respi diseases [compatibility mode]

8/6/2019 RESPI DISEASES [Compatibility Mode]

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RESPIRATORY DISEASES


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CRONIC OBSTRUCTIVE

PULMONARY DISEASESCOPD


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Chronic Obstructive Pulmonary Disease (COPD)Chronic Obstructive Lung Disease

Chronic Airway Limitation- Chronic Bronchitis and Emphysema

- Features of this disease:

- Pts almost always have a history of smoking

- labored breathing (dyspnea) becomesprogressively more severe

- Coughing and frequent pulmonary infections arecommon

- most victims retain carbon dioxide, are hypoxic,and have respiratory acidosis

- those infected will ultimately develop respiratory

failure


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SIGNS AND SYMPTOMS:

- Easy fatigue

- Pursed lip breathing

- Barrel chest

- Dyspnea, Orthopnea- Retraction

- Wheezing on expiration

- Clubbing


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Chronic ObstructiveChronic Obstructive

Pulmonary Disease (COPD)Pulmonary Disease (COPD)


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- Basis:

- chronic airway blockage- resistance- progressive airflow limitation both ways- irreversible alveolar distentionair trapping

alveolar damageABG imbalances:low pO2, high pCO2

- Possible Complications:- pulmonary hypertension- respiratory insufficiency or failure- Cor Pulmonale- CO2 narcosis- atelectasis


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CHRONIC BRONCHITISCHRONIC BRONCHITIS


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- Is an inflammation of the bronchioles thatimpairs airflow- Mucosa of the lower respiratory passages

becomes severely inflamed- Mucus production increases- Pooled mucus impairs ventilation and gas

exchange- Risk of lung infection increases- Pneumonia is common- Hypoxia and cyanosis occur early


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PATHOPHYSIOLOGY:

a. Enlargement and hyperactivity of goblet cellsb. irritation of bronchiole tissuec. inflammation and narrowing of airwaysd. concurrent infections

e. further obstructionf. Pneumonia (as complication)g. chronic can lead to emphysema

SIGNS AND SYMPTOMS:- coughing- excessive sputum production- shortness of breath


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NURSING INTERVENTIONS:

a.a. eliminate/minimize pts exposure to irritantseliminate/minimize pts exposure to irritantsand people with RTIand people with RTI

b.b. Clear airways with chest physical therapy orClear airways with chest physical therapy orsuctioning as orderedsuctioning as ordered

c.c. Mucolytics as prescribedMucolytics as prescribedd.d. DeepDeep--breathing exercisesbreathing exercises

e.e. Patient teaching about adequate nutritionPatient teaching about adequate nutritionand medication therapyand medication therapy


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EMPHYSEMAEMPHYSEMA


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-Terminal stage of COPD- Overdilated alveoli and bronchioles- Chronic inflammation promotes lung fibrosis- Airways collapse during expiration- Patients use a large amount of energy to

exhale- Overinflation of the lungs leads to a

permanently expanded barrel chest- Cyanosis appears late in the disease

- Nsg Dx: impaired gas exchange


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ETIOLOGY

A. Predisposing factors:

- A-ge- H-eredity

- A- uto Immune tendency

B. Precipitating factors:

- B-ronchitis, chronic

- A-ir pollution

- S-moking- A-sthma, chronic


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LUNG CANCER


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- Refers to malignant tumor growth within thebronchial tissue or lung parenchyma

- Types include:- Squamous cell 35-50% of all lung Ca- Adenocarcinoma 15-35% of all lung Ca- Small cell 20-25% of all lung Ca- Large cell 10-15% of all lung Ca


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ETIOLOGY AND INCIDENCE:

- Predisposing factors:- chronic exposure to pulmonary irritants- Family history of lung cancer- Tend to have poor prognosis, unless it is well

defined and removed by surgery

PATHOPHYSIOLOGY:a. As lung tissue is irritated, it undergoes series

of changes giving rise to a tumor.b. Metastasis can occur, especially if primary

tumor is an area of lymph drainagec. Some tumors secrete hormones: ADH, ACTH


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SIGNS AND SYMPTOMS:

- cough- wheezing- shortness of breath- chest pains- hoarseness of voice- dysphagia

- weight loss


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NURSING INTERVENTIONS:

