respiratory disorders
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Respiratory DisordersNio C. Noveno, RN ,MAN
nionoveno@yc respi disorders 2
PneumoniaAcute inflammatory process of the alveolar spaces
lung consolidation exudate [alveoli]
Classification CAP: most common; occurs in the community or 48
H before hospitalizationS. pneumoniae, H. influenza, M. pneumoniae
Nosocomial: onset of S/S is 48-72 H post-hospitalization
P. aeruginosa, S. pneumoniae, K. pneumoniae
Aspiration pneumoniaS. pneumoniae, H. influenza, S. pneumoniae, gastric contents
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PneumoniaTypes
Bacterial pneumonia Lobar [Strep] – constant dry, hacking cough,
pleuritic pain, watery to rust-colored sputum Bronchopneumonia [Strep/Staph] – due to
aspiration, productive cough w/ yellow or green sputum
Alveolar pneumonia [viral] – scanty sputum
Atypical pneumonia [rickettsial] – “walking”, non-productive cough
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Pneumonia
Clinical ManifestationsCoughChills
DyspneaElevated temperature
Crackles Rhonchi
Pleural friction rubSputum production
Rusty, green, or bloody: pneumococcalYellow-green: BPN
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PneumoniaPneumocystis carinii pneumonia
Opportunistic infectionOften related to HIV
& other immunocompromised conditions
Clinical ManifestationsIncreasing SOB
Nonproductive coughLow-grade fever
TreatmentCotrimoxazolePentamidine
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Pneumonia
ManagementIncrease OFI 3-4 L/day.
Administer O2.Assess respiratory status.
Monitor VS, I/O, lab studies, & pulse oxMonitor & record color, consistency,
& amount of sputum
Home careRecognize s/sx of infection.
Avoid exposure to people with infections.Increase OFI at 3 L/day.
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Chronic Obstructive Pulmonary DiseaseBronchitis
Emphysema
CausesCongenital weakness
Respiratory irritants: smoke, polluted air, chemical irritants
Respiratory tract infectionsGenetic predisposition
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Chronic Obstructive Pulmonary Disease
Chronic Bronchitis
Excessive bronchialmucus
production
Chronic or recurrent
productive cough
Smoking, RTI, PollutantsSmoking, RTI, Pollutants
Mucosal edemaMucosal edema
InflammationInflammation
Bradykinin, Histamine, PGsBradykinin, Histamine, PGs
Fluid/Cellular ExudationFluid/Cellular Exudation
Hypersecretion of mucusHypersecretion of mucus
Persistent CoughPersistent Cough
Capillary permeabilityCapillary permeability
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Chronic Obstructive Pulmonary Disease
Emphysema
Destruction of elastin alters alveolar walls& narrows airways
Enlargement of air spaces distal
to terminal bronchioles leads to coalesced alveoli
& air trapping
Smoking, heredity,Smoking, heredity,aging processaging process
Loss of elastic recoilLoss of elastic recoil
Disequilibrium betweenDisequilibrium betweenelastase & antielastaseelastase & antielastase
Overdistention of alveoliOverdistention of alveoli
CO2 retentionCO2 retention
HypoxiaHypoxia
Respiratory acidosisRespiratory acidosis
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EmphysemaEmphysema
No cyanosis (Pink)Thin appearance
Exertional dyspneaIneffective cough
Barrel chestPursed-lip breathingProlonged expiration
Use of accessory muscles
R-sided Heart FailurePulmonary HPNSpontaneous
pneumothorax
ChronicChronicBronchitisBronchitis
Cyanosis (Blue)Edematous
Exertional dyspneaRecurrent cough w/Sputum production
Digital clubbingRespiratory rateUse of accessory
musclesR-sided Heart Failure
Cor pulmonale
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Chronic Obstructive Pulmonary DiseaseManagement
Rest: O2 demand of tissues Fluid intake: 3 L/day Diet: calorie, CHON, CHO, vit. C Low-flow O2 therapy: 1-3 LPM Breathing exercises [pursed-lip] Avoid cigarette smoking, alcohol, pollutants CPT: postural drainage percussion vibration Bronchial hygiene measures: steam, aerosol,
medimist inhalation Pharmacotherapy: Antitussives, bronchodilators,
antihistamine, steroids, antimicrobials
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Chronic Obstructive Pulmonary Disease
Bronchiectasis
Destruction of bronchial mucosa with fibrous scar
tissue formation
Loss of resilience& airway dilation causes
pooling of secretions
Obstruction of airflow
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Chronic Obstructive Pulmonary DiseaseAsthma ALLERGY (Extrinsic)
INFLAMMATION (Intrinsic)
BronchospasmMucosal edema
Hypersecretion of mucus
Histamine, Bradykinin,
PG, Serotonin, Leukotrienes…
Narrowing of AWs, work of breathing
Hypoxia & Respiratory Acidosis
Respiratory effortExhaustion
Hypoventilation Air trapping
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Chronic Obstructive Pulmonary Disease
Clinical Manifestations
OrthopneaRestlessness
Dyspnea, tachypneaTachycardiaNasal flaringRetractions
CoughChest tightness
Cold clammy skinWheezingCyanosis
Asthma Management Pharmacotherapy
Beta agonists [Epinephrine, Terbutaline]
Methylxanthines [Aminophylline]
CorticosteroidsAnticholinergics [Atropine]Mast cell inhibitors
[Cromolyn] Oxygen via nasal cannula Fluids to 3L/day Breathing exercises Metered dose inhaler
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Acute Respiratory Distress Syndrome
