Respiratory System Disorders

HLTAP501A

Analyse Health Information

Pneumonia

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Types

•Aspiration

•Lobar

•Bronchial

•Viral

•Bacterial - most common

•Atypical - mycobacterium

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Aspiration pneumonia

Is an inflammatory condition of the lungs and bronchi caused by the inhalation of food/fluid or vomitus

The affects of this type will depend on The substance inhaled The amountThe resulting inflammation and/or destruction of lung tissue

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Infective pneumonia

The body’s defences fail to prevent inhaled or airborne microbes reaching and colonising in the lungsThis can be achieved by Inhalation of infective organismsAspiration of infective organisms from

The upper respiratory tractFrom gastric contents

Haematogenous – common in bacteraemia or secondary to UTI

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Causes

Lowered resistanceURTIDepression of CNS (head injuries, drugs)Alcohol abuse Cardiac failureDebilitating illnessSuper-infection in hospitalised patientsExposure to intense cold, dampnessAny bronchial obstructionProlonged immobilisationPulmonary oedema and congestion Impaired coughing

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Treatment

Mouth / skin careEncourage fluidsNurse client sitting uprightEncourage cough / physiotherapyAnalgesia (pleuritic pain)O2 therapy

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Prevention

Natural resistance should be maintainedAvoid contact with people with URTIsObliteration of cough reflex and aspiration should be avoided

Highly susceptible people should be immunised

Immobilised patients should be turned every two hours and encouraged to deep breath and cough

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Complications

Pleuritis – may lead to pneumothorax, empyema

Pleural fibrosis Abscess formationChronic lung disease – leading to interstitial fibrosis

Bronchiectasis (bronchial dilation)

Chronic Obstructive Airway Disease (COAD)

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Exemplified by chronic bronchitis and obstructive emphysema and asthma

Patients may have a history of:SmokingDyspnoea, where labored breathing occurs and

gets progressively worseCoughing and frequent pulmonary infections

People with COPD may develop respiratory failure accompanied by hypoxaemia, carbon dioxide retention, and respiratory acidosis

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Pathogenesis of COAD

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Asthma

Characterized by shortness of breath, wheezing, and chest tightness

Active inflammation of the airways precedes bronchospasm

Airway inflammation is an immune response caused by release of IL-4 and IL-5, which stimulate antibodies and recruit inflammatory cells

Airways thickened with inflammatory mucus magnify the effect of bronchospasm

15 http://www.dentalgentlecare.com/new_page_31.htm

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Other Respiratory DiseasesTuberculosisInfectious disease caused by the bacterium Mycobacterium tuberculosis

Symptoms include fever, night sweats, weight loss, a racking cough, and splitting headache

Treatment entails a 12-month course of antibiotics

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Lung Cancer Squamous cell carcinoma (20-40% of cases) arises

in bronchial epithelium Adenocarcinoma (25-35% of cases) originates in

peripheral lung area Small cell carcinoma (20-25% of cases) contains

lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize

Other Respiratory Diseases

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Incidence and mortality rates: national

Lung cancer is the fifth most common registerable cancer in Australia.

Around 8,200 Australians are diagnosed with lung cancer each year.

More than 7,000 Australians die from lung cancer each year.

One in 33 Australians will develop lung cancer by the age of 75.

http://www.cancercouncil.com.au

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Risk factors/Prevention

Smoking is a major cause of lung cancer. Smokers and workers exposed to industrial

substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons and chloromethyl ether have a significantly higher risk of developing lung cancer.

Research has also demonstrated a link between passive smoking and lung cancer.

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Symptoms

Lung cancer is very difficult to detect at an early stage, some symptoms may include: A new or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion.

Recurring episodes of lung infection, weight loss and swelling of the face or arms are also common symptoms.

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Treatment

There are a few different types of treatment for lung cancer (with different aims):Surgery - This is used to remove all the

cancer in the hope of a cure. Chemotherapy - This is a course of drugs

given to kill or control the cancer cells. Radiotherapy - This is a course of x-rays

given to kill or control the cancer. Laser treatment - This is used to control the

cancer cells. It is used to unblock airways full of tumour, but it does not cure the cancer.

http://www.cancercouncil.com.au

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Lung Cancer

Pneumothorax

Is the accumulation of air or gas in the pleural cavity, resulting in the collapse of the lung on the affected sideHaemothorax – blood in pleural cavityHaemopneumothorax – blood and air in the pleural cavity

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Pneumothorax

http://www.virtualrespiratorycentre.com/HumanAtlas/flash_content/clientNF.asp?anid=207

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Types

Closed

Open – sucking wound

Tension

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Causes

•Spontaneous

•Chest trauma

•Surgery

•Central line insertion

•Positive pressure ventilation

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Spontaneous pneumothorax

May occur in healthy individuals and is often due to a rupture of a sub pleural bleb (often affects tall, thin men between 20-40 yrs)

May be a complication of underlying pulmonary disease such as COAD, asthma, cystic fibrosis, TB, pertussis

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Clinical manifestations

Sudden sharp chest pain - made worse by deep breath or cough

Dyspnoea – sudden onset Chest tightness Easily fatigued Tachycardia Cyanosis Unilateral pleuritic pain

Tachypnoea Subcutaneous

emphysema Pallor Diaphoresis Reduced movement on

affected side Open pneumothorax may

reveal obvious haemorrhage or foreign body in chest wall

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Treatment

If small then it may require no intervention

More extensive Insertion of an intercostal catheter (ICC)Connection to underwater seal drainage (UWSD) system

Non resolution or reoccurrences may need surgical intervention

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Thoracic drainage

This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural spaceAirFluids such as blood, pus, chyle, serous fluid, gastric juices

Solids such as blood clots

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Thoracic drainage

This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural space Air Fluids such as blood, pus,

chyle, serous fluid, gastric juices

Solids such as blood clots

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Thoracic drainageTube placementIs placed in the 2nd, 3rd, or 4th intercostal space.The tube is sutured in and has an occlusive dressing applied to prevent air leaksDetermined by the substance to be drainedSmaller gauge tubes for airLarger gauge tubes for fluidsPneumothorax – usually one tubeHaemothorax – usually two tubes

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Under water seal drainage

This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to reenter.

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Under water seal drainage system

This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to re-enter.

A chamber containing water

A chamber for collection of fluids or solids

May be connected to suction

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Nursing care

Patient may be nursed in semi Fowlers positionOxygen and analgesia may be needed Allay anxietyEncourage deep breathing and coughingPatient to splint the affected side when coughingCheck respirations – noting chest movementReport increase in respiratory rate or distress,

increase in pain or abnormally large increase in drainage to RN Div 1

Check dressing daily – maintain asepsis

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Nursing care

TubingClamping – to be achieved with two clamps (rubber clipped forceps) above the connection to the UWSD when It is necessary to lift system above the level of the bed Changing the system

Observe for Kinks Dependent loops Flattening Loosening of connections Blockage Tube dislodgement

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Nursing care

Drainage systemCheck the character, consistency and quality of

drainageMark the drainage level – noting time and date

(usually done each shift)Check for oscillation (swinging of the fluid in

rhythm with the patient’s breathing) may be as much as 5-10cm

Check for intermittent bubbling of air (pneumothorax)

Ensure suction is maintained at ordered pressure