1. Respiratory System Disorders
HLTAP501A
Analyse Health Information

2. Pneumonia

3. Types Aspiration Lobar Bronchial Viral Bacterial - most common
Atypical - mycobacterium

5. Aspiration pneumonia
Is an inflammatory condition of the lungs and bronchi caused by the inhalation of food/fluid or vomitus
The affects of this type will depend on
The substance inhaled
The amount
The resulting inflammation and/or destruction of lung tissue

6. Infective pneumonia
The body’s defences fail to prevent inhaled or airborne microbes reaching and colonising in the lungs
This can be achieved by
Inhalation of infective organisms
Aspiration of infective organisms from
The upper respiratory tract
From gastric contents
Haematogenous – common in bacteraemia or secondary to UTI

7. Causes Lowered resistance URTI
Depression of CNS (head injuries, drugs)
Alcohol abuse
Cardiac failure
Debilitating illness
Super-infection in hospitalised patients
Exposure to intense cold, dampness
Any bronchial obstruction
Prolonged immobilisation
Pulmonary oedema and congestion
Impaired coughing
alcohol suppresses macrophage function and white cell mobilisation

8. Treatment Mouth / skin care Encourage fluids
Nurse client sitting upright
Encourage cough / physiotherapy
Analgesia (pleuritic pain)
O2 therapy

9. Prevention Natural resistance should be maintained
Avoid contact with people with URTIs
Obliteration of cough reflex and aspiration should be avoided
Highly susceptible people should be immunised
Immobilised patients should be turned every two hours and encouraged to deep breath and cough

10. Complications Pleuritis – may lead to pneumothorax, empyema
Pleural fibrosis
Abscess formation
Chronic lung disease – leading to interstitial fibrosis
Bronchiectasis (bronchial dilation)

11. Chronic Obstructive Airway Disease (COAD)

12. Exemplified by chronic bronchitis and obstructive emphysema and asthma
Patients may have a history of:
Smoking
Dyspnoea, where labored breathing occurs and gets progressively worse
Coughing and frequent pulmonary infections
People with COPD may develop respiratory failure accompanied by hypoxaemia, carbon dioxide retention, and respiratory acidosis

13. Pathogenesis of COAD

14. Asthma
Characterized by shortness of breath, wheezing, and chest tightness
Active inflammation of the airways precedes bronchospasm
Airway inflammation is an immune response caused by release of IL-4 and IL-5, which stimulate antibodies and recruit inflammatory cells
Airways thickened with inflammatory mucus magnify the effect of bronchospasm

16. Other Respiratory Diseases
Tuberculosis
Infectious disease caused by the bacterium Mycobacterium tuberculosis
Symptoms include fever, night sweats, weight loss, a racking cough, and splitting headache
Treatment entails a 12-month course of antibiotics

18. Other Respiratory Diseases
Lung Cancer
Squamous cell carcinoma (20-40% of cases) arises in bronchial epithelium
Adenocarcinoma (25-35% of cases) originates in peripheral lung area
Small cell carcinoma (20-25% of cases) contains lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize

19. Incidence and mortality rates: national
Lung cancer is the fifth most common registerable cancer in Australia.
Around 8,200 Australians are diagnosed with lung cancer each year.
More than 7,000 Australians die from lung cancer each year.
One in 33 Australians will develop lung cancer by the age of 75.

20. Risk factors/Prevention
Smoking is a major cause of lung cancer.
Smokers and workers exposed to industrial substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons and chloromethyl ether have a significantly higher risk of developing lung cancer.
Research has also demonstrated a link between passive smoking and lung cancer.

21. Symptoms
Lung cancer is very difficult to detect at an early stage, some symptoms may include:
A new or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion.
Recurring episodes of lung infection, weight loss and swelling of the face or arms are also common symptoms.

22. Treatment
There are a few different types of treatment for lung cancer (with different aims):
Surgery - This is used to remove all the cancer in the hope of a cure.
Chemotherapy - This is a course of drugs given to kill or control the cancer cells.
Radiotherapy - This is a course of x-rays given to kill or control the cancer.
Laser treatment - This is used to control the cancer cells. It is used to unblock airways full of tumour, but it does not cure the cancer.

23. Lung Cancer

24. Pneumothorax
Is the accumulation of air or gas in the pleural cavity, resulting in the collapse of the lung on the affected side
Haemothorax – blood in pleural cavity
Haemopneumothorax – blood and air in the pleural cavity

25. Pneumothorax

26. Types
Closed
Open – sucking wound
Tension

27. Causes Spontaneous Chest trauma Surgery Central line insertion
Positive pressure ventilation

28. Spontaneous pneumothorax
May occur in healthy individuals and is often due to a rupture of a sub pleural bleb (often affects tall, thin men between yrs)
May be a complication of underlying pulmonary disease such as COAD, asthma, cystic fibrosis, TB, pertussis

29. Clinical manifestations
Sudden sharp chest pain - made worse by deep breath or cough
Dyspnoea – sudden onset
Chest tightness
Easily fatigued
Tachycardia
Cyanosis
Unilateral pleuritic pain
Tachypnoea
Subcutaneous emphysema
Pallor
Diaphoresis
Reduced movement on affected side
Open pneumothorax may reveal obvious haemorrhage or foreign body in chest wall

30. Treatment If small then it may require no intervention More extensive
Insertion of an intercostal catheter (ICC)
Connection to underwater seal drainage (UWSD) system
Non resolution or reoccurrences may need surgical intervention

31. Thoracic drainage
This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural space
Air
Fluids such as blood, pus, chyle, serous fluid, gastric juices
Solids such as blood clots

32. Thoracic drainage
This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural space
Air
Fluids such as blood, pus, chyle, serous fluid, gastric juices
Solids such as blood clots

34. Thoracic drainage Tube placement
Is placed in the 2nd, 3rd, or 4th intercostal space.
The tube is sutured in and has an occlusive dressing applied to prevent air leaks
Determined by the substance to be drained
Smaller gauge tubes for air
Larger gauge tubes for fluids
Pneumothorax – usually one tube
Haemothorax – usually two tubes

35. Under water seal drainage
This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to reenter.

36. Under water seal drainage system
This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to re-enter.
A chamber containing water
A chamber for collection of fluids or solids
May be connected to suction

37. Nursing care Patient may be nursed in semi Fowlers position
Oxygen and analgesia may be needed
Allay anxiety
Encourage deep breathing and coughing
Patient to splint the affected side when coughing
Check respirations – noting chest movement
Report increase in respiratory rate or distress, increase in pain or abnormally large increase in drainage to RN Div 1
Check dressing daily – maintain asepsis

38. Nursing care
Tubing
Clamping – to be achieved with two clamps (rubber clipped forceps) above the connection to the UWSD when
It is necessary to lift system above the level of the bed
Changing the system
Observe for
Kinks
Dependent loops
Flattening
Loosening of connections
Blockage
Tube dislodgement

39. Nursing care Drainage system
Check the character, consistency and quality of drainage
Mark the drainage level – noting time and date (usually done each shift)
Check for oscillation (swinging of the fluid in rhythm with the patient’s breathing) may be as much as 5-10cm
Check for intermittent bubbling of air (pneumothorax)
Ensure suction is maintained at ordered pressure