Respiratory System Disorders and Assessment

• Respiratory System: includes conditions like Influenza, Pneumonia, Tuberculosis, Restrictive Lung Disease, and COPD.

Learning Objectives

• Explain key terms and medical terminology related to respiratory disorders.
• Apply knowledge of the pathophysiology of selected respiratory disorders in adults.
• Apply the nursing process in the maintenance of health to promote self-care of adult patients with respiratory disorders.
• Relate the diagnostic tests to the patient with respiratory disorders.
• Apply pharmacotherapeutics to the treatment of the adult patient with respiratory disorders.
• Determine the normal developmental changes and the changes of aging as they pertain to the patient with respiratory disorders.
• Articulate nursing responsibilities regarding nutritional requirements of the patient with respiratory disorders.
• Develop health promotion and maintenance practices as they relate to the patient with acute and chronic respiratory diseases.
• Determine the unique teaching/learning needs of the patient with selected respiratory disorders.
• Demonstrate the ability to deliver dignified nursing care considering the diverse cultural needs of the patient with respiratory conditions.
• Utilize verbal and non-verbal communication techniques effectively when delivering care to patients experiencing common health care deviations.
• Discuss principles of safety and efficient use of systems resources in the care of the patient experiencing common health care deviations related to air.

Normal Anatomy and Physiology

• The respiratory system includes structures like the Nasal cavity, Pharynx, Larynx, Trachea, Primary bronchus, Diaphragm, Secondary bronchus, Tertiary bronchus, Respiratory bronchiole, Pulmonary venule/arteriole, Alveolar duct/sac, Alveolus, and Capillary for gas exchange (O2, CO2).

Nursing Health History

• Risk factors for respiratory issues include smoking/secondhand smoke, family history, genetics, allergens/pollutants, and occupational exposures.

General Signs and Symptoms

• Dyspnea: Shortness of breath; DOE (dyspnea on exertion.)
• Orthopnea: Paroxysmal nocturnal dyspnea may be cardiac-related, with sudden waking and difficulty breathing.
• Wheezing.
• Club Fingers.
• Cough: Assess if coughing causes chest pain (pleuritic).
• Sputum production/Hemoptysis may originate from cardiac, pulmonary, nasal, stomach, or gum sources.
• Cyanosis: a very late sign of respiratory distress.
• Chest pain.

Objective Assessment for Respiratory Issues

• Symmetry: Normal antero-posterior to lateral ratio is 1:2 and the spine should be assessed.
• Respiratory pattern: Asses rate, depth, rhythm, and accessory muscle use.
  • Tachypnea: Rapid breathing (>20 breaths/min).
  • Bradypnea: Slow breathing (<10 breaths/min).
  • Hyperventilation: Rapid, deep breathing.
  • Apnea: Periods of cessation (absence) of breathing or total cessation.

Assessment of Breath Sounds

• Normal Breath Sounds:
  • Vesicular: inspiration > expiration. Heard over lung fields.
  • Bronchovesicular: 1st and 2nd interspaces anteriorly.
  • Bronchial: Over Manubrium.
  • Tracheal: Over the trachea.
• There are three lobes on the right side and two on the left.
• Abnormal (Adventitious) Breath Sounds: Crackles (fine, coarse), wheezes, and friction rubs.

Changes with Aging

• Alveolar surface area and elastic recoil decrease.
• Chest wall compliance and vital capacity decrease, while residual volume increases.
• The efficiency of O2/CO2 exchange and respiratory muscle strength decreases
• Large bronchi and alveoli become enlarged.
• Ciliary (cilia numbers) mobility decreases
• Vascular resistance increases
• Vital capacity is the sum of Total Volume + Inspiratory Reserve + Expiratory Reserve.

Crackles

• Primarily heard during inspiration in conditions like CHF, COPD, and PNA from collapsed or waterlogged alveoli.
• Fine: Indicates the beginning of fluid buildup or atelectasis.
• Coarse: Indicates a greater volume of fluid buildup.
• Management: involves managing fluids and promoting expectoration.

Wheezes

• Sonorous wheezes (Rhonchi): Deep, low-pitched sounds during expiration, usually caused by narrowed passages due to secretions.
• Sibilant wheezes: Continuous, high-pitched, whistle-like sounds during both inspiration and expiration.
• Sibilant wheezes indicate narrowed passageways from secretions or bronchospasms.
• Treatment: Deep breathing and cough, hydration (two to three liters per day).

Friction Rub

• A creaking, leathery, grating sound heard at the end of inspiration of expiration.
• Caused by rubbing of inflamed pleural surfaces against lung tissue.
• Interventions: Chest X-ray to diagnose and anti-inflammatory medications like steroids.

