Respiratory System PDF

Respiratory System WEEK 3 / CLESTER ANN SUAREZ TERMINOLOGY LOWER RESPIRATORY SYSTEM Dyspnea- subjective sensation of breathlessness. - Enables the exchange of gases to regulate serum PaO2, PaCO2,...

Respiratory System WEEK 3 / CLESTER ANN SUAREZ TERMINOLOGY LOWER RESPIRATORY SYSTEM Dyspnea- subjective sensation of breathlessness. - Enables the exchange of gases to regulate serum PaO2, PaCO2, Hemoptysis- coughing of blood and pH. Hypoxemia- PaO2 less than normal 1. BRONCHI Hypoxia- insufficient oxygenation at the cellular level The bronchi are the main airways into the lungs. When Orthopnea- Shortness of breath when reclining position you breathe, air enters your body through your mouth Prefusion- blood flow, carrying O2 and CO2 that passes or nose and passes through the larynx and trachea. The by alveoli. trachea branches into a bronchus in each lung. The Surfactant- fluid secreted by the alveolar cells that bronchi are equipped with tiny, hair-like structures reduces tension and aids in elasticity. called cilia. Cilia help move mucus out of your lungs, Pleura- serous membrane inclosing the lung. keeping the bronchi clean and healthy. Ventilation- movement of AIR, in and out of the lung. 2. BRONCHIOLES Diffusion- movement of gas from area of higher Bronchioles are small, branching air passages inside the concentration to lower concentration. lungs. They serve as conduits for air, connecting the larger bronchi to the alveoli. Alveoli are where gas UPPER RESPIRATORY SYSTEM exchange occurs: oxygen enters the bloodstream, and - Filters, moistens, and warms air during inspiration. carbon dioxide is removed during exhalation. Bronchioles deliver air to a diffuse network of 1. NOSE & NASAL CAVITY approximately 300 million alveoli. The nose serves as the primary entry point for air. Inside the nose, we find the nasal cavity, which filters incoming 3. ALVEOLI air, removing dust and particles; warms and humidifies Alveoli are tiny, air sacs located at the end of the the air before it reaches the lungs; and contains bronchioles. These structures play a crucial role in gas olfactory receptors for our sense of smell. exchange during breathing. In the alveolus, oxygen molecules move through a single layer of lung cells, 2. MOUTH & ORAL CAVITY entering the bloodstream. Simultaneously, carbon The mouth can also serve as an alternate entry point for dioxide (Co2) molecules pass from the bloodstream into air. The oral cavity plays a minor role in respiration but is the alveolus. essential for speech and swallowing. If the nasal passages are blocked, breathing through the mouth becomes essential. 3. PHARYNX (THROAT) The pharynx connects the nasal cavity and mouth to the trachea. It serves as a common pathway for both air and food. The epiglottis, a flap-like structure in the pharynx, prevents food from entering the trachea during swallowing. 4. LARYNX (VOICE BOX) The larynx is a tough, flexible segment of the respiratory ASSESSMENT: (SUBJECTIVE DATA) tract that connects the pharynx (the back of the nose and throat) to the trachea (windpipe). It allows air to DYSPNEA pass through it while preventing food and drink from Characteristic- acute or chronic? ask the patient rate of blocking the airway. dyspnea on scale of 1-10. 5. TRACHEA (WINDPIPE) Associated Factor- productive or not? seasonal or not? History- chronic lung diseases? The trachea is a wide, hollow tube that connects the larynx to the bronchi (airways) of the lungs. Its primary function is to enable airflow to and from the lungs. This CHEST PAIN preparation ensures that the air entering the lungs is at Characteristic-sharp, dull, stabbing or aching? an optimal temperature and humidity level for efficient Associated Factor- inspiration or expiration pain? gas exchange. History- smoking or environment exposure? HAYAHAY | BSN 3E 1 Respiratory System WEEK 3 / CLESTER ANN SUAREZ COUGH Characteristic- dry, hacking, loose, barky, wheezy, or more like clearing the throat? Associated Factor- productive? Consistency, amount, color and odor of the sputum? History- smoking? allergy? HEMOPTYSIS Characteristic- from lung or GI system or upper airway? Associated Factor- was there a salty tastes or burning or bubbling sensation. COMPUTED TOMOGRAPHY SCAN History- trauma or respiratory treatment (chest Cross sectional X-ray of the lungs are taken from many percussion) different angles and process through a computer to create a three-dimensional image. DIAGNOSTIC TEST ARTERIAL BLOOD GAS Measures O2, CO2 and pH of blood, assessing Ventilation PaCO2, metabolic status (ph) and oxygenation (PaO2) Indicating if acidosis or alkalosis, respiratory or metabolic in origin, and if compensated or uncompensated. SPUTUM EXAMINATION Gross appearance, microscopic examination, gram stain, culture and sensitivity, acid-fast bacillus and cytology Deric smear shows presence of WBC, intra and MAGNETIC RESONANCE IMAGING extracellular Bacteria. A non- invasive procedure that uses a powerful magnetic field, radio wave, and a computer to produce Gram Stain shows either the Gram positive of Gram detailed pictures