Respiratory System Disorders

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Author:
scyiza
ID:
176522
Filename:
Respiratory System Disorders
Updated:
2012-10-09 13:50:57
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Respiratory
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Nursing block 1
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  1. Respiratory Disorders: Viral Infections
    • ¡Smallest
    • of all microorganisms

    • ¡The
    • scope of infections run from the common cold to AIDS

    • ¡Antibiotics
    • have no effect on viral infections

    • ¡Antiviral
    • medications are available for some viral infections
  2. Common Cold
    • ¡Most contagious 1-4 days before symptoms and
    • through first 3 days

    • ¡Transmission occurs most frequently from
    • contact with contaminated surfaces

    • ¡Rhinorrhea,
    • nasal congestion, cough, ↑ mucosal secretions
  3. Cold Medications
    • ¡Most
    • are sympathomimetic

    • ¡May
    • contain pseudoephedrine, analgesic, antihistamine

    • ¡Generally
    • safe for children >6yrs

    • ¡Call
    • Dr. before taking if:

    • lHeart
    • disease

    lHTN

    • lThyroid
    • disease
  4. Cold Medications
    • ¡Side
    • effects of sympathomimetic:

    lHeadache

    lNervousness

    • lIncreased
    • blood pressure

    lInsomnia

    • ¡Side
    • effects of antihistamine:

    lDrowsiness
  5. 2nd  generation Antihistimines
    ¡“Non-sedating antihistimines”

    • ¡Zyrtec,
    • Claritin

    ¡Little to no effect on sedation
  6. Cough Medications
    Antitussives

    • Act
    • on medulla to suppress cough

    • Increased
    • effect with other CNS depressants

    Expectorants

    Loosen bronchial secretions

    Found in combination with antitussives, analgesics

    Can cause nausea/vomiting
  7. Nasal & systemic decongestants
    • Produce vascular constriction within the
    • nasal mucosa → decrease in fluid
    • secretion

    Nasal sprays, drops

    • “rebound”
    • nasal congestion

    • Tablet, capsule & liquid (allergic
    • rhinitis)

    • May cause the client to be “jittery” or
    • restless

    Avoid caffeine
  8.            Coccidioidomycosis
    • Valley
    • Fever

    • Fungal
    • (mold/spore)

    • Grows
    • in soil of the southwest

    • Often
    • asymptomatic, or….

    • Symptoms
    • similar to influenza

    • Usually
    • resolves without treatment

    • Worst
    • case-pleuritic pain, arthritis of knees, ankles, systemic
    • infection of skin and meninges of the brain (<1%)
  9. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    • ¡Etiology
    • & Pathophysiology

    • lInflammation
    • of lung tissue

    • lUsually
    • caused by an infectious agent (bacterial, viral, fungal, parasitic)

    • lCan
    • also be caused by inhalation of chemicals & aspiration of gastric contents

    • lLifespan
    • consideration: Elderly

    • ¡Less
    • air exchange and more air and secretions remain in lungs
  10. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    ¡S/S – Subjective

    lDyspnea

    • lChest
    • pain that increases on inspiration

    ¡S/S - Objective

    lFever, chills, ↑ WBCs

    • lCough,
    • purulent sputum, crackles, bronchial sounds
  11. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    ¡Diagnostics

    • lPositive
    • CXR

    • lPositive
    • sputum culture
  12. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    • ¡Collaborative
    • Care

    • lDrug
    • therapy - antibiotics based on C&S

    • lOxygen
    • therapy

    • ¡Nursing
    • Care – Assessment

    • lVS;
    • breathing patterns

    • lColor,
    • amount, consistency of sputum

    • lAdventitious
    • lung sounds

    • lMental
    • status changes
  13. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    • ¡Nursing
    • Care – Analysis/NDX

    • lIneffective
    • airway clearance R/T copious tracheobronchial
    • secretions

    • lActivity
    • intolerance R/T oxygenation/perfusion mismatch

    • lRisk
    • for deficient fluid volume R/T fever & dyspnea
  14. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    • ¡Nursing
    • Care-Planning/Implementation

    • lEncourage
    • coughing & deep breathing after CPT; 
    • splint chest as needed

    • lCollect
    • sputum for C&S

    • lIncrease
    • fluid intake to 3L/day

    • lMaintain
    • semi-Fowler’s position

    • lMonitor
    • for s/s respiratory distress

    • lPlan
    • rest periods

    • lInstruct
    • pt. to cover nose & mouth when coughing
  15. Lower Respiratory Tract
    Disorders
    PNEUMONIA
    • ¡Nursing
    • Care-Planning/Implementation

