Respiratory Disorders

Pharyngitis – inflammation or infection causing symptoms of sore throat - mostly caused by viral infection: “strep throat” if caused by Group A beta hemolytic streptococcus Body responds through:        inflammation in the pharynx pain fever Edema Vasodilation tissue damage creamy exudates

Nursing Mgt: 1. Bed rest during febrile stage 2. Dispose used tissues properly to avoid infection 3. Inspect skin for rashes 1x-2x weekly which can precede some communicable disease (ex: rubella) 4. Warm saline gargle or irrigation (40.6 C – 43.3. C) to reduce spasm in the pharyngeal muscles and relieving soreness 5. Ice collar 6. Mouth care to prevent fissures (cacking) in the lips and oral inflammation. 7. Take full course of antibiotic. TONSILITIS – faucial and palatine tonsils and lingual tonsils -adenoid or pharyngeal tonsil (near the center f the posterior wall of the esophagus) - caused by Group A beta streptococcus (most common causative organism) S/Sx:           Sore throat earache snoring fever difficulty swallowing foul-smelling breath draining ears voice impairment mouth breathing noisy respiration

Complications:         S/Sx:       fiery red pharyngeal membrane and tonsils swollen lymph nodes follicles and white purple exudates tender cervical lymph nodes fever malaise sore throat Sinusitis otitis media peritonsillar abscess mastoiditis cervical adenitis pneumonia meningitis rheumatic heart fever

Complications:   otitis media acute mastoiditis

Medical Mgt.: A. Pharmacological Therapy TOC: Penicillin Cephalosporins and macrolides (Clarithromycin and azithromycin) For patients allergic to penicillin or organism resistant to erythromycin (S. aureus) administer antibiotic within at least 10 days Analgesic medications: Aspirin and acetaminophen Antitussive: Codeine and dextromethorphan (for persistent and painful cough)

Medical Management: 1. Tonsillectomy – for recurrent, hypertrophic, obstruction during sleep, peristonsillar abcess which obstructs the pharynx. 2. Antibiotic therapy is initiated - Penicillin, amoxicillin, eryhromycin Nursing Management 1. 2. 3. 4. Prone position; head turned to side Oral airway must be in place first Ice collar is placed. Provide basin and tissues


Provide post-op care. B. Nutritional Therapy - Liquid or soft diet on the acute stage. IV fluids if cannot tolerate PO due to pain. - Increase OFI up to 2-3 L/day 1. Bright red (bleeding) If no bleeding, give water and ice chips. Check on the 1st day and 10th day postop for sloughing of tissues.
1 Fernandez BSN

squeezing pain while swallowing) unilateral tonsillar hypertrophy dehydration dysphagia (difficulty of swallowing) otalgia (pain in the ear) drooling marked swallowing of the soft palate.2. using saline or alkaline solutions (40. 7. RHINITIS. allergic Causes: Fernandez BSN Clinical Manifestaion of Viral Rhinitis: Foreign bodies entering the nose   nasal congestion runny nose 2 . often occluding Pharmacologic Management:      Meds for allergic and non-allergic rhinitis focuses on symptomatic relief Antihistaminic: sneezing. 5. Liquids and semi-liquid for several days. including the soft palate. 6. 2. acute inflammation of the mucous membrane of the nasal cavity. Avoid vigorous brushing and gargling. virus shed for about 2 days before the symptoms appear and during the 1st part of the symptomatic phase Causative Agent:       Rhinovirus (50% of all cases) Parainfluenza virus Coronavirus Respiratory Synctial Virus Influenza Virus Adenovirus   Nursing Management 1.6 to 43. Considerable relief maybe obtained by the use of topical anesthetic agents and throat irrigation on the frequent use of mouthwashes or inflammation of the mucous membranes of the nose. infectious.primarily bactericidal If treatment is delayed the abscess is evacuated through surgery (in a sitting position for easier expectoration of pus and blood) single or repeated aspiration to decompress the abscess Incision and draining Nursing Management: 1. Highly contagious. S/Sx:       structured deformities neoplasm and masses chronic use of nasal decongestants use of oral contraception. Saline nasal or aerosol spray Common Colds/ Viral Rhinitis The “cold” refers to an afebrile.3 degC) 2. hot. Avoid allergens 3. 8. Teach patient’s self-care. Avoid spicy. 4. It is believed to develop after acute tonsillar infection which progresses into a local cellulitis and abcess. acidic. rough foods. itching and rhinorrhea Oral decongestants: nasal obstruction Intranasal corticosteroids. Shorbet and gelatin. 3. Milk and milk products may be restricted Hallitosis and minor ear pain may occur for the first few days. 12-25 hours bleeding may occur. cocaine and antihypertensive rhinorrhea nasal congestion nasal discharge nasal itchiness sneezing headache Medical Management:    (viral) meds are given to relieve the symptoms (allergic) tests may be performed to determine the allergens Desensitizing immunization and corticosteroids may be required S/Sx: symptoms of infection raspy voice odynophagia (a severe sensation of burning. PERITONSILLAR ABCESS – a collection of purulent exudate between the tonsillar capsule and the surrounding tissue.for severe congestion Opthalmic agents Medical Management:   Antibiotics (usually penicillin). classified as infections (most commonly caused by URI). Liquids that are cool or at room temperature may be well tolerated. 3. Instruct the patient to gargle at intervals of 1 to 2 hours for 24 to 36 hours.

