Download Respiratory Disorders (Assessment to Resp Infections)

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
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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
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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
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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
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pH
PaCO2
PaO2
HCO
SaO2
7.35-7.45
35-45 mm Hg
80-100 mm Hg
21-28 mEq/L
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
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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
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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
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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
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Avoid allergen
Antihistamines
Decongestants
Topical or nasal corticosteroids
• Vancenase, Beconase
– Analgesics
– Hot packs over facial sinuses
Upper Airway Obstruction
• Etiology/Pathophysiology
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Inflammation of tissue
Dentures
Aspiration
Tongue
Laryngeal spasm
Upper Airway Obstruction
• Signs & Symptoms
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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
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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
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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
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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)
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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
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Enlarged, tender, cervical lymph nodes
Sore throat
Fever
Chills
Enlarged, purulent tonsils
Elevated WBC
Acute Follicular Tonsillitis
Acute Follicular Tonsillitis
• Treatment
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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
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Inflammation of the larynx
Acute or chronic
Viral or bacterial
May cause severe respiratory distress in
children under 5 yrs
Laryngitis
• Signs & Symptoms
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Hoarseness
Voice loss
Scratchy and irritated throat
Persistent cough
Laryngitis
• Treatment
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Viral; no specific treatment
Bacterial; antibiotics
Analgesics
Antipyretics
Antitussives
Warm or cool mist vaporizer
Limit use of voice
Pharyngitis
• Etiology/Pathophysiology
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Inflammation of the pharynx
Chronic or acute
Frequently accompanies the common cold
Viral, most common
Bacterial
• Gonococcal
• Streptococcus (strep throat)
Pharyngitis
• Signs & Symptoms
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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
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Constant, severe headache
Pain and tenderness in involved sinus region
Purulent exudate
Malaise
Fever
Sinusitis
• Treatment
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Antibiotics
Analgesics
Antihistamines
Vasoconstrictor nasal spray (Afrin)
Warm mist vaporizor
Warm, moist packs
Nasal windows