    • lAdminister
    • abx, as ordered

    • lTeach
    • preventative measures

    ¡Nutrition/fluids

    • ¡Avoid
    • respiratory irritants

    ¡Vaccinations

    • ¡Nursing
    • Care - Evaluation
  16. Lower
    Respiratory Tract Disorders
    PULMONARY TUBERCULOSIS
    • ¡Etiology
    • & Pathophysiology

    • lLung
    • infection caused by Mycobacterium tuberculosis

    • ¡Acid-fast
    • bacillus

    • ¡Spread
    • via airborne droplets

    • lPredisposing
    • factors include debilitating diseases like alcoholism, diabetes, HIV infection

    • lCauses
    • fibrosis and calcification of lungs

    • lResistant
    • strains
  17. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    ¡S/S – Subjective

    • lMalaise,
    • pleuritic pain, fatigue

    ¡S/S – Objective

    • lFever,
    • night sweats, wt loss

    • lCough,
    • becoming more persistent, productive or non-productive

    • Sputum
    • – green, purulent, yellowish mucoid,
    • or blood tinged
  18. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    ¡Diagnostics

    • lSkin
    • test – PPD

    lCXR

    • Sputum
    • for AFB
  19. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    ¡Collaborative Care

    lDrug therapy

    ¡Long-term, 6-9 Months

    lFirst phase 2 months

    lSecond phase 4-7 months

    ¡Combination Therapy required

    lIsoniazid & rifampin or

    • lIsoniazid, rifampin & ethambutol
    • or  Isoniazid, rifampin & pyrazinamide

    Must comply with the drug regime!

    Avoid antacids, ETOH, sunlight
  20. Antitubercular Drugs
    • 5
    • First Line Medications

    • ¡INH
    • – isoniazid (also used for prophylaxis w/
    • exposure)

    • lPeripheral
    • neuropathy & hepatotoxicity, visual problems

    • lFood
    • ↓ absorption  rate

    lMay need vitamin B6 supplements

    • ¡Rifampin
    • (RIF)

    lHepatotoxicity

    • lTurns
    • body fluids orange colored!

    • ¡PZH
    • – Pyrazinamide

    ¡Ethambutol

    • lVisual
    • problems

    • ¡(possibly)
    • Streptomycin

    lhepatotoxicity
  21. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    ¡Collaborative Care

    lBedrest

    lIsolation


    • ¡Airborne
    • precautions

    • ¡Specially-ventilated
    • room

    • ¡HEPA
    • mask for staff

    • lProphylactic
    • therapy for immediate contacts (6 months- 1 year)

    • lNutrition:  high-protein, high-vitamin,
    • supplemental B-6 to counter INH side effects
  22. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    • ¡Nursing
    • Care – Assessment

    • lFatigue,
    • anorexia, fever, night sweats

    • lColor,
    • amt/consistency of sputum

    • lAdventitious
    • lung sounds

    • ¡Nursing
    • Care – Analysis/NDX

    • lActivity
    • intolerance R/T impaired oxygenation

    • lNoncompliance
    • R/T long-term nature of therapy, medication side effects
  23. Lower Respiratory Tract
    Disorders
    PULMONARY TUBERCULOSIS
    Nursing Care - Planning/Implementation

    • Provide
    • for rest periods

    • Encourage
    • coughing/deep breathing

    • Dietary
    • teaching

    • Teach importance of adhering to medication schedule & the
    • importance of follow-up

    • Teach
    • prevention of infection

    • Teach
    • s/s hemorrhage - hemoptysis

    Nursing Care - Evaluation
  24. Chronic Obstructive Pulmonary Disease -

    CHRONIC BRONCHITIS:
    Etiology & Pathophysiology

    • lInflammation
    • of the lower respiratory tract characterized by excessive mucous production and
    • cough

    • lAcute
    • – usually viral or bacterial infection

    • lChronic
    • – without infection

    ¡
  25. airway

    Interventionsfor clients with infectious or inflammatory disorder
    Monitor for resp. distress

    Assist in coughing

    Suction prn

    Assist with nebulizer TX

    Administer bronchodilators

    Change position frequently

    Increase fluid intake

    Humidification

    Monitor O2 therapy

    Teach about transmission
  26. Chronic Obstructive Pulmonary Disease -

    EMPHYSEMA
    Etiology & Pathophysiology

    • Obstruction
    • caused by hyperinflation of alveoli (air trapping), loss of lung tissue
    • elasticity, & narrowing of small airways

    • Pursed
    • lip breathing especially helpful here
  27. Chronic Obstructive Pulmonary Disease
    S/S – Subjective

    • Fatigue
    • & weakness, dyspnea; headache; impaired sensorium

    S/S - Objective

    Orthopnea, expiratory wheezing, cough

    • Barrel chest, cyanosis, clubbing
    • of fingers, use of accessory muscles; pursed lip breathing

