NUR319 Respiratory Disorders (STUDENT).pptx

RESPIRATORY SYSTEM DISORDERS AND TREATMENT McCance: CH 34- Structure & Function CH 35- Alterations ATI Pharm: CH 17- Upper Resp Disorders CH 16- Airflow Disorders + Acid-Base & ABG Review  Anatomy of the...

RESPIRATORY SYSTEM DISORDERS AND TREATMENT McCance: CH 34- Structure & Function CH 35- Alterations ATI Pharm: CH 17- Upper Resp Disorders CH 16- Airflow Disorders + Acid-Base & ABG Review  Anatomy of the Chest and Thoracic Space  Structure of the Pulmonary System Function of the Pulmonar y System Pulmonary and Bronchial Circulation Mechanics of (1)Majorand accessory muscles of inspiration and expiration: Breathing (1)Diaphragm (2)External intercostal muscles (2)Elastic properties of the lungs and chest wall (3)Resistance to airflow through the conducting airways   Dyspnea  Altered breathing patterns  Hypo/hyper Clinical  Cough Manifestations  Sputum (Hemoptysis) of Pulmonary  Cyanosis/ Hypoxemia Alterations  Nail clubbing  Chest pain  Hypercapnia   Subjective and/or Objective  Transient or Chronic  Dyspnea on exertion (DOE)  Orthopnea  Paroxysmal nocturnal dyspnea Dyspnea (PND)  Nasal flaring  Use of accessory muscles  Retraction   Hypoventilation  Hypercapnia  Respiratory Acidosis Hypo  Neuro or mechanical etiology and Hyperventilatio  Hyperventilation n  Hypocapnia  Respiratory Alkalosis  Severe anxiety, acute head injury, pain   Hypercapnia  Hypoventilation of alveoli  Increased Carbon Dioxide (PaCO2)  Impaired removal of PaCo2 from alveoli through ventilation  Respiratory Acidosis Hypercapnia  Causes: Restrictive and obstructive pulmonary disorders vs.   Drugs (depressants, opioids etc.) Hypoxemia   Head Trauma, CNS infections Spinal Cord injuries, neuromuscular disorders vs. Hypoxia  Hypoxemia vs. Hypoxia  Hypoxemia- Reduced PaO2 in blood Hypoxia- Not enough oxygen in the tissue  Causes:  High altitude, pulmonary edema, pulmonary embolism, fibrosis  Acute Respiratory Failure Upper Respiratory Disorders Common cold  Etiology: rhinovirus  Affects nasopharyngeal tract Acute rhinitis  Inflammation of nasal mucous membranes Sinusitis  Inflammation of mucous membranes of sinuses Acute pharyngitis  Inflammation of throat  Upper Respiratory Disorders COMMON COLD: Contagious period  1-4 days before onset of symptoms  During first 3 days of cold Transmission  Touching contaminated surfaces and then touching nose or mouth  Viral droplets from sneezing Symptoms of common cold  Nasal congestion, nasal discharge, cough, increased mucosal secretions  Upper Respiratory Infections Symptoms Treatment Secretions, runny nose Antihistamines Itchy eyes Intranasal Inflammation of the Glucocorticoids upper respiratory mucosa Nasal Decongestant Nasal congestion Expectorants Sneezing Antitussives Chest Congestion OTC analgesics Cough Fluids Antibiotics  ATI CH 17- Upper Respiratory  The medications in this section work on the CNS, nasal passages, or other parts of the respiratory system to treat the effects of allergic or non-allergic rhinitis or coughs from the common cold, influenza, and other disorders.  Antihistamines, often prescribed for allergic rhinitis, are also used to treat nausea, motion sickness, allergic reactions, and insomnia.  Medications in this section are frequently combined for increased effectiveness. For example, an antitussive is combined with an expectorant to reduce a cough. Antitussives:  Opioids- Codeine, Hydrocodone  Non-Opioid- Dextromethorphan, Benzonatate, Diphenhydramine Expectorant: Guaifenesin Mucolytics: Acetylcysteine Decongestants: Phenylephrine, Ephedrine, Naphazoline, Pseudoephedrine Antihistamines: Diphenhydramine, Promethazine, Loratadine, Cetirizine Nasal Glucocorticoids: Mometasone, Fluticasone, Triamcinolone, Budesonide  Antitussives Treat the Cough Examples:  Nonopioid: Dextromethorphan, Benzonatate (Good for COPD)  Opioid: Hydrocodone, Codeine Therapeutic Uses:  Used for chronic nonproductive cough to decrease the frequency and intensity. Action  Act on the cough-control center in the medulla to suppress the cough reflex and increases cough threshold Complications:  Dizziness, drowsiness, respiratory