Respiratory System2

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Respiratory System2

  1. 1. RESPIRATORY SYSTEM Ma. Victoria J. Recinto RN, USRN University of the Philippines-Manila Philippine General Hospital
  2. 2. OVERVIEW <ul><li>Basic Process of Oxygenation </li></ul><ul><ul><li>Ventilation- degree of compliance, airway resistance, accessory muscles (Respiratory System) </li></ul></ul><ul><ul><li>Diffusion- thickness of membranes (Hematologic System) </li></ul></ul><ul><ul><li>Perfusion- integrity of transport system (CV and Hematologic System) </li></ul></ul>
  3. 3. OVERVIEW <ul><li>Function: Respiratory System </li></ul><ul><ul><li>Obtains O2, removes CO2 </li></ul></ul><ul><ul><li>Filters particles from incoming air </li></ul></ul><ul><ul><li>Control T and water content </li></ul></ul><ul><ul><li>Role in sense of smell </li></ul></ul><ul><ul><li>Regulates blood pH </li></ul></ul>
  4. 4. OVERVIEW
  5. 5. OVERVIEW <ul><li>Upper Respiratory Tract </li></ul><ul><ul><li>Filtering of air, warming, moistening </li></ul></ul><ul><ul><li>Humidification </li></ul></ul><ul><li>A. Nose </li></ul><ul><li>Framework of cartilage </li></ul><ul><li>2 septum/nostril </li></ul><ul><li>Anastomosis of capillaries (Keisselbach) </li></ul><ul><li>B. Pharynx (Throat)- organ of GI and RT </li></ul><ul><li>Muscular pasageway for food and air </li></ul><ul><li>Nasopharynx </li></ul><ul><li>Oropharynx </li></ul><ul><li>Laryngopharynx </li></ul>
  6. 6. OVERVIEW <ul><li>C. Larynx (Voicebox) </li></ul><ul><li>Phonation (speech production) </li></ul><ul><li>Cough reflex </li></ul><ul><li>Frameworks </li></ul><ul><li>Arythenoid and cricoid cartilage </li></ul><ul><li>Thyroid gland </li></ul><ul><li>Hyoid bone </li></ul><ul><li>Glottis </li></ul><ul><li>Epiglottis </li></ul><ul><ul><li>Opens: passage of air </li></ul></ul><ul><ul><li>Closes: passage of food </li></ul></ul>
  7. 7. Upper Respiratory Tract
  8. 8. OVERVIEW <ul><li>Lower Respiratory System </li></ul><ul><ul><li>Gas exchange </li></ul></ul><ul><ul><li>A. Trachea (windpipe) </li></ul></ul><ul><ul><li>Cartilaginous rings, ‘U’ shape </li></ul></ul><ul><ul><li>Site of permanent artificial airway (tracheostomy) </li></ul></ul><ul><ul><li>B. Carina- area of bifurcation of bronchi </li></ul></ul><ul><ul><li>C. Bronchi </li></ul></ul><ul><ul><li>R main bronchus- wider straighter </li></ul></ul><ul><ul><li>L main bronchus </li></ul></ul>
  9. 9. OVERVIEW <ul><li>Lower Respiratory System </li></ul><ul><ul><li>D. Lungs- covered by serous membrane </li></ul></ul><ul><ul><li>R- 3 lobes </li></ul></ul><ul><ul><li>L- 2 lobes </li></ul></ul><ul><ul><li>Pleural cavity </li></ul></ul><ul><ul><ul><li>Parietal- with 20 cc of fluid to prevent friction, with nerve endings </li></ul></ul></ul><ul><ul><ul><li>Visceral- without nerve endings </li></ul></ul></ul><ul><ul><ul><li>Pleural space </li></ul></ul></ul>
  10. 10. OVERVIEW <ul><li>Lower Respiratory System </li></ul><ul><ul><li>D. Lungs </li></ul></ul><ul><ul><li>Terminal bronchioles </li></ul></ul><ul><ul><ul><li>Alveoli (Acinar cells)- site of gas exchange (CO2 and O2) </li></ul></ul></ul><ul><ul><ul><li>Type II cells- secretes SURFACTANT (phospholipid lipoprotein)   surface tension </li></ul></ul></ul>
  11. 11. PNEUMONIA <ul><li>Inflammation of lung parenchyma  pulmonary consolidation as the alveoli are filled with exudates </li></ul><ul><li>Causative Agents </li></ul><ul><ul><li>Streptococcus pneumoniae (Pneumococcal pneumonia) </li></ul></ul><ul><ul><li>Hemophilus influenzae (Bronchopneumonia) </li></ul></ul><ul><ul><li>E. Coli </li></ul></ul><ul><ul><li>Klebsiella </li></ul></ul><ul><ul><li>Pseudomonas aeruginosa </li></ul></ul>
  12. 12. PNEUMONIA
  13. 13. Predisposing Factors: PNEUMONIA <ul><li>Excessive smoking </li></ul><ul><li>Air pollution </li></ul><ul><li>Over fatigue </li></ul><ul><li>Prolonged immobility  hypostatic pneumonia </li></ul><ul><li>Aspiration </li></ul><ul><li>Immunocompromised state </li></ul><ul><ul><li>AIDS- Pneumocystis carinii taking Zidovudine (AZT) </li></ul></ul><ul><ul><li>Bronchogenic CA </li></ul></ul>
