RESPIRATORY Disorders

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RESPIRATORYDisorders

• Esmeralda Garza
• South Texas College

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ASSESSMENT

• HISTORY
• what questions will you ask the client/family?

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ASSESSMENT

• INSPECTION
• Is chest symmetrical with normal A/P diameter
• What are respirations like?
• Skin color

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ASSESSMENT

• AUSCULTATION
• Normal breath sounds
• Abnormal breath sounds
• Adventitious sounds

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NORMAL BREATH SOUNDS

• Bronchial
• Bronchovesicular
• Vesicular

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ABNORMAL SOUNDS

• Location
• Pitch
• Expiratory length

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ADVENTITIOUS SOUNDS

• Crackles/rales
• Rhonchi
• Wheeze
• Friction rub

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HYPOXEMIA

• THE MOST COMMON CAUSE IS A VENTILATION/PERFUSION
  MISMATCH

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VENTILATION

• The exchange of gases between the atmosphere and
  alveoli
• Causes for inadequate ventilation
• narrowed airways
• breakdown of
  defenses

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PERFUSION

• The exchange of gases between the alveoli and the
  blood
• Causes for inadequate perfusion
• decreased surface area
• Obstruction to flow
• anemia

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DIAGNOSTIC TESTS

• Chest X-ray
• Pulmonary Function test
• Preoperative evaluation
• Response to bronchodilator therapy

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PFT Nursing Implications

• Light meal prior to PFT
• No smoking 6-8 hours prior to PFT
• No bronchodilators 4-6 hrs. before
• Note height and weight

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DIAGNOSTIC TESTS

• Sputum Studies
• Culture Sensitivity
• Identify organisms
• Acid-Fast bacilli
• Cytology

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Nursing Implications

• Best collected 1st thing in a.m.
• Saliva is not sputum
• One tsp. Is needed
• Rinse out mouth prior to collection
• Should not use toothpaste or mouthwash
• Send specimen immediately

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DIAGNOSTIC TESTS

• Bronchoscopy
• Diagnostic
• Therapeutic

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Procedure

• NPO after MN
• Sign informed consent
• Administer atropine /or diazepam
• Remove dentures
• Versed
• Back of throat sprayed with lidocaine

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DIAGNOSTIC TESTS

• Thoracentesis
• Diagnostic
• Therapeutic

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PROCEDURE

• NPO not necessary
• Permit required
• Best position side of bed, leaning over bed side
  table
• Sterile technique
• Small bandage afterwards
• Pt. turned on unaffected side for 1 hr.

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PULSE OXIMETRY

• Saturation of hemoglobin
• Ideal normal 95-100
• Below 91 - emergency
• Below 85 - tissues not well oxygenated
• Below 70 - life-threatening for some below 80

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Oxygen Therapy

• Goal is to provide adequate transport of oxygen
  in the blood while decreasing the work of
  breathing and reducing stress on the heart

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HAZARDS

• Combustion
• O2 Induced Hypoventilation
• O2 Toxicity
• Absorption Atelectasis
• Drying of Membranes
• Infection

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TYPES OF SYSTEMS

• Low-flow
• Nasal cannula
• Simple face mask
• Partial Rebreather mask
• Non-Rebreather mask

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TYPES OF SYSTEMS

• High-flow
• Venturi Mask
• Delivers most accurate concentrations

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SINUSITIS

• Facial pain
• Nasal obstruction
• Fatigue
• Nasal drainage

• Ear pain fullness
• HA
• Cough
• Fever

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SINUSITIS

• Non-surgical
• Antibiotics
• Tylenol
• Decongestants
• Steam humidification
• Hot packs

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SINUSITIS

• Surgical
• Antral irrigation
• Endoscopic Sinus Surgery
• Caldwell-Luc Procedure

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BACTERIAL PHARYNGITIS

• Fiery red membranes
• Swollen lymph glands
• Fever gt 101 F (38.3 C)

