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RESPIRATORY DISEASES

CRONIC OBSTRUCTIVE PULMONARY DISEASES COPD

Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Lung Disease Chronic Airway Limitation - Chronic Bronchitis and Emphysema - Features of this disease: - Pts almost always have a history of smoking - labored breathing (dyspnea) becomes progressively more severe - Coughing and frequent pulmonary infections are common - most victims retain carbon dioxide, are hypoxic, and have respiratory acidosis - those infected will ultimately develop respiratory failure

SIGNS AND SYMPTOMS: Easy fatigue Pursed lip breathing Barrel chest Dyspnea, Orthopnea Retraction Wheezing on expiration Clubbing

Chronic Obstructive Pulmonary Disease (COPD)

- Basis: - chronic airway blockage - resistance - progressive airflow limitation both ways - irreversible alveolar distention air trapping alveolar damage ABG imbalances: low pO2, high pCO2 - Possible Complications: - pulmonary hypertension - respiratory insufficiency or failure - Cor Pulmonale - CO2 narcosis - atelectasis

CHRONIC BRONCHITIS

- Is an inflammation of the bronchioles that impairs airflow - Mucosa of the lower respiratory passages becomes severely inflamed - Mucus production increases - Pooled mucus impairs ventilation and gas exchange - Risk of lung infection increases - Pneumonia is common - Hypoxia and cyanosis occur early

- May be: a. acute: when bronchus becomes inflamed b. chronic: results when inflammation occurs several times a year; dx by presence of cough that persist for 3 months a year for 2 years - Etiology: a. exposure to pulmonary irritants b. infections including RTi and influenza

PATHOPHYSIOLOGY: a. Enlargement and hyperactivity of goblet cells b. irritation of bronchiole tissue c. inflammation and narrowing of airways d. concurrent infections e. further obstruction f. Pneumonia (as complication) g. chronic can lead to emphysema SIGNS AND SYMPTOMS: - coughing - excessive sputum production - shortness of breath

NURSING INTERVENTIONS: a. eliminate/minimize pts exposure to irritants and people with RTI b. Clear airways with chest physical therapy or suctioning as ordered c. Mucolytics as prescribed d. Deep-breathing exercises Deepe. Patient teaching about adequate nutrition and medication therapy

EMPHYSEMA

-Terminal stage of COPD - Overdilated alveoli and bronchioles - Chronic inflammation promotes lung fibrosis - Airways collapse during expiration - Patients use a large amount of energy to exhale - Overinflation of the lungs leads to a permanently expanded barrel chest - Cyanosis appears late in the disease - Nsg Dx: impaired gas exchange

ETIOLOGY A. Predisposing factors: - A-ge - H-eredity - A- uto Immune tendency B. Precipitating factors: - B-ronchitis, chronic - A-ir pollution - S-moking - A-sthma, chronic

LUNG CANCER

- Refers to malignant tumor growth within the bronchial tissue or lung parenchyma - Types include: - Squamous cell 35-50% of all lung Ca - Adenocarcinoma 15-35% of all lung Ca - Small cell 20-25% of all lung Ca - Large cell 10-15% of all lung Ca

ETIOLOGY AND INCIDENCE: - Predisposing factors: - chronic exposure to pulmonary irritants - Family history of lung cancer - Tend to have poor prognosis, unless it is well defined and removed by surgery PATHOPHYSIOLOGY: a. As lung tissue is irritated, it undergoes series of changes giving rise to a tumor. b. Metastasis can occur, especially if primary tumor is an area of lymph drainage c. Some tumors secrete hormones: ADH, ACTH

SIGNS AND SYMPTOMS: - cough - wheezing - shortness of breath - chest pains - hoarseness of voice - dysphagia - weight loss

NURSING INTERVENTIONS: - Prepare pt for surgery if tumor is small enough to be removed - Prepare pt for planned treatments chemotherapy/radiation therapy - Analgesics as ordered to control pain - Adequate oxygenation through O2 therapy or planned activity-rest - Maintain nutritional status - Provide emotional support to patient and family

ATELECTASIS

Refers to collapse of previously expanded lung - A shrunken airless state of the alveoli - Can be primary or secondary

