Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Lower Airway)
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Transcript of Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Lower Airway)
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Nursing of AdultsWith
Medical & Surgical Conditions
Respiratory Disorders
(Lower Airway)
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Acute Bronchitis
• Etiology/Pathophysiology– Inflammation of the trachea and bronchial tree– Retention of secretions causes high risk of
bacterial growth– Usually secondary to upper respiratory
infection– Exposure to inhale irritants
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Acute Bronchitis
• Signs & Symptoms– Productive cough– Rhonchi/wheezes– Dyspnea– Chest pain– Lowgrade temperature– Malaise– Headache
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Acute Bronchitis• Treatment
– Cough suppressants• Codeine
– Antitussives• Pertussin
– Antipyretics• Tylenol
– Bronchodilators
– Brethine
– Antibiotics
– Vaporizer
– Encourage fluids
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Legionnaires’ Disease
• Etiology/Pathophysiology– Legionella pneumophila– First identified in 1976 at the American Legion
convention in Philadelphia– Thrives in water reservoirs
• Air conditioners and humidifiers
– Causes life-threatening pneumonia– Leads to respiratory failure, renal failure,
bacteremic shock, and ultimately death
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Legionnaires’ Disease
• Signs & Symptoms– Elevated temperature
• 102 – 105 degrees
– Headache
– Nonproductive cough
– Difficult and rapid respirations
– Crackles or wheezes
– Tachycardia
– Signs of shock
– Hematuria
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Legionnaires’ Disease
• Treatment– Oxygen– Mechanical ventilation, if necessary– IV therapy– Antibiotics
• Erythromycin
• Rifampin
– Antipyretics– Vasopressors
• For shock
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Tuberculosis
• Etiology/Pathophysiology– Tubercle bacillus (Mycobacterium tuberculosis)– Chronic pulmonary and extrapulmonary infectious disease– Inhalation of droplet containing tubercle bacillus– Infection
• Presence of mycobacteria in the tissue of a person who has no s/s of TB
• Positive TB skin test• 10% will become active disease
– Active Disease• S/S of TB are present
– NOT easily transmitted• Most inhaled TB organisms are destroyed by the upper resp.
system
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Tuberculosis
• Signs & Symptoms– Fever– Weight loss– Weakness– Productive cough– Chills– Night sweats– Hemoptysis
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Tuberculosis• Diagnostic Tests
– Presumptive Diagnosis• Mantoux Tuberculin Skin Test
– Read 48 – 72 hours after given
– Enduration (raised hardened tissue)
– <5mm negative
– >5mm positive
• Chest X-ray• Acid-fast bacilli smear x 3
– Confirmed Diagnosis• Sputum culture
– Positive for TB bacilli
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Tuberculosis
• Treatment– Tuberculosis Isolation (AFB)
• Isolation room• Negative air pressure• Particulate respiration masks
– Medications• 6-9 months• First Line:
– isoniazid (INH), rifampin, rifampin and isoniazid (Rifamate), pyrazinamide, ethambutol, streptomycin
• Second Line: – Ethionamide, para-aminosalicylate sodium (PAS), cycloserine,
capreomycin, kanamycin, amikacin
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Pneumonia
• Etiology/Pathophysiology– Inflammatory process of the bronchioles and the
alveolar spaces due to infection– Bacteria, viruses, mycoplasma, fungi, and parasites– Aspiration– Retained secretions become infected– Inflammation of respiratory tract occurs– Decreased oxygen/carbon dioxide exchange
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Pneumonia
• Signs & Symptoms– Productive cough
• Sputum depends on cause
– Severe chills– Elevated temperature– Increased heart rate– Increased respiratory rate– Dyspnea
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Pneumonia• Treatment
– Oxygen– Chest percussion and postural drainage– Encourage to cough and deep breathe– Antibiotics
• Penicillin, erythromycin, cephalosporin, and tetramycin
– Analgesics• Tylenol or aspirin
– Expectorants– Bronchodilators– Humidifier or nebulizer
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Pleurisy
• Etiology/Pathophysiology– Inflammation of the visceral and parietal pleura– Bacterial or viral
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Pleurisy
• Signs & Symptoms– Sharp inspiratory pain
• Usually radiates to the shoulder or abdomen
– Dyspnea– Cough – Elevated temperature– Pleural friction rub
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Pleurisy
• Treatment– Antibiotics– Analgesics
• Demerol or morphine
– Antipyritics• Tylenol
– Oxygen– Anesthetic block for intercostal nerves
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Pleural Effusion/Empyema• Etiology/Pathophysiology
– Pleural Effusion– Accumulation of fluid in
