Care Of Adults With Respiratory Disorders PDF

CARE OF ADULTS WITH RESPIRATORY DISORDERS ANDREA MORGAN-EASON NUR 299 MOLLOY COLLEGE  ASSESSMENT OF THE RESPIRATORY SYSTEM  HEALTH HISTORY: -major signs and symptoms associated with resp. status -how these signs and symptoms affect...

CARE OF ADULTS WITH RESPIRATORY DISORDERS ANDREA MORGAN-EASON NUR 299 MOLLOY COLLEGE  ASSESSMENT OF THE RESPIRATORY SYSTEM  HEALTH HISTORY: -major signs and symptoms associated with resp. status -how these signs and symptoms affect the pt’s adls, work and families’ function -Risk factors -Medical history ASSESSMENT OF RESPIRATORY SYSTEM  ASSESSMENT OF RESPIRATORY SYSTEM  PHYSICAL ASSESSMENT -General Appearance: mentation -Upper respiratory system -Lower respiratory system: thorax -chest -breathing patterns- prolonged expiratory phase -respiratory rates -breath sounds-p.481(Table 20-6).  DIAGNOSTIC EVALUATION OF THE RESPIRATORY SYSTEM  Lab & Diagnostic Testing: -ABG’s, pulse oximetry, PFT’s, throat cultures, sputum, CBC -Imaging studies: CXR, CT MRI, lung scans -Endoscopic studies: bronchoscopy, thoracoscopy, thoracentesis -Biopsy Nursing Interventions NURSING INTERVENTIONS  AIRWAY  O2 THERAPY-DIFFERENT WAYS OF IMPLEMENTATION  ARTIFICAL AIRWAYS  TRACH CARE  DISORDERS OF THE RESPIRATORY SYSTEM  ATELECTASIS: refers to closure or collapse of alveoli due reduced alveolar ventilation.  Causes: excess secretions, breathing patterns, pain, alteration in airway function, prolonged supine position, musculoskeletal & neurological disorders  At Risk: post-op, immobilized, pt. who has an impaired cough(bronchial obstruction) DISORDERS OF THE RESPIRATORY SYSTEM  Signs and Symptoms -insidious, dyspnea, cough, sputum production, tachycardia, tachypnea, pleural pain, anxiety, dec., or absent breath sounds Diagnostic testing Prevention- Chart 23-1 Nursing Management: improve ventilation and remove secretions  DISORDERS OF THE RESPIRATORY SYSTEM  ACUTE TRACHEOBRONCHITIS: an inflammation of the mucous membranes of the trachea and bronchial tree -secondary to an upper respiratory tract infection SYMPTOMS: cough, fever, chills, night sweats, headache and weakness, as it progress SOB, noisy respirations  DISORDERS OF THE RESPIRATORY SYSTEM  Medical Management -Medications Nursing Management -encourage fluid intake -fatigue-not overexert themselves -encourage pt. to cough  DISORDERS OF THE RESPIRATORY SYSTEM  PNEUMONIA -most common cause of death from infectious diseases in the U.S. -inflammation of lungs-commonly secondary to an infection or inhaled toxins(aspiration) -inflammatory reaction that occurs in the alveoli-interferes with gas exchange- occludes the bronchi or alveoli  DISORDERS OF THE RESPIRATORY SYSTEM  FOUR TYPES: A. Community-acquired -pneumococcal- post upper respiratory infection-high fever, sputum -mycoplasma pneumonia-in older children and adults-spread by respiratory droplets-earache  DISORDRES OF THE RESPIRATORY SYSTEM Community-acquired(contd) -H. influenza- affects elderly and those with comorbid illnesses; cough, low grade temp -Viral Pneumonia- most common in infants and children-in immunocompromised adult- cytomegalovirus is common, follow by herpes simplex.  DISORDERS OF THE RESPIRATORY SYSTEM  B. Hospital-Acquired -onset of symptoms more than 48 hours after admission -VAP- endotracheal intubation and mechanical intubation -common organisms: Klebsiella, P.aeruginosa, MRSA  DISORDERS OF THE RESPIRATORY SYSTEM  Hospital-Acquired(contd.) -Pseudomonas pneumonia- occur in patients who debilitated, ams, prolonged intubation or tracheosotomy -Staphylococcal pneumonia-via inhalation or blood borne often accompanied by bacteremia and positive blood cultures. Mortality is high MRSA-resistant to most antibiotic  DISORDERS OF THE RESPIRATORY SYSTEM  Hospital-Acquired(contd.) -Klebsiella-gram negative-at risk – elderly, alcoholics, patients with chronic diseases(diabetes)-sxs: characterized by destruction of the lung structures and alveolar walls –consolidation-tissues solidifies as a result of collapse alveoli or infectious process; fever, cough, lung abscess, tissue necrosis  DISORDERS OF THE RESPIRATORY SYSTEM  Pneumonia in immunocomprised host: -PCP- occur with the use of steriods, chemotherapy, nutritional depletion, use of broad spectrum antimicrobials, AIDS and immunosuppressive agents -organisms are the same that causes CAP and HAP-dyspnea, fever and cough  DISORDERS OF THE RESPIRATORY SYSTEM  Aspiration pneumonia -aspiration of bacteria that normally resides in the upper airway -aspiration of other substances in the lungs-bacterial growth  DISORDERS OF THE RESPIRATORY SYSTEM  Pathophysiology: -occur from normal flora in patients who resistance is altered -occur from bloodborne organisms -affects ventilation and diffusion  DISORDERS OF THE RESPIRATORY SYSTEM  Risk Factors: -residence in long term facility -compromised defenses -underlying disorders Clinical Manifestation: -varies in its sign and symptoms depending on the type, organism and presence of underlying disease.  