Chapter 86 Respiratory Disorders Copyright 2012 Wolters Kluwer

Chapter 86 Respiratory Disorders Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Respiratory System • Respiration requires a patent airway for oxygen to reach the lungs, and lungs that are physically capable of exchanging oxygen for carbon dioxide. • The respiratory system consists of the upper and lower respiratory tracts. What ‘s included in each ie. . lungs, nose, trachea • Pulmonologist • Respiratory therapy • Respiratory therapists • Respiratory technicians Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Laboratory Tests • Sputum specimen: Best early in the am • Lavage specimen: sterile saline/ diagnosis TB • Throat culture vs rapid strep test r/o streptococci only • Blood gas determinations-best indicator for O 2 deficiency – Level of arterial blood gases (ABGs) – Partial pressure of oxygen (Pa. O 2) -80 -100 mm. Hg – Partial pressure of carbon dioxide (Pa. CO 2)-35 -45 – Hydrogen ion concentration (p. H) of the blood-7. 35 -7. 45 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

X-ray and Fluoroscopy Examinations • Chest x-ray (CXR) • Computed tomography (CT) scan • Lung perfusion scan • Pulmonary angiography Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Other Diagnostic Tests • Magnetic resonance imaging (MRI) • Pulmonary function test (PFT) • Bronchoscopy • Skin and blood tests – Skin tests • Purified protein derivative (PPD) tuberculin test – Blood tests Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The spirometer can be used interchangeably with the incentive spirometer. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False The spirometer should not be confused with the incentive spirometer. The spirometer measures pulmonary function. The incentive spirometer also measures pulmonary function, in a sense, but it is used by the client. The incentive spirometer helps the client, such as after surgery, to perform respiratory exercises to maintain lung function. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Medical Treatments • Postural drainage- used to drain secretions and mucus from the lungs – Chest physiotherapy (CPT) • Inhalations- Bronchodilators Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

CPT and postural drainage Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Surgical Treatments • Thoracentesis-puncturing the chest wall to remove fluid; purpose is to relieve breathing difficulty • must sign informed consent signed; specimen is collected- complication pneumothorax • Paracentesis- removal of fluid in the Abdomen • Nursing alert!!!!!!>1000 ml causes vasodilation and hypovolemia • Thoracotomy- incision into the thorax – Caring for the client after chest surgery- guideline 1414 – Chest suction-how it works the pressure of the chest cavity is lower than the pressure of the air outside of the lungs the negative pressure creates a vacuum – Closed water-seal drainage-must be kept air tight – Nursing implications- guidelines on 1415 – DOPE acronym DOPE stands for Displacement of breathing tube, Obstruction, Pneumothorax, Equipment failure Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Thoracentesis/paracentesis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chest tube Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chest tube set up Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? During paracentesis or thoracentesis, the nurse must take the client’s blood pressure and pulse immediately after the procedure and every 15 minutes until readings are stable. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True A large amount of fluid withdrawn (>1, 000 m. L) during paracentesis or thoracentesis can result in vasodilation and hypovolemia (decreased circulating fluid volume). These situations can cause syncope (temporary loss of consciousness, fainting) and shock. The nurse should take the client’s blood pressure and pulse immediately after paracentesis or thoracentesis and every 15 minutes until readings are stable and within acceptable levels. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? It is perfectly safe for a client with a respiratory system disorder to receive a narcotic. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False If a person with any disorder of the respiratory system is receiving a narcotic, be particularly watchful for respiratory depression. Depressed respirations can be an undesirable side effect in anyone, but the situation is most dangerous for the client whose respiratory function is already compromised. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process • Data collection – Noting alterations in respiratory status • Aspiration • Hyperventilation – Hypoxia • Hypoxemic hypoxia • Circulation hypoxia • Anemic hypoxia • Histotoxic hypoxia Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process (cont’d) • Planning and implementation – Relieving respiratory distress • Orthopneic position • Turning, coughing, and deep breathing – Administering respiratory treatments • Postural drainage • Breathing exercises and incentive spirometer • Breathing treatments, oxygen Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process (cont’d) – Administering nasal treatments – Suctioning to remove oral–nasal secretions • Dysrhythmia and desaturation • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Possible Alterations in Respiratory Status • Dyspnea • Biot’s respirations • Orthopnea • Apnea • Tachypnea • Central apnea • Hyperpnea • Obstructive apnea • Mixed apnea • Bradypnea • Hypoventilation • Hyperventilation • Adult sleep apnea • Kussmaul’s respirations • Cheyne-Stokes breathing Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious Respiratory Disorders • The common cold or acute rhinitis • Streptococcal sore throat • Influenza • Laryngitis • Bronchitis • Lung abscess Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infections • Streptococcal • Common Cold • 100 viruses • 48 hour after exposure • Last 5 d-2 weeks • Rest best medicine • Plenty of fluids • More than 2 -3 days of fever need to see PMD • Blunted smell and taste • Other symptoms • Symptoms, headache, fever malaise, weakness • Most dangerous is rheumatic fever and glomerulonephritis • PCN Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious Respiratory Disorders (cont’d) • Pneumonia – Bacterial pneumonia – Viral pneumonia – Pneumocystis carinii pneumonia – Chemical pneumonia – Aspiration pneumonia • Pleurisy • Histoplasmosis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infections • Influenza • Type a-D = place of origin • Parkinsonism • Pneumonia • Suddenly ill, muscle pains, fever, cough sore throat emesis • Prevention flu vaccine= does not give the flu to people • Treatment • Large fluids • Do not give milk • Rest • Tamiflu with in 48 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

