This document provides an overview of respiratory disorders and their nursing management. It begins with reviewing respiratory system functions and assessment techniques. Common diagnostic tools for evaluating the respiratory system are described. Upper respiratory disorders covered include infections like the common cold, sinusitis, pharyngitis, and tonsillitis. Obstruction and trauma disorders discussed are sleep apnea, epistaxis, nasal fractures, and laryngeal issues. For each disorder, clinical manifestations and nursing management are outlined. The document concludes with a case study example and links to creative commons images used.

1. MEDICAL-SURGICAL
NURSING 1
Respiratory Disorders (Part 1)
1
ARYAN RAJ
B.Sc nursing
Florence college of nursing

2. RESPIRATORY 1 OBJECTIVES
1. Identify and explain the rationale for each component of a
respiratory assessment.
2. Identify common diagnostic tools used for the respiratory
system and the rational for each use.
3. Explain the clinical manifestations and nursing management
of common infections of the upper respiratory tract.
4. Identify ways to prevent upper respiratory tract infections
from occurring and spreading.
5. Explain the clinical manifestations and nursing management
of common upper respiratory disorders including obstruction
and trauma.

3. RESPIRATORY DISORDERS
(PART 1)
Review of Functions
Assessment of Respiratory
System
Diagnostic Evaluation
Upper Respiratory Disorders 3

4. REVIEW OF RESPIRATORY
TRACT FUNCTIONS
• Oxygen transport
• Respiration
• Ventilation
• Diffusion and perfusion
• Gas exchange
4

5. RESPIRATORY SYSTEM
ASSESSMENT
• Health History
• focusing on physical and functional
problems
• Chief complaint
• When it started, how long it has
lasted, how it feels, etc.
• Impact on ADLs
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6. RESPIRATORY ASSESSMENT
Important Signs and Symptoms
Dyspnea, orthopnea
Cough
Sputum
Chest pain
Wheezing
Clubbing of nails
Sputum and hemoptysis
Cyanosis
6

7. CLUBBING
OF FINGER-
NAILS
7
1
2

8. RESPIRATORY ASSESSMENT
• Inspection
• posture
• shape
• movement (symmetry)
• chest configuration (barrel,
funnel, pigeon)
• flared nostrils
• use of accessory muscles
• skin color and turgor
• rate, depth, & rhythm of
respiration
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9. RESPIRATORY ASSESSMENT
• Palpation
• respiratory
excursion
(expansion)
• masses
• fremitus
• tenderness
• lesions
•
• Percussion
• flat
• dull
• resonant
• hyperresonant
• tympany
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10. RESPIRATORY ASSESSMENT
• Auscultation
• breath sounds
• vesicular, bronchio-vesicular,
bronchial/tracheal
• adventitious sounds
• Crackles
• wheezes
• friction
• voice sounds
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11. DIAGNOSTIC EVALUATION
• Cultures
• Throat and nasal swabs
• Sputum Studies
• Collection methods:
• Expectoration, saline inhalation, bronchial washing
• Arterial Blood Gases
• Measurements of blood pH , arterial O2 & CO2 tensions
• Determines acid-base balance
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12. DIAGNOSTIC EVALUATION
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Non Invasive:
Pulse Oximetry
Chest X-ray
CT scan
Pulmonary Function Tests
-Peak flow monitoring
Invasive:
Endoscopic Procedures
Bronchoscopy
Laryngoscopy
Biopsy
1
1
2

13. UPPER RESPIRATORY
DISORDERS
Review:
-What are the upper airway structures?
-What is the function of these
structures?
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14. UPPER AIRWAY DISORDERS
INFECTIONS
• Common cold
• Acute & Chronic Sinusitis
• Rhinitis
• Acute & Chronic Pharyngitis
• Tonsillitis & Adenoiditis
• Peritonsillar Abscess
• Epiglotittis
• Laryngitis
14

