This action might not be possible to undo. Are you sure you want to continue?
- is an inflammation of the bronchi accompanied by mucus production and subsequent obstruction of airflow. Infectious agents, such as influenza virus, streptococci, pneumococci, staphylococci and haemophilus, can cause acute bronchitis.
ACUTE RESPIRATORY FAILURE
- is caused by the cardiac and pulmonary system Inadequately exchanging O2 and CO2 in the lungs.
ATELECTASIS - is the collapse of the lung tissue or incomplete
expansion of a lung caused by the absence of air in a portion of the lung or the entire lung.
BRONCHIECTASIS - is a condition marked by chronic abnormal
dilation of bronchi and destruction of bronchial wall.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE - refers to a group of long term pulmonary
disorders marked by resistance to airflow. TYPES
• ASTHMA - episodic airway obstruction caused by bronchospasm, increased mucus secretions, and mucosal edema. - maybe intrinsic or extrinsic (atopic)
• INTRINSIC - a reaction to internal, non-allergic factors. • EXTRINSIC
- a reaction to a specific external allergens.
- characterized by excessive mucus production with productive cough lasting at least 3 months per year for 2 consecutive years. Usually caused by prolonged exposure To bronchial irritants such as smoking,second hand smoke air pollution, dust, and toxic fumes.
- abnormal, permanent enlargement of the acini that’s accompanied by destruction of the alveolar walls. it occurs when alveolar gas is trapped and gas exchange is compromised.
- is a heart condition in which hypertension of pulmonary circulation leads to enlargement of the right ventricle.
- is a severe inflammation and obstruction of the upper airway that usually follows an upper respiratory tract infection. It’s a childhood disease characterized by a sharp bark like cough.
- is a multisystem genetic disorder, a defect of the Exocrine glands, causing tenacious mucus in the lungs.
- is a form of pleural effusion in which the fluid in the pleural space contain pus.
- is an acute inflammation of the epiglottis that tends to cause airway obstruction.
- is a collection of blood in the pleural cavity.
- is a deficiency of O2 in the arterial blood but isn’t as severe as anoxia.
HYPOXIA - is a deficiency of O2 at a cellular level.
-is an acute noncommunicable bronchopneumonia caused by an airborne bacillus.
- is a lung infection accompanied by pus accumulation and tissue destruction.
- is accumulation of fluid in the interstitial space of the lung.
- is an inflammation of the pleurae characterized by dyspnea and stabbing pain, leading to restriction of breathing.
- is an acute infection of lung parenchyma commonly impairing gas exchange.
- is a collection of air in the pleural cavity that Leads to partial or complete lung collapse.
- condition in which air enters the pleural space From within the lungs.
-condition in which atmospheric air flows directly into the pleural cavity.
- condition in which air in the pleural space compresses the thoracic organ and blood vessels, thus reducing blood flow to and from the heart.
- is a common complications of cardiac disorder in which extravascular fluid accumulates in the tissue and alveoli.
- occurs when a clot or foreign substance lodges in a pulmonary artery.
- any condition that increases resistance to blood flow in the pulmonary vessels. (COPD).
- is scar tissue formation in the connective tissue of the lungs.
- occurs when lung tissue is denied blood flow and dies.
RESPIRATORY DISTRESS SYNDROME (hyaline membrane disease)
- is the most common cause of neonatal mortality. in respiratory distress syndrome, the premature infant develops a widespread alveolar collapse.
- is a multisystem, granulomatous disorder that characteristically produces enlarge lymph nodes,
pulmonary infiltration, and skeletal, liver, eye or skin lesions. SILICOSIS
- is a progressive disease characterized by nodular lesion that commonly progress to fibrosis.
SUDDEN INFANT SYNDROME
- kills apparently healthy infants, usually between ages 4 weeks and 7 months, for reason that remain unexplained even after an autopsy.
