Respiratory disorders

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-hospitalizationP. aeruginosa, S. pneumoniae, K. pneumoniae

Aspiration pneumoniaS. pneumoniae, H. influenza, S. pneumoniae, gastric contents

nionoveno@hc respi disorders 3

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


PneumoniaClinical Manifestations

CoughChills

DyspneaElevated temperature

Crackles Rhonchi

Pleural friction rubSputum production

Rusty, green, or bloody: pneumococcalYellow-green: BPN


PneumoniaPneumocystis carinii pneumonia

Opportunistic infectionOften related to HIV

& other immunocompromised conditions

Clinical ManifestationsIncreasing SOB

Nonproductive coughLow-grade fever

TreatmentCotrimoxazolePentamidine


PneumoniaManagement

Increase OFI 3-4 L/day.Administer O2.Assess respiratory status.

Monitor VS, I/O, lab studies, & pulse oxMonitor & record color, consistency,

& amount of sputumHome care

Recognize s/sx of infection.Avoid exposure to people with infections.

Increase OFI at 3 L/day.


Chronic Obstructive Pulmonary DiseaseBronchitis

EmphysemaCauses

Congenital weaknessRespiratory irritants: smoke, polluted air,

chemical irritantsRespiratory tract infections

Genetic predisposition


Chronic Obstructive Pulmonary DiseaseChronic

BronchitisExcessive bronchialmucus

productionChronic or recurrent

productive cough

Smoking, RTI, PollutantsSmoking, RTI, Pollutants

Mucosal edemaMucosal edema

InflammationInflammationBradykinin, Histamine, PGsBradykinin, Histamine, PGs

Fluid/Cellular ExudationFluid/Cellular Exudation

Hypersecretion of mucusHypersecretion of mucusPersistent CoughPersistent Cough

Capillary permeabilityCapillary permeability


Chronic Obstructive Pulmonary Disease

EmphysemaDestruction 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 alveoliCO2 retentionCO2 retention

HypoxiaHypoxiaRespiratory acidosisRespiratory acidosis


EmphysemaEmphysema

No cyanosis (Pink)Thin appearance

Exertional dyspneaIneffective cough

Barrel chestPursed-lip breathingProlonged expiration

Use of accessory musclesR-sided Heart Failure

Pulmonary HPNSpontaneous

pneumothorax

ChronicChronicBronchitisBronchitis

Cyanosis (Blue)Edematous

Exertional dyspneaRecurrent cough w/Sputum production

Digital clubbingRespiratory rateUse of accessory

musclesR-sided Heart FailureCor pulmonale


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


Chronic Obstructive Pulmonary DiseaseBronchiectasis

Destruction of bronchial mucosa with fibrous scar

tissue formation

Loss of resilience& airway dilation causes

pooling of secretions

Obstruction of airflow


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


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


Acute Respiratory Distress SyndromeClinical syndrome of respiratory insufficiency

Damaged capillary membranesInterstitial edema

Intraalveolar hemorrhageHypoxemia

CausesViral pneumonia

Fat emboliSepsis

Decreased surfactant production


Acute Respiratory Distress Syndrome


Acute Respiratory Distress SyndromeClinical

ManifestationsDyspnea

TachypneaCracklesRhonchiAnxiety

Breath sounds

Management Intubation & mechanical

ventilation using PEEP Pharmacotherapy

AntibioticsAnalgesicsSteroidsNeuromuscular blocking

agentsDiagnosticsABGs:

Respiratory acidosis,

hypoxemiaCXR:

interstitial edema


Chest PhysiotherapyPostural 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


Chest PhysiotherapyPostural Drainage


Pulmonary TuberculosisAirborne, infectious, communicable

Acute or chronicMycobacterium tuberculosis

Clinical ManifestationsFatigue, malaise

Anorexia, weight lossNight sweats

Late afternoon low-grade feverProductive chronic coughHemoptysis (advanced)


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


Pleural Effusion & PneumothoraxCausesTrauma

Thoracic surgeryPositive pressure

ventilationThoracentesis

CVP line insertionEmphysema


Pleural Effusion & PneumothoraxClinical ManifestationsSudden sharp chest painShortness of breath (SOB)

Restlessness/anxietyTachycardia, tachypneaDiminished/absent BS

Chest asymmetryTracheal deviation

towards unaffected sideTympany

ManagementHigh-Fowler’s

Pain reliefO2 therapy

Chest tube insertionThoracentesisChest x-ray

ABGsMonitor for shock


Pulmonary EmbolismUndissolved substance in pulmonary vasculature

obstructs blood flow

Types: Fat, Air, Thrombus

CausesFlat or long bone fractures

ThrombophlebitisVenous stasis


Pulmonary EmbolismClinical Manifestations

Dyspnea, tachypnea, crackles

DiagnosticsABGs

Respiratory alkalosis, hypoxemiaLung Scan

Pulmonary circulation & blood flow obstructionAngiography

Location of embolusFilling defect of pulmonary artery


Pulmonary Embolism

ManagementIntubation & mechanical ventilation

AnticoagulantsThrombolytics

Assess for (+) Homan’s signMonitor PT & PTT

WOF S/S of excessive anticoagulation


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 lungEtiology

Inhaled carcinogens [cigarette smoke, asbestos, nickel, iron oxides]

Pre-existing pulmonary DO [COPD, TB]


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


Bronchogenic CarcinomaManagement

Depends on cell type, stage of disease,and condition of the patient

Radiation therapyChemotherapy

Surgery

Provide support & guidance to clientRelief/control of pain and nauseaMeds as ordered, monitor effects


Lung CancerMaybe metastatic or primaryLeading cause of mortality

Smoking-relatedPoor prognosisDies in 5 years

AdenocarcinomaMost prevalent typeSmall cell carcinoma

Poorest prognosis


Laryngeal CarcinomaRisk Factors

Cigarette smokingChronic laryngitis

Vocal abuseAlcohol abuse

Familial tendency

TypesGlottic

Hoarseness for >2 weeksDyspnea

SupraglotticLocalized throat pain

Burning when drinking hot liquids or orange juice

Lump in the neckDysphagia, odynophagia


Laryngeal CarcinomaManagement

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

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Respiratory disorders