    ABGs:  ↑ PCO2 & ↓ PO2
  28. Chronic Obstructive Pulmonary Disease
    Diagnostics

    Pulmonary Function Tests

    Labs

    ABGs

    RBCs-polycythemia
  29. Chronic Obstructive Pulmonary Disease
    ¡Collaborative Care

    • *Pt’s
    • w/ COPD become accustomed to a residual carbon
    • dioxide level (hypercarbia) & do not respond
    • to high CO2 concentrations as the normal respiratory stimulant;  they respond, instead, to a drop in
    • oxygen concentration in the blood, THEREFORE:

    • WATCH
    • O2 ADMINISTRATION! Hypoxemia becomes drive to breath; too much O2 will knock
    • out this drive!

    • Typically
    • 1-2L/min is the maximum O2 delivery for these patients
  30. Chronic Obstructive Pulmonary Disease
    ¡Collaborative Care

    • lDrug
    • therapy

    ¡Bronchodilators

    Corticosterioids

    Mucolytics & expectorants

    Antibiotics

    • Oxygen
    • therapy

    • Respiratory
    • therapy – SVNs, CPT

    • Hi
    • protein, soft diet, sml frequent amts
  31. Chronic Obstructive Pulmonary Disease
    • ¡Nursing
    • Care – Assessment

    • lHx
    • of ↑ s/s during early morning,
    • in cold weather, when sleeping & smoking

    • lBreathing
    • patterns: abdominal, pursed lip, asynchronous, accessory muscles, adventitious
    • breath sounds

    • Frequency
    • of respiratory infections

    • lEvidence
    • of acute/chronic hypoxia
  32. Chronic Obstructive Pulmonary Disease
    • ¡Nursing
    • Care – Analysis/NDX

    • lIneffective
    • airway clearance R/T bronchospasm and secretions

    • lActivity
    • intolerance R/T oxygenation/perfusion mismatch

    • lPowerlessness
    • R/T loss of self-care capability

    • Anxiety
    • R/T oxygen deprivation
  33. Chronic Obstructive Pulmonary Disease
    • ¡Nursing
    • Care-Planning/Implementation

    • lAdvise
    • smoking cessation/other external irritants

    • lRespiratory
    • exercises

    • Teach
    • use of inhalers/spacers

    • Pace
    • activities-avoid overexertion

    • Adequate
    • rest, nutrition, fluids

    • Encourage
    • close medical supervision
  34. Chronic Obstructive Pulmonary Disease
    • ¡Nursing
    • Care-Planning/Implementation

    lTeaching

    • ¡Maintain
    • resistance – adequate nutrition/fluids, vaccinations

    • ¡Avoid
    • exposure to infection

    • ¡Avoid
    • use of sedatives/hypnotics

    • ¡Early
    • s/s infection

    • ¡Nursing
    • Care - Evaluation
  35. Metered Dose Inhaler
    Used in patients with Chronic Obstructive
    Pulmonary Disease (COPD) & Asthma
    ¡Provides a fine mist to the lungs.

    • ¡Coordinating a quick puff from the inhaler
    • and taking a deep breath can pose a problem for some clients.

    • ¡A SPACER/HOLDING CHAMBER allows for the
    • correct distance from the mouth and the taking in of a deep breath to get the
    • medication in the clients lungs.

    • ¡If the spacer is missing, a temporary one can
    • be made by rolling a six-to-eight-inch piece of paper.

    ¡
  36. MDI WITH SPACER: Instruction
    • 1.Verify
    • Physician Order.

    • 2.Remove
    • the plastic cap on the MDI and the cap on the spacer.

    • 3.Insert
    • the MDI into the back of the spacer.

    • 4.Hold
    • the two together and shake.

    • 5.Monitor
    • pulse and breath sounds before and after therapy.

    • 6.Instruct
    • the patient to take a maximal inspiration and exhale completely, then place MDI
    • and spacer near the  patient’s
    • mouth and have patient inspire slowly while activating the MDI.

    • lNOTE:
    • A maximum, slow deep breath held for 5 to 10 seconds (if possible) is important
    • to proper usage of the MDI and to improve drug deposition.

    • 7.Repeat
    • steps 4 and 6 for each puff, waiting at least 30 seconds between puffs.
  37. Powder Inhalants (Advair Diskus)
    ¡fluticasone- Corticosteroid

    • ¡&
    • salmeterol-
    • Bronchodilator

    • ¡Patient
    • should rinse mouth after administering the medication
  38. SVN (Small Volume Nebulizer)
  39. ¡Usually
    • administered by R.T. but nurses need to know how to operate the SVN machines
    • and related equipment.

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