Adult 3

Respiratory
Assessment Upper Airway Structure a. Nose: Inspection tilt head back swelling, polyps, deviated septum b. Sinuses: Palpation, w/light (will light up or solid = infection or blood) c. Pharynx: Inspection ahhh ulcerations, redness, pus pockets, swallowing, can they talk? Anything abnormal d. Mouth: same as pharynx teeth e. Trachea: midline (mass or growth pushing it off midline) i. Sign of if lungs have tension pneumo: can push over trachea or hematoma Lower: & breathing patterns 1) Chest configuration a. Barrel chested COPD (hyper-inflate lungs) 1:2 ratio b. Funnel chested depression in lower portion of sternum Rickets & marphans syndrome (tall) c. Pigeon chested bowed out shallow breathing set up for pneumonia d. Kyphoscliosis elevation of scapula and corresponding S-shaped spine 1. severe birth defects 2) Breathing Patterns / Respiratory Rate a. Normal breathing pattern = Eupnea (12-18) b. Bradypnea slow <10/min regular c. Tachypnea fast > 24/min regular d. Hyperventilation = rapid, shallow breaths (Kausmauls= diabetic ketoacidosis- fast, deep) e. Hypoventilation = slow, shallow breaths 1. bag 2. chin-lift, jaw thrust, naso-pharyngeal trumpet & then bag (open airway) f. Apnea = cessation of breathing g. Cheynes-Stokes = irregular shallow breaths followed by deep breaths followed by apnea h. Biots Respirations = 3-4 breaths followed by 1 minute of apnea 3) Thoracic Palpation a. Respiratory excursion watch, expansion (range & symmetry) b. Tactile fremitus vibrate (have pt say how now brown cow or 99 to create resonance in lungs make fluid vibrate) 4) Thoracic Percussion a. Should sound hollow if fluid in there = dull, thud COPD = tympanic b. Diaphragm excursion (4a) percuss diaphragm ( normal on bottom, flat as going up = obstruction = fluid in lungs CHF, pneumonia, lung cancer type pts can tell how much fluids are in lungs

5) Thoracic Auscultation air in to bronchial tree & lung structures a. Breath sounds 21.4 p. 481 **** i. Wheeze high pitched, musical notes narrowing airways = asthma, chemical exposure ii. Rale crackles pneumonia, bronchitis, CHF, pulmonary fibrosis iii. Friction rubs 2 pieces of paper & rub against each other 1. pleuritis (lungs rubbing along ribs- no lubricants) iv. Vocal sounds if you can speak, you are getting air Physical assessment of breathing ability 1) Tidal volume volume of each breath a. Spirometer, Wright peak meter 2) Vital capacity maximum breath breathing & exhaling through spirometer a. Age, sex, weight, race (dependent upon) b. Males, younger, caucasian = larger capacity 3) Minute Ventilation tidal volume + respiratory rate a. Detect respiratory failure 4) Inspiratory Force evaluates effort pt is making during inspiration a. Use on unconscious pt Determines if someone needs to be intubated or not Diagnostic Evaluation 1) Pulmonary Function Tests: tests lung capacity (dysfunction) measures breathing capacity, how much in & out, vital capacity 1. Can purge whole system with nitrogen & see how well you re-oxygenate you body with O2- how well you perfuse (perfusion) 2. COPD, surgical candidates, CHF, Pulmonary fibrosis, asthmatics 2) Blood Gas Respiratory Acidosis Symptoms: Rapid, shallow respirations Dyspnea Disorientation Muscle weakness Lung pH pCO2 Lung

Typically drawn radially/brachial arterial blood Allen clamp radial & ulnar arteries for 30 seconds until fingers blanchecollateral circulation chance of splitting artery in 1/2 or hit nerve Blood pressure will fill syringe up if pull syringe, huge risk of collapsing artery & sucking needle through

If longer than 5 minutes, put blood gas on ice Blood gas measures O2 and CO2 in blood (CO2 very toxic to body- triggers to breathe) - Process in which O2 is exchanged from air to tissue and CO2 to ? 3 step process: 1. Mechanical ventilation exchange of air between atmosphere & alveoli Can depend on air pressure variances (sea level, mountain), resistance to air flow (asthmatics), lung compliancy how well/easy it can blow up and let down COPD = stiff lung 2. Diffusion exchange of o2 and co2 between alveoli & capillaries happens in lungs alveoliar gasses cross membranes into cap beds 3. Transportation : O2 moving into cells & CO2 moved out of cells circulation through body Measure: pH of blood normal = 7.35 to 7.45 CO2 = 35-40 Bicarb 22-26 neutralizes O2 sat 80-100

