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Respiratory disorders(student)[1]
 

Respiratory disorders(student)[1]

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    Respiratory disorders(student)[1] Respiratory disorders(student)[1] Presentation Transcript

    • Respiratory Disorders Gail C. Hoyer 2010-1
    • Foreign Body Aspiration• Definition – Inhalation of any object (solid, or liquid, food or non food) into the respiratory tract – A major health threat for infants and toddlers due to their increased tendency to put objects in their mouth• Pathophysiology – Severity depends on size and composition of object and its location in the respiratory tract
    • Foreign Body Aspiration: Manifestations• Manifestations – Dysphonia (muffled hoarse, or absent voice sounds) – Wheezing may also occur and may last up to hours depending where object has lodged – If a child can not say “P” words they have diminished expiratory effort – If prolonged, s/s of hypoxia will become evident • Anxiety, upright position neck extended • Irritability and decreased responsiveness
    • Foreign Body Aspiration: Nursing Interventions• Assessment and Diagnosis – Physiological Assessment – Psychosocial Assessment – Developmental Assessment• Planning and Implementation – Complete obstruction • Infant – Back blows and chest thrusts • Child – Abdominal thrusts – Partial Obstruction • Resuscitation equipment at bedside • Avoid anxiety increasing procedures to prevent a complete obstruction• Evaluation
    • Croup Syndromes• Croup- broad group of upper airway illnesses that result from swelling of the epiglottis and larynx• Syndromes – Laryngotracheobronchitis- most common – Epiglottitis (Supraglottitis) – Bacterial Thracheitis• The initial symptoms of all three conditions – Stridor, “seal like” barking cough, and hoarseness
    • LTB: Nursing Interventions• Assessment and Diagnosis – Respiratory assessment – Cardio-respiratory monitoring and pulse oximetry• Planning and Implementation – Maintaining Airway Patency • Oxygen • Position • Communication • Medications (beta-agonists and beta adrenergics, and corticosteroids) • Albuterol, racemic epinephrine, dexamethasone – Meet Fluid and Nutritional Needs – Discharge Planning and Home Care Teaching• Evaluation
    • Epiglottitis (Supraglottitis): Nursing Interventions• Assessment and Diagnosis – Airway management- • Intubation is the treatment (do not leave the child unattended) • Position • Respiratory assessment – Drug therapy • Antibiotics to treat infection – Hydration – Emotional and Psychosocial support of the child and parents • Postpone anxiety provoking procedures• Planning and Implementation – Pt will be in a critical care setting while intubated – Teach parents about intubation and prepare for discharge• Evaluation
    • Bacterial Tracheitis: Nursing Interventions• Secondary infection of the upper trachea following a viral LTB – Staphylococcus aureus, group a streptococcus, moraxella catarrhalis, or haemophilis influnzae• Commonly misdiagnosed for LTB – Similar symptoms but patient gets worse with therapy instead of better – Diagnosed by blood cultures• Nursing – Critical care setting • Intubation – Frequent suctioning, oxygen or humidified air, antibiotics – Refer to epiglottitis
    • Bronchiolitis and RSV• Bronchiolitis – Lower respiratory tract infection that occurs when a viral or bacterial organism causes inflammation and obstruction of the bronchioles• Etiology – RSV is the most common cause • Occurs in annual epidemics from October to march • Transmitted through direct contact with respiratory secretions or indirectly through contaminated surfaces
    • Bronchiolitis: Manifestations and Clinical Therapy• Manifestations – Mild-rhinitis, cough, low grade fever, wheezing, tachypnea, poor feeding, vomiting, and diarrhea – Severe- tachypnea greater than 70bpm, grunting, increased wheezing, retractions, nasal flaring, irritability, lethargy, poor fluid intake, and a distended abdomen from over-expanded lungs• Clinical Therapy – No treatment – Isolation – Antipyretics – Ribavirin • Expensive with marginal benefit and high risk to caregivers
    • Bronchiolitis: Nursing Interventions• Assessment and Diagnosis – Physiologic Assessment – Psychosocial Assessment• Planning and Implementation – Maintain Respiratory Function – Support Physiologic Function – Reduce Anxiety – Discharge Planning and Home Care Teaching• Evaluation
