King saud university nursing collage master degree 1431-1432H

1. King saud university nursing collage master degree1431-1432H Nursing management for acute disease in: Respiratory system Endocrine system Hematology system Immunology system Done by : mahaalonazi

2. Objective • At the end of the lecture the master student well be able to : • Know the most common of acute respiratory disease . • Identify nursing management for RD . • Know the most common of acute endocrine disease . • Identify nursing management for ED . • Know the most common of acute hematology & immunology disease . • Identify nursing management for HD & ID .

3. Outline • RESPIRATORY DISEASE : • Anatomy of respiratory system . • Croup. • Acute epiglottitis • Broncholitis . • Pneumonia. • Aspiration pneumonia . • ARDS • Asthma. • ENDOCRINE DISEASE : • Anatomy of endocrine system .

4. Diabetes Mellitus • Diabetic ketoacidosis . • Diabetes Insipidus. • SIADH . • Hyperthyroidism. • Hypothyroidism. • Gigantism • HEMATOLOGY & IMMUNOLOGY DISEASE : • Anatomy of immune & hemato system .

5. Anemia • Sickle cell disease • DIC • Hemophilia • Leuckemia • Thalasmia

6. Pulmonary System

7. Anatomy of respiratory system • Upper airway . • Lower airway . • Thoracic cavity .

8. Upper Airway • Ideally above larynx is the upper airway • Practically speaking Nose, Larynx (Glottic opening and vocal cords) and trachea (Up to Carina). The upper airway is responsible for warming, humidifying and filtering air before it reaches the trachea. • Nose • Pharynx • Larynx

10. Lower Airway (Lung) • Trachea • Lung • Conducting Airways • Gas exchange units (Alveoli)

11. Thoracic Cavity • Diaphragm • The chest wall

12. Spectrum of Resp. diseases Upper AW - Stridor, croup, laryngomalacia Lower AW - Asthma, bronchiolitis Lung Parenchymal- Pneumonia, Pulmonary edema Pleural - Empyema, Pneumothorax

13. When will you suspect UAW dis.? • Stridor • Neck retraction • Suprasternal retraction • Sniffing position

14. Acute Laryngotracheobronchitis (Croup) • Definition : inflammatory swelling of the submucosa in the subglottic area & trachea ,bronchi ,bronchioles • Commonest cause of acute stridor usually occure for child from age 3 month to 5 yrs . • causes : Viruses: Parainfluenza. RSV . • Sing & symptoms: • barking cough. • Hoarseness. • stridor. • Low fever.

15. (Croup) management • Mild: Stridor at rest, cough - Minimal handling • Moderate to severe: Stridor at rest. - Racemic epinephrine nebulization Dexamethazone IV or IM, also oral or Nebulized Budesonide • Severe: Impending respiratory failure Intubation for 2-3 days. Improves in a week. • Majority may not need intubation

16. X-ray Neck in croup Sharpened pencil appearance

17. Nursing management • provide medication as order . • Provide cool & humidified oxygen as needed • Check vital sign . • Monitor pulse oximetry. • Minimal handling. • Provide quit environment . • Enteral feeding may be considered in pt. with respiratory distress .

18. Definition :Is severe life threatening rapidly progressive infection of the epiglottis &aryepiglottic folds & surrounding tissue . • Usually occurs in children aged 2-6 yrs but can occurs any any age. • Caused: before the use of the HiB vaccine • ( haemophilus influanzae type B) was the moust commonly identified cause of acute epiglotittis ,the usual cause in the vaccinated child is now streptococcus pyogenes, S.pneumoniae ,or staphylococcus aureus .

19. Sing & symptom : • Sudden onset of high fever. • dysphagia. • drooling,. • muffled voice. • soft stridor. • inspiratory retractions.

20. Normal Lateral neck

21. Acute epiglottitis - Management • Intubation by a skilled person • IV Ceftriaxone • O2 and other supportive management • Usually extubatable in 3-4 days • Antibiotics for 10 days.

22. Nursing management • Close monitoring . • Arm restraint to prevent self extubation . • Decreased movement of the ETT in the larynx . • Deliver oxygen as necessary .

23. Croup Epiglottitis • Age: Younger infants • No fever • Harsh stridor • Parainfuenza virus • Usually no antibiotics, no intubation • Age: older children • High fever, toxic • Soft stridor, Drooling, muffled • H influenza(Bacteria) • Needs antibiotics and intubation

24. DO and DON’T in UAW dis. • Allow the patient in his position of comfort • Do not separate the child from mother • Do not force the child to lie down • Do not make the child cry? • Do not send the child for X-ray without accompanied by medical team • Continuously monitor for the need for intubation.

25. Broncholitis • Definition : acute inflammatory disease of the lower tract that result in obstruction of small airways . • Causeas : viral infection . • Sing & symptom : • Cough. • Wheezing . • Prolong expiration. • Irritability . • Low grade fever . • Tachypnea . • Retraction .

26. Nursing management • Maintained fluid & nutritional requirement • Monitor child closely for respiratory failure. • provide medication as order . • Provide oxygen as needed or M.V if respiratory failure ,hypoxemia or apnea are developed . • Check vital sign . • Monitor pulse oximetry • Prevent nosocomial infection by good HW.

27. Pneumonia • Pneumonia is infection of the lung caused most often by bacteria or viruses . • Mode of transmission: 1-Inspiration. 2-Aspiration. 3-Circulation. • Bypass of nasal defense • Pulmonary aspiration (CNS, GER, TEF) • Abnormal secretions or mucociliary clearance • Underling chronic disease/nutrition • Defect in the immune system

28. Sign & symptom : • Chills, fever and cough • Stuffy nose • Irritability • Resp distress: expiratory grunting, nasoflaring, retraction, tachypnea, tachycardia. • Cyanosis, air hunger, and occasionally apnea

29. Nursing management • Monitor V\S ,ABG level ,oxygen saturation . • Administered nebulization & oxygen at concentration as prescribed . • Placed in high fowler position . • Rendered chest physiotherapy . • Encourage pt. to deep breathing & cough . • Encourage pt. to increased fluid intake to liquefy secretion . • Assess lung sound . • Administered antibiotic as ordered . • Avoid contact with people with URTI .

