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Nursing of Adults With
Medical & Surgical Conditions
Respiratory Disorders(Diagnostic Tests & Upper Airway
Disorders)
Normal Breath Sounds
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
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
Adventitious Breath Sounds
• Wheezes– Sound
• High-pitched, musical, whistlelike sound during inspiration or expiration
– Cause• Narrowed bronchioles due to tumor, bronchospasm,
or foreign matter
Adventitious Breath Sounds
• Pleural Friction Rub– Sound
• Dry, creaking, grating, low-pitched sound
– Cause• Inflammation of pleural surfaces
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
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
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
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
Bronchoscopy
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
Diagnostic Tests
• Cytology Studies– To detect the presence of abnormal or
malignant cells in sputum, pleural fluid, etc.
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
Thoracentesis
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
Pulse Oximetry
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
Diagnostic Tests
• Normal Values• pH 7.35-7.45
• PaCO2 35-45 mm Hg
• PaO2 80-100 mm Hg
• HCO 21-28 mEq/L
• SaO2 95-100%
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
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
Epistaxis
• Signs & Symptoms– Bright red bleeding from one or both nostrils– Can lose as much as 1 liter per hour
Epistaxis
• Treatment– Sitting postion, leaning forward– Direct pressure by pinching nose– Ice compresses to nose– Nasal packing– Cautery– Balloon tamponade
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
Deviated Septum and Nasal Polyps
• Signs & Symptoms– Stertorous respirations (snoring)– Dyspnea– Postnasal drip
Deviated Septum and Nasal Polyps
• Treatment– Medications
• Corticosteroids
• Antihistamines
• Antibiotics
• Analgesics
– Nasoseptoplasty– Nasal polypectomy
Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever)
• Etiology/Pathophysiology– Antigen/antibody reactions in the nasal
membranes, nasopharynx, and conjunctiva due to allergens
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
Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever)
• Treatment– Avoid allergen– Antihistamines– Decongestants– Topical or nasal corticosteroids
• Vancenase, Beconase
– Analgesics– Hot packs over facial sinuses
Upper Airway Obstruction
• Etiology/Pathophysiology– Inflammation of tissue– Dentures– Aspiration– Tongue– Laryngeal spasm
Upper Airway Obstruction
• Signs & Symptoms– Stertorous respirations– Altered resp. rate and character– Apneic periods– Hypoxia– Cyanosis– Wheezing– Stridor
Upper Airway Obstruction
• Treatment– Open the airway– Remove obstruction– Artificial airway
• Pharyngeal, endotracheal, and tracheal
– Tracheostomy
Tracheostomy
Tracheotomy Tubes
Cancer of the Larynx
• Etiology/Pathophysiology– Squamous cell carcinoma– Heavy smoking and alcohol use– Chronic laryngitis– Vocal abuse– Family history
Squamous Cell Carcinoma of the Larynx
Cancer of the Larynx
• Signs & Symptoms– Progressive or persistent hoarseness– Pain radiating to the ear– Difficulty swallowing– Hemoptysis
Cancer of the Larynx
• Treatment– Radiation– Surgery
• Partial laryngectomy– temporary tracheostomy
• Total laryngectomy– Permanent tracheostomy
– No voice
• Radical neck dissection
Acute Rhinitis(Common Cold, Acute Coryza)
• Etiology/Pathophysiology– Inflammation of the mucous membranes of the
nose and accessory sinuses– Virus(es)
Acute Rhinitis(Common Cold, Acute Coryza)
• Signs & Symptoms– Thin, serous nasal exudate– Productive cough– Sore throat– Fever
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
Acute Follicular Tonsillitis
• Etiology/Pathophysiology– Inflammation of the tonsils– Bacterial infection (streptococcus)– Viral
Acute Follicular Tonsillitis
• Signs & Symptoms– Enlarged, tender, cervical lymph nodes– Sore throat– Fever– Chills– Enlarged, purulent tonsils– Elevated WBC
Acute Follicular Tonsillitis
Acute Follicular Tonsillitis
• Treatment– Antibiotics– Analgesics– Antipyretics– Warm saline gargles– Tonsillectomy and adenoidectomy
• 4-6 weeks after infection has subsided
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
Laryngitis
• Etiology/Pathophysiology– Inflammation of the larynx– Acute or chronic– Viral or bacterial– May cause severe respiratory distress in
children under 5 yrs
Laryngitis
• Signs & Symptoms– Hoarseness– Voice loss– Scratchy and irritated throat– Persistent cough
Laryngitis
• Treatment– Viral; no specific treatment– Bacterial; antibiotics– Analgesics– Antipyretics– Antitussives– Warm or cool mist vaporizer– Limit use of voice
Pharyngitis
• Etiology/Pathophysiology– Inflammation of the pharynx– Chronic or acute– Frequently accompanies the common cold– Viral, most common– Bacterial
• Gonococcal
• Streptococcus (strep throat)
Pharyngitis
• Signs & Symptoms– Dry cough– Tender tonsils– Enlarged cervical lymph glands– Red, sore throat– Fever
Pharyngitis
• Treatment– Antibiotics
• Penicillin, erythromycin
– Analgesics– Antipyretics– Warm or cool vaporizor
Sinusitis
• Etiology/Pathophysiology– Inflammation of the sinuses– Usually begins with an upper respiratory
infection– Chronic or acute– Viral or bacterial
Sinusitis
• Signs & Symptoms– Constant, severe headache– Pain and tenderness in involved sinus region– Purulent exudate– Malaise– Fever
Sinusitis
• Treatment– Antibiotics– Analgesics– Antihistamines– Vasoconstrictor nasal spray (Afrin)– Warm mist vaporizor– Warm, moist packs– Nasal windows
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