) Epiglottitis – bacterial infection of the epiglottis . . Antibiotics should not be used Nursing Management: 1.Increase mucus production Assessment:  Rhinorrhea and decrease fever  Lethargy  Poor feeding  Irritability  Tachypnea  Dyspnea  Nasal Flaring  Wheezing  Diminished Breath Sound Nursing Care  Maintain airway  High Fowler’s 3 Fernandez BSN . rest. 3. due to voice abuse.         nasal discharge nasal itchiness teary watery eyes “scratchy” sore throat general malaise low-grade fever chills headaches muscle ache   Expectorant may be used 3 L of daily fluid intake COMMON PEDIATRIC RESPIRATORY DISORDERS A. Zinc lozenges 5. 9. NSAIDS 2. Medical Management:  No specific treatment  Adequate fluid intake. Balanced diet LARYNGITIS.inflammation of the larynx. chemicals.EMERGENCY situation .Caused by Haemophilius Influenza type B or strep pneumonia . 10.Age group : 2-5 y. Nasotracheal tube intubation Monitr signs of distress Maintain patent airway NPO Don’t have child unattended Don’t restrain IV Fluids Antibiotics Analgesic and antipyretic Cool mist oxygen Increase humidification Resuscitation Immunization (Haemophilus type B) B.Onset is abrupt . 4.Bacterial may be secondary . expectorants  Warm salt water gargles Pharmacologic Therapy: 1. 11.An inflammation of the bronchioles .Viral infection . exposure to dust. Rimantadine (flumadine) 7.) Broncholitis (Respiratory Synctial Virus) . 14. Handwashing 4. Antihistamines 3.Tripod position S/Sx:         fever sore throat (red & inflamed) spontaneous coughing drooling muffled voice respiratory stridor agitation TRIPOD position May last 1 to 2 weeks If severe persists with S/Sx. 8. Direct contact must be avoided 3. Teach patient self-care 2. smoke. Topical decongestants (rebound) 4. Amantadine (symmetrel) 6. URTI. 13. Rest 5. increase Vitamin C. 6.Often occurs in winter . 5. 12. Send immediately to hospital.Associated woth other conditions Clinical manifestation:  ACUTE o Hoarseness o Aphonia o Severe cough  Chronic o Persistent hoarseness o complications of URTI Medical Management:        Resting the voice Avoid smoking Resting Inhaling cool steam or alcohol Antibiotic is started Topical corticosteroids: Beclomethasone dipropionate (Vanceril) inhalation Rest the voice Nursing Care 1. 2. other pollutants and may be infection . 7.o.