- is an infectious disease in which pulmonary infiltrates accumulates in the lungs, cavities develop, and masses of granulated tissue form.
most common manifestations by client with pulmonary disorder. a subjective symptom.
note when and how the cough began. (sudden/gradually).
how long it has been present. use the clients own words to describe the cough. determine which medications or treatments the client has used for the cough.
normal 3 ounces per day as part of normal cleansing mechanism. color, odor, quality, and quantity. increase in several disorders.
identify the source of the blood lungs ---- bright red git ---- dark red forceful coughing e.g.; chronic bronchitis, bronchiectasis, PTB
produce when air passes to a partially obstructed / narrowed airways
high pitched sounds produces when air passes a partially obstructed airway. associated with respiratory distress e.g; apnea, heartfailure, aspiration inquire about voice changes. e.g; hoarness of voice
• Chest pain
can be present both in pulmonary and cardiac problem. conduct a symptom analysis. - onset - location - duration - characteristics - aggravating factor - relieving factor
• Associated manifestations
chills fever night sweats hoarseness -weight loss - excessive fatigue - anxiety
• Childhood and infectious disease
- occurrence of tuberculosis, bronchitis, influenza, asthma, pneumonia, and frequency of lower and upper respiratory infection.
- pneumonia --- pneumovax
• Family health history
- genetically transmitted disease e.g; asthma - infectious conditions e.g; PTB, COPD
• Psychosocial history
occupation geographic location environment habits
Chest wall configuration
1. Barrel chest - AP diameter is increased and equals the transverse diameter.
• Pigeon chest
- the sternum just forward and increased AP diameter.
e.g; congenital septal defect marfans syndrome
• Funnel chest - deformity in which sternum is depressed
and the organs that lie below it are compressed.
• Thoracic kyphoscoliosis
- hunched back appearance - accentuation of the normal thoracic curve
e.g; spinal tuberculosis, aging poor posture
• Chest movements
men – abdominal breathing women -- thoracic breathing - use of accessory muscle - retractions, symmetry
• Adventitious breath sounds
- abnormal breath sounds superimposed on normal breath sounds.
• Normal breath sounds
• vesicular breath sounds heard throughout the chest and heard best in the base of the lungs. they are low pitched,soft,swishing sounds, best heard during inspiration
• Bronchial breath sounds (anteriorly)
- heard over the manubrium in the large tracheal airways. - high pitched sounds and have a hollow or harsh
• Bronchovesicular sounds
- heard anteriorly and posteriorly over the central large airways. - heard equally during inspiration and expiration. - tubular or breezy sounding quality.
Adventitious breath sounds • Crackles (formerly called rales)
- audible when there is a sudden opening of small airways that contain fluids. - heard during inspiration and do not clear with a cough. e.g; pulmonary edema, pulmonary fibrosis, and pneumonia
• Rhonchi (also known as gurgles)
- occur as a result of air passing through fluid filled, narrowed passages. - disease with excess mucus production. - usually heard during expiration and may clear with cough. e.g; pneumonia, bronchitis, bronchiectasis
- a continuous musical or hissing noise that result from the passage of air through a narrowed airway.
• Pleural friction rub
- a creaking, grating sound. - a result of pleural inflammation often associated with pleurisy pneumonia or pleural infarct.
INSERT: BREATH SOUNDS SITES OF RESPIRATORY RETRACTIONS
1. Test to evaluate Respiratory Function • pulmonary function test
- provide information about respiratory function by measuring lung volumes, lung mechanics, and diffusion capabilities of the lungs. e.g; peak flow meter - measure expiratory flow ( 300 to 700 L/min.)
1. Forced spirometry
- the flow and volume capacities of the lungs are measured.
2. Lung volume determination
- lung volume is measured by a gas dilution technique or body plethysmography ( an instrument for measuring and recording changes in the size and volume of extent and organs by blood volume).
3. Diffusion capacity
- studies of the lung diffusing capacity or carbon monoxide capacity.
1. Education about the purpose, procedure and implication of the test. 2. Give explicit instructions. 3. Client should not smoke or use bronchodilators for 6 hours before undergoing a PFT. 4. Normal to feel shortness of breath.
• Pulse oximetry
- simple and safest method of assessing oxygenation. - gives a percentage of hemoglobin that is saturated with oxygen. - any condition that can cause decrease arterial blood flow can give inaccurate or no reading.
- noninvasive procedure use to measure exhaled CO2 concentration of clients receiving mechanical ventilation. • Arterial Blood Gas - use of arterial blood to measure PaO2 PaCO2 and Ph directly. - measures the efficiency of gas exchange.
1. Perform Allen's test - quick test for collateral circulation 2. Apply continuous pressure to the site for 5 min --- radial/brachial site 10 min – femoral site
Insert video clip: -Performing Allen's test. -Withdrawing arterial blood samples. -Pulse oximetry.
