Download Assessment & Management of Patients With Respiratory Tract

Assessment & Management
of Patients
With
Respiratory Tract
Disorders
Lower Respiratory Tract
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Trachea
Bronchi
Bronchioles
Alveoli
Cilia
Respiratory anatomy
Alveoli at the terminal end of the lower airway
Clinical Manifestations
1. Local Manifestations
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Cough
 chronic, paroxysmal, dry , productive
Excessive Nasal Secretion
Expectoration of Sputum
 mucoid, purulent, mucopurulent, rusty,
hemoptysis
Pain
 pleuritic, intercostal, generalized chest
pain
Dyspnea- shortness of breath
Function
Gases are moved in and out of the lung
through pressure changes.
Intrapleural pressure is negative (less
than atmospheric pressure –
760mmHg)
Please refer to suggested reading notes
Clinical Manifestations
2. Systemic Manifestations
 Hypoxemia
 insufficient oxygenation of the blood
 cyanosis- bluish, grayish discoloration of skin &
mucous membranes
 Hypoxia
 inadequate tissue oxygenation
 Hypercapnia
 CO2 in arterial blood above normal limits
 Hypocapnia
 CO2 in arterial blood below normal limits
 Respiratory Failure
Medical Terminology
(Respiratory conditions)
Respiratory Failure: The inability of 
the cardovascular and pulmonary
systems to maintain an adequate
exchange of oxygen and carbondioxide
in the lungs.
Maybe caused by a failure in oxygen or 
in ventilation.
Can be hypoxemic or hypercapneic. 
Medical terminology cont.
Ventilation: the process of moving 
gases into and out of the lungs
Work of Breathing: The effort required
for expanding and contracting of the
lungs. The influencing factors: the rate
and depth of breathing, the ease in
which the lungs can be expanded and
airway resistance
Assessment of Respiratory
System
Health History
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Risk Factors
Major Clinical Manifestations
 Cough
 Sputum production
 Chest pain
 Wheezing
 Clubbing of the fingers
 Cyanosis
Assessment of Respiratory System
Physical Examination
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Inspection
 posture, shape, movement, dimensions of
chest, flared nostrils, use of accessory
muscles, skin color, and rate, depth, & rhythm
of respiration
Palpation
 respiratory excursion, masses, tenderness
Percussion
 flat, dull, resonant, hyperresonant sounds
Auscultation
 breath sounds, voice sounds, crackles,
wheezes
Crackles
Diagnostic Procedures
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Sputum Studies
 Methods- standard, saline inhalation,
gastric washing
Arterial Blood Gases
 measurements of blood pH , arterial O2
& CO2 tensions, acid-base balance
Pulse Oximetry
Chest X-ray
Bronchoscopy
Thoracentesis
Laryngoscopy
Lower
Respiratory
Disorders
Pneumonia
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Inflammation & infection of lunginfecting organisms typically inhaledorganisms transmitted to lower airways
and alveoli causing inflammation- impairs
gas exchange
Etiology: bacteria, virus, Mycoplasma,
fungus, or from aspiration or inhalation
of chemicals or other toxic substances
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Risk factors: cigarette smoking, chronic
underlying disorders, severe acute
illness, suppressed immune system, &
immobility
Pneumonia
Assessment: Questions to ask
 Have you been experiencing difficulty
breathing?
 Are you having pain? Where?
 Do you have a cough?
 Have you been running a fever?
 Have you been feeling tired?
