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Nursing of Adults With Medical & Surgical Conditions

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Presentation on theme: "Nursing of Adults With Medical & Surgical Conditions"— 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 Antitussives
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) Medications
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 Severe chills
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 Dyspnea Cough
Usually radiates to the shoulder or abdomen Dyspnea Cough Elevated temperature Pleural friction rub

17 Pleurisy Treatment Antibiotics Analgesics Antipyritics Oxygen
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 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

31

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 Barrel chest
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) Chest physiotherapy
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 Dyspnea
Especially in the mornings Dyspnea Use of accessory muscles to breath Wheezing

52 Chronic Bronchitis Treatment Bronchodilators Mucolytics Antibiotics
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 Acute Asthma Attack
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 Acute or Rescue 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 Bronchiectasis 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) Chest physiotherapy
1-2 liters per NC Chest physiotherapy Hydration Mucolytic agents Mucomyst Antibiotics Bronchdilators Theophylline Cool mist vaporizer Surgery Lobectomy


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