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Respiratory Disorders Nio C. Noveno, RN ,MAN
Pneumonia <ul><li>Acute inflammatory process of the alveolar spaces </li></ul><ul><li>   lung consolidation    exudate [...
Pneumonia <ul><li>Types </li></ul><ul><li>Bacterial pneumonia </li></ul><ul><ul><li>Lobar [Strep] – constant dry, hacking ...
Pneumonia <ul><li>Clinical Manifestations </li></ul><ul><li>Cough </li></ul><ul><li>Chills </li></ul><ul><li>Dyspnea </li>...
Pneumonia <ul><li>Pneumocystis carinii  pneumonia </li></ul><ul><li>Opportunistic infection </li></ul><ul><li>Often relate...
Pneumonia <ul><li>Management </li></ul><ul><li>Increase OFI 3-4 L/day. </li></ul><ul><li>Administer O 2 . </li></ul><ul><l...
Chronic Obstructive Pulmonary Disease <ul><li>B ronchitis </li></ul><ul><li>E mphysema </li></ul><ul><li>Causes </li></ul>...
Chronic Obstructive Pulmonary Disease <ul><li>Chronic  </li></ul><ul><li>Bronchitis </li></ul><ul><li>Excessive  </li></ul...
Chronic Obstructive Pulmonary Disease <ul><ul><li>Emphysema </li></ul></ul><ul><ul><li>Destruction of elastin  </li></ul><...
[email_address] respi disorders Emphysema No cyanosis (Pink) Thin appearance Exertional dyspnea Ineffective cough Barrel c...
Chronic Obstructive Pulmonary Disease <ul><li>Management </li></ul><ul><li>Rest:    O2 demand of tissues </li></ul><ul><l...
Chronic Obstructive Pulmonary Disease <ul><li>Bronchiectasis </li></ul><ul><li>Destruction of bronchial  </li></ul><ul><li...
Chronic Obstructive Pulmonary Disease [email_address] respi disorders Asthma ALLERGY (Extrinsic) INFLAMMATION (Intrinsic) ...
Chronic Obstructive Pulmonary Disease <ul><li>Clinical  </li></ul><ul><li>Manifestations </li></ul><ul><li>Orthopnea </li>...
Acute Respiratory Distress Syndrome <ul><ul><li>Clinical syndrome of respiratory insufficiency </li></ul></ul><ul><ul><li>...
Acute Respiratory Distress Syndrome [email_address] respi disorders
Acute Respiratory Distress Syndrome [email_address] respi disorders Clinical Manifestations Dyspnea Tachypnea Crackles Rho...
Chest Physiotherapy <ul><li>Postural drainage    Percussion    Vibration </li></ul><ul><li>Nursing Care </li></ul><ul><l...
Chest Physiotherapy Postural Drainage [email_address] respi disorders
Pulmonary Tuberculosis <ul><li>Airborne, infectious, communicable </li></ul><ul><li>Acute or chronic </li></ul><ul><li>Myc...
Pulmonary Tuberculosis <ul><li>Diagnostics </li></ul><ul><li>Mantoux test </li></ul><ul><li>Read after 48-72 H </li></ul><...
Pleural Effusion & Pneumothorax <ul><li>Causes </li></ul><ul><li>Trauma </li></ul><ul><li>Thoracic surgery </li></ul><ul><...
Pleural Effusion & Pneumothorax <ul><li>Clinical Manifestations </li></ul><ul><li>Sudden sharp chest pain </li></ul><ul><l...
Pulmonary Embolism <ul><li>Undissolved substance in pulmonary vasculature  </li></ul><ul><li>obstructs blood flow </li></u...
Pulmonary Embolism <ul><li>Clinical Manifestations </li></ul><ul><li>Dyspnea, tachypnea, crackles </li></ul><ul><li>Diagno...
Pulmonary Embolism <ul><li>Management </li></ul><ul><li>Intubation & mechanical ventilation </li></ul><ul><li>Anticoagulan...
Bronchogenic Carcinoma <ul><li>Primary pulmonary tumors arising from bronchial  </li></ul><ul><li>epithelium; metastasis p...
Bronchogenic Carcinoma <ul><li>Clinical Manifestations </li></ul><ul><li>Persistent cough </li></ul><ul><li>[productive, b...
Bronchogenic Carcinoma <ul><li>Management </li></ul><ul><li>Depends on cell type, stage of disease, </li></ul><ul><li>and ...
Lung Cancer <ul><li>Maybe metastatic or primary </li></ul><ul><li>Leading cause of mortality </li></ul><ul><li>Smoking-rel...
Laryngeal Carcinoma <ul><li>Types </li></ul><ul><li>Glottic </li></ul><ul><li>Hoarseness for >2 weeks </li></ul><ul><li>Dy...
Laryngeal Carcinoma <ul><li>Management </li></ul><ul><li>Subtotal laryngectomy: retains voice </li></ul><ul><li>Total: abs...
Respiratory Disorders Nio C. Noveno, RN ,MAN THANK YOU!
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  • BY: NIO C. NOVENO, RN, MAN RESPIRATORY DISORDERS NCLEX - RN REVIEW JUNE 2008
  • Transcript of "Respiratory Disorders"

    1. 1. Respiratory Disorders Nio C. Noveno, RN ,MAN
    2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 16. Acute Respiratory Distress Syndrome [email_address] respi disorders
    17. 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. 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. 19. Chest Physiotherapy Postural Drainage [email_address] respi disorders
    20. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 33. Respiratory Disorders Nio C. Noveno, RN ,MAN THANK YOU!
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