Respiratory Disorders and Conditions PDF

## Respiratory Disorders and Conditions This video focuses on the second part of caring for patients with respiratory disorders and conditions. ### **Lower Airway Disorders** - **Acute Bronchitis:** Inflammation of the trachea and bronchial tree. Usually thick. - **Causes:** Respiratory inf...

## Respiratory Disorders and Conditions This video focuses on the second part of caring for patients with respiratory disorders and conditions. ### **Lower Airway Disorders** - **Acute Bronchitis:** Inflammation of the trachea and bronchial tree. Usually thick. - **Causes:** Respiratory infection or exposure to inhaled irritants. - **Clinical Manifestations:** - Productive cough - Wheezes - Shortness of breath - Chest pain and tightness - Low-grade fever - Headache - **Medical Management:** - Euclitics - Tusifs - Antipyretics - Analgesics - Bronchodilators - Antibiotics - Vaporizer - **Nursing Interventions:** - Encourage fluids (avoid milk). - Provide rest. - Encourage cough and deep breathing. - Monitor vital signs and lung sounds. - Avoid smoking. - **Legionnaire's Disease:** Caused by *Legionella pneumophila* bacteria. Thrives in water reservoirs. - **Causes:** - AC units - Fires - Hot tubs - **Clinical Manifestations:** - Life-threatening pneumonia. - Respiratory failure. - Renal failure. - Back trimic shock. - Ultimately death. - **Clinical Manifestations Onset:** 2-14 days after exposure. - **Clinical Manifestations:** - High fever - Headache - Diarrhea - Malaise - Muscle pain - Non-productive cough - Shortness of breath - Chest pain on inspiration. - Crackles or wheezes. - **Diagnostic Tests:** - Cultures (blood, sputum, or lung tissue) - Chest X-ray - Urine screening for Legionella antigens. - **Medical Management:** - Antibiotics (Aryltramiasin is the primary drug of choice) - Antipyretics - Vasal Pressors (depending on severity) - Oxygen - Mechanical ventilation (if needed) - IV therapy - Renal dialysis - Rest and comfort for the patient and family. - **Severe Acute Respiratory Syndrome (SARS):** Caused by a coronavirus. - **Transmission:** Airborne or through droplet contact. - **Medical Manifestations:** - Elevated temperature - Headache - Muscle aches - Mild respiratory symptoms (dry cough, shortness of breath) - **Diagnostic Tests:** - Chest X-ray - SARS antibody testing. - White blood cell count. - Platelet count. - CPK levels. - Nasal and galeal swabs. - Bronchial lavage (to remove irritation and bacteria). - **Medical Management:** - Antibiotics (for secondary infections) - Antivirals (for viral infections) - Corticosteroids (to reduce inflammation and irritation) - Respiratory isolation - Meticulous handwashing. ### **Tuberculosis** - **Transmission:** Airborne or droplet contact. - **Clinical Manifestations:** - Fever - Chills - Night sweats - Weight loss - Weakness - Chronic productive cough - Clubbing of fingers or toes - Swollen or tender lymph nodes in the neck. - **Diagnostic Tests:** - Tuberculin skin test (Mantoux test). - **Positive:** Greater than or equal to 10 mm in duration after 48-72 hours. - **Negative:** Less than 5 mm in duration. - QuantiFERON-TB Gold test (blood test). - Chest X-ray. - Acid-fast bacilli (AFB) smear. - Sputum cultures. - **Medical Management:** - **Active TB:** - Drug therapy (INH, Rifampin, Ethambutol) - **Latent TB:** - Prophylactic INH or Rifampin for 6-9 months. **Drug Therapy Side Effects:** - **INH:** - Peripheral neuritis (numbness and tingling) - Hepatotoxicity (hepatitis) - **Rifampin:** - Changes to body fluids (orange color) - Affects oral contraceptives. - **Ethambutol:** - Optic neuritis - Color blindness - **Pyrazinamide:** - Hepatotoxicity - Liver problems - Changes in vision - Orange or brown tears/rash. - **DOT (Directly Observed Therapy):** To ensure medication compliance. - **BCG Vaccine:** Used for children in foreign countries to prevent TB. ### **Pneumonia** - **Definition:** Inflammation of the alveoli in the lungs. - **Causes:** - Bacteria - Viruses - Mycoplasma - Fungi - Parasites - Inadequate ventilation - Aspiration - **Clinical Manifestations:** - Productive, painful cough - Chills - Fever - Increased heart rate - Increased respiratory rate - Shortness of breath - Crackles or wheezes - Cyanosis - Sputum production (color can indicate cause): - Rust-colored: *Streptococcus pneumoniae* - Salmon-colored: *Staphylococcus aureus* - Yellow or green: *Haemophilus influenzae* - Blood-tinged: Viral - Non-productive: *Mycoplasma pneumoniae* - **Diagnostic Tests:** - Chest X-ray - Sputum cultures - Blood cultures - White blood cell count - Platelet count - CPK levels - Nasal and galeal swabs - Arterial blood gas analysis. - **Medical Management:** - Antibiotics (for