• Ventilation – Perfusion Studies
- assessment of the distribution of ventilation ( ventilation scan). - assessment of the pulmonary vasculature ( perfusion scan). 1. Ventilation scan - radioactive gas is inhaled and produce an image of the areas where ventilation occurs. e.g: pulmonary embolus 2. Perfusion scan (non-iodine base) - radiologic material is injected intravenously and carried to the pulmonary vasculature.
2. Test to Evaluate Anatomic Structure
• • • • Radiographic Imaging Radionuclide studies Endoscopy Alveolar lavage
1. Radiography - able to illustrate graphically the cause of respiratory dysfunction. 1.1 Chest X-ray
• part of routine screening procedure • when pulmonary disease is suspected
• to monitor the status of respiratory disorder and abnormalities. e.g: pleural effusion atelectasis tubercular lesion • • • to confirm endotracheal or tracheostomy tube placement. after traumatic chest injury in any other situation in which radiographic information helps in the management of a respiratory problem.
1. Posteroanterior view - x – ray beam penetrates from the back - shoulder are rotated forward to pull the scapula away from the lung field. 2. Anteroposterior view - x – ray beam penetrates from the front of the chest. - heart appears larger than it really is and larger than PA view. 3. Lateral view - accompanies a standard PA view - view is taken from the right or left side of the chest. - allows better visualization of the heart the heart and dome of diaphragm.
4. Lateral Decubitus view (lying down) - client lies on the right or left side depending on which side of the chest is being assessed. - to determine whether opaque areas on the pleura are due to solid or liquid media. 5. Oblique view - used to visualized behind and around under lying structure. 6. Lordotic view - use for clearer view of the upper lung fields. - beam is directed @ an upward angle. - results in removal of the clavicle and 1st and 2nd ribs from the field of vision.
• Fluoroscopy - use to visualize the chest and intra thoracic structure whether they function dynamically. e.g; observing transbrochial passage of biopsy forceps during bronchoscopy. Indications: observing the diaphragm during inspiration and expiration. determine mediastinal shift movement during deep breathing. assessing the heart, blood vessels and related structures. identifying esophageal abnormalities detecting mediastinal masses.
Images are not as clear and definitive as Obtained on a standard chest film.
• computed tomography - helpful in identifying peripheral or mediastinal lung disease. • magnetic resonance imaging - more detailed images of anatomic structure. • ultrasonography - use in conjunction with other pulmonary diagnostic procedure. e.g: thoracentesis and pleural biopsy (to asses fluid or fibrotic abnormalities) - accurate in detecting the amount of pleural fluid.
• gallium scan - used to distinguished embolism from pneumonitis. - many organs take up radioactive gallium as do some tumors and areas of inflammation. - done 24 to 48 hours after injection - not iodine base and produces no side effects. • bronchoscopy - fiberoptic instruments - involves passage of lighted bronchoscope into the bronchial tree - maybe performed for diagnostic or therapeutic purpose.
diagnostic: - examination of tissue. - evaluation of tumor for potential surgical resection. - collection of tissue,specimens for diagnostic therapeutic: - remove foreign body - remove thick, viscous secretions. - treat post-operative atelectasis. - destroy and remove lesion. Nursing Responsibility: - informed consent - NPO for 6 hours (until swallowing reflex returned). - throat may be sore after the procedure. - remove any dentures.
-patient position is supine and head is hyperextend. -observe for respiratory distress. dyspnea change in respiratory rate use of accessory muscle change in or absent lung sounds -observe for Hemoptysis -pneumothorax sudden sharp pain. difficult rapid breathing. cessation of normal chest movements on affected side. -diaphoresis. tachycardia. -increased temperature weak pulse. -pallor hypotension. -dizziness. -anxiety.
Insert video clip: - assisting with insertion and management of closed chest drainage. -changing a disposable chest tube drainage.
