Respiratory Tract Disorders Assessment & Management of Patients With.
-
Upload
gwenda-kelley -
Category
Documents
-
view
220 -
download
1
Transcript of Respiratory Tract Disorders Assessment & Management of Patients With.
Respiratory Tract DisordersRespiratory Tract Disorders
Assessment & Assessment & Management of Patients Management of Patients
WithWith
Clinical Manifestations 1. Local Manifestations
Cough chronic, paroxysmal, dry , productive
Excessive Nasal Secretion Expectoration of Sputum
mucoid, purulent, mucopurulent, rusty, hemoptysis
Pain pleuritic, intercostal, generalized
chest pain Dyspnea- shortness of breath
Function
Gases are moved in and out of the lung
through pressure changes.
Intrapleural pressure is negative (less than atmospheric pressure – 760mmHg)
Please refer to suggested reading notes
2. Systemic Manifestations Hypoxemia
insufficient oxygenation of the blood cyanosis- bluish, grayish discoloration of
skin & mucous membranes Hypoxia
inadequate tissue oxygenation Hypercapnia
CO2 in arterial blood above normal limits Hypocapnia
CO2 in arterial blood below normal limits Respiratory Failure
Clinical Manifestations
Medical Terminology (Respiratory conditions)
Respiratory Failure: The inability of the cardovascular and pulmonary systems to maintain an adequate exchange of oxygen and carbondioxide in the lungs .
Maybe caused by a failure in oxygen or in ventilation.
Can be hypoxemic or hypercapneic.
Medical terminology cont.
Ventilation: the process of moving gases into and out of the lungsWork of Breathing: The effort required for expanding and contracting of the lungs. The influencing factors: the rate and depth of breathing, the ease in which the lungs can be expanded and airway resistance
Assessment of Respiratory System
Health History Risk Factors Major Clinical Manifestations
Cough Sputum production Chest pain Wheezing Clubbing of the fingers Cyanosis
Physical Examination Inspection
posture, shape, movement, dimensions of chest, flared nostrils, use of accessory muscles, skin color, and rate, depth, & rhythm of respiration
Palpation respiratory excursion, masses, tenderness
Percussion flat, dull, resonant, hyperresonant sounds
Auscultation breath sounds, voice sounds, crackles,
wheezes
Assessment of Respiratory System
Diagnostic Procedures Sputum Studies
Methods- standard, saline inhalation, gastric washing
Arterial Blood Gases measurements of blood pH , arterial
O2 & CO2 tensions, acid-base balance
Pulse Oximetry Chest X-ray Bronchoscopy Thoracentesis Laryngoscopy
Pneumonia Inflammation & infection of lung-
infecting organisms typically inhaled- organisms transmitted to lower airways and alveoli causing inflammation- impairs gas exchange
Etiology: bacteria, virus, Mycoplasma, fungus, or from aspiration or inhalation of chemicals or other toxic substances
Risk factors: cigarette smoking, chronic underlying disorders, severe acute illness, suppressed immune system, & immobility
Assessment: Questions to ask Have you been experiencing difficulty
breathing? Are you having pain? Where? Do you have a cough? Have you been running a fever? Have you been feeling tired?
Clinical Manifestations: fever, pleuritic chest pain, tachypnea,
SOB, tachycardia, cough, sputum production- rusty, blood-tingled or yellow-green, fatigue, poor appetite
Pneumonia
Diagnostic: Sputum and blood cultures, CBC, ABGs, CXR,
& BronchoscopyNursing Diagnoses: Ineffective airway clearance sec. to thick,
tenacious sputum Ineffective breathing pattern sec.to
tachypnea, chest pain, & airway inflammation Impaired gas exchange sec. to exudate in
alveoli Activity intolerance sec. to hypoxemia, fatigue Acute pain sec.to disease process
Pneumonia
Planning: Client Outcomes Maintain open & clear airway, normal RR, PO2 level
without supplemental O2, complete physical care without frequent rest periods
Interventions Improve airway patency- auscultate lung sounds,
monitor ABGs or pulse oximetry, elevate HOB, C & DB q 2hrs, ambulate , O2 as needed
Promote fluid intake & promote activity tolerance Monitor & prevent complications High fowler’s positioning to facilitate air exchange
Pneumonia
Pharmacology: Antibiotic therapy based on sputum culture &
sensitivity Levaquin, Tequin, Rocephin, Primaxin, Zithromax,
Ketek, Zinacef, Cipro, Tetracycline Instruct to finish all antibiotics at prescribed
intervals Short acting beta 2 agonist such as Salbutamol Corticosteroids ,Prednisolone to decrease
inflammation Influenza vaccine, pneumococcal vaccine
Pneumonia
Period of bed rest Promote adequate nutrition Provide support Evaluation:
breathing easier without chest pain temperature normal, activity level increased without frequent
rest periods
ARDS
Acute Respiratory Disease Syndrome
A form of Acute Lung InjuryDiffused alveolar injury
An acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia
Build up fluid in alveolar
ARDS - Causes
Breathing vomit into lungs (aspirations)
Inhaling chemicalsLung transplannt
PneumoniaSeptic shock (infection thru body)
Trauma
ARDS -Characterstics
Stiff heavy lungs(decreases the lungs ability to expand)
The level of oxygen in the blood can stay dangerously low (even if oxygen is
given via a ventilator)
ARDS - Symptoms
Symptoms usually develop 24 to 48 hrs of illness or injury
DyspnoeaLow blood pressure (infection) and
organ failureRapid breathing
ARDS - Diagnostics
Arterial Blood GasBlood Tests
Blood and Urine culturesBronchoscopy
Chest x-raySputum culture and analysis
ARDS - Treatment
Intensive Care AdmissionAntibiotic therapy
Steroid therapyDiuretics
Ventilatory support
PULMONARY EMBOLISM
Is a complication of an underlying venous thrombosis
Patient may not show classic signs and symptoms
PE – Signs and symptomsSeizuresSyncope
Abdominal painFever
Productive coughWheezing
Altered level of consciousness
PE - Diagnosis
ECGChest xray, CT, MRI, Echo, VQ scan
Blood tests –Dimer, coagulation profile, Arterial blood gas
PE - Management
Anticoagulation (warfarin, heparin, retaplse)
Surgical intervention :Emoblectomy
Vena Cava filters
TUBERCULOSIS Infectious disease that primarily affects the
lungs; may be transmitted to other parts of the body
Pulmonary infiltrates accumulate, cavities develop, & masses of granulated tissue form within the lungs
Primary infectious agent- Mycobacterium Bacilli Transmitted by inhalation of droplets )talking, coughing, sneezing, & singing)
Risk factors: immune system disorder, preexisting medical conditions, institutionalized, health care workers
Pulmonary Tuberculosis
Mycobacterium tuberculosisAirborne transmissionTuberculin skin testingPharmacologic therapy- multi-drug regimens and prophylaxis
TuberculosisAssessment: Questions to ask - Are you suffering from
night sweats? Have you lost weight? Have you been having low-grade fever? Have you been having SOB and coughing up anything from your lungs? Have you had chest pain? Where? Have you had weight loss?
Clinical Manifestations- low-grade fever (late afternoon), night sweats, weight loss, anorexia, fatigue, chronic productive cough,pleuritic chest pain, hemoptysis
Diagnostic: Sputum culture- + acid-fast bacilli (AFB) Skin testing CBC- WBC elevated CXR BronchoscopyNursing Diagnosis: Ineffective airway clearance r/t thick, tenacious
secretions Ineffective breathing pattern r/t airway
inflammation
Tuberculosis
Altered nutrition less than body requirements sec. to anorexia and fatigue
Fatigue sec. to disease process Anxiety sec. to social isolation secondary
to isolation protocolsPlanning: Clients Outcomes Maintain clear airway,normal RR, achieve
weight gain, anxiety decreasedInterventions: Maintain respiratory isolation- infectious
period - diversional activities Barrier protection should be used
Tuberculosis
Evaluation: Client adheres to isolation precautions,
takes medication as prescribed Complications Miliary TB The organism invade the blood stream
and can spread to multiple body organ Meningitis Pericarditis
Promote airway clearance- bedrest, increase fluid intake, high humidity
Pharmacology First-line meds- Isoniazid, Rifampin,
Ehtambutol, & Pyrazinamide for 4 months Isoniazid and Rifampin continued for an
additional 2 months or up to 12 months. Advocate adherence & prevention Monitor and manage potential
complications Adequate nutrition Provide client and family education Provide emotional support
Tuberculosis
Questions to ask Do you have difficulty breathing- all the
time or is it caused by exertion? Do you cough frequently and is it
productive? Have you had a weight loss? Do you feel tired quite often and are your
activities impaired by SOB or fatigue? Do you have many respiratory infections?