- Prepare pt for surgery if tumor is smallenough to be removed

- Prepare pt for planned treatmentschemotherapy/radiation therapy

- Analgesics as ordered to control pain- Adequate oxygenation through O2 therapy

or planned activity-rest- Maintain nutritional status- Provide emotional support to patient and

family


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ATELECTASIS


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Refers to collapse of previously expanded lung

- A shrunken airless state of the alveoli- Can be primary or secondary


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ETIOLOGY:

a. Primary- lung tissue remains uninflated as a result ofinsufficient surfactant production

- present at birth typically on premature and at-risk infants

b. Secondary- caused by airway obstruction, lung

compression, and increased recoil due todiminished surfactants

c. airway obstruction may be due to mucusplugs, tumors or exudates

d. its risks increases after surgery


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PATHOPHYSIOLOGY/MANIFESTATIONS

a. surfactant must be constantly replenishedb. ineffective cough reflexdecreased tidalvolume poor alveolar expansion

c. increased viscosity of sputum pooling ofsecretions

d. complete airway obstruction collapse ofthat portion of lung

SYMPTOMS:- crackles- diminshed breath sounds from poor air entry- dyspnea and tachycardia- hypoxemia


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OVERVIEW OF NURSING INTERVENTIONS

- encourage deep breathing and coughing

- encourage the performance of incentivespirometry- administer antibiotics as ordered- administer oxygen if necessary


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PNEUMOTHORAXPNEUMOTHORAX


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- It is the accumulation of air in the pleural space,which results in partial or complete lung collapse

TYPES:a. tension - air enters but cant leave pleural spaceb. secondary - air enters pleural space as a result of

injury to chest wall, resp. structures or esophagusc. spontaeous air enters pleural space when air-filled blebs (blisters) on lung surface ruptures

ETIOLOGY:a. tension unknown causeb. secondary injury to chest wall from traumac. spontaneous ruptured bleb(common in

smokers)


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SYMPTOMS:- pleuritic pain (sharp pain during inhalation)

- tachypnea- dyspnea- asymmetry of chest wall (from rib fractures)- decreased breath sounds over area of

pneumothorax- trachea deviating to injury site- shifting of mediastinal structures to unaffected

side of unaffected chest

- signs of shock (from large pneumothorax)

In tension pneumothorax, onset is sudden andpainful


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NURSING INTERVENTIONS

- monitor v/s, signs of shock- observe respirations; changing patterns may

indicate worsening situations- semi-Fowlers position

- administer oxygen as necessary- analgesics as ordered- chest tube:

- maintain sterile dressing at chest tube

insertion site- maintain patency and integrity of closed

chest drainage system- evaluate amount of fluid and breath sounds


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PLEURAL EFFUSION


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-Refers to an abnormal accumulation of fluid inthe pleural space or cavity

-fluid may be transudate(hydrothorax),exudates(empyema), blood(hemothorax), orchyle(chylothorax) chyle is a milky fluidfound in lymph fluid from GI tract


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ETIOLOGY

a. Hydrothorax results from CHF, RF,nephrosis and liver failure

b. Emyema - from infections, malignancies, SLE

c. Hemothorax chest injuries, chest surgerycomplications, malignancies, blood vesselrupture

d. Chylothorax trauma, inflammation ormalignant infiltration


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PATHOPHYSIOLOGY/MANIFESTATIONS1. 5 mechanisms:

- increase capillary pressure- increase capillary permeability- increase intrapleural negative pressure- impaired lymphatic drainage of the pleura

2. results in decreased lung volume on theaffected side and a mediastinal shift onthe other sidedecreased lung volume onthe other side as well

3. characteristic signs: diminished breathsounds, flatness and dullness topercussion


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4. Other symptoms are:- dyspnea, pleuritic pain, constant discomfort

5. severeity of hemothorax is determined by

volume of fluid:- minimal(300-500cc) resolves in 10-14 days- moderate(500-1000cc)- large(1000cc or more) fills half or more of

the chest and requires immediatedrainage


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1. observe patient for signs of shock2. administer analgesics as prescribed3. for moderate to large:

- maintain fluid replacement as ordered- assist with insertion of chest tube as ordered- maintain patency of tube

- prepare for surgery if bleeding doesnt stop


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ADULT RESPIRATORY

DISTRESS SYNDROME(ARDS)


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-A sequelae of several diseases in which thelungs fill with water, making gas exchange

impossible

ETIOLOGYa. unknown cause

b. Predisposing factors:- pneumonia- near drowning- reaction to drugs and inhaled gases

