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Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Diagnostic Tests & Upper Airway Disorders)

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

1 Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Diagnostic Tests & Upper Airway Disorders)

2 Normal Breath Sounds

3 Adventitious Breath Sounds Crackles (Rales) Fine, Medium,Coarse –Sound Sounds like hair being rolled between the fingers close to the ear –Cause Fluid, mucous, or pus in the small bronchi, bronchioles, and alveoli

4 Adventitious Breath Sounds Rhonchi –Sound Low-pitched, loud, coarse, snoring sounds –Cause Narrowing of the tracheobronchial passages due to secretions, tumors, spasms May clear with coughing if due to secretions

5 Adventitious Breath Sounds Wheezes –Sound High-pitched, musical, whistlelike sound during inspiration or expiration –Cause Narrowed bronchioles due to tumor, bronchospasm, or foreign matter

6 Adventitious Breath Sounds Pleural Friction Rub –Sound Dry, creaking, grating, low-pitched sound –Cause Inflammation of pleural surfaces

7 Diagnostic Tests Chest X-ray Provides visualization of the lungs, ribs, clavicles, humeri, scapulae, vertebrae, heart, and major thoracic vessels –Nursing Interventions Hospital gown No metal such as pins, bra hooks, jewelry Computed Tomography (CT) Pictures of small layers of pulmonary tissue Diagonal or cross-sectional

8 Diagnostic Tests Pulmonary Function Testing (PFT) Assess the presence and severity of disease in the large and small airways –Lung Volume Volume of air that can be completely and slowly exhaled after a maximum inhalation –Ventilation Evaluate the volume of air inhaled or exhaled in each respiratory cycle –Pulmonary Spirometry Evaluate the amount of air that can be forcefully exhaled after maximum inhalation – Gas Exchange Determines the degree of function in the pulmonary capillary beds in contact with functioning alveoli

9 Diagnostic Tests Mediastinoscopy –Surgical endoscopic procedure –Endoscope is passed into the upper mediatinum to gather lymph nodes for biopsy Laryngoscopy –Indirect Use of a laryngeal mirror to view the larynx –Direct Local or general anesthesia Laryngoscope passed over the tongue to view the larynx

10 Diagnostic Tests Bronchoscopy –Performed by passing a bronchoscope into the trachea and bronchi –Rigid or flexible bronchoscope –Local anesthetic and IV general anesthetic –Used to observe for abnormalities, tissue biopsy, and secretions collected for exam –Nursing Interventions NPO for 6-8 hours NPO until gag reflex returns Semi-Fowler’s position and turned to side Assess for signs of laryngeal edema or laryngospasms Assess for signs of hemorrhage

11 Bronchoscopy

12 Diagnostic Tests Sputum Specimen Obtained for microscopic examination –Nursing Interventions Must be brought up from the lungs Collect before meals Rinse mouth with water before collection Inhale and exhale deeply three times, cough forcefully, and expectorate into sterile cup Early morning samples are ideal

13 Diagnostic Tests Cytology Studies –To detect the presence of abnormal or malignant cells in sputum, pleural fluid, etc.

14 Diagnostic Tests Thoracentesis The surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid Diagnostic or therapeutic –Nursing Interventions Informed consent Pt sits on the edge of the bed; arms resting on a pillow on overbed table Monitor vital signs, general appearance, and respiratory status during and after procedure Place on unaffected side after procedure

15 Thoracentesis

16 Diagnostic Tests Pulse Oximetry –Monitoring of SaO2 –Measures the amount of light being absorbed by oxygenated and deoxygenated hemoglobin –Clothespin type probe is applied to finger, toe, earlobe or nose

17 Pulse Oximetry

18 Diagnostic Tests Arterial Blood Gases –PaO2 Amount of oxygen dissolved in the plasma (mmHg) –SaO2 Amount of oxygen bound to the hemoglobin compared to the amount of oxygen the hemoglobin can carry (%) –PaCO2 Partial pressure of CO2 in the blood –HCO3 Bicarbonate

19 Diagnostic Tests Normal Values pH PaCO mm Hg PaO mm Hg HCO21-28 mEq/L SaO %

20 Diagnostic Tests Respiratory vs Metabolic –Respiratory PaCO2 Elevated with acidosis; decreased in alkalosis –Metabolic HCO3 Elevated with alkalosis; decreased in acidosis Acidosis vs alkalosis –Acidosis pH of 7.35 and lower –Alkalosis pH of 7.45 and higher

21 Epistaxis Etiology/Pathophysiology –Bleeding from the nose –Congestion of the nasal membranes, leading to capillary rupture –Primary –Seconday Hypertension Irritation of nasal mucosa –Dryness, chronic infection, trauma

22 Epistaxis Signs & Symptoms –Bright red bleeding from one or both nostrils –Can lose as much as 1 liter per hour

23 Epistaxis Treatment –Sitting postion, leaning forward –Direct pressure by pinching nose –Ice compresses to nose –Nasal packing –Cautery –Balloon tamponade

