Altered Respiratory Function

**[Altered Respiratory Function]** COPD, Asthma, Emphysema, Tuberculosis, Pneumonia, Sinusitis, URI **Anatomy and Physiology:** - - - - - - ** Upper respiratory airway** - - - - - - - - **Lower respiratory airway** - - - - - - - - -...

**[Altered Respiratory Function]** COPD, Asthma, Emphysema, Tuberculosis, Pneumonia, Sinusitis, URI **Anatomy and Physiology:** - - - - - - ** Upper respiratory airway** - - - - - - - - **Lower respiratory airway** - - - - - - - - - - - - - Etiology (cause) - - - - - - - - - - - - - - - - +-----------------------+-----------------------+-----------------------+ | **MEDICATION:** | **MOA:** | **S/E and Teaching:** | +=======================+=======================+=======================+ | **Antihistamines:** | relieves acute s/s | few if any | | | like nasal | | | 2nd Generation | secretions, itching | | | | and sneezing, **No | | | deslorata**dine(**Cla | help with | | | rinex)**,** | congestion** | | | cetirizine(Zyrtec), | | | | fexofena**dine**(Alle | | | | gra) | | | +-----------------------+-----------------------+-----------------------+ | **Decongestant:** | promotes | **increases BP** and | | | vasoconstriction of | intraocular | | pseudo**ephedrine**(S | vessels in the nose | pressure(IOP), | | udafed)(PO), | | increases **HR**(**be | | phenylephrine(Nasal | | aware of pre-existing | | Spray) | | conditions**). | | | | **Rebound nasal | | | | congestion can | | | | occur** | +-----------------------+-----------------------+-----------------------+ | **Nasal | inhibits inflammatory | low chance of | | Steroids:**\*\*first- | response, facilitates | systemic s/e, **mild | | line | drainage of sinuses | irritation** with | | drug therapy | | admin.(nosebleeds, | | | | irritation) | | **Nasacort** | | | | | | teaching: adherence | | **Nasonex** | | is important; most | | | | effective when used | | **Beconase** | | regularly | | | | | | **Flonase** | | | +-----------------------+-----------------------+-----------------------+ - - - - - **\*\*Don\'t forget pt education!!** - **Acute Viral Rhinitis - Common Cold** - - - - - - - - - - - **\*pt might ask for them and might aid in s/s but doesn\'t affect disease length. Watch out for secondary infection which antibiotic may be needed** - - **Influenza** - - - - - - - - - **Manifestations**: - - - - - - - - - - - - - - **Sinusitis** - - - - - - - - - -  - - - - - - - - - - - - - - - - - - - - - - \*\*topical decongestants used for no longer than 4 to 5 days to prevent rebound congestion - - - - - - - - - - - - **Pharyngitis** **Etiology** - - - - - **\*\*These will most likely be the ones which you will need to know how to differentiate. Please refer to textbook/class notes if still unclear on viral vs bacterial\*\*** +-----------------------+-----------------------+-----------------------+ | | **Bacterial**: | **Viral:** | +=======================+=======================+=======================+ | **Clinical | **- Fever** | \- red/swollen | | manifestations:** | | pharynx | | | \- cervical lymph | | | | node enlargement | \- palpable lymph | | | | nodes | | | \- | | | | tonsillar/pharyngeal | pink nasal mucosa | | | **exudate** | | | | | \- clear lungs | | | **- absence of | | | | cough** | | +-----------------------+-----------------------+-----------------------+ | **Nursing care:** | \- contagious!!, | use pain meds for | | | continue abx therapy | relief | | | all the way through | | +-----------------------+-----------------------+-----------------------+ | **Treatment:** | \- infection | \- Symptom management | | | control(PCN, | | | | erythromycin, | \- Mouth Care(gargle | | | clindamycin are drugs | salt water, drink | | | of choice) | warm/cold liquid for | | | | pain relief, | | | \- s/s management | lozenges) | | | | | | | \- rapid antigen test | \- Fluids | | | to determine cause | | | | and treatment | | +-----------------------+-----------------------+-----------------------+ **Lower Respiratory Problems** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **Tuberculosis** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **Obstructive Pulmonary Disease (COPD and Asthma)** **Asthma** - The main pathophysiologic process in asthma is **persistent but variable inflammation of the airways.** - **Chronic** inflammatory disorder of the airways that causes varying degrees of obstruction in the airways d/t **bronchospasms** - Causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing associated with airflow obstruction that may resolve spontaneously; it is often reversible with treatment.