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Chapter 86
Respiratory Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Respiratory System
• Respiration requires a patent airway for oxygen to
reach the lungs, and lungs that are physically capable
of exchanging oxygen for carbon dioxide.
• The respiratory system consists of the upper and lower
respiratory tracts.
• Pulmonologist
• Respiratory therapy
• Respiratory therapists
• Respiratory technicians
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Laboratory Tests
• Sputum specimen
• Lavage specimen
• Throat culture
• Blood gas determinations
– Level of arterial blood gases (ABGs)
– Partial pressure of oxygen (PaO2)
– Partial pressure of carbon dioxide (PaCO2)
– Hydrogen ion concentration (pH) of the blood
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X-ray and Fluoroscopy Examinations
• Chest x-ray (CXR)
• Computed tomography (CT) scan
• Lung scan
• Lung perfusion scan
• Pulmonary angiography
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Other Diagnostic Tests
• Magnetic resonance imaging (MRI)
• Pulmonary function test (PFT)
• Bronchoscopy
• Skin and blood tests
– Skin tests
• Purified protein derivative (PPD) tuberculin test
– Blood tests
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement true or false?
The spirometer can be used interchangeably with the
incentive spirometer.
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Answer
False
The spirometer should not be confused with the incentive
spirometer. The spirometer measures pulmonary function.
The incentive spirometer also measures pulmonary
function, in a sense, but it is used by the client. The
incentive spirometer helps the client, such as after
surgery, to perform respiratory exercises to maintain lung
function.
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Common Medical Treatments
• Postural drainage
– Chest physiotherapy (CPT)
• Inhalations
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Common Surgical Treatments
• Thoracentesis
• Paracentesis
• Thoracotomy
– Caring for the client after chest surgery
– Chest suction
– Closed water-seal drainage
– Nursing implications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement true or false?
During paracentesis or thoracentesis, the nurse must
take the client’s blood pressure and pulse immediately
after the procedure and every 15 minutes until readings
are stable.
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Answer
True
A large amount of fluid withdrawn (>1,000 mL) during
paracentesis or thoracentesis can result in vasodilation
and hypovolemia (decreased circulating fluid volume).
These situations can cause syncope (temporary loss of
consciousness, fainting) and shock.
The nurse should take the client’s blood pressure and
pulse immediately after paracentesis or thoracentesis
and every 15 minutes until readings are stable and
within acceptable levels.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement true or false?
It is perfectly safe for a client with a respiratory system
disorder to receive a narcotic.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
If a person with any disorder of the respiratory system is
receiving a narcotic, be particularly watchful for
respiratory depression.
Depressed respirations can be an undesirable side effect
in anyone, but the situation is most dangerous for the
client whose respiratory function is already
compromised.
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Nursing Process
• Data collection
– Noting alterations in respiratory status
• Aspiration
• Hyperventilation
– Hypoxia
• Hypoxemic hypoxia
• Circulation hypoxia
• Anemic hypoxia
• Histotoxic hypoxia
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Nursing Process (cont’d)
• Planning and implementation
– Relieving respiratory distress
• Orthopneic position
• Turning, coughing, and deep breathing
– Administering respiratory treatments
• Postural drainage
• Breathing exercises and incentive spirometer
• Breathing treatments, oxygen
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Nursing Process (cont’d)
– Administering nasal treatments
– Suctioning to remove oral–nasal secretions
• Dysrhythmia and desaturation
• Evaluation
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Possible Alterations in Respiratory Status
• Dyspnea
• Biot’s respirations
• Orthopnea
• Apnea
• Tachypnea
• Central apnea
• Hyperpnea
• Obstructive apnea
• Mixed apnea
• Bradypnea
• Hypoventilation
• Hyperventilation
• Adult sleep apnea
• Kussmaul’s respirations
• Cheyne-Stokes breathing
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Infectious Respiratory Disorders
• The common cold or acute rhinitis
• Streptococcal sore throat
• Influenza
• Laryngitis
• Bronchitis
• Lung abscess
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Infectious Respiratory Disorders (cont’d)
• Pneumonia
– Bacterial pneumonia
– Viral pneumonia
– Pneumocystis carinii pneumonia
– Chemical pneumonia
– Aspiration pneumonia
• Pleurisy
• Histoplasmosis
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Infectious Respiratory Disorders (cont’d)
• Tuberculosis (TB)
– Latent and active TB
– Pulmonary TB
– Pott’s disease and miliary TB
– Atypical TB
– Multidrug-Resistant TB
• Empyema
– Acute empyema
– Chronic empyema
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Question
Is the following statement true or false?
The number of cases of TB has decreased dramatically
during the last several decades because of the
developments in science and medicine.
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Answer
False
The number of cases of TB has increased dramatically
during the last several decades because of the increase
in multidrug-resistant TB organisms, increasing numbers
of persons with HIV infection, substance abuse,
homelessness, and poor compliance with medication
treatment plans.
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Chronic Respiratory Disorders
• Snoring
• Sleep apnea syndrome
• Allergic rhinitis
• Pneumoconioses
• Chronic obstructive pulmonary disease
– Bronchial asthma, bronchiectasis, chronic
bronchitis, pulmonary emphysema
• Acute respiratory distress syndrome
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement true or false?
The continuous positive airway pressure apparatus is
commonly used to assist persons with allergic rhinitis.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
The continuous positive airway pressure (CPAP)
apparatus is commonly used to assist persons with sleep
apnea.
This machine looks like an oxygen-delivery system and
is used at night so the person can sleep. It delivers air,
and sometimes oxygen, to the person at a continuous
positive pressure that holds the alveoli open. This
positive pressure prevents respiratory obstruction,
increases oxygenation, and reduces breathing effort.
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Trauma
• Absence of air exchange
• Chest trauma
• Respiratory complications in drug poisoning
• Drowning/near drowning
• Pneumothorax
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Neoplasms
• Benign neoplasms
• Lung cancer
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Disorders of the Nose
• Inflammatory disorders
– Sinusitis
– Acute sinusitis
– Chronic sinusitis
• Structural disorders
– Deviated septum
– Nasal polyps
– Plastic surgery (rhinoplasty)
– Care of the client undergoing nasal surgery
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Disorders of the Nose (cont’d)
• Nasal trauma
– Fractures
– Epistaxis
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Disorders of the Throat
• Trauma
– Aspiration of foreign bodies
• Cancer of the larynx
– Nursing considerations
• Communication and speech
• Identification as a laryngectomee
• Supportive resources
• Water dangers
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End of Presentation
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