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Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
Respiratory disorders
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Respiratory disorders

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  • BY: NIO C. NOVENO, RN, MAN RESPIRATORY DISORDERS NCLEX - RN REVIEW JUNE 2008
  • Transcript

    • 1. Respiratory Disorders Nio C. Noveno, RN ,MAN
    • 2. Pneumonia <ul><li>Acute inflammatory process of the alveolar spaces </li></ul><ul><li> lung consolidation  exudate [alveoli] </li></ul><ul><li>Classification </li></ul><ul><li>CAP: most common; occurs in the community or 48 H before hospitalization </li></ul><ul><li>S. pneumoniae, H. influenza, M. pneumoniae </li></ul><ul><li>Nosocomial: onset of S/S is 48-72 H post-hospitalization </li></ul><ul><li>P. aeruginosa, S. pneumoniae, K. pneumoniae </li></ul><ul><li>Aspiration pneumonia </li></ul><ul><li>S. pneumoniae, H. influenza, S. pneumoniae, gastric contents </li></ul>[email_address] respi disorders
    • 3. Pneumonia <ul><li>Types </li></ul><ul><li>Bacterial pneumonia </li></ul><ul><ul><li>Lobar [Strep] – constant dry, hacking cough, pleuritic pain, watery to rust-colored sputum </li></ul></ul><ul><ul><li>Bronchopneumonia [Strep/Staph] – due to aspiration, productive cough w/ yellow or green sputum </li></ul></ul><ul><li>Alveolar pneumonia [viral] – scanty sputum </li></ul><ul><li>Atypical pneumonia [rickettsial] – “walking”, non-productive cough </li></ul>[email_address] respi disorders
    • 4. Pneumonia <ul><li>Clinical Manifestations </li></ul><ul><li>Cough </li></ul><ul><li>Chills </li></ul><ul><li>Dyspnea </li></ul><ul><li>Elevated temperature </li></ul><ul><li>Crackles </li></ul><ul><li>Rhonchi </li></ul><ul><li>Pleural friction rub </li></ul><ul><li>Sputum production </li></ul><ul><ul><li>Rusty, green, or bloody: pneumococcal </li></ul></ul><ul><ul><li>Yellow-green: BPN </li></ul></ul>[email_address] respi disorders
    • 5. Pneumonia <ul><li>Pneumocystis carinii pneumonia </li></ul><ul><li>Opportunistic infection </li></ul><ul><li>Often related to HIV </li></ul><ul><li>& other immunocompromised conditions </li></ul><ul><li>Clinical Manifestations </li></ul><ul><li>Increasing SOB </li></ul><ul><li>Nonproductive cough </li></ul><ul><li>Low-grade fever </li></ul><ul><li>Treatment </li></ul><ul><li>Cotrimoxazole </li></ul><ul><li>Pentamidine </li></ul>[email_address] respi disorders
    • 6. Pneumonia <ul><li>Management </li></ul><ul><li>Increase OFI 3-4 L/day. </li></ul><ul><li>Administer O 2 . </li></ul><ul><li>Assess respiratory status. </li></ul><ul><li>Monitor VS, I/O, lab studies, & pulse ox </li></ul><ul><li>Monitor & record color, consistency, </li></ul><ul><li>& amount of sputum </li></ul><ul><li>Home care </li></ul><ul><li>Recognize s/sx of infection. </li></ul><ul><li>Avoid exposure to people with infections. </li></ul><ul><li>Increase OFI at 3 L/day. </li></ul>[email_address] respi disorders
    • 7. Chronic Obstructive Pulmonary Disease <ul><li>B ronchitis </li></ul><ul><li>E mphysema </li></ul><ul><li>Causes </li></ul><ul><li>Congenital weakness </li></ul><ul><li>Respiratory irritants: smoke, polluted air, chemical irritants </li></ul><ul><li>Respiratory tract infections </li></ul><ul><li>Genetic predisposition </li></ul>[email_address] respi disorders
    • 8. Chronic Obstructive Pulmonary Disease <ul><li>Chronic </li></ul><ul><li>Bronchitis </li></ul><ul><li>Excessive </li></ul><ul><li>bronchial </li></ul><ul><li>mucus </li></ul><ul><li>production </li></ul><ul><li>Chronic or </li></ul><ul><li>recurrent </li></ul><ul><li>productive </li></ul><ul><li>cough </li></ul>[email_address] respi disorders Smoking, RTI, Pollutants Mucosal edema Inflammation Bradykinin, Histamine, PGs Fluid/Cellular Exudation Hypersecretion of mucus Persistent Cough  Capillary permeability