  14. 14. Signs and Symptoms: PNEUMONIA <ul><li>Productive cough (greenish to rusty sputum) </li></ul><ul><li>Dyspnea with prolonged expiratory grunt </li></ul><ul><li>Fever, chills, anorexia, N/V, weight loss </li></ul><ul><li>Pleuritic friction rub </li></ul><ul><li>Rales, crackles, Bronchial wheezing </li></ul><ul><li>Cyanosis </li></ul><ul><li>Chest pain </li></ul><ul><li>Abdominal distension  paralytic ileus (most feared Cx) </li></ul>
  15. 15. Diagnostic Procedures: PNEUMONIA <ul><li>Sputum C/S </li></ul><ul><li>Gram-staining C/S </li></ul><ul><li>Chest X-Ray- reveals pulmonary consolidation </li></ul><ul><li>ABG-  pO2 </li></ul><ul><li>CBC-  WBC,  ESR </li></ul>
  16. 16. Nursing Management: PNEUMONIA <ul><ul><li>CBR </li></ul></ul><ul><ul><li>Place pt. on semi-fowler’s </li></ul></ul><ul><ul><li>Low flow O2 as ordered </li></ul></ul><ul><ul><li>Give comfortable and humid environment </li></ul></ul><ul><ul><li>Diet:  CHON,  CHO,  Vit C </li></ul></ul><ul><ul><li>Force fluids to liquefy secretions </li></ul></ul><ul><ul><li>Importance of receiving immunization as recommended </li></ul></ul>
  17. 17. Nursing Management: PNEUMONIA <ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><ul><li>Broad spectrum antibiotics </li></ul></ul></ul><ul><ul><ul><ul><li>Penicillin, Tetracycline, Macrolides </li></ul></ul></ul></ul><ul><ul><ul><li>Antipyretics </li></ul></ul></ul><ul><ul><ul><li>Mucolytics/ Expectorants (Guiafenesin, Glycerine, Guiacolate) </li></ul></ul></ul>
  18. 18. Nursing Management: PNEUMONIA <ul><ul><li>Institute pulmonary toilet </li></ul></ul><ul><ul><ul><li>DBE </li></ul></ul></ul><ul><ul><ul><li>Coughing </li></ul></ul></ul><ul><ul><ul><li>Chest physiotherapy (CPT) </li></ul></ul></ul><ul><ul><ul><li>Turning and repositioning </li></ul></ul></ul><ul><ul><li>Nebulize and suction prn </li></ul></ul>
  19. 19. Chest Physiotherapy
  20. 20. Nursing Management: PNEUMONIA <ul><ul><li>Institute postural drainage as ordered </li></ul></ul><ul><ul><ul><li>Pt is placed on various positions to promote drainage of secretions, stay for 20-30 minutes </li></ul></ul></ul><ul><ul><ul><li>Best done before breakfast, or 2-3 hrs p.c. </li></ul></ul></ul><ul><ul><ul><li>Pt. should be well hydrated, knows how to cough </li></ul></ul></ul><ul><ul><ul><ul><li>Prone with pillow on abdomen- drains lower part of the lungs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Supine with buttocks up- drains upper part of the lungs </li></ul></ul></ul></ul>
  21. 21. Postural Drainage
  22. 22. Postural Drainage
  23. 23. Nursing Management: PNEUMONIA <ul><ul><li>Institute postural drainage as ordered </li></ul></ul><ul><ul><ul><li>Monitor VS, breath sounds </li></ul></ul></ul><ul><ul><ul><li>Administer bronchodilators 15-30 minutes prior </li></ul></ul></ul><ul><ul><ul><li>Encourage DBE </li></ul></ul></ul><ul><ul><ul><li>Stop if pt can’t tolerate the procedure </li></ul></ul></ul><ul><ul><ul><li>Give oral care post procedure </li></ul></ul></ul><ul><ul><ul><li>No to pt with: hemoptysis, unstable VS,  ICP,  IOP </li></ul></ul></ul>
  24. 24. Nursing Management: PNEUMONIA <ul><ul><li>Discharge Health Teaching </li></ul></ul><ul><ul><ul><li>Stop smoking </li></ul></ul></ul><ul><ul><ul><li>Regular adherence to meds </li></ul></ul></ul><ul><ul><ul><li>Dietary modification </li></ul></ul></ul><ul><ul><ul><li>Follow-up care </li></ul></ul></ul><ul><ul><ul><li>Prevent Cx: atelectasis and meningitis </li></ul></ul></ul>
  25. 25. PULMONARY TUBERCULOSIS <ul><li>Or Koch’s Disease </li></ul><ul><li>Causative agent: MTB- acid-fast, non-motile </li></ul><ul><li>Predisposing Factors </li></ul><ul><ul><li>Malnutrition </li></ul></ul><ul><ul><li>Overcrowding </li></ul></ul><ul><ul><li>Alcoholism </li></ul></ul><ul><ul><li>Ingestion of affected cattle (with M. bovis) </li></ul></ul><ul><ul><li>Virulence of the microorganism </li></ul></ul>
  26. 26. PULMONARY TUBERCULOSIS
  27. 27. Signs and Symptoms: PTB <ul><ul><li>Productive cough- yellowish secretions > 2 wks </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Low grade afternoon fever- Pathognomonic Sign </li></ul></ul><ul><ul><li>Night sweats- Classical Sign </li></ul></ul><ul><ul><li>Anorexia, general body malaise </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Hemoptysis </li></ul></ul>
