Respiratory Disorders of the Lower Respiratory Tract PDF

Lower Respiratory Tract Disorders  Acute Tracheobronchitis An acute inflammation of the mucous membranes of the trachea and the bronchial tree Often precipitated by URTI  Acute Tracheobronchitis Clinical Manifestations (Early): Dry, irritatin...

Lower Respiratory Tract Disorders  Acute Tracheobronchitis An acute inflammation of the mucous membranes of the trachea and the bronchial tree Often precipitated by URTI  Acute Tracheobronchitis Clinical Manifestations (Early): Dry, irritating cough with scan mucoid sputum- initial sign Sternal soreness Fever or chills Night sweats Headache Generalized malaise  Acute Tracheobronchitis Clinical Manifestations (Late): SOB (shortness of breath) Stridor and Wheeze (obstructed airway) Purulent sputum Blood- streaked sputum, in severe cases  Acute Tracheobronchitis Medical Management: Antibiotic treatment (based on C&S), as ordered Analgesic, as ordered Suctioning, as ordered Bronchoscopy  Acute Tracheobronchitis Nursing Management: Encourage increased oral fluid intake – to thin viscous secretions Encourage coughing exercises Emphasize to complete full course of antibiotics Steam inhalation – helps relieve laryngeal and tracheal irritation Apply moist heat to chest to relieve soreness and pain Advise to rest in between activities  Pneumonia Pneumonia is an inflammation of the lung parenchyma  Pneumonia Community- Health care- Hospital- Ventilator- Acquired Associated Acquired Associated Pneumonia Pneumonia Pneumonia Pneumonia (CAP) (HCAP) (HAP) (VAP) Occurs at Occurs in non- Occurs ≥ 48 Occurs ≥ 48 community level hospitalized hours after hours after or within 48 hours patients with admission Intubation after admission extensive health- care contact CA is often multi- drug resistant Classification of Pneumonia  Community- Acquired Pneumonia (CAP) Causative agents: Streptococcus pneumoniae Most common cause of CAP Haemophilus influenzae – frequently affects older adults and those with comorbidity  Community- Acquired Pneumonia Causative agents: Mycoplasma pneumoniae Causes Mycoplasma pneumonia Inflammatory infiltrate is primarily interstitial rather than alveolar Viruses - common in children but not in adults Cytomegalovirus (most common), herpes simplex virus, adenovirus, and respiratory syncytial virus may cause CAP in immunocompromised adults  Community- Acquired Pneumonia Mode of Transmission Droplet spread Transmission precaution Droplet precaution Cough etiquette  Community- Acquired Pneumonia Risk Factors: Immunosuppression Smoking (inc. second - hand smoke) Prolong immobility and shallow breathing pattern Depressed cough reflex Aspiration Presence of NGT, OGT, or ETT Supine positioning in patients unable to protect airway Antibiotic therapy Alcohol intoxication - suppresses reflexes Advanced age Respiratory therapy with improperly cleaned equipment  Community- Acquired Pneumonia PULMONARY CONSOLIDATION A radiologic sign seen when a region of lung tissue is filled with substances (such as pus, Entire lobe (1 or more) is blood, water, stomach contents or cells) instead consolidated of air. Patchy areas of consolidation More common form of pneumonia  Community- Acquired Pneumonia Clinical Manifestations Sudden onset of chills Rapidly rising fever (38.5C to 40.5C) Pleuritic chest pain Tachypnea (RR= 25 to 45 cpm) Shortness of breath Use of accessory muscles Cough Sputum production Orthopnea - SOB when reclining or supine Poor appetite Crackles  Community- Acquired Pneumonia Diagnostics: CXR Reveals areas of consolidation/infiltration Complete Blood Count (+) leukocytosis (elevated WBCs)  Community- Acquired Pneumonia Prevention Vaccination Pneumococcal Conjugate Vaccine(PCV 13) Recommended for all older adult aged 65 years and up, as well as adults 19 years or older with conditions that weaken the immune system  Community- Acquired Pneumonia Medical Management: Hydration - to counter insensible fluid loss Antipyretics, as ordered Warm, moist inhalation- helps relieve bronchial irritation Supplemental oxygen, as ordered if with hypoxemia For viral pneumonia, Same management, except for antibiotics  Pulmonary Tuberculosis (PTB) Tuberculosis is an infectious disease that primarily affects the lung parenchyma About 1 million Filipinos have ACTIVE TB More than 70 Filipinos die of PTB every day  Pulmonary Tuberculosis (PTB) Causative Agent: Mycobacterium tuberculosis Acid- fast aerobic rod Sensitive to heat and UV light Mode of transmission: Airborne Precautions: Airborne Precautions  Community- Acquired Pneumonia Nursing Management Encourage increased oral fluid intake (2-3L/day), unless contraindicated