depression Nursing Considerations:  Vitals (resp), safety, take with food, increase fluids (constipation),  Expectorants Example: Guaifenesin (mucolytic/ Expectorants) Action  Loosens bronchial secretions by reducing surface tension of secretions, Allows elimination by coughing Complications/Side effects  Drowsiness, dizziness, irritability, nausea, sensivity Nursing Considerations:  Take with plenty of water, and food  Mucolytic Example: Acetylcysteine (inhalation), Hypertonic Saline Uses/ Action:  Mucolytics are used in clients who have acute and chronic pulmonary disorders exacerbated by large amounts of secretions.  Mucolytics are used in clients who have cystic fibrosis.  Acetylcysteine (oral or IV) is the antidote for acetaminophen poisoning. Complications/Side effects  Bronchospasms, dizziness, drowsiness, hypotension, tachycardia  Hepatotoxicity Nursing Considerations:  Take with plenty of water, for oral administration consider strong rotten egg odor  Monitor secretions, need for suctioning and respiratory status  Nasal Congestion Nasal congestion  Dilation of nasal blood vessels  Due to infection, inflammation, allergy  Transudation of fluid into tissue spaces  Leads to swelling nasal cavity Nasal decongestants  Stimulate alpha-adrenergic receptors  Produces nasal vascular constriction  Shrinks nasal mucous membranes  Reduces nasal secretion  Use  Allergic rhinitis, hay fever, acute coryza  Nasal Decongestants Examples: Phenylephrine, Ephedrine, Naphazoline, Pseudoephedrine Uses/ Action  Sympathomimetic decongestants stimulate alpha1-adrenergic receptors, causing reduction in the inflammation of the nasal membranes.  Treat nasal congestion Administration  Nasal spray, nasal drops, topical, tablet, capsule, liquid  Short-term treatment (3-5 days), taper off to prevent rebound congestion Side effects/adverse reactions  Nervous, restless  Rebound nasal congestion if use is prolonged  Caution with HTN, and DM  Antihistamines Use  Acute and allergic rhinitis, Common cold, sneezing, cough  Prevent motion sickness, Sleep Aid (Secondary Effect) Action  Competes with histamine for receptor sites and prevents a histamine response.  By blocking the H1 receptor sites, nasopharyngeal secretions and itching sneezing decrease. Antihistamine groups First-generation: Diphenhydramine, Promethazine, Dimenhydrinate Second-generation: Cetirizine, Loratadine, Fexofenadine  Usually have less drowsiness  Usually have fewer anticholinergic symptoms Intranasal: Azelastine, Olopatadine - Antihistamines also are potent muscarinic receptor antagonists - Acetylcholine receptors are part of the muscarinic receptor group - When we block (Antagonist)Acetylcholine we block all over the body and cause Anti-Cholinergic effects  Antihistamines Side Effects/ Complications  Sedation  Anticholinergic effects Contraindications/cautions  Narrow-angle glaucoma  Urinary retention, Severe liver disease Interactions  Increases CNS depression with alcohol and other CNS depressants Nursing Considerations  Take with fluids and food, monitor I & O, bowel function, safety (drowsiness), avoid alcohol and other sedatives *Because of the histamine receptors are found throughout the body, when we block one, we block them all and cause the side effects (primary & secondary)  Intranasal Glucocorticoids Example: Mometasone, Fluticasone, Triamcinolone, Budesonide Action/ Use  Decrease inflammation  Decrease rhinorrhea, sneezing, and congestion  Allergic rhinitis  Can take up 7 days or more for relief Side effects/ Complications  Nosebleed, headache, irritation Nursing Considerations  Education (Metered-dose spray),  Given daily (maintenance not rescue)  Upper Respiratory Health & Nutritional Considerations  Protein and Fiber- Build and maintain strong respiratory muscles  Echinacea- Echinacea is now one of the most popular supplements in Europe for fighting respiratory infections such as the common cold.  Elderberry- boosts the production of some immune cells and may also unblock the flu virus’s ability to spread.  