1. Monitor ABGs PO2 > 80 mm Hg; PCO2 35-45 mm Hg; HCO3 21-28 mEq/L; pH 7.35-7.45 2. Chronic bronchi- tis Airway destruction Chronic sputum with cough production on a daily basis for a minimum of 3 months in 2 consecutive years Reduced responsiveness of respiratory center to hypox- emia st...
1 monitor abgs po2 gt 80 mm hg pco2 35 45 mm hg hco3 21 28 meql ph 735 745 2 chronic bronchi tis airway destruction chronic sputum with cough production on a daily basis for a minimu
Med-Surg Exit HESI
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1. Monitor ABGs PO2 > 80 mm Hg; PCO2 35-45 mm Hg; HCO3 21-
28
mEq/L; pH 7.35-7.45
2. Chronic Airway destruction
bronchi- tis Chronic sputum with cough production on a daily
basis for a minimum of 3 months in 2
consecutive years
Reduced responsiveness of respiratory center to
hypox- emia stimuli
Precipitating factor: higher incidence in
smokers "Blue bloaters" - generalized cyanosis
of lips, mucous membranes, face, and nail
beds
Right-sided heart failure (distended neck veins,
crackles) Lowest FiO2 possible to prevent CO2
retention
Monitor for fluid overload
Maintain PO2 between 55
and 60
Administer bronchodilators and anti-inflammatory
agents
3. Emphysema Alveoli destruction
Increased air trapping (increased AP
diameter) Increased work, increased O2
consumption Precipitating factor:
cigarette smoking
"Pink puffers"
Barrel chest, pursed-lip breathing,
wheezing Lowest FiO2 possible to
prevent CO2 retention
Administer bronchodilators and anti-inflammatory
agents Teach prolonged expiratory phase to clear
trapped air
4. Asthma Unlike COPD, asthma is an intermittent disease
1/
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with re-
versible airflow obstruction and wheezing
5. COPD Emphysema and chronic bronchitis
Characterized by bronchospasm and
dyspnea
Compensation occurs over time in clients with
chronic lung disease and ABGs are altered
The amount of O2 in the blood decreased
(hypoxemia) and the amount of CO2 in the blood
increases (hypercap- nia) causing chronic
respiratory acidosis, which results in metabolic
alkalosis as compensation
2/
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6. Clients at risk Altered LOC
for pneumonia Depressed or absent gag and cough reflexes
Susceptible to aspirating oropharyngeal
secretions (alco- holics, anesthetized individuals)
Brain injury
Drug
overdose
Stroke
victims
7. Adrenergics and Immunocompromised
sympathomimet-
ics Epinephrine; Albuterol (Proventil); Terbutaline
(Brethine); Salmeterol (Serevent); Metaproterenol
(Alupent); Lev- abuterol (Xopenex)
Bronchodilation
Adverse reactions: anxiety, increased HR, N/V,
urinary retention
8. Methylxanthine Aminophylline (IV); Theophylline (PO)
Bronchodilation
Adverse reactions: hyperactivity, tachycardia,
sleepless- ness, cardiac dysrhythmias
Monitor therapeutic
range Crosses
placenta
9. Corticosteroids Prednisone (PO); Solu-Medrol (IV); Budesonide
(Pulmi-
cort); Fluticasone (Flovent); Triamcinolone
(Azmacort) Anti-inflammatory
Encourage oral care after use
10. Anticholinergics Ipratropium (Atrovent); Tiotropium (Spiriva)
Bronchodilator; control of rhinorrhea
Adverse reactions: dry mouth, blurred visions,
cough
11. O2 delivery O2 must be humidified if given at >4 L/min or
delivered
directly to the trachea
3/
, Med-Surg Exit HESI
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12. Tuberculosis Airborne precautions*****
Symptoms: fever with night sweats, anorexia,
weight loss, malaise, fatigue, cough, hemoptysis,
dyspnea, pleuritic chest pain with inspiration,
positive sputum culture, re- peated upper
respiratory infection
4/
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