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Chapter021 Chapter021 Presentation Transcript

  • Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 21: Caring for Clients with Lower Respiratory Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Acute Bronchitis • Inflammation of Bronchial Mucous Membranes; Tracheobronchitis – Cause: Bacterial and fungal infection; Chemical irritation – Diagnostics: Sputum cultures; Chest film – Signs/Symptoms: (Initial) Non-productive cough, Fever, Malaise; (Later) Blood-streaked sputum, Coughing attacks; Inspiratory crackles – Treatment: Antipyretics; Expectorants; Antitussives; Humidifiers; Broad-spectrum antibiotics – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pneumonia • Inflammatory Process Affecting Bronchioles and Alveoli; Classified by Cause – Causes: Acute infection; Radiation therapy; Chemical ingestion, inhalation; Aspiration – Diagnostics: Chest film; Blood count; Sputum C&S – Signs/Symptoms: Wheezing; Cyanosis – Treatment: Antibiotic (bacterial); Hydration; O2; Chest physical therapy; Bronchodilators; Analgesics/Antipyretics; Expectorants or cough suppressants – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Question Is the following statement true or false? Pneumonias are classified according to their etiology. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Answer True. Pneumonias are classified according to their etiology. Classifications include typical, atypical, viral, radiation, chemical, and aspiration pneumonias. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pleurisy • Acute Inflammation of Parietal, Visceral Pleurae – Cause: Usually secondary to pneumonia, pulmonary infections, tuberculosis, lung cancer, pulmonary embolism – Diagnostics: Chest radiography; Sputum culture; Thoracentesis: Fluid specimen, pleural biopsy – Signs/Symptoms: Inspirational severe, sharp pain; Shallow respirations; Pleural fluid accumulation; Dry cough; Dyspnea; Friction rub – Treatment: Treat underlying condition; NSAIDs Analgesics/antipyretic drugs – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pleural Effusion • Abnormal Fluid Collection Between Visceral, Parietal Pleurae – Cause: Pneumonia; Lung cancer; Pulmonary embolism; CHF – Diagnostics: Chest radiograph; CT scan – Signs/Symptoms: Fever; Pain; Dyspnea; Dullness upon chest percussion; Dim breath sounds; Friction rub – Treatment: Antibiotics; Analgesics; Thoracentesis; Chest tube – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pleural Effusion Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Influenza • Acute Respiratory Disease of Short Duration – Cause: Viral contamination via respiratory transmission; Mutations • Fatalities related to secondary bacterial complications, esp. those immunocompromised – Diagnostics: Chest radiography; Sputum analysis – Signs/Symptoms: See Table 21-2 – Treatment: Prevention (vaccine); Symptomatic – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Question Is the following statement true or false? Flu is a gastrointestinal malady involving vomiting and/or diarrhea. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Answer False. Influenza is an acute respiratory disease of short duration, which can result in death due to secondary bacterial complications, especially among populations who are immunocompromised (older adults, children, HIV+, etc.) Gastroenteritis is a gastrointestinal malady involving vomiting and/or diarrhea. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Tuberculosis • Primarily a bacterial infectious disease affects lungs; may infect kidneys, other organs; Affects one-third of world’s population; Leading cause of death from infectious disease, among those with HIV – Cause: Tubercle bacilli: Gram-positive; Transmitted via droplet inhalation; Classifications – Diagnostics: Chest radiographs; Tuberculin skin tests; CT scan; MRI; Gastric lavage; Gastric aspiration; Bronchoscopy; C & S tests – Signs/Symptoms: (Onset) Asymptomatic; (Early) Fatigue, weight loss; (Latent) Asymptomatic; clients at risk; (Progressive) Low fever; Night sweats; Cough; Blood-streaked sputum; (Late) Weakness; Hemoptysis; Dyspnea Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Tuberculosis • (Cont’d) – Technique to destroy; Transmission – Predisposing factors; Classification of TB – Stages; Bacilli remains dormant and then reactivate – Secondary Tuberculosis: Reactivation of initial infection; Immune response; Lung lesions; Exacerbation /Remissions – Treatment: Antitubercular medications (toxicity, resistance); Surgery: Segmental resection; Wedge resection; Lobectomy; Pneumonectomy – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Obstructive Pulmonary Disease • Airflow in lungs is obstructed caused by bronchial obstruction, congenital abnormalities • Increased resistance to expiration, creating prolonged expiratory phase of respiration – COPD • Symptoms: Chronic cough, expectoration; Dyspnea; SOB; Wheezing; Impaired expiratory airflow – Atelectasis; Asthma; Chronic bronchitis; Emphysema; Sleep apnea; Cystic fibrosis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Atelectasis • Collapse of Alveoli Prevents Gas Exchange – Causes: Mucus plug; Aspiration; Prolonged bed rest; Fluid or air in thoracic cavity; Enlarged heart; Aneurysm – Diagnostics: Chest radiograph; ABGs – Signs/Symptoms: (Small area) Few; (Large area): Cyanosis; Dyspnea; Fever; Pain; Tachycardia; Tachypnea; Increased secretions – Treatment: Removal of cause; Raise secretions; Bronchodilators; Humidification; O2 administration – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Chronic Bronchitis • Prolonged inflammation of bronchi; Chronic cough; Gradual development – Cause: Multiple factors – Diagnostics: Pulmonary function test; Symptom eval.; History – Signs/Symptoms: Chronic, productive cough; Thick mucus; Frequent respiratory infections, lasting several weeks (winter) – Treatment: Prevent pulmonary irritation; Medications – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Emphysema • Abnormal Alveoli Distention, Destruction; Chronic, disabling disease – Cause: Smoking; Environmental factors – Diagnostics: Chest radiography; Fluoroscopy; CT scan – Signs/Symptoms: (Initial) Exertional dyspnea; (Progressive) Chronic cough; Mucopurulent sputum; “Barrel chest”; Pursed-lip breathing; Prolonged, difficult expiration; Wheezing; (Advanced) Memory loss; CO2 narcosis – Treatment: Slow progression; Treat obstructed airways (Bronchodilators, O2, ATB, physical therapy, corticosteroids (limited) – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Asthma • Reversible Obstructive Disease of Lower Airway – Cause: Inflammation; Airway hyperreactivity to stimuli (Allergic; Non-allergic; Mixed) – Diagnostics: Pulmonary function tests; Chest auscultation – Signs/Symptoms: Paroxysms of SOB, wheezing, coughing; Thick, tenacious sputum – Treatment: Symptomatic; Prevention – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Asthma Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Cystic Fibrosis • Inherited, multisystem disorder which obstructs lungs, pancreas – Cause: Defective autosomal recessive gene inherited from both parents resulting in: Faulty transport of Na, Cl; Mucus – Diagnostics: Sweat test; Chest radiograph; Pulmonary function tests – Signs/Symptoms: Respiratory symptoms; failure-to-thrive; foul-smelling, bulky, greasy stools; Salty-tasting skin; Finger-clubbing Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Question Is the following statement true or false? Cystic Fibrosis is an inherited disorder where one of the parents contributes the specific, defective gene. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Answer False. Cystic Fibrosis is an inherited disorder where both parents contribute the specific, defective gene. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Cystic Fibrosis • Inherited, multisystem disorder which obstructs lungs, pancreas (Cont’d) – Treatment • Respiratory: Postural drainage; Chest physical therapy; Bronchodilator medications; Nebulized mist treatments • Digestive System: Pancreatic enzyme replacements; Fat-soluble vitamin supplements; High-calorie diet • Lung and Liver Transplant; Mucus-thinning drugs; NSAIDs; Gene therapy – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Postural Drainage Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Occupational Lung Diseases • Cause: Exposure to organic, inorganic dusts and noxious gases of long periods of time • Diagnostics: Chest radiograph; Pulmonary function tests • Symptoms: Dyspnea; cough; (Coal dust) Blackstreaked sputum • Treatment: Conservative; Symptomatic; O2 therapy for severe dyspnea • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Arterial Hypertension • Continuous High Pressure in the Pulmonary Arteries – Cause: Heart disease; Lung disease; Both – Diagnostics: Electrocardiogram; ABG analysis; Cardiac catheterization; Pulmonary function tests; Echocardiography; Ventilation-perfusion scan; Pulmonary angiography – Signs/Symptoms: (Primary) Dyspnea on exertion; Weakness; (Secondary) Underlying cause symptomology – Treatment: Vasodilators, Anticoagulants; (Right-sided failure) Digitalis, diuretics; Heart– lung transplantation – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Embolism • Obstruction of Pulmonary Arteries or Branches – Cause: Thrombus formed in the venous system or right side of heart – Diagnostics: Chest radiograph; Serum enzymes; Lung, CT scan; Pulmonary angiography; Ultrasonography; Impedance plethysmography – Signs/Symptoms: (Small area) Pain; Tachycardia; Dyspnea (Large area) Severe dyspnea; Severe pain; Cyanosis; Tachycardia; Restlessness; Shock; Sudden death – Treatment: Thrombolytics; Anticoagulation; Surgery; Procedures – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Pulmonary Edema • Fluid Accumulation in Interstitium, Alveoli of Lungs – Cause: Right side of heart delivers more blood to pulmonary circulation than left side can handle – Signs/Symptoms: Dyspnea; Cyanotic extremities; Skin color; Continual blood-tinged (pink), frothy sputum; Cough – Treatment: Emergency treatment for cardiogenic pulmonary edema – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Respiratory Failure • Inability to Exchange Sufficient Amounts of O2, CO2 – Cause: (Acute) Life-threatening, occurs suddenly; (Chronic) Underlying disease – COPD, neuromuscular disorders – Diagnostics: Chest radiography; Serum electrolytes; History; ABGs – Signs/Symptoms: Restlessness; Wheezing; Cyanosis; Accessory muscle use for breathing – Treatment: Endotracheal, tracheostomy tube; Humidified O2 via nasal cannula, Venturi or rebreather masks; Mechanical ventilation – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Respiratory Failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Acute Respiratory Distress Syndrome • Noncardiogenic Pulmonary Edema, secondary to other clinical condition; Can lead to respiratory failure, death – Causes: Post-aspiration; Drug ingestion/overdose; Hematologic disorders; Lung damage; Metabolic disorders; Shock; Trauma; Surgery; Embolism; Septicemia – Diagnostics: Chest radiography; Evidence of acute respiratory failure; ABGs – Signs/Symptoms: Tachypnea; Dyspnea; Cyanosis; Anxiety; Restlessness; Mental confusion – Treatment: Intubation; Mechanical ventilation; Colloids; Nutritional support – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Lung Cancer • Common Cancer, esp. smokers; #1 cause of CA death in U.S. – Cause: Unknown, well-established link between lung CA + irritants – Diagnostics: CT, PET scan; MRI; Chest radiograph; Sputum analysis; Biopsies; Lung scan – Signs/Symptoms: Cell type, tumor size + location, degree of metastasis determine S/S; (Cardinal) Cough, productive of mucopurulent or bloodstreaked sputum – Treatment: Factor dependent, esp. on tumor classification, stage – Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Thoracic Surgery • Thoracotomy; Thoracentesis: Remove, repair chest wall traumas, tumors; Obtain biopsy sample • Post-operative Nursing Management – Surgery interferes with normal thoracic cavity pressures; Lung expansion – Lungs must be post-operatively reinflated • Draining secretions, air, blood from thoracic cavity via surgically-placed catheter(s) • Connected to closed, underwater-seal drainage system: 1 – 2 catheters • Anterior: Removes air • Posterior: Removes fluid Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • Thoracic Surgery Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins