Chapter 31 Nursing Care of Patients with Lower

Learning Outcomes · Explain the pathophysiology of each of the disorders of the lower

Learning Outcomes · List data to collect when caring for patients with disorders of

Bronchiectasis · Pathyphysiology ‒ Chronic Infection ‒ Dilation of One or More Large Bronchi

Bronchiectasis · Signs and Symptoms ‒ Dyspnea ‒ Cough ‒ Large Amounts of Sputum

Bronchiectasis · Diagnosis ‒ X-Ray ‒ CT Scan ‒ Sputum Culture ‒ Tests to

Bronchiectasis · Therapeutic Interventions ‒ Antibiotics ‒ Mucolytics, Expectorants ‒ Bronchodilators ‒ Chest Physiotherapy

Pneumonia · Pathophysiology ‒ Acute Lung Infection ‒ Inflammation and Alveolar Damage ‒ Alveoli

Pneumonia · Etiology ‒ Bacteria, Usually Streptococcus pneumoniae ‒ Virus ‒ Fungus ‒ Aspiration

Pneumonia · Persons at Risk ‒ Very Young ‒ Elderly ‒ Hospitalized ‒ Intubated

Pneumonia Prevention · · · Pneumococcal Vaccine Flu Vaccine Coughing and Deep Breathing Hand

Pneumonia · Signs and Symptoms ‒ Chest Pain ‒ Fever, Chills ‒ Cough, Dyspnea

Pneumonia · Signs and Symptoms in Elderly ‒ New Onset § Confusion § Lethargy

Pneumonia · Complications ‒ Pleurisy ‒ Pleural Effusion ‒ Atelectasis ‒ Spread of Infection

Pneumonia · Diagnosis ‒ Chest X-Ray ‒ Sputum Culture ‒ Blood Cultures Copyright ©

Pneumonia · Therapeutic Interventions ‒ Antibiotics – PO or IV ‒ Antiviral Medication (Zovirax)

Tuberculosis · Pathophysiology ‒ AFB Implant on Bronchioles or Alveoli ‒ Tubercle Formed ‒

Tuberculosis · Persons at Risk ‒ Elderly ‒ Alcoholics ‒ Those Living in Crowded

Tuberculosis · Signs and Symptoms ‒ Cough ‒ Blood-tinged Sputum ‒ Night Sweats ‒

Tuberculosis · Diagnostic Tests ‒ PPD Skin Test ‒ Chest X-Ray ‒ Sputum Cultures

Tuberculosis · Therapeutic Interventions ‒ Combination of Drugs for 6 to 24 Months §

Nursing Diagnoses: Lower Respiratory Disorders · · Impaired Gas Exchange Ineffective Airway Clearance Ineffective

Impaired Gas Exchange · Monitor ‒ Lung Sounds, Respiratory Rate And Effort ‒ Dsypnea

Ineffective Airway Clearance · Monitor ‒ Lung Sounds ‒ Sputum · Encourage ‒ Fluids

Ineffective Breathing Pattern · Monitor ‒ Respiratory Rate, Depth, Effort ‒ ABGs, Sp. O

Activity Intolerance · Monitor Response to · Allow Rest Between Activity Activities ‒ Vital

Additional Diagnoses for TB · Risk for Ineffective Self Health Management · Teach Patient

Prevention of TB Spread · · Clean, Well-ventilated Living Areas Isolation of Patients Who

Restrictive Disorders · Reduced Compliance- Caused by a decrease in compliance (elasticity) of lungs