Management of PNEUMOTHORAX • place patient in fowlers position • administer oxygen therapy via nasal cannula • pain medications ( avoid respiratory depression) • insertion of chest tube and attached to a chest drainage system. • provide intermittent positive pressure breathing -teach patient how to cough, breath deeply and perform passive exercise. • may give ice chips and small sips of water laryngoscopy - visual examination of the larynx e.g: nodules laryngeal papillomas polyps cancer
INSERT VIDEO CLIP
1. Indirect laryngoscopy - indirect visualization allows inspection of nasopharynx and posterior soft pallate using a small or an instrument resembling a telescope. note: - drainage - bleeding - ulcerations - masses 2. Direct laryngoscopy - direct visualization of the larynx with the use of lighted endoscope. avoid touching the tongue to avoid stimulating the gag reflex.
• alveolar lavage - sterile saline is injected using a bronchoscope to wash tissue, (or during bronchoscopy) the saline is then aspirated and examined for typical cell. e.g: interstitial lung disease pneumocystic carilli • endoscopic thoracotomy - a diagnostic procedure that is an alternative open lung biopsy • pulmonary angiography - assessment of the vascular structure of the thorax. - congenital abnormalities of the pulmonary vascular tree. - abnormalities of the pulmonary venous circulation.
Pls. Insert video: Nurse’s role in a pulmonary catheter insertion.
-destructive effects of emphysema. contrast medium is injected into the vascular system through an indwelling catheter (pulmonary artery).
3. Specimen Recovery Analysis
• sputum collection - normally the goblet cells produce 100ml of mucus a day. - note for bacteria, fungus, cellular elements - inspect for: color quantity quality presence of blood food particles - should be done before the start of any antimicrobial treatment.
1. Direct method - the client coughs into a sputum container.
2. Indirect method - sterile suction catheter with an attached sputum trap. - transtracheal aspiration nsert video clip: a puncture is made with a needle collect specimen for culture through a cricothyroid membrane sputum/throat into the trachea and sputum is aspirated.
• gastric lavage - use to uncooperative patient or severely ill patients. - sputum is swallowed during sleep and after coughing. gram stain culture and sensitivity study
Gram stain --- to classify bacteria Gram positive provide guidelines for Gram negative appropriate antimicrobial (cultures) therapy.
• nose and throat culture pls. insert video: - sterile cotton swabs collect a specimen for • thoracenthesis culture / nasal - procedure used to drain fluid or air found in the pleural space.
- is a procedure in which fluid between the chest cavity and lungs is collected through a needle
Indications: • help determine the cause of fluid in the lung cavity
• relieve shortness of breath and pain caused by an accumulation of excess pleural fluid
• to determine the cause of an infection or empyema. specific gravity glucose protein pH cytology evaluation Post procedure/ nursing responsibility • amount color and consistency of the fluid. • turn the patient on the unaffected side to facilitate lung expansion (1 hour). PLEURODESIS - cytotoxic medications is injected into the pleural space after thoracentesis. - patient must roll about to coat the entire pleural space.
• biopsy - removal of a small piece of living tissue from an organ. plerual biopsy - can be performed surgically through a small thoracotomy incision or during thoracentesis. thoracotomy - surgical opening in the thoracic cavity needle biopsy - the needle removes a small fragments of parietal pleura. - required microscopic examination
Nursing Responsibility: • informed consent • position same as thoracentesis • patient must hold still (procedure is painful) • prepare chest tube and chest drainage (pneumothorax may develop) • Lung Biopsy (open lung biopsy) - to identify pulmonary tumors or parenchymal changes.