of organs, soft tissue, bone and other negative. internal structures. Culture identifies specific presence of pathogen Acid-fast detect presence of pathogen such as BRONCHOSCOPY Mycobacterium Tuberculosis Direct observation and inspection of upper and lower Cytology identifies abnormal and possible malignant respiratory tract through fiber optic (flexible). cells. PLEURAL FLUID ANALYSIS Pleural fluid is obtained by aspiration (thoracentesis), the fluid is examined for cancerous cells, cellular make GAS EXCHANGE up, chemical content and microorganisms. During external respiration, oxygen-rich air enters RADIOLOGY & IMAGING the alveoli during inhalation Oxygen molecules diffuse across the think alveolar CHEST X-RAY walls into the bloodstream, where they bind to Normal pulmonary tissue is radiolucent and appears hemoglobin in red blood cells black on film. Thus, densities produced by tumors, Simultaneously, carbon dioxide (produced by foreign bodies, and infiltrates can be detected as lighter cellular metabolism) diffuses from the blood into the or white images alveoli During internal respiration, oxygen is delivered to body tissues, and carbon dioxide is removed from the tissues and transported back to the lungs for exhalation. LOWER RESPIRATORY SYSTEM Enables the exchange of gases to regulate serum PaO2, PaCO2 and pH - Bronchi - Bronchioles HAYAHAY | BSN 3E 2 Respiratory System WEEK 3 / CLESTER ANN SUAREZ - Alveoli ARTIFICIAL AIRWAY Oropharyngeal Airway Curved plastic device inserted through the mouth CLINICAL MANIFESTATION and position in posterior pharynx Rhinorrhea (excessive nasal drainage, runny low-grade Short-term use to unconscious patient fever nose) Does not protect against aspiration Nasal congestion Sneezing Nasopharyngeal Airway Pruritus of the nose, roof of the mouth, throat, eyes, and ears Soft rubber tube inserted through the nose into the Low-grade fever posterior pharynx Rhinorrhea and nasal discharge Halitosis, sneezing Laryngeal Airway Mask Tearing watery eyes A tube with a cuffed mask like projection at the “scratchy” or sore throat distal end; inserted through the mouth into the General malaise, chills pharynx; seal the larynx and leaves distal opening Headache and muscle aches just above glottis MANAGEMENT Combitude Antihistamines Airway management device consisting of two Corticosteroid nasal sprays lumens and two inflation cuffs Desensitizing immunizations Symptomatic therapy NURSING CARE Adequate fluid intake and rest 1. Ensure adequate ventilation and oxygenation Prevention of chilling 2. Assess breath sounds every 2 hours. Note and Warm salt-water gargles to soothe the sore throat record NSAIDs to relieve aches and pains Antihistamines are used to relieve sneezing, rhinorrhea, 3. Provide adequate humidity when the natural and nasal congestion humidifying pathway of the oropharynx is bypassed Inhalation of steam or heated, humidified air 4. Provide adequate suctioning of oral secretions to prevent aspiration and decrease oral microbial ACUTE PHARYNGITIS colonization 5. Use clean technique when inserting an oral or naso- A sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, pharyngeal airway, and take it out and clean it with and tonsils hydrogen peroxide and rinse with water at least Commonly referred “sore throat” every 8 hrs CHRONIC PHARYNGITIS RESPIRATORY DISORDER Chronic pharyngitis is a persistent inflammation of the pharynx. It is common in adults, who work in dusty surroundings, use their voice to excess, suffer from chronic cough, or habitually use alcohol and tobacco. DISORDERS OF THE UPPER RESPIRATORY Three types of chronic pharyngitis RHINITIS 1.Hypertrophic - characterized by general thickening and congestion of the pharyngeal mucous membrane A group of disorders characterized by inflammation and irritation of 2. Atrophic - late stage of the first type (the membrane is thin, the mucous membranes of the nose whitish, glistening, and at times winkled) 3. Chronic Granular ("clergyman's sore throat") - characterized ALLERGIC RHINITIS by numerous swollen lymph follicles on the pharyngeal wall Further classified as seasonal rhinitis (occurs during pollen seasons or perennial rhinitis (occurs throughout the year) Commonly associated with exposure to airborne particles such as dust, dander, or plant pollens in people who are allergic to these substances VIRAL RHINITIS (COMMON COLD) Most frequent viral infection in the general population caused by CLINICAL MANIFESTATION coronavirus Fiery-red pharyngeal membrane and tonsils Highly contagious because virus is shed for about 2 days before the Swollen lymphoid follicles symptoms appear and during the first part of the symptomatic phase Enlarged and tender cervical lymph nodes Fever HAYAHAY | BSN 3E 3 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Malaise NURSING INTERVENTIONS (post-op) Sore throat Constant sense of irritation or fullness in the throat In the immediate postoperative period, the most Mucus that collects in the throat comfortable position is prone, with the patient's head Difficulty swallowing Chronic Granular ("clergyman's turned to