Chapter 86 Respiratory Disorders

1. Chapter 86Respiratory Disorders

2. The Respiratory System • Respiration requires a patent airway for oxygen to reach the lungs, and lungs that are physically capable of exchanging oxygen for carbon dioxide. • The respiratory system consists of the upper and lower respiratory tracts. What ‘s included in each ie..lungs, nose, trachea • Pulmonologist • Respiratory therapy • Respiratory therapists • Respiratory technicians

3. Laboratory Tests • Sputum specimen: Best early in the am • Lavage specimen: sterile saline/ diagnosis TB • Throat culture vs rapid strep test r/o streptococci only • Blood gas determinations-best indicator for O2 deficiency • Level of arterial blood gases (ABGs) • Partial pressure of oxygen (PaO2) -80-100mmHg • Partial pressure of carbon dioxide (PaCO2)-35-45 • Hydrogen ion concentration (pH) of the blood-7.35-7.45

4. X-ray and Fluoroscopy Examinations • Chest x-ray (CXR) • Computed tomography (CT) scan • Lung scan • Lung perfusion scan • Pulmonary angiography

5. Other Diagnostic Tests • Magnetic resonance imaging (MRI) • Pulmonary function test (PFT) • Bronchoscopy • Skin and blood tests • Skin tests • Purified protein derivative (PPD) tuberculin test • Blood tests

6. Question Is the following statement true or false? The spirometer can be used interchangeably with the incentive spirometer.

7. Answer False The spirometer should not be confused with the incentive spirometer. The spirometer measures pulmonary function. The incentive spirometer also measures pulmonary function, in a sense, but it is used by the client. The incentive spirometer helps the client, such as after surgery, to perform respiratory exercises to maintain lung function.

8. Common Medical Treatments • Postural drainage- used to drain secretions and mucus from the lungs • Chest physiotherapy (CPT) • Inhalations- Bronchodilators

9. CPT and postural drainage

10. Common Surgical Treatments • Thoracentesis-puncturing the chest wall to remove fluid; purpose is to relieve breathing difficulty • must sign informed consent signed; specimen is collected- complication pneumothorax • Paracentesis- removal of fluid in the Abdomen • Nursing alert!!!!!!!!!!!!>1000ml causes vasodilation and hypovolemia • Thoracotomy- incision into the thorax • Caring for the client after chest surgery- guideline 1414 • Chest suction-how it works the pressure of the chest cavity is lower than the pressure of the air outside of the lungs the negative pressure creates a vacuum • Closed water-seal drainage-must be kept air tight • Nursing implications- guidelines on 1415 • DOPE acronym DOPE stands for Displacement of breathing tube, Obstruction, Pneumothorax, Equipment failure

11. Thoracentesis/paracentesis

12. Chest tube

13. Chest tube set up

14. Question Is the following statement true or false? During paracentesis or thoracentesis, the nurse must take the client’s blood pressure and pulse immediately after the procedure and every 15 minutes until readings are stable.

15. Answer True A large amount of fluid withdrawn (>1,000 mL) during paracentesis or thoracentesis can result in vasodilation and hypovolemia (decreased circulating fluid volume). These situations can cause syncope (temporary loss of consciousness, fainting) and shock. The nurse should take the client’s blood pressure and pulse immediately after paracentesis or thoracentesis and every 15 minutes until readings are stable and within acceptable levels.

16. Question Is the following statement true or false? It is perfectly safe for a client with a respiratory system disorder to receive a narcotic.

17. Answer False If a person with any disorder of the respiratory system is receiving a narcotic, be particularly watchful for respiratory depression. Depressed respirations can be an undesirable side effect in anyone, but the situation is most dangerous for the client whose respiratory function is already compromised.

18. Nursing Process • Data collection • Noting alterations in respiratory status • Aspiration • Hyperventilation • Hypoxia • Hypoxemic hypoxia • Circulation hypoxia • Anemic hypoxia • Histotoxic hypoxia

19. Nursing Process (cont’d) • Planning and implementation • Relieving respiratory distress • Orthopneic position • Turning, coughing, and deep breathing • Administering respiratory treatments • Postural drainage • Breathing exercises and incentive spirometer • Breathing treatments, oxygen

20. Nursing Process (cont’d) • Administering nasal treatments • Suctioning to remove oral–nasal secretions • Dysrhythmia and desaturation • Evaluation

21. Possible Alterations in Respiratory Status • Biot’s respirations • Apnea • Central apnea • Obstructive apnea • Mixed apnea • Adult sleep apnea • Kussmaul’s respirations • Dyspnea • Orthopnea • Tachypnea • Hyperpnea • Bradypnea • Hypoventilation • Hyperventilation • Cheyne-Stokes breathing

22. Infectious Respiratory Disorders • The common cold or acute rhinitis • Streptococcal sore throat • Influenza • Laryngitis • Bronchitis • Lung abscess

