Caring for Individuals Caring for Individuals Experiencing Respiratory Experiencing Respiratory

ChallengesChallenges

NURS2016NURS2016

Upper Respiratory TractUpper Respiratory Tract

Self-StudySelf-Study

Common ColdCommon Cold

Acute/Chronic SinusitisAcute/Chronic Sinusitis

RhinitisRhinitis

Acute/Chronic PharyngitisAcute/Chronic Pharyngitis

Tonsillitis and AdenoiditisTonsillitis and Adenoiditis

Clinical Manifestations & Clinical Manifestations & TreatmentTreatment

Sore throat, fever, snoring and difficulty Sore throat, fever, snoring and difficulty swallowing.swallowing.

Mouth breathing, earaches, halitosis, Mouth breathing, earaches, halitosis, frequent colds.frequent colds.AntibioticsAntibiotics

Surgical tonsillectomy (& adenoidectomy)Surgical tonsillectomy (& adenoidectomy)

Nursing Care related to T&ANursing Care related to T&A

Pre-op assessment.Pre-op assessment.

Pre-op teaching Pre-op teaching

Post-opPost-op– Assess operative siteAssess operative site– Ice collarIce collar– AnalgesiaAnalgesia– Ice chips/waterIce chips/water– No straws, no No straws, no

coughing, limit talkingcoughing, limit talking

Risk of HemorrhageRisk of HemorrhageAssess expectorantAssess expectorantAssessment Assessment swallowingswallowingAssess VSAssess VSRestlessnessRestlessness

Hemorrhage at Hemorrhage at operative site is an operative site is an

emergency.emergency.

Ostruction/Trauma of URTOstruction/Trauma of URT

Sleep apneaSleep apnea

ObstructiveObstructive

Apnea>10sec. & Apnea>10sec. & >5x/hr>5x/hr

Tx: +ve airway Tx: +ve airway pressure or surgerypressure or surgery

Nurse educate pt re tx Nurse educate pt re tx and use of oxygenand use of oxygen

EpistaxisEpistaxis

Pressure, Head tiltPressure, Head tilt

Chemical cautery or Chemical cautery or vasoconstrictorsvasoconstrictors

Assess vital signsAssess vital signs

Preventative Preventative strategiesstrategies

Cancer of LarynxCancer of Larynx

Glottic area, supraglottic area, subglottisGlottic area, supraglottic area, subglottis

Risk factors: carcinogens & othersRisk factors: carcinogens & others

Radiation treatmentRadiation treatment

Surgical treatmentSurgical treatment– Partial laryngectomyPartial laryngectomy– Supraglottic laryngectomySupraglottic laryngectomy– HemilaryngectomyHemilaryngectomy– Total laryngectomyTotal laryngectomy

Airflow and Communication Airflow and Communication Post-LaryngectomyPost-Laryngectomy

Primary Nursing Interventions: Primary Nursing Interventions: LaryngectomyLaryngectomy

Pre-operative teachingPre-operative teaching

Reducing anxiety and depressionReducing anxiety and depression

Maintaining a patent airwayMaintaining a patent airway

Promoting alternative communication Promoting alternative communication methodsmethods

Promoting adequate nutritionPromoting adequate nutrition

Promoting home-based carePromoting home-based care

Primary Nursing Interventions: Primary Nursing Interventions: LaryngectomyLaryngectomy

Monitoring and managing potential Monitoring and managing potential complicationscomplications– Respiratory distress and hpyoxiaRespiratory distress and hpyoxia– HemorrhageHemorrhage– InfectionInfection– Wound breakdownWound breakdown

Lower Respiratory TractLower Respiratory Tract

AtelectasisAtelectasisClosure or collapse of alveoliClosure or collapse of alveoli

Prevention: Prevention: Education and ReinforcementEducation and Reinforcement

Frequent position changeFrequent position change

Early ambulationEarly ambulation

DB&CDB&C

Incentive spirometerIncentive spirometer

AtelectasisAtelectasis

Management: Management:

Positive expiratory pressurePositive expiratory pressure

Suctioning secretions, chest physical Suctioning secretions, chest physical therapy, bronchiodilatorstherapy, bronchiodilators

ThoracentesisThoracentesis

Respiratory InfectionsRespiratory Infections(lower RT)(lower RT)

