Caring for Individuals Experiencing Respiratory Challenges NURS2016

Upper Respiratory Tract

Self-Study Common Cold Acute/Chronic Sinusitis Rhinitis Acute/Chronic Pharyngitis

Tonsillitis and Adenoiditis Clinical Manifestations & Treatment Sore throat, fever, snoring and difficulty swallowing. Mouth breathing, earaches, halitosis, frequent colds. Antibiotics Surgical tonsillectomy (& adenoidectomy)

Nursing Care related to T&A Pre-op assessment. Pre-op teaching Post-op –Assess operative site –Ice collar –Analgesia –Ice chips/water –No straws, no coughing, limit talking Risk of Hemorrhage Assess expectorant Assessment swallowing Assess VS Restlessness Hemorrhage at operative site is an emergency.

Ostruction/Trauma of URT Sleep apnea Obstructive Apnea>10sec. & >5x/hr Tx: +ve airway pressure or surgery Nurse educate pt re tx and use of oxygen Epistaxis Pressure, Head tilt Chemical cautery or vasoconstrictors Assess vital signs Preventative strategies

Cancer of Larynx Glottic area, supraglottic area, subglottis Risk factors: carcinogens & others Radiation treatment Surgical treatment –Partial laryngectomy –Supraglottic laryngectomy –Hemilaryngectomy –Total laryngectomy

Airflow and Communication Post-Laryngectomy

Primary Nursing Interventions: Laryngectomy Pre-operative teaching Reducing anxiety and depression Maintaining a patent airway Promoting alternative communication methods Promoting adequate nutrition Promoting home-based care

Primary Nursing Interventions: Laryngectomy Monitoring and managing potential complications –Respiratory distress and hpyoxia –Hemorrhage –Infection –Wound breakdown

Lower Respiratory Tract

Atelectasis Closure or collapse of alveoli Prevention: Education and Reinforcement Frequent position change Early ambulation DB&C Incentive spirometer

Atelectasis Management: Positive expiratory pressure Suctioning secretions, chest physical therapy, bronchiodilators Thoracentesis

Respiratory Infections (lower RT) Acute tracheobronchitis Pneumonia Pulmonary Tuberculosis

Acute Tracheobronchitis Management Antibiotic treatment Expectorants Deep suctioning and ventilation support Nursing Care Increasing fluuid intake Breathing and coughing exercises Encourage rest Education related to medications

Pneumonia Inflammation of Lung Parenchyma Caused by microbial agent: Strep pneumoniae, haemophilus influenzae, legionella, pseudomonas aeruginosa Community Aquired Pneumonia Hospital Aquired Pneumonia Immunocompromised Aspiration Pneumonia

Medical Managment & Complications Management Antibiotic according to sensitivity and Gram stain. Supportive treatment when viral Oxygen if hypoxic Complications Shock and respiratory failure Atelectasis and pleural effusion (empyema) Superinfection

Nursing Assessment Pneumonia T & P Secretions/expectora nt CoughRespirations Chest assessment

Nursing Diagnoses

Nursing Interventions Pneumonia Improving airway patency Promoting rest and conserving energy Promoting fluid intake Maintaining nutrition Monitoring and managing potential complications

Pulmonary Tuberculosis Infectious disease of the lung parenchyma Mycobacterium tuberculosis Worldwide public health problem Common TB meds: isoniazid, rifampin, streptomycin, pyrazinamide, ethamutol

Nursing Assessment TB FeverAnorexia Weight loss Night sweats Fatigue Enlarged and painful lymph nodes CoughSputum Ecophony, fremitus Diminished bronchial sounds & crackles

Nursing Diagnosis Knowledge deficit about tx regimen & preventative health measures Medication regimen is complex TB is highly communicable – meds are the most effective means of preventing transmission Medication side effects are primary reason for D/C

COPD A disease state characterized by airflow limitation that is not fully reversible Often include diseases such as chronic bronchitis and emphysema Risk factors: active and passive smoking, occupational exposure, air pollution and genetic abnormalities

Chronic Bronchitis Presence of cough and sputum for at least 3 months past 2 years. Bronchial walls thicken and lumen narrows Increased susceptability to RTI

Emphysema Abnormal distention of the air spaces beyond the terminal bronchioles with destruction of the walls of the aveoli. Usually long history of smoking Dyspnea becomes the major symptoms

Nursing Care COPD Nursing Assessment Focus on symptoms Disease history Become familiar with chart pg 578 Nursing Diagnosis Impaired gas exchange Ineffective airway clearance Ineffective breathing pattern Self-care deficit Activity intolerance Ineffective coping Knowledge deficit

Nursing Interventions COPD Breathing exercises Inspiratory muscle training Activity pacing Self-care activities Physical conditioning Oxygen therapy Nutritional therapy Coping measures

Therapeutic Approach COPD Treatment to improve ventilation and decrease work of breathing. Prevention & tx of infection Improve energy conservation techniques Proper environmental conditions Psychological support Ongoing education

Oxygen therapy and COPD Because hypoxemia, rather than high carbon dioxide, drives respiration in COPD, and Because oxygen therapy can raise oxygen levels in the blood COPD patient receiving oxygen tx may experience decreased stimulation to breath

Asthma Inflammatory disease of airways –Hyper-responsiveness –Mucosal edema –Mucous production –Reversible process *Prevention: identify substances that precipitate symptoms

Nursing Care Asthma Assess resp status Severity of symptoms Breath sounds Peak flow Pulse oxymetry Vital signs Hx of allergy to meds Current med regimen Admin and monitor medication Ensure hydration Monitor S&S infection Provide psychological support

Pulmonary Embolism Obstruction of pulmonary artery by a thrombus Can also be air, fat, or amniotic fluid emboli Risk factors (p.472) Venous stasis Hypercoagulability Venous endothelial disease Certain disease state Other: age, obesity, clothing, pregnancy.

Nursing Care Pulmonary Embolism Minimize the risk (know the risks) Prevent thrombus formation Monitor thrombolytic therapy Manage pain Oxygen therapy

Pulmonary Embolism Often sudden Painful: ischemia Immediate SOB

Reminder Self study upper respiratory track Focus on promoting health through –Preventative approaches –Facilitate quality of life while living with chronic respiratory challenges