Respiratory Disorders

Nio C. Noveno, RN ,MAN

Pneumonia
Acute inflammatory process of the alveolar spaces lung consolidation exudate [alveoli]

Classification
CAP: most common; occurs in the community or 48 H before hospitalization S. pneumoniae, H. influenza, M. pneumoniae Nosocomial: onset of S/S is 48-72 H posthospitalization P. aeruginosa, S. pneumoniae, K. pneumoniae

Aspiration pneumonia S. pneumoniae, H. influenza, S. pneumoniae, gastric contents

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Pneumonia
Types
Bacterial pneumonia Lobar [Strep] constant dry, hacking cough, pleuritic pain, watery to rust-colored sputum Bronchopneumonia [Strep/Staph] due to aspiration, productive cough w/ yellow or green sputum Alveolar pneumonia [viral] scanty sputum Atypical pneumonia [rickettsial] walking, nonproductive cough
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Pneumonia
Cough Chills Dyspnea Elevated temperature Crackles Rhonchi Pleural friction rub Sputum production Rusty, green, or bloody: pneumococcal Yellow-green: BPN

Clinical Manifestations

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Pneumonia
Opportunistic infection Often related to HIV & other immunocompromised conditions Clinical Manifestations Increasing SOB Nonproductive cough Low-grade fever

Pneumocystis carinii pneumonia

Treatment Cotrimoxazole Pentamidine

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Pneumonia
Management Increase OFI 3-4 L/day. Administer O2. Assess respiratory status. Monitor VS, I/O, lab studies, & pulse ox Monitor & record color, consistency, & amount of sputum Home care Recognize s/sx of infection. Avoid exposure to people with infections. Increase OFI at 3 L/day.
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Chronic Obstructive Pulmonary Disease

Bronchitis

Emphysema
Causes Congenital weakness Respiratory irritants: smoke, polluted air, chemical irritants Respiratory tract infections Genetic predisposition
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Chronic Obstructive Pulmonary Disease

Chronic Bronchitis
Excessive bronchial mucus production Chronic or recurrent productive cough
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Smoking, RTI, Pollutants

Inflammation
Bradykinin, Histamine, PGs Capillary permeability Fluid/Cellular Exudation Mucosal edema

Hypersecretion of mucus
Persistent Cough
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Chronic Obstructive Pulmonary Disease

Smoking, heredity, aging process

Emphysema
Destruction of elastin alters alveolar walls & narrows airways Enlargement of air spaces distal to terminal bronchioles leads to coalesced alveoli & air trapping
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Disequilibrium between elastase & antielastase

Loss of elastic recoil Overdistention of alveoli CO2 retention Hypoxia Respiratory acidosis
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Emphysema
No cyanosis (Pink) Thin appearance Exertional dyspnea Ineffective cough Barrel chest Pursed-lip breathing Prolonged expiration Use of accessory muscles

Chronic Bronchitis
Cyanosis (Blue) Edematous Exertional dyspnea Recurrent cough w/ Sputum production Digital clubbing Respiratory rate Use of accessory muscles

R-sided Heart Failure R-sided Heart Failure Pulmonary HPN Cor pulmonale Spontaneous pneumothorax respi disorders nionoveno@yc

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Chronic Obstructive Pulmonary Disease

Management
Rest: O2 demand of tissues Fluid intake: 3 L/day Diet: calorie, CHON, CHO, vit. C Low-flow O2 therapy: 1-3 LPM Breathing exercises [pursed-lip] Avoid cigarette smoking, alcohol, pollutants CPT: postural drainage percussion vibration Bronchial hygiene measures: steam, aerosol, medimist inhalation Pharmacotherapy: Antitussives, bronchodilators, antihistamine, steroids, antimicrobials
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Chronic Obstructive Pulmonary Disease

Bronchiectasis
Destruction of bronchial mucosa with fibrous scar tissue formation Loss of resilience & airway dilation causes pooling of secretions Obstruction of airflow
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Chronic Obstructive Pulmonary Disease Asthma

Histamine, Bradykinin, PG, Serotonin, Leukotrienes Exhaustion ALLERGY (Extrinsic) INFLAMMATION (Intrinsic) Bronchospasm Mucosal edema Hypersecretion of mucus Respiratory effort Narrowing of AWs, work of breathing

Hypoventilation

Air trapping

Hypoxia & Respiratory Acidosis

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Chronic Obstructive Pulmonary Disease Asthma

Orthopnea Restlessness Dyspnea, tachypnea Tachycardia Nasal flaring Retractions Cough Chest tightness Cold clammy skin Wheezing Cyanosis
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Clinical Manifestations

Pharmacotherapy Beta agonists [Epinephrine, Methylxanthines

Terbutaline] [Aminophylline]

Management

Corticosteroids Anticholinergics [Atropine] Mast cell inhibitors [Cromolyn] Oxygen via nasal cannula Fluids to 3L/day Breathing exercises Metered dose inhaler
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Acute Respiratory Distress Syndrome

Clinical syndrome of respiratory insufficiency
Damaged capillary membranes Interstitial edema Intraalveolar hemorrhage Hypoxemia Causes Viral pneumonia Fat emboli Sepsis Decreased surfactant production
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Acute Respiratory Distress Syndrome