Respiratory Acidosis see above - COPD, pneumonia, asthmatics, drug overdose, sedatives, any condition that obstructs airway Respiratory Alkalosis Symptoms Tingling of extremities Confusion Deep, rapid breathing Seizures

pH pCO2 Overexcitement, hyperventilation, extreme fevers non-rebreather w/2L Metabolic Acidosis- kidneys - let breathe into paper bag

Symptoms Disorientation, Kussmaul respirations, Muscle twitching Changes in LOC HCO3

pH

Renal disease, diabetic ketoacidosis, losing too much base (drug od-aspirin) -help by hydration, oxygenate- nasal cannula to tubing, bicarb (sodium bicarbonate (1mg to 1kg) does not cross blood/brain barrier

Metabolic alkalosis -

Symptoms Nausea & vomiting Diarrhea Restlessness Slow respiration Dysrhythmias, HCO3

(use of diuretics)

pH

How to tell if someone is in one of these states: Normal values in one column ph high = alkalosis/acidosis CO2 / Bicarb

Pulse oximetry oxygen levels in tissues (finger, forehead, ear) Smoke inhalation CO2 binds to receptor sites tricks into thinking theres O2 there false sense of security (says 100% when only 80%) Sat probes worthlessmeasures Bound & unbound hemoglobin & CO2 will bind Cultures lung, nasal through nebulizer Remember: ROME lung- cough into sterile container or hypertonic saline sputum culture Respiratory Opposite, Metabolic Equal

Acute Respiratory Distress Syndrome (ARDS)

1. Definition a. A sudden and progressive (shock) pulmonary edema characterized by crackles b. Will not respond to O2 c. Decreased lung compliance stiff (will not expand) In absence of left-sided heart failure, pt exhibits: Sudden & progressive pulmonary edema bilateral infiltrates (x-ray = white lung) fluid, blood, pus as disease gets worse, progressively goes from bottom to top Hypoxemia refractory to O2 Reduction in lung compliance

2. Pathophysiology see paper i. Kidneys- no perfusion = not peeing ii. Liver - ** decreased blood flow impair livers ability to carry on metabolic functions body will not get any energy to do any type of work to get better - important for meds liver detoxes and breakdowns many meds- adjust dosages on meds iii. GI stress ulcers - bloody diarrhea have portions of intestines removed due to necroize tissues iv. DIC - Spider veins, throwing up blood, blood from rectum, eyes, ears v. Usually die from multi-system organ failure Injury to alveolar cap membrane p. 544 smoking, injury, pneumonia, As cap membrane starts popping, air leaks out = crackles, Secretions & inflammation of lungs narrow airway Decreased lung compliance Severe hypoxemia

3. Clinical Manifestations a. Rapid onset of severe dyspnea b. cyanotic c. short of air- anxious, tripoding, sniffing (do not lay flat) give O2, breathing treatment (bronciahl dilators), steroids (decrease inflammation), anti-anxiety med (ativan), turn lights down, be reassuring, smooth purposeful movements labs = ABG with O2 (to see if truly have refractory O2) x-ray, ECG, Cardiac enzymes, angio CT, liver function tests, arterial hypoxemia despite O2 4. Assessment and Diagnostic Findings a. Rapid, shallow breathing b. Change in mental status intercostal retractions

5. Medical Management a. Mechanical ventilation i. O2 - 21% (RA) to 100% Cranked up to 100% and O2 sat still 80% 1. Any O2 over 80% = free radicals- will damage lungs & make them stuff 2. 100% for 2 hrs 80% for 6-8 hrs anything after that will damage lungs and make them non-compliant b. Vent can control, rate, volume, (weight x10 per kg), peep (positive end expiratory pressure)- minimal amt of pressure to keep lungs expanded and adhere to side of chest (so wont collapse) #1 thing treat the problem ex: septic antibiotics supportive care turn, suction, deep breathe or sign on ventilator suction because cant cough up when on vent (q2h) Body = normal peep 5ml if go higher on peep, diaphragm go down and lungs go up, eventually lungs will pop if too much peep (compliancy issues to begin with