(bronchodilators) +-----------------------------------+-----------------------------------+ | *Intrinsic* | *Extrinsic* | +===================================+===================================+ | - - - | - - - - - - | +-----------------------------------+-----------------------------------+ **Risk Factors of Exacerbation:** - - - - - - - **Assessment:** - - - - - - - - - - - - - **Diagnostic Tests:** - - - - - - **Interventions** - - - **Chronic Obstructive Pulmonary Disease** **THE NUMBER \#1 CAUSE IS CIGARETTE SMOKING!!!!!!!** - - - - - - - - - **Chronic Bronchitis** ** Assessment** - - - - - - - - - - - - - - - - - - **Emphysema** - - - - - - - **Assessment:** - - - - - - - **COPD Interventions** - - - - - - - **Complications of COPD\ ** **Polycythemia Vera**- Increased Hemoglobin due to chronic hypoxia\ **Cor Pulmonale**- **Right sided heart failure due to pulmonary hypertension,** This is an emergency. Not all patients with COPD develop cor pulmonale.Dyspnea is the most common symptom of chronic cor pulmonale.These include distended neck veins, hepatomegaly with right upper quadrant tenderness, peripheral edema, and weight gain. **Oxygen Therapy** O2 therapy is often used in the treatment of COPD and other problems associated with hypoxemia. Giving supplemental O2 increases the partial pressure of O2 (PO2) in inspired air. Used clinically, it is considered a prescribed medication. It is the only one that has been linked to improved survival of COPD patients. +-----------+-----------+-----------+-----------+-----------+-----------+ | High Flow | O2 | O2 | Oxygen | Nursing | Example | | or Low | Delivery | Descripti | Amount in | Intervent | | | Flow | Device | on | Liters | ions | | +===========+===========+===========+===========+===========+===========+ | Low Flow | **Nasal | Most used | 1 L/min- | - **COP | | | | Cannula** | device , | 6 L/min | D** | | | | | Safe and | | patie | | | | | simple | | nts | | | | | | | can | | | | | | | toler | | | | | | | ate | | | | | | | up to | | | | | | | **2L/ | | | | | | | min** | | | | | | | | | | | | | | - Asses | | | | | | | s | | | | | | | nose | | | | | | | and | | | | | | | ears | | | | | | | for | | | | | | | skin | | | | | | | break | | | | | | | down | | | | | | | | | | | | | | - Humid | | | | | | | ify | | | | | | | if | | | | | | | flow | | | | | | | rates | | | | | | | **\>5 | | | | | | | L/min** | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Low Flow | **Simple | - Cover | 6-12 | **Mask |  | | | | and | | snug** | | | | | mouth | | | | | | | | | | | | | | - **Use | | | | | | | d | | | | | | | for | | | | | | | short | | | | | | | perio | | | | | | | ds** | | | | | | | | | | | | | | - 35%-5 | | | | | | | 0% | | | | | | | flow | | | | | | | rates | | | | | | | of | | | | | | | 6-12 | | | | | | | L/min | | | | | | | | | | | | | | - Humid | | | | | | | ified | | | | | | | Inspi | | | | | | | red | | | | | | | Air | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Low Flow | **Partial | ** Used | **10-15 | ** O2 | | | | and | for | L/min** | flow rate | | | | Non-Rebre | short-ter | | must be | | | | ather | m | | sufficien | | | | \`** | (24 hr) | | t | | | | | therapy | | to keep | | | | | for | | bags from | | | | | patients | | deflating | | | | | needing | | during | | | | | higher O2 | | inspirati | | | | | concentra | | on | | | | | tions | | to avoid | | | | | (60%--90% | | CO2 | | | | | at | | buildup | | | | | 10--15 L/ | | and | | | | | min).** | | rebreathi | | | | | | | ng | | | | | ** O2 | | of CO2.** | | | | | flows | | | | | | | into the | | ** keep | | | | | reservoir | | the bag | | | | | bag and | | inflated! | | | | | mask | | !** | | | | | during | | | | | | | inhalatio | | ** Mask | | | | | n.** | | should | | | | | | | fit | | | | | | | snugly.** | | | | | | | | | | | | | | ** | | | | | | | Monitor | | | | | | | patient | | | | | | | closely, | | | | | | | since | | | | | | | more | | | | | | | advanced | | | | | | | intervent | | | | | | | ions | | | | | | | may be | | | | | | | needed | | | | | | | such as | | | | | | | CPAP, | | | | | | | BiPAP** | | +-----------+-----------+-----------+-----------+-----------+-----------+ | High Flow | **Nasal | ** | **Up to | |  | | | | compresse | | | | | | | d | | | | | | | air to | | | | | | | generate | | | | | | | FIO2 up | | | | | | | to 1.0 at | | | | | | | flow rate | | | | | | | of up to | | | | | | | 60 L/min. | | | | | | | ** | | | | | | | | | | | | | | ** | | | | | | | Active | | | | | | | heated | | | | | | | humidifie | | | | | | | r | | | | | | | capable | | | | | | | of | | | | | | | providing | | | | | | | 100% body | | | | | | | humidity. | | | | | | | ** | | | | +-----------+-----------+-----------+-----------+-----------+-----------+