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Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Lower Airway)

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Presentation on theme: "Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Lower Airway)"— Presentation transcript:

1 Nursing of Adults With Medical & 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 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 RBCs 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 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

51 Chronic Bronchitis Signs & Symptoms –Productive cough Especially in the mornings –Dyspnea –Use of accessory muscles to breath –Wheezing

52 Chronic Bronchitis Treatment –Bronchodilators Theophylline, aminophylline, etc –Mucolytics Mucomyst –Antibiotics Erythromycin –Oxygen (low-flow) 1-2 liters per NC –Pursed-lip breathing

53 Asthma Etiology/Pathophysiology –Narrowing of the airways due to various stimuli –Extrinsic External factors –Pollens, dust, feathers, animal dander, foods –Intrinsic Internal causes –Respiratory infection –Influenced by secondary factors Mental or physical fatigue and emotional factors –Antigen-antibody reaction

54 Asthma Signs & Symptoms –Mild Asthma Dyspnea on exertion Wheezing –Acute Asthma Attack Usually at night Tachypnea Expiratory wheezing Use of accessory muscles Nasal flaring Cyanosis Productive cough –Status asthmaticus Severe, unrelenting attack that fails to respond to usual treatment Leads to exhaustion and respiratory failure

55 Asthma Treatment –Maintenance Therapy Serevent inhalant, prophylactic Corticosteroid inhalant –Floevent Avoid allergens –Acute or Rescue Therapy Proventil inhalant Corticosteriod and epinephrine oral or sq Aminophylline IV Oxygen –Monitor by pulse oximetry

56 Bronchiectasis Etiology/Pathophysiology –Gradual, irreversible process that involves chronic dilation of bronchi resulting in loss of elaticity –Repeated pulmonary infections –Secondary causes may be cystic fibrosis, foreign body, or tumor

57 Bronchiectasis

58 Signs & Symptoms –Dyspnea –Cyanosis –Clubbing of fingers –Coughing Esp in the morning and when lying down Copious amounts of foul-smelling sputum –Fatigue –Weakness –Loss of appetite –Wheezes and crackles

59 Bronchiectasis Treatment –Oxygen (low-flow) 1-2 liters per NC –Chest physiotherapy –Hydration –Mucolytic agents Mucomyst –Antibiotics –Bronchdilators Theophylline –Cool mist vaporizer –Surgery Lobectomy

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