You are on page 1of 9

c  

Alterations in respiratory function and oxygenation deprive body cells


and organs of the oxygen needed for metabolism and ATP production.
Lack of oxygen, regardless of the reason, poses a risk for organ
function and for life. Respiratory infections are common, recurring and
sometimes life threatening problems of both children and adults, which
alter oxygenation. Respiratory infections are the focus for teaching the
concepts of nursing care related to altered respiratory function.

 c
c  
Upon completion of this unit, the student will:
1. Discuss concepts of altered respiration and oxygenation.
2. Describe altered respiratory function and design nursing actions to
promote oxygenation.

  c
1. Read Brunner:
a. Assessment of Respiratory Function, Chapter 21
b. Prototype and related diseases readings, Chapter 23 (pp. 552-
578)
c. Review infectious process, immunizations and infection
prevention, Chapter 70 (pp. 2122-2144)
d. Review respiratory care modalities, Chapter 25
2. Read Ball & Bindler:
a. Prototype and related treatment, Chapter 20 (pp. 677-688:694-
710)
b. Immunization with tables of communicable diseases, Chapter
18 (pp. 584-624)
3. Review structure and function of alveoli and the process of gas exchange

   c


  
1. Discuss the clinical features, diagnostic assessment, special
examination techniques, medical management, and nursing care for
patients with:

  c    ! "
"#! $$ %&#& '   "!# $ ( )
A. Definition.
1. Discuss the physiological impact of oxygen
deprivation to the body systems
B. Etiology/epidemiology
1. Identify factors that place individuals at
increased risk for the development of
pneumonia.
2. Describe the factors that place an elderly patient
at increased risk for pneumonia.
3. Identify the high risk groups that should have
pneumococcal vaccines.
4. Differentiate community acquired and hospital
acquired pneumonia.
5. Compare and contrast the epidemiology, clinical
features and effective antibiotics of common
pneumonias
C. Clinical manifestations.
D. Understand the following diagnostic tests:
1. CBC (individual components of WBC)
2. CXR
3. Sputum analysis.
4. ABG (normal vs abnormal).
E. Understand the medical management of patients
experiencing altered respiratory function including:
1. Identification of causitive organism
2. Antibiotic therapy
3. Symptomatic treatment of fever, cough,
bronchial irritation and dehydration.
4. Oxygen therapy
F. Consider the nursing management of patients with altered
respiratory function:
1. Nursing assessment
a. Demonstrate competency at the
following skills: vital signs, breath
sounds, breathing patterns,
characteristics of cough, complaints
of dyspnea, characteristics of
sputum, hydration
2. Apply nursing diagnosis to the patient
experiencing pneumonia
a. Activity intolerance related to altered
respiratory function
b. Ineffective airway clearance related
to thick secretions/ fatigue
c. Potential fluid volume deficit related
to effects of abnormal fluid loss from
lungs and perspiration.
d. Sleep pattern disturbance related to
effects of dyspnea, cough and /or
discomfort
3. Understand nursing interventions:
a. Chest physiotherapy.
b. Oxygen administration.
c. Airway patency.
d. Promotion of rest, comfort and fluid
intake.
e. Providing information to patient and
family.
f. Recognition of and attention to fears.
g. Participation in discharge planning.
h. Health promotion as it relates to
respiratory health
4. Understand nursing evaluation:
a. Compare patient status to outcomes.
b. Revise as necessary to
maintain/restore health.
G. Understand complications of bacterial pneumonia,
specifically:
1. Fluid volume deficit and/or shock
2. Altered blood gas values/acidosis.
3. Systemic infection/sepsis.
4. Atelectasis/pleural effusion.
5. Respiratory failure.

2. RELATED ALTERATIONS: Tuberculosis, lung abscess, pleurisy,


pleural effusion, empyema
A. Compare each of the related alterations to the ³prototype.´
B. Identify similarities and differences.
C. Discuss differences: focus upon nursing interventions
specific to each related alterations.

