Respiratory Disorders Lola Oyedele MSN, RN, CTN Majuvy L. Sulse MSN, RN, CCRN

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  • Respiratory DisordersLola Oyedele MSN, RN, CTNMajuvy L. Sulse MSN, RN, CCRN

  • LOWER AIRWAY AND PULMONARY VESSEL DISORDERSPneumoniaSARSTuberculosisInhalation AnthraxChronic Airflow Limitation

  • Pneumonia Excess of fluid in the lungs resulting from an inflammatory processInflammation triggered by infectious organisms and inhalation of irritantsAtelectasisHypoxemia

  • PneumoniaNosocomial or hospital-acquiredCommunity acquired

  • Laboratory AssessmentGram stain, culture, and sensitivity testing of sputumComplete blood countArterial blood gas levelSerum blood, urea nitrogen levelElectrolytesCreatinine

  • Impaired Gas ExchangeInterventions include:Cough enhancementOxygen therapyRespiratory monitoring

  • Ineffective Airway ClearanceInterventions include:Help client to cough and deep breathe at least every 2 hours.Administer incentive spirometerchest physiotherapy if complicated.Prevent dehydration.

    (Continued)

  • Ineffective Airway Clearance (Continued)Monitor intake and output of fluids.Use bronchodilators, especially beta2 agonists.Inhaled steroids are rarely used.

  • Potential for Sepsis

    Primary intervention is prescription of anti-infectives for eradication of organism causing the infection.Drug resistance is a problem, especially among older people.Interventions for aspiration pneumonia aimed at preventing lung damage and treating infection.

  • Severe Acute Respiratory Syndrome (SARS)A virus from a family of virus types known as coronavirusesVirus infection of cells of the respiratory tract, triggering inflammatory responseNo known effective treatment for this infectionPrevention of spread of infection

  • Pulmonary TuberculosisHighly communicable disease caused by Mycobacterium tuberculosisMost common bacterial infectionTransmitted via aerosolizationInitial infection multiplies freely in bronchi or alveoliSecondary TBIncrease related to the onset of HIV

  • Assessment Diagnosis of TB considered for any client with a persistent cough or other compatible symptoms (weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills)Bacillus Calmette-Guerin vaccine within previous 10 years produces positive skin test, complicating interpretation of TB test.

  • Clinical Manifestations of TBProgressive fatigueLethargyNauseaAnorexia

  • Clinical Manifestations of TBWeight lossIrregular mensesLow-grade fever, night sweatsCough, mucopurulent sputum, blood streaks

  • Diagnostic AssessmentManifestation of signs and symptomsPositive smear for acid-fast bacillusConfirmation of diagnosis by sputum culture of M. tuberculosisTuberculin test (Mantoux test) purified protein derivative given intradermally in the forearmInduration of 10 mm or greater diameter indicative of exposure(Continued)

  • Diagnostic Assessment (Continued)Positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease.

  • Interventions Combination drug therapy strict adherenceIsoniazidRifampinPyrazinamideEthambutol or streptomycin Negative sputum culture indicative of client no longer being infectious

  • Health TeachingFollow exact drug regimen.Proper nutrition must be maintained.Reverse weight loss and severe lethargy.Educate client about the disease.

  • Lung AbscessLocalized area of lung destruction caused by liquefaction necrosis, usually related to pyogenic bacteriaPleuritic chest painInterventionsAntibioticsDrainage of abscessFrequent mouth care for Candida albicans

  • Inhalation AnthraxBacterial infection is caused by the gram-positive, rod-shaped organism Bacillus anthracis from contaminated soil.Fatality rate is 100% if untreated.Two stages are the prodromal stage and the fulminant stage.Drug therapy includes ciprofloxacin, doxycycline, and amoxicillin.

  • Pulmonary EmpyemaA collection of pus in the pleural spaceMost common cause: pulmonary infection, lung abscess, and infected pleural effusionInterventions include:Emptying the empyema cavityRe-expanding the lungControlling the infection

  • Activity IntoleranceInterventions to increase activity level:Encourage client to pace activities and promote self-care.Do not rush through morning activities.Gradually increase activity.Use supplemental oxygen therapy.

  • Interventions for PalliationOxygen therapyDrug therapyRadiation therapyLaser therapyThoracentesis and pleurodesisDyspnea managementPain management

  • Chronic Airflow LimitationAsthmaEmphysemaChronic Bronchitis

  • Chronic Airflow LimitationChronic lung diseases of chronic airflow limitation include:AsthmaChronic bronchitisPulmonary emphysemaChronic obstructive pulmonary disease includes emphysema and chronic bronchitis characterized by bronchospasm and dyspnea.

  • Asthma Intermittent and reversible airflow obstruction affects only the airways, not the alveoli.Airway obstruction occurs due to inflammation and airway hyperresponsiveness.

  • Aspirin and Other NonsteroidalAnti-Inflammatory DrugsIncidence of asthma symptoms after taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)However, response not a true allergyResults from increased production of leukotriene when other inflammatory pathways are suppressed

  • Collaborative ManagementAssessmentHistoryPhysical assessment and clinical manifestations:No manifestations between attacksAudible wheeze and increased respiratory rateUse of accessory musclesBarrel chest from air trapping

  • Laboratory AssessmentAssess arterial blood gas level.Arterial oxygen level may decrease in acute asthma attack.Arterial carbon dioxide level may decrease early in the attack and increase later indicating poor gas exchange.

    (Continued)

  • Laboratory Assessment (Continued)Atopic asthma with elevated serum eosinophil count and immunoglobulin E levelsSputum with eosinophils and mucous plugs with shed epithelial cells

  • Pulmonary Function TestsThe most accurate measures for asthma are pulmonary function tests using spirometry including:Forced vital capacity (FVC)Forced expiratory volume in the first second (FEV1)Peak expiratory rate flow (PERF)Chest x-rays to rule out other causes

  • Interventions Client education: asthma is often an intermittent disease; with guided self-care, clients can co-manage this disease, increasing symptom-free periods and decreasing the number and severity of attacks.Peak flow meter can be used twice daily by client.Drug therapy plan is specific.

  • Drug TherapyPharmacologic management of asthma can involve the use of:BronchodilatorsBeta2 agonistsShort-acting beta2 agonistsLong-acting beta2 agonistsCholinergic antagonists(Continued)

  • Drug Therapy (Continued)MethylxanthinesAnti-inflammatory agentsCorticosteroidsInhaled anti-inflammatory agentsMast cell stabilizersMonoclonal antibodiesLeukotriene agonists

  • Other Treatments for AsthmaExercise and activity is a recommended therapy that promotes ventilation and perfusion.Oxygen therapy is delivered via mask, nasal cannula, or endotracheal tube in acute asthma attack.

  • Status AsthmaticusStatus asthmaticus is a severe, life-threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to common therapy.If the condition is not reversed, the client may develop pneumothorax and cardiac or respiratory arrest.Emergency department treatment is recommended.

  • Emphysema In pulmonary emphysema, loss of lung elasticity and hyperinflation of the lungDyspnea and the need for an increased respiratory rateAir trapping, loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)

  • Classification of EmphysemaPanlobular: destruction of the entire alveolusCentrilobular: openings occurring in the bronchioles that allow spaces to develop as tissue walls break downParaseptal: confined to the alveolar ducts and alveolar sacs

  • Chronic BronchitisInflammation of the bronchi and bronchioles caused by chronic exposure to irritants, especially tobacco smokeInflammation, vasodilation, congestion, mucosal edema, and bronchospasmAffects only the airways, not the alveoliProduction of large amounts of thick mucus

  • Complications Chronic bronchitisHypoxemia and acidosis Respiratory infectionsCardiac failure, especially cor pulmonaleCardiac dysrhythmias

  • Physical Assessment and Clinical ManifestationsUnplanned weight loss; loss of muscle mass in the extremities; enlarged neck muscles; slow moving, slightly stooped posture; sits with forward-bendRespiratory changesCardiac changes

  • Laboratory AssessmentStatus of arterial blood gas values for abnormal oxygenation, ventilation, and acid-base statusSputum samplesHemoglobin and hematocrit blood testsSerum alpha1-antitrypsin levels drawnChest x-rayPulmonary function test

  • Impaired Gas ExchangeInterventions for chronic obstructive pulmonary disease:Airway managementMonitoring client at least every 2 hours Oxygen therapyEnergy management

  • Drug TherapyBeta-adrenergic agentsCholinergic antagonistsMethylxanthinesCorticosteroidsCromolyn sodium/nedocromilLeukotriene modifiersMucolytics

  • Surgical ManagementLung transplantation for end-stage clientsPreoperative care and testingOperative procedure through a large midline incision or a transverse anterior thoracotomyPostoperative care and close monitoring for complications

  • Ineffective Breathing PatternInterventions for the chronic obstructive pulmonary disease client:Assessment of clientAssessment of respir