Brain Stem

Brain stem Palpation single view, promote safety:
Medulla oblongata – center vocal or tactile fremitus assess LMP, remove jewelry,
for breathing/respi chest expansion (<1 in = hold breath
Pons – “pneumotaxic center” atelectasis) Sputum exam collection of
control rate and rythm sputum for analysis to
Percussion determine infection and
2 major divisions resonance sensitivity to antibiotics
upper-“airway track” trachea, tympany – pneumothorax increase fluid intake, NSS or
nose dullness – solid mass water for oral hygiene
Lower – “breathe deeply then cough”
Auscultation
Bronchoscopy visualization of
trachea>bronchus>bronchiole Normal-brath sounds
the trachea and bronchus
s>alveoli Bronchial (tracheal/tubular)
using rigid flexible fiber optic
(anterior neck) passing of air
Alveoli-terminal airway, filled scope verify informed consent,
in a large airway, harsh and
with capillary network “for gas explain and answer questions
loud
exchange” Pre: assess for allergy, NPO,
bronchovesicular (1st or 2nd
alveolar cell type I-maintain semi fowlers
ICS towards sternum) air
alveolar wall Post: check gag reflex (+) sore
passing through bronchus,
alveolar cell type II – produce throat – ice chips, cool liquid,
moderate pitch, moderate
lung surfactant, control soft food, DAT
intensity
surface tension “during monitor for complication
Vesicular breath sounds (lung
exhalation” prevent Bronchospasm wheeze
periphery or lower lobe of
atelectasis (absence of breath atelectasis
lungs) passing of air in smaller
sounds Thoracentesis aspiration of
airway (bronchiole and alveoli)
alveolar cell type III – produce fluid or air from the pleura
gentle sighing
macrophage, prevent assess for allergy,
pulmonary infection Abnormal breath sounds Pre: position before
Rales/ crackles fluid filled procedure: sitting, leaning
Respiration forward/straddling, side lying
alveoli – popping (fine or
pulmonary-ventilation, gas [unaffected side]
coarse)
exchange Post: position:side lying
wheeze air passing through
cellular-perfusion (unaffected side), maintain
narrow airway- high pitch
musical bed rest, monitor VS. –
C3 & C4 Phrenic nerve
Ronchi inflammation of the atelectasis, bleeding,
Exhalation is twice as long as upper airway – gurgling hemoptysis
inhalation friction rub inflammation of
Modalities of treatment
pleural membrane – grating
Patient assessment IPPA 1. O2 therapy – monitor twice
sound
each shift
Inspection stridor airway obstruction
shape(elliptical) “DANGER SIGN” 2. incentive spirometry (SMI) –
symmetry of breathing sustained maximal inhalation
color(clitoral pink) DIAGNOSTIC TEST
to clear secretion, to improve
chest x-ray (radiography)
ventilation, to prevent lung
collapse 5. Chest tube thoracotomy – Palpate tissue around the tube
Position: sitting or upright, to re-expand the lung to check for subcutaneous
encourage deep breathing, AIR- 2nd or 3rd intercostals emphysema
place tube tightly into the space Do not milk or straighten tube
mouth, inhale deeply, hold FLUID/BLOOD- 5th to 9th Do not clamp TENSION
breath 5-10 secs (assess 700- intercostals space PNEUMOTHORAX
900 marking) exhale through
purse lip, repeast stes, 10 BOTTLE SYSTEM BEDSIDE FOR CTT
breaths per hour one way drainage- water seal 1. Occlusice/non porous
two way drainage- water seal dressing
3. Chest physiotherapy- drain three way drainage- water 2. Extra bottle
secretion and prevent seal 3.Clamp
infectious elements four way seal- water seal, Removal: chest x-ray
a.) postural drainage suction Pre: check and verify doctor’s
positioning with aid of gravity, order, analgesic, positioning
10-15 minutes per segment, 3- 1st bottle drainage collection- semi fowler’s,
4 times a day before meals, first 24 hours- bloody, 500- inhale, exhale, hold breath,
auscultate, administer 1000 ml/ hr bear down or valsalva, apply
bronchodilator, it there is unexpected 70-100 ml/hr occlusive dressing
intolerance STOP (-) drainage Obstruction , lung monitor VS and RR, Document
b.) chest percussion – hands: resolution
