Respiratory System Disorders HLTAP501A Analyse Health Information

Pneumonia

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

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

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

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

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

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

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

Chronic Obstructive Airway Disease (COAD)

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

Pathogenesis of COAD

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

http://www.dentalgentlecare.com/new_page_31.htm

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

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

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. http://www.cancercouncil.com.au

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.

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.

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. http://www.cancercouncil.com.au

Lung Cancer

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

Pneumothorax http://www.virtualrespiratorycentre.com/HumanAtlas/flash_content/clientNF.asp?anid=207

Types Closed Open – sucking wound Tension

Causes Spontaneous Chest trauma Surgery Central line insertion Positive pressure ventilation

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 20-40 yrs) May be a complication of underlying pulmonary disease such as COAD, asthma, cystic fibrosis, TB, pertussis

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

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

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

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

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

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.

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

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

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

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