the side to allow drainage from the mouth and sore throat") - characterized by numerous swollen lymph pharynx follicles on the pharyngeal wall Apply ice collar to the neck Assess for post op bleeding such as frequent swallowing MANAGEMENT Instruct the patient to refrain from coughing and too much talking ❑ Pharmacologic Therapy Ice chips may be given to the patient Alkaline mouthwashes and warm saline solutions are Penicillin is the treatment of choice useful in coping with the thick mucus and halitosis that Cephalosporins may be present after surgery Macrolides Milk and milk products (ice cream and yogurt) may be Gargles with benzocaine may relieve symptoms restricted Nasal sprays or medications containing ephedrine sulfate Provide soft, adequate diet or phenylephrine hydrochloride Instruct the patient to avoid vigorous tooth brushing or Antihistamine decongestant medications gargling Acetaminophen Encourage the use of a cool-mist vaporizer or humidifier in the home NURSING INTERVENTIONS Instruct patient to avoid smoking and heavy lifting or exertion for 10 days Liquid or soft diet is provided during Instruct the patient to avoid contact the acute stage with PERITONSILLAR ABSCESS (QUINSY) others until the fever subsides to prevent the spread of infection Most common major suppurative complication of sore Cool beverages, warm liquids, and prevent the spread of throat/tonsillitis. This collection of purulent exudate between the infection flavored frozen desserts such as Popsicles are tonsillar capsule and the surrounding tissues, including the soft often soothing palate, may develop after an acute tonsillar infection that progress to Avoidance of alcohol, tobacco, secondhand smoke, and a local cellulitis and abscess exposure to cold or to environmental or occupational pollutants CLINICAL MANIFESTATIONS Warm saline gargles or throat irrigations Increase oral fluid intake Severe sore throat, fever trismus (inability to open the Ice collar can relieve severe sore throats mouth), and drooling Instruct the patient about preventive measures Severe pain, raspy voice Odynophagia (a severe sensation of burning, squeezing TONSILITIS AND ADENODITIS pain while swallowing) Dysphagia (difficulty swallowing Acute inflammation/ infection that is usually caused by GABHS Otalgia (pain in the ear), tender and enlarged cervical (group A beta-hemolytic streptococcus) lymph nodes Airway obstruction may occur CLINICAL MANIFESTATIONS Sore throat, fever, snoring and difficulty swallowing Enlarged adenoids may cause mouth-breathing, earache, draining MANAGEMENT ears, frequent head colds, bronchitis, foul- smelling breath, voice Antimicrobial agents (Penicillin) impairment, and noisy respiration Corticosteroid therapy Needle aspirations are performed to decompress the abscess MANAGEMENT Penicillin (first-line therapy) or cephalosporins Tonsillectomy or adenoidectomy is indicated if the patient has had repeated episodes of tonsillitis despite antibiotic therapy NURSING INTERVENTIONS Assist in performing intubation, cricothyroidotomy, or tracheotomy to treat airway obstruction Assist in needle aspiration when indicated Gentle gargling after the procedure with a cool normal saline gargle may relieve discomfort Provide cool liquids Instruct the patient to refrain from or cease smoking It is also important to reinforce the need for good oral hygiene HAYAHAY | BSN 3E 4 Respiratory System WEEK 3 / CLESTER ANN SUAREZ MANAGEMENT Radiation therapy Chemotherapy Surgery: Partial Laryngectomy - A portion of the larynx is removed, along with one vocal cord and the tumor Complication: change in voice quality or hoarseness of voice Total Laryngectomy - Laryngeal structures are removed, LARYNGITIS including the hyoid bone, epiglottis, cricoid cartilage, and two or An inflammation of the larynx, often occurs as a result of voice three rings of the trachea abuse or exposure to dust, chemicals, smoke and other pollutants. Complication: permanent loss of voice, salivary leak, wound Most common cause is virus, bacterial invasion may be secondary infection, stomal stenosis and dysphagia CLINICAL MANIFESTATIONS Hoarseness of voice - initial sign Aphonia (complete loss of voice) Severe cough Throat feels worse in the morning and improves when the patient is in a warmer climate MANAGEMENT Instruct the patient to rest the voice and avoid irritants (including smoking) Inhaling cool steam or an aerosol is provided Administer antibacterial therapy as ordered Topical corticosteroids may be given by inhalation Increased oral fluid intake DISORDERS OF THE LOWER RESPIRATORY CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Refers to a disease characterized by airflow limitation that is not fully reversible. The airflow limitations is generally progressive and is normally associated with an inflammatory response of the lungs due to irritants, COPD includes chronic bronchitis and pulmonary emphysema Diagnostic Criteria: Cough of 3 months for 2 consecutive years CANCER OF THE LARYNX Etiology Most tumors of the larynx are squamous cell carcinoma Men > women, age 60-70 Cigarette smoking and alcohol