic Exam: ABG- O2: 99% Increased PaCO2 Decreased PaO2 Increased HCO3 RESPIRATORY ACIDOSIS WITH S/Sx: -Tachycardia (110bpm) -Paleness
BP: 130/80mmHG
Hypoxemia
Recovery
CUES
Subjective:
RATION ALE
Normally there is a balance between ventilation and perfusion; however, certain conditions can offset this balance, resulting in impaired gas exchange. Altered blood flow from a pulmonary embolus, or decreased cardiac output or shock can cause ventilation without perfusion. Conditions that cause changes or collapse of the alveoli (e.g., atelectasis, pneumonia , pulmonary edema, and adult respiratory distress syndrome [ARDS]) impair ventilation.
PLAN
Patient maintains optimal gas exchange as evidenced by normal arterial blood gases (ABGs) and alert responsive mentation or no further reduction in mental status.
INTERVENTIO N
1.Assessed respirations: note quality, rate, pattern, depth, and breathing effort.
RATIONALE
Both rapid, shallow breathing patterns and hypoventilation affect gas exchange. Collapse of alveoli increases physiological shunting.
EVALUATI ON
2. Assessed for
signs and symptoms of atelectasis: diminished chest excursion, limited diaphragm excursion, bronchial or tubular breath sounds, rales, tracheal shift to affected side. 3.Assessed skin color for development of cyanosis. 4.Monitored vital signs.
For cyanosis to be present, 5 g of hemoglobin must desaturate. With initial hypoxia and hypercapnia, blood pressure (BP), heart rate, and respiratory rate all rise. As the hypoxia and/or hypercapnia becomes more severe, BP may drop, heart rate tends to continue to be rapid with arrhythmias, and respiratory failure may ensue with the patient unable to maintain the rapid respiratory rate. Restlessness is an early sign of hypoxia. Chronic hypoxemia may result in cognitive changes such as memory changes. Increasing PaCO2 and decreasing PaO2 are signs of respiratory
CUES
PLAN
INTERVENTION
RATIONALE
EVALUATI ON
-Dyspnea Tachypnea -Fremitus -Cyanosis -Cough -Nasal flaring Respirator y depth changes -Altered chest excursion -Use of accessory muscles -Pursed-lip breathing or prolonged expiratory phase -Increased anteropost erior chest diameter
Patients breathing pattern is maintaine d as evidenced by eupnea, normal skin color, and regular respirator y rate/patte rn.
1. Assess respiratory
rate and depth by listening to lung sounds.
4.Monitor for changes in orientation, increased restlessness, anxiety, and air hunger. 5.Ensure that oxygen delivery system is applied to the patient.
Respiratory rate and rhythm changes are early warning signs of impending respiratory difficulties. Dyspnea that occurs with activity may indicate activity intolerance. The accessory muscles of inspiration are not usually involved in quiet breathing. These include the scalenes (attach to the first two ribs) and the sternocleidomasto id (elevates the sternum). Restlessness is an early sign of hypoxia.
The appropriate amount of oxygen is continuously delivered so that the patient does not desaturate.
6.
PLAN
INTERVENTION
RATIONALE
EVALUATI ON
CUES
RATIONA LE
PLAN
INTERVENTION
RATIONALE
EVALUATI ON
CUES
RATIONA LE
PLAN
INTERVENTION
RATIONALE
EVALUATI ON