Respiratory Disorders

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redpursuit
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12913
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Respiratory Disorders
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2010-04-02 19:25:08
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Respiratory
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MS1 Respiratory Disorders
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  1. Physical Exam of Respiratory
    System
    • Review Table 26-10 page 526
    • Describe exam findings associated with the following disorders:
    • COPD
    • Pneumonia=Percussion
    • Dull over gunk/Frem Inc
    • Atelectasis
    • Pulmonary Edema
    • Pleural Effusion
    • Pneumothorax
    • Pulmonary Fibrosis

    Fremitus more vibration than air

    Pneumoth/Absent breath sounds/Percuss=hyperressonant-trap air but no mvmt

    Connect Patho
  2. Pulmonary Function Test (PFTs)
    Evaluates function of airways, diffusion, lung compliance.

    • Values calculated on percent of predicted by age-lose volume,
    • height-taller more volume, gender

    • Decreased Forced Expiratory Volume in 1 second (FEV-1)
    • indicative of obstructive lung disease (Asthma or COPD)

    • Decreased Vital Capacity indicates restrictive lung disease
    • (Pulmonary fibrosis or neuromuscular disorders)


    Obstr-dead space in lungs/trapping/narrowing/ability to blow out hard quick diminished

    Restr-Low volumes
  3. Epistaxis-Nose bleeds
    Etiology

    ¨Trauma

    • ¨Nasal
    • Sprays

    • ¨Street
    • Drugs

    • ¨Coagulopathy-
    • Ex. INR of 10

    First Aid

    • ¨Sit
    • patient up

    • ¨Direct
    • pressure to soft tissue X 10-15 minutes

    • ¨Apply
    • ice

    • ¨Assess
    • V/S and bleeding risks

    Medical Management

    ¨Cauterization

    • ¨Vasoconstrictive
    • agents

    • ¨Packing
    • to Tamponaud the bleed

    • Assess
    • airway and oxygenation
  4. Allergic Rhinitis
    Nasal Mucosa react to allergens

    • ¨IgE
    • mediated

    • ¨Mast
    • Cells and basophils release histamine, prostaglandins and leukotrienes
    • (mediators that cause symptoms

    Identify Triggers

    Medications

    • ¨Nasal
    • corticosteroids

    • ¨1st generation antihistamines: Diphenhydramine
    • (Benadryl®)

    • ¨2nd
    • generation non-sedating : Loratadine (Claritin®)

    • ¨Leukotriene
    • inhibitors: Montelukast
    • (Singulair®)
  5. Influenza
    Viral Respiratory Infection

    • ¨36,000
    • annual deaths

    Vaccination

    • ¨Annual
    • reformulation

    • ¨Target
    • high risk groups

    Anti-virals

    • ¨Oseltamivir
    • (Tamiflu®)

    Complications

    • ¨Bacterial
    • pneumonia

    • ¨Viral
    • pneumonia
  6. Obstructive Sleep Apnea (OSA)
    • Apnea results in hypoxemia
    • Risk Factors

    ¨Obesity

    • ¨Age
    • > 65

    Symptoms

    ¨Snoring

    • ¨AM
    • headache

    ¨Somnolence

    ¨Hypertension

    Diagnosis

    • ¨Polysomnography
    • (Sleep Study)

    Management

    • ¨Weight
    • loss

    • ¨Avoid
    • sedatives

    • ¨CPAP(continuous)
    • or BiPAP(responds to bleeding)

    • HTN,CAD, higher r/o stroke bc of catecholamine
    • surge/startling
  7. Simple Mask
    • ¨Set
    • gauge at 6-10 L

    ¨Uncomfortable
  8. Venturi Mask
    • Delivers
    • 24-55%

    • ¨Ensure
    • valves are patent

    ¨If needs or more than 6L


    • Allows
    • CO2 to escape
  9. Non-Rebreather
    Up to 100% O2

    Intake Valves

    Reservoir Bag
  10. Endotracheal Intubation
    Short-term mechanical ventilation, not more than week
  11. Tracheostomy
    Long-term mechanical ventilation

    Upper airway obstruction
  12. inflated cuff
  13. Tracheostomy Management
    • Equipment at bedside
    • Ambu bag
    • Suction
    • Oxygen
    • Obturator-Use to insert trach tube if de-cannulated
    • Trach tube

    Humidification-Collar on to deliver

    Cuff

    • Communication
    • Passy-Muir-inserting into trach, cuff deflated before use

    • Suctioning
    • Limit attempts
    • 10 seconds per attempt
    • Pre-oxygenate
    • Assessment (Pre and Post) lungs sounds/HR for tachycardias
    • and arrhthy/PO2/ouputs

    Capping

    Sterile procedure for suctioning
  14. Pneumonia

    Risk factors:
    ¨Chronic lung disease

    ¨Immunocompromised

    ¨Immobility

    ¨Altered LOC-aspirate

    ¨Intubation-vent req. pneumo

    ¨Tube Feeding- if large aspirate than not digesting

    Infection in lung tissue

    Pneumo-Chlorhexodone mixes for prevention
  15. Community-Acquired Pneumonia
    • Typical Organisms
    • Strep Pneumoniae
    • Haemophilus Influenzae

    • Atypical Organisms
    • Mycoplasma-walking pnemonia
    • Chlamydia-not STD
    • Legionella-Ventilation sx. transmission
  16. Hospital-Acquired Pneumonia
    • ¨Second
    • most common nosocomial infection

    • ¨Ventilator-Associated
    • Pneumonia

    Prevention (Oral flora, HOB, closed circuit, subglottic suctioning)
  17. consolidation
  18. Pneumonia Key Concept
    • Infectious Disease
    • ¨Signs and symptoms
    • ¨Diagnosis
    • ¨Patient complication risk
    • ¨Resistance-Strep Pneumo/Amox. resistant
    • ¨Core Measure
    • Antibiotic administration within 4 hours
    • Blood cultures for ICU admission

    • Bronchophany, etc?
    • Can hear her talking through lung sounds=Wispered Pect
    • Sepsis bacteria in blood- Septic shock=hypotension/toxins vasodilating/dec. perfusion/Decr. LOC/ can be afebrile
  19. Pneumonia Key Concept
    Diagnosis by CXR
  20. Tuberculosis (TB)
  21. TB cont.
    • S/S-Hemoptysis, fever spike late pm,Weight Loss, exposure?,
    • homelessness?, jails?, healthcare workers

    Sputum pos for AFB

    N95 Respirator- fitted for

    Treated minimum 6 mo. Up to 2 yrs./ drugs taken for 1 yr.

    Home when no coughing up sputum
    • SIADH= Too much ADH. Na goes down=hyponatremic


  22. Part of lung collapses bc air in pleural space, less expansion/tension

    Spontaneus- Blebs tissue rupture, tall, thin white men

    Absent breath sounds, hyperresonance, pain, etc
  23. Air/Blood in pleural spaces
  24. Chest Tube (see table 28-21 page 591)


    Drainage should slow down- mark drainage and character

    Serial Xray Qday
  25. Normal/Bronchoconstrictive
  26. Beta Blockers
    Beta-SNS

    • B2 in lungs
    • Tachycardia, tremors with B2
  27. Beta-2 Agonists
    Adverse Effects
    • Tachycardia
    • Angina
    • Tremors
    • Palpitations
    • Anxiety
    • Stimulation heart


  28. Ashtma exacer= dec frem, hyperrres, breath sounds diminshed… pg. 526 chart, second slide


  29. Ideal=Albuterol 1-2/week


  30. CO2 retainer=driven by hypoxia to breath

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