the pleural space– Usually secondary– Empyema
• Fluid accumulation with pleural effusion becomes infected
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Pleural Effusion/Empyema
• Signs & Symptoms– Dyspnea– Air hunger– Respiratory distress
• Nasal flaring
• Tachypnea
• Dyspnea
• Decreased breath sounds
– Fever
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Pleural Effusion/Empyema• Treatment
– Thoracentesis– Chest tube with closed
water seal drainage system
• Glass bottle system• Pleur-evac• (Pg. 385 Box 9-6
Maintaining chest tubes and closed chest drainage bottles)
– Antibiotics– Cough and deep breath
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Atelectasis
• Etiology/Pathophysiology– Abnormal condition characterized by the collapse of
lung tissue– Due to occlusion of air to a portion of the lung– Postoperative complication– Secretions– Foreign body– Mucous plug– Emphysema, pneumothorax, tumor
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Atelectasis
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Atelectasis
• Signs & Symptoms– Dyspnea– Tachypnea– Pleural friction rub– Restlessness – Hypertension > hypotension– Elevated temperature– Decreased breath sounds– Crackles
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Atelectasis• Treatment
– Cough and deep breath– Analgesia– Early ambulation– Incentive spirometery– Intermittent positive pressure breathing– Oxygen– Chest percussion and postural drainage– Bronchodilators
• Proventil
– Antibiotics– Mucolytic agents
• Mucomyst - Decrease viscosity of secretions
– Chest tube
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Pneumothorax
• Etiology/Pathophysiology– A collection of air or gas in the pleural space,
causing the lung to collapse– Penetrating chest injury– Coughing– Ruptured bleb– Spontaneous
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Pneuomothorax
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Pneumothorax
• Signs & Symptoms– Decreased breath sounds– Sudden, sharp chest pain with dyspnea– Diaphoretic– Increased heart rate– Tachypnea– No chest movement on affected side– Sucking chest wound– Mediastinal shift
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Pneumothorax
• Treatment– Chest tube to water seal drainage system– Oxygen– Analgesics– Encourage fluids
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Chest Tube Placement
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Chest Tube Drainage System
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Lung Cancer
• Etiology/Pathophysiology– Primary tumor or metastasis– Small cell lung cancer– Non-small cell lung cancer– Squamous cell carcinoma– Large-cell carcinoma– 80% linked to smoking
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Lung Cancer
• Signs & Symptoms– Hemoptysis– Dyspnea– Fever– Chills– Wheezing – Pleural effusion
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Lung Cancer
• Treatment– Surgery– Most are not diagnosed early enough for curative
surgical intervention– Segmental resection– Lobectomy– Pneumonectomy– Radiation– Chemotherapy
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Pulmonary Edema
• Etiology/Pathophysiology– Accumulation of serous fluid in interstitial
tissue and alveoli • Left ventricular failure
• Inhalation of irritating gases
• Rapid administration of IV fluids
• Barbiturate or opiate overdose
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Pulmonary Edema• Signs & Symptoms
– Dyspnea– Tachypnea– Tachycardia – Cyanosis – Pink or blood tinged, frothy sputum– Restlessness– Agitation– Wheezing – Crackles– Sudden weight gain– Decreased urinary output
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Pulmonary Edema• Treatment
– Oxygen– Mechanical ventilation, if necessary– Diuretics
• Lasix
– Narcotic analgesics• Morphine will help decrease resp rate
– Nipride• Vasodilator that improves myocardial contraction and
reduces pulmonary congestion
– Strict I&O; Daily weight– Low sodium diet
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Pulmonary Embolus
• Etiology/Pathophysiology– Foreign substance in the pulmonary artery
• Blood clot, fat, air, or anmiotic fluid
– High risk• Prior thrombophlebitis
• Recent surgery, pregnancy, or given birth
• Taking contraceptives long-term
• Hx of CHF, obesity, or immobilization from fracture
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Pulmonary Embolus
• Signs & Symptoms– Sudden, unexplained dyspnea– Rapid respiratory rate– Hemoptysis– Chest pain– Elevated temperature– Increased WBC
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Pulmonary Embolus
• Treatment– Oxygen– HOB up 30 degrees– Anticoagulants
• Heparin (IV)– Gradually tapered
• Coumadin (oral)– Initiated as Heparin is tapered – Continued at home for up to 1 year
– Fibrinolytic agents
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Adult Respiratory Distress Syndrome(ARDS)
• Etiology/Pathophysiology– Complication of other disease processes
– Direct or indirect pulmonary injury