Acute tracheobronchitisAcute tracheobronchitis

PneumoniaPneumonia

Pulmonary TuberculosisPulmonary Tuberculosis

Acute TracheobronchitisAcute Tracheobronchitis

ManagementManagement

Antibiotic treatmentAntibiotic treatment

ExpectorantsExpectorants

Deep suctioning and Deep suctioning and ventilation supportventilation support

Nursing CareNursing Care

Increasing fluuid Increasing fluuid intakeintake

Breathing and Breathing and coughing exercisescoughing exercises

Encourage restEncourage rest

Education related to Education related to medicationsmedications

PneumoniaPneumoniaInflammation of Lung ParenchymaInflammation of Lung Parenchyma

Caused by microbial agent: Strep Caused by microbial agent: Strep pneumoniae, haemophilus influenzae, pneumoniae, haemophilus influenzae, legionella, pseudomonas aeruginosalegionella, pseudomonas aeruginosa

Community Aquired PneumoniaCommunity Aquired Pneumonia

Hospital Aquired Pneumonia Hospital Aquired Pneumonia

ImmunocompromisedImmunocompromised

Aspiration PneumoniaAspiration Pneumonia

Medical Managment & Medical Managment & ComplicationsComplications

ManagementManagement

Antibiotic according to Antibiotic according to sensitivity and Gram sensitivity and Gram stain.stain.

Supportive treatment Supportive treatment when viralwhen viral

Oxygen if hypoxicOxygen if hypoxic

ComplicationsComplications

Shock and respiratory Shock and respiratory failurefailure

Atelectasis and Atelectasis and pleural effusion pleural effusion (empyema)(empyema)

SuperinfectionSuperinfection

Nursing AssessmentNursing AssessmentPneumoniaPneumonia

T & PT & P

Secretions/Secretions/expectorantexpectorant

CoughCough

RespirationsRespirations

Chest assessmentChest assessment

Nursing DiagnosesNursing Diagnoses

Nursing InterventionsNursing InterventionsPneumoniaPneumonia

Improving airway Improving airway patencypatency

Promoting rest and Promoting rest and conserving energyconserving energy

Promoting fluid intakePromoting fluid intake

Maintaining nutritionMaintaining nutrition

Monitoring and Monitoring and managing potential managing potential complicationscomplications

Pulmonary TuberculosisPulmonary Tuberculosis

Infectious disease of the lung parenchymaInfectious disease of the lung parenchyma

Mycobacterium tuberculosisMycobacterium tuberculosis

Worldwide public health problemWorldwide public health problem

Common TB meds: isoniazid, rifampin, Common TB meds: isoniazid, rifampin, streptomycin, pyrazinamide, ethamutolstreptomycin, pyrazinamide, ethamutol

Nursing AssessmentNursing AssessmentTBTB

FeverFever

AnorexiaAnorexia

Weight lossWeight loss

Night sweatsNight sweats

FatigueFatigue

Enlarged and painful Enlarged and painful lymph nodeslymph nodes

CoughCough

SputumSputum

Ecophony, fremitusEcophony, fremitus

Diminished bronchial Diminished bronchial sounds & cracklessounds & crackles

Nursing DiagnosisNursing DiagnosisKnowledge deficit about tx regimen Knowledge deficit about tx regimen

& preventative health measures& preventative health measures

Medication regimen is complexMedication regimen is complexTB is highly communicable – meds are the TB is highly communicable – meds are the most effective means of preventing most effective means of preventing transmissiontransmission

Medication side effects are primary Medication side effects are primary reason for D/Creason for D/C

COPDCOPD

A disease state characterized by airflow A disease state characterized by airflow limitation that is not fully reversiblelimitation that is not fully reversible

Often include diseases such as chronic Often include diseases such as chronic bronchitis and emphysemabronchitis and emphysema

Risk factors: active and passive smoking, Risk factors: active and passive smoking, occupational exposure, air pollution and occupational exposure, air pollution and genetic abnormalitiesgenetic abnormalities

Chronic BronchitisChronic Bronchitis

Presence of cough and sputum for at least Presence of cough and sputum for at least 3 months past 2 years.3 months past 2 years.

Bronchial walls thicken and lumen narrowsBronchial walls thicken and lumen narrows

Increased susceptability to RTIIncreased susceptability to RTI

EmphysemaEmphysema

Abnormal distention of the air spaces Abnormal distention of the air spaces beyond the terminal bronchioles with beyond the terminal bronchioles with destruction of the walls of the aveoli.destruction of the walls of the aveoli.

