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NCM 112 Notes
NCM 112 Notes
Anthony Estolas prevents food and drink from entering the windpipe.
8 hrs/ week Angle of the right bronchi is more vertical- so
possible ingested
Remove segment-segmental resection
Orientation Remove lungs- pneumonectomy
Criteria for Assessment TOTAL – 100% Life support- ecmo
Attendance- 5% Wedge resection- segment
Group Activity / Presentation- 10% Lobectomy- lobe removal
o Presentations should be Face to Face
Pneumonectomy- total removal of lungs
Class Performance and Attitude- 10% Tracheal deviation happens when your trachea is
o Assignments/ research etc pushed to one side of your neck by abnormal pressure
Minor Examination (Quizzes)- 25% in your chest cavity or neck. (especially when there is
Major Examination (Midterms and Finals) – 50% a problem in one side of the lungs)
o Midterm – 9th week When using AMBU bag- connect it oxygen supply
o Artificial Mechanical Breathing Unit-
What is the lung with 3 lobes? AMBU
Right lung- because left lung should save space for
the heart Boyle’s Law
- in a closed space, pressure and volume are inversely
D5w- hypertonic related
- When it is metabolized, it becomes hypotonic - pressure up= volume down
- Anything containing dextrose- hyper - pressure down= volume up
- Only saline- isotonic
Inspiration and Expiration
Fluids and Electrolytes - pressure- kilopascal, cm of H2O
- Most abundant positively charged ion- potassium - transfer of gases- same gases
- Most abundant negatively charged ion- phosphorus o higher to lower concentration
- Outside- sodium and chloride o higher to lower pressure
o oxygen to oxygen
Reading List:
Brunner and Suddarth’s Textbook of Medical 3 ELEMENTS OF RESPIRATORY PROCESS
Surgical Nursing, Janice L. Hinke, Kerry H. Cheever 1. External Respiration or Ventilation
14th edition a. body, oxygen is taken into the lungs by
inhalation and carbon dioxide is expelled
Lesson 1 from the lungs by exhalation
Oxygenation Problems b. encompasses the mechanical processes
related to breathing: contraction and
relaxation of the diaphragm and accessory
1.1 Anatomic and Physiologic Review, Assessment, muscles, as well as breathing rate- hypernea/
Diagnostic Evaluation tachypnea/ tachycardia.
1.2 Management of Upper and Lower RTD 2. Internal Respiration
1.3 Management of COPD 3. Cellular respiration, either aerobic or anaerobic
1.4 Respiratory Care Modalities a. Glycolysis
Anatomy and Physiology b. tricarboxylic acid cycle/ Krebs Cycle
c. oxidative phosphorylation
- Usual complains after; sorethroat PaO2- partial pressure of arterial oxygen – 75-100 mmHg