overinflate & put constant pressure on - Complications of peep a. popping a lung/lung collapse no breath sounds unequal rise & fall of chest tracheal deviation tension pneumo pushes over = CO , b/p, extremely tachycardic, Fix needle compression (14 gauge midclavicular, 2nd intercostals space) put in middle (too low hit mammary artery = surgery) - put chest tubes in A cause of attack = pneumothorax Bronchodilators Pharmacology Interleukin I (lung compliances) & neutrophil inhibitors (inflammation process) inflammation response w/steroids to help dilate bronchial tree better, Surfactant surface tension on lungs pulmonary vasodilators get more blood flow to lungs so they can carry O2 to rest of body better Treat sepsis Nutritional aspect stomach is not getting any blood & liver isnt getting any blood necessary to break down - manufacture enzymes TPA, tube feedings Nutritional support Get away from gastric ulcers 35-45 kcal/Kil 6. Nursing management General considerations: close monitoring, watch neurological status, High Fowlers if anxious, calm down, turn down lights, etc. Consider ventilation if peep is to be used, physiological peep = 5 ml if on vent, unnatural breathing pattern a. If cant sedate enough, paralyze them so vent can work Pavulon (1 mg per kg) Cant blink eyes dry out so moisturize and close (tape down) SCD pumps or passive ROM lying there can cause DVT o Turn q2h o May be paralyzed but may still feel pain and hear you versed, ativan, valium, morphine (b/p, pulse to tell if anxious) o Pain

Pulmonary Embolism
1. Definition infection of pulmonary artery or one of its branches Anything that obstructs pulmonary artery or one of its branches thrombus r side heart o Emboli, fat, amniotic fluid, bone, sepsis, air from pressure injectors airbag (in saline bag) o Systems problem = catheter fits on b/P cuff air to kill someone = 60cc if did not prime tubing, 60 lbs of pressure & will push blood back up into bag o Air emboli traps in atrium lay on side Obstruction of pulmonary artery or branch by a thrombus Will originate in venous system or r side of heart Risk factors: venous stasis, hypercoagulability, venous endothelial disease, certain disease states (burns, just give birth, post-op, DVT, a fib, 50 years +, certain types of tumors, long immobilization (fractured hip surgery) p. 548 2. Pathophysiology i. See paper PE = garden hose has to pump 5L of blood thru body ii. Kink artery engorge & back up pump pressure so high cant handle it then decompensate = co = death 3. Clinical manifestations iii. Most common: dyspnea, tachypnea (rapid & hurt) iv. Duration & intensity depends on size & extent ex: distal not do much saddle PE- where branches to lungs = die v. Chest pain mimic attack pleuretic in nature vi. Anxiety, cough, fever, diaphoresis, ptosis, syncopy, apprehension vii. Occurs from onset of chest pain til die = 1 hour viii. Typically chest pain, soa, diaphoratic 30-40 min before call ambulance 4. Assessment & diagnostic findings a. Death is common w/in first hour b. DVT closely associated with PE i. Dont occur in same spot*** w/1 blood clot, probably have more ii. Act goofy check head for clot c. X-ray might show something- typically will look normal o Atelectasis in lungs (dead space) elevated diaphragm on affected side o Not clear cut sign d. EKG kink in partial blockage = strain on heart = will show in EKG prolonged PR intervals as compression Dependent on size & area of thrombus Calf- humans + dopplar & bloodflow studies Lung- pulmonary angiography - Chest x-ray

ABGs v/q scan

- O2, Co2

Early recognition - Right side- shortest pathway into - IV right side for dye (pulmonary angiography) 5. Prevention - #1 get up & walking after surgery - Active exercise, avoid stasis - TED hose - Heparin (Lovenox), Coumadin, aspirin, Coumadin- 5 days to build up to therapeutic levels in body heparin 1/2 life very short Warfarin (Coumadin) gets blood drawn all the time PTT, INR between therapeutic dose & toxic dose = 1% (narrow margin) Warfarin binds to albumin so nutritional status very important - if eating well, sub-therapeutic albumin in knocking out Warfarin, not eating well, go toxic Coumadin 5000u sub-q Lovenox 40mg - passive ROM, blood thinners, leg pumps 6. Medical Management Emergency O2, big IV, minimal of 2, AGB & D-Dimer (factor that shows blood has clotted), co = b/p treat hypotension albutamine (makes pound harder, b/p by squeezing heart , fluids (dopamine = peripheral) EKG, urinary catheter (if peeing, profusing kidneys = if profusing kidneys, profusing brain with backing up in blood, get dysrhytthmias (Cardizem) book says digitalis helps regular beat (lining ducks up in a row) beat more even, more regular, diuretics fluid in lungs help preload and afterload (nitrates nitroglycerine sublingual) Thrombolytics clot busters urokinase, streptokinase, tKase, retovase, enzymes that dissolve fibrinogen (dissolves clot) - may cause CVA , dissolve fresh surgical & IV clot, best case scenario- dissolve clot & function returned to and lungs guidelines of whether to use thrombolytics or not (Pharmacologic) Surgical management i. feed a small catheter in groin through heart to where PE is at & snare it ii. PE thrombus (saddle) less than 12 hours old iii. water jet gently bust away clot Greenfield filter thigh and permanent filter placed (hx of throwing DVT), lets blood flow through and catches clot (coumadin rest of life for prevention) treated = 4% mortality rate