Garlic- immune booster and natural remedy for respiratory disorders  Ginger- packed with antiviral compounds  Oregano Oil- has been shown to work well at treating respiratory illness after it has already developed, and is considered a potent antibiotic and antiviral herb  Vitamin D- Boosts immune system  Vitamin C- Boosts immune system Lower Respiratory Disorders Restrictive or  Restrictive=Limiting volumes Obstructiv  Obstructive= Limiting airflow e   Pneumothorax  Air or gas in the pleural space Disorders  Impaired oxygenation and ventilation Spontaneous or traumatic of the  Primary or Secondary Chest Wall and Pleura  Pleural Effusion  Fluid in the pleural space  5 categories based on mechanism  Pathophysiologic changes Decrease in total lung capacity due to fluid accumulation and loss of elasticity of lung tissues Restrictiv e Lung  Aspiration Diseases  Atelectasis  Bronchiectasis  Bronchiolitis  Pulmonary Fibrosis   Exposure to toxic gases  Pneumoconiosis  Hypersensitivity pneumonitis  Pulmonary edema Inhalation Disorders  Adult Respiratory Distress Syndrome  Acute inflammation, pulmonary edema and persistent hypoxemia despite supplemental oxygen.   Asthma  Most common, heterogenous, familial, inflammation, triggered bronchoconstriction/spasms, Obstructi wheezing ve Lung  Chronic Obstructive Diseases Pulmonary Disease (COPD)  Chronic bronchitis  Emphysema *dyspnea and wheezing   Respiratory infections  Pneumonia Other  Acute bronchitis Disorders of  Tuberculosis the  Abscess Respiratory  Pulmonary Embolism System  Pulmonary Hypertension  Malignancies  ATI CH 16- Airflow Disorders  Medication management usually addresses both inflammation and bronchoconstriction.  These same medications used to treat asthma and manifestations of chronic obstructive pulmonary disease (COPD).  Medications include:  Bronchodilator agents: Beta2‑adrenergic agonists: Albuterol Methylxanthines: Theophylline Inhaled anticholinergics: Ipratropium  Anti‑inflammatory agents: Glucocorticoids: Beclomethasone, prednisone Leukotriene modifiers: Montelukast & Zileuton 32  Bronchodilators  Short-Acting Beta2 Agonists Long-Acting (SABAs) Beta2 Agonists (LABAs) Albuterol Aformoterol Ephedrine Formoterol Epinephrine Idacaterol Levalbuterol Metaproterenol Terbutaline  Activate B2 adrenergic receptors and  Activate B2 adrenergic receptors cause bronchodilation and and cause vasodilation. bronchodilation and  Long term relief vasoconstriction  Acute symptom relief “Rescue” “management” 33  Bronchodilators: Methylxanthines Examples: Theophylline Side effects/adverse effects Dysrhythmias Action Dizziness, headache,  Relaxes smooth muscle of bronchi and Irritability, Nervousness, bronchioles promoting bronchodilation Hyperreflexia GI distress, intestinal bleeding Use Seizure  Asthma (No longer first-line) Insomnia  Oral route used for long-term control Hyperglycemia of COPD or chronic asthma Tachycardia, palpitations Primary hypertension Therapeutic range Secondary Hypotension from the  5-15 mcg/mL Tachycardia  Toxicity greater than 20 34 Methylxanthines 35  Bronchodilators: Anticholinergics Ipratropium bromide (Short-acting), Tiotropium (Long-acting) Use:  Maintenance treatment of bronchospasms associated with COPD  Dilating the Bronchioles  Allergen-induced and exercise-induced bronchospasm  Administered by inhalation only with the HandiHaler device (dry-powder capsule inhaler) Common side effects Anticholinergic effects Nursing Considerations Sugarless candy for dry mouth, rinse mouth after inhalation Do not swallow 36  Bronchodilators Expected Action Side Effects/ Complications  Bronchospasm is relieved.  Tachycardia  Histamine release is inhibited.  Hypo/ Hypertension  Ciliary motility is increased.  