ࡱ> qsp{ 'bjbjzz Dj2@@8=.E=G=G=G=G=G=G=$>Ak=k==444vE=4E=447tq<p\~*I;^1==0=;*Bj*Bq<*Bq<"4 k=k==*B@ `: Behavioral ObjectivesContent OutlineClinical ObjectivesLearning opportunitiesApply the terms listed in the content column appropriate to the clients situations. Compare and contrast the normal anatomy and physiology to the pathophysiology of the disease processes in the respiratory system across the lifespan. Analyze factors including the assessment of the client experiencing complex problems of the respiratory system, including the developmental and cultural considerations. Application of terms Bronchiolectasis Carbon dioxide narcosis Emphysema Muscular dystrophy Sleep Apnea Sudden infant death syndrome (SIDS) II. Anatomy & Physiology of the Respiratory System A. Developmental considerations 1. Infant 2. Child 3. Adolescent 4. Adult 5. Older adult B. Pathophysiology of respiratory system: Alteration in Ventilation/Perfusion Acidosis Alkalosis Respiratory Assessment Interview Chief complaint Present illness Prior medical history Family/social/occupational history Medication history Prescription/non-prescription Knowledge of health maintenance Identify risk factors Physical Exam Vital signs Level of consciousness Breathing pattern (rate, depth, rhythm, effort, symmetry) Chest pain Breath sounds Breath odor Tracheal position Color (central & peripheral) Cough Sputum Activity level Capillary refill Diagnostic Tests Laboratory Complete blood count (CBC) Pulmonary function tests Acid-fast bacillus Sweat test Coagulation study (PT/PTT/INR) Culture & sensitivity Radiology Chest x-ray Lung Scan Bronchoscopy Other Arterial blood gases (ABG) Pulse oximeter Skin test D. Cultural Influences Hereditary Environmental Health beliefs/practices Developmental Age specific assessment data Vital signs Breathing pattern Capillary refill Fluid/electrolyte nutritional needs Behavioral/emotional response to health care providersAnalyze client data to compare expected and achieved outcomes for client. Implement cost effective care. Use current technology and evidence-based information to formulate and modify the nursing plan of care. Collaborate with other health care providers with treatments and procedures. Select and carry out safe and appropriate activities to assist client to meet basic physiologic needs, including: circulation, nutrition, oxygenation, activity, elimination, comfort, rest and sleep. Collaborate with others to develop and modify individualized teaching plans based on developmental and health care learning needs. Individualize and implement established teaching plans. Evaluate learning outcomes of the client receiving instruction. Modify teaching methods to accommodate client differences. Adjust priorities for nursing interventions in emergency situations. Evaluate and communicate quality and effectiveness of therapeutic interventions.READ: Lewis (2011) Lehne (2010) McKinney (2009) VIDEOS: #M017 Physical Assessment: The Lungs #1158 Asthma, Emphysema and Chronic Bronchitis #M067 Normal and Abnormal Breath Sounds #226 Respiratory Alkalosis & Acidosis #227 Metabolic Alkalosis & Acidosis #M124 Tuberculosis: Prevention and Practices for Healthcare Workers COMPUTER SIMULATIONS: Laser 5033 Physical Examination of the Respiratory System Laser 5017 Promoting Oxygenation Laser 5045 Critical Care Nursing Critical Thinking: Pulmonary Care MEDCOM ONLINE FILMS: VIDM238-T The Basics of Oxygen Administration VIDM240-T Assessment of Respiratory Distress in the Pediatric Patient VIDM199S-T Tuberculosis: New Strategies for the Healthcare Worker Differentiate between the etiology, pathophysiology, and clinical manifestations of selected complex respiratory problems. Discuss analysis, planning, implementation and evaluation for the nursing management of clients with complex respiratory problems and associated technology.  Complex Respiratory Problems Arterial blood gases Croup syndrome/Respiratory syncytial virus Mechanical ventilator Tracheostomy Care Chronic Obstructive Pulmonary Disease (COPD) Chronic bronchitis 2) Emphysema Pneumo/hemothorax Pleural effusion Cystic fibrosis Scoliosis Myasthenia gravis Pulmonary embolus/Deep vein thrombosis Adult Respiratory Distress Syndrome (ARDS) Tuberculosis Guillain-Barre Selected nursing diagnoses/nursing implementation/evaluation. Impaired gas exchange: Ventilation/perfusion inequality. Independent interventions Respiratory status Pulmonary toilet Positioning for maximum ventilation Energy conservation Fluid volume balance Nutritional support Breathing techniques Monitoring pertinent diagnostic tests Maintain asepsis Collaborative interventions Oxygen support Mechanical ventilation Collaborate with Respiratory Therapy Administer medications and monitor for desired effects/adverse effects/side effects Steroids Antibiotics Analgesics Mucolytics Expectorants Anticoagulant Antituberculosis Antipyretics Cough suppressants Nebulized epinephrine (Racemic epi) Bronchodilators Pancreatic enzymes Leukotriene Modifiers Surgical modalities Chest tubes Thoracentesis Bronchoscopy Lung biopsy Vena-cava ligation umbrella Rod instrumentation Pleurodesis Tracheostomy Nutritional support High carbohydrate, high salt Recognition of complications Mediastinal shift Airway obstruction Respiratory failure Infection Hemorrhaging Crepitus(subcutaneous emphysema) Flail chest Spontaneous pneumothorax Ventilatory dependence Tracheal erosion Vocal cord trauma Nutritional problems (anorexia) Reproductive problems Febrile seizures Rectal prolapse The client will exhibit improved gas exchange as evidenced by: Breathing pattern Level of consciousness Vital signs Color Cough/sputum Decreased pain Activity level Arterial blood gases & pulse oximeter Altered health maintenance: Knowledge deficit. Client teaching Assess readiness to learn, ability, knowledge/educational level Avoid aggravating factors/alleviating factors Breathing techniques Reportable signs/symptoms Medication teaching Rest/activity Relaxation technique Nutritional Milwaukee brace Community resources Cystic Fibrosis foundation American Lung Association Sudden Infant Death Syndrome Association Empty Cradle Home Health Department of Public Health Long term care facility for ventilator dependent client Pulmonary rehabilitation program Genetic counseling The client will have improved health maintenance as evidenced by: Identifying aggravating and alleviating factors Identifying reportable signs and symptoms Describing the purpose, correct administration and side effects of meds Ability to discuss diagnosis surgical procedure, and post care Demonstrates osmotic care Increasing activity as tolerated Achieves optimum level of nutrition through prescribed diet Utilizing community resources Ineffective coping: Anxiety, fear, powerlessness, dependence Establish trust and rapport Therapeutic communication techniques Diversional activity Parenting skills Involve in decision making Counseling (vocational, spiritual, psychosocial, grief) Age specific coping strategies The client will have effective coping as evidenced by: Verbalization of different methods/techniques to cope effectively Seeking appropriate counseling when necessary Engaging in activities appropriate for age, interest, condition, and cognitive level Demonstrating a willingness and ability to resume self care/role responsibility    n:soph\fall\Unit III Respiratory Revised 04/10 Reviewed 07/11     RNSG 2535 Integrated Client Care Management Unit III - Care of the Client Experiencing Respiratory Problems ^ b . 5 [ s H08;<q=>IK =!>!$$%%;&<&Ͳ hSCJ hENCJ hCJ h/CJhgMhh CJ h CJhgMh5>*CJ hgMhCJ h CJ hd0CJ h6HuCJhX5>*CJ h@<CJ h%CJ h<CJ hVmCJ hXCJ8&:QR]SMM$If & F$Ifkd$$Ifl4\ *8< 0`94 la $$Ifa$ ? 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