RESPIRATORY DISORDERS

RESPIRATORY DISORDERS

Health History The health history focuses on the physical and

functional problems and the effects of these problems on the
patient, including the ability to carry out activities of daily living

If the patient is experiencing severe dyspnea, the nurse may

need to modify or abbreviate the questions asked and the
timing of the health history to avoid increasing the patient’s
breathlessness and anxiety.

COMMON SIGNS AND

SYMPTOMS

Dyspnea (subjective feeling of difficult or labored breathing,

breathlessness, shortness of breath) is a symptom common to many
pulmonary and cardiac disorders, particularly when there is decreased
lung compliance or increased airway resistance .
SYMPTOMS

Dyspnea (subjective feeling of difficult or labored breathing,

breathlessness, shortness of breath) is a symptom common to
many pulmonary and cardiac disorders, particularly when there
is decreased lung compliance or increased airway resistance.

Orthopnea (inability to breathe easily except in an

upright position) may be found in patients with heart
disease and occasionally in patients with COPD

Cough- Cough is a reflex that protects the lungs from the

accumulation of secretions or the inhalation of foreign bodies.
Its presence or absence can be a diagnostic clue because some
disorders cause coughing and others suppress it
SYMPTOMS

Dyspnea (subjective feeling of difficult or labored breathing,

breathlessness, shortness of breath) is a symptom common to
many pulmonary and cardiac disorders, particularly when there
is decreased lung compliance or increased airway resistance.

Orthopnea (inability to breathe easily except in an

upright position) may be found in patients with heart
disease and occasionally in patients with COPD

Cough- Cough is a reflex that protects the lungs from the

accumulation of secretions or the inhalation of foreign bodies.
Its presence or absence can be a diagnostic clue because some
disorders cause coughing and others suppress it
SYMPTOMS

Sputum Production - A patient who coughs long enough almost

invariably produces sputum. Sputum production is the reaction of the
lungs to any constantly recurring irritant. It also may be associated
with a nasal discharge

Chest pain - or discomfort may be associated with pulmonary or cardiac

disease. Chest pain associated with pulmonary conditions may be sharp,
stabbing, and intermittent, or it may be dull, aching, and persistent. The pain
usually is felt on the side where the pathologic process is located, but it may be
referred elsewhere—for example, to the neck, back, or abdomen.
SYMPTOMS

Wheezing is a high-pitched, musical sound heard mainly on expiration

(asthma) or inspiration (bronchitis). It is often the major finding in a
patient with bronchoconstriction or airway narrowing

Hemoptysis (expectoration of blood from the respiratory tract) is a

symptom of both pulmonary and cardiac disorders. The onset of
hemoptysis is usually sudden, and it may be intermittent or continuous
SYMPTOMS

Clubbing of the fingers is a sign of lung disease that is found in

patients with chronic hypoxic conditions, chronic lung infections, or
malignancies of the lung (Bickley, 2007). This finding may be
manifested initially as sponginess of the nail bed and loss of the nail
bed angle

Cyanosis - a bluish coloring of the skin, is a very late indicator of

hypoxia. The presence or absence of cyanosis is determined by the
amount of unoxygenated hemoglobin in the blood. Cyanosis appears
when there is at least 5 g/dL of unoxygenated hemoglobin
DIAGNOSTIC EVALUATION
TEST

1. Pulmonary Function Tests

Pulmonary function tests (PFTs) are routinely used in patients with chronic respiratory disorders. They are
performed to assess respiratory function and to determine the extent of dysfunction. Such tests include
measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas
exchange.

2. Arterial Blood Gas Studies Measurements of blood pH and of arterial oxygen and carbon dioxide
tensions are obtained when managing patients with respiratory problems and adjusting oxygen
therapy as needed.

1
DIAGNOSTIC EVALUATION
TEST

3. Pulse oximetry is a noninvasive method of continuously monitoring the oxygen

saturation of hemoglobin (SaO2). When oxygen saturation is measured with pulse
oximetry, it is referred to as SpO2 (Clark, Giuliano & Chen, 2006.

4. Cultures Throat cultures (see Chapter 22) may be performed to identify organisms
responsible for pharyngitis. Throat culture may also assist in identifying organisms
responsible for infection of the lower respiratory tract. Nasal swabs may be
performed for the same purpose.

5. Sputum Studies Sputum is obtained for analysis to identify pathogenic organisms

and to determine whether malignant cells are present. A sputum specimen also may
be obtained to assess for hypersensitivity states (in which there is an increase in
eosinophils).

1
DIAGNOSTIC EVALUATION
TEST

Imaging Studies
Imaging studies, including x-rays, computed tomography (CT), magnetic resonance
imaging (MRI), contrast studies, and radioisotope diagnostic scans may be part of any
diagnostic workup, ranging from a determination of the extent of infection in sinusitis
to tumor growth in cancer

1
 ACUTE
PHARYNGITIS
ACUTE PHARYNGITIS
• Acute pharyngitis is a sudden painful inflammation of the pharynx, the back
portion of the throat that includes the posterior third of the tongue, soft palate,
and tonsils. It is commonly referred to as a sore throat.

Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex
virus. Bacterial infection accounts for the remainder of cases. Ten percent of adults with pharyngitis
have group A beta-hemolytic streptococcus (GABHS), which is commonly referred to as group A
streptococcus (GAS) or streptococcal pharyngitis. Streptococcal pharyngitis warrants use of
antibiotic treatment
ACUTE PHARYNGITIS
1.Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus.
2. Group A beta-hemolytic streptococcus (GABHS), which is commonly referred to as group A streptococcus
(GAS) or streptococcal pharyngitis

The body responds by triggering an

inflammatory response in the pharynx.