1. Pleuritis · Pathophysiology ‒ Inflammation of Visceral and Parietal Pleurae ‒ Friction Between

1. Pleuritis · Diagnostic Tests ‒ Chest X-Ray ‒ CBC ‒ FVC, FEV 1

1. Pleuritis · Signs and Symptoms ‒ Sharp Pain on Inspiration ‒ Shallow Breathing

1. Pleuritis · Therapeutic Interventions ‒ Pain Management ‒ Treat Underlying Cause -(NSAIDS or

2. Pleural Effusion · Pathophysiology -Fluid collected in space between lungs and the sac

2. Pleural Effusion · Etiology -Can be caused by heart failure, liver disease, pneumonia,

2. Pleural Effusion · Diagnostic Tests ‒ Chest X-Ray ‒ Thoracentesis ‒ Tests to

2. Pleural Effusion · Signs and Symptoms ‒ Dyspnea ‒ Pain ‒ Cough ‒

2. Pleural Effusion · Therapeutic Interventions ‒ Treat Underlying Cause ‒ Analgesics ‒ Thoracentesis/Chest

3. Pulmonary Fibrosis · Pathophysiology · Etiology ‒ Injury to Alveoli ‒ Scarring, Fibrosis

3. Pulmonary Fibrosis · Signs and Symptoms ‒ Progressive Dyspnea ‒ Crackles ‒ Chronic

3. Pulmonary Fibrosis · Therapeutic Interventions ‒ Glucocorticoids ‒ Immune Suppressants ‒ Smoking Cessation

4. Atelectasis · Pathophysiology ‒ Collapse of Alveoli · Etiology ‒ Hypoventilation S/S include

Nursing Diagnoses: Restrictive Disorders · Impaired Gas Exchange · Ineffective Breathing Pattern · Acute

Obstructive Disorders · Airway Obstruction · Difficult Exhalation · Includes Chronic Bronchitis, Emphysema, Asthma,

COPD · Combination of ‒ Chronic Bronchitis ‒ Emphysema ‒ (Asthma) · Chronic Airflow

COPD Copyright © 2015. F. A. Davis Company

COPD · Pathophysiology ‒ Chronic Bronchitis § § § Chronic Inflammation Low-grade Infection Hypertrophied

COPD · Pathophysiology (cont’d) ‒ Emphysema § Destruction of Alveolar Walls § Loss of

COPD · Etiology ‒ Smoking ‒ Passive Smoke Exposure ‒ Pollutants ‒ Familial Predisposition

Effects of Smoking Copyright © 2015. F. A. Davis Company

Prevention Smoking!! Copyright © 2015. F. A. Davis Company

Types of Emphysema Copyright © 2015. F. A. Davis Company

Air Trapping Copyright © 2015. F. A. Davis Company

COPD · Signs and Symptoms ‒ Cough ‒ Sputum Production ‒ Dyspnea ‒ Prolonged

Chronic Bronchitis · Signs and Symptoms ‒ Wheezing, Crackles ‒ Chronic Cough ‒ Dyspnea

Emphysema · Signs and Symptoms ‒ Diminished Breath Sounds ‒ Dyspnea ‒ Progressive Activity

Complications of COPD · · Cor Pulmonale Weight Loss Pneumothorax Respiratory Failure Copyright ©

COPD · Diagnostic Tests ‒ Chest X-Ray ‒ CT Scan ‒ ABGs ‒ CBC

COPD · Therapeutic Interventions ‒ Stop Smoking!! ‒ Oxygen 1 to 2 L/m ‒

Pulmonary Rehabilitation Copyright © 2015. F. A. Davis Company

Nursing Diagnoses: COPD · Impaired Gas Exchange · Ineffective Airway Clearance · Ineffective Breathing

Asthma · Pathophysiology ‒ Inflammation of Bronchial Mucosa ‒ Spasm of Bronchial Smooth Muscles

Asthma · Etiology ‒ Heredity ‒ Airborne Allergies ‒ Pollution ‒ Smoking · Triggers

Asthma · Signs and Symptoms ‒ Dyspnea ‒ Wheezing ‒ Cough ‒ Sputum ‒

Asthma · Complication ‒ Status Asthmaticus § Bronchospasm is not controlled and symptoms are

Asthma · Diagnostic Tests ‒ History and Physical Examination ‒ Spirometry ‒ ABGs ‒

Asthma · Therapeutic Interventions · Self Monitor- Monitor With Peak Flow Meter- know normal

Peak Flow Chart Copyright © 2015. F. A. Davis Company

Asthma · Therapeutic Interventions (cont’d) ‒ Bronchodilators § Adrenergic (Albuterol) § Leukotriene Inhibitors (Accolate,

Cystic Fibrosis · Etiology: Hereditary exocrine gland disorder with thick secretions. · Pathophysiology: Abnormal

Cystic Fibrosis · Signs and Symptoms ‒ Thick, Tenacious Sputum ‒ Frequent Respiratory Infections

Cystic Fibrosis · Diagnostic Tests ‒ “Kiss Your Baby” Campaign ‒ Sweat Chloride Test

Cystic Fibrosis · Therapeutic Interventions ‒ Hydration ‒ Inhaled Mucolytic Medication ‒ Bronchodilators, Corticosteroids