- shock infection- diabetic ketoacidosis- trauma- burns


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PATHOPHYSIOLOGY- results to decreased lung compliance andincreased work of breathing

Symptoms include:- crackles and gurgles- hypoxemia due to poor diffusion- respiratory distress

- x-ray result: mass consolidation- ABG analysis: respiratory acidosis


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1. monitor fluid intake2. administer steroids as ordered reduceinflammation3. assess for complication like pneumothorax4. institute PEEP5. provide care necessary for a mechanicalventilator

6. protect the airway from injury7. relieve anxiety


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ACUTE RESPIRATORYFAILURE


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-A disease sequelae which occurs when thelungs are unable to adequately oxygenatethe blood(hypoxemia)

- pO2 is less than 50 mmHg and CO2 is morethan 50 mmHg

ETIOLOGY

a. infections like pneumoniab. COPD exacerbations


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PATHOPHYSIOLOGY

a. loss of ventilation/perfusionaltered gasexchange hypoxia and hypercapniab. hypoxia stupor, coma, bradycardia, andhypotension

c. hypercapnia:- vasodilation shock- sedation of CNS- respiratory acidosis

d. other symptoms- tachycardia, diaphoresis, restlessness,agitation, cool skin


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1. mechanical ventilator with O2 asordered to maintain airway, nutritionand hydration2. assess for complications ofpneumothorax3. administer antibiotics as ordered(if

infection is present)4. administer bronchodilator asprescribed


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PNEUMONIA


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-An acute infection of the lung parenchyma

ETIOLOGY- include bacteria, viruses, fungi and protozoa- severity may depend on extent present(partial/full,lobar or diffused-bronchopneumonia

SYMPTOMS:

- fever, chills, rales and ronchi, dyspnea,malaise, cough, pleuritic chest pain


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PATHOPHYSIOLOGYa. organisms enter respiratory tractb. overwhelming infxn/immunosuppression

(invading organism multiplies)

c. release toxinsd. increase capillary permeabilitye. edema of the lung parenchymaf. cellular debris and exudates

g. if filled, may lead to airless stateh. cosolidation


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NURSING INTERVENTIONS1. administer antibiotics specific for thecausative agent, as ordered2. control fever3. encourage adequate fluid intake4. provide bronchial hygiene5. maintain adequate nutritional status6. chest physiotherapy

7. oxygen, as ordered


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RESPIRATORY TRACT

INFECTION


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-RTI affects airway clearance and breathingpatterns by changing the amount and character

of secretions- severe RTI include Pneumonia and PTB- risk factors:

- exposure to infected persons

- stress or other immunocompromised states


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EPISTAXIS


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- causes: trauma, HPN, cancer, foreign

body- Nsg Interventions:- sit up, lean forward, head tipped- pressure application for 5 mins

- cold compress or ice pack- liquid then soft diet- avoid oral temp taking- do not blow nose for 2 days after

removal nasal pack- notify MD if epistaxis is persistent or

recurrent


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SINUSITIS


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- URTI, cigarette smoking, allergic rhinitis

- S/S:- pain

- maxillary-cheek/upper teeth- frontal-above eyebrows

- ethmoid-in and around eyes- shpenoid-behind eye,occiput, top of head

- general body malaise- stuffy nose headache

- post nasal drip- persistent cough- fever


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TONSILLITIS


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- S/S: sore throat, fever, snoring, dysphagia,mouth breathing, earache,frequent head colds,bronchitis, halitosis, voice impairment, noisyrespirations, draining ears

-Nsg. Interventions:- promote rest- increase oral fluid intake- warm saline gargle

- analgesics as ordered- antimicrobial as ordered


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-Preop care:- assess for URTI, coughing & sneezing may

cause bleeding- check prothrombin time

- Post op care:- prone, head turned to side or lateral position

- oral airway until swallowing reflex returns- monitor for hemorrhage- frequent swallowing- bright red vomitus

- increased PR- promote comfort- ice collar- acetaminophen- foods and fluids


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CLIENT EDUCATION- avoid clearing of throat- avoid coughing, clearing of throat for 2 weeks- 2-3 L of fluids until mouth odor disappears

- avoid hard scratchy food until throat is healed- report signs of bleeding- throat discomfort on the 4th-8th post op day isnormal

- stool may be black/dark for a few days due toswallowed blood


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