  28. 28. Diagnostic Procedures: PTB <ul><ul><li>Mantoux Test- skin test, injection of PPD </li></ul></ul><ul><ul><ul><li>Reading: after 48-72 hrs </li></ul></ul></ul><ul><ul><ul><li>(+) exposure to PTB: </li></ul></ul></ul><ul><ul><ul><ul><li>DOH: 8-10 mm induration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>WHO: 10-14 mm induration </li></ul></ul></ul></ul>
  29. 29. Diagnostic Procedures: PTB <ul><ul><li>Sputum AFB- (+) MTB </li></ul></ul><ul><ul><li>Chest X-ray- pulmonary infiltrates (caseous necrosis) </li></ul></ul><ul><ul><li>CBC-  WBC </li></ul></ul>
  30. 30. PULMONARY TUBERCULOSIS <ul><li>Nursing Management </li></ul><ul><ul><li>CBR </li></ul></ul><ul><ul><li>Comfortable environment </li></ul></ul><ul><ul><li>O2 inhalation as ordered </li></ul></ul><ul><ul><li>Force fluids to liquefy secretions </li></ul></ul><ul><ul><li>NO CPT, only DBE and coughing </li></ul></ul><ul><ul><li>Nebulize and suction prn </li></ul></ul><ul><ul><li>Place on semi-fowler’s </li></ul></ul><ul><ul><li>Diet:  CHON,  CHO,  Vit C </li></ul></ul>
  31. 31. PULMONARY TUBERCULOSIS <ul><li>Short Course Chemotherapy </li></ul><ul><ul><li>I. Intensive Phase </li></ul></ul><ul><ul><ul><li>INH- given for 4 mos., taken a.c. </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: peripheral neuritis- give Vit B6 </li></ul></ul></ul></ul><ul><ul><ul><li>Rifampicin- given for 4 mos., taken a.c. </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: all body secretions turned red-orange </li></ul></ul></ul></ul><ul><ul><ul><li>PZA- given for 2 mos., taken p.c. </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: skin rashes, nephro and hepatotoxicity </li></ul></ul></ul></ul><ul><ul><ul><li>PZA is replaced by Ethambutol </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: optic neuritis (visual disturbance) </li></ul></ul></ul></ul>
  32. 32. PULMONARY TUBERCULOSIS <ul><li>Short Course Chemotherapy </li></ul><ul><ul><li>II. Standard Regimen </li></ul></ul><ul><ul><ul><li>Streptomycin IM (Aminoglycoside) </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: Ototoxicity due to damage to CN VIII  temporary hearing loss </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nephrotoxicity- monitor BUN and Crea levels </li></ul></ul></ul></ul>
  33. 33. PULMONARY TUBERCULOSIS <ul><li>Discharge Health Teaching </li></ul><ul><ul><li>Avoid precipitating factors </li></ul></ul><ul><ul><li>Take meds religiously </li></ul></ul><ul><ul><ul><li>If missed 1 day’s meds, NEVER  the dose on the next day, simply let the pt continue taking the meds </li></ul></ul></ul><ul><ul><li>Prevent Cx: Atelectasis and Miliary TB </li></ul></ul><ul><ul><li>Follow-up care </li></ul></ul>
  34. 34. HISTOPLASMOSIS <ul><li>Acute fungal infection characterized by inhalation of contaminated dust with Histoplasma capsulatum from bird’s manure </li></ul>
  35. 35. HISTOPLASMOSIS <ul><li>S/Sx: PTB, Pneumonia-like </li></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Hemoptysis </li></ul></ul><ul><ul><li>Fever, chills, anorexia, general body malaise </li></ul></ul><ul><ul><li>Chest and joint pain </li></ul></ul>
  36. 36. HISTOPLASMOSIS <ul><li>Diagnostic Procedure </li></ul><ul><li>(+) Histoplasmin skin test </li></ul><ul><li>(+) agglutination test </li></ul><ul><li> WBC </li></ul><ul><li>ABG-  pO2 </li></ul><ul><li>CXR- (+) infiltrates </li></ul>
  37. 37. HISTOPLASMOSIS <ul><li>Nursing Management </li></ul><ul><ul><li>CBR, semi Fowler’s position </li></ul></ul><ul><ul><li>O2 inhalation as ordered </li></ul></ul><ul><ul><li>Force fluids </li></ul></ul><ul><ul><li>Encourage coughing & DBE </li></ul></ul><ul><ul><li>Nebulize and suction prn </li></ul></ul>
  38. 38. HISTOPLASMOSIS <ul><li>Nursing Management </li></ul><ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><ul><li>Antifungal agent: Amphotericin B (Fungizone) </li></ul></ul></ul><ul><ul><ul><ul><li>S/E: nephrotoxicity and hypoK+ </li></ul></ul></ul></ul><ul><ul><ul><li>Corticosteroids </li></ul></ul></ul><ul><ul><ul><li>Antipyretics </li></ul></ul></ul><ul><ul><ul><li>Antihistamines </li></ul></ul></ul><ul><ul><ul><li>Mucolytics/expectorants </li></ul></ul></ul>