ETIOLOGY: a. Primary - lung tissue remains uninflated as a result of insufficient surfactant production - present at birth typically on premature and atrisk infants b. Secondary - caused by airway obstruction, lung compression, and increased recoil due to diminished surfactants c. airway obstruction may be due to mucus plugs, tumors or exudates d. its risks increases after surgery

PATHOPHYSIOLOGY/MANIFESTATIONS a. surfactant must be constantly replenished b. ineffective cough reflexdecreased tidal volume poor alveolar expansion c. increased viscosity of sputum pooling of secretions d. complete airway obstruction collapse of that portion of lung SYMPTOMS: - crackles - diminshed breath sounds from poor air entry - dyspnea and tachycardia - hypoxemia

OVERVIEW OF NURSING INTERVENTIONS - encourage deep breathing and coughing - encourage the performance of incentive spirometry - administer antibiotics as ordered - administer oxygen if necessary

PNEUMOTHORAX

- It is the accumulation of air in the pleural space, which results in partial or complete lung collapse TYPES: a. tension - air enters but cant leave pleural space b. secondary - air enters pleural space as a result of injury to chest wall, resp. structures or esophagus c. spontaeous air enters pleural space when airfilled blebs (blisters) on lung surface ruptures ETIOLOGY: a. tension unknown cause b. secondary injury to chest wall from trauma c. spontaneous ruptured bleb(common in smokers)

SYMPTOMS: - pleuritic pain (sharp pain during inhalation) - tachypnea - dyspnea - asymmetry of chest wall (from rib fractures) - decreased breath sounds over area of pneumothorax - trachea deviating to injury site - shifting of mediastinal structures to unaffected side of unaffected chest - signs of shock (from large pneumothorax) In tension pneumothorax, onset is sudden and painful

NURSING INTERVENTIONS - monitor v/s, signs of shock - observe respirations; changing patterns may indicate worsening situations - semi-Fowlers position - administer oxygen as necessary - analgesics as ordered - chest tube: - maintain sterile dressing at chest tube insertion site - maintain patency and integrity of closed chest drainage system - evaluate amount of fluid and breath sounds

PLEURAL EFFUSION

-Refers to an abnormal accumulation of fluid in the pleural space or cavity -fluid may be transudate(hydrothorax), exudates(empyema), blood(hemothorax), or chyle(chylothorax) chyle is a milky fluid found in lymph fluid from GI tract

ETIOLOGY a. Hydrothorax results from CHF, RF, nephrosis and liver failure b. Emyema - from infections, malignancies, SLE c. Hemothorax chest injuries, chest surgery complications, malignancies, blood vessel rupture d. Chylothorax trauma, inflammation or malignant infiltration

PATHOPHYSIOLOGY/MANIFESTATIONS 1. 5 mechanisms: - increase capillary pressure - increase capillary permeability - increase intrapleural negative pressure - impaired lymphatic drainage of the pleura 2. results in decreased lung volume on the affected side and a mediastinal shift on the other sidedecreased lung volume on the other side as well 3. characteristic signs: diminished breath sounds, flatness and dullness to percussion

4. Other symptoms are: - dyspnea, pleuritic pain, constant discomfort 5. severeity of hemothorax is determined by volume of fluid: - minimal(300-500cc) resolves in 10-14 days - moderate(500-1000cc) - large(1000cc or more) fills half or more of the chest and requires immediate drainage

NURSING INTERVENTIONS 1. observe patient for signs of shock 2. administer analgesics as prescribed 3. for moderate to large: - maintain fluid replacement as ordered - assist with insertion of chest tube as ordered - maintain patency of tube - prepare for surgery if bleeding doesnt stop

ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)

-A sequelae of several diseases in which the lungs fill with water, making gas exchange impossible ETIOLOGY a. unknown cause b. Predisposing factors: - pneumonia - near drowning - reaction to drugs and inhaled gases - shock infection - diabetic ketoacidosis - trauma - burns