    • 9. Chronic Obstructive Pulmonary Disease <ul><ul><li>Emphysema </li></ul></ul><ul><ul><li>Destruction of elastin </li></ul></ul><ul><ul><li>alters alveolar walls </li></ul></ul><ul><ul><li>& narrows airways </li></ul></ul><ul><ul><li>Enlargement </li></ul></ul><ul><ul><li>of air spaces distal </li></ul></ul><ul><ul><li>to terminal bronchioles </li></ul></ul><ul><ul><li>leads to coalesced alveoli </li></ul></ul><ul><ul><li>& air trapping </li></ul></ul>[email_address] respi disorders Smoking, heredity, aging process Loss of elastic recoil Disequilibrium between elastase & antielastase Overdistention of alveoli CO2 retention Hypoxia Respiratory acidosis
    • 10. [email_address] respi disorders Emphysema No cyanosis (Pink) Thin appearance Exertional dyspnea Ineffective cough Barrel chest Pursed-lip breathing Prolonged expiration Use of accessory muscles R-sided Heart Failure Pulmonary HPN Spontaneous pneumothorax Chronic Bronchitis <ul><li>Cyanosis (Blue) </li></ul><ul><li>Edematous </li></ul><ul><li>Exertional dyspnea </li></ul><ul><li>Recurrent cough w/ </li></ul><ul><li>Sputum production </li></ul><ul><li>Digital clubbing </li></ul><ul><li>Respiratory rate </li></ul><ul><li>Use of accessory muscles </li></ul>R-sided Heart Failure Cor pulmonale
    • 11. Chronic Obstructive Pulmonary Disease <ul><li>Management </li></ul><ul><li>Rest:  O2 demand of tissues </li></ul><ul><li> Fluid intake: 3 L/day </li></ul><ul><li>Diet:  calorie,  CHON,  CHO,  vit. C </li></ul><ul><li>Low-flow O2 therapy: 1-3 LPM </li></ul><ul><li>Breathing exercises [pursed-lip] </li></ul><ul><li>Avoid cigarette smoking, alcohol, pollutants </li></ul><ul><li>CPT: postural drainage  percussion  vibration </li></ul><ul><li>Bronchial hygiene measures: steam, aerosol, medimist inhalation </li></ul><ul><li>Pharmacotherapy: Antitussives, bronchodilators, antihistamine, steroids, antimicrobials </li></ul>[email_address] respi disorders
    • 12. Chronic Obstructive Pulmonary Disease <ul><li>Bronchiectasis </li></ul><ul><li>Destruction of bronchial </li></ul><ul><li>mucosa with fibrous scar </li></ul><ul><li>tissue formation </li></ul><ul><li> </li></ul><ul><li>Loss of resilience </li></ul><ul><li>& airway dilation causes </li></ul><ul><li>pooling of secretions </li></ul><ul><li> </li></ul><ul><li>Obstruction of airflow </li></ul>[email_address] respi disorders
    • 13. Chronic Obstructive Pulmonary Disease [email_address] respi disorders Asthma ALLERGY (Extrinsic) INFLAMMATION (Intrinsic) Bronchospasm Mucosal edema Hypersecretion of mucus Histamine, Bradykinin, PG, Serotonin, Leukotrienes… Narrowing of AWs,  work of breathing Hypoxia & Respiratory Acidosis Respiratory effort Exhaustion Hypoventilation Air trapping
    • 14. Chronic Obstructive Pulmonary Disease <ul><li>Clinical </li></ul><ul><li>Manifestations </li></ul><ul><li>Orthopnea </li></ul><ul><li>Restlessness </li></ul><ul><li>Dyspnea, tachypnea </li></ul><ul><li>Tachycardia </li></ul><ul><li>Nasal flaring </li></ul><ul><li>Retractions </li></ul><ul><li>Cough </li></ul><ul><li>Chest tightness </li></ul><ul><li>Cold clammy skin </li></ul><ul><li>Wheezing </li></ul><ul><li>Cyanosis </li></ul>[email_address] respi disorders Asthma <ul><li>Management </li></ul><ul><li>Pharmacotherapy </li></ul><ul><ul><li>Beta agonists [Epinephrine, Terbutaline] </li></ul></ul><ul><ul><li>Methylxanthines [Aminophylline] </li></ul></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><ul><li>Anticholinergics [Atropine] </li></ul></ul><ul><ul><li>Mast cell inhibitors [Cromolyn] </li></ul></ul><ul><li>Oxygen via nasal cannula </li></ul><ul><li>Fluids to 3L/day </li></ul><ul><li>Breathing exercises </li></ul><ul><li>Metered dose inhaler </li></ul>