  39. 39. HISTOPLASMOSIS <ul><li>Nursing Management </li></ul><ul><ul><li>Spraying of breeding places </li></ul></ul><ul><ul><li>Prevent Cx: Atelectasis and Bronchiectasis </li></ul></ul>
  40. 40. SEVERE ACUTE RESPIRATORY SYNDROME (SARS) <ul><li>Cause: Coronavirus </li></ul><ul><li>Begins with fever, body aches, mild respiratory Sxs </li></ul><ul><li>After 2-7 days, dry cough & dyspnea develops </li></ul><ul><li>MOT: close person-to-person contact (direct contact with infectious secretions and soiled articles) </li></ul><ul><li>Prevention: avoiding contact with those suspected of having SARS, avoiding travel to countries with SARS outbreak, frequent hand washing </li></ul>
  41. 41. INHALATION INJURIES: CO poisoning <ul><li>CO: colorless, odorless, tasteless, with affinity for Hgb 200X greater than O2, forming carboxyHgb  tissue hypoxia </li></ul>Blood Level Assessment 1-10% Impaired visual acuity 11-20% Flushing, HA 21-30% N/, impaired dexterity 31-40% Vom,dizziness,syncope 41-50%  HR,  RR >50% Coma, death
  42. 42. INHALATION INJURIES: CO poisoning <ul><li>Interventions </li></ul><ul><ul><li>Remove victim from exposure </li></ul></ul><ul><ul><li>Administer 100% O2 </li></ul></ul><ul><ul><li>Assess need for CPR </li></ul></ul><ul><ul><li>Monitor VS and CO levels </li></ul></ul>
  43. 43. OCCUPATIONAL LUNG DISEASE: SILICOSIS <ul><li>Or Asbestosis or Coal Workers’ Pneumoconiosis </li></ul><ul><li>Fibrotic lung disease caused by inhalation or organic dusts over long periods of time </li></ul><ul><li>Common among miners & sandblasters </li></ul>
  44. 44. OCCUPATIONAL LUNG DISEASE: SILICOSIS <ul><li>S/Sx </li></ul><ul><ul><li>Uncomplicated or simple: asymptomatic with evidence of fibrosis on CXR </li></ul></ul><ul><ul><li>Chronic complicated: malaise, A/, wt loss, severe dyspnea on exertion, massive fibrosis on CXR </li></ul></ul>
  45. 45. OCCUPATIONAL LUNG DISEASE: SILICOSIS <ul><li>Interventions </li></ul><ul><ul><li>Eliminate the toxic substance </li></ul></ul><ul><ul><li>O2 as ordered </li></ul></ul><ul><ul><li>Coughing and DBE </li></ul></ul><ul><ul><li>Administer antitussives for cough & anti-TB meds as ordered (Cx: PTB) </li></ul></ul>
  46. 46. COPD <ul><li>Types </li></ul><ul><li>Chronic Bronchitis </li></ul><ul><li>Bronchial Asthma </li></ul><ul><li>Bronchiectasis </li></ul><ul><li>Pulmonary Emphysema </li></ul>
  47. 47. COPD-Chronic Bronchitis <ul><li>Inflammation of bronchi  hyperplasia of goblet mucus-producing cells  narrowing of smaller airways </li></ul>
  48. 48. COPD-Chronic Bronchitis <ul><li>Predisposing Factors </li></ul><ul><ul><li>Excessive, chronic smoking </li></ul></ul><ul><ul><li>Air pollution </li></ul></ul>
  49. 49. COPD-Chronic Bronchitis <ul><li>S/Sx </li></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>Dyspnea at exertion </li></ul></ul><ul><ul><li>Prolonged expiratory grunt </li></ul></ul><ul><ul><li>Scattered rales, rhonchi </li></ul></ul><ul><ul><li>Anorexia, general body malaise </li></ul></ul><ul><ul><li>Cyanosis- Blue Bloaters </li></ul></ul><ul><ul><li>Feeling of breathlessness </li></ul></ul><ul><ul><li>Pulmonary HTN leading to peripheral edema and Cor Pulmonale (most feared Cx) </li></ul></ul>
  50. 50. Cor Pulmonale
  51. 51. COPD-Bronchial Asthma <ul><li>Reversible inflammatory disorder of lung tissue due to hypersensitivity to allergens  narrowing of smaller airways </li></ul><ul><li>Predisposing Factors (based on 3 types) </li></ul><ul><ul><li>Extrinsic (Atopic/Allergic) </li></ul></ul><ul><ul><ul><li>Pollen, dust, furs, fumes, gases, smoke, danders, lints </li></ul></ul></ul>
  52. 52. COPD-Bronchial Asthma <ul><ul><li>Intrinsic (Non-Atopic/Non-Allergic) </li></ul></ul><ul><ul><ul><li>Hereditary </li></ul></ul></ul><ul><ul><ul><li>Drugs: ASA, Pen, Phenylbutazone, Beta blockers </li></ul></ul></ul><ul><ul><ul><li>Foods: seafoods, eggs, chicken, chocolate, milk and its products </li></ul></ul></ul><ul><ul><ul><li>Food additives- nitrates (also can cause CA) </li></ul></ul></ul><ul><ul><ul><li>Sudden change in T, air pressure and humidity </li></ul></ul></ul><ul><ul><ul><li>Extreme emotion </li></ul></ul></ul><ul><ul><ul><li>Physical stress </li></ul></ul></ul><ul><ul><li>Mixed- combination of the 2 </li></ul></ul><ul><ul><ul><li>Most common type (90% of cases) </li></ul></ul></ul>