bacterial infections) - Oxygen therapy - Rest - Fluid management - Analgesics for pain - Antipyretics for fever. - Positioning - **Nursing Interventions:** - Monitor lung sounds - Monitor positioning - Encourage deep breathing - Cough and deep breathing. - Provide chest physiotherapy. - Fluid management - Nutritional support - Consider a chest tube for empyema (pus in the pleural space). - **Pneumonia Vaccine:** Recommended for high-risk individuals. ### **Pleural Effusion** - **Definition:** Accumulation of fluid in the pleural space. - **Causes:** - Inflammation - Infection (empyema) - Lung tumors - Injury - TB. - **Clinical Manifestations:** - Shortness of breath - Pain that radiates to the shoulder or abdomen - Cough - Fever - Pleural friction rub - Pleural effusions - **Diagnostic Tests:** - Chest X-ray. - **Medical Management:** - Thoracentesis (removal of pleural fluid) - Antibiotics (for bacterial infections) - Oxygen therapy. - Pain management - Fluid management - **Nursing Interventions:** - Monitor for respiratory distress. - Assist with ADLs. - Protect from infection. ### **Pneumothorax** - **Definition:** Collection of air or gas in the pleural space. - **Causes:** - Emphysema - Severe coughing - Penetrating chest injury - Fractured ribs - Medical procedures - **Clinical Manifestations:** - Sudden, sharp chest pain - Shortness of breath - Decreased or absent breath sounds on the affected side - Tachypnea - Tachycardia - Sucking chest wound (if caused by injury). - Tension pneumothorax: Mediastinal shift, pushing on the heart and blood vessels, decreasing cardiac output. - **Diagnostic Tests:** - Chest X-ray - **Medical Management:** - Chest tube insertion with water-seal drainage system - Oxygen therapy - Analgesics - Rest - Fluid management - Positioning: Semi-Fowler's position - **Nursing Interventions:** - Assist with ADLs - Protect from infection - Monitor for respiratory distress - **Chest Tubes: ** - Re-establish negative pressure in the pleural space. - Drain fluid, blood, or air - **Drainage Systems:** - Closed systems: - Water-seal drainage system. - One-way system - **Commercial Drainage Systems:** - PloraVac: Three-chambered system. - **Chest Tube Management:** - Monitor: - Drainage (amount, color, consistency). - Air leaks - Tidal fluctuations. - Change dressing when needed and check for: - Inflammation - Excess drainage - Crepitus. - Check insertion site for: - Induration - Vaseline leakage. - Do not clamp chest tubes for prolonged periods (can lead to tension pneumothorax) - Ensure the drainage system remains below the insertion site. - Secure the system to the floor to prevent accidental spills. - Provide education to the patient and family. ### **Pleural Effusion vs Pneumothorax** - **Pleural Effusion:** Fluid in the pleural space. - **Pneumothorax:** Air in the pleural space. **Complications of Pleural Effusion:** - Empyema (infection of the pleural fluid). - Tension pneumothorax (air pressure in the pleural space is higher than atmospheric pressure) ### **Lung Cancer** - **Causes:** - Smoking - Air pollution - Genetics - **Manifestations:** - New or persistent cough - Hoarseness - Chest pain - Shortness of breath - Weight loss - Fatigue - Loss of appetite - **Diagnostic Tests:** - Chest X-ray - CT scan - MRI - PET scan - Bronchoscopy - Biopsy of lymph nodes. - **Medical Management:** - Surgery: - Pneumonectomy (removal of the entire lung) - Lobectomy (removal of one lobe of the lung) - Wedge resection (removal of a small portion of the lung) - Radiation therapy - Chemotherapy - **Prognosis:** - Varies depending on the size, location, and stage of the cancer. ### **Pulmonary Embolism** - **Definition:** Blood clot that travels to the lungs. - **Causes:** - Deep vein thrombosis (DVT) - Fat emboli (from bone fractures or pregnancy). - Air emboli. - Amniotic fluid embolism. - **Risk Factors:** - Smoking - Obesity - Immobility - Central line placement - Oral contraceptives - Injury. - **Clinical Manifestations:** - Sudden, sharp, constant, non-radiating chest pain. - Shortness of breath - Dyspnea - Tachypnea - Tachycardia - Hypoxemia - Pleural friction rub - Crackles - Wheezes - Cyanosis - Clubbing of the fingers - Decreased urinary output - Sudden weight gain - Restlessness - Agitation - Impending doom. - **Diagnostic Tests:** - Chest X-ray - VQ scan (ventilation/perfusion scan) - Spiral CT - CT angiogram - D-dimer levels - Pulmonary angiogram (invasive) - Doppler ultrasound - **Medical Management:** - Anticoagulants (heparin, warfarin, factor Xa inhibitors) - Thrombolytics (to dissolve the clot). - **Nursing Interventions:** - Monitor for bleeding - Education - TED hose to prevent DVT - Maintain a high Fowler's position. ### **Acute