Chest pain Therapeutic Uses/ Actions Nursing Considerations   Avoid stimulants (caffeine) Inhaled, short-acting prevention of asthma episode (exercise-  Bronchodilators before inhaled induced) steroids  Inhaled, short-acting treatment for  SABAs for acute symptoms bronchospasm and asthma  LABAs need to be taken daily  Oral, long-acting, long-term control of asthma 37  Glucocorticoids (Steroids) Examples: Beclomethasone, Budesonide, Formoterol (Inhaled) Prednisone (oral), Hydrocortisone, Methylprednisone (IV) Action  Prevent inflammation,  suppress airway mucus production, Reduction in airway mucosa edema Administration  MDI inhaler, tablet, intravenous Side effects  Oral- hyperglycemia, suppression of adrenal gland (cortisol)  Inhaled- hoarseness, candidiasis, osteoporosis, bleeding,  Fluid and Electrolyte imbalance Nursing Considerations  Rinse mouth after inhalation, use spacer, monitor  Taper dose to avoid adrenal imbalance  Weight-bearing exercises, monitor glucose, avoid NSAIDS, monitor stools  Monitor I&O, Potassium levels 38  Leukotriene Modifiers Examples: Zafirlukast, Montelukast, Zileuton Action  Reduce inflammatory process and decrease bronchoconstriction Use  Not for treatment of acute asthmatic attacks  Long-term therapy of asthma in adults and children  Maintenance therapy for chronic asthma  Used for Prophylaxis of exercise-induced bronchospasm Common side effects  Dizziness, headache, confusion  GI distress, depression, weakness, infection, hepatotoxicity Nursing Considerations  Monitor liver function, monitor behavior changes  monitor for interactions with other drugs (potentiates warfarin and theophylline)  Take on an empty stomach, once daily 39  Antimicrobials Trimethoprim-sulfamethoxazole Use Mild to moderate acute exacerbations of chronic bronchitis from infectious causes Give for symptoms that last more then 7 days and/ or fever Collect sputum first 40  COPD and Nutrition How Does Food Relate to Breathing?  Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used; metabolism of fat produces the least. For some people with COPD, eating a diet with fewer carbohydrates and more fat and protein helps them breathe easier.  Choose complex carbohydrates- whole-grain bread and pasta, fresh fruits and vegetables.  Limit simple carbohydrates- table sugar, candy, cake and regular soft drinks 41  COPD and Nutrition  Rest just before eating  Eat more food early in the morning if you're usually too tired to eat later in the day  Avoid foods that cause gas or bloating. They tend to make breathing more difficult  Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets your lungs fill with air and empty out more easily  Consider Calcium Replacement if taking steroids long-term 42  Acid-Base Imbalances Normal arterial blood pH 7.35–7.45 Obtained by arterial blood gas (ABG) sampling Acidosis pH is less than 7.35. Systemic increase in H+ concentration Alkalosis pH is greater than 7.45. Systemic decrease in H+ concentration or excess of base  Metabolic Acidosis pH less than 7.35 PaCO2 normal HCO3 less than 22 mEq/L Causes: Lactic acidosis Renal failure Diabetic ketoacidosis Diarrhea Starvation Treatment Buffering solution administration ( Sodium Bicarb) Treat the underlying cause(s) Correct sodium and water deficits  Metabolic Alkalosis pH greater than 7.45 PaCO2 normal HCO3 greater than 26 mEq/L Causes Prolonged vomiting or Gastric suctioning Excessive bicarbonate intake Hyperaldosteronism with hypokalemia Diuretic therapy Treatment: Sodium chloride, potassium, chloride IV (chloride replaces HCO3−)  Respiratory Acidosis pH less than 7.35 PaCO2 greater than 45 mmHg HCO3 normal Causes Depression of the respiratory center (brainstem trauma, oversedation) Respiratory muscle paralysis Disorders of the chest wall and lung tissue and alveolar hypoventilation Treatment Restore adequate ventilation; may need mechanical ventilation; oxygen therapy  Respiratory Alkalosis pH greater than 7.45 PaCO2 less than 35 mmHg HCO3 normal Causes High altitudes Hypermetabolic states, fever, anemia, and thyrotoxicosis (Hyperthyroid) Early salicylate intoxication Anxiety or panic disorder Hyperventilation Treatment Paper bag; treat hypoxemia and hypermetabolic states  Reading ABG’s PH 7.45 Alkalosis If CO2 matches, then Respiratory (High is acid/ Acidosis) If HCO3 matches, then metabolic (High is base/alkalosis)  Let’s Practice 7.35-7.45 7.35-7.45 pH pH 7.24 LOW 7.24 (low (low acid-high acid-high alk) alk) ACIDOSIS 35-45 35-45 PaCO2 PaCO2 52 mm 52 mm Hg Hg HIGH (low (low alk-high alk-high acid) acid) (Respiratory) ACIDOSIS 22-26 22-26 HCO3 HCO3 24 mEq/L 24 mEq/L (low (low acid- acid- high high alk) alk) (Metabolic) NORMAL