infections • Laryngitis- infection larynx • Excessive use voice and smoking • Humidity • Viral • Test cancer • Bronchitis- cough • Cough, general malaise, fever • Treatment bed rest diet , fluids humidifiers • Antibotics Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Inflammation of the lungs • Consolidation- liquid/solid feeling up the air space in the lung • Bacterial- young/ old/abuse substances • Viral- variant of the flu usually secondary rarely fatal • Pneumocystis carinii – immunocompromised • Chemical ingest or inhale • Aspiration; vomits/inhales foreign substances • Symptoms • : sharp chest wall pain Fever, chills, sputum, cough mental changes • Treatment: • Bullets on 1420 • Guideline on 1422 • pleurisy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

tb • Caused by spore; tubercle-inactive • Tb develops lower resistance • Spread-inhaled; n 95 • Latent bullets /active • Symptoms of active bullet • Treatment box –goal of treatment? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious Respiratory Disorders (cont’d) • Tuberculosis (TB) – Latent and active TB – Pulmonary TB – Pott’s disease and miliary TB – Atypical TB – Multidrug-Resistant TB • Empyema – Acute empyema – Chronic empyema Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The number of cases of TB has decreased dramatically during the last several decades because of the developments in science and medicine. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False The number of cases of TB has increased dramatically during the last several decades because of the increase in multidrug-resistant TB organisms, increasing numbers of persons with HIV infection, substance abuse, homelessness, and poor compliance with medication treatment plans. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chronic Respiratory Disorders • Snoring • Sleep apnea syndrome-most commonly waking up multiple times at night ; fall asleep easily; middle age – overweight men/women; five cessation for at 10 sec every hour; bullets • Allergic rhinitis-hay fever • Pneumoconioses-dust disease( black lung)prevention once damage is done not reversible Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chronic obstructive pulmonary disease • Different classifications • Brachial asthma inflammation of the lining of the bronchial airway- • Irreversible and associated persistent dyspnea on exertion reduce air flow to less than ½ normal • Cells that line the bronchi release chemicals that cause inflammation • Causing bronchospasms • Signs sudden attack, coughing wheezing pale white mucus • Poor control leads to emphysema • Children symptoms lessen while adults get worse • Status asthmatics medical emergency lasting for more than 24 hours • TX: Teaching bullets on 1427 • Nursing educating the client page 1428 • Spacer? • Bullets on goals to improve ventiliation • O 2 not exceed 3/l • Pursed-lip breathing Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The continuous positive airway pressure apparatus is commonly used to assist persons with allergic rhinitis. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False The continuous positive airway pressure (CPAP) apparatus is commonly used to assist persons with sleep apnea. This machine looks like an oxygen-delivery system and is used at night so the person can sleep. It delivers air, and sometimes oxygen, to the person at a continuous positive pressure that holds the alveoli open. This positive pressure prevents respiratory obstruction, increases oxygenation, and reduces breathing effort. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pulmonary Emphysema • Abnormal , permanent enlargement of the alveoli and alveolar ducts with destruction of alveolar walls =elasticity • Chronic bronchitis is the direct cause • Difficulty breathing after exertion • Use accessory muscle to breath • Orthopnea Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Trauma • Absence of air exchange • Chest trauma • Respiratory complications in drug poisoning • Drowning/near drowning • Pneumothorax Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Neoplasms • Benign neoplasms • Lung cancer Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Nose • Inflammatory disorders – Sinusitis – Acute sinusitis – Chronic sinusitis • Structural disorders – Deviated septum – Nasal polyps – Plastic surgery (rhinoplasty) – Care of the client undergoing nasal surgery Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Nose (cont’d) • Nasal trauma – Fractures – Epistaxis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Throat • Trauma – Aspiration of foreign bodies • Cancer of the larynx – Nursing considerations • Communication and speech • Identification as a laryngectomee • Supportive resources • Water dangers Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins