Upper respiratory disorders and nursing mangement

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management of patients (adults including elderly) with respiratory problems ANILKUMAR BR LECTURER MEDICAL-SURGICAL NURSING

Transcript of Upper respiratory disorders and nursing mangement

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Nursing management of patients (adults

including elderly) with respiratory

problems ANILKUMAR BR

LECTURERMEDICAL-SURGICAL NURSING

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* Nursing assessment – History and physical assessment

* Etiology, Pathophysiology, clinical manifestations, diagnosis, treatment modalities and medical, surgical, dietetics and nursing management of various respiratory disorders.

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Upper respiratory tract infections Bronchitis Asthma Emphysema Empyema Atelectasis

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Chronic obstructive pulmonary diseases ( COPD)

Bronchiectasis pneumonia Pulmonary Tuberculosis (TB) Lung abscess

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Pleural effusion Cysts and Tumors Chest injuries Respiratory arrest and

insufficiency Pulmonary embolism

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Review of anatomy and physiology of respiratory system

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The respiratory system is composed of the mainly

1) Upper respiratory tracts2) Lower respiratory tracts

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Together, the two tracts are responsible for ventilation (movement of air in and out of the airways).

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The upper respiratory tract, known as the upper airway, warms and filters inspired air so that the lower respiratory tracts (the lungs) can accomplish gas exchange.

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Conti

Gas exchange involves delivering oxygen to the tissues through bloodstream and expelling waste gases, such as carbon dioxide, during expiration.

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Anatomy of the upper respiratory Tract Upper airway structures consist of Nose Sinuses and nasal passages Pharynx Tonsils and adenoids Larynx and trachea

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Lower respiratory tract

The lower respiratory tracts consist of the

1) Lungs (two) which contain the bronchial and alveolar structures needed for gas exchange

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Structures of lungs

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The lungs are paired elastic structures enclosed in the thoracic cage, which is an airtight chambers with distensible walls.

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PLEURA : The lungs and wall of the thorax are lined with a serious membrane called pleura.

MEDIASTINUM : The mediastinum is in the middle of the thorax, between the pleural sac that contains the two lungs.

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LOBES : Each lung is divided into lobes . The left lung consists of an upper and lower lobe, whereas the right lung has an upper, middle and lower lobe

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Nursing assessment – History and physical assessment History collection • Personal history • Reason for seeking care • Past health history • Present illness /problems • Previous illness

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Conti

Family history Occupational history Medications

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Physical examination

Skin – cyanosis, Pallor Nail clubbing cough and sputum production Inspect – palpate – Percussion - & auscultate the thorax.

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Common respiratory sings and symptoms Dyspnea or SOB Wheezing Chest pain Cough Hemoptysis Sputum production

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Common diagnostic evaluation Pulmonary functions test (PFT) PFT is non-invasive diagnostic test. In this test the volume and capacity test aid diagnosis in patients with suspected pulmonary dysfunction.

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PFT

PFT evaluates ventilatory functions

Determine whether obstructive or irritative disease

Can be utilize as screening test

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ABGs (Arterial blood gas analysis) ABGs analysis is a diagnosis

procedure it involves measurement of blood pH and arterial oxygen and carbon dioxide tensions are obtained when managing patients with respiratory problems and adjusting oxygen as needed.

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ABGs normal valves

Pao2 – 80 to 100 mm hg Paco2- 35 to 45 mm hg pH - 7.35 to 7.45 O2 saturation - 95 to 99 %

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Suptum analysis

The suptum test analysis involves a sample of sputum to diagnose respiratory disease, identify organsim and identify abnormal cells and also identify pathogenic organisms.

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Pulse oximetry

Pulse oximetry is a non-invasive method of continously monitoring the oxygen saturation of hemoglobin (sao2)

A sensor or probe is attached to the ear lobe, forehead, fingertip or the bridge of the nose.

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Imaging studies Chest x-ray Computed tomography (CT) MRI Fluroscopic studies Bronchoscopy

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Bronchoscopy

Bronchoscopy is the using for diagnostic and therapeutic purpose. It’s involves a direct inspection of the trachea and bronchi through a flexible fiber optic or a rigid Bronchoscopy

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Bronchoscopy using for to determine location of pathologic lesions, to remove foreign objects, to collect tissues specimen and remove secretions or any aspirated materials.

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Thoracentesis

Pleural fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection.

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Common Diagnostic Tests for Respiratory Disorders1.Laboratory Tests (Hemoglobin; Arterial

blood gases; Pulmonary Function Tests; “Sputum Analysis& culture”).

2.Radiologic Studies (Chest X-ray; Ventilation-perfusion scan; CAT scan; Pulmonary angiography).

3.Other (Pulse oximetry; Bronchoscopy; Thoracentesis; MRI).

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Assessment

Auscultation(Listening for Normal and Adventitious Breath Sounds)

Palpation and Percussion

Inspection(client's color, level of consciousness, emotional state)

(Rate, depth, quality, rhythm, effort relating to respiration)

Health History(allergies, occupation, lifestyle, health habits)

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COMMON UPPER RESPIRATORY TRACT INFECTIONS Rhinitis or common cold Allergic rhinitis Sinusitis Pharyngitis Tonsillitis Laryngitis

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Are the common conditions that affect most people on occasion, some infections are acute and other are chronic.

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Viral rhinitis or common cold

Often is used when referring to a symptoms of an upper respiratory tract infection by nasal congestion ,sore throat , & cough

Cold referred to a febrile, infectious, acute inflammation, of the mucus membranes of the nasal cavity.

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Rhinitis

Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose.

It may be acute or chronic ,non-allergic or allergic.

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Causes of rhinitis

Idiopathic Abuse of nasal decongestants Irritants e.g. smoke, air pollution etc. Forgin bodies

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Clinical manifestations1. Rhinorrhea “ excessive nasal

drainage”2. Nasal congestion, Itching ,&

sneezing3. Headache may occur

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Medical Management of rhinitis1. Treatment of cause “antibiotics”2. Decongestant agents3. Antihistamine 4. In severe cases corticosteroids5. Teaching patient self care

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Acute Sinusitis

It is inflammation of sinuses , it is resolved promptly if their opening into nasal cavity .

Clinical Manifestations 1. Pressure , pain over the sinus area 2. Tenderness3. Purulent nasal secretions

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Acute Sinusitis

Medical Management 1. Antimicrobial agent “Amoxicillin”2. Oral & Topical Decongestant3. Heated mist or Saline irrigation Nursing management “Teaching patient self care”

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Complications1. Meningitis & osteomylitis2. Brain abscess 3. Ischemic infarction

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Chronic Sinusitis

It is an inflammation of sinuses that persists for more than 8 weeks in adult & or 2 weeks in children

Clinical Manifestations1. Impaired mucociliary clearness & ventilation 2. Chronic hoarseness & cough3. Chronic Headache4. Facial pain

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Acute Pharyngitis

Acute pharyngitis is sudden inflammation of the pharynx.

It is a febrile inflammation of throat ,caused by virus about 70% , uncomplicated viral infection usually subsided promptly within 3-10 days

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Clinical Manifestations1. Fiery red pharyngeal membrane&

tonsils2. Lymphoid follicles that are swollen 3. Enlarge tender cervical lymph node4. Fever & malaise5. Sore throat , hoarseness,& cough

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Acute Pharyngitis

Medical Management1. Supportive measures for viral infection2. Pharmacologic therapy antibiotics for 10 days

“cephalosporin "analgesic for severe sore anti tussive medications

3. Nutritional therapy liquid or soft diet "If liquid can’t tolerated IV fluid administered “

4. Nursing Management (bed rest ,skin assessment, mouth care &normal saline gargle & self care teaching .

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Chronic pharyngitis

Chronic pharyngitis is a persistent inflammation of the pharynx.

Common in adults who work or live in dusty surrounding ,use the voice too excess , suffer from chronic cough , & habitually use alcohol & tobacco.

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Chronic Pharyngitis

Clinical Manifestations 1. Constant sense of irritation or fullness in throat 2. Mucus expelled by coughing 3. Difficulty in swallowing Medical Management 1. Relieving symptoms Avoiding exposure to irritant Correct respiratory & cardiac conditions

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Chronic pharyngitis

2. Antihistamine drugs3. Decongestant4. Controlling malaise Nursing Management1. Patient teaching of self care2. Avoid alcohol , tobacco , exposure to cold3. Face mask to avoid pollutant 4. Warm fluids,& warm saline gargle

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Tonsillitis

The tonsils are composed of lymphatic tissue & situated on each side of the oropharynx ,they frequently are the site of acute infection (tonsillitis)

Clinical Manifestations Tonsils : sore throat, fever , snoring &

difficulty of swallowing Adenoids : ear ache , mouth breathing ,

drainage ear ,frequent cold , bronchitis, noisy respiration, foul smelling breath &voice impairment

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Tonsillitis

Medical Management1. For recurrent tonsillitis

“tonsillectomy”2. Conservative or symptomatic therapy3. Antimicrobial therapy “penicillin” for

7 days

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Nursing Management1. Provide post op. care :V/S ,hemorrhage ,

position head turned to side, water or ice chips

2. Teaching patient :S&S of hemorrhage3. Avoid too much talking or coughing4. Liquid or semi liquid diet for several days 5. Alkaline mouth washing with warm saline

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Laryngitis

It is an inflammation of larynx ,often occur as a result of voice abuse or exposure to dust , chemicals , smoke , & other pollutants

Common in winter & easily transmitted The cause of infection is almost virus Clinical Manifestations 1. Hoarseness or aphonia2. Severe cough

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Laryngitis

Medical Management1. Resting voice & avoid smoking 2. Inhale cool steam or an aerosol3. Conservative treatment 4. Antibiotics for bacterial organisms

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Nursing Management1. Rest voice 2. Maintain a well humidified environment 3. Daily fluid intake