• Pain
• Hoarseness
• Abrupt onset
• WBC elevated

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VIRAL PHARYNGITIS

• Slightly red membranes
• Possible swollen glands
• No fever or low-grade

• Pain
• Mild hoarseness
• Gradual onset
• WBC normal

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ACUTE PHARYNGITIS

• Bedrest during febrile phase
• Analgesics
• Antibiotics

• Ice collar
• Warm saline gargles
• Monitor for complications

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PERITONSILLAR ABSCESS

• Potential complication of tonsillitis
• Infection spreads from the tonsils to the
  surrounding area
• Pus forms behind tonsils
• Usually occurs 3-5 days after infection

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ASSESSMENT OF PTA

• Uvula deviation
• Dysphagia
• Drooling
• Thickening of voice
• Pain severe

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MANAGEMENT OF PTA

• Antibiotics
• Warm saline gargles
• Ice collar
• Analgesics
• Abscess is evacuated if necessary

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TONSILLECTOMY

• Prone or side-lying
• Observe for hemorrhage
• No coughing

• Ice collar
• Analgesics
• No straws
• Cool water

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PNEUMONIA

• An inflammatory process
• Results in edema movement of fluid into alveoli
• 7th leading cause of death

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Different types

• BacteriaL
• Myoplasma
• VIRAL
• CHEMICAL

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ASSESSMENT

• Shaking chills
• High fever
• Tachypnea
• Sputum GREEN production
• Crackles/wheezes

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ASSESSMENT

• Tachycardia
• Pleuritic pain
• Nasal flaring
• Cough
• Chest expansion

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Treatment

• Antibiotics
• Oxygen
• Rest
• Proper Diet
• Pain Medicine for chest pain
• Cough Medicine
• Respiratory treatments

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Risk

• Over 65 years of age and under 2
• Chronic disease
• Long term facility
• Altered immunity
• PREVENTION
• Flu shot yearly
• Preumo cal vax every 5 years

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TUBERCULOSIS

• Infectious disease that primarily affects lung
• Mycobacterium tuberculosis
• Why an increase in TB????

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RISK FACTORS
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TUBERCULOSIS

• TB Disease (Active)
• bacteria are multiplying and can spread to others
• usually causes symptoms
• TB Infection (Inactive)
• exposure to TB
• no symptoms
• not contagious

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DIAGNOSTIC TESTS

• Sputum culture
• Confirms diagnosis of TB disease
• Mycobacterium tuberculosis
• Takes 1-3 weeks
• Acid-fast bacillus smear
• Sputum stained with dye treated with acid
  alcohol to remove stain
• TB bacillus does not de-stain
• Not definitive test

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DIAGNOSTIC TESTS

• Tuberculin test (Mantoux test, PPD)
• most reliable determinant of TB infection
• 0.1 ml of PPD
• measure area of induration in mm at 48-72 hrs.
• Chest X-ray
• Shows inflammation and lesions

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PPD MEASUREMENT

• Greater than or equal to 5 mm
• children lt one year of age
• persons known to have or suspected of having HIV
• close contacts of a person with active TB
• IV drug abuse

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PPD MEASUREMENT

• Greater than or equal to 10 mm
• children 1-4 years
• persons with certain medical conditions
• Recent immigrants
• Residents and employees of high-risk settings
• Medically under-served populations

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PPD MEASUREMENT

• Greater than or equal to 15 mm
• all persons with no known risk factors for TB
• People over age of 4

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TB ASSESSMENT

• Night sweats
• P.M. temperature elevation
• Productive cough
• Mild weight loss
• Hemoptysis
• Positive PPD

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TB MEDICATIONS

• Ethambutol
• Isoniazid
• Pyrazinamide

• Rifampin
• Rifapentine
• Streptomycin

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treatment

• Direct observation therapy
• Combination drugs
• Rest
• Diet
• Side effect of drugs
• MDR-TB
• Surgery