Usually long history of smokingUsually long history of smoking

Dyspnea becomes the major symptomsDyspnea becomes the major symptoms

Nursing CareNursing CareCOPDCOPD

Nursing AssessmentNursing Assessment

Focus on symptomsFocus on symptoms

Disease historyDisease history

Become familiar with Become familiar with chart pg 578chart pg 578

Nursing DiagnosisNursing DiagnosisImpaired gas exchangeImpaired gas exchange

Ineffective airway Ineffective airway clearanceclearance

Ineffective breathing Ineffective breathing patternpattern

Self-care deficitSelf-care deficit

Activity intoleranceActivity intolerance

Ineffective copingIneffective coping

Knowledge deficitKnowledge deficit

Nursing InterventionsNursing InterventionsCOPDCOPD

Breathing exercisesBreathing exercisesInspiratory muscle trainingInspiratory muscle trainingActivity pacingActivity pacingSelf-care activitiesSelf-care activitiesPhysical conditioningPhysical conditioningOxygen therapyOxygen therapyNutritional therapyNutritional therapyCoping measuresCoping measures

Therapeutic ApproachTherapeutic ApproachCOPDCOPD

Treatment to improve ventilation and Treatment to improve ventilation and decrease work of breathing.decrease work of breathing.

Prevention & tx of infectionPrevention & tx of infection

Improve energy conservation techniquesImprove energy conservation techniques

Proper environmental conditionsProper environmental conditions

Psychological supportPsychological support

Ongoing educationOngoing education

Oxygen therapy and COPDOxygen therapy and COPD

Because hypoxemia, rather than high Because hypoxemia, rather than high carbon dioxide, drives respiration in carbon dioxide, drives respiration in COPD, andCOPD, and

Because oxygen therapy can raise oxygen Because oxygen therapy can raise oxygen levels in the bloodlevels in the blood

COPD patient receiving oxygen tx may COPD patient receiving oxygen tx may experience decreased stimulation to experience decreased stimulation to breath breath

AsthmaAsthma

Inflammatory disease of airwaysInflammatory disease of airways– Hyper-responsivenessHyper-responsiveness– Mucosal edemaMucosal edema– Mucous productionMucous production– Reversible processReversible process

*Prevention: identify substances that precipitate *Prevention: identify substances that precipitate symptomssymptoms

Nursing CareNursing CareAsthmaAsthma

Assess resp statusAssess resp status

Severity of symptomsSeverity of symptoms

Breath soundsBreath sounds

Peak flowPeak flow

Pulse oxymetryPulse oxymetry

Vital signsVital signs

Hx of allergy to medsHx of allergy to meds

Current med regimenCurrent med regimen

Admin and monitor Admin and monitor medicationmedication

Ensure hydrationEnsure hydration

Monitor S&S infectionMonitor S&S infection

Provide psychological Provide psychological supportsupport

Pulmonary EmbolismPulmonary Embolism

Obstruction of Obstruction of pulmonary artery by a pulmonary artery by a thrombusthrombus

Can also be air, fat, or Can also be air, fat, or amniotic fluid emboliamniotic fluid emboli

Risk factors (p.472)Risk factors (p.472)

Venous stasisVenous stasis

HypercoagulabilityHypercoagulability

Venous endothelial Venous endothelial diseasedisease

Certain disease stateCertain disease state

Other: age, obesity, Other: age, obesity, clothing, pregnancy.clothing, pregnancy.

Nursing CareNursing CarePulmonary EmbolismPulmonary Embolism

Minimize the risk (know the risks)Minimize the risk (know the risks)

Prevent thrombus formationPrevent thrombus formation

Monitor thrombolytic therapyMonitor thrombolytic therapy

Manage painManage pain

Oxygen therapyOxygen therapy

Pulmonary EmbolismPulmonary Embolism

Often suddenOften sudden

Painful: ischemiaPainful: ischemia

Immediate SOBImmediate SOB

ReminderReminder

Self study upper respiratory trackSelf study upper respiratory track

Focus on promoting health throughFocus on promoting health through– Preventative approachesPreventative approaches– Facilitate quality of life while living with chronic Facilitate quality of life while living with chronic

respiratory challengesrespiratory challenges