PULMONARY CONCEPT IN

CRITICAL CARE

 PULMONARY

Pertaining to the lungs.

CRITICAL

CARE

Continuous and closely monitored health care that is provided to critically ill patients.

PNEUMONIA
An inflammatory process, involving the terminal
airways and alveoli of the lung, caused by infectious agents (viral/ bacterial). Is the most common cause of death from infectious diseases. Recurring pneumonia commonly indicates underlying disease, such as cancer of lung, multiple myeloma, or COPD.

PNEUMONIA
Signs/Symptoms: 1. Sudden onset; shaking chill; rapidly fever of 38.3 40 C . 2. Cough productive of purulent sputum. 3. Pleuritic chest pain aggravated by respiration/coughing. 4. Dyspnea, tachypnea. 5. Rapid, pounding pulse.

PNEUMONIA
Nursing Management: 1. Administer medications as prescribed (antibiotics, antipyretics) 2. Improving gas exchange. a. Observe for cyanosis, dyspnea, hypoxia, and confusion. b. Checking ABGs. c. Administer oxygen. d. Place patient in an upright position.

PNEUMONIA
3. Improving airway patency. a. Encourage pt. to cough. b. Suctioning. c. Encourage increased fluid intake. d. Humidify air or oxygen therapy. e. Chest physiotherapy. f. Changing pt. position frequently. 4. Relieving pleuritic pain. a. Place patient in semi Fowler position. b. Administer analgesics as prescribed. (avoid opioids in patient's with a history of COPD) c. Avoid suppressing a productive cough. 5. Monitoring for complications.

PNEUMONIA
6. Patient education. a. Advise smoking cessation, and excessive alcohol intake, and heavy exercises. b. Advise the patient to keep up natural resistance with good nutrition, adequate rest. c. Encourage breathing exercises.

Gerontologic Considerations:
Sedatives, opioids, and cough suppressants should be used cautiously in elderly pt.s, because their tendency to suppress cough and gag reflexes and respiratory drive. Also , provide frequent oral care for Pneumonia prevention.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Includes

diseases that cause airflow obstruction 1. Chronic Bronchitis A disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. Primarily viral etiology, but may also arise from bacterial agents.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2. Asthma Chronic inflammatory disease of airways causing airway hyper responsiveness, mucosal edema, and mucus production. Reversible, either spontaneously or with treatment. Allergy is strongest predisposing factor.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

3. Emphysema A pathological term that describes an abnormal distention of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Primary Symptoms: Cough Sputum production Dyspnea Chest Pain

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Nursing Management:
1. Improving airway clearance a. Encourage smoking cessation. b. Keep patients room as dust free as possible. c. Administer bronchodilators as prescribed. d. Use postural drainage position. e. Encourage coughing. f. Encourage oral fluids intake. 2. Improving breathing pattern a. Encourage breathing, coughing exercises. b. Use pursed- lip breathing at intervals and during periods of dyspnea. 3. Administer antibiotics as prescribed.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

4. Improving gas exchange a. Check ABGs. b. Administer oxygen. c. Inspiratory muscle training. 5. Improving nutrition. a. Encourage frequent small meals if pt. is dyspneic. b. Avoid foods producing gas and abdominal discomfort. c. Monitor body weight. 6. Increasing activity tolerance. a. Encourage pt. to carry out regular exercise program. b. Encourage use of portable oxygen system for ambulation for patients with hypoxemia.

PULMONARY EMBOLISM
Refers

to the obstruction of one or more pulmonary arteries by a thrombus originating usually in the deep veins of the legs or the right side of the heart. Predisposing Factors: 1. Stasis, prolonged immobilization. 2. Previous heart (CHF, MI) or ling diseases. 3. Coagulation disorders. 4. Advancing age, estrogen therapy.

PULMONARY EMBOLISM
Signs/Symptoms (occur suddenly): 1. Dyspnea, pleuritic pain, tachypnea. 2. Chest pain. 3. Cyanosis. Emergency Management: 1. Anticoagulation therapy is used to prevent new clot formation but does not dissolve previously formed clots. 2. Thrombolytic therapy is used to dissolve clots.

PULMONARY EMBOLISM
Nursing Management: 1. Administer prescribed medications. Anticoagulant (IV Heparin, followed by Warfarin) and Thrombolytic (streptokinase). Sedatives (Morphine) to relief pain. 2. Administer oxygen to relief hypoxemia, respiratory distress, and cyanosis. 3. Apply anti-embolism stockings to help improve venous return.

PULMONARY EMBOLISM
4. Instruct the pt. do not do activities that increase venous stasis such as crossing legs, sitting or standing for long periods. Instruct pt. to elevate the legs above the level of heart. 5. Patient education.

PULMONARY EDEMA
Acute

pulmonary edema refers to excess fluid in the lung, either in the interstitial spaces or in the alveoli. Most often occurs as result of cardiac disorders such as CHF and MI.

PULMONARY EDEMA
Signs/Symptoms: 1. Crackles. 2. Dyspnea and cough. 3. Tachycardia. 4. Cyanosis, cold diaphoretic skin. 5. Restlessness. 6. Jugular venous distention. (JVD)

PULMONARY EDEMA
Nursing Management: 1. Administer medications as prescribed. Morphine, diuretics, cardiac glycosides,vasodilators,aminophylline. 2. Give oxygen in high concentration. 3. Position the pt. upright to decrease venous return and allow maximum lung expansion. 4. Monitor vital signs and electrolytes balance.

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Presented By:
ANGUE, Aileen T. CASTILLO, Ma. Princess M. PERLADO, Karen B. BSN IV - 2