This results in pain, fever, vasodilation, edema, and tissue damage, manifested by
redness and swelling in the tonsillar pillars, uvula, and soft palate .

A creamy exudate may be present in the

tonsillar pillars

Other bacterial organisms implicated in acute pharyngitis include Mycoplasma pneumoniae, Neisseria gonorrhoeae, and H. influenzae type B (Braun, Wagner,
Huttner, et al., 2006). M. pneumoniae is one of the most common known bacterial pathogens of the respiratory tract and is encountered frequently in people with
upper respiratory symptoms.
 CLINICAL MANIFESTATIONS a
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ASSESSMENT and DIAGNOSTIC FINDINGS
Accurate diagnosis of
pharyngitis is essential to
determine the cause (viral or
bacterial) and to initiate
treatment early.

the rapid streptococcal

antigen test [RSAT]

Swab
specimens
obtained from
posterior
pharynx and
tonsils
 MEDICAL MANAGEMENT

Viral pharyngitis is treated with supportive measures because antibiotics have no effect on the
causal organism. Bacterial pharyngitis is treated with a variety of antimicrobial agents.

Pharmacologic Therapy
Bacterial Pharyngitis - penicillin is usually the treatment of choice. Penicillin V potassium given
for 5 days is the regimen of choice.
OR: *azithromycin may be given for only 3 days due to its long half-life
*5- or 10-day course of cephalosporin may be prescribed.
* Five-day administration of cefpodoxime and cefuroxime has also been successful in
producing bacteriologic cures.
*aspirin or acetaminophen can be taken at 4- to 6-hour intervals
(severe pharyngitis) ***salt-water gargling to be soothing. In severe cases,
gargles with benzocaine may relieve symptoms.
 Nutritional Therapy

A liquid or soft diet is provided during the acute stage of the disease, depending on the patient’s appetite and the
degree of discomfort that occurs with swallowing.
Cool beverages, warm liquids, and flavored frozen desserts such as Popsicles are often soothing.

1.Prompt initiation and correct administration of

prescribed antibiotic therapy.
2. Patient to stay in bed during the febrile stage of illness
and to rest
3. Used tissues should be disposed of properly to
prevent the spread of infection.
NURSING
4. The nurse or family members should examine the skin
MANAGEMENT
once or twice daily for possible rash
5. warm saline gargles or throat irrigations are used.
6. An ice collar also can relieve severe sore throats
resume activity gradually and to delay returning to work
or school until after 24 hours of antibiotic therapy.
 REMINDERS

A full course of antibiotic therapy is indicated in patients

with strep infection because of the potential
complications such as nephritis and rheumatic fever,
which may have their onset 2 or 3 weeks after the
pharyngitis has subsided

instructs the patient about preventive measures that

include not sharing eating utensils, glasses, napkins,
food, or towels; cleaning telephones after use; using a
tissue to cough or sneeze; disposing of used tissues NURSING
appropriately; and avoiding exposure to tobacco and MANAGEMENT
secondhand smoke.
CHRONIC PHARYNGITIS
 Chronic pharyngitis is a persistent
inflammation of the pharynx. It is common
in adults who work in dusty surroundings,
use their voice to excess, suffer from
chronic cough, or habitually use alcohol and
tobacco.
 There are three types of chronic pharyngitis:
• Hypertrophic: characterized by general thickening and
congestion of the pharyngeal mucous membrane
• Atrophic: probably a late stage of the first type (the
membrane is thin, whitish, glistening, and at times
wrinkled)
• Chronic granular (“clergyman’s sore throat”),
characterized by numerous swollen lymph follicles on the
pharyngeal wall
 Clinical Manifestations

Patients with chronic pharyngitis complain of:

1. a constant sense of irritation or fullness in the throat.
2.mucus that collects in the throat and can be expelled by coughing,
and difficulty swallowing.
3. Difficulty of Swallowing
MEDICAL MANAGEMENT

Treatment of chronic pharyngitis is based on relieving symptoms, avoiding exposure to

irritants, and correcting any upper respiratory, pulmonary, gastrointestinal, or cardiac
condition that might be responsible for a chronic cough. For adults with chronic
pharyngitis, tonsillectomy is an effective option, if consideration is given to morbidity
and complications relating to the surgery
 MEDICAL MANAGEMENT

Nasal congestion may be relieved by short-term use of nasal sprays or

medications containing ephedrine sulfate (Kondon’s Nasal) or
phenylephrine hydrochloride (NeoSynephrine).
History of allergy, one of the antihistamine decongestant
medications, such as Pseudoephedrine (Sudafed) or
brompheniramine/pseudoephedrine, is prescribed orally every 4 to 6
hours
Treatment of chronic pharyngitis is based on relieving symptoms, avoiding
exposure to irritants, and correcting any upper respiratory, pulmonary,
gastrointestinal, or cardiac condition that might be responsible for a chronic
cough.
 NURSING MANAGEMENT Nursing Management
- Teaching Patients Self-Care To prevent the
infection from spreading.
- The nurse instructs the patient to avoid
contact with others until the fever
subsides.
- The nurse recommends avoidance of
alcohol, tobacco, secondhand smoke, and
exposure to cold or to environmental or
occupational pollutants.
- The patient may minimize exposure to
pollutants by wearing a disposable
facemask.
. - The nurse encourages the patient to drink
plenty of fluids. Gargling with warm saline
solution may relieve throat discomfort.
- Lozenges keep the throat moistened