consumption are associated with laryngeal cancer DIAGNOSTIC PROCEDURE Virtual endoscopy Optical imaging CHRONIC BRONCHITIS CT scan MRI Direct laryngoscope examination Chronic inflammation of the lower respiratory tract characterized by excessive mucous secretion, cough, and dyspnea associated with recurring infections of the lower respiratory CLINICAL MANIFESTATIONS tract characterized by three primary symptoms: chronic cough, Hoarseness of voice for more than 2 weeks sputum production, and dyspnea on exertion Persistent cough and sore throat Dyspnea CLINICAL MANIFESTATIONS Dysphagia Blue bloater Pain radiating to ear and burning sensation in the throat Usually insidious, developing over a period of years Weight loss Presence of a productive cough lasting at least 3 months a year for Enlarged cervical lymph nodes 2 successive years Unilateral nasal obstruction Production of thick, gelatinous sputum; greater amounts produced during superimposed infections Wheezing and dyspnea as disease progresses EMPHYSEMA Complex lung disease characterized by destruction of the alveoli, enlargement of distal airspaces, and a breakdown of alveolar walls. There is a slowly progressive deterioration of lung function for many years before the development of illness HAYAHAY | BSN 3E 5 Respiratory System WEEK 3 / CLESTER ANN SUAREZ CLINICAL MANIFESTATIONS Inhaled and systemic corticosteroids Pink puffer Alpha 1-antitrypsin augmentation therapy Dyspnea, decreased exercise tolerance Antibiotic agents, Mucolytic agents Antitussive agents, vasodilators Cough may be minimal, except with respiratory infection and narcotics Sputum expectoration Barrel chest - Increased anteroposterior diameter of chest due to Surgical Management air trapping with diaphragmatic flattening Bullectomy - surgical removal of enlarged airspaces that do not contribute to ventilation but occupy space in the thorax Lung Volume Reduction Surgery - removal of a portion of the diseased lung parenchyma Nursing Interventions For COPD Pulmonary rehabilitation to reduce symptoms, improve quality of life and increased physical and emotional participation in everyday activities Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the patient control the rate and depth of respiration Instruct the patient to coordinate diaphragmatic breathing with activities such as walking, bathing, bending, or climbing stairs Provide small frequent meals and offer liquid nutritional supplements to improve caloric intake and counteract weight loss Administer low flow of oxygen (1-2L/min) Administer bronchodilator as prescribed Adequately hydrate the patient Instruct the patient to avoid bronchial irritants If indicated, perform CPT int the morning and at night as prescribed Encourage alternating activity with rest periods Teach relaxation technique or provide a relaxation tape for patient Enroll patient in pulmonary rehabilitation program where available Panlobular Emphysema - destruction of respiratory bronchiole, Monitor respiratory status, including rate and pattern of alveolar duct and alveolus respirations, breath sounds, and signs and symptoms of acute › All air spaces within the lobule are essentially enlarged, but there is respiratory distress little inflammatory disease Hyperinflated (hyperexpanded) chest, marked dyspnea on BRONCHIAL ASTHMA exertion, and weight loss typically occurs Chronic inflammatory disease of the airways that causes airway Negative pressure is required during inspiration to move air into hyperresponsiveness, mucosal edema, and mucus production is and out of the lungs reversible and diffuse airway inflammation that leads to airway Expiration becomes active and requires muscular effort narrowing Centrilobular (Centroacinar) Emphysema - pathologic changes Clinical Manifestations take place mainly in the center of the secondary lobule, preserving Three most common symptoms of asthma: the peripheral portions of the acinus - Cough There is a derangement of ventilation-perfusion rations, producing - Dyspnea chronic hypoxemia, hypercapnia, - Wheezing polycythemia, and episodes of right-sided heart failure Chest tightness, diaphoresis, tachycardia, and a widened pulse Leads to central cyanosis and respiratory failure, and patient also pressure, hypoxemia and central cyanosis develops peripheral edema Pharmacologic Therapy There are two general classes of asthma medications: Diagnostic Procedure for COPD Quick relief medications for immediate treatment of asthma Spirometry - used to evaluate airflow obstruction symptoms and exacerbations ABG levels - decreased Pao2, pH, and increased CO2 Short-acting beta2-adrenergic agonists (albuterol [Proventil Chest X-ray - in late stages, hyperinflation, flattened diaphragm, Ventolin], levalbuterol [Xopenex], and pirbuterol [Maxair]) increased retrosternal space, decreased vascular markings, possible Long-acting medications to achieve and maintain control of bullae persistent asthma Alpha-1-antitrypsin assay useful in identifying genetically - Corticosteroids determined deficiency in emphysema Long-acting beta2-adrenegic agonists Leukotriene modifiers (inhibitors) Medical Management for COPD Antileukotrienes, Montelukast (Singulair), zafirlukast (Accolate), Smoking cessation and zileuton (Zyflo) Bronchodilators to relieve bronchospasm HAYAHAY | BSN 3E 6 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Instruct the patient to avoid exposure to people with upper respiratory or other infection Assess nutritional status and ensure adequate diet OCCUPATIONAL LUNG DISEASES 3 TYPES Nursing Interventions Assesses the patient's respiratory status by monitoring the severity of symptoms, breath sounds peak flow, pulse oximetry, and vital signs Administer medications as prescribed and monitor the patient's responses to those medications Administer fluids if the patient is dehydrated emphasize adherence to prescribed therapy, preventive measures, and the need to keep follow-up appointments with health care providers Asbestosis is diffuse interstitial fibrosis of the lung caused by inhalation of asbestos dust and particles. Found in workers involved in manufacture, cutting and demolition of asbestos-containing materials BRONCHIECTASIS Silicosis is a chronic pulmonary fibrosis caused by inhalation of A chronic, irreversible dilation of the bronchi and bronchioles silica dust Etiology Exposure to silica dust is encountered in almost any form of mining Airway obstruction because the earth's crust is composed of silica and silicates (gold, Diffuse airway injury coal, tin, copper mining); also stone cutting, quarrying, manufacture Pulmonary infections and obstruction of the bronchus or of abrasives, ceramics, pottery, and foundry work complications of long-term pulmonary infections Generic disorders such as cystic fibrosis Abnormal host defense (eg, ciliary dyskinesia or humoral immunodeficiency) Idiopathic causes Clinical Manifestations Chronic cough with copious amount of purulent sputum Hemoptysis Sarcoidosis Clubbing of the fingers Granulomatous disease in which clumps of inflammatory epithelial Repeated episodes of pulmonary infection cells occur in many organs, primarily in lungs. Lymph node enlargement seen on chest X-ray Diagnostic Procedure CT scan - reveals bronchial dilation Clinical Manifestations Chronic cough; productive in silicosis Dyspnea on exertion; progressive and irreversible in asbestosis Susceptibility to lower respiratory tract infections Management Bibasal crackles in asbestosis Smoking cessation Chest physiotherapy Bronchoscopy to remove mucopurulent sputum Antimicrobial therapy based on result of culture and sensitivity of the sputum Influenza and pneumococcal vaccines Bronchodilators Surgical interventions for patients who continue to expectorate large amount of sputum and hemoptysis despite adherence to Management treatment regimen There is no specific treatment; exposure is eliminated, and the patient is treated symptomatically Nursing intervention Give prophylactic isoniazid (INH) to patient with positive tuberculin Assess the patient in alleviating the symptoms and in clearing test, because silicosis is associated with high risk of TB pulmonary secretions Persuade people who have been exposed to asbestos fiber to stop Encourage the patient in smoking cessation smoking to decrease risk of lung cancer Educate the patient and his family in performing postural drainage Keep asbestos worker under cancer surveillance; watch for changing cough, hemoptysis, weight loss, melena HAYAHAY | BSN 3E 7 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Bronchodilators may be of some benefit if any degree of airway obstruction is present Nursing Interventions Administer oxygen therapy as required Administer or teach self-administration of bronchodilators as ordered Encourage smoking cessation Advise patient on pacing activities to prevent fatigue Provide information to healthy workers on prevention of occupational lung disease Clinical Manifestations PENETRATING TRAUMA Hyperresonance; diminisher breath sounds Reduced mobility of affected half of thorax Tracheal deviation away from affected side in tension pneumothorax - Clinical picture of open or tension pneumothorax is one of air hunger, agitation, hypotension, cyanosis and profuse diaphoresis Mild to moderate dyspnea and chest discomfort may be present with spontaneous pneumothorax Pneumothorax Pneumothorax occurs when the parietal or visceral pleura is breached, and the pleural space is exposed to positive atmospheric pressure Simple/Spontaneous Pneumothorax Occurs when air enters the pleural space through a breach of either the parietal or visceral pleura. Most commonly, this occurs as Spontaneous pneumothorax air enters the pleural space through the rupture of a bleb or a Treatment is generally nonoperative if pneumothorax is not too bronchopleural fistula extensive. - Observe and allow for spontaneous resolution for less Traumatic Pneumothorax than 50% pneumothorax in otherwise healthy person. A traumatic pneumothorax occurs when air escapes from a - Needle aspiration or chest tube drainage may be laceration in the lung itself and enters the pleural space or from a necessary to achieve re-expansion of collapsed lung if wound