15. UPPER AIRWAY
INFECTIONS
• Common Cold/Viral Rhinitis
• S&S – nasal congestion, sore
throat, sneezing, tearing, malaise,
fever, chills, aches
• Nursing Management – primarily
of patient education and self care:
• Breakt the chain of infection!!
• Hand washing, disposable tissues
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16. UPPER AIRWAY
INFECTIONS
• Acute Sinusitis
• Pathophysiology- infection of
the paransal sinuses caused
by an obstruction of the
sinus cavity.
• S&S – pressure and/or pain
over sinus area, purulent
nasal secretions, fatigue,
headache, ear pain, dental
pain, impaired smell, eyelid
edema
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17. UPPER AIRWAY INFECTIONS
• Acute Sinusitis
• Complications – if left untreated can cause:
meningitis, brain abscess, and osteomylitis
• Nursing Management:
• teaching self care to promote nasal drainage such as:
inhaling steam, increase fluids, hot showers
• medication teaching: complete cycle of antibiotics if
ordered and the caution use of nasal decongestants

18. UPPER AIRWAY
INFECTIONS
• Chronic Sinusitis
• Patho- sinusitis lasting longer than 3 weeks for
adult and 2 weeks for child
• S&S – impaired ventilation, cough, hoarseness,
chronic headache & facial pain, fatigue
• Nursing Management – patient teaching for self
care and to increase nasal drainage and antibiotic
teaching
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19. UPPER AIRWAY
INFECTIONS
• Acute Pharyngitis
• Patho- Can be viral or bacterial. Usually viral,
but if bacterial the most common pathogen is
group A strep ('strep throat’)
• S&S - Fiery-red pharyngeal membranes and
tonsils flecked with exudate, swollen and tender
lymph nodes, fever, malaise, sore throat
19

20. UPPER AIRWAY
INFECTIONS
• Chronic Pharyngitis
• Common occurrence when living/working in dusty
environments.
• S&S – irritation or “fullness” in throat, mucous
production, difficulty swallowing, fever
• Nursing Management (Acute and Chronic) – rest, saline
gargles, oral hygiene, maintain fluid and nutritional
therapy, antibiotic schedule if indicated, analgesia if
needed, avoid irritants!
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21. UPPER AIRWAY
INFECTIONS
• Tonsillitis & Adenoiditis
• S&S – sore throat, fever, snoring,
difficulty swallowing, ear ache, frequent
colds, bronchitis, foul-smelling breath,
hoarseness
• Complications – otitis media which can
lead to spontaneous rupture of the
eardrums and cause deafness
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22. UPPER AIRWAY INFECTIONS
• Medical Management- a tonsillectomy
and/or adenoidectomy may be
indicated when medical treatment has
been unsuccessful (ex: antibiotics) and
there is chronic hypertrophy,
asymmetry, or peritonsillar abscess'
occluding the pharynx

23. UPPER AIRWAY INFECTIONS
• Post Operative T&A Nursing Management-
• All nursing interventions are centered around close
observation and prevention of a post op hemorrhage
• -emergency supplies ready
• -OBSERVE/CHECK frequently (minimum every hour)
• -frequent fluids to keep area moist
• -adequate pain medication- NO NSAIDS
• -no nose blowing/no coughing/no sneezing
• -soft foods
• -oral hygiene
• -no dairy products

