TOPICAL OUTLINE –Review Chapter 21 and notes from NURS 125 Oxygenation Unit!LINCOLN MEMORIAL UNIVERSITYCaylor School of Nursing Nursing 241Spring 2008LESSON PLAN: Nursing Strategies: Alterations in Respiratory FunctionDATES: See syllabusTIMES: See syllabusOBJECTIVES: Upon completion of this unit, the student will be able to demonstrate in the clinical and campus laboratory settings, in individual and group conferences, and on written materials, the ability to:1. Define and use the key terms as listed in the assigned readings2. Using the four adaptive modes of Roy’s Adaptation Model (RAM), recognize human adaptiveresponses to behavior or stimuli that affect respiratory function.3. Identify differences, which affect the respiratory system in young, middle, and older adults.4. Identify signs and symptoms of acute respiratory distress from impaired gas exchange.5. Incorporate assessment of respiratory risk factors into the nursing history and physicalassessment.6. Identify components of a physical examination for a client with compromised respiratoryfunction.7. Identify the clinical significance and related nursing implications of laboratory and diagnostictests and procedures used for assessment and evaluation of respiratory function.8. Specify nursing care of patients undergoing diagnostic procedures of the respiratory system.9. Explain the indications, principles, procedures and nursing management of adults withcompromised respiratory status requiring mechanical ventilation and thoracic surgery.10. Describe stimuli and behaviors, pathophysiology, diagnosis, medical management, complications, and nursing care for clients experiencing respiratory disorders (including: respiratory infections, chronic obstructive disorders, environmental lung diseases, respiratory emergencies, pulmonary vascular disorders, pleural disorders, and neoplastic disorders).11. Identify properly the medications on the drug list by generic name, classification, mechanism of action, clinically significant side effects, normal dosage, and nursing implications. Be able tocorrectly calculate IV, IM and PO dosages.12. Compare and contrast nursing assessment findings, care and evaluation of patients with bacterial, viral, and fungal respiratory illnesses.13. Develop a teaching/learning plan for adults experiencing compromised respiratory function.14. Utilize the RAM nursing process to develop a plan of care for clients experiencing compromised respiratory function.Revised 8/18/07- tp1TOPICAL OUTLINE – Review Chapter 21 and notes from NURS 125 Oxygenation Unit!I. Nursing Care of Adults with common respiratory disorders.A. Respiratory Infections 1. Upper Respiratory Infections – (see handout attached to syllabus)a. Common Coldb. Sinusitisc. Pharyngitis2. Influenza3. Bronchitis4. Pneumonias - Stimuli, Behaviors, Diagnostics, Planning, Nursing Interventions and Evaluation of adults experiencing:a. Community Acquired Pneumoniasi. Streptococcalii. H. influenzaiii. Legionnaires’ iv. Mycoplasma b. Hospital Acquired Pneumonias i. Pseudomonasii. Staphylococcaliii. Klebsiellac. Ventilator Acquired Pneumoniai. Head of bed elevated 30 - 45ii. “Sedation Vacation” – daily assessment without sedationiii. Peptic Ulcer Disease prophylaxisiv. Deep Vein Thrombosis prophylaxisd. Pneumonia in Immunocompromised Hosti. Pneumocystis Pneumonia (PCP)ii. Fungal5. TuberculosisB. Chronic Obstructive Pulmonary Diseases - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:1. Emphysema/Chronic Bronchitis 2. Sleep Apnea/Obstructive Sleep ApneaC. Environmental Lung Diseases - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:1. Pneumoconiosis2. Toxic Lung InjuriesII. Nursing Care of Adults Requiring Thoracic Surgery - - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:A. PneumonectomyB. LobectomyC. Segmentectomy (Resection)D. Wedge ResectionE. Pre-operative CareF. Post-operative CareG. Nursing Diagnoses1. Alteration in comfort: PainRevised 8/18/07- tp22. Impaired Physical Mobility3. Risk for fluid volume imbalance (excess or deficit)4. Knowledge deficit of home care (teaching/learning)III. Pulmonary Vascular Disorders - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:A. Pulmonary EmbolismIV. Neoplastic Disorders - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:A. Cancer of the LarynxB. Lung Cancer V. Respiratory Emergencies - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:A. Adult/Acute Respiratory Distress Syndrome (ARDS)B. EpistaxisC. Chest Trauma1. Blunt Chest Traumaa. Rib Fractureb. Flail Chestc. Pulmonary Contusion2. Penetrating Chest Trauma3. Pneumothoraxa. Spontaneous/Closed Pneumothoraxb. Traumatic/Open Pneumothoraxc. Tension Pneumothorax4. HemothoraxVI. Nursing Care of Adults requiring mechanical ventilation - Stimuli, Behaviors, Diagnostics, Goals, Planning, Nursing Interventions and Evaluation of adults experiencing:A. Indications for Mechanical VentilationB. Types of Ventilators (See ventilator handout attached to syllabus)1. Negative Pressure – i.e. body wrap for MS of CF2. Positive Pressure – most common – used in hospital settingsC. Controlling Modes & Vent Settings1. Control and Assist/Control2. Synchronized Intermittent Mechanical Ventilation (SIMV)3. Positive End Expiratory Pressure (PEEP)4. Positive Airway Pressure (PAP) & Continuous PAP (CPAP)5. Pressure Support6. Tidal VolumeD. Nursing Diagnoses for adults requiring mechanical ventilation1. Impaired gas exchange2. Ineffective airway clearance3. Risk for trauma and/or infection4. Inability to sustain spontaneous respiration5. Impaired verbal communicationRevised 8/18/07- tp36. Defensive coping and powerlessnessE. Complications of Mechanical Ventilation1. Ventilator malfunction2. Fighting (“bucking”) the ventilator3. Atelectasis4. Tissue trauma5. Respiratory infections6. Impaired communicationF. Weaning Adults from Mechanical VentilationREQUIRED READINGS:Smeltzer, S.C., and Bare, B.G. (2008). Brunner & Suddarth’s textbook of medical surgical nursing. (11th ed.). Philadelphia: Lippincott. Chapters 21,