PE not treated = 40% chance will die Heparin = cheap

Emergency, General, Pharmacologic, Surgical

Nursing Management 1. Minimize risk of PEID risk factors p. 548 23.8 2. Prevention - active movement, dont cross legs, 0 constrictive clothing, dont dangle legs over side of bed 3. Assessment- Homans sign 4. Monitoring have pt on heparin hospital protocol blood draw q4-6 hours to see if thinned out too much 5. Systems problem heparin drop set IV pump for 6 hours and then will go off & not miss blood draw- always double check others drug calculations 6. Pain hurts long acting pain management = morphine, hydromorphone,Diludid (dilate venous system for pain & blood flow) 7. Managing O2 dead space in lungs (due to blood clot) does not oxygenate load up RBC to carry O2 to body (dont trust finger monitor) - Relieving anxiety answer questions, know what happening to them 8. Complications ARDS, cardiogenic shock, death (blue from nipple- line up) will die instantly Post-Operative Care Monitoring pulmonary pressures Provide comfort Promote how to prevent in future

assess, assess, assess

Blunt Chest Trauma

1. Common causes a. Mechanical re-distribution of energy into the body b. Car wrecks c. Fall d. Bicycle/motorcycles 2. Pathophysiology a. Energy is transferred into the chest dont care about broken bones but care about organs that lie underneath the structures 1. ex: broken sternum, bruises heart, as gets bigger & bigger, messes up both electrical & mechanical function of 2. Ribs can puncture or lungs 3. Problems: hypoxemia, hypovolemia, cardiac failure Hypoxemia- collapsed lung- cant maintain mechanical integrity tension-pneumo (2nd intercostals) shoves everything over and leads to cardiac failure- kinks off can deviate trachea Hypovolemia tear in chest, anterior aortic aneurysm, (t-bone shears vessel off) can bleed to death in seconds --- rib punctures pulmonary vein Cardiac failure/cardiac tamponade- fluid in sac & crowds , heart gets smaller until cant beat

3. Assessment & diagnostic findings a. Paramedics- tell what exactly happened at scene b. Mechanism of injury c. LOC head injury patterns head bleeds d. Estimated blood loss e. Drugs or ETOH on board? f. What did paramedics do en route? Intubate, IV, medications (narcotics) 4. Medical Management a. Aggressive treatment ABC airway tube breathing- bag cardiac CPR treat problem whats going to kill them first b. Blunt chest trauma & dead crack chest open, cardiac tamponade, cut sack open to release to re-start cardiac function c. Lung collapsed chest tube 4th 5th = blood higher = air d. Looses too much blood give O- type blood 5. Sternal and Rib Fractures a. Clinical manifestations i. Most common cause of sternum = steering wheel ii. 50% of all broken sternums die - lies underneath sheer amount to break is enormous & then transferred to iii. If not die, bruised gradually develop over course of hours to days - dysrhythmias, blood displacing tissue = tachycardic, drop in b/p - as inflammation gets larger, decreasing space that blood can pump b. Assessment & Diagnostic Findings i. Most common problem: pain ii. How to tell if break rib bony crepitus (rice krispies under skin), bruise, swelling, possible chest wall deformity (if in 2 places, free floating- loss of structural integrity) a. Shallow breathing b. can get pneumona ARDS Assessment: breath sounds Inability to take deep breath Crackling/grating sounds if take a deep breath Sternum cardiac contusion Ribs pulmonary contusion Chest x-ray, ABG (white = blood pooling), pulse oximetry, EKG (both and lungs), as lung swells, vascular resistance c. Medical Management i. Pain control ii. Fixators on sternum if pushing against heart iii. Turn, cough, deep breathe iv. Nerve blocks