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Acute Respiratory Distress Syndrome

Clinical Manifestations
Dyspnea Tachypnea Crackles Rhonchi Anxiety Breath sounds
Intubation & mechanical ventilation using PEEP Pharmacotherapy Antibiotics Analgesics Steroids Neuromuscular blocking agents

Management

ABGs: Respiratory acidosis, hypoxemia CXR: interstitial edema

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Diagnostics

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Chest Physiotherapy
Postural drainage Percussion Vibration

Nursing Care
Perform before or 3-4 hrs after meal Bronchodilators 15-20 mins before Remove all tight clothing Percuss on area approx 3mins during I & E Vibrate on area during E Assist pt in coughing & positioning Provide good oral hygiene
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Chest Physiotherapy Postural Drainage

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Pulmonary Tuberculosis
Airborne, infectious, communicable Acute or chronic Mycobacterium tuberculosis Clinical Manifestations Fatigue, malaise Anorexia, weight loss Night sweats Late afternoon low-grade fever Productive chronic cough Hemoptysis (advanced)

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Pulmonary Tuberculosis
Mantoux test Read after 48-72 H [>10 mm induration] Chest x-ray Calcified lesions Sputum exam Acid-fast bacillus

Diagnostics

TB medications [6-12 mos] INH, RIF, (6 mos); PZA, ethambutol, streptomycin (2 mos) Pt non-infectious 2-3wks of Tx 9 mos continuous therapy

Management

RIF: discoloration ; hepatotoxic INH: peripheral neuropathy (B6), liver function test (AST, ALT) PZA: thrombocytopenia, hyperurecemia OFI ETHAMBUTOL: optic neuritis STREPTOMYCIN: hepatotoxic, nephrotoxic, ototoxic, given IM
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Pleural Effusion & Pneumothorax

Causes
Trauma Thoracic surgery Positive pressure ventilation Thoracentesis CVP line insertion Emphysema

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Pleural Effusion & Pneumothorax

Clinical Manifestations
Sudden sharp chest pain Shortness of breath (SOB) Restlessness/anxiety Tachycardia, tachypnea Diminished/absent BS Chest asymmetry Tracheal deviation towards unaffected side Tympany
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Management
High-Fowlers Pain relief O2 therapy Chest tube insertion Thoracentesis Chest x-ray ABGs Monitor for shock

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Pulmonary Embolism
Undissolved substance in pulmonary vasculature obstructs blood flow Types: Fat, Air, Thrombus Causes Flat or long bone fractures Thrombophlebitis Venous stasis
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Pulmonary Embolism
Clinical Manifestations
Dyspnea, tachypnea, crackles

Diagnostics
ABGs Respiratory alkalosis, hypoxemia Lung Scan Pulmonary circulation & blood flow obstruction Angiography Location of embolus Filling defect of pulmonary artery
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Pulmonary Embolism
Management
Intubation & mechanical ventilation Anticoagulants Thrombolytics Assess for (+) Homans sign Monitor PT & PTT WOF S/S of excessive anticoagulation

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Bronchogenic Carcinoma
Primary pulmonary tumors arising from bronchial epithelium; metastasis primarily by direct extension, via the circulatory or the lymphatic systems Incidence Men > 40 years; 1 out of 10 heavy smokers Right lung > Left lung Etiology Inhaled carcinogens [cigarette smoke, asbestos, nickel, iron oxides] Pre-existing pulmonary DO [COPD, TB]
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Bronchogenic Carcinoma
Clinical Manifestations
Persistent cough [productive, blood-tinged] Chest pain, dyspnea Unilateral wheezing Friction rub Fatigue, anorexia Nausea & vomiting Pallor
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Diagnostics
CXR Presence of tumor; metastasis Sputum for cytology Malignant cells Thoracentesis Pleural fluid with malignant cells
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Bronchogenic Carcinoma
Management
Depends on cell type, stage of disease, and condition of the patient Radiation therapy Chemotherapy Surgery Provide support & guidance to client Relief/control of pain and nausea Meds as ordered, monitor effects
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Lung Cancer
Maybe metastatic or primary Leading cause of mortality Smoking-related Poor prognosis Dies in 5 years Adenocarcinoma Most prevalent type Small cell carcinoma Poorest prognosis
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Laryngeal Carcinoma
Risk Factors
Cigarette smoking Chronic laryngitis Vocal abuse Alcohol abuse Familial tendency

Types
Glottic Hoarseness for >2 weeks Dyspnea Supraglottic Localized throat pain Burning when drinking hot liquids or orange juice Lump in the neck Dysphagia, odynophagia
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Laryngeal Carcinoma
Management
Subtotal laryngectomy: retains voice Total: absolute loss of voice Tracheostomy: temporary or permanent Maintain patent airway HOB elevated 45 Assist patient in communicating; provide writing materials, etc. Practice swallowing Cover tracheostomy with porous material Avoid powder, spray, aerosol near trachea
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THANK YOU!
Respiratory Disorders
Nio C. Noveno, RN ,MAN