Facilitate chest physiotherapy, as ordered Instruct patient to assume a comfortable position to promote rest and breathing – Semi- Fowler’s Instruct to avoid overexertion Advise small, frequent meals Encourage intake of fluids with electrolytes (Gatorade, Pocari Sweat)  Pulmonary Tuberculosis (PTB) Clinical Manifestations: Cardinal signs: Cough Unexplained fever Unexplained weight loss Night sweats Other signs: Sputum production Hemoptysis  Pulmonary Tuberculosis (PTB) Diagnostics CXR- PA view Screening test for all presumptive cases Sputum GenXpert Primary diagnostic test for PTB Direct Sputum Smear Microscopy (DSSM) Serves as alternative dx tool IF Xpert is not available Mantoux Test Shall only serve as adjuvant when there is doubt in making clinical diagnosis in children Source: National Tuberculosis Program Manual of Procedures 6th Edition  Pulmonary Tuberculosis (PTB) Medical Management: Anti-tuberculosis medications- primary treatment Taken as intensive phase and maintenance phase Adherence is challenging & a must!  Pulmonary Tuberculosis (PTB) Anti-TB Medications: Rifampicin Isoniazid Pyrazinamide Ethambutol Source: National Tuberculosis Program Manual of Procedures 6th Edition  Pulmonary Tuberculosis (PTB) Source: National Tuberculosis Program Manual of Procedures 6th Edition  Pulmonary Tuberculosis (PTB) Nursing Management: Focus on health education  Transmission  Treatment  Precautions  PTB is an infection that can be cured through religious intake of antibiotics for TB.  PTB is transmitted through air  Take medications regularly as advised  Medications may be given for free via health centers  Take medications on an empty stomach for better absorption.  Avoid alcohol intake while on anti-TB  PTB is no longer contagious after 2 to 3 weeks from start of treatment  Cover nose and mouth when coughing, sneezing, or laughing  Observe frequent hand hygiene  Wear mask when advised Sample Patient Education Material: PTB  Pneumothorax A pneumothorax is caused by air entering the pleural cavity Open pneumothorax resulting from collapse of lung due to disruption of chest wall and outside air entering.  Visceral Pleura Parietal Pleura Negative Air Pressure Air fills the lungs HEAVY CAUTION! If humans didn't maintain a slightly negative pressure even when exhaling, their lungs would collapse on themselves because all the air would rush towards the area of lower pressure. Normal Physiology of Inspiration  Pneumothorax Clinical Manifestations: Small pneumothorax: Mild tachycardia Dyspnea Large pneumothorax: Shallow, rapid respirations Dyspnea Air hunger Desaturation Absent breath sounds on affected area (+) air/fluid seen on CXR  Pneumothorax Types of Pneumothorax Spontaneous Pneumothorax Occurs due to the rupture of small blebs (air-filled blisters) located at the apex of the lungs Risk factors: Smoking Tall and thin stature Male gender Family history History of spontaneous pneumothorax  Pneumothorax Types of Pneumothorax Iatrogenic Pneumothorax Occurs due to laceration or puncture of the lung during medical procedures. Cause/s: Transthoracic needle aspiration- most common Thoracentesis Pleural biopsy Tearing during NGT insertion  Pneumothorax Types of Pneumothorax Traumatic Pneumothorax Can occur from either penetrating (open) or non- penetrating (closed) chest trauma. Penetrating chest wound a.k.a. sucking chest wound; air enters the pleural space through the chest wall during inspiration  Pneumothorax Types of Pneumothorax Tension Pneumothorax Occurs when air enters the pleural space but cannot escape. Cause/s: Mechanical ventilation CPR Clamped/occluded chest tubes  Pneumothorax Types of Pneumothorax Tension Pneumothorax Clinical manifestations: Dyspnea Marked tachycardia Tracheal deviation to unaffected side Decreased of absent breath sounds Neck vein distention Cyanosis Profuse diaphoresis  Pneumothorax Types of Pneumothorax Tension Pneumothorax Emergency management Needle decompression TUSUKA ANG AFFECTED SIDE UG STERILE NEEDLE! (Done by trained personnel) Chest tube insertion Supplemental oxygen, as ordered  Chest Wall Trauma Medical Management: If stable and shows minimal air and/or fluid accumulation, no treatment may be necessary as it spontaneously resolves Thoracentesis Chest tube thoracostomy Pleurodesis  Atelectasis Atelectasis refers to closure or collapse of alveoli Microatelectasis - undetectable on CXR Macroatelectasis - includes loss of segmental, lobar, or over all lung volume Atelectasis  Atelectasis Clinical Manifestations: Dyspnea, especially in supine Cough Sputum production Anxiety Tachycardia Tachypnea Pleural pain Decreased breath sounds over affected area Desaturation (SpO2