RSV) commonly found in children less than 5 y. sedative hypertropics Types: 1. barky.larynx contains a narrow space between the vocal chords (glottis) through which the air pass -swelling of the laryngeal mucous membranes sloughs off the opening tightly leading to suffocation because larynx cannot stretch Causes:  Laryngitis  Client with uticaria  Severe inflammation of the throat  Death in severe anaphylaxis  Foreign bodies Fernandez BSN . brassy cough hoarseness restlessness low-grade fever inspiratory stridor non-toxic appearance Management:  mist tents  rocemiec epinephrine  corticosteroids  HELIOX.passageway of air through the nostrils obstructed by deviated nasal septum . Mixed.simultaneously cessation of airflow and respiratory movements 3. Obstructive.) Laryngeotracheobronchitis (LTB)/ Croup S/Sx:       inflammation of mucosal lining with the larynx and trachea and sometimes reaches the bronchi usually viral causative agent (Parainfluenza virus.svere cases (TOC)  Monitor for respiratory status  Rest  Avoid use of cough syrup and cold medicine  Walk the child outdoors  Open the faucet (steam inhalation)  Increase moisture in the air  Cool vapor therapy/stram inhalation to relieve laryngeal and tracheal irritation  Moist heat to chest to relieve soreness and pain  Povide mild analgesics Daytime sleepiness Morning headache Sore throat Intellectual deterioration Personality Disorders Behavioral changes Enuresis (urinary incontinence) Impotence Obesity Loud Snoring Nursing Management: 1.Hypertrophy of the turbinate bones or pressure of the nasal polyp (grapelike swelling) . CPAP. frequent snoring and breathing cessation for 10 seconds or more Risk Factors:  Men  Overweight  Smoking  Reduced pharyngeal muscle tone  Neuromuscular disease. considered as TERATOGENS Medical Management:  SC epinephrine or a corticosteroid if caused from an allergic reaction  Ice pack to the neck  Foreign body airway obstruction (FBAO) from APHYXIA  Subdiaphragmatic abdominal thrust maneuver  Immediate tracheotomy b. Central.lack of air flow due to pharyngeal obstruction 2.        Cool humidified oxygen Oral and IV fluids Assess for dehydration (for RSV) Place patient in private Room Observe proper handwashing Avoid contamination for others RIBAVIRIN (Virazol) DOC Pregnant health care providers must avoid contact with patients.) Sleep Apnea Syndrome.face mask c.) Laryngeal Obstruction.May lead to nasal infection Management:  Removal of obstruction  Treat chronic infection and allergy  Endoscopic surgery  Submucous resection/ Septoplasty -incision of mucous membrane and removing deviated bone and cartilage  Nasal polyp removal by clipping them at the base with a WIRE SNARE 4 OBSTRUCTION of the UPPER AIRWAY a.o.cessation of breaqthing during sleep.) Nasal Obstruction.a combination of central and obstructive apnea with one apneic episode S/Sx:           c.

child displays respiratory distress despite vigorous treatment Assessment:  Wheezing  Dyspnea  Chest tightness  Exacerbation. ipratoropium bromide.increase the cAMP which relaxes the smooth muscles promoting bronchodilation 5. behind the obstruction I Alveoli distended. deformity Assessment:  X-ray.Disease state characterized by airflow limitation that is NOT REVERSIBLE .disorder of the bronchial airways characterized by periods of reversible bronchospasm o Commonly caused by physical and chemical irritants o Bronchial obstruction Status Asthmaticus. Asthma. occluded Asthmatic Episode:  Irritability  Restlessness  Headache  Chest tightness  Non-productive cough  Later stage: productive.) Fracture of the Nose. Systemic corticosteroids 4. Brethine. yellowish halo ring Management:  Cold compress for bleeding  Nose symmetry assessed before and after swelling  Reffered to a specialist 7-10 days after injury  Apply ice pack to nose for 20 min 4x a day to decrease swelling  Mouth rinses to moisten mucous membrane MANAGEMENT of CLIENTS with LOWER AIRWAY VESSEL DISORDER 1. pulmonary vasculature I Chronic inflammation and body’s effort to repair it I Narrowing in small peripheral airways I Chronic injury and repair process I Scar tissue formation and narrowing of airway lumen I Airflow Obstruction Risk Factors:  Exposure to tobacco smoking  Passive smoking  Occupational exposure  Ambient air pollution  Deficient alpha 1 reveal displacement of fractured bones and possible fracture of the skull  Internal examination  DIPSTICK or DEXTROSTIX.air is trapped behind. Terbutaline sulfate (Brethaire.Includes emphysema and chronic bronchitis Pathophysiology: Inflammation response to noxious particles and gases I Affecting airways. Metaproterinol sulfate ( Alupent). Salbutamol (Ventolin). B2 Agonist.Zafirlukast (Accoloate) and Zileuton (Zyfic). parenchyma.albuterol (Froventil). frothy Nursing Management:  Airway  Humidified oxygen  Monitor respiratory status  Oral and IV fluids  Nutrition: Electrolyte replacement if needed  Prepare the child for CXR Medications: 1. Anticholinergic. bacteria.atropine sulfate. diminishing lung capacity I 5 . Long-Acting Bronchodilators Home Care Measures:  Allergens control  Avoid extremes of temperature  Avoid exposure to viral respiratory infection  Recognize early symptoms  Exercise as tolerated CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) . Bricanyl) Fernandez BSN 2. Leukotrienes Modifiers.Include disease that cause airflow obstruction .clear fluid draining from either nostril suggest CSF leakage. and other foreign matter I Airflow is obstructed and air becomes trapped. Methylxanthines.d. given for ABOVE 12 years old only 6. atrovent enzyme inhibitor that protect the lung parenchyma Effects of Smoking Depresses activity of scavenger cells and affects the ciliary cleansing mechanism which keeps breathing passages free of assault.