    • 15. Acute Respiratory Distress Syndrome <ul><ul><li>Clinical syndrome of respiratory insufficiency </li></ul></ul><ul><ul><li>Damaged capillary membranes </li></ul></ul><ul><ul><ul><li>Interstitial edema </li></ul></ul></ul><ul><ul><ul><li>Intraalveolar hemorrhage </li></ul></ul></ul><ul><ul><li>Hypoxemia </li></ul></ul><ul><ul><li>Causes </li></ul></ul><ul><ul><li>Viral pneumonia </li></ul></ul><ul><ul><li>Fat emboli </li></ul></ul><ul><ul><li>Sepsis </li></ul></ul><ul><ul><li>Decreased surfactant production </li></ul></ul>[email_address] respi disorders
    • 16. Acute Respiratory Distress Syndrome [email_address] respi disorders
    • 17. Acute Respiratory Distress Syndrome [email_address] respi disorders Clinical Manifestations Dyspnea Tachypnea Crackles Rhonchi Anxiety  Breath sounds <ul><li>Management </li></ul><ul><li>Intubation & mechanical ventilation using PEEP </li></ul><ul><li>Pharmacotherapy </li></ul><ul><ul><li>Antibiotics </li></ul></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>Steroids </li></ul></ul><ul><ul><li>Neuromuscular blocking agents </li></ul></ul>Diagnostics ABGs: Respiratory acidosis, hypoxemia CXR: interstitial edema
    • 18. Chest Physiotherapy <ul><li>Postural drainage  Percussion  Vibration </li></ul><ul><li>Nursing Care </li></ul><ul><li>Perform before or 3-4 hrs after meal </li></ul><ul><li>Bronchodilators 15-20 mins before </li></ul><ul><li>Remove all tight clothing </li></ul><ul><li>Percuss on area approx 3mins during I & E </li></ul><ul><li>Vibrate on area during E </li></ul><ul><li>Assist pt in coughing & positioning </li></ul><ul><li>Provide good oral hygiene </li></ul>[email_address] respi disorders
    • 19. Chest Physiotherapy Postural Drainage [email_address] respi disorders
    • 20. Pulmonary Tuberculosis <ul><li>Airborne, infectious, communicable </li></ul><ul><li>Acute or chronic </li></ul><ul><li>Mycobacterium tuberculosis </li></ul><ul><li>Clinical Manifestations </li></ul><ul><li>Fatigue, malaise </li></ul><ul><li>Anorexia, weight loss </li></ul><ul><li>Night sweats </li></ul><ul><li>Late afternoon low-grade fever </li></ul><ul><li>Productive chronic cough </li></ul><ul><li>Hemoptysis (advanced) </li></ul>[email_address] respi disorders
    • 21. Pulmonary Tuberculosis <ul><li>Diagnostics </li></ul><ul><li>Mantoux test </li></ul><ul><li>Read after 48-72 H </li></ul><ul><li>[>10 mm induration] </li></ul><ul><li>Chest x-ray </li></ul><ul><li>Calcified lesions </li></ul><ul><li>Sputum exam </li></ul><ul><li>Acid-fast bacillus </li></ul>[email_address] respi disorders Management TB medications [6-12 mos] INH, RIF, (6 mos); PZA, ethambutol, streptomycin (2 mos) Pt non-infectious 2-3wks of Tx 9 mos continuous therapy R IF : discoloration ; hepatotoxic I NH : peripheral neuropathy (B6), liver function test (AST, ALT) P ZA : thrombocytopenia, hyperurecemia -> ↑ OFI E THAMBUTOL : optic neuritis S TREPTOMYCIN : hepatotoxic, nephrotoxic, ototoxic, given IM
    • 22. Pleural Effusion & Pneumothorax <ul><li>Causes </li></ul><ul><li>Trauma </li></ul><ul><li>Thoracic surgery </li></ul><ul><li>Positive pressure </li></ul><ul><li>ventilation </li></ul><ul><li>Thoracentesis </li></ul><ul><li>CVP line insertion </li></ul><ul><li>Emphysema </li></ul>[email_address] respi disorders
    • 23. Pleural Effusion & Pneumothorax <ul><li>Clinical Manifestations </li></ul><ul><li>Sudden sharp chest pain </li></ul><ul><li>Shortness of breath (SOB) </li></ul><ul><li>Restlessness/anxiety </li></ul><ul><li>Tachycardia, tachypnea </li></ul><ul><li>Diminished/absent BS </li></ul><ul><li>Chest asymmetry </li></ul><ul><li>Tracheal deviation </li></ul><ul><li>towards unaffected side </li></ul><ul><li>Tympany </li></ul>[email_address] respi disorders Management High-Fowler’s Pain relief O2 therapy Chest tube insertion Thoracentesis Chest x-ray ABGs Monitor for shock
    • 24. Pulmonary Embolism <ul><li>Undissolved substance in pulmonary vasculature </li></ul><ul><li>obstructs blood flow </li></ul><ul><li>Types : F at, A ir, T hrombus </li></ul><ul><li>Causes </li></ul><ul><li>Flat or long bone fractures </li></ul><ul><li>Thrombophlebitis </li></ul><ul><li>Venous stasis </li></ul>[email_address] respi disorders