3. Discuss the clinical features, diagnostic assessment, special


examination techniques, medical management, and nursing care for
patients with:
c
*c +  # ' ,! - ./ 
  $ #   "# %&#&
0    "!# $ ( )
A. Definition.
B. Etiology / pathology.
C. Clinical manifestations.
D. Diagnostic tests: ELISA, rapid immunoflorescent antibody
(IFA), from direct aspiration of nasal secretions or
nasopharyngeal washings
E. Medical management: Ribavirin, RespiGam.
F. Nursing management/process:
1. Nursing assessment: focus on respiratory rate and
effort, vital signs, breath sounds, breathing patterns,
characteristics of cough, complaints of dyspnea,
characteristics of sputum, hydration.
2. Nursing diagnosis.
a. neffective airway clearance related to
increased airway secretions
b. Ineffective breathing pattern related to
tracheobronchial inflamation
c. Fluid volume deficit related to inability
to meet fluid input needs
3. Nursing interventions:
a. Oxygen administration.
b. Airway patency.
c. Promotion of rest, comfort and fluid
intake.
d. Participation in discharge planning.
e. Work to counteract isolationism
f. Discuss and refer family to financial
resources
g. give special attention to families fears
h. application of growth & development
principles in communication and
teaching.
4. Nursing evaluation.
a. Compare patient status to outcomes.
b. Revise as necessary to maintain/restore
health.
G. Consider the following complications and preventative nursing
interventions:
1. Pneumonia (due to aspiration).
2. Respiratory failure/arrest.

4. RELATED PEDIATRIC ALTERATIONS: Croup syndrome,


epiglottitis, acute laryngotracheal, bronchitis
A. Compare each of the related alterations to the ³prototype.´
B. Identify similarities and differences.
C. Discuss differences: focus upon nursing interventions
specific to each related alterations.

    


As assigned by clinical instructor.

   c
 
None
 1   2!# $ c(  -  %.
?

c  
In addition to infections, there are several diseases which appear to
originate as a result of the interaction of genetics and the environment.
These disorders, referred to as Chronic Obstructive Pulmonary
Diseases or COPD, alter respiratory function and oxygenation by
obstructing airflow -- although the exact mechanism of airway
obstruction varies with each disease. These disorders are irreversible
and are progressive in impairment of respiratory function.

 c
c  
Upon completion of this unit, the student will:
1. Describe how chronic obstructive pulmonary diseases like emphysema
and asthma cause alterations in respiratory function.
2. Design nursing interventions to promote respiratory function for patients
with obstructive pulmonary diseases.

  c
1. Read Brunner:
a. COPD, Emphysema, Asthma Chapter 24
b. Review Respiratory Care Modalities, Chapter 25
2. Read Ball & Bindler:
a. Cystic Fibrosis, Chapter 20 (pp. 726-733)
b. Asthma, Chapter 20 (pp. 712-726)
3. Review normal defense mechanisms of the respiratory tree.

   c


  
1. Examine the psycho-social effects of chronic obstructive pulmonary
disease (COPD) on lifestyle, social interaction and independence.
2. Describe the variety of education topics the patient needs for optimal
management of COPD.
3. Discuss the pulmonary rehabilitation needs: education; psychosocial;
behavioral; and physical.
4. Discuss the clinical features, diagnostic assessment, special
examination techniques, medical management, surgical interventions
and nursing care for patients with:

*c
c 
   c3    -
c .
   #&# $  &  '  
"!# $ (  4 4!# " "'%)
A. Definition
1. Describe the three respiratory diseases that are
characterized by obstructed airflow
B. Describe pathology associated with COPD
C. Consider the clinical manifestations of COPD.
D. Explain diagnostic studies for COPD
1. Pulmonary function studies.
E. Explain medical management of COPD
1. Symptomatic management- Respiratory meds,
Oxygen
F. Explain nursing management/process of patients experiencing
COPD
1. Practice skills of nursing assessment
2. Consider nursing diagnoses applicable to patients
experiencing COPD
a. Ineffective airway clearance related to
bronchospasm, increased respiratory
secretions
b. Impaired gas exchange related to
obstructions of airways with secretions,
alveoli destruction
c. Altered Nutrition: Less than body
requirements related to dyspnea, fatique,
side effects of medication
3. Consider nursing interventions for COPD patients
a. Oxygen therapy ( special considerations
)
b. Removal of bronchial secretion.
c. Breathing exercises and training.
d. Patient education especially related to
prevention of infections.
e. Self-care activities
1) Setting realistic goals
2) Avoiding temperature
extremes
3) Altering lifestyle
f. Promoting smoking cessation
g. Improving gas exchange
h. Achieving airway clearance
i. Preventing bronchopulmonary infections
j. Monitoring managing potential
complications
k. Coping measures
l. Information sharing and discharge planning
m. Demonstration of caring for an individual
with a chronic disease process
4. Consider nursing evaluation related to outcomes of the
COPD patient
a. Compare patient status to outcomes.
b. Demonstrates improved gas exchange
c. Achieves maximal airway clearance
d. Improves breathing pattern
e. Maintains maximal level of self-care and
physical functioning
f. Develops effective coping mechanisms
g. Participates in pulmonary rehabilitation
program
h. Adheres to therapeutic program
i. Avoids or reduces complications
j. Revise as necessary to maintain/restore
health.
G. Identify the complications and preventative nursing measures
of COPD
1. Acid-base imbalance.
2. Dehydration.
3. Infection.
4. Respiratory failure.