  53. 53. COPD-Bronchial Asthma
  54. 54. COPD-Bronchial Asthma <ul><li>S/Sx </li></ul><ul><ul><li>Non-productive cough </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Wheezing on expiration </li></ul></ul><ul><ul><li>Slight cyanosis </li></ul></ul><ul><ul><li>Mild restlessness and apprehension </li></ul></ul><ul><ul><li>Tachycardia and palpitation </li></ul></ul><ul><ul><li>Diaphoresis </li></ul></ul>
  55. 55. COPD-Bronchial Asthma <ul><li>Diagnostic Procedures </li></ul><ul><ul><li>ABG-  pO2 </li></ul></ul><ul><ul><li>PFT-  vital lung capacity (max. vol. of air that can be exhaled with the deepest breath possible) </li></ul></ul>
  56. 56. COPD-Bronchial Asthma <ul><li>Nursing Management </li></ul><ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><ul><li>Bronchodilators- inhalation or metered dose inhaler (pump) </li></ul></ul></ul><ul><ul><ul><li>Corticosteroids </li></ul></ul></ul><ul><ul><ul><li>Mucolytics/Expectorants </li></ul></ul></ul><ul><ul><ul><li>Anti-histamine </li></ul></ul></ul><ul><ul><li>O2 as ordered </li></ul></ul>
  57. 57. COPD-Bronchial Asthma
  58. 58. COPD-Bronchial Asthma <ul><li>Nursing Management </li></ul><ul><ul><li>Force fluids </li></ul></ul><ul><ul><li>Nebulize and suction prn </li></ul></ul><ul><ul><li>Comfortable and humid environment </li></ul></ul>
  59. 59. COPD-Bronchial Asthma <ul><ul><li>Discharge Health Teaching </li></ul></ul><ul><ul><ul><li>Avoid precipitating factors </li></ul></ul></ul><ul><ul><ul><li>Regular adherence to meds </li></ul></ul></ul><ul><ul><ul><ul><li>Sudden withdrawal to corticosteroids  status asthmaticus </li></ul></ul></ul></ul><ul><ul><ul><li>Prevent Complications </li></ul></ul></ul><ul><ul><ul><ul><li>Emphysema </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Status asthmaticus- Drug of Choice: Epinephrine </li></ul></ul></ul></ul>
  60. 60. COPD-Bronchiectasis <ul><li>Permanent dilatation of bronchus  destruction of elastic and muscular tissues of the alveolar walls </li></ul>
  61. 61. COPD-Bronchiectasis <ul><li>Predisposing Factors </li></ul><ul><ul><li>Recurrent URTI and LRTI </li></ul></ul><ul><ul><li>Congenital anomalies (LTB) </li></ul></ul><ul><ul><li>Lung tumor </li></ul></ul><ul><li>Signs and Symptoms </li></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Anorexia, general body malaise </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Hemoptysis </li></ul></ul>
  62. 62. COPD-Bronchiectasis <ul><li>Diagnostic Procedures </li></ul><ul><ul><li>ABG-  pO2 </li></ul></ul><ul><ul><li>Bronchoscopy </li></ul></ul>
  63. 63. COPD-Bronchiectasis <ul><li>Bronchoscopy: Nursing Management </li></ul><ul><ul><li>Pre-op: informed consent, maintain on NPO, monitor VS </li></ul></ul><ul><ul><li>Post-op </li></ul></ul><ul><ul><ul><li>Feed when gag reflex returns </li></ul></ul></ul><ul><ul><ul><li>Avoid talking, coughing, smoking  chronic irritation </li></ul></ul></ul><ul><ul><ul><li>Monitor for S/ of gross/frank bleeding </li></ul></ul></ul><ul><ul><ul><li>WOF laryngospasm and edema  DOB, SOB  prepare trache set at bedside </li></ul></ul></ul>
  64. 64. COPD-Bronchiectasis <ul><li>Nursing Management </li></ul><ul><ul><li>Same as in pulmonary emphysema </li></ul></ul><ul><ul><li>Assist in surgical procedure </li></ul></ul><ul><ul><ul><li>Pneumonectomy </li></ul></ul></ul><ul><ul><ul><ul><li>Position post-op: lie on affected side </li></ul></ul></ul></ul><ul><ul><ul><li>Segmental wedge lobectomy </li></ul></ul></ul><ul><ul><ul><ul><li>Position post-op: lie on unaffected side </li></ul></ul></ul></ul>
  65. 65. Pneumonectomy vs. Lobectomy
  66. 66. COPD-Pulmonary Emphysema <ul><li>Irreversible, end-stage stage of COPD characterized by inelasticity of alveolar wall  air trapping  maldistribution of gases  over distension of thoracic cavity   A:P diameter (Barrel-chest) </li></ul>
  67. 67. COPD-Pulmonary Emphysema
