Nursing of Adults With Medical & Surgical Conditions

1. Nursing of AdultsWithMedical & Surgical Conditions Respiratory Disorders (Lower Airway)

2. Acute Bronchitis • Etiology/Pathophysiology • Inflammation of the trachea and bronchial tree • Retention of secretions causes high risk of bacterial growth • Usually secondary to upper respiratory infection • Exposure to inhale irritants

3. Acute Bronchitis • Signs & Symptoms • Productive cough • Rhonchi/wheezes • Dyspnea • Chest pain • Lowgrade temperature • Malaise • Headache

4. Acute Bronchitis • Treatment • Cough suppressants • Codeine • Antitussives • Pertussin • Antipyretics • Tylenol • Bronchodilators • Brethine • Antibiotics • Vaporizer • Encourage fluids

5. Legionnaires’ Disease • Etiology/Pathophysiology • Legionella pneumophila • First identified in 1976 at the American Legion convention in Philadelphia • Thrives in water reservoirs • Air conditioners and humidifiers • Causes life-threatening pneumonia • Leads to respiratory failure, renal failure, bacteremic shock, and ultimately death

6. Legionnaires’ Disease • Signs & Symptoms • Elevated temperature • 102 – 105 degrees • Headache • Nonproductive cough • Difficult and rapid respirations • Crackles or wheezes • Tachycardia • Signs of shock • Hematuria

7. Legionnaires’ Disease • Treatment • Oxygen • Mechanical ventilation, if necessary • IV therapy • Antibiotics • Erythromycin • Rifampin • Antipyretics • Vasopressors • For shock

8. Tuberculosis • Etiology/Pathophysiology • Tubercle bacillus (Mycobacterium tuberculosis) • Chronic pulmonary and extrapulmonary infectious disease • Inhalation of droplet containing tubercle bacillus • Infection • Presence of mycobacteria in the tissue of a person who has no s/s of TB • Positive TB skin test • 10% will become active disease • Active Disease • S/S of TB are present • NOT easily transmitted • Most inhaled TB organisms are destroyed by the upper resp. system

9. Tuberculosis • Signs & Symptoms • Fever • Weight loss • Weakness • Productive cough • Chills • Night sweats • Hemoptysis

10. Tuberculosis • Diagnostic Tests • Presumptive Diagnosis • Mantoux Tuberculin Skin Test • Read 48 – 72 hours after given • Enduration (raised hardened tissue) • <5mm negative • >5mm positive • Chest X-ray • Acid-fast bacilli smear x 3 • Confirmed Diagnosis • Sputum culture • Positive for TB bacilli

11. Tuberculosis • Treatment • Tuberculosis Isolation (AFB) • Isolation room • Negative air pressure • Particulate respiration masks • Medications • 6-9 months • First Line: • isoniazid (INH), rifampin, rifampin and isoniazid (Rifamate), pyrazinamide, ethambutol, streptomycin • Second Line: • Ethionamide, para-aminosalicylate sodium (PAS), cycloserine, capreomycin, kanamycin, amikacin

12. Pneumonia • Etiology/Pathophysiology • Inflammatory process of the bronchioles and the alveolar spaces due to infection • Bacteria, viruses, mycoplasma, fungi, and parasites • Aspiration • Retained secretions become infected • Inflammation of respiratory tract occurs • Decreased oxygen/carbon dioxide exchange

13. Pneumonia • Signs & Symptoms • Productive cough • Sputum depends on cause • Severe chills • Elevated temperature • Increased heart rate • Increased respiratory rate • Dyspnea

14. Pneumonia • Treatment • Oxygen • Chest percussion and postural drainage • Encourage to cough and deep breathe • Antibiotics • Penicillin, erythromycin, cephalosporin, and tetramycin • Analgesics • Tylenol or aspirin • Expectorants • Bronchodilators • Humidifier or nebulizer

15. Pleurisy • Etiology/Pathophysiology • Inflammation of the visceral and parietal pleura • Bacterial or viral

16. Pleurisy • Signs & Symptoms • Sharp inspiratory pain • Usually radiates to the shoulder or abdomen • Dyspnea • Cough • Elevated temperature • Pleural friction rub

17. Pleurisy • Treatment • Antibiotics • Analgesics • Demerol or morphine • Antipyritics • Tylenol • Oxygen • Anesthetic block for intercostal nerves

18. Pleural Effusion/Empyema • Etiology/Pathophysiology • Pleural Effusion • Accumulation of fluid in the pleural space • Usually secondary • Empyema • Fluid accumulation with pleural effusion becomes infected

19. Pleural Effusion/Empyema • Signs & Symptoms • Dyspnea • Air hunger • Respiratory distress • Nasal flaring • Tachypnea • Dyspnea • Decreased breath sounds • Fever

20. Pleural Effusion/Empyema • Treatment • Thoracentesis • Chest tube with closed water seal drainage system • Glass bottle system • Pleur-evac • (Pg. 385 Box 9-6 Maintaining chest tubes and closed chest drainage bottles) • Antibiotics • Cough and deep breath

21. Atelectasis • Etiology/Pathophysiology • Abnormal condition characterized by the collapse of lung tissue • Due to occlusion of air to a portion of the lung • Postoperative complication • Secretions • Foreign body • Mucous plug • Emphysema, pneumothorax, tumor

22. Atelectasis

23. Atelectasis • Signs & Symptoms • Dyspnea • Tachypnea • Pleural friction rub • Restlessness • Hypertension > hypotension • Elevated temperature • Decreased breath sounds • Crackles