Diagnostic Tests

• Pulmonary function tests, evaluate height, weight, and trending changes.
• Sputum (not saliva) tests, may require suction or endoscopy assistance.
• Chest is X-rayed, with two views (PA and Lateral) for densities, fluid (pleural effusion), collapse such as Pneumothorax or atelectasis.
• Blood Cultures
• Pulse oximetry measures oxygen saturation, with a normal range of 95-100%.

Other Diagnostic Tests

• Computed Tomography (CT).
• Magnetic Resonance Imaging (MRI).
• Fluoroscopic studies and angiography. Dyes are used.
• Radioisotope procedures (lung scans).
• V/Q Scan.
• Gallium Scan.
• PET Scan.
• Biopsies

Thoracentesis

• Remove pleural fluid to improve 02, Biopsy and conduct fluid studies (cultures and cytology).
• Used to instill medication to treat pneumothorax.
• Requires monitoring pressure, bed rest, and a CXR following the procedure.
• Observe for complications. If cancer is present, cytotoxic meds can be instilled directly.

Arterial Blood Gases (ABGs) and Acid-base Balance ROME

• ABGs measure arterial O2 and CO2 levels; Assess acid-base balance and kidney function. Respiratory Opposite Metabolic Equal
• Respiratory: pH decreases in Acidosis
• Respiratory: pH increases in Alkalosis
• Metabolic: pH decreases in Acidosis
• Metabolic: pH increases in Alkalosis

Nursing Responsibilities pre and post-bronchoscopy

• Assure surgical consent is obtained before the procedure.
• Provide nothing by mouth for six hours before the procedure.
• Remove dentures before the procedure.
• Educate the patient about IV local anesthesia.
• Administer pre-op medications such as conscious sedation and Atropine.

Cold vs Flu

• Fever is rare with a cold but characteristic and high with the flu.
• Headaches are rare with a cold but prominent with the flu.
• The general feeling of aches and pains is slight with a cold but usual and often severe with the flu.
• Fatigue and weakness from colds are categorized as quite mild, but from flu they can last up to 2 to 3 weeks.
• Exhaustion is never felt with a cold, but with the flu, it feels early and prominent.
• A stuffy nose can be common with a cold but sometimes present with the flu.
• Sneezing is usual with a cold, but for the flu, it's sometimes.
• A sore throat is common with a cold but sometimes present with the flu.
• Chest discomfort with a cold has hacking cough and mid to moderate discomfort, but when dealing with the flu, common as well but could become severe.

Influenza (Flu)

• A highly contagious infection that spreads rapidly between people
• Type A is most severe due to mutation making people susceptible through mutation.
• Risk factors include old or young age, occupation, close living quarters immunocompromise, or pre-existing chronic illness and/or prenancy.
• Influenza spreads via aerosolization of small droplets or from fomites (inanimate objects that carry organisms), such as stethoscopes, scissors, or pens.
• Prevention is key by annual vaccination and treatment with antivirals.
• Treatment includes antipyretics/analgesics, adequate fluid intake, and rest are typically prescribed for symptom relief.
• Major complications include dyspnea, persistent fever, and cardiovascular compromise, bacterial pneumonia, and Streptococcus pneumoniae.

Antivirals

• Rimantadine (Flumadine): Used to control outbreaks of Influenza A.
• Oseltamivir (Tamiflu): Used to treat the flu virus, can reduce of reduce recovery time, take with or without food but is rarely life threatening.
• Amantadine (Symmetrel): Blocks the uncoating of the virus, preventing penetration to the host, but has side effects like dizziness, lightheadedness, with anxiety and inability to concentrate.
• Zanamivir (Relenza): A disk inhaler delivery system. Use cautiously with COPD and asthmatic patients.

Teaching

• An inactivated virus contains influenza vaccines but produces mild cold-like symptoms.

Pneumonia

• Obstruction of Bronchioles.
• Decrease in Gas Exchange.
• Increase in Exudate.
• Symptoms: are Cough, Fever, Chills, Tachycardia, Tachypnea, Dyspnea, Pleural Pain, Malaise or Respiratory Distress, and altered breath sounds

Types Of Pneumonia (PNA)

• Community Acquired Pneumonia (CAP): Infection occurs within 48 hours after hospitalization.
• Health Care Associated Pneumonia (HCAP): (Multi-Drug Resistance).
• Hospital Acquired Pneumonia (HAP).
• Ventilator Acquired PNA (VAP).
• Aspiration PNA: Staph pneumoniae, H. Influenza, Staph aureus), stomach contents, chemicals, gases.
• PCP (Pneumocystis Jirovecii): Pneumonia among immunocompromised people).