– Viral or bacterial pneumonia, chest trauma, aspiration, shock, drug over doses, renal failure, pancreatitis, COPD, Guillain-Barre’ syndrome, and myasthenia gravis
• .increased permeability of capillary membrane
• .allows fluid to leak into interstitial spaces and alveoli
• .pulmonary edema and hypoxia
• .alveoli lose their elasticity and collapse
• .capillaries allow plasma and RBC’s to leak out, resulting in hemorrhage
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Adult Respiratory Distress Syndrome(ARDS)
• Signs & Symptoms– Respiratory distress
• Dyspnea
• Restlessness
– Tachycardia– Hypotension– Decreased urinary output
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Adult Respiratory Distress Syndrome(ARDS)
• Treatment– Treat cause– Oxygen– Corticosteroids– Diuretics– Morphine– Lanoxin– Antibiotics
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Chronic Obstructive Pulmonary Disease
• Chronic airflow limitation
• Includes
• Emphysema
• Chronic Bronchitis
• Asthma
• Bronchiectasis
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Emphysema
• Etiology/Pathophysiology– The bronchi, bronchioles and alveoli become
inflamed as a result of chronic irritation– Air becomes trapped in the alveoli during
expiration, causing alveolar distention, rupture, and scar tissue
– Cigarette smoking is primary irritant– Complication:
• Cor pulmonale– Right-sided congestive heart failure due to pulmonary
hypertension
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Emphysema
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Emphysema
• Signs & Symptoms– Dyspnea on exertion– Sputum
• Initially there is very little
• Eventually becomes copius
– Barrel chest• Increased anteroposterior diameter caused by
overinflation
– Chronic weight loss– Emaciation– Clubbing of fingers
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Barrel-Chest
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Emphysema• Treatment
– Oxygen (low-flow)• 1-2 liters per NC
– Chest physiotherapy
– Bronchodilators• Theophylline or aminophylline, Isuprel, Brethine, Alupent, Proventil,
Bronkosol
– Corticosteroids
– Antibiotics
– Diruretics
– Humidifier
– Pursed-lip breathing
– High-protein, high-calorie diet• Encourage fluids between meals rather than with meals
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Chronic Bronchitis
• Etiology/Pathophysiology– Hypertrophy of mucous gland causes
hypersecretion and alters cilia function– Increases suseptibility to infection causing
airway scaring– Increased airway resistance causes
bronchospasm– Most common cause is cigarette smoking
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Chronic Bronchitis
• Signs & Symptoms– Productive cough
• Especially in the mornings
– Dyspnea– Use of accessory muscles to breath– Wheezing
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Chronic Bronchitis• Treatment
– Bronchodilators• Theophylline, aminophylline, etc
– Mucolytics• Mucomyst
– Antibiotics• Erythromycin
– Oxygen (low-flow)• 1-2 liters per NC
– Pursed-lip breathing
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Asthma• Etiology/Pathophysiology
– Narrowing of the airways due to various stimuli– Extrinsic
• External factors– Pollens, dust, feathers, animal dander, foods
– Intrinsic• Internal causes
– Respiratory infection
– Influenced by secondary factors• Mental or physical fatigue and emotional factors
– Antigen-antibody reaction
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Asthma• Signs & Symptoms
– Mild Asthma• Dyspnea on exertion• Wheezing
– Acute Asthma Attack• Usually at night• Tachypnea• Expiratory wheezing• Use of accessory muscles• Nasal flaring• Cyanosis• Productive cough
– Status asthmaticus• Severe, unrelenting attack that fails to respond to usual treatment• Leads to exhaustion and respiratory failure
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Asthma• Treatment
– Maintenance Therapy• Serevent inhalant, prophylactic• Corticosteroid inhalant
– Floevent
• Avoid allergens
– Acute or Rescue Therapy• Proventil inhalant• Corticosteriod and epinephrine oral or sq• Aminophylline IV• Oxygen
– Monitor by pulse oximetry
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Bronchiectasis
• Etiology/Pathophysiology– Gradual, irreversible process that involves
chronic dilation of bronchi resulting in loss of elaticity
– Repeated pulmonary infections– Secondary causes may be cystic fibrosis,
foreign body, or tumor
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Bronchiectasis
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Bronchiectasis• Signs & Symptoms
– Dyspnea– Cyanosis– Clubbing of fingers– Coughing
• Esp in the morning and when lying down
• Copious amounts of foul-smelling sputum
– Fatigue– Weakness– Loss of appetite– Wheezes and crackles
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Bronchiectasis• Treatment
– Oxygen (low-flow)• 1-2 liters per NC
– Chest physiotherapy– Hydration– Mucolytic agents
• Mucomyst
– Antibiotics– Bronchdilators
• Theophylline
– Cool mist vaporizer– Surgery
• Lobectomy