Over what period of time?
Tuberculosis
Nursing Diagnosis Ineffective airway clearance r/t thick, tenacious
secretion and fatigue Ineffective breathing pattern r/t fatigue and
obstruction of the bronchial tree Impaired gas exchange r/t increased sputum
production Activity intolerance r/t hypoxemia & fatigue Altered nutrition r/t increased metabolic
demands, fatigue, & anorexia
Anxiety r/t inability to breathe effectively
Tuberculosis
Diagnostics: ABGs, CBC, sputum culture, CXR, Pulmonary
function testsPlanning: Client Outcomes Effectively clear airway and breathing pattern,
maintain normal ABGs, increase activity with decrease SOB or fatigue, maintain weight, and less anxious with episodes of SOB
Tuberculosis
Inflammation of the bronchi caused by irritants or infection
hypertrophy & hypersecretion of mucous- cause increase in sputum production
increase mucous- decrease airway lumen size- lumen becomes colonized with bacteria.
Bronchial wall becomes scarred - leads to stenosis & airway obstruction
Defined as a productive cough that lasts 3 months a year for 2 consecutive years with other causes excluded.
Cough in the morning with sputum production is indicative of Chronic Bronchitis
Bronchitis
Risk Factors: cigarette smoking, exposure to pollution, hazardous airborne substances
Clinical Manifestations: productive cough, dyspnea esp. on exertion, wheezing, use of accessory muscles to breathe, cyanosis- “blue bloater”, clubbed fingers
Interventions: Assess patency of airway- suction if cough
ineffective, RR, accessory muscle use, lung sounds, skin color changes, ABGs
Encourage high fluid intake & instruct in effective breathing & coughing
Monitor oxygen administration & aerosol therapy
Bronchitis
Encourage to report sputum changes or worsening of symptoms
Encourage exercise to improve resp. fitness Counsel to avoid respiratory irritants and
stop smoking Immunize against common flu and
pneumonia
Pharmacology: Antibiotic therapy- Tequin, Levaquin Bronchodilators- Albuterol, Combivent,
Theophylline Corticosteroids- Prednisone, Solumedrol
Chronic Bronchitis
Bronchiolitis:Bronchiolitis is a common illness of the respiratory tract
usually caused by viral infection. It affects
the tiny airways, called the bronchioles,
that lead to the lungs. As these airways
become inflamed, they swell and fill with
mucus, making breathing difficult.
The variable degrees of obstruction
produced in air passage by these changes
lead to hyperpnoea & progressive
emphysema.
Bronchiolitis:Nursing Assessment
Sometimes more severe respiratory difficulties gradually develop:
Rapid, shallow breathing .
Drawing in of the neck and chest with each breath, known as retractions.
Flaring of the nostrils.
Irritability, with difficulty sleeping and signs of fatigue or lethargy.
BronchiolitisNursing care:
Follow strict precautions to prevent spread of infection.
Administer high humidified oxygen.
Clear nasal congestion, try a bulb syringe and saline (saltwater) nose
drops.
Provide adequate Ng. Care for vomiting, fever, & diarrhea.
Small frequent diet, & increase fluid intake.
A lung abscess is a localized area of lung destruction
liquefaction necrosis usually related to pyogenic bacteria
Cavity formation
Clinical manifestation Dyspnoea Chest pain Tachycardia
Lung abscess