  68. 68. COPD-Pulmonary Emphysema <ul><li>Predisposing Factors </li></ul><ul><ul><li>Excessive, chronic smoking </li></ul></ul><ul><ul><li>Allergy </li></ul></ul><ul><ul><li>Air pollution </li></ul></ul><ul><ul><li>Hereditary- deficiency of alpha-1 anti-trypsin  elastase/elastin  alveolar recoil (Northern European origin) </li></ul></ul><ul><ul><li>Elderly- high risk group </li></ul></ul>
  69. 69. COPD-Pulmonary Emphysema <ul><li>Types </li></ul><ul><ul><li>Centrilobular/Panlobular </li></ul></ul><ul><ul><ul><li>Blue Bloaters </li></ul></ul></ul><ul><ul><ul><li>pCO2  , pO2  , resp. acidosis with hypoxemia </li></ul></ul></ul><ul><ul><li>Centriacinar/Panacinar </li></ul></ul><ul><ul><ul><li>Pink Puffers </li></ul></ul></ul><ul><ul><ul><li>pCO2  , pO2  , resp. alkaosis with hyperoxemia </li></ul></ul></ul>
  70. 70. Blue Bloater vs. Pink Puffer
  71. 71. The Blue Bloater
  72. 72. COPD-Pulmonary Emphysema <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>Dyspnea at rest </li></ul></ul><ul><ul><li>Anorexia, general body malaise </li></ul></ul><ul><ul><li>On lung percussion- resonance to hyperresonance </li></ul></ul>
  73. 73. COPD-Pulmonary Emphysema <ul><li>Signs and Symptoms </li></ul><ul><ul><li>(+) alar flaring </li></ul></ul><ul><ul><li>rales, rhonchi </li></ul></ul><ul><ul><li> breath sounds, vocal fremiti </li></ul></ul><ul><ul><li>Barrel chest- Pathognomonic Sign </li></ul></ul><ul><ul><li>(+) pursed-lip breathing </li></ul></ul>
  74. 74. COPD-Pulmonary Emphysema <ul><li>Nursing Management </li></ul><ul><ul><li>CBR </li></ul></ul><ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><ul><li>Bronchodilator </li></ul></ul></ul><ul><ul><ul><li>Corticosteroid </li></ul></ul></ul><ul><ul><ul><li>Antibiotics </li></ul></ul></ul><ul><ul><ul><li>Mucolytics/expectorants </li></ul></ul></ul>
  75. 75. COPD-Pulmonary Emphysema <ul><li>Nursing Management </li></ul><ul><ul><li>Low flow, Fixed concentration O2 inhalation as ordered not to remove the Hypoxic Drive </li></ul></ul>
  76. 76. COPD-Pulmonary Emphysema <ul><li>Nursing Management </li></ul><ul><ul><li>Force fluids </li></ul></ul><ul><ul><li>Diet:  CHON,  Vit & min.,  CHO </li></ul></ul><ul><ul><li>DBE- pursed-lip, cascade coughing, CPT </li></ul></ul><ul><ul><li>Nebulize and suction secretions prn </li></ul></ul>
  77. 77. COPD-Pulmonary Emphysema <ul><ul><li>Discharge Health Teaching </li></ul></ul><ul><ul><ul><li>Stop smoking </li></ul></ul></ul><ul><ul><ul><li>Regular adherence to meds </li></ul></ul></ul><ul><ul><ul><li>Prevent Complications </li></ul></ul></ul><ul><ul><ul><ul><li>Atelectasis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cor Pulmonale </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CO2 narcosis- severe disorientation/confusion  coma </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pneumothorax </li></ul></ul></ul></ul><ul><ul><ul><li>Follow-up care </li></ul></ul></ul>
  78. 78. Restrictive Lung Disorders <ul><li>Pneumothorax </li></ul><ul><li>Partial/complete collapse of the lungs due to accumulation of air in the pleural space </li></ul>
  79. 79. Pneumothorax <ul><li>3 types </li></ul><ul><ul><li>Spontaneous- without obvious cause </li></ul></ul><ul><ul><ul><li>e.g. rupture of bleb (alveolar fluid sac) in recurrent lung inflammation and infection </li></ul></ul></ul><ul><ul><li>Open- thru chest opening </li></ul></ul><ul><ul><ul><li>e.g. stab, gunshot wounds </li></ul></ul></ul><ul><ul><li>Tension- from blunt chest injury or from mech. vent. With PEEP air enters pleural space with each inspiration and cannot escape  thoracic cavity  mediastinal shift </li></ul></ul><ul><ul><ul><ul><li>E.g. flail chest (with paradoxical breathing) </li></ul></ul></ul></ul>
  80. 80. Pneumothorax <ul><li>Predisposing Factors </li></ul><ul><ul><li>Chest trauma </li></ul></ul><ul><ul><li>Recurrent inflammatory lung condition </li></ul></ul><ul><ul><li>Lung tumors </li></ul></ul>
  81. 81. Pneumothorax <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Cool, moist skin (beginning of shock) </li></ul></ul><ul><ul><li>Sharp, chest pain </li></ul></ul><ul><ul><li>Unexplained dyspnea </li></ul></ul><ul><ul><li> breath sounds  lung collapse </li></ul></ul><ul><ul><li> lung expansion </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul>