5. RELATED ALTERATIONS: Chronic bronchitis, bronchiectasis, emphysema.


A. Compare each of the related alterations to the ³prototype.´
B. Identify similarities and differences.
C. Discuss differences: focus upon nursing interventions
specific to each related alterations.

6. Discuss the clinical features, diagnostic assessment, special examination


techniques, medical management, surgical interventions and nursing care for
patients with:
 *     #&# $  "
#&'$ %&#& '   "!# $ (  4
4!# "  "'%)
A. Definition. Chronic inflammatory disorder of the airway
B. Etiology/epidemiology.
C. Pathology.
D. Clinical manifestations.
E. Diagnostic tests. Pulmonary function studies
1. Spirometer
2. Peak expiratory flow rate (PEFR)
3. Skin testing for asthma triggers
F. Medical management: inhaled steroids
G. Nursing management/process:
1. Nursing assessment.
a. Respiratory Status
b. Psychosocial
2. Nursing diagnosis.
a. Ineffective airway clearance r/t airway
compromise, copious mucus secretions,
coughing
b. Ineffective breathing pattern r/t
obstruction, addition respiratory illness,
poor response to meds
c. Anxiety/Fear (child or parents) r/t
airway obstruction, poor response to
medications, possible additional
respiratory illness
d. Knowledge deficit r/t medical
management of chronic disease
3. Nursing interventions.
a. Maintain airway patency
b. Meet fluid needs
c. Promote rest and stress reduction
d. Support family participation
e. Discharge planning and home care
teaching
4. Nursing evaluation
a. Compare patient status to outcomes.
b. Revise as necessary to
maintain/restore health.
H. Consider the following complications and preventative
nursing interventions:
1. Fatigue/exhaustion.
2. Acid-base imbalance.
3. Respiratory fatigue/arrest.
I. Asthma in the adult.

7. Discuss the clinical features, diagnostic assessment, special


examination techniques, medical management, surgical interventions
and nursing care for patients with:

3 
2c    !5! #&'$&$ $ 
# ! 4!# " "'% $ '$ ( )
A. Definition: A chronic inherited disorder of the
exocrine glands characterized by abnormal thick
secretions, salty taste to skin and other multisystem
affects.
B. Etiology = inherited.
C. Pathology = altered function of exocrine glands.
D. Clinical manifestations.
1. Thick, sticky mucus production
2. Meconium ileus in newborn
3. Fecal impaction and intussusception
4. Steatorrhea
5. Chronic moist productive cough
6. Frequent respiratory infections
E. Diagnostic studies: sweat test; classic symptoms;
positive family history
F. Medical management.
1. Maintaining respiratory function
2. Managing infection
3. Promoting optimal nutrition and exercise
4. Preventing gastrointestinal blockage
G. Nursing management /process:
1. Nursing assessment.
2. Nursing diagnosis.
a. Ineffective airway clearance
r/t thick mucus in lungs
b. Ineffective breathing pattern
c. Risk for infection
d. Altered nutrition
e. Fear/anxiety
f. Knowledge deficit
3. Nursing interventions:
a. Patient/family education
related to chest physiotherapy
and genetic counseling.
b. Supportive home care.
4. Nursing evaluation.
a. Compare patient status to
outcomes.
b. Revise as necessary to
maintain/restore health.
H. Consider the following complications and
preventative nursing interventions:
1. Bowel obstruction.
2. Malnutrition.
3. Increased sodium and chloride excretion.
4. Respiratory infection.
5. Death.

    


As assigned by instructor.

   c
 
None
?