RV must maintain a higher blood pressure in the PA 2.Distribution of the bronchioles.“BLUE BLOATER” .Dysfunctional macrophages from damaged and fibrosed bronchioles Assessment  Chronic cough  “blue bloater”  Edematous cyanotic 2. Centrilobular (Centroacinar) . preserving the peripheral portions of the alveoli .Enlarged air spaces but little inflammatory disease .Presence of cough and sputum production for at least 3 months in each of two consecutive years .Impaired oxygen diffusion resulting to hypoxemia . rigid chest) 2. mucus plug airways . Pneumonia 4.hyperinflated.Pathologic changes in the center of the secondary lobule. hypercapnea. alveolar ducts and alveoli . Respiratory Insufficiency and failure 3.Recurrent infection destroy alveoli walls . episodes of RHF which may lead to cyanosis.Hypoxemia.R-sided heart failure .Weight loss Complication: 1.Impaired gas exchange (oxygen and carbon dioxide) results from destruction of the walls of overdistended alveoli .Abnormal distention of the air spaces begin the terminal bronchioles with alveoli wall destruction . reduce airway obstruction by allowing increased oxygen distribution through out the lungs and improving alveolar ventilation 6 Fernandez BSN . Cor pulmonale . involuntary passive act o Emphysema: active and muscular effort (SOB. Emphysema .Smoke/ environmental pollutants irritate the airways .relieve bronchospasm. Chronic Bronchitis . peripheral edema and respiratory failure Risk Factors: Smoking cigarette and passive smoker Prolonged intense exposure to occupational dusts and chemicals Air pollution (indoor and outdoor) Deficient alpha 1-antitryspin (enzyme inhibitor test that protects lung parenchyma) S/Sx:       Cough Sputum production Dyspnea or exertion and at rest.Increase pulmonary blood flow because of reduced capillary blood flow .Goblet cells and mucus irritation I Increased accumulation of muscles (more mucus irritation) I CO binds with Hemoglobin and becomes carboxyhemoglobin I Insufficient transport of oxygen 1. causing respiratory acidosis .Hypercapnea.Thickened bronchial walls. Panlobular (Panacinar) . hyperexpanded  Inhalation o Normal: (-) pressure o Emphysema: Resting Position  Exhalation o Normal: (+) pressure. Pneumothorax S/Sx:        Types of Emphysema: 1. narrowed bronchial lumen.“BARREL CHEST” appearance. if severe Weight loss Barrel chest Shoulders heave forward and upward Exertional dyspnea Congestion Dependent edema Distended neck veins Pain in the region of the liver (RUQ) Weight loss “PINK PUFFER” Management:  Risk reduction  Smoking cessation  Meds for long term smoking  Abstinence  Bupropion SR (zyban)  Antidepressant  Nicotine Gum  Nicotine Inhaler  Nicotine Nasal Spray  Nicotine patch Pharmacologic Therapy o Bronchodilators .

1.Beclomethasone (beclovent) . LUNG TRANSPLANTATION – end-stage emphysema. involve alveolar ventilation. rust (blood) or yellowish sputum (greenish with atypical pneumonia)  Sudden fever.Fluticasone (fluvent) . liquids. Hospital if with uncontrolled dyspnea. foods. respiratory distress. worsening of central cyanosis. anorexia  Productive. distress: SOB.Every 3-5 years pneumonia vaccine .Triamcinolone (azmacort) o Other meds . nebulization. muscle fatigue.IV or oral macrolide or doxycyline 7  Nursing Management Patient Education  Breathing exercises teach diaphragmatic breathing. tachypnea  Decrease breath sounds in affected side  Crackles. B-blockers R or L sided heart failure.Fluoroqionolone 2. (Yoga Breathing)  Pursed –lip breathing Slow expiration prevents collapse of small airways. tube (feedings) into the airways. peripheral edema. chills  Nasal flaring.IV azithromycin (zithromax) . chest trauma Inappropriate use of sedatives. coma (mixed flora of URT cause pneumonia) HEMATOGENOUS PNEUMONIA BACTERIAL INFECTIONS -related to spread of bacteria from the bloodstream S/Sx: Marked tachypnea Signs of resp. Identify primary cause. Active self-care and activity pacine Fernandez BSN . Pharmacological Therapy 1. bronchial breath sound  Dullness on percussion over consolidated area  Possible friction rub  Chest rertraction (air hunger in infants) Management: A. 3. In patients with CP disease .antibiotics.  LUNG VOLUME REDUCTION – removal of a portion of a diseased lung parenchyma. Optimize bronchodilator therapy. BRONCHIECTASIS – a chronic irreversible dilation of the bronchi and bronchioles ASPIRATION PNEUMONIA Non-infectious Aspiration of fluids (gastric secretion). Oxygen 1-2 LPM Surgery  BULLECTOMY – removal of BULLOUS EMPHYSEMA Bullous are enlarged air spaces that do not contribute to ventilation but occupy space in the thorax compressing areas of lungs that have adequate space. 2. mucolytic Management of Exacerbation: Casues: Tracheobronchial infection Air pollution Pneumonia Pulmonary embolism Pneumothorax Rib fractures. allowing expansionof functional tissue improving elastic recoil. circumoral cyanosis  Respiratory distress. 4. oral B adrenergic agonists -anticholinergic -methylxanthine o Corticosteriods . Hospital patient with no CP disease . BACTERIAL ASPIRATION PNEUMONIA -related to poor cough mechanisms due to anesthesia. organs are in short in supply.Flusisonide . reffered to abdominal shoulder and flank  Flushed cheeks and cyanotic lips and nailbeds  Orthopnea  Poor appetite  Diaphoretic and tires easily  N/V. sore throat PREDOMINANT SYMPTOMS  Headeache  Low grade fever  Pleuretic pain  Myalgia  Rash  Pharyngitis  Pain location: chest (affected side).IV beta-lactam . use of accessory muscles RAPID bouncing pulse URTI: nasal congestion. expel as much air as possible during expiration. opiods.Yearly influenza vaccine . lethargy.Alpha 1-antitrypsin augmentation therapy .Budesonide . Physical fitness and respiratory fitness Oxygen therapy Nutrition C. reduce RR.Inhaled or systemic (oral IV) . antitussive.-via metered dose inhaler (MDI).