  82. 82. Pneumothorax <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Mild restlessness/apprehension </li></ul></ul><ul><ul><li>On lung percussion- resonance to hyperresonance </li></ul></ul><ul><ul><li>SQ emphysema (crepitus on palpation) </li></ul></ul><ul><ul><li>Tracheal deviation to unaffected side </li></ul></ul>
  83. 83. Pneumothorax <ul><li>Diagnostic Procedure </li></ul><ul><ul><li>ABG-  pO2 </li></ul></ul><ul><ul><li>Chest X-ray- partial or complete lung collapse </li></ul></ul>
  84. 84. Nursing Management: Pneumothorax <ul><ul><li>Assist in intubation </li></ul></ul><ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><ul><li>Narcotic analgesic </li></ul></ul></ul><ul><ul><ul><li>Antibiotics </li></ul></ul></ul>
  85. 85. Nursing Management: Pneumothorax <ul><ul><li>Assist in thoracentesis/ chest tube thoracostomy </li></ul></ul><ul><ul><ul><li>Remove air- insert at 2 nd -3 rd ICS </li></ul></ul></ul><ul><ul><ul><li>Remove fluid- insert laterally near base, posteriorly at 8 th -9 th ICS </li></ul></ul></ul><ul><ul><ul><li>Pt position: struggling to a chair, pt exhales and hold breath during insertion (under local anesthesia) </li></ul></ul></ul>
  86. 86. Thoracentesis
  87. 87. Nursing Management: Pneumothorax <ul><ul><ul><li>Attach tube to water-seal drainage </li></ul></ul></ul><ul><ul><ul><ul><li>Objectives: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>To reestablish (-) pressure in the lungs </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>To promote lung expansion </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>To drain air, fluid and blood and to prevent its reflux </li></ul></ul></ul></ul></ul>
  88. 88. Nursing Management: Water Seal Drainage <ul><ul><li>Monitor VS, I/O, breath sounds </li></ul></ul><ul><ul><li>DBE </li></ul></ul><ul><ul><li>Administer meds as ordered </li></ul></ul><ul><ul><li>Maintain strict asepsis </li></ul></ul>
  89. 89. Nursing Management: Water Seal Drainage <ul><ul><li>Prepare at bedside: </li></ul></ul><ul><ul><ul><li>vaselinized gauze </li></ul></ul></ul><ul><ul><ul><li>Hemostan clamp </li></ul></ul></ul><ul><ul><ul><li>Extra bottle with water </li></ul></ul></ul>
  90. 90. Nursing Management: Water Seal Drainage <ul><ul><li>Monitor for oscillation and fluctuation </li></ul></ul><ul><ul><ul><li>N- (+) intermittent bubbling,  with inspiration,  expiration </li></ul></ul></ul><ul><ul><ul><li>Check for leakage </li></ul></ul></ul><ul><ul><ul><li>If (-) bubbling: check for kinks, obstruction- milk towards drainage bottle, or lungs are fully expanded </li></ul></ul></ul>
  91. 91. Water Seal Drainage
  92. 92. Nursing Management: Water Seal Drainage <ul><li>3 parameters to remove chest tube </li></ul><ul><ul><li>(-) bubbling/fluctuations </li></ul></ul><ul><ul><li>(+) symmetrical breath sounds </li></ul></ul><ul><ul><li>Chest X-ray confirms full lung expansion </li></ul></ul>
  93. 93. Nursing Management: Water Seal Drainage <ul><li>Before, During and After Removal of Chest Tube </li></ul><ul><ul><li>Encourage DBE </li></ul></ul><ul><ul><li>Monitor VS, breath sounds </li></ul></ul><ul><ul><li>Give analgesic prior to removal </li></ul></ul><ul><ul><li>Instruct pt to perform Valsalva maneuver for easy removal and to prevent air entry to pleural space </li></ul></ul><ul><ul><li>Apply vaselinized occlusive dressing, WOF bleeding </li></ul></ul>
  94. 94. PLEURAL EFFUSION <ul><li>Collection of fluid in the pleural space </li></ul><ul><li>S/Sx </li></ul><ul><ul><li>Pleuritic pain that is sharp &  with inspiration </li></ul></ul><ul><ul><li>Dyspnea on exertion </li></ul></ul><ul><ul><li>Dry, nonproductive cough caused by bronchial irritation or mediastinal shift </li></ul></ul><ul><ul><li> HR,  T </li></ul></ul><ul><ul><li> breath sounds </li></ul></ul><ul><ul><li>CXR: confirms the dx & shows mediastinal shift </li></ul></ul>