Respiratory Distress Syndrome (ARDS)** - **Definition:** Severe lung injury that leads to fluid buildup in the alveoli (alveolar edema). - **Causes:** - Pneumonia - Sepsis - Aspiration - Near drowning - Trauma - Fat embolism - Drug overdose - Pancreatitis - COPD - Neuromuscular disorders - Prolonged mechanical ventilation. - **Pathophysiology:** - Injury to the alveoli. - Increased capillary permeability. - Leakage of fluid into the alveoli. - Decreased gas exchange - **Clinical Manifestations:** - Rapid onset (12-24 hours after the inciting event) - Severe dyspnea - Crackles - Wheezes - Tachycardia - Hypertension - Decreased urinary output - Altered mental status. - **Diagnostic Tests:** - Arterial blood gas analysis (ABG) - Chest X-ray - Pulmonary function tests. - **Medical Management:** - Oxygen therapy (mechanical ventilation) - Drug therapy (antibiotics for infection, corticosteroids to reduce inflammation, diuretics, morphine for respiratory distress) - Fluid management (maintain fluid balance). - Positioning: High Fowler's position. ### **Chronic Obstructive Pulmonary Disease (COPD)** - **Definition:** A progressive, irreversible lung disease that causes airflow obstruction and air trapping in the lungs. - **Causes:** - Smoking - Exposure to inhaled irritants. - Genetic predisposition (alpha-1 antitrypsin deficiency). - **Types:** - Emphysema - Chronic bronchitis. - **Clinical Manifestations:** - **Initial Stage:** - Shortness of breath on exertion. - Sputum production. - External retractions - Weight loss. - **Late Stages:** - Barrel chest. - Dyspnea at rest. - Cough - Wheezes - Crackles - Cyanosis - Digital clubbing - Weight loss - Emaciation - Hypoxia - Hypercapnia - Cor pulmonale (right heart failure) - Pulmonary hypertension. - **Diagnostic Tests:** - Pulmonary function tests (spirometry) - Chest X-ray - ABGs - Alpha-1 antitrypsin levels (assess genetic predisposition) - **Medical Management:** - **Acute COPD:** - Oxygen therapy- Slow and low flow - Bronchodilators (short-acting and long-acting) - Corticosteroids - Antibiotics (for infections) - **Chronic COPD:** - Oxygen therapy (long-term for hypoxemia) - Bronchodilators - Corticosteroids - Pulmonary rehabilitation - Smoking cessation - Vaccination (influenza and pneumococcal vaccine). - **Nursing Interventions:** - Provide oxygen therapy. - Encourage deep breathing - Position changes - Chest physiotherapy - Encourage rest - Fluid management - Nutritional support - Monitor for respiratory distress. ### **Asthma** - **Definition:** A chronic inflammatory disease of the airways that causes bronchospasm, inflammation, and mucus production. - **Causes:** - Triggers: - Allergens, such as pollen, dust mites, pet dander - Irritants, such as smoke, fumes, and air pollution - Exercise - Cold air - Infections - Stress - Aspirin and other nonsteroidal anti-inflammatory medications - Foods, such as shellfish, peanuts, and eggs - **Clinical Manifestations:** - Wheezing - **Dyspnea:** - Cough - Chest tightness - Cyanosis (in severe cases). - **Diagnostic Tests:** - Pulmonary function tests (spirometry) - Chest X-ray - ABGs - Eosinophil count (in blood or sputum) - **Medical Management:** - **Rescue Therapy:** - Bronchodilators (short-acting beta-agonists), such as albuterol - **Long-Term Control:** - Inhaled corticosteroids - Leukotriene modifiers - Long-acting beta-agonists - Combination inhalers - Oral corticosteroids (for severe exacerbations) - Immunotherapy (allergy shots). - **Nursing Interventions:** - Monitor for respiratory distress. - Administer medications. - Encourage rest - Provide education on asthma triggers and management. ### **Chronic Bronchitis** - **Definition:** Inflammation and irritation of the bronchi, causing excess mucus production and airflow obstruction. - **Causes:** - Smoking - Exposure to inhaled irritants. - Air pollution. - **Clinical Manifestations:** - Productive cough (with thick, yellow or green mucus) - Dyspnea - Wheezing - Chest tightness - Cyanosis (in severe cases) - **Diagnostic Tests:** - Pulmonary function tests (spirometry) - Chest X-ray - ABGs - **Medical Management:** - Bronchodilators - Corticosteroids - Mucolytics - Antibiotics (for infections) - Oxygen therapy (for hypoxemia) - Smoking cessation - Pulmonary rehabilitation - **Nursing Interventions:** - Monitor respiratory status - Encourage deep breathing - Hydration - Chest physiotherapy - Promote rest - Provide education. ### **Asthma vs. COPD** - **Asthma:** Inflammation of the airways with reversible bronchospasm. - **COPD:** Permanent inflammation and airflow obstruction, primarily from smoking. ## **Important Note:** This document is intended for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any health concerns.