24. UPPER AIRWAY
INFECTIONS
• Peritonsillar Abscess
• S&S – usual infection symptoms plus: dysphagia, thickening of
voice, drooling, local pain, and ear pain
• Nursing Management – antibiotic education and administration,
topical anesthetics, throat irrigations, mouth washes- wash and
gargle with a warmed saline solution (40-43 degrees C) every 1-2
hours for 24-36 hours
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25. UPPER AIRWAY
INFECTIONS
• Laryngitis
• Patho- almost always a viral infection of the larynx (vocal cords)
causing inflammation.
• S&S – hoarseness or aphonia, severe cough, often associated
with other respiratory disorders
• Nursing Management – inhaling steam or aerosol, treat
underlying disorder, resting voice, encourage fluids- to thin
secretions if present
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26. UPPER AIRWAY INFECTIONS
• General Nursing Interventions
• Maintain a patent airway
• Promote comfort
• Promote communication
• Encourage fluid intake
• Teaching self-care
• Always complete antibiotic course
• Discourage smoking and second hand smoke
and irritants
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27. UPPER AIRWAY DISORDERS:
OBSTRUCTION AND TRAUMA
• Sleep apnea
• Epistaxis
• Nasal Fracture
• Laryngeal Obstruction
• Laryngeal Cancer
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28. OBSTRUCTION AND
TRAUMA
• Obstructive Sleep Apnea
• Patho- lack of air flow caused by a pharyngeal obstruction
• S&S – loud snoring, apnea for 10 seconds or more for 5 or more
episode per hr, daytime sleepiness, morning headache, sore
throat, cognitive deterioration, personality changes
• Nursing Management – explain the disorder, instruct about
treatment regiment including medications, O2 therapy, or CPAP
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29. OBSTRUCTION AND
TRAUMA
• Epistaxis
• S&S – bleeding from the nose
• Nursing Management – instruct patient to sit upright, face
forward, pinch nose for 15 mins, control bleeding. Patient may
require packing, vasoconstrictors or cautery by Dr., monitor VS,
manage anxiety
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30. OBSTRUCTION AND
TRAUMA
• Nasal Fracture
• S&S – bleeding, edema, deformity
• Nursing Management – ice/cold compresses- 20 minutes to area 4 times
a day, mouth rinses (usually mouth breathing which causes dryness)
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31. OBSTRUCTION AND TRAUMA
• Laryngeal Cancer
• S&S - Hoarseness of more than 2 weeks duration,
sore throat, may feel a mass, difficulty swallowing
or breathing, foul breath
• Nursing Management – supportive care related to
the medical management (eg. Postoperative care),
reducing anxiety, patient teaching related to
tracheostomy

32. OBSTRUCTION AND TRAUMA
• Laryngeal Obstruction
• Edema of the larynx is a serious, often fatal
condition.
• May be edema of the glottis due to infection or
an anaphylactic reaction
• Can be caused by foreign body aspiration
leading to breathing difficulties and airway
irritation.
• Management: treat the cause!
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33. CASE STUDY
Miss sonam is 19 and presents with:
• sore throat
• fever
• snoring
• difficulty swallowing
• ear ache
• foul-smelling breath
• hoarseness
• difficulty taking adequate fluids
• What condition do you think she has?
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34. CASE STUDY
• Assessment: State 4 pieces of information (2
subjective and 2 objective) you want to gather with
rationale.
• Diagnosis: List 2 possible nursing diagnoses.
• Planning: State expected outcomes and outcome
criteria for each diagnosis
• Intervention: List 2 interventions for each diagnosis
with rationale
• Evaluation: State how you will evaluate the
outcomes.
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35. LINKS/CREATIVE COMMONS
• Slide 7 Image 1: http://upload.wikimedia.org/wikipedia/commons/d/d5/Clubbing1.JPG
• Slide 7 Image 2: http://upload.wikimedia.org/wikipedia/commons/0/03/Clubbing2.JPG
• Slide 12 Image 1: http://www.nonin.com/Go2Nonin/Images/0.gif
• Slide 12 Image 2:
http://upload.wikimedia.org/wikipedia/commons/f/f2/Chest_labeled.png
• Slide 15 Image:
http://upload.wikimedia.org/wikipedia/commons/1/1b/OCD_handwash.jpg
• Slide 16 Image:
http://upload.wikimedia.org/wikipedia/commons/4/47/Paranasal_Sinuses_lat.jpg
• Slide 21 Image: http://upload.wikimedia.org/wikipedia/commons/4/4a/Pos_strep.JPG
• Slide 22 Image:
http://upload.wikimedia.org/wikipedia/commons/d/db/Tonsillectomy09.jpg
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36. REFERENCES
Smeltzer, S.C., & Bare, B.G. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing. (12th ed.). Philadelphia,
PA: Lippincott Williams & Wilkins.
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