    • Asthma• Definition – Common chronic disorder of the airways that is characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresonsiveness, and underlying inflammation• Etiology and Pathophysiology – Caused by an interplay of multiple factors • Environmental exposures, viral illnesses, allergens, and a genetic predisposition – Risk factors • Passive smoke exposure, indoor air contaminants (pet dander, cockroach feces), outdoor air pollutants, recurrent respiratory viral infections, and allergic disease (atopic eczema, food allergies)
    • • Manifestations – asthma attack – asthma and children – Sudden cough, wheezing, shortness of breath is referred to as an asthma episode or flare• Clinical Therapy – Medications • bronchodilators – Hydration – Education and support of parents and child
    • Asthma: Nursing Interventions• Assessment and Diagnosis – Physiologic – Assess Asthma Management – Psychosocial Assessment• Planning and Implementation – Maintain Airway Patency – Meet Fluid Needs – Promote Rest and Stress Reduction – Support Family Participation – Discharge Planning and Home Care Teaching• Evaluation
    • Cystic Fibrosis• Definition – Autosomal recessive disorder of the exocrine glands that results in physiologic alterations in the respiratory, gastrointestinal, and reproductive systems• Etiology – Decreased chloride secretion due to a defective protein results in increased sodium absorption, causing the body to produce unusually thick, sticky, mucus that clogs the lungs leading to infections, and obstructs the pancreas secretion of natural enzymes that enable the body to digest and absorb food
    • CF: Manifestations and Clinical Therapy• Manifestations • Clinical Therapy – Salty taste of skin noticed by – Sweat test parents first • Seat chloride concentration of – Newborns- meconium ileus 50 to 60 meq/L is suspicious. If the chloride is greater than – Stool- steatorrhea(fat or 60meq/L is diagnosed with greasy), frothy (bulky and other signs large quantity), foul smelling, and floating – Respiratory-chronic moist, productive cough and frequent respiratory infections – GI- difficulty gaining weight because of malabsorption and increased metabolic rate
    • CF: Nursing Management• Assessment and Diagnosis – Physiologic Assessment – Psychosocial Assessment• Planning and Implementation – Provide Respiratory Therapy • CPT, aerosol treatment with a bronchodilator – Administer Medications and Meet Nutritional Needs • Antibiotics for acute exacerbation via PO, inhalation or IV • Pancreatic enzymes taken with all meals and snacks • Fat soluble vitamins (ADEK) in water form b/c not easily absorbed from food • Nutritional supplements or NG/GT feeding to meet high metabolic rate/demands – Provide Psychosocial Support – Discharge and Home Care Teaching • Finances – Nursing Care in the Community• Evaluation
    • Pharyngitis• Acute pharyngitis is an infection that primarily affects the pharynx including the tonsils• Major complaint- sore throat – See page 1303 Clinical Manifestations• Nursing Management – Symptomatic relief • Acetaminophen for pain and fever • Cool, non-acidic fluids and soft foods, ice chips, or frozen ice pops • Humidification, chewing gum, warm slat water gargle • Home remedies more effective than O.T.C. throat sprays – Teach parents to complete 10-day course of antibiotic is prescribed for bacterial pharyngitis • Treating strep infections prevents infections such as rheumatic fever, cervical adenitis, sinusitis, glomerulonephritis, or meningitis)
    • Pharyngitis: Manifestations
    • Otitis Media• Inflammation of the middle ear• Etiology – Specific cause unknown, but appears to be related to Eustachian tube dysfunction – URI precedes the otitis media – Most common causative organisms of infection are streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis• Manifestations – Pulling at the ear – Diarrhea, vomiting and fever – Acting out and irritability may be a sign of hearing loss
    • Otitis Media: Nursing Management• Assessment and Diagnosis• Planning and Implementation – Preventative measures – Family stressor of chronic otitis media – Pain relief Techniques – Hearing and Language exams• Evaluation
    • Otitis Media and Otitis Media with EffusionAcute otitis media- characterized by pain Otitis media with effusion-fluidand a red, bulging non-mobile membrane line or air bubbles