PaCO2- 35-45 mmHg
Lung Scan- most often used to diagnose and locate emboli H3CO2- 26-28
Continuation
(clots or other small tissue masses) within the blood vessels
1. Ventilation Scan When the kidney is associated the there will be metabolic
2. Perfusion Scan acidosis/ ketoacidosis.
3. VQ scan- definitive study for pulmonary embolism
RISK
1. Slight discomfort Pulse Oximetry- determine oxygen saturation in the blood
2. Allergic reaction - Below 93% should be supplemented with oxygen
3. Injury to fetus - Infrared sensors- detect how much oxygen is in your
4. Contaminate breast milk with radionuclei blood based by the way infrared and red light passes
thru finger
Sputum Examination- assess gross appearance of the sputum - Monitoring- to determine if oxygen
that may characterize specific disease conditions supplementation is effective
1. Rusty - Flat sign= not picking up= check for troubleshoot and
2. Greenish- protozoal temp of skin
3. Blood-tinged- TB - Hynotopic- norepinephrine- vasoconstrictor- impede
a. Afb training- detect PTB (3x/day) peripheries to increase blood pressure
b. Sputum C&S – done to detect that actual
microorganism causing lung infections Thoracentesis- removal of fluid in the thorax= intrapleural
space
Proper collection - Centesis- removal of fluid (mid-axillary line)
1. Collect early morning - Invasive procedure
2. Rinse mouth with plain water - Short acting
3. Use sterile container - Test tube thoracentesis
4. C&s before antibiotics - Sitting/ semi-fowlers position
5. AFB staining, collect sputum for specimen for three - Aspiration of fluid or air in the pleural space
consecutive mornings
NURSING INTERVENTIONS
Sputum Trap- connected to the suction catheter to collect the a. Secure informed, written consent
sputum using oropharyngeal or endotracheal suctioning b. Take Vs
c. Position Px in upright position (preferable because
Lung Biopsy- procedure in which sample of lung tissue is fluid remain at the bottom)
removed to determine if lung disease or cancer is present d. Instruct client to remain
- Needle biopsy- guided through the chest wall e. Prepare topical anesthetic (before IM lidocaine)- can
- Also known as closed transthoracic or percutaneous be spray or gel
(through the skin) biopsy
AFTER
a. Can be for CS, Analysis, AFB
Oxygen Therapy Tracheobronchial Suctioning- remove secretions in the
AFTER tracheobronchial structure
a. Turn the client on the unaffected side - Sterile technique
b. Bed rest Adult- 12- white, 14- green, 16- orange
c. Check expectoration of blood Pedia- 10
d. Monitor VS
Internal Hemorrhage – Hypotension-hypovolemia tachycardia How?
tachypnea 1. Assessment- auscultate for secretions and O2
saturation
2. Hyperventilate the patient with O2 before and after-
to prevent hypoxia
Oxygen therapy- deliver of oxygen to aid in respiration 3. Order- suction every 2 hrs PRN
process 4. Insert with gloved hand- one hand
- Should have the oxygen source 5. When withdrawing catheter, apply suction in rotating
motion while applying intermittent suction- because
How? it may suction mucosa (circular and open-close)
1. Assess signs and symptoms of hypoxemia/ CLOSE- suction
respiratory distress OPEN- close
a. Hypoxemia- low o2 saturation in the blood 6. Suctioning must only be 5-10 seconds (maximum of
b. Hypoxia- low 02 saturation 15 seconds)
2. Check doctor’s orders- you can remind the doctor 7. Evaluate breath sounds after giving supplemental
3. Position patient in Semi-fowlers oxygen .Assess ( auscultation) to measure the
4. Open source of oxygen before putting the oxygen effectiveness
device
5. Regulate oxygen flow accurately- can you increase Thick secretion- tracheobronchial wash as 3-5 ml with saline
the 02 liters (3 liters titrate= up to 6 liters)
6. Place a NO smoking sign at the bedside (pwede TIP
sumabog ang oxygen tank) Hold your breath while inserting the tube then if your
7. Check electrical appliances, avoid use of oil, grease, suctioning (if you feel difficult), withdraw suction
alcohol and other near the patient
8. Humidify oxygen- connect to humidifier (water)
because o2 is a dry gas can irritate mucosa
9. Provide good oronasal hygiene Incentive spirometry- use of incentive spirometer, a medical
10. Assess effectiveness of oxygen therapy device that aid the lung tissues in recovering after trauma in
11. Make relevant documentation the lungs (one that decrease the function of the lungs)
- RT/ radial therapist
- The more the better to help the lungs reoperate
- Deep breathing- inhale and exhale ( in exhale to
prevent Co2 retention)
Nursing Responsibilities
1. Immerse tip of the tube in 2-3cm sterile NSS
2. Keep the bottle at least 2-3 feet below chest level
3. Never raise the bottle above chest level
4. Observe for intermittent bubbling of fluid- hindi
effective or there is leak
5. Accidental break- clamp the catheter proximal to
patient to avoid pneumothorax
6. Bedside instrument- clamp
7. Documentation – indicate what you drain and how ANTERIOR VS POSTERIOR
many
8. Assessment