  95. 95. PLEURAL EFFUSION <ul><li>Interventions </li></ul><ul><ul><li>Identify & tx the underlying cause </li></ul></ul><ul><ul><li>Monitor breath sounds </li></ul></ul><ul><ul><li>High Fowler’s position </li></ul></ul><ul><ul><li>Coughing & DBE </li></ul></ul><ul><ul><li>Prepare the pt for thoracentesis </li></ul></ul>
  96. 96. PLEURAL EFFUSION <ul><li>Interventions </li></ul><ul><ul><li>If recurrent, prepare the pt for: </li></ul></ul><ul><li>Pleurectomy: surgically stripping parietal away from visceral pleura to promote adhesion of the 2 layers during healing </li></ul><ul><li>Pleurodesis: instilling sclerosing substance into pleural space via thoracotomy tube </li></ul>
  97. 97. EMPYEMA <ul><li>Collection of pus in the pleural cavity (thick, opaque, foul-smelling) </li></ul><ul><li>Causes: pulmonary infection, lung abscess due to thoracic surgery or chest trauma </li></ul><ul><li>Goal of tx: emptying empyema cavity, reexpanding the lung, controlling infection </li></ul>
  98. 98. EMPYEMA <ul><li>S/Sx of infection +  chest wall mov’t & pleural exudate on CXR </li></ul><ul><li>Interventions </li></ul><ul><ul><li>Semi or High Fowler’s position </li></ul></ul><ul><ul><li>Monitor breath sounds </li></ul></ul><ul><ul><li>Coughing and DBE </li></ul></ul><ul><ul><li>Splint the chest if in pain </li></ul></ul><ul><ul><li>Antibiotics as ordered </li></ul></ul>
  99. 99. EMPYEMA <ul><li>Interventions </li></ul><ul><ul><li>Assist in chest tube insertion </li></ul></ul><ul><ul><li>If (+) marked pleural thickening, prepare the pt for Decortication: surgical removal of restrictive mass of fibrin & inflammatory cells </li></ul></ul>
  100. 100. PLEURISY <ul><li>Inflammation of the visceral & parietal pleura, rubbing together during breathing causing pain </li></ul><ul><li>May be caused by pulmonary infarction or pneumonia </li></ul><ul><li>Usually occurs on one side of the chest (lower lateral portion) </li></ul>
  101. 101. PLEURISY <ul><li>S/Sx </li></ul><ul><ul><li>Knifelike pain aggravated by deep breathing & coughing </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Pleural friction rub on auscultation </li></ul></ul><ul><ul><li>Apprehension </li></ul></ul>
  102. 102. PLEURISY <ul><li>Interventions </li></ul><ul><ul><li>Identify and tx the cause </li></ul></ul><ul><ul><li>Monitor breath sounds </li></ul></ul><ul><ul><li>Hot or cold applications as ordered </li></ul></ul><ul><ul><li>Encourage coughing & DBE </li></ul></ul><ul><ul><li>Lie on affected side to splint the chest </li></ul></ul><ul><ul><li>Analgesics as ordered </li></ul></ul>
  103. 103. ACUTE RESPIRATORY DISTRESS SYNDROME <ul><li>A form of acute respiratory failure as a complication of other condition, caused by diffuse lung injury  extravascular lung fluid  compression of terminal airways   lung vol. & compliance </li></ul><ul><li>ABG= resp. acidosis & hypoxemia not responding to  O2 concentration </li></ul><ul><li>CXR= interstitial edema </li></ul>
  104. 104. ACUTE RESPIRATORY DISTRESS SYNDROME <ul><li>Predisposing factors </li></ul><ul><ul><li>Sepsis </li></ul></ul><ul><ul><li>Fluid overload </li></ul></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Neuro injuries </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>DIC </li></ul></ul><ul><ul><li>Drug ingestion </li></ul></ul><ul><ul><li>Toxic substance inhalation </li></ul></ul>
  105. 105. ACUTE RESPIRATORY DISTRESS SYNDROME <ul><li>S/Sx </li></ul><ul><ul><li> HR </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li> breath sounds </li></ul></ul><ul><ul><li>Deteriorating blood gas levels </li></ul></ul><ul><ul><li>Hypoxemia despite high O2 concentration </li></ul></ul><ul><ul><li> pulm. compliance </li></ul></ul><ul><ul><li>Pulm. infiltrates </li></ul></ul>
  106. 106. ACUTE RESPIRATORY DISTRESS SYNDROME <ul><li>Interventions </li></ul><ul><ul><li>Identify & tx the cause </li></ul></ul><ul><ul><li>O2 as ordered </li></ul></ul><ul><ul><li>High Fowler’s position </li></ul></ul><ul><ul><li>Fluid restriction as ordered </li></ul></ul><ul><ul><li>Diurretics, anticoagulants, corticosteroids as ordered </li></ul></ul><ul><ul><li>Prepare for intubation and mechanical ventilation with PEEP </li></ul></ul>

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