Clinical Manifestations:
 fever, pleuritic chest pain, tachypnea, SOB,
tachycardia, cough, sputum productionrusty, blood-tingled or yellow-green, fatigue,
poor appetite
Pneumonia
Diagnostic:
 Sputum and blood cultures, CBC, ABGs, CXR, &
Bronchoscopy
Nursing Diagnoses:
 Ineffective airway clearance sec. to thick, tenacious
sputum
 Ineffective breathing pattern sec.to tachypnea, chest
pain, & airway inflammation
 Impaired gas exchange sec. to exudate in alveoli
 Activity intolerance sec. to hypoxemia, fatigue
 Acute pain sec.to disease process
Pneumonia
Planning: Client Outcomes
 Maintain open & clear airway, normal RR, PO2 level
without supplemental O2, complete physical care
without frequent rest periods
Interventions
 Improve airway patency- auscultate lung sounds,
monitor ABGs or pulse oximetry, elevate HOB, C & DB q
2hrs, ambulate , O2 as needed
 Promote fluid intake & promote activity tolerance
 Monitor & prevent complications
 High fowler’s positioning to facilitate air exchange
Pneumonia
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Pharmacology:
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Antibiotic therapy based on sputum culture &
sensitivity
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Levaquin, Tequin, Rocephin, Primaxin, Zithromax,
Ketek, Zinacef, Cipro, Tetracycline
Instruct to finish all antibiotics at prescribed intervals
Short acting beta 2 agonist such as Salbutamol
Corticosteroids ,Prednisolone to decrease
inflammation
Influenza vaccine, pneumococcal vaccine
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Period of bed rest
Promote adequate nutrition
Provide support
Evaluation:
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breathing easier without chest pain
temperature normal,
activity level increased without frequent rest
periods
ARDS
Acute Respiratory Disease Syndrome
A form of Acute Lung Injury 
Diffused alveolar injury 
An acute condition characterized by bilateral
pulmonary infiltrates and severe hypoxemia
Build up fluid in alveolar 
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ARDS - Causes
Breathing vomit into lungs (aspirations)
Inhaling chemicals 
Lung transplannt 
Pneumonia 
Septic shock (infection thru body) 
Trauma 
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ARDS -Characterstics
Stiff heavy lungs(decreases the lungs 
ability to expand)
The level of oxygen in the blood can 
stay dangerously low (even if oxygen is
given via a ventilator)
ARDS - Symptoms
Symptoms usually develop 24 to 48 hrs
of illness or injury
Dyspnoea 
Low blood pressure (infection) and 
organ failure
Rapid breathing 
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ARDS - Diagnostics
Arterial Blood Gas 
Blood Tests 
Blood and Urine cultures 
Bronchoscopy 
Chest x-ray 
Sputum culture and analysis
ARDS - Treatment
Intensive Care Admission
Antibiotic therapy 
Steroid therapy 
Diuretics 
Ventilatory support 
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PULMONARY EMBOLISM
Is a complication of an underlying 
venous thrombosis
Patient may not show classic signs and
symptoms
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PE – SIGNS AND SYMPTOMS
Classic presentation:
Pleuretic chest pain 
Dyspnoea 
Hypoxia 
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PE – Signs and symptoms
Seizures 
Syncope 
Abdominal pain 
Fever 
Productive cough 
Wheezing 
Altered level of consciousness
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PE – Signs and Symptoms
New onset of atrial fibrillation
Hemoptysis 
Flank pain 
Delirium 
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PE - Diagnosis
ECG 
Chest xray, CT, MRI, Echo, VQ scan 
Blood tests –Dimer, coagulation profile,
Arterial blood gas
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PE - Management
Anticoagulation (warfarin, heparin,
retaplse)
Surgical intervention : 
Emoblectomy 
Vena Cava filters 
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TUBERCULOSIS
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Infectious disease that primarily affects
the lungs; may be transmitted to other
parts of the body
Pulmonary infiltrates accumulate,
cavities develop, & masses of
granulated tissue form within the lungs
Primary infectious agentMycobacterium Bacilli Transmitted by
inhalation of droplets (talking, coughing,
sneezing, & singing)
Risk factors: immune system disorder,
preexisting medical conditions,
institutionalized, health care workers
Pulmonary Tuberculosis
Mycobacterium tuberculosis
 Airborne transmission
 Tuberculin skin testing
 Pharmacologic therapy- multidrug regimens and prophylaxis
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Tuberculosis
Assessment:
 Questions to ask - Are you suffering from night
sweats? Have you lost weight? Have you been
having low-grade fever? Have you been having
SOB and coughing up anything from your lungs?
Have you had chest pain? Where? Have you
had weight loss?
Clinical Manifestations- low-grade fever (late
afternoon), night sweats, weight loss, anorexia,
fatigue, chronic productive cough,pleuritic chest
pain, hemoptysis
Tuberculosis
Diagnostic:
 Sputum culture- + acid-fast bacilli (AFB)
 Skin testing
 CBC- WBC elevated
 CXR
 Bronchoscopy
Nursing Diagnosis:
 Ineffective airway clearance r/t thick, tenacious
secretions
 Ineffective breathing pattern r/t airway
inflammation
Tuberculosis
Altered nutrition less than body requirements
sec. to anorexia and fatigue
 Fatigue sec. to disease process
 Anxiety sec. to social isolation secondary to
isolation protocols
Planning: Clients Outcomes
 Maintain clear airway,normal RR, achieve
weight gain, anxiety decreased
Interventions:
 Maintain respiratory isolation- infectious period
- diversional activities
 Barrier protection should be used
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Evaluation:
 Client adheres to isolation precautions, takes
medication as prescribed
Complications
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Miliary TB
The organism invade the blood stream and can
spread to multiple body organ
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Meningitis
Pericarditis
Tuberculosis
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Promote airway clearance- bedrest, increase
fluid intake, high humidity
Pharmacology
 First-line meds- Isoniazid, Rifampin,
Ehtambutol, & Pyrazinamide for 4 months
 Isoniazid and Rifampin continued for an
additional 2 months or up to 12 months.