UPPER AIRWAY DISORDER
LOWER AIRWAY AND PULMONARY VESSEL DISORDER
ASTHMA HEMORRHAGIC, INFECTIOUS - intrinsic - extrinsic AND INFLAMATORY DISORDERS. CHRONIC OBSTRUCTIVE - epitaxis - sinusitis PULMONARY DISEASE - pharyngitis - tonsilitis - asthma - rhinitis - diphtheria - emphysema - peritonsilar abscess - chronic obstructive bronchitis AIRWAY OBSTRUCTION TRACHEOBRONCHITIS - laryngeal edema BRONCHIECTASIS - laryngospasm PULMONARY EMBOLISM - laryngeal paralysis PULMONARY HYPERTENSION - laryngeal injury - nasal polyps - deviated nasal septum and nasal fracture
PARENCHYMAL AND PLEURAL DISORDER INFECTIOUS DISORDER - influenza - malignant lung tumor - pneumonia - benign lung tumors - lung abcess RESTRICTIVE LUNG DISORDER - pulmonary tuberculosis - cystic fibrosis - extrapulmonary - sarcoidosis tuberculosis PLEURA AND PLEURAL SPACE ATELECTASIS NEOPLASTIC LUNG DISORDER
- pleural effusion - bronchopleural fistula
NURSING DIAGNOSIS FOR CLIENTS WITH UPPER AIRWAY DISORDER
• • • • • • • •
anxiety and fear impaired nutrition: less than body requirements impaired verbal communication ineffective airway clearance risk for aspiration risk for constipation risk for impaired gas exchange risk for ineffective family/individual therapeutic regimen management • risk for infection
NURSING DIAGNOSIS FOR CLIENTS WITH LOWER AIRWAY AND PULMONARY VESSEL DISORDER
• • • • • • • • • • • • • activity intolerance anxiety deficient knowledge decisional conflict disturbed sleep pattern imbalance nutrition: less than body requirements impaired gas exchange ineffective airway clearance ineffective breathing pattern ineffective coping interrupted family process risk for infection sexual dysfunction
NURSING DIAGNOSIS FOR CLIENTS WITH PARENCHYMAL AND PLEURALN DISORDER
• • • • • • • • • • • • activity intolerance acute pain anxiety deficient knowledge disturbed sleep pattern imbalance nutrition: less than body requirements impaired gas exchange impaired oral mucous membrane impaired physical mobility ineffective airway clearance ineffective breathing pattern ineffective coping
ASTHMA - a disorder of the bronchial airways characterized by serious bronchospasm.
NON-ALLERGIC TRIGGERED BY INTERNAL DISORDER SUCH AS: - common colds - upper respiratory infection - exercise
ALLERGIC DUST LINT POLLEN INSECTS MOLD SPORES SMOKE MEDICATIONS FOODS
Facts: • asthma is believed to be an inherited disorder that interacts with environment fx to cause the disease. • asthmatic symptoms usually worsen @ night • a severe, life threatening complications of asthma is status asthmaticus. It is an acute episode of bronchospasm that can increase the workload of breathing 5 to 10 times. • risk factors include air pollution and cigarette smoking.
CLINICAL MANIFESTATIONS: • marked respiratory effort • feeling of chest constrictions • inspiratory and expiratory wheezing • non-productive coughing • tachycardia/tachypnea • prolonged expiration
EMERGENCY MANAGEMENT inhaled beta-adrenergic intravenous theophylline intravenous steroids oxygen if needed STATUS ASTHMATICUS intravenous corticosteroids inhaled beta-adrenergics oxygen if needed intubation and mechanical ventilation, if needed
Nursing Management: • • • • • • • • • • assess respiratory effort monitor arterial blood gas monitor results of pulmonary function test monitor color, consistency, and amount of sputum place client’s in fowler’s position encourage fluids to thin secretions reposition frequently administer oral care every 2 to 4 hours assess effectiveness of therapy monitor for side effects of bronchodilator therapy
Chronic Obstructive Bronchitis - inflammation of the bronchi which cause cause increased mucous production and chronic cough. Thicker, more tenacious mucus and impaired ciliary function is present. The airway collapse, and air is trapped in the distal part of the lung. Emphysema - a disorder in which the alveolar walls are destroyed, which leads to permanent over distention of the air space. Air passages are obstructed due to these changes, rather than from mucous production
CHRONIC BRONCHITIS EMPHYSEMA productive cough dyspnea on exertion which decreased exercise progress eventually to tolerance dyspnea wheezing at rest shortness of breath tachypnea with prolonged prolonged expiration expirations elevated hematocrit use of accessory muscle polycythemia barrel chest cyanosis and peripheral thinness edema (blue bloater) pink color and dyspnea signs and symptoms of cor(pink puffer) pulmonale / right sides heart characteristic sitting position failure of leaning forward with arms braced on knees to support the shoulder and chest for breathing
NURSING MANAGEMENT • assess respiratory status and report changes to physician • maintain high fowlers position • administer low flow oxygen • monitor effectiveness of bronchodilators and assess for side effects encourage 8 to 10 glasses of fluid daily, if not contraindicated • use cautions in administering narcotics • instruct on: - proper coughing technique - pursed lip breathing - diaphragmatic breathing • assess for any changes in vital signs during activity and instruct client to stop if these occurs
• • • •
remain with the client during acute episodes use/encourage relaxation technique provide emotional support facilitate discussion of changes in sexual function
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.