in the chest wall, it may result from blunt trauma (eg, rib greater than 50% pneumothorax fractures), penetrating chest or abdominal trauma (eg, stab wounds Surgical intervention by pleurodesis or thoracotomy with resection or gunshot wounds), or diaphragmatic fear of apical blebs is advised for patients with recurrent spontaneous pneumothorax Tension Pneumothorax Open Pneumothorax Immediate decompression to prevent cardiovascular collapse by One form of traumatic pneumothorax. It occurs when a wound in thoracentesis or chest tube insertion to let air escape the chest wall is large enough to allow air to pass freely in and out of Chest tube drainage with underwater-seal suction to allow for full the thoracic cavity with each attempted respiration lung expansion and healing Tension Pneumothorax Open Pneumothorax Occurs when air is drawn into the pleural space from a lacerated Close the chest wound immediately to restore adequate ventilation lung or through a small opening or wound in the chest wall. It may and respiration be a complication of other types of pneumothorax. The air that - Patient is instructed to inhale and exhale gently against a enters the chest cavity with each inspiration is trapped. this causes closed glottis (Valsalva maneuver) as a pressure dressing the lung to collapse and the heart, the great vessels, and the trachea (petroleum gauze secured with elastic adhesive) is to shift toward the unaffected side of the chest (mediastinal shift) applied. This maneuver helps to expand collapsed lung Chest tube is inserted and water-seal drainage set up to permit evacuation of fluid/air and produce re-expansion of the lung Surgical intervention may be necessary to repair trauma HAYAHAY | BSN 3E 8 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Can result in hidden blood Patient may be asymptomatic, dyspneic, apprehensive, or in shock Management Assist with thoracentesis to aspirate blood from pleural space Assist with chest tube insertion and set up drainage system for complete and continuous removal of blood and air Auscultate lungs and monitor for relief of dyspnea Monitor amount of blood loss in drainage - Replace volume with I.V. fluids or blood products (transudate = malaksi,,,, exudate= mahinay) PLEURAL CONDITION PLEURISY (PLEURITIS) Inflammation of both layers of the pleurae (parietal and visceral) May develop in conjunction with pneumonia or an upper respiratory tract infection, TB or collagen disease When the inflamed pleural membranes rub together during respiration (intensified on inspiration), the result is severe, sharp, knifelike pain PLEURAL EFFUSION Collection of fluid (transudate or exudate) in the pleural space, Clinical Manifestations Maybe a complication of heart failure, pulmonary infection or Pleuritic pain during deep breath, coughing or sneezing nephrotic syndrome, Usually caused by underlying disease Pain is limited in distribution rather than diffuse Pleural friction rub can be heard with stethoscope Clinical Manifestations Dyspnea Diagnostic Procedures Difficulty lying on flat Chest X-ray Coughing/fever Sputum Analysis Chills Thoracentesis Pleuritic chest pain Pleural Biopsy Diagnostic Procedure CT scan Lateral Decubitus X-ray Nursing Interventions Management Instruct the patient in heat/cold application for pain relief Treatment of underlying disease Instruct the patient to turn onto the affected side to splint the chest Thoracentesis or chest tube drainage is performed wall and reduce the stretching of the pleurae Surgical pleurectomy for pleural effusion caused by malignancy Teach the patient to use hands or pillow to splint the ribcage while Pleuroperitoneal shunt - fluids from the pleural space is drain into coughing the peritoneum Management Nursing Intervention Treatment of underlying condition causing pleurisy Assist in thoracentesis Topical applications of heat or cold Record the amount of fluid aspirated and send it to the laboratory Indomethacin for pain relief Administer medications as ordered such as analgesics and Intercostal Nerve Block if pain is severe antibiotics Assist the patient in a comfortable position EMPHYEMA THORACIS Accumulation of purulent fluid in the pleural space HEMOTHORAX Occur as complication of bacterial pneumonia, lung abscess or Blood in pleural space as a result of penetrating or blunt chest chest trauma trauma Patient is acutely ill and has signs and symptoms similar to acute Accompanies a high percentage of chest injuries respiratory infection HAYAHAY | BSN 3E 9 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Diagnosis is established by chest CT Main objective is to drain the fluid in the pleural cavity Management Thoracentesis is done if fluid is not too thick Administration of the appropriate antibiotic as determined by the Tube Thoracostomy is done to patients with loculated or results of a Gram stain complicated pleural effusions S. pneumonia Open chest drainage via thoracotomy is done to remove thickened - macrolide antibiotic (azithromycin, clarithromycin, or erythromycin pleura, pus and debris Pseudomonas infection - anti pneumococcal, antipseudomonal