Cystic Fibrosis · Therapeutic Interventions (cont’d) ‒ Prevent Infection ‒ Pancreatic Enzyme Replacement (Pancrease,

Pulmonary Embolism (PE) · Pathophysiology ‒ A pulmonary embolism is usually a blood clot

Pulmonary Embolism (PE) Copyright © 2015. F. A. Davis Company

Prevention of Pulmonary Embolism · Regular Ambulation · Prompt Treatment of DVT · In

Pulmonary Embolism · Signs and Symptoms ‒ Sudden Onset Dyspnea ‒ Tachycardia ‒ Tachypnea

Pulmonary Embolism · Diagnosis ‒ Spiral CT Scan ‒ Lung Scan ‒ Angiogram ‒

Pulmonary Embolism · Therapeutic Interventions ‒ Thrombolytics ‒ Heparin ‒ Warfarin (Coumadin) ‒ Oxygen

Pulmonary Embolism · Nursing Diagnoses ‒ Impaired Gas Exchange ‒ Risk for Injury Related

Pneumothorax · Pathophysiology · Air in the Intrapleural Space ‒ Complete or Partial Collapse

Types of Pneumothorax Copyright © 2015. F. A. Davis Company

Pneumothorax · Signs and Symptoms ‒ Shallow, Rapid Respirations ‒ Asymmetrical Chest Expansion ‒

Tension Pneumothorax · Signs and Symptoms ‒ Tracheal Deviation ‒ Bradycardia ‒ Cyanosis ‒

Pneumothorax · Diagnostic Tests ‒ History and Physical Examination ‒ Bedside Ultrasound ‒ Chest

Pneumothorax · Therapeutic Interventions ‒ Monitor ABGs and Respiratory Status ‒ Chest Tube to

Pneumothorax · Nursing Care ‒ Monitor Respiratory Status ‒ Monitor Chest Drainage System ‒

Rib Fractures · Etiology ‒ Trauma ‒ Cough ‒ CPR · Care ‒ Control

Flail Chest · Cause ‒ Multiple Rib Fractures ‒ Ribcage Not Able to Maintain

Nursing Diagnoses: Chest Trauma · Impaired Gas Exchange · Ineffective Breathing Pattern · Acute

Acute Respiratory Failure · Pathophysiology ‒ Hypoventilation ‒ Unable to Maintain ABGs Copyright ©

Acute Respiratory Failure · Etiology ‒ COPD ‒ Aspiration ‒ Neurological Disease Copyright ©

Acute Respiratory Failure · Signs and Symptoms ‒ Worsening ABGs ‒ Increasing Dyspnea ‒

Acute Respiratory Failure · Diagnostic Tests ‒ ABGs § Pa. O 2 <60 mm

Acute Respiratory Failure · Therapeutic Interventions ‒ Oxygen ‒ Bronchodilators ‒ Correct Underlying Cause

Acute Respiratory Distress Syndrome (ARDs) · Pathophysiology ‒ Alveolocapillary Membrane Damage ‒ Pulmonary Edema

ARDs · Etiology ‒ Acute Lung Injury § Sepsis § Shock § Aspiration ‒

ARDs · Signs and Symptoms ‒ Dyspnea ‒ Elevated RR ‒ Fine Crackles ‒

ARDs · Diagnostic Tests ‒ ABGs ‒ Chest X-Ray ‒ ECG ‒ Tests to

ARDs · Therapeutic Interventions ‒ Oxygen ‒ Intubation ‒ Mechanical Ventilation ‒ Treat Underlying

Nursing Diagnoses: Respiratory Failure · · · · Impaired Gas Exchange Ineffective Airway Clearance

Lung Cancer · · Small Cell Lung Cancer Large Cell Carcinoma Adenocarcinoma Squamous Cell

Lung Cancer · Etiology ‒ Smoking § Smoking Causes 80 -90% of Lung Cancers

Lung Cancer · Signs and Symptoms ‒ None Until Late ‒ Productive Cough ‒

Lung Cancer · Diagnostic Tests ‒ Chest X-Ray ‒ CT Scan ‒ Sputum Analysis

Lung Cancer · Complications ‒ Pleural Effusion ‒ Superior Vena Cava Syndrome ‒ Ectopic

Lung Cancer Copyright © 2015. F. A. Davis Company

Lung Cancer · Therapeutic Interventions ‒ Stage (TNM System) ‒ Chemotherapy (Usually Palliative) ‒

Lung Cancer · Therapeutic Interventions (cont’d) Copyright © 2015. F. A. Davis Company

Lung Cancer · Nursing Diagnoses ‒ Impaired Gas Exchange ‒ Ineffective Airway Clearance ‒

Thoracic Surgery · · · Pneumonectomy Lobectomy Resection VATS Transplant Copyright © 2015. F.