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TB OSHA GUIDELINES

• Risk assessments
• Employee training
• Prevention of transmission
• Healthcare workers
• Patients
• isolation room with negative air flow at least
  6 air changes per hour
• wearing of special respiratory mask

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SARS

• Virus from coronavirus family
• Virulent
• Close person-to-person contact
• Respiratory droplets
• Surface contact
• Incubation 2-7 days

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ASSESSMENT

• Begins with fever
• HA
• Diarrhea
• Dry hacking cough
• Develop pneumonia

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ANTHRAX

• Bacillus anthracis is gram-positive, encapsulated
  rod
• Sporulates when exposed to air
• As aerosol is odorless and invisible and can
  travel great distance
• Incubation is 1-6 days

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METHODS OF INFECTION

• Skin contact
• Skin lesions, edema, pruitis, ulcerations
• GI ingestion
• Fever, N/V, abdominal pain, diarrhea
• Inhalation
• Most severe

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INHALATION ANTHRAX

• Prodromal Stage
• Mimics flu
• Feels better in 2-4 days
• Diagnostic testing looking for
• Positive Gram stain
• Mediastinal widening

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INHALATION ANTHRAX

• Fulminant Stage
• Right after Pt. feels better
• Sudden breathlessness
• High fever
• Septic shock
• Near 100 mortality

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INTERVENTIONS

• Penicillin, doxycycline, ciprofloxacin
• Antibiotics within 24 hrs prevent death
• Known exposure IV antibiotics for 7 days then po
  for 60 days
• Prophylaxis 60 days po
• Standard precautions
• Cremation recommended

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CHRONIC AIRFLOW LIMITATIONCHRONIC OBSTRUCTIVE
DISEASE

• To be labeled CAL or COPD, client must have at
  least 2 of the following diagnoses
• asthma
• chronic bronchitis
• emphysema

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ASTHMA

• An inflammatory disease of the airways, resulting
  in
• airway hyperresponsiveness
• mucosal edema
• mucus production

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What are Asthma Triggers?
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PATHOPHYSIOLOGY

• Inflammation leads to obstruction from
• Swelling
• Contraction
• Increased mucus production

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TYPES OF ASTHMA

• Extrinsic or atopic
• Caused by allergen
• Intrinsic
• Not related to specific allergen
• Mixed

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ASSESSMENT

• Dry to productive cough
• Dyspnea
• Tachypnea
• Apprehension
• Wheeze
• Diaphoresis
• Retractions

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ASTHMA MEDS

• Long-term control meds
• Quick relief (rescue) medications

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LONG-TERM CONTROL

• Taken daily to achieve and maintain control of
  persistent asthma

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CORTOCOSTEROIDS INHALED

• Suppress inflammation in the airways
• Increase number and sensitivity of beta 2
  receptors

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INHALED STEROIDS

• Beclomethasone (Vanceril,Beclovent)
• Triamcinolone (Azmacort)
• Flunisolide (AeroBid)
• Fluticasone (Flovent)
• Budesonide (Pulmocort)

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SIDE EFFECTS

• candidiasis
• dysphonia (hoarseness)
• dry mouth
• coughing

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ORAL STEROIDS

• Prednisone
• Hydrocortisone

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SIDE EFFECTS

• fluid retention, weight gain
• mood alteration
• elevated cholesterol
• impaired growth, diabetes
• osteoporosis,

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MAST CELL INHIBITORS

• Prevents the release of broncho-restrictive and
  inflammatory substances when mast cells are
  confronted with allergens and other stimuli.