beta- lactam Nursing intervention: provide care specific to the method of Treatment of viral pneumonia is primarily supportive drainage of the pleural fluid Oxygen therapy if patient has inadequate gas exchange Complications Shock and respiratory failure Pleural Effusion INFECTIOUS DISEASES OF THE LOWER RESPIRATORY SYSTEM NURSING INTERVENTIONS Encourage coughing and deep breathing after chest physiotherapy, splinting the chest if necessary Maintain semi-Fowler's position Promote hydration (2-3 L/day) to liquefy secretions Teach effective coughing techniques to minimize energy expenditure; plan rest periods Parenchyma – natural healing of the lungs Suction if necessary Instruct client to cover nose and mouth when coughing PNEUMONIA Teach the need to continue entire course of antimicrobial therapy Inflammation of the lung parenchyma caused by various which is usually seven to ten days microorganisms, including bacteria, mycobacteria, fungi and viruses Teach the patient about proper administration of antibiotics and potential side effects Community-Acquired Pneumonia Teach that findings are expected to be less within 48 to 72 hours of Occurs either in the community setting or within the first 48 initial therapy hours after hospitalization or institutionalization Nutritionally enriched drinks or shakes maybe helpful in maintaining nutrition Hospital-Acquired Pneumonia Also known as nosocomial pneumonia, is defined as the onset of PULMONARY TUBERCULOSIS pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the Aspiration Pneumonia body, including the meninges, kidneys, bones and lymph nodes The Refers to the entry pulmonary consequences resulting from entry primary infectious agent, M, tuberculosis, is an acid-fast aerobic rod of endogenous or exogenous substances into the lower airway that grows slowly and is sensitive to heat and ultraviolet light spreads from person to person by airborne transmission Diagnostic Procedure Chest X-ray shows presence/extent of pulmonary disease typically Clinical Manifestations consolidation. Fatigue, anorexia, weight loss, low-grade fever, night sweats Gram stain and culture and sensitivity test of sputum may indicate Some patients have acute febrile illness, chills, and flu-like offending organism symptoms Blood culture detects bacteremia (bloodstream invasion) occurring Cough (insidious onset) progressing in with bacterial pneumonia frequency and producing mucoid or mucopurulent sputum Hemoptysis, chest pain, dyspnea (indicates extensive involvement) Clinical Manifestation Diagnostic Evaluation Sudden onset, rapidly rising fever of 38.3°C to 40.5°C Sputum smear/Sputum culture confirms a diagnosis of TB Cough productive of purulent sputum Chest X-ray to determine presence and extent of disease Pleuritic chest pain aggravated by deep respiration/coughing Tuberculin skin test (purified protein derivative [PPD] or Mantoux Dyspnea, tachypnea accompanied by respiratory grunting, nasal test) flaring use of accessory muscles of respiration fatigue Rapid, bounding pulse Orthopnea Rusty, blood-tinged sputum Poor appetite, diaphoresis HAYAHAY | BSN 3E 10 Respiratory System WEEK 3 / CLESTER ANN SUAREZ Classification Encourage rest and avoidance of exertion - Data from the history, physical examination, TB test, chest Provide nutritional plan that allows for small, frequent meals x-ray, and microbiologic studies are used to classify TB Instruct the patient about important hygiene measures, including into one of five classes. A classification scheme provides mouth care, covering the mouth and nose when coughing and public health officials with a systematic way to sneezing, proper disposal of tissues, and hand washing monitor epidemiology and treatment of the disease Class 0: no exposure; no infection ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Class 1: exposure; no evidence of infection Severe form of acute lung injury. This clinical syndrome is Class 2: latent infection; no disease (eg, positive PPD characterized by a sudden and progressive pulmonary edema, reaction but no clinical evidence of active TB) increasing bilateral infiltrates on chest x-ray, hypoxemia Class 3: disease; clinically active unresponsive to oxygen supplementation regardless of the amount Class 4: disease; not clinically active of Positive End-Expiratory Pressure (PEE) and the absence of an Class 5: suspected disease; diagnosis pending elevated left atrial pressure. Patients often demonstrate reduced lung compliance Clinical Manifestations Typically develops over 4 to 48 hours Severe dyspnea, severe hypoxemia Arterial hypoxemia that does not respond to supplemental oxygen Chest x-ray are similar to those seen with cardiogenic pulmonary edema Increased alveolar dead space Severe crackles and rhonchi heard on auscultation Labored breathing and tachypnea Management Pulmonary TB is treated primarily with antituberculosis agents for 6 to 12 months The initial phase consists of a multiple- medication regime of INH, rifampin, pyrazinamide, and ethambutol and is administered daily for 8 weeks DIAGNOSTICS Continuation phase of treatment