Pathophysiology of PNA

• Organisms enter via airways or bloodborne routes and become trapped in the pulmonary capillary bed.
• Acute inflammation of the lung parenchyma (lung tissue). Many are bacterial.
• Microbes spread in alveoli activating an inflammatory and immune response.
• Edema due to Antigen/Antibody Ag/Ab response which damages the membranes of bronchioles and alveoli producing Cellular debris and exudate that fill or clog alveoli impeding gas exchange.

Pneumonia- Outcomes and Goals

• Improved airway clearance.
• Adequate rest and energy conservation.
• Adequate fluid volume and nutrition.
• Provide Knowledge of care and future prevention.
• Achieve Absence of complications.
• Prevention of complications: Septic shock, respiratory failure, pleural effusions, and empyema.

Aspiration

• Aspiration occurs when protective airway reflexes are compromised, leading to foreign material inhalation.
• Its complications can result in tachycardia, dyspnea, cyanosis, hypertension, hypotension.
• Patho: The severity depends on the volume and nature of aspirate causing acute inflammation to bacteria. Common causative organisms include S. aureus, S. pneumoniae, H. influenzae, and Enterobacter species.

Prevent Aspiration

• Maintain head-of-bed elevation at an angle of 30 to 45 degrees, unless contraindicated.
• Use sedatives sparingly.
• Before initiating enteral tube feeding, confirm the tip location
• For patients receiving tube feedings, assess placement of the feeding tube at 4-hour intervals, assess for gastrointestinal residuals.
• For patients receiving tube feedings, avoid bolus feedings in those at risk for aspiration.
• Swallowing evaluation should be performed before starting oral feedings post-extubation with prolonged intubation.
• Maintain endotracheal cuff pressures at an appropriate level ensuring secretions are cleared.

Lung Abscesses

• A lung abscess is a localized collection of pus caused by aspiration of anaerobic bacteria; evident on chest x-rays as a 2 cm cavity.
• High-risk Patients: those with impaired cough reflexes, CNS disorders, substance use disorder, compromised immune function, and those receiving nasogastric tube feedings or are anesthetized.
• Patho: Lung abscesses are caused by aspiration of oral anaerobes due to mechanical obstruction by tumors, foreign bodies, or bronchial stenosis, necrotizing pneumonias, TB etc.

Tuberculosis (TB)

• Fatigue and progressive anemia.
• Anorexia and weight Loss.
• Chronic Cough (Productive).
• Night Sweats.
• Hemoptysis (Advanced State).
• Nonproductive cough that can turn productive.
• Frequent cough with pink sputum.
• Occurs with Pleuritic Chest Pain.
• Low-Grade Temp (Late Afternoon).
• Exposure History of someone who has TB.
• Diagnosis: Skin Test, X-Ray, Sputum Studies+Mantoux Test.
• Treatment: TB Medications 6 to 12 Months, Bed rest; Resp Isolation.

TB Statistics

• Globally, ⅓ of the pop is infected, becoming the leading cause of death.
• It is communicated easily and reportable to doctors.
• TB affects areas such as lungs, kidneys, bone and cerebral cortex.
• Exposure occurs 2 to 10 weeks after.

What Is It?

• Mycobacterium tuberculosis is an acid-fast gram-positive bacillus that is both light and heat sensitive.
• Transmitted through airborne droplets in close environments.
• Can be detected through Ghon tubercle on CXR, can reactivate, ulcerate and spread, become contagious

TB risk factors

• Are that of medically underserved, recent immigrants from countries with high TB, constant work with health workers
• Those with care at long term facilities and are alcoholics, iv drug abusers , and who are immunosuppressed.

Mantoux Test

• Follow CDC guidelines considering patient's social history.
• +5 mm if the patient is HIV positive, immunosuppressed, or recently received an organ transplant.
• +10 mm if patients are in high risk, working environment, or with children less than 4 years.
• +15 mm can be found to anyone that has no risks or if +10mm then requires CXR in 72 hrs.
• Sputum culture X3 becomes symptomatic

Mantoux test: False Positives

• False positive can occur from being vaccinated with BCG vaccine Bacilli Calmette Guerin, it is given mostly in Canada. Europe, Latin America (76% effective)
• False are immunosuppressed and recently vaccinated with the live virus such as small pos, and measles.
• Anergy. False negative is the inability to produce a reaction

Diagnostic studies

• PPD (Purified Protein Derivative) for screening can be done in two steps for new employees
• CXR for being positive.
• Spuntum for gram stain. -QuantIferons Tb tests aren't affected by Bacilli.