Thoracic Surgery · Preoperative Care ‒ Monitor Respiratory Status ‒ Teach § Routine Pre-op

Thoracic Surgery · Postoperative Care ‒ Intensive Care Setting ‒ Monitor § § Vital

Thoracic Surgery · Nursing Diagnoses ‒ Ineffective Airway Clearance ‒ Impaired Gas Exchange ‒

Review Question What are symptoms of bacterial pneumonia? Select all that apply. 1. 2.

Review Question What percent of people infected with mycobacterium tuberculosis develop TB disease? 1.

Review Question When reading a PPD test, the nurse should check for which finding?

Review Question What are nursing interventions for impaired gas exchange? Select all that apply.

Review Question Which of the following is a restrictive disorder? 1. 2. 3. 4.

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Learning Outcomes · Explain the pathophysiology of each of the disorders of the lower respiratory tract. · Describe the etiologies, signs, and symptoms of each of the disorders. · Identify tests that are used to diagnose lower respiratory disorders. · Describe therapeutic measures used for disorders of the lower respiratory tract. Copyright © 2015. F. A. Davis Company

Learning Outcomes · List data to collect when caring for patients with disorders of the lower respiratory tract. · Plan nursing care for patients with disorders of the lower respiratory tract. · Identify interventions for patients experiencing impaired gas exchange, ineffective airway clearance, or ineffective breathing pattern. · Explain how you will know if your nursing interventions have been effective. Copyright © 2015. F. A. Davis Company

Tuberculosis · Pathophysiology ‒ AFB Implant on Bronchioles or Alveoli ‒ Tubercle Formed ‒ Immune System Keeps in Check ‒ 5% to 10% Infected Become Ill ‒ May Activate with Impaired Immunity ‒ Can live in dark places in dried sputum for months but a few hours in direct sunlight kills it Copyright © 2015. F. A. Davis Company

Tuberculosis · Therapeutic Interventions ‒ Combination of Drugs for 6 to 24 Months § INH § Rifampin § Streptomycin § Ethambutol ‒ Occasional Surgical Removal ‒ Isolation Copyright © 2015. F. A. Davis Company

Impaired Gas Exchange · Monitor ‒ Lung Sounds, Respiratory Rate And Effort ‒ Dsypnea ‒ Mental Status ‒ Sp. O 2, ABGs · Position ‒ Fowler’s ‒ Good Lung Down · Administer Oxygen · Teach Breathing Exercises · Discourage Smoking Copyright © 2015. F. A. Davis Company

Ineffective Airway Clearance · Monitor ‒ Lung Sounds ‒ Sputum · Encourage ‒ Fluids ‒ Deep Breathing ‒ Coughing · Administer Expectorants · Turn Every 2 Hours Daily or Ambulate · Suction PRN · Consider CPT or Mucus Clearance Device Copyright © 2015. F. A. Davis Company

Activity Intolerance · Monitor Response to · Allow Rest Between Activity Activities ‒ Vital Signs · Obtain Bedside ‒ Sp. O 2 Commode · Use Portable O 2 for · Increase Activity Ambulation Slowly · Refer to Pulmonary Rehabilitation Copyright © 2015. F. A. Davis Company

Additional Diagnoses for TB · Risk for Ineffective Self Health Management · Teach Patient and Family ‒ Consider Visiting Nurse/DOT · Risk For Infection Transmission ‒ Teach Patient and Family ‒ Maintain Isolation Precautions Copyright © 2015. F. A. Davis Company

Prevention of TB Spread · · Clean, Well-ventilated Living Areas Isolation of Patients Who Have Active TB High-efficiency Filtration Masks Gowns, Gloves, Goggles if Contact with Sputum Likely Copyright © 2015. F. A. Davis Company

Restrictive Disorders · Reduced Compliance- Caused by a decrease in compliance (elasticity) of lungs or chest wall · Limited Chest Wall Expansion-Conditions that limit the pt’s ability to expand his or her lungs making inhalation difficult 1. Pleuritis 2. Pleural Effusion 3. Pulmonary Fibrosis 4. Atelectasis Copyright © 2015. F. A. Davis Company

1. Pleuritis · Pathophysiology ‒ Inflammation of Visceral and Parietal Pleurae ‒ Friction Between Pleurae on Inspiration · Etiology ‒ Secondary to Pneumonia, TB, CA, PE Copyright © 2015. F. A. Davis Company

1. Pleuritis · Signs and Symptoms ‒ Sharp Pain on Inspiration ‒ Shallow Breathing ‒ Fever, Elevated WBC ‒ Friction Rub Complications: as pleural membranes become more inflamed, serous fluid production increases which could lead to pleural effusion Copyright © 2015. F. A. Davis Company

2. Pleural Effusion · Pathophysiology -Fluid collected in space between lungs and the sac surrounding the lungs (visceral and parietal spaces) Pleural fluid is not reabsorbed and may collapse lung. Copyright © 2015. F. A. Davis Company

3. Pulmonary Fibrosis · Pathophysiology · Etiology ‒ Injury to Alveoli ‒ Scarring, Fibrosis Diagnosed chest x-ray, CT scan, bronchoscopy, lung biopsy, ANA Titre ‒ Heredity ‒ Virus ‒ Environmental/ Occupational Exposure ‒ Immune Dysfunction ‒ Idiopathic Copyright © 2015. F. A. Davis Company

3. Pulmonary Fibrosis · Therapeutic Interventions ‒ Glucocorticoids ‒ Immune Suppressants ‒ Smoking Cessation ‒ Oxygen ‒ Flu/Pneumonia Vaccines ‒ Pulmonary Rehabilitation ‒ Lung Transplant Copyright © 2015. F. A. Davis Company

4. Atelectasis · Pathophysiology ‒ Collapse of Alveoli · Etiology ‒ Hypoventilation S/S include fine crackles, diminished breath sounds, dyspnea Interventions include CDB, incentive spirometer, ambulate, turn Copyright © 2015. F. A. Davis Company

COPD · Pathophysiology ‒ Chronic Bronchitis § § § Chronic Inflammation Low-grade Infection Hypertrophied Mucous Glands in Bronchi Impaired Ciliary Function Ineffective Airway Clearance ‒ Diagnosed After Ill 3 Months of Year for 2 Consecutive Years Copyright © 2015. F. A. Davis Company

COPD · Pathophysiology (cont’d) ‒ Emphysema § Destruction of Alveolar Walls § Loss of Elastic Recoil § Damage to Pulmonary Capillaries § Air Trapping § Impaired Gas Exchange Copyright © 2015. F. A. Davis Company

Chronic Bronchitis · Signs and Symptoms ‒ Wheezing, Crackles ‒ Chronic Cough ‒ Dyspnea ‒ Thick, Tenacious Sputum ‒ Increased Susceptibility to Infection ‒ Mucous Plugs Copyright © 2015. F. A. Davis Company

COPD · Therapeutic Interventions ‒ Stop Smoking!! ‒ Oxygen 1 to 2 L/m ‒ Supportive Care ‒ Pulmonary Rehab ‒ Surgery ‒ Endobronchial Valve ‒ Mechanical Ventilation ‒ End-of-Life Planning ‒ Medications § Bronchodilators § Corticosteroids § Expectorants ‒ NMT/MDI Copyright © 2015. F. A. Davis Company

Nursing Diagnoses: COPD · Impaired Gas Exchange · Ineffective Airway Clearance · Ineffective Breathing Pattern · Activity Intolerance · Imbalanced Nutrition · Anxiety Patient Education: Assist patient to stop smoking, pulmonary rehab, breathing exercise, energy conservation Copyright © 2015. F. A. Davis Company

Asthma · Therapeutic Interventions · Self Monitor- Monitor With Peak Flow Meter- know normal expiratory flow rate and when normal rate begins to fall from norm, pt is treated · Avoid Triggers · Avoid Smoking Copyright © 2015. F. A. Davis Company

Asthma · Therapeutic Interventions (cont’d) ‒ Bronchodilators § Adrenergic (Albuterol) § Leukotriene Inhibitors (Accolate, Singulair) § Theophylline (Rare) ‒ Corticosteroids § Inhaled, IV, PO ‒ Antihistamines ‒ Oxygen PRN Copyright © 2015. F. A. Davis Company

Cystic Fibrosis · Etiology: Hereditary exocrine gland disorder with thick secretions. · Pathophysiology: Abnormal sodium and chloride transport across cell membranes causing thick, tenacious secretions Copyright © 2015. F. A. Davis Company