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MAST CELL INHIBITORS

• Cromolyn (Intal)
• Nedocromil (Tilade)

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SIDE EFFECTS

• Are rare
• dry throat
• bad taste in mouth
• cough

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BETA AGONISTLONG-ACTING

• Stimulates the beta 2 adrenergic receptors in the
  smooth muscle of the bronchi and bronchioles
  which then causes broncho- dilation

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BETA AGONISTLONG-ACTING

• Salmeterol (Serevent)
• Terbutaline (Brethine)
• Metaproterenol (Alupent)

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SIDE EFFECTS

• Tachycardia
• Palpitations
• Nervousness
• Tremors
• Insomnia

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METHYLXANTHINES

• Relax smooth muscle, stimulate the CNS, stimulate
  cardiac muscle, and act on kidneys to promote
  diuresis

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METHYLXANTHINES

• Theo-dur - long acting theophylline

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SIDE EFFECTS

• Gastrointestinal effects
• CNS effects
• Cardiovascular effects

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LEUKOTRIENE MODIFIERS

• Inhibition of leukotriene production
• Prevention of leukotriene binding to receptors

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LEUKOTRIENE MODIFIERS

• Zafirlukast (Accolate)
• Montelukast (Singular)
• Zileuton (Zyflo)

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SIDE EFFECTS

• Headache
• Abdominal pain
• Nausea
• Elevated ALT
• Myalgia

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QUICK RELIEF MEDICATIONS

• Provide prompt relief of asthma attack symptoms
  chest tightness, wheezing and coughing

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BETA AGONISTSHORT-ACTING

• Relaxes airway smooth muscle which causes a
  prompt increase in airflow

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SHORT-ACTING

• Epinephrine (Adrenalin)
• Albuterol (Proventil, Ventolin)
• Isoetharine (Bronkosol)
• Isoproterenol (Isuprel)

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SIDE EFFECTS

• Tachycardia
• Palpitations
• Tremors, nervousness
• Headache
• Insomnia

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METHYLXANTHINE

• Aminophylline
• very effective
• given mainly IV

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ANTICHOLINERGICS

• Blocks acetylcholine in bronchial smooth muscle
  prevents vasoconstriction of bronchi

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ANTICHOLINERGICS

• Ipratropium bromide (atrovent)
• Ipratropium bromide (combivent)

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SIDE EFFECTS

• Dry mouth
• Headache
• Nausea
• Dizziness
• Blurred vision

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ADVAIR DISKUS

• Contains serevent and flovent
• Different strengths available
• Breath activated
• Is not a rescue inhaler

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SPIRIVA (TIOTROPIUM BROMIDE

• Long acting anticholinergic
• Dose once a day
• See handout for method of use

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STATUS ASTHMATICUS

• A severe asthma that is unresponsive to
  conventional therapies
• Clinical assessment
• Severe respiratory distress
• Audible wheezing
• Engorged neck veins
• Rising PCO2

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STATUS ASTHMATICUS

• Aminophylline IV
• Oxygen
• Corticosteroids
• IV fluids
• Epinephrine
• Possible intubation

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CHRONIC BRONCHITIS

• mucous gland hypertrophy
• excessive mucus production
• obstruction to airflow bronchospasms
• V/Q mismatch
• hypercapnia, hypoxemia, acidosis

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ASSESSMENT

• Blue-tinged, dusky appearance
• Productive cough
• Dyspnea
• Polycythemia
• Cor pulmonale
• Clubbing

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MANAGEMENT

• Bronchodilators
• Antibiotics
• Hydration
• Postural drainage
• Corticosteroids
• NO SMOKING

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EMPHYSEMA

• abnormal enlargement of the alveoli
• destruction of alveolar walls
• V/Q mismatch
• expiration no longer an involuntary passive act
• Imbalance between proteases and alpha-antitrypsin

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ASSESSMENT

• Progressive dyspnea
• Prolonged expiration time
• Chronic cough
• Diminished breath sounds
• Weight loss
• Barrel chest

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PURSED LIP BREATHING
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MEDICATIONS

• Bronchodilators
• Sympathomimetics (adrenergic)
• Methylxanthines
• Anticholinergics
• Corticosteroids
• Antibiotics
• Oxygen

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