pulmonary emboli.X-Ray : patches of consolidation. Pneumonia – acute inflammation of lungs with exudates accumulated in alveoli and other respiratory passages that interferes with ventilation Management: o Rest o Supplemental oxygen o Ca-Channel blockers for VASODILATION o Cardiac Glycosides to improve cardiac function Ex.Revise antibiotics or D/C entirely .Turn and early ambulation . CHD. Frequent respiratory assessment 3. Superinfection – very large doses of penicillin. Mycoplasma Pneumonia . mediastinial shift These are strategies to expand the lung: Frequent turning Early mobilization Deep breathing q 2 hours Incentive spirometry voluntary deep breathing coughing suctioning aerosol nebulizer treatment: postural drainage chest percussion bronchoscopy Management: 1.Need to repeat s/sx for early recognition of problem . 7. Atelectasis and Pleural Effusion Tx: o Thoracentesis *empymea (thick purulent fluid which in th pleural space) o Chest Tube for proper drainiage of empyema 3. o IV prostacylin (epoprostanol) . Relieve hypoxia 2.Increase fluid intake to liquefy secretions Health Teachings .If patient improves and fever DIMINISHES after the intial antibiotic therapy but SUBSEQUENTLY there is a rise in temperature with cough and evidence that pneumonia has spread . such as those with COPD.3. anitpyretucs for headache and fever Antitussive Warm moist inhalation Anitihistamines Bed rest Oxygen & ABG 4. elevated diaphragm. 8 Fernandez BSN .Bacteria become RESISTANT to the antibiotic . or a combination of antibiotics . Shock and Respiratory Failure TX: o Hemodynamic and ventilator support to combat peripheral collapse o Maintain BP and provide adequate oxygenation o Vasopressors (vasopressin. norepinephrine) o Corticosteroids (digoxin. Positive End Expiratory Pressure (PEEP) Therapy (simple mask and 1-way valve system that provides varying amounts of oxygen) COMPLICATIONS: 1. 5.Importance of coughing and deep breathing INFECTIOUS DISORDER A.Doxycyline or Macrolide VIRAL Treatment is supportive antibiotics are ineffective in viral URTI. Hydration. dobutamine) 2. Cough and deep breathing exercise Use bedside spirometer q 1 hour Oxygen as ordered Monitor effects of respiratory therapy. Respiratory hygiene measures Prevent Complications . Digoxin (+) inotropic o In presence of COR PULMONALE. ventilators Position: On unaffected side to allow for lung expansion. and Mitral Valve disease o Must be alert for s/sx o Administer oxygen therapy appropriately o Health teaching and monitor patient’s compliance to meds. tx include: fluid restriction o Diuretics to decrease fluid accumulation o Manage the underlying cardiac or pulmonary condition.Helps to decrease pulmonary hypertension by reducing pulmonary vascular resistance and pressure and increase carbon dioxide o Anticoagulants: Warfarin Nursing Management: o Identify patient at high risk.Antibiotics as ordered . 6.