6. Flail Chest a. Pathophysiology- 3 or more rib fractures at 2 or more places chest wall loses ability to stabilize itself - paradoxical: when chest moves in & sucks out chest expanding it sucks in & breath in it goes out b. With damage, lungs make more secretions Atelectasis, respiratory acidosis CO2 c. Medical management i. Suction ii. O2 iii. Pain control iv. TCDB and ambulate v. IS vi. Intubate How can you tell if the ventilator is doing a good job? O2 sats, ABG, central cyanosis, if not paralyzed Agitated, anxious, pulse rate , if not enough O2 (hypoxic squirm) 7. Pulmonary Contusion a. Pathophysiology - abnormal accumulation of fluid in interstitial and interaveloar spaces leave protein which leads to blood loss, edema, and cellular debris - pulmonary resistance, more susceptible to hypoxemia & _____________________ b. Lungs get hurt, lead fluid, inflammation vascular resistance, ability to blow off CO2 and oxygenate the lung c. Clinical manifestations i. Tachypnea ii. Tachycardia iii. Chest pain iv. Blood tinged sputum v. Severe frank blood vi. Crackles vii. Severe hypoxemia viii. Respiratory acidosis d. Assessment and Diagnostic Findings i. Change may not be for 1-2 days ii. X-ray, O2 sat, e. Medical Management i. Maintain airway ii. Provide o2 iii. Pain control iv. IV fluids v. Prophylactic antibiotics

Penetrating Chest Trauma- knife & gun club

1. Common cures 2. Medical Management a. ABC b. Chest tube >1500 cc to OR w/fluids

3.

4. 5. 6.

c. Aggressive treatment Pneumothorax a. When the lung is exposed to atmospheric pressure, it collapses (hole in lung) b. Simple & Tension Simple spontaneous in nature, most common associated with bleb on lung (outpouching of lung tissue) ex: hernia of the lung weakened piece of lung tissue prone to popping when pops, lung deflate emphesema interstitial lung disease more susceptible Tension sucking chest wounds traumatic knife & gun , rib fractures, where things are pushed over can put needle in them air comes in & not allowed to escape as air comes in creates more pressure & pushes everything over = cardiac failure, air hunger, deviate trachea, pain Clinical Manifestations a. Physical exam- hollow/tympanic (air in there) percussion dull = blood Medical Management a. Chest tube air = 2nd intercostals space blood = 4th 5th intercostals space Tension Pneumothorax subcategory of traumatic a. Definition - air sucked in & trapped pushes everything over b. Clinical Manifestations same as above c. Medical Management SAA

Laryngeal Cancer
1. Definition cancer around the larynx and voice box (tumor insidious takes time) a. Smokers chewing tobacco b. Asbestos or mustard gas exposure c. Men more than women d. Singers strain vocal cords/voice 2. Clinical Manifestations a. #1 hoarseness more than 2 weeks due to tumor b. cough c. lumps in neck d. harsh, raspy voice i. tumor impedes action of vocal cords e. Dyspnea f. Foul breath 3. Assessment & Diagnostic Findings a. Biopsy b. CT, bronchioscope (visual inspection of tumor & vocal cords) thru nose c. Palpation of lymph node, thyroid gland enlarged 4. Medical Management a. Surgery stage 1 most survivable stage 4 worst b. Partial: early stages 1&2 partially remove the tumor

i. Radiation therapy voice raspy & keep airway

Under Partial: c. Supraglottic: remove false vocal cords (glottis) & hyoid bone i. risk for aspiration ii. temporary trach no taste, no moisture (crusty critters), air particles from air get sucked into lung (no filter) set up for infections tons of secretions dry out clean out & suction humidified O2 iii. For gag reflex semi-soft foods, thickened liquids chance of aspiration d. Hemilaryectomy: 1/2 tumor goes beyond vocal cords limited to sub-glottic areas some vocal cords removed, have trach & NG, will never speak normally again (rough, raspy, hard to understand) most common problem: dont get all cancer out & have to go back and get total e. Total: cancer is beyond the vocal cords removal of hyoid bone, cricoid cartilage, epiglottis, and 2-3 rings of trachea i. radical neck strip all lymph nodes out, blunt dissection ii. permanent stoma lots of inflammation JP drains pull out if below 30 - 60cc/day set up for ARDS - high risk for aspiration of foods Radiation: for stage 1-2 knocks out mucous reduction (dry mouth) - Speech therapy: learn how to speak again - Esophageal speech: belching words (belching technique) - Mechanical voice box - Tracheo-esophageal puncture special type of trachmanipulate & vibrate artificial voice box