PATHOPHYSIOLOGY - results to decreased lung compliance and increased work of breathing Symptoms include: - crackles and gurgles - hypoxemia due to poor diffusion - respiratory distress - x-ray result: mass consolidation - ABG analysis: respiratory acidosis

NURSING INTERVENTIONS 1. monitor fluid intake 2. administer steroids as ordered reduce inflammation 3. assess for complication like pneumothorax 4. institute PEEP 5. provide care necessary for a mechanical ventilator 6. protect the airway from injury 7. relieve anxiety

ACUTE RESPIRATORY FAILURE

-A disease sequelae which occurs when the lungs are unable to adequately oxygenate the blood(hypoxemia) - pO2 is less than 50 mmHg and CO2 is more than 50 mmHg ETIOLOGY a. infections like pneumonia b. COPD exacerbations

PATHOPHYSIOLOGY a. loss of ventilation/perfusionaltered gas exchange hypoxia and hypercapnia b. hypoxia stupor, coma, bradycardia, and hypotension c. hypercapnia: - vasodilation shock - sedation of CNS - respiratory acidosis d. other symptoms - tachycardia, diaphoresis, restlessness, agitation, cool skin

NURSING INTERVENTIONS 1. mechanical ventilator with O2 as ordered to maintain airway, nutrition and hydration 2. assess for complications of pneumothorax 3. administer antibiotics as ordered(if infection is present) 4. administer bronchodilator as prescribed

PNEUMONIA

-An acute infection of the lung parenchyma ETIOLOGY - include bacteria, viruses, fungi and protozoa - severity may depend on extent present (partial/full,lobar or diffusedbronchopneumonia SYMPTOMS: - fever, chills, rales and ronchi, dyspnea, malaise, cough, pleuritic chest pain

PATHOPHYSIOLOGY a. organisms enter respiratory tract b. overwhelming infxn/immunosuppression (invading organism multiplies) c. release toxins d. increase capillary permeability e. edema of the lung parenchyma f. cellular debris and exudates g. if filled, may lead to airless state h. cosolidation

NURSING INTERVENTIONS 1. administer antibiotics specific for the causative agent, as ordered 2. control fever 3. encourage adequate fluid intake 4. provide bronchial hygiene 5. maintain adequate nutritional status 6. chest physiotherapy 7. oxygen, as ordered

RESPIRATORY TRACT INFECTION

-RTI affects airway clearance and breathing patterns by changing the amount and character of secretions - severe RTI include Pneumonia and PTB - risk factors: - exposure to infected persons - stress or other immunocompromised states

EPISTAXIS

- causes: trauma, HPN, cancer, foreign body - Nsg Interventions: - sit up, lean forward, head tipped - pressure application for 5 mins - cold compress or ice pack - liquid then soft diet - avoid oral temp taking - do not blow nose for 2 days after removal nasal pack - notify MD if epistaxis is persistent or recurrent

SINUSITIS

- URTI, cigarette smoking, allergic rhinitis - S/S: - pain - maxillary-cheek/upper teeth - frontal-above eyebrows - ethmoid-in and around eyes - shpenoid-behind eye,occiput, top of head - general body malaise - stuffy nose headache - post nasal drip - persistent cough - fever

TONSILLITIS

- S/S: sore throat, fever, snoring, dysphagia, mouth breathing, earache,frequent head colds, bronchitis, halitosis, voice impairment, noisy respirations, draining ears -Nsg. Interventions: - promote rest - increase oral fluid intake - warm saline gargle - analgesics as ordered - antimicrobial as ordered

-Preop care: - assess for URTI, coughing & sneezing may cause bleeding - check prothrombin time - Post op care: - prone, head turned to side or lateral position - oral airway until swallowing reflex returns - monitor for hemorrhage - frequent swallowing - bright red vomitus - increased PR - promote comfort - ice collar - acetaminophen - foods and fluids

CLIENT EDUCATION - avoid clearing of throat - avoid coughing, clearing of throat for 2 weeks - 2-3 L of fluids until mouth odor disappears - avoid hard scratchy food until throat is healed - report signs of bleeding - throat discomfort on the 4th-8th post op day is normal - stool may be black/dark for a few days due to swallowed blood

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