Respiratory Disorders

By James R. Tekiko R.N.,M.A.N.

MAJOR FUNCTION: Gas Exchange During gas exchange, air is taken into the body by inhalation and travels through respiratory passages to the lungs. In the lungs, O2 diffuses into the blood and CO2 is removed by exhalation Sense of smell, speech, acid base balance, body water levels and maintains heat balance

DIAGNOSTIC TESTS
 Skin testing : mantoux test ( PPD)ID read 48 -72 hrs, +10mm up indurration exp.to Myco T  Chest X-ray X Sputum examination- C &S AFB 3xAM examination Lung biopsy needle biopsy, open lung, VATS

Diagnostics Test 2
 Computed Tomography permits better visualization of layer or plane of lungs slices; done to check cavities, neoplasms, lung densities, stereoscopic 3D  D. Ultrasound or echogram harmless, high frequency sound wave emitted and penetrates the thorax and bounces back to transducer to picture image

Diagnostics 3
 Bronchoscopy direct examination of trachea, bronchi and larynx
 Purposes: a. Inspect parts of respiratory tract a.Inspect b. Aspirate secretions and exudates n air passage c. Remove foreign body d. Do biopsy  Prep consent, topical anesthesia, NPO 6-8 hours, atropine sulfate, 6sedation  Post head of bed elevated, lateral position, , check gag reflex and hoarseness,

Diagnostics 4
 Thoracentesis aspiration of fluid and air from pleural cavity;
site of insertion: for fluid 7th to 8th intercostal space mid-axillary; for air 2nd or 3rd intercostal midspace mid-clavicular midprep: prep: consent, no moving, no coughing, proper positioning, remoe not more than 1500cc within 30 mins (to prevent intravascular shift) post: turned to unaffecte4d side seal itself; to prevent seepage

Diagnostics 5
 Pulmonary Function Test non-invasive nonmethod of assessing the functional capacity of the lungs; ability of gas to diffuse across the alveoli capillary membrane and ratio of ventilated alveoli to perfused capillaries.
 A. Pulse oximetry non-invasive technique that nonmeasures the oxygen saturation (SaO2) of arterial blood (uses pulse oximeter)  B. Spirometry measures lung capacity, volumes and flow rates with the use of an instrument called spirometer.

ABG
 . Arterial Blood Gases provides objective determination of arterial blood oxygenation, gas exchange, alveolar ventilation and acid-base balance; acid use heparinized 2ml syringe.
Sites: radial, brachial, femoral artery PaO2 measures O2 dissolved in blood shows efficiency of gas exchange ventilation and perfusion

ABG 2
PaCO2 determines the adequacy of ventilation; depends upon the amount of O2 produced and ability of lungs to eliminate; shows effectiveness of ventilation pH measurement of hydrogen ion concentration SaO2 measures oxyhemoglobin saturation

ACID BASE BALANCE

COMPARISON OF ARTERIAL or VENOUS BLOOD GASES
ARTERIAL pH pO2 pCO2 SaO2 HCO3 Base ex 7.35-7.45 7.358080-100 mmHg 3535-45 9696-98% 2222-26 -2+2 VENOUS 7.31-7.41 7.3135-40 mmHg 3541-51 4170-75% 7023-25 23-2+2

ACID BASE BALANCE

ABG PROFILE IN RESPIRATORY ACIDOSIS or ALKALOSIS
ACIDOSIS Decreased pH Increased pCO2 Normal HCO3 RESP 7.4 40 ALKALOSIS Increased pH Decreased pCO2 Normal HCO3

24

ACID BASE BALANCE

ABG PROFILE IN METABOLIC ACIDOSIS or ALKALOSIS
ACIDOSIS Decreased pH Decreased HCO3 Decreased BE Normal pCO2 MET <7.4> <24> <0> 40 ALKALOSIS Increased pH Increased HCO3 Increased BE Normal pCO2

Signs and Symptoms of Acid-Base AcidImbalances:

 Acidosis increased CO depression of CNS decrease in mental capacity delirium, coma or death  Alkalosis increased O2 overexcitability or irritability of CNS extreme nervousness, over excitability, tetany or convulsions

Common Upper Respiratory Problems

 Epistaxis (nosebleeding) usually originates from the blood vessels in the anterior part of the septum
Causes: 1. Trauma to nasal mucosa from foreign object 2. Picking of the nose 3. Local irritation of the mucous membrane from lack of humidity in the air (O2 cannula) 4. Violent sneezing or blowing of the nose

Epistaxis

Epistaxis
Nursing Management: 1. Patient sits up leaning forward with head tipped downward 2. Compress soft tissues of nose against septum with fingers and maintain pressure for at least five minutes 3. Apply ice or cold compress to nose to constrict blood vessels 4. If bleeding does not stop with direct pressure, place cotton ball soaked in topical vasoconstrictor (neo-synephrine) into nose (neoand apply pressure (dependent nursing function) 5. Instruct not to blow nose for several hours after nose bleed 6. Silver nitrate stick or electrocautery (dependent nursing function) 7. Post nasal pack (dependent nursing function)

SINUSITIS
 inflammation of air filled cavities that lines the mucous membranes of the sinuses
Causes: 1. Viral influenza, adenovirus, staphyloccocus aureus 2. Bacterial streptococcus pneumoniae, haemophilus influenzae 3. Allergic seasonal

Sinusitis
Signs and Symptoms: 1. Fever and malaise 2. Stuffy nose 3. Slowly developing pressure over the involved sinus 4. Persistent cough 5. Post nasal drip 6. Headache