Cystic Fibrosis · Signs and Symptoms ‒ Thick, Tenacious Sputum ‒ Frequent Respiratory Infections ‒ Finger Clubbing ‒ Malabsorption ‒ Fatty, Foul-smelling Stools ‒ Death from Antibiotic-resistant Infection Copyright © 2015. F. A. Davis Company

Cystic Fibrosis · Therapeutic Interventions ‒ Hydration ‒ Inhaled Mucolytic Medication ‒ Bronchodilators, Corticosteroids ‒ Expectorants ‒ Chest Physiotherapy ‒ Antibiotics Copyright © 2015. F. A. Davis Company

Cystic Fibrosis · Therapeutic Interventions (cont’d) ‒ Prevent Infection ‒ Pancreatic Enzyme Replacement (Pancrease, Viokase) ‒ Ibuprofen May Slow Lung Deterioration ‒ Lung Transplant Copyright © 2015. F. A. Davis Company

Pulmonary Embolism (PE) · Pathophysiology ‒ A pulmonary embolism is usually a blood clot that has traveled into pulmonary artery causing a ventilation perfusion mismatch · Etiology: ‒ DVT -Most Common ‒ Fat Emboli From Compound Fracture ‒ Amniotic Fluid Emboli During L&D Copyright © 2015. F. A. Davis Company

Pulmonary Embolism · Therapeutic Interventions ‒ Thrombolytics ‒ Heparin ‒ Warfarin (Coumadin) ‒ Oxygen ‒ Embolectomy (Rare) ‒ Jugular or Femoral Filter for Recurrent PE Copyright © 2015. F. A. Davis Company

Pneumothorax · Therapeutic Interventions ‒ Monitor ABGs and Respiratory Status ‒ Chest Tube to Water Seal Drainage ‒ Pleurodesis (Sclerosis) for Recurrent Collapse Copyright © 2015. F. A. Davis Company

Acute Respiratory Failure · Therapeutic Interventions ‒ Oxygen ‒ Bronchodilators ‒ Correct Underlying Cause ‒ Intubation and Ventilation § Check Advance Directives Copyright © 2015. F. A. Davis Company

Acute Respiratory Distress Syndrome (ARDs) · Pathophysiology ‒ Alveolocapillary Membrane Damage ‒ Pulmonary Edema ‒ Alveolar Collapse ‒ Lungs Stiff and Noncompliant ‒ Lungs May Hemorrhage Copyright © 2015. F. A. Davis Company

Nursing Diagnoses: Respiratory Failure · · · · Impaired Gas Exchange Ineffective Airway Clearance Ineffective Breathing Pattern Activity Intolerance Anxiety Disturbed Thought Processes Self-care Deficit Copyright © 2015. F. A. Davis Company

Lung Cancer · Signs and Symptoms ‒ None Until Late ‒ Productive Cough ‒ Recurrent Infection ‒ Dyspnea ‒ Hemoptysis ‒ Anorexia and Weight Loss ‒ Pain ‒ Wheezing/Stridor Copyright © 2015. F. A. Davis Company

Lung Cancer · Complications ‒ Pleural Effusion ‒ Superior Vena Cava Syndrome ‒ Ectopic Hormone Secretion § ADH (SIADH) § ACTH (Cushing’s Syndrome) § PTH (Hypercalcemia) ‒ Actelectasis ‒ Metastasis Copyright © 2015. F. A. Davis Company

Lung Cancer · Nursing Diagnoses ‒ Impaired Gas Exchange ‒ Ineffective Airway Clearance ‒ Imbalanced Nutrition ‒ Pain ‒ Constipation ‒ Anticipatory Grieving ‒ Activity Intolerance Copyright © 2015. F. A. Davis Company

Thoracic Surgery · Postoperative Care ‒ Intensive Care Setting ‒ Monitor § § Vital Signs Sp. O 2, ABGs Hemodynamic Parameters Lung Sounds ‒ Ventilator ‒ Chest Tubes Copyright © 2015. F. A. Davis Company

Review Question What are nursing interventions for impaired gas exchange? Select all that apply. 1. 2. 3. 4. 5. Administer oxygen. Place patient in Fowler’s position. Administer PRN morphine. Provide a room humidifier. Encourage use of vibratory PEP device. Copyright © 2015. F. A. Davis Company