23. Infections • Common Cold • 100 viruses • 48 hour after exposure • Last 5d-2 weeks • Rest best medicine • Plenty of fluids • More than 2-3 days of fever need to see PMD • Blunted smell and taste • Other symptoms • Streptococcal • Symptoms, headache, fever malaise, weakness • Most dangerous is rheumatic fever and glomerulonephritis • PCN

24. Infectious Respiratory Disorders (cont’d) • Pneumonia • Bacterial pneumonia • Viral pneumonia • Pneumocystis carinii pneumonia • Chemical pneumonia • Aspiration pneumonia • Pleurisy • Histoplasmosis

25. Infections • Influenza • Type a-D = place of origin • Parkinsonism • Pneumonia • Suddenly ill, muscle pains, fever, cough sore throat emesis • Prevention flu vaccine= does not give the flu to people • Treatment • Large fluids • Do not give milk • Rest • Tamiflu with in 48

26. infections • Laryngitis- infection larynx • Excessive use voice and smoking • Humidity • Viral • Test cancer • Bronchitis- cough • Cough, general malaise, fever • Treatment bed rest diet , fluids humidifiers • Antibotics

27. Inflammation of the lungs • Consolidation- liquid/solid feeling up the air space in the lung • Bacterial- young/ old/abuse substances • Viral- variant of the flu usually secondary rarely fatal • Pneumocystis carinii –immunocompromised • Chemical ingest or inhale • Aspiration; vomits/inhales foreign substances • Symptoms: sharp chest wall pain • Fever, chills,sputum, cough mental changes • Treatment: • Bullets on 1420 • Guideline on 1422 • pleurisy

28. tb • Caused by spore; tubercle-inactive • Tb develops lower resistance • Spread-inhaled; n95 • Latent bullets /active • Symptoms of active bullet • Treatment box –goal of treatment?

29. Infectious Respiratory Disorders (cont’d) • Tuberculosis (TB) • Latent and active TB • Pulmonary TB • Pott’s disease and miliary TB • Atypical TB • Multidrug-Resistant TB • Empyema • Acute empyema • Chronic empyema

30. Question Is the following statement true or false? The number of cases of TB has decreased dramatically during the last several decades because of the developments in science and medicine.

31. Answer False The number of cases of TB has increased dramatically during the last several decades because of the increase in multidrug-resistant TB organisms, increasing numbers of persons with HIV infection, substance abuse, homelessness, and poor compliance with medication treatment plans.

32. Chronic Respiratory Disorders • Snoring • Sleep apnea syndrome-most commonly waking up multiple times at night ;fall asleep easily; middle age – overweight men/women; five cessation for at 10 sec every hour; bullets • Allergic rhinitis-hay fever • Pneumoconioses-dust disease( black lung)-prevention once damage is done not reversible

33. Chronic obstructive pulmonary disease • Different classifications • Irreversible and associated persistent dyspnea on exertion reduce air flow to less than ½ normal • Bullets on goals to improve ventiliation • O2 not exceed 3/l • Pursed-lip breathing • Brachial asthma inflammation of the lining of the bronchial airway- • Cells that line the bronchi release chemicals that cause inflammation • Causing bronchospasms • Signs sudden attack, coughing wheezing pale white mucus • Poor control leads to emphysema • Children symptoms lessen while adults get worse • Status asthmatics medical emergency lasting for more than 24 hours • TX: Teaching bullets on 1427 • Nursing educating the client page 1428 • Spacer?

34. Question Is the following statement true or false? The continuous positive airway pressure apparatus is commonly used to assist persons with allergic rhinitis.

35. Answer False The continuous positive airway pressure (CPAP) apparatus is commonly used to assist persons with sleep apnea. This machine looks like an oxygen-delivery system and is used at night so the person can sleep. It delivers air, and sometimes oxygen, to the person at a continuous positive pressure that holds the alveoli open. This positive pressure prevents respiratory obstruction, increases oxygenation, and reduces breathing effort.

36. Pulmonary Emphysema • Abnormal , permanent enlargement of the alveoli and alveolar ducts with destruction of alveolar walls =elasticity • Chronic bronchitis is the direct cause • Difficulty breathing after exertion • Use accessory muscle to breath • Orthopnea

37. Trauma • Absence of air exchange • Chest trauma • Respiratory complications in drug poisoning • Drowning/near drowning • Pneumothorax

38. Neoplasms • Benign neoplasms • Lung cancer

39. Disorders of the Nose • Inflammatory disorders • Sinusitis • Acute sinusitis • Chronic sinusitis • Structural disorders • Deviated septum • Nasal polyps • Plastic surgery (rhinoplasty) • Care of the client undergoing nasal surgery

40. Disorders of the Nose (cont’d) • Nasal trauma • Fractures • Epistaxis

41. Disorders of the Throat • Trauma • Aspiration of foreign bodies • Cancer of the larynx • Nursing considerations • Communication and speech • Identification as a laryngectomee • Supportive resources • Water dangers

42. End of Presentation