include INH and rifampicin and Clinical presentation and history of findings lasts for an additional 4 or 7 months Hypoxemia on ABG despite increasing inspired oxygen level Vitamin B (pyridoxine) is usually Chest x-ray shows bilateral infiltrates administered with INH to prevent IHN-associated peripheral Plasma Brain Natriuretic Peptide (BNP) neuropathy Echocardiography Pulmonary Artery Catheterization FIRST-LINE ANTITUBERCULOSIS MEDICATIONS Commonly Used Adult Daily Most Common Agents Dosage Side Effects Isoniazid (INH) 5 mg/kg (300 mg Peripheral neuritis maximum daily) hepatic enzyme elevation, hepatitis, hypersensitivity Rifampicin 10 mg/kg (600 mg Hepatitis, febrile maximum daily) reaction, purpura Management (rare), nausea, Treatment of the underlying condition vomiting Optimize oxygenation Pyrazinamide 15-30 mg/kg (2.0 g Hyperuricemia, Intubation and mechanical ventilation maximum daily) hepatotoxicity, skin Sedation may be required rash, arthralgias, GI Paralytic agents may be necessary distress Antibiotics, as indicated Ethambutol 15-25 mg/kg (no Optic neuritis (may PEEP usually improves oxygenation (Myambutol) maximum daily lead to blindness; Supportive drugs includes surfactant replacement therapy, dose, but base on very rare at 15 pulmonary antihypertensive agents and antisepsis agent lean body) mg/kg), skin rash Nursing Intervention Nursing Intervention Requires close monitoring in the intensive care unit Instructs the patient to increase fluid intake and about correct Assess the patient's status frequently to evaluate the effectiveness positioning to facilitate airway drainage of the treatment Discuss the medications schedule and side effects of the drugs Turn the patient frequently to improve ventilation and perfusion in Instructs the patient to take the medication either on an empty the lungs and enhance drainage secretions stomach or atleast 1 hour before meals because Res is essential for patient to limit oxygen consumption and reduce food interferes with medication absorption oxygen needs Patients taking INH should avoid foods that contain tyramine and Adequate nutritional support is vital, 35 to 45 kcal/kg/day is histamine because it may result in headache, flushing, hypotension, required to meet caloric requirements lightheadedness, palpitations, and diaphoresis Monitors for side effects of anti-TB drugs HAYAHAY | BSN 3E 11 Respiratory System WEEK 3 / CLESTER ANN SUAREZ - Assess patient for bleeding related to anticoagulant or thrombolytic therapy Advise patient of the possible need to continue taking anticoagulant therapy Monitor for potential complication of cardiogenic shock or right ventricular failure Encourage ambulation and active/passive leg exercises to prevent venous stasis Advise the patient not to sit or lie in bed for prolonged periods, not to cross the legs, and not to wear constrictive clothing PULMONARY EMBOLISM Refers to the obstruction of the pulmonary artery or one of its Clinical Manifestations branches by a thrombus (or thrombi) that originates somewhere in the venous system in the right side of the heart Dyspnea is the most frequent symptom Often associated with trauma, surgery (orthopedic, major Chest pain (sudden and pleuritic), may be substernal and abdominal, pelvic, gynecologic, pregnancy, heart failure, age older any mimic angina pectoris or a myocardial than 50 years, hypercoagulable states, and prolonged immobility Petechiae over the chest Anxiety, fever, tachycardia and apprehension Diagnostic Procedures Cough, diaphoresis, hemoptysis, and syncope. The most Chest x-ray - shows infiltrates, atelectasis, elevation of the frequent sign is tachypnea diaphragm on the affected side ECG - shows sinus tachycardia, PR-interval depression and nonspecific T-wave changes Arterial blood gas analysis - shows hypoxemia and hypocapnia Spiral computed CT scan of the lung Management Treatment goal is to dissolve the existing emboli Improve respiratory and vascular status, anticoagulation therapy, thrombolytic therapy, and surgical intervention Stabilize the cardiopulmonary system Nasal oxygen is administered immediately to relieve hypoxemia, respiratory distress, and central cyanosis Intravenous infusion lines are inserted to establish routes for medications or fluids that will be needed Hypotension is treated by a slow infusion of dobutamine (Dobutrex), which has a dilating effect on the pulmonary vessels and bronchi, or dopamine (Intropin) Small doses of IV morphine or sedatives are administered to relieve patient anxiety, to alleviate chest discomfort, to improve tolerance of the endotracheal tube, and to ease adaptation to the mechanical ventilator Anticoagulant therapy (heparin, warfarin sodium Coumadin has traditionally been the primary method for managing PE Thrombolytic therapy (urokinase, streptokinase, alteplase) is used in treating PE, particularly in patients who are severely compromised Surgical embolectomy is performed if the patient has massive PE Nursing Intervention Monitor oxygen therapy and assess the patient for hypoxia Watch patient for s of discomfort and pain HAYAHAY | BSN 3E 12