cupped shape, 3-5 mins per LUNG SURGERIES
2nd bottle water seal, a) lobectomy- sx removal of
segment, hollow sound
immersion 2-3 cm, lung lobe, semi fowler, side
c.) chest vibration – hands:
intermittent bubbling lying (unaffected)
flat, quivering/ isometric
unexpected continuous b) segmentectomy- sx removal
contractions, 5 vibrations per
bubbling (air leak) of lung segment, semi fowler
exhalation per segment,
expect tidaling/ c) wedge resection- sx
encourage client to cough
fluctuation/oscillation removal of a small
4. Suctioning- to maintain unexpected (-) fluctuation circumscribed lesion, semi
patent airway, to prevent (obstruction/ lung expansion/ fowler, side lying (unaffected)
pulmonary infection, schedule low suction) d) pneumonectomy- sx
PRN, arrhythmia removal of deceased lung, side
3rd bottle- wet suction
POSITION: semi fowler, or side lying affected side
control, immersion 10-20 cm,
lying hyper oxygenate, wear
continuous gentle bubbling Post-op care
PPE, lubricate tip with NSS,
unexpected continuous monitor vs
check equipment, measure
vigorous bubbling (high RR, watch out for atelectasis
length to be inserted, insert
suction pressure) BP, for shock, hypotension
catheter withdraw while
applying intermittent suction, Temp. Malignant
NURSING RESPONSIBILITIES
circular or rotating motion, hyperthermia, genetics-
prevent hypoxia, rest with unsafe inhalation anesthetic
Changing of position towards
interval of 2 mins, repeat the SAFEST: NITROUS OXIDE (blue
unaffected side
process, document tank)
Encourage deep breathing
teach about diaphragmatic expectorant—expectorate risk for addisonian disease
breathing and use SMI NURSING CONSIDERATION NURSIG INTERVENTION
positioning: semi fowler monitor for candidiasis(white
PNEUMONIA oral fluid intake patche in the mouth; anti
inflammation of the lung encourage deep breathing fungal)
suction secretion long term bone
CAUSE: S. Pneumonia, K.
provide bed rest demineralization
Pneumoniae, H. Influenza, P.
DIET: high caloric high protein reverse isolation, private room
Aeroginosa
with vitamins and minerals, positive pressure
MODE OF TRANSMISSION:
small frequent meals, low bacteria diet, no raw
droplet
implement droplet precaution foods
TYPES: hospital acquired: after
sx mask on patient during THEOPHYLLINE &
48-72 hours of admission
transportation AMINOPHYLLINE (xantrines)
Community acquired within
hand hygiene 10-20 mcg/ml treatment of
48-72 hours of admission
Pulse ox /O2 sat 95-100% status asthmaticus (short
RISK FACTORS: extreme age,
confirmatory test ABG acting bronchodilator)
poverty, overcrowding,
development of toxicity
immobility, immune Peak flow meter (neurotoxicity)
suppression used to determine degree of hoarse hand tremors –
S/SX:high grade fever airflow limitation activated charcoal
productive cough-rusty green-normal, no airflow HISTAMINE ANTAGONIST
sputum limitation DYPHENHYDRAMINE
anorexia yellow-reactive airway (BENADRYL)
nausea/vomiting disease, slight airflow SIDE drowsiness –safety, avoid
headache limitation driving, dryness of secretion,
chest pain red-EMERGENCY acute provide fluids
cyanosis exacerbation, marked airflow MASK O2 metered dose
restlessness limitation inhaler, monteleukast
develops DOB
ANTICHOLINERGIC
fatigue TREATMENT
sympathomimetic
DX adrenergic-agonist B2 –ROL
chest x-ray Terbutarol
sputum culture and sensitivity SIDE FX tachycardia,
TX: provide IV fluid palpitation, nervousness
O2 therapy ADVERSE rebound
chest physiotherapy bronchospasm
antibiotics (penicillin COUNTER beta blocker –non
hypersensitivity assess for selective
allergy) STEROIDS –SONE anti
check result for sputum CS inflammatory
teach to finish course of SIDE gastrointestinal upset,
antibiotics weight gain, hyperglycemia,
bronchodilators inhalation swelling
mucolytic –cysteine –liquify ADVERSE immunosuppression,

Brain Stem

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Brain Stem

Uploaded by

Copyright:

Available Formats

Brain stem Palpation single view, promote safety:

You might also like