24 Deviated Septum and Nasal Polyps Etiology/Pathophysiology –Congenital abnormality –Injury –Nasal septum deviates from the midline and can cause a partial obstruction –Nasal polyps are tissue growths usually due to prolonged inflammation

25 Deviated Septum and Nasal Polyps Signs & Symptoms –Stertorous respirations (snoring) –Dyspnea –Postnasal drip

26 Deviated Septum and Nasal Polyps Treatment –Medications Corticosteroids Antihistamines Antibiotics Analgesics –Nasoseptoplasty –Nasal polypectomy

27 Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Etiology/Pathophysiology –Antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens

28 Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Signs & Symptoms –Edema –Photophobia –Excessive tearing –Blurring of vision –Pruritus –Excessive nasal secretions and/or congestion –Sneezing –Cough –Headache

29 Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Treatment –Avoid allergen –Antihistamines –Decongestants –Topical or nasal corticosteroids Vancenase, Beconase –Analgesics –Hot packs over facial sinuses

30 Upper Airway Obstruction Etiology/Pathophysiology –Inflammation of tissue –Dentures –Aspiration –Tongue –Laryngeal spasm

31 Upper Airway Obstruction Signs & Symptoms –Stertorous respirations –Altered resp. rate and character –Apneic periods –Hypoxia –Cyanosis –Wheezing –Stridor

32 Upper Airway Obstruction Treatment –Open the airway –Remove obstruction –Artificial airway Pharyngeal, endotracheal, and tracheal –Tracheostomy

33 Tracheostomy

34 Tracheotomy Tubes

35 Cancer of the Larynx Etiology/Pathophysiology –Squamous cell carcinoma –Heavy smoking and alcohol use –Chronic laryngitis –Vocal abuse –Family history

36 Squamous Cell Carcinoma of the Larynx

37 Cancer of the Larynx Signs & Symptoms –Progressive or persistent hoarseness –Pain radiating to the ear –Difficulty swallowing –Hemoptysis

38 Cancer of the Larynx Treatment –Radiation –Surgery Partial laryngectomy –temporary tracheostomy Total laryngectomy –Permanent tracheostomy –No voice Radical neck dissection

39 Acute Rhinitis(Common Cold, Acute Coryza) Etiology/Pathophysiology –Inflammation of the mucous membranes of the nose and accessory sinuses –Virus(es)

40 Acute Rhinitis(Common Cold, Acute Coryza) Signs & Symptoms –Thin, serous nasal exudate –Productive cough –Sore throat –Fever

41 Acute Rhinitis(Common Cold, Acute Coryza) Treatment –No specific treatment –Analgesic NO Aspirin for infants, children and adolescents (Reye’s Syndrome) –Antipyretic –Cough suppressent –Expectorant –Antibiotic, if infection present –Encourage fluids

42 Acute Follicular Tonsillitis Etiology/Pathophysiology –Inflammation of the tonsils –Bacterial infection (streptococcus) –Viral

43 Acute Follicular Tonsillitis Signs & Symptoms –Enlarged, tender, cervical lymph nodes –Sore throat –Fever –Chills –Enlarged, purulent tonsils –Elevated WBC

44 Acute Follicular Tonsillitis

45 Treatment –Antibiotics –Analgesics –Antipyretics –Warm saline gargles –Tonsillectomy and adenoidectomy 4-6 weeks after infection has subsided

46 Acute Follicular Tonsillitis –Post-op Assess for excessive bleeding –Frequent swallowing Ice cold liquids – ice cream –Avoid acidic juices Ice collar Avoid coughing, sneezing, or vigorous nose blowing

47 Laryngitis Etiology/Pathophysiology –Inflammation of the larynx –Acute or chronic –Viral or bacterial –May cause severe respiratory distress in children under 5 yrs

48 Laryngitis Signs & Symptoms –Hoarseness –Voice loss –Scratchy and irritated throat –Persistent cough

49 Laryngitis Treatment –Viral; no specific treatment –Bacterial; antibiotics –Analgesics –Antipyretics –Antitussives –Warm or cool mist vaporizer –Limit use of voice

50 Pharyngitis Etiology/Pathophysiology –Inflammation of the pharynx –Chronic or acute –Frequently accompanies the common cold –Viral, most common –Bacterial Gonococcal Streptococcus (strep throat)

51 Pharyngitis Signs & Symptoms –Dry cough –Tender tonsils –Enlarged cervical lymph glands –Red, sore throat –Fever

52 Pharyngitis Treatment –Antibiotics Penicillin, erythromycin –Analgesics –Antipyretics –Warm or cool vaporizor

53 Sinusitis Etiology/Pathophysiology –Inflammation of the sinuses –Usually begins with an upper respiratory infection –Chronic or acute –Viral or bacterial

54 Sinusitis Signs & Symptoms –Constant, severe headache –Pain and tenderness in involved sinus region –Purulent exudate –Malaise –Fever

55 Sinusitis Treatment –Antibiotics –Analgesics –Antihistamines –Vasoconstrictor nasal spray (Afrin) –Warm mist vaporizor –Warm, moist packs –Nasal windows


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