    • 25. Pulmonary Embolism <ul><li>Clinical Manifestations </li></ul><ul><li>Dyspnea, tachypnea, crackles </li></ul><ul><li>Diagnostics </li></ul><ul><li>ABGs </li></ul><ul><li>Respiratory alkalosis, hypoxemia </li></ul><ul><li>Lung Scan </li></ul><ul><li> Pulmonary circulation & blood flow obstruction </li></ul><ul><li>Angiography </li></ul><ul><li>Location of embolus </li></ul><ul><li>Filling defect of pulmonary artery </li></ul>[email_address] respi disorders
    • 26. Pulmonary Embolism <ul><li>Management </li></ul><ul><li>Intubation & mechanical ventilation </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Thrombolytics </li></ul><ul><li>Assess for (+) Homan’s sign </li></ul><ul><li>Monitor PT & PTT </li></ul><ul><li>WOF S/S of excessive anticoagulation </li></ul>[email_address] respi disorders
    • 27. Bronchogenic Carcinoma <ul><li>Primary pulmonary tumors arising from bronchial </li></ul><ul><li>epithelium; metastasis primarily by direct extension, </li></ul><ul><li>via the circulatory or the lymphatic systems </li></ul><ul><li>Incidence </li></ul><ul><li>Men > 40 years; 1 out of 10 heavy smokers </li></ul><ul><li>Right lung > Left lung </li></ul><ul><li>Etiology </li></ul><ul><li>Inhaled carcinogens </li></ul><ul><li>[cigarette smoke, asbestos, nickel, iron oxides] </li></ul><ul><li>Pre-existing pulmonary DO [COPD, TB] </li></ul>[email_address] respi disorders
    • 28. Bronchogenic Carcinoma <ul><li>Clinical Manifestations </li></ul><ul><li>Persistent cough </li></ul><ul><li>[productive, blood-tinged] </li></ul><ul><li>Chest pain, dyspnea </li></ul><ul><li>Unilateral wheezing </li></ul><ul><li>Friction rub </li></ul><ul><li>Fatigue, anorexia </li></ul><ul><li>Nausea & vomiting </li></ul><ul><li>Pallor </li></ul>[email_address] respi disorders Diagnostics CXR Presence of tumor; metastasis Sputum for cytology Malignant cells Thoracentesis Pleural fluid with malignant cells
    • 29. Bronchogenic Carcinoma <ul><li>Management </li></ul><ul><li>Depends on cell type, stage of disease, </li></ul><ul><li>and condition of the patient </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Surgery </li></ul><ul><li>Provide support & guidance to client </li></ul><ul><li>Relief/control of pain and nausea </li></ul><ul><li>Meds as ordered, monitor effects </li></ul>[email_address] respi disorders
    • 30. Lung Cancer <ul><li>Maybe metastatic or primary </li></ul><ul><li>Leading cause of mortality </li></ul><ul><li>Smoking-related </li></ul><ul><li>Poor prognosis </li></ul><ul><li>Dies in 5 years </li></ul><ul><li>Adenocarcinoma </li></ul><ul><li>Most prevalent type </li></ul><ul><li>Small cell carcinoma </li></ul><ul><li>Poorest prognosis </li></ul>[email_address] respi disorders
    • 31. Laryngeal Carcinoma <ul><li>Types </li></ul><ul><li>Glottic </li></ul><ul><li>Hoarseness for >2 weeks </li></ul><ul><li>Dyspnea </li></ul><ul><li>Supraglottic </li></ul><ul><li>Localized throat pain </li></ul><ul><li>Burning when drinking hot liquids </li></ul><ul><li>or orange juice </li></ul><ul><li>Lump in the neck </li></ul><ul><li>Dysphagia, odynophagia </li></ul>[email_address] respi disorders Risk Factors Cigarette smoking Chronic laryngitis Vocal abuse Alcohol abuse Familial tendency
    • 32. Laryngeal Carcinoma <ul><li>Management </li></ul><ul><li>Subtotal laryngectomy: retains voice </li></ul><ul><li>Total: absolute loss of voice </li></ul><ul><li>Tracheostomy: temporary or permanent </li></ul><ul><li>Maintain patent airway </li></ul><ul><li>HOB elevated 45º </li></ul><ul><li>Assist patient in communicating; provide writing materials, etc. </li></ul><ul><li>Practice swallowing </li></ul><ul><li>Cover tracheostomy with porous material </li></ul><ul><li>Avoid powder, spray, aerosol near trachea </li></ul>[email_address] respi disorders
    • 33. Respiratory Disorders Nio C. Noveno, RN ,MAN THANK YOU!

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