DISORDERS OF THE RESPIRATORY SYSTEM  Assessment: dyspnea, tachypnea, fever, sputum, chest pain, WBC, change in mental status, breath sounds: early inspiratory or expiratory crackles, ronchi, rales, absent breath sounds Prevention: Pneumovax >65, chronic illness, spleenectomy, asthma and smokers, influenza vaccine, infection control, post-op and prevent aspiration  DISORDERS OF THE RESPIRATORY SYSTEM  Medical Management:  Antibiotics- determined by the results of the gram stain, causative agent; common is PCN for strep; 3rd generation cephalosporins for gram negative; pseudomonas-broad spectrum fluoroquinlones  Guidelines exist to guide antibiotic choice, however the resistance patterns, prevalence of etiologic agents, patient risk factors and cost and availability must be considered.  DISORDERS OF RESPIRATORY SYSTEM  Nursing Interventions -activity -hydration -oxygen therapy -chest PT -cough - treat fever -education  DISORDERS OF THE RESPIRATORY SYSTEM  Nursing diagnosis -ineffective airway clearance -activity intolerance -risk for fluid volume deficit  DISORDERS OF THE RESPIRATORY SYSTEM  PULMONARY TUBERCULOSIS: communicable infection caused by mycobacterium TB. - it infects an estimated one third of the world’s population and remains the leading cause of death from infectious disease in the world. -WHO- estimates that Tb is the cause of death for 11% of all patients with AIDS -TB is closely associated with poverty malnutrition, overcrowding, substandard housing & inadequate health care  DISORDERS OF THE RESPIRATORY SYSTEM  TRANSMISSION: airborne via droplet nuclei < 5microns which can remain suspended in the air for long periods- coughing, talking & singing  Risk Factors: HIV+, immune suppressed, homeless, immigrant from poorer nations, malnourished and crowded living conditions, healthcare workers (Chart 23- 6)  DISORDERS OF THE RESPIRATORY SYSTEM  Clinical Manifestations: insidious, low grade fever, cough, night sweats, fatigue and weight loss; cough(non-productive, copurulent sputum, hemoptysis)  Assessment: health history, physical examination: CXR-reveals lesion in the upper lobes and Breath sounds: diminished, crackles  DISORDERS OF THE RESPIRATORY SYSTEM  DIAGNOSTIC TESTING: -Mantoux PPD testing-only indicates initial exposure not active disease-intradermal injections 27-28 gauge-read after 48-72 hours -a reaction occurs when both and induration and erythema are present -positive & significant in patient who have normal or mildly impaired immunity if induration is 10mm; >5mm in @risk patients(HIV+)  DISORDERS OF THE RESPIRATORY SYSTEM  DIAGNOSTIC TESTING (CONTD) -BCG vaccine-given to produce greater resistance to the development of TB-can give a positive response – CXR is needed. QuantiFERON-TB Gold Test-detection of TB- indicates that a person has been infected with TB, does not indicate whether or not the person has active progression of the disease.  DISORDERS OF THE RESPIRATORY SYSTEM  Sputum-AFB & culture of the sputum are used to diagnose TB-early in the am specimen x 3- may take weeks.  CLASSIFICATION: -data from the history, physical examination, TB test, CXR and microbiologic are used to classify TB into one of five classes.  DISORDERS OF THE RESPIRATORY SYSTEM  CLASSIFICATION -Class 0-no exposure, no infection -Class 1: exposure, but no infection -Class 2: latent infection, no disease -Class 3: disease, clinically active -Class 4: disease, not clinically active -Class 5: suspected disease, diagnosis pending  DISORDERS OF THE RESPIRATORY SYSTEM  Medical Management -antituberculosis agents for 6-12 mths -prolonged treatment to eradicate the disease and prevent relapse -the 1st line antituberculosis medications (Table 23-4); second line then others.  DISORDERS OF THE RESPIRATORY SYSTEM  Medical management (contd) Treatment Guidelines: Two phases: a. Initial treatment: consists of multiple medications regimen of INH , rifampin, pyrazinamide, and ethambutol- daily x 8weeks b. Continuation: INH and rifampin or INH and rifapentine-last 4-7 months People are considered non-infectious after 2-3 wks of continuous med. therapy  DISORDERS OF THE RESPIRATORY SYSTEM  Medical Management (contd) -Vitamin B is usually administered with INH to prevent INH-peripheral neuropathy. -INH also may be used as a prophylactic measure for people at risk/latent disease (6-12months). Monitor liver enzymes, bun, creatinine, sputum culture, side effects of medications  DISORDERS OF THE RESPIRATORY SYSTEM  Airborne Isolation-AFB isolation precautions: -private room, negative pressure, respirator mask, continue precautions until AFB is negative-2-3weeks  DISORDERS OF THE RESPIRATORY SYSTEM  Nursing Management -airway clearance -adherence to treatment regimen -activity and nutrition -prevention- pt. education on hygiene and handwashing, living conditions, nutrition