Medication for Combos and Resistance

• Treatment of active diseases consist of:
  • isonaziad , rifampin pyrazinaimide & ethambutol X 8 weeks
  • isonaziad and rifampin should be in every 18 weeks, followed with taking vitamin B6 50mg to prevent leg numbness
• Latent diseases
  • inH for 6-9 months decreases vitamin B6.
  • High risks for about 12 months.
• masks and Non-infectious can wear masks in puplic.
• Decreases transmission risk after 3 weeks of antibiotics.

Nursing Care

• Have the patient in a private room with negative airflow.
• Always have gowns mask are worn the visitor.
• Medication has to followed.
• Airway clearance of spudum and nutrition.

Occupational lung diseases: Pneumonconioses

• Exposure to inorganic damages which causes fibrosis, from fumes of substances.
• Role of the occupational nurse is as an employer advocate, health education, the prevention measures.
• The nurse's duty is to protect the airways.

Restrict lung conditions

• Workers who face black lungs such as coal workers.

Restrictive Lung Diseases: Silicosis

• Occupation lung disease.
• Inhaling dust leads from oxygen in the air where scar tissues for.

Restrictive lung and Damage of the Fibers

• Asbestoids dusts can damage lungs and can increase the risk of C.A.
• Progressive is mostly related to exposure with fibers and causes chronic cough. Radon

Lung Damage of Asbestos

• Asbestos and fibers has always caused the fiber to become inflamed which causes cough and chest pain.
• The needle may migrate into pleural which causes building of lung tissue.
• Higher chance to be diagnosed with cancer increased by those who use smoking.

Cause of Restrictive lung diseases

• Causes the allowance of cells to scar tissues in the lungs.
• Smoking is at 90% as for damage in genes.
• Diet Low is important the cause of not eating fruits and vegetables.

Classification of Lung Cancer

• Is a small cell that can turn into Non-small 10-15% into 85%
• NSCLC is squamous in central bronchi's.
• Fast growing to metastasize

Stages

• tumor where tumors and cancer have meta-sides in nodes
• metastasized to lymph nodes before it is diagnosed
• early stage and cure rate, with metastasis in state four.

Symptoms of lung cancer.

• change in cough and coughing up blood.
• hoarseness and wheezing.
• swelling of neck and face.
• weight loss and fatigue
• chest shoulder pain of is a later sigh.

Diagnostics

• x- ray checks for density and infection in tissue.
• C.T scans the is for smaller modules that may not be picked up from x-rays.

Mangement

• Surgery can be done by Pneumenectomy and can to be made done from laparoscopically.
• therapy is used to open Airways.
• chemotherapy also used to reduce tumors and masses from pressure.

CARE

• Lung Caner care from lungs is supportive and pain relieving.
• Air clearance is with deep cough for physical therapy.
• Oxygen is needed and allow of constant rest.

Patient Care

• with diagnosis and lung diagnosis and losing loss in appetite
• what should you eat
• eat meals 3 times
• eat large meals only you are are hungry

Chronic

• causes is pulmonary disease which characterized by smoking.
• lung diseases which related to chronic emphsema

Chronic Bronchiti

• is at 3 months
• in both years.
• function which results in the secretion and information.

Chronic

• Goblet cells which cause to air traffic .
• Inflamation which causing the chronic infections
• The hyper increase in glands and decrease function such has airways may plug.
• The alveolar damage is the macrophage that diminishes.

Pursed lips

• can be exhaled

Care Emphsema

• duskey cyatotic.
• problem wheezing minimal coughing lungs hyper

Risk factors

• Tobacco has the highest potential, with genetic abnormalities
• The higher potential to caused by smoke and pollution.
• Lack the ability of oxygen to come in 24%
• Always ensure to have 60% of partial oxygen to breath to ensure.

Treatment

• bullecomty
• reduce with the lung of volume, and pullman
• ensure 5% to provide. for intermitting action of activity.

Pharmacology

• and first then you have admin. before and after each infections.

Inhalants

• are for short quick relief.
• maintenance has serevent diskus for long time.

Pulmonary function from B6

• ensure prevent for 12 months to breath easily.

Inhalents

• has different types are all are have bronco constrcitos.

Treatment for meds

• helps with cough that has different effects.

Steroids

• always look from sensitivity for adrenergic rectors.

Gas exchange.

Huff cough exercises can increase the process at which patients have difficulties breathing. Proper breathing is needed always to check for toxicity.

This quiz covers respiratory system disorders, assessment techniques, and appropriate interventions. Topics include the effects of aging on respiratory function, COPD management, pneumonia assessment, and asthma interventions. Focus is on recognizing respiratory patterns and understanding underlying physiological processes.