Care of Clients with Respiratory Disorders

Care of Clients with Respiratory Disorders

• Respiration is the gas exchange process between the body and the environment. The process involves two phases: ventilation (inhaling and exhaling) and diffusion (gas exchange in the alveoli). Perfusion is the availability of blood for gas transport.

Respiratory Structure

• Upper Airways: These transport gas to the lower airways. They include the nasal cavity, pharynx (naso-, oro-, laryngopharynx), and larynx. The pharynx is a passageway for both air and food, while the larynx protects the lower airway, humidifies incoming air, and contains the epiglottis. Trachea, right and left bronchi, cilia, and sinuses are also included in the upper airways.

• Lower Airways: These include the trachea, the right and left bronchi, and the alveoli. The lower airways are responsible for the immunologic response. The pleura is a serous membrane that encloses the lungs. The visceral pleura covers the lungs directly, while the parietal pleura lines the cavity of each pleura. 

• Lungs: The right lung has 3 lobes, and the left lung has 2 lobes. The right lung is shorter than the left due to the position of the liver, which is positioned underneath the right lung.

Thorax and Diaphragm

• The thorax is composed of 12 pairs of ribs. The diaphragm is the main muscle of respiration. The pectoralis major and minor, traps, and sternocleidomastoid are accessory muscles involved in inhalation.

Respiratory Centers

• The medulla oblongata and pons contain the primary respiratory centers, which control breathing. The pons also contains the pneumotaxic center which controls the rhythm of breathing, and the apneustic center which prolongs inspiration. Peripheral and central chemoreceptors are involved in regulation of breathing rate and depth depending on CO2 and oxygen levels in the blood.

Diagnostic Tests and Studies

• Mantoux test is a skin test to detect exposure to TB.
• Chest X-ray is done to examine the chest and lungs, looking for infection or abnormalities.
• Fluoroscopy and Bronchoscopy show the lungs in motion and are used to view the airways.

Nursing Responsibilities

• Pre-op procedures include obtaining informed consent; assessing baseline vital signs; positioning the patient in a semi-Fowler or sitting position. Patient education related to procedure and actions that should not be performed, such as coughing, is also important.
• Post-op procedures include monitoring vital signs; positioning the patient on the unaffected side to prevent fluid leakage.
• Instructions relating to preventing aspiration should be provided.

Sputum Examination

• Sputum examination helps identify infections and other abnormalities in the lungs, such as pneumococcal pneumonia or pseudomonas infection.
• Acid-fast bacillus (AFB) staining is used to detect tuberculosis (TB).
• Cytologic examination is used to identify cancer cells.

Pulmonary Function Studies

• Vital capacity is the maximum amount of air a person can exhale after a maximum inhalation.
• Tidal volume is the amount of air inhaled and exhaled during normal quiet breathing.
• Inspiratory reserve volume (IRV) is the extra air that can be inhaled after normal inhalation.
• Expiratory reserve volume (ERV) is the extra air that can be exhaled after normal exhalation.
• Functional residual capacity (FRC) is the amount of air remaining in the lungs after normal exhalation.
• Residual volume (RV) is the amount of air remaining in the lungs after forceful exhalation.

Other Procedures-

• Thoracentesis: fluid or air removal from the pleural space. Preparation and post-procedure care are crucial given the invasiveness of procedure.

• Bronchoscopy: direct inspection and observation of the larynx, trachea, and bronchi. Function includes obtaining secretion samples, taking biopsies, and using instruments to examine pathologies and to treat issues.

• Lung Biopsy is used to take samples from the lungs to asses pathological conditions or to assess spread to other organs like lymphoma.

• ABG (Arterial Blood Gas): A blood test used to assess ventilation and acid-base balance. Procedures, including checking for satisfactory collateral circulation, pre-procedure prep, and post-procedure monitoring for appropriate response are required to complete the procedure.

Important Reminders

• Always check for bubbles during respiration or when doing procedures that may cause issues like air leakages.
• Always ensure that the patient is appropriately positioned following procedures such as chest tube insertion or following testing, such as ABG collection, or for procedures to ensure patient safety and comfort and prevent issues such as hemolysis.

Other Diseases/Conditions

• Deviated septum: a deflection of the nasal septum, a condition resulting from trauma or congenital factors, and that can cause breathing issues and potential epistaxis.
• Nasal fracture: trauma-induced fracture of the nasal bones, resulting in potential airway obstruction, epistaxis, hematoma, or other medical complications.
• Sinusitis: infection or inflammation of the sinus lining, potentially causing congestion, facial pain, headaches, and difficulty breathing.
• Atelectasis: a lung collapse that can occur due to factors like trauma, compression, tumors, obstruction, or hyperventilation. Symptoms and treatment to support the lungs' functionality should be addressed appropriately.
• Epistaxis: nosebleed (can be due to various causes). 
• Pulmonary embolism: blockage of lung artery by blood clot.
• Pulmonary edema: fluid buildup in the alveoli of the lungs, frequently related to other health conditions but usually leading to impairment in the function of organs or related systems.

Nursing Interventions

• Nursing interventions for each condition and procedure are detailed in the provided text for managing patient care and improving patient outcomes.