Advocate adherence & prevention
Monitor and manage potential complications
Adequate nutrition
Provide client and family education
Provide emotional support
Tuberculosis
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Questions to ask
 Do you have difficulty breathing- all the time
or is it caused by exertion?
 Do you cough frequently and is it productive?
 Have you had a weight loss?
 Do you feel tired quite often and are your
activities impaired by SOB or fatigue?
 Do you have many respiratory infections?
Over what period of time?
Tuberculosis
Nursing Diagnosis
 Ineffective airway clearance r/t thick, tenacious
secretion and fatigue
 Ineffective breathing pattern r/t fatigue and obstruction
of the bronchial tree
 Impaired gas exchange r/t increased sputum production
 Activity intolerance r/t hypoxemia & fatigue
 Altered nutrition r/t increased metabolic demands,
fatigue, & anorexia
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Anxiety r/t inability to breathe effectively
Tuberculosis
Diagnostics:
 ABGs, CBC, sputum culture, CXR,
Pulmonary function tests
Planning: Client Outcomes
 Effectively clear airway and breathing
pattern, maintain normal ABGs, increase
activity with decrease SOB or fatigue,
maintain weight, and less anxious with
episodes of SOB
Bronchitis
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Inflammation of the bronchi caused by irritants
or infection
hypertrophy & hypersecretion of mucous- cause
increase in sputum production
increase mucous- decrease airway lumen sizelumen becomes colonized with bacteria.
Bronchial wall becomes scarred - leads to
stenosis & airway obstruction
Defined as a productive cough that lasts 3
months a year for 2 consecutive years with other
causes excluded.
Cough in the morning with sputum production is
indicative of Chronic Bronchitis
Bronchitis
Risk Factors: cigarette smoking, exposure to
pollution, hazardous airborne substances
Clinical Manifestations: productive cough,
dyspnea esp. on exertion, wheezing, use of
accessory muscles to breathe, cyanosis- “blue
bloater”, clubbed fingers
Interventions:
 Assess patency of airway- suction if cough
ineffective, RR, accessory muscle use, lung
sounds, skin color changes, ABGs
 Encourage high fluid intake & instruct in effective
breathing & coughing
 Monitor oxygen administration & aerosol therapy
Chronic Bronchitis
Encourage to report sputum changes or
worsening of symptoms
 Encourage exercise to improve resp. fitness
 Counsel to avoid respiratory irritants and stop
smoking
 Immunize against common flu and pneumonia
Pharmacology:
 Antibiotic therapy- Tequin, Levaquin
 Bronchodilators- Albuterol, Combivent,
Theophylline
 Corticosteroids- Prednisone, Solumedrol
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Bronchiolitis:Bronchiolitis is a common illness
of the respiratory tract
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usually caused by viral infection. It affects the
tiny airways, called the bronchioles, that lead to
the lungs. As these airways become inflamed,
they swell and fill with mucus, making
breathing difficult.
The variable degrees of obstruction produced in
air passage by these changes lead to
hyperpnoea & progressive emphysema.
Bronchiolitis:
Nursing Assessment
Sometimes more severe respiratory
difficulties gradually develop:
Rapid, shallow breathing.
Drawing in of the neck and chest with
each breath, known as retractions.
Flaring of the nostrils.
Irritability, with difficulty sleeping and
signs of fatigue or lethargy.
Bronchiolitis
Nursing care:
Follow strict precautions to prevent spread
of infection.
Administer high humidified oxygen.
Clear nasal congestion, try a bulb syringe
and saline (saltwater) nose drops.
Provide adequate Ng. Care for vomiting,
fever, & diarrhea.
Small frequent diet, & increase fluid intake.
Lung abscess
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A lung abscess is a localized area of lung
destruction
liquefaction necrosis usually related to pyogenic
bacteria
Cavity formation
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Clinical manifestation
Dyspnoea
Chest pain
Tachycardia
Diagnosis Method
CT
 Chest X ray
 Encourage exercise to improve resp. fitness
 Counsel to avoid respiratory irritants and stop
smoking
 Immunize against common flu and pneumonia
Pharmacology:
 Antibiotic therapy- Tequin, Levaquin
 Bronchodilators- Albuterol, Combivent,
Theophylline
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