24. Atelectasis • Treatment • Cough and deep breath • Analgesia • Early ambulation • Incentive spirometery • Intermittent positive pressure breathing • Oxygen • Chest percussion and postural drainage • Bronchodilators • Proventil • Antibiotics • Mucolytic agents • Mucomyst - Decrease viscosity of secretions • Chest tube

25. Pneumothorax • Etiology/Pathophysiology • A collection of air or gas in the pleural space, causing the lung to collapse • Penetrating chest injury • Coughing • Ruptured bleb • Spontaneous

26. Pneuomothorax

27. Pneumothorax • Signs & Symptoms • Decreased breath sounds • Sudden, sharp chest pain with dyspnea • Diaphoretic • Increased heart rate • Tachypnea • No chest movement on affected side • Sucking chest wound • Mediastinal shift

28. Pneumothorax • Treatment • Chest tube to water seal drainage system • Oxygen • Analgesics • Encourage fluids

29. Chest Tube Placement

30. Chest Tube Drainage System

32. Lung Cancer • Etiology/Pathophysiology • Primary tumor or metastasis • Small cell lung cancer • Non-small cell lung cancer • Squamous cell carcinoma • Large-cell carcinoma • 80% linked to smoking

33. Lung Cancer • Signs & Symptoms • Hemoptysis • Dyspnea • Fever • Chills • Wheezing • Pleural effusion

34. Lung Cancer • Treatment • Surgery • Most are not diagnosed early enough for curative surgical intervention • Segmental resection • Lobectomy • Pneumonectomy • Radiation • Chemotherapy

35. Pulmonary Edema • Etiology/Pathophysiology • Accumulation of serous fluid in interstitial tissue and alveoli • Left ventricular failure • Inhalation of irritating gases • Rapid administration of IV fluids • Barbiturate or opiate overdose

36. Pulmonary Edema • Signs & Symptoms • Dyspnea • Tachypnea • Tachycardia • Cyanosis • Pink or blood tinged, frothy sputum • Restlessness • Agitation • Wheezing • Crackles • Sudden weight gain • Decreased urinary output

37. Pulmonary Edema • Treatment • Oxygen • Mechanical ventilation, if necessary • Diuretics • Lasix • Narcotic analgesics • Morphine will help decrease resp rate • Nipride • Vasodilator that improves myocardial contraction and reduces pulmonary congestion • Strict I&O; Daily weight • Low sodium diet

38. Pulmonary Embolus • Etiology/Pathophysiology • Foreign substance in the pulmonary artery • Blood clot, fat, air, or anmiotic fluid • High risk • Prior thrombophlebitis • Recent surgery, pregnancy, or given birth • Taking contraceptives long-term • Hx of CHF, obesity, or immobilization from fracture

39. Pulmonary Embolus • Signs & Symptoms • Sudden, unexplained dyspnea • Rapid respiratory rate • Hemoptysis • Chest pain • Elevated temperature • Increased WBC

40. Pulmonary Embolus • Treatment • Oxygen • HOB up 30 degrees • Anticoagulants • Heparin (IV) • Gradually tapered • Coumadin (oral) • Initiated as Heparin is tapered • Continued at home for up to 1 year • Fibrinolytic agents

41. Adult Respiratory Distress Syndrome(ARDS) • Etiology/Pathophysiology • Complication of other disease processes • Direct or indirect pulmonary injury • Viral or bacterial pneumonia, chest trauma, aspiration, shock, drug over doses, renal failure, pancreatitis, COPD, Guillain-Barre’ syndrome, and myasthenia gravis • .increased permeability of capillary membrane • .allows fluid to leak into interstitial spaces and alveoli • .pulmonary edema and hypoxia • .alveoli lose their elasticity and collapse • .capillaries allow plasma and RBC’s to leak out, resulting in hemorrhage

42. Adult Respiratory Distress Syndrome(ARDS) • Signs & Symptoms • Respiratory distress • Dyspnea • Restlessness • Tachycardia • Hypotension • Decreased urinary output

43. Adult Respiratory Distress Syndrome(ARDS) • Treatment • Treat cause • Oxygen • Corticosteroids • Diuretics • Morphine • Lanoxin • Antibiotics

44. Chronic Obstructive Pulmonary Disease • Chronic airflow limitation • Includes • Emphysema • Chronic Bronchitis • Asthma • Bronchiectasis

45. Emphysema • Etiology/Pathophysiology • The bronchi, bronchioles and alveoli become inflamed as a result of chronic irritation • Air becomes trapped in the alveoli during expiration, causing alveolar distention, rupture, and scar tissue • Cigarette smoking is primary irritant • Complication: • Cor pulmonale • Right-sided congestive heart failure due to pulmonary hypertension

46. Emphysema

47. Emphysema • Signs & Symptoms • Dyspnea on exertion • Sputum • Initially there is very little • Eventually becomes copius • Barrel chest • Increased anteroposterior diameter caused by overinflation • Chronic weight loss • Emaciation • Clubbing of fingers

48. Barrel-Chest

49. Emphysema • Treatment • Oxygen (low-flow) • 1-2 liters per NC • Chest physiotherapy • Bronchodilators • Theophylline or aminophylline, Isuprel, Brethine, Alupent, Proventil, Bronkosol • Corticosteroids • Antibiotics • Diruretics • Humidifier • Pursed-lip breathing • High-protein, high-calorie diet • Encourage fluids between meals rather than with meals

50. Chronic Bronchitis • Etiology/Pathophysiology • Hypertrophy of mucous gland causes hypersecretion and alters cilia function • Increases suseptibility to infection causing airway scaring • Increased airway resistance causes bronchospasm • Most common cause is cigarette smoking