Clinical syndrome of respiratory insufficiencyDamaged capillary membranes
Interstitial edemaIntraalveolar hemorrhage
HypoxemiaCauses
Viral pneumoniaFat emboli
SepsisDecreased surfactant production
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Acute Respiratory Distress Syndrome
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Acute Respiratory Distress SyndromeClinical
ManifestationsDyspnea
TachypneaCracklesRhonchiAnxiety
Breath sounds
Management Intubation & mechanical
ventilation using PEEP Pharmacotherapy
AntibioticsAnalgesicsSteroidsNeuromuscular blocking
agentsDiagnosticsABGs:
Respiratory acidosis,
hypoxemiaCXR:
interstitial edema
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Chest Physiotherapy
Postural drainage Percussion Vibration
Nursing CarePerform before or 3-4 hrs after mealBronchodilators 15-20 mins before
Remove all tight clothingPercuss on area approx 3mins during I & E
Vibrate on area during EAssist pt in coughing & positioning
Provide good oral hygiene
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Chest PhysiotherapyPostural Drainage
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Pulmonary Tuberculosis
Airborne, infectious, communicableAcute or chronic
Mycobacterium tuberculosis
Clinical ManifestationsFatigue, malaise
Anorexia, weight lossNight sweats
Late afternoon low-grade feverProductive chronic coughHemoptysis (advanced)
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Pulmonary TuberculosisDiagnosticsMantoux test
Read after 48-72 H[>10 mm induration]
Chest x-rayCalcified lesionsSputum exam
Acid-fast bacillus
ManagementTB medications [6-12 mos]
INH, RIF, (6 mos);PZA, ethambutol, streptomycin
(2 mos)Pt non-infectious 2-3wks of Tx
9 mos continuous therapy
RIF: discoloration ; hepatotoxicINH: peripheral neuropathy (B6), liver function test (AST,
ALT)PZA: thrombocytopenia, hyperurecemia → ↑ OFIETHAMBUTOL: optic neuritis STREPTOMYCIN: hepatotoxic, nephrotoxic, ototoxic, given
IM
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Pleural Effusion & Pneumothorax
CausesTrauma
Thoracic surgeryPositive pressure
ventilationThoracentesis
CVP line insertionEmphysema
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Pleural Effusion & Pneumothorax
Clinical ManifestationsSudden sharp chest pain
Shortness of breath (SOB)Restlessness/anxiety
Tachycardia, tachypneaDiminished/absent BS
Chest asymmetryTracheal deviation
towards unaffected sideTympany
ManagementHigh-Fowler’s
Pain reliefO2 therapy
Chest tube insertionThoracentesisChest x-ray
ABGsMonitor for shock
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Pulmonary Embolism
Undissolved substance in pulmonary vasculature obstructs blood flow
Types: Fat, Air, Thrombus
CausesFlat or long bone fractures
ThrombophlebitisVenous stasis
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Pulmonary Embolism
Clinical ManifestationsDyspnea, tachypnea, crackles
DiagnosticsABGs
Respiratory alkalosis, hypoxemiaLung Scan
Pulmonary circulation & blood flow obstructionAngiography
Location of embolusFilling defect of pulmonary artery
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Pulmonary Embolism
Management
Intubation & mechanical ventilationAnticoagulantsThrombolytics
Assess for (+) Homan’s signMonitor PT & PTT
WOF S/S of excessive anticoagulation
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Bronchogenic CarcinomaPrimary pulmonary tumors arising from bronchial
epithelium; metastasis primarily by direct extension,via the circulatory or the lymphatic systems
IncidenceMen > 40 years; 1 out of 10 heavy smokers
Right lung > Left lung
EtiologyInhaled carcinogens
[cigarette smoke, asbestos, nickel, iron oxides]Pre-existing pulmonary DO [COPD, TB]
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Bronchogenic Carcinoma
Clinical ManifestationsPersistent cough
[productive, blood-tinged]Chest pain, dyspneaUnilateral wheezing
Friction rubFatigue, anorexia
Nausea & vomitingPallor
DiagnosticsCXR
Presence of tumor; metastasis
Sputum for cytology Malignant cellsThoracentesis
Pleural fluidwith malignant cells
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Bronchogenic Carcinoma
ManagementDepends on cell type, stage of disease,
and condition of the patientRadiation therapy
ChemotherapySurgery
Provide support & guidance to clientRelief/control of pain and nauseaMeds as ordered, monitor effects
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Lung Cancer
Maybe metastatic or primaryLeading cause of mortality
Smoking-relatedPoor prognosisDies in 5 years
AdenocarcinomaMost prevalent typeSmall cell carcinoma
Poorest prognosis
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Laryngeal Carcinoma
Risk FactorsCigarette smokingChronic laryngitis
Vocal abuseAlcohol abuse
Familial tendency
Types
GlotticHoarseness for >2 weeks
Dyspnea
SupraglotticLocalized throat pain
Burning when drinking hot liquids or orange juice
Lump in the neckDysphagia, odynophagia
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Laryngeal Carcinoma
Management Subtotal laryngectomy: retains voice Total: absolute loss of voice Tracheostomy: temporary or permanent Maintain patent airway HOB elevated 45º Assist patient in communicating; provide writing
materials, etc. Practice swallowing Cover tracheostomy with porous material Avoid powder, spray, aerosol near trachea
Respiratory DisordersNio C. Noveno, RN ,MAN
THANK YOU!