Nursing Process of the Patient undergoing Laryngectomy 1. 2. 3. 4. Teach the pt before surgery One of pts biggest concerns How will & I talk & Fear Explain surgery & what to expect afterwards TCDB, IS - do before surgery - return demonstration (have them show us) effectiveness listen to lungs 5. Reduce anxiety & depression a. Have them talk to someone whos had the surgery done & their experiences b. answer questions honestly c. maintain and airway semi-fowlers position restlessness, shallow respirations, pulse, cyanotic

6. Fix: TCDB, O2 suction (pain med before) - clean stoma daily - humidity- so wont dry inside stoma & lung - cant talk other ways of communication: call light, magic board, pictures - set up before surgery - adequate nutrition will not eat or drink for 14 days then thickened food o NG, TPN - ARDS need 35-45 calories - Avoid sweets increase saliva (& decrease appetite) - Keep extra stoma in room

Lung Cancer (Bronchogenic Carcinoma)

1. Definition - #1 cancer in men & women due to smoking transformed epithelial cells & squamous cells change- fast growing tumor stages 1-4 Riks factors: 2nd hand smoke, chemical/occupational exposure, genetic/dietary 2. Pathophysiology 3. Classification and Staging 4. Risk Factors 5. Clinical Manifestations a. Cough, wheezes, weight loss, fluid built up in cavity (can drain off w/needle) 6. Assessment & Diagnostic Findings a. Chest x-ray (white cotton balls), CT vascularity of it, size, sputum samples, aspiration 7. Medical Management 1. surgery 2. radiation 3. chemo 4. palliative care 8. Treatment Related Complications Radiation N/V, weight loss, pulmonary fibrosis, pericarditis, respiratory failure, radiation scars lungs 9. Nursing Management 1. supportive care (n/v, anorea, antiemetics, ng tube, caloric intake) manage symptoms relieve breathing problemss deep breathing, suction, O2 2. reduce fatigue 3. psych support

Thoracic Surgeries
1. Types of Procedures Pneumoectomy removal of total lung

1. Diaphragm goes up, heart goes over, other lung hyperinflates cavity fills with fluid cut tidal volumes of vent by 1/2 Lobectomy removal of 1 lobe (segment/wedge) f. Small hyperinflation of same side lung, diaphragm goes up a bit 1. Preoperative Management p.625 a. Assessment and Diagnostic Findings i. Breathing patterns ii. How many pillows do you sleep on per night iii. Cardio-pulmonary function iv. Psych status b. Preoperative Nursing Management 1. Pack year how many packs per day x # years smoked = pack year gives indication of how much damage done p. 627 2. Improve airway - stop smoking - humidified O2 - teach IS - TCDB - Diaphragm breathe - Relieve anxiety 2. Postoperative Management Airway: TCDB, chest tube, pain control, ambulate, prophylactic antibiotic, teach of symptoms go to doctor can live off of 1/4 of lung Chest Drainage 1. Traditional Water Seal 2. Dry Suction Water Seal 3. Dry Suction with One-way valve system 4. Nursing Process for a Patient Undergoing Thoracic Surgery 1. 2. 3. 4. 5. Physical assessment of breathing ability Diagnostic evaluation I. II. III. IV. Pulmonary function tests Arterial blood gases Pulse oximetry Cultures

V.

Sputum Cultures

Imaging Studies 1. Chest x-rays 2. computed tomography (CT) 3. magnetic resonance imaging (MRI) 4. fluoroscopic studies 5. pulmonary angiography 6. radioisotope diagnostic procedures (lung scan)

Endoscopic procedures i. Bronchoscopy i. Nursing interventions ii. Thorascoy i. Nursing interventions iii. Thoracentesis iv. Biopsy i. Pleural biopsy ii. Lung biopsy 1. Nursing interventions v. Lymph Node Biopsy 1. Nursing interventions Respiratory Pharmacology I. II. III. IV. V. VI. VII. VIII. Bronchodilators Corticosteroids Expectorants Cough suppressants Antibiotics Mucolytics Decongestants Antitussive

Oxygen Therapy 1. Indications 2. Cautions in Oxygen Therapy 1. 2. 3.

3. Methods of Oxygen Administration 1. 2. 4. Ventilators 1. 2. 5. Nursing Process for a pt on a ventilator 1. 2. 3. 4. 5.