Sinusitis URTI Allergic Rhinitis

Rest increase fluid intake hot wet packs antianti-infectives or antihistamines depending on the cause of sinusitis  Nasal decongestants- Dimetapp, decongestantsSudafed  irrigation with warm NSS

   

UST COLLEGE OF NURSING

Cald-welCald-wel-luc surgery (radical antrum operation) incision made under the upper lip to treat chronic maxillary sinusitis
Priority Nursing Care: a. Proper oral hygiene done with caution to avoid injury to the incision b. Dont chew on affected side c. No dentures for ten days d. No blowing of nose for two weeks e. No sneezing (if you must sneeze, keep mouth open)

TONSILITIS
 Inflammation of the tonsils
Signs and Symptoms: 1.Sore throat 1.Sore 2.Pain on 2.Pain swallowing 3.Fever and chills 3.Fever 4.General muscle 4.General aching and malaise

TONSILITIS
Nursing Management: 1. 2. 3. 4. 5. 6.
7.

Rest and increase fluid intake Warm saline throat irrigation Ice collar to relieve discomfort Analgesic and antipyretics Antibiotics Surgery tonsillectomy
Avoid carbonated and citrus juices- irritate the incision juices-

- Ice chips, small sips of cold fluid, popsicles (1st day) - Soft foods on 2nd day

Tonsillectomy
PrePre-op Care: a. Check for loose tooth PostPost-op Care: a. HOB to 45 elevated to reduce e 45 b. Monitor for hemorrhage frequent swallowing, bright red vomitus, rapid pulse, and restlessness c. Comfort apply ice collar to neck; use acetaminophen in place of aspirin d. Food and fluids no milk.
Avoid carbonated and citrus juices- irritate the incision juices-

- Ice chips, small sips of cold fluid, popsicles (1st day) - Soft foods on 2nd day

Post Tonsillectomy
Patient teaching
No clearing of throat No coughing, sneezing, vigorous nose bleeding and vigorous exercise for one to two weeks Drink fluids two to three liters a day Avoid hard and scratchy foods such as popcorn and pretzels Expect stools to be black or dark for a few days

Laryngitis
 Inflammation and swelling of mucous membrane of larynx  Cause: Infection, improper use of voice, smoking  Manifestations: Hoarse voice, throat irritation, dry, nonnonproductive cough Treatment: ATB Stop smoking Removal of cause
UST COLLEGE OF NURSING

CANCER OF THE LARYNX Risk factors Carcinogens smoking, alcohol, cement/ wood dust,petrol/paint fumes Others straining the voice, chronic laryngitis,60 and up, men, african american, family history S/S  Hoarseness for more than 2 weeks .cough, Sore throat  Lump on the throat. dysphagia  Pain in the Adam's apple that radiates to the ear  Dyspnea, enlarged cervical nodes and cough TX Radiation, Laryngectomy

Post Op Laryngetomy
 Head of bed elevated 45o  Assist patient in communicating provide writing materials, etc  Post partial laryngectomy patient will be able to talk  Post total laryngectomy no voice; artificial larynx now available

 Practice swallowing

Chronic Obstructive Pulmonary Disease

 Includes diseases that cause airflow obstruction  Chronic Bronchitis  Emphysema  Risk Factors include environmental exposures and host factors  Primary symptoms are cough, sputum production and dyspnea

Common Lower Respiratory Problems

 Chronic bronchitis  Excessive mucous production and recurrent productive cough for at least 3 months in each of the two consecutive two years or more  Causes:
 Smoking and pollutants  Viral or bacterial infections

UST COLLEGE OF NURSING

Normal VS Chronic Bronchitis

S/S Chronic Bronchitis

      

Chronic productive cough cigarette cough Grayish white sputum Dyspnea Cyanosis, tachycardia Respiratory acidosis Ankle edema, distended neck vein Blue bloaters

Management of Chronic Bronchitis

 Pharmacotherapeutics mucolytic, expectorants, antitussives, antihistamines  Supportive measures avoid smoking, inhaled irritants, control of environmental temperature, proper nutrition, adequate hydration

EMPHYESEMA
 Destructive changes in alveolar walls and enlargement of air spaces distal to bronchioles; loss of recoil and air trapping  Over distended and non functional alveoli leading to rupture  retention of CO2 and hypoxia leading to respiratory acidosis

 Predisposing factors:
 Smoking  Alpha1 antitrypsin deficiency( enzyme inhibitor that protects the lung parenchyma from injury) for Caucasians  Familial tendency
 the stimulus to breathe is a low pO2 instead of an increased pCO2

Emphysema
 Signs and symptoms:
   

Uses accessory muscles to breathe Ruddy collor No cyanosis Thin with barrel-chest barrel-

 Nursing management:
 Pursed-lip breathing Pursed Forward leaning position  Low O2 concentration

Asthma
 Bronchial spasms and constrictions characterized by expiratory wheezing  Causes:
   

Genetic Immunologic Allergic Environmental

Asthma
 Common Factors that Triggers an Attack:
       Environmental factors change in temperature or humidity Atmospheric pollutants cigarettes, industrial smoke Strong odors perfume, insecticides Allergens feathers, dust, food, pollens, laundry detergents Exercise Stress or emotional upset Medications aspirin, NSAIDs

Asthma
 Signs and symptoms:
    

Episodic dyspnea Accessory muscle breathing Inspiratory or expiratory wheezing Respiratory alkalosis Status asthmaticus respiratory acidosis

 Nursing management:
 Bronchodilators epinephrine, theophylline, aminophylline, proventil, terbutaline  Corticosteroids solumedrol, dexamethanol