30. Aspiration pneumonia • Definition :inflammation caused by pulmonary aspiration of gastric fluid produced direct injury to the mucosal surface of the respiratory tract . • Causes :see table • Sing & symptom : • Cough ,fever . • acute dyspnea. • wheezing , crackles or absent breathing sound in the effected lobes , • cyanosis, retraction , tachypnea .

31. Causes of Aspiration Pneumonia

32. Nursing management • Monitor V\S ,ABG level ,oxygen saturation . • Administered nebulization & oxygen at concentration as prescribed . • Placed in high fowler position . • Rendered chest physiotherapy . • Encourage pt. to deep breathing & cough . • Encourage pt. to increased fluid intake to liquefy secretion . • Assess lung sound . • Administered antibiotic as ordered .

33. ARDS • Definition :acute lung injury & noncardiogenic pulmonary edema . • Causes : • Gastric aspiration. • Toxic inhalation . • Pulmonary infection . • FBA .

34. Sing & symptom : • Stage 1 :(1-2 day) : mild tachypnea, hypoxemia,anxiety or restlessness. • Stage2 :(2-3 day) :cyanosis in room air ,tachycardia,retraction . • Stage 3:(3-10 day ):symptom change from distress to failure (inability to oxygenate & ventilate,alveolar collapse desaturation ,high oxygen requirement . • Stage 4 : (after 10 day ):development of pulmonary fibrosis & progressive impairment of oxygenation are observed .

35. Nursing management • Encourage coughing & deep breathing in awake pt. • Frequent position change with CPT as needed . • Reduce abdominal distention by NGT if necessary . • Check vital sign . • Monitor pulse oximetry . • Do VBG & ABG analysis . • Provide supplemental oxygen for pt. with adequate ventilation . • Provide medication such as sedative ,analgesic ,neuromuscular blocking agents ,bronchodilator as ordered . • Provide high calories & high protein diet.

36. Asthma (chronic disease ) • Definition :obstructive pulmonary disease characterized by airway inflammation with mucosal edema,thick secretion that cause plugging & hyperreactivity of the tracheobronchial tree that result in bronchospasm of the smooth muscle . • Causes :inflamatory mediators are thought to stimulate the vagus nerve ( cholinergic stimulation )causing smooth muscle constriction & increased production of mucus.

37. Sing & symptom: Tachycardia. Tachypnea. Cynosis. Expiratory wheezing in severe case. Inspiratory & expiratory wheezing . Hypoxemia .

38. Nursing management • Monitor pattern of breathing & V\S at regular interval . • Assess S & S of respiratory distress . • Administer oxygen & nebulization as indicated . • Assess lung sound . • Monitor pulse oximetry & ABG level as indicated . • Encourage rest in between activity to prevent fatigue & encourage deep breathing .

39. Endocrine System

40. 1- Endocrine glands : secrete hormones directly into the bloodstream ( adrenal , pancreas ,thyroid glands) • 2-Exocrine glands :secrete biochemical substances that are released into ducts to be delivered to target organs ( salivary ,sweat glands )

41. Major glands : • 1-Hypothalamus-pituitary complex .(ACTH,TSH,ADH,Oxytocin ) • 2-Thyroid gland.(T3,T4) • 3-Parathyroid gland.(PTH) • 4-Adrenal gland.(sex hor. Cortisol,epinephrine,norepinephrine) • 5-Islets of langerhans in the pancreas.insullin-beta cell, glucagon-alpha cell, somatostatin-delta cells • 6-Gonads.estrogen,progesterone,testosterone .

42. Fig 1. Pituitary Hormones and their target organs.

43. Diabetes Mellitus • Definitions • Type I: Insulin-dependent mellitus (IDDM) • It is autoimmune disease that result in the T-cell-mediated destruction of the beta pancreatic cells .it is the most common form of diabetes in infants & children & requires insulin replacement therapy . • Type II: Non-insulin-dependent diabetes mellitus (NIDDM) • Is associated with obesity ,strong family history & older age .it is not autoimmune process but instead due to insulin resistance enough insulin is produced to prevent ketoacidosis. it can treated by oral hypoglycemia agents , diet.exercise .

44. Diabetes Mellitus • Diabetic ketoacidosis • Is the absence of insulin & cellular uptake of glucose is inhibited & glucose production by the liver is increased & glucose utilization decreased resulting in hyperglycemia . • Etiology : • is related to inadequate endogenous insulin secretion . Acute stress, infection ,trauma , high dose of steroide .

45. Table 1. Signs and symptoms

46. Management • Fluid • Electrolytes • Insulin • Monitoring

47. Nursing management • Monitor V\S & blood sugar level . • Provide 3 regular diabetic meals with in between snacks as tolerated . • Check weight daily \weekly as indicated . • Observed for circulation on feet . • Monitor intake & output . • Check urine for protein & ketones . • Monitor S\S of hypo & hyperglycemia . • Administered insulin regimen as prescribed .

48. Table 3. Clinical observation in dehydration

49. Table 4. Insulin preparation

50. Syndrome of Inappropriate antidiuretic hormone • Characterized by inappropriate, excessive secretion of ADH • Occurs in the face of low serum Na and low serum osmolality • Clinical signs and symptoms are secondary to increased blood volume and hyponatremia.