Respiratory-Disorders.pdf

Evolve. Adapt. Overcome. CEFI is now ready. RESPIRATORY DISORDERS OF ADULTS NCM 112 PREPARED BY: Niña Mae L. Sumilang, RN  COLLEGE OF NURSING Calayan Educational Foundation, Inc. LEARNING...

Evolve. Adapt. Overcome. CEFI is now ready. RESPIRATORY DISORDERS OF ADULTS NCM 112 PREPARED BY: Niña Mae L. Sumilang, RN  COLLEGE OF NURSING Calayan Educational Foundation, Inc. LEARNING OBJECTIVES: At the end of the lesson, the students would be able to: ⮚ Describe nursing management of patients with respiratory disorders ⮚ Define the disorders according to its cause, pathophysiology, and clinical manifestations. ⮚ Use nursing management in creating a care plan for patients with respiratory disorders. COLLEGE OF NURSING Calayan Educational Foundation, Inc. Rhinitis Pharyngitis TOPICS Tonsillitis UPPER RESPIRATORY TO DISCUSS Laryngitis TRACT DISORDERS Epistaxis COLLEGE OF NURSING Calayan Educational Foundation, Inc.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. ANATOMY AND PHYSIOLOGY Primary Function Provides oxygen Removes carbon dioxide Secondary Function Facilitates sense of smell Produces speech Maintains acid-base balance Maintains body water levels Maintains heat balance  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CENTERS IN BRAIN RESPONSIBLE FOR BREATHING Brain Stem Medulla oblongata Pons come on brain, you gotta breathe Muscles where’s the CO2? Diaphragm Accessory muscles COLLEGE OF NURSING Calayan Educational Foundation, Inc. LET’S MATCH THE BODY PART TO ITS FUNCTION!  COLLEGE OF NURSING Calayan Educational Foundation, Inc. Nose Prevents food from entering the bronchial tree. Sinuses Humidifies, warms, filters inspired air. Pharynx Commonly called the voice box. Larynx Provides resonance during speech. Epiglottis Passageway for respiratory and digestive tract. COLLEGE OF NURSING Calayan Educational Foundation, Inc. WHICH LUNG IS LARGER? UPPER RESPIRATORY DISORDERS  COLLEGE OF NURSING Calayan Educational Foundation, Inc. RHINITIS Classified as seasonal or perennial rhinitis. Inflammation and irritation of the mucous membranes of the nose. Cause: Temperature or humidity change, odor, infection, age, systemic disease, OTC drugs, allergen exposure, dust COLLEGE OF NURSING Calayan Educational Foundation, Inc.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. MEDICAL MANAGEMENT Depends on the cause Antihistamines Decongestant If viral rhinitis – symptomatic treatment Allergic rhinitis – allergy test Desensitizing immunization Corticosteroid nasal spray Bacterial infection – antibiotic Nasal polyps – refer to ENT  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Avoid or reduce exposure to allergens and irritants. Assist patient in taking all medications through health education. Instruct patient to control environment at home and work. Saline nasal sprays or aerosols may be helpful in soothing mucous membranes, softening crusted secretions, and removing irritants. Instruct not to share the spray. If infectious rhinitis, review hand hygiene with the patient. Influenza vaccination for older adult and high-risk population.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. Rhinitis Viral Rhinitis (Common Colds) Rhinosinusitis (Sinusitis) Group of disorders – Acute inflammation of mucous Inflammation of paranasal inflammation and irritation of membranes of nasal cavity sinuses and nasal cavity mucous membrane Rhinorrhea, nasal congestion Nasal congestion, rhinorrhea, Nasal drainage, facial pain, and discharge, sneezing, sneezing, sore throat, general pressure or fullness, cloudy or pruritus, headache malaise colored nasal discharge, symptoms of 10 days or more Environment, allergen Caused by flu Caused by unresolved viral, or bacterial infection or exacerbation of allergic rhinitis. Antihistamine Symptomatic treatment Antibiotic if bacterial (Augmentin) Antibiotic if bacterial Intranasal lavage Decongestant Intranasal corticosteroids  COLLEGE OF NURSING Calayan Educational Foundation, Inc. PHARYNGITIS Sudden painful inflammation of the pharynx, back portion of throat, soft palate, and tonsils. Etiology: Viral infection: adenovirus, influenza virus, Epstein-Barr virus, HSV Poorly ventilated rooms GABHS  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CLINICAL MANIFESTATIONS Fiery-red pharyngeal membrane and tonsils Swollen lymphoid follicles Enlarged and tender cervical lymph node No cough Fever (>38.3C) Malaise Sore throat Occasionally, those infected with GABHS manifest vomiting, anorexia, and scarlatina-form rash with urticaria (Scarlet fever)  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CLINICAL MANIFESTATIONS For streptococcal pharyngitis Painful sore throat Malaise Fever Headache Myalgia Painful cervical adenopathy Nausea Swollen and red tonsils Bad breath is common.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. DIAGNOSTIC FINDINGS RAT to determine presence of microorganism Throat culture  COLLEGE OF NURSING Calayan Educational Foundation, Inc. MEDICAL MANAGEMENT Viral pharyngitis – supportive measures Bacterial pharyngitis – antimicrobial agent (Penicillin V potassium PO x 5 days) If severe sore throats, give analgesic In severe cases, gargle with benzocaine Liquid or soft diet IV fluids  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Symptomatic treatment For those with complications, prompt treatment of antibiotic therapy if needed. Educate patient on reporting worsening condition – dyspnea, drooling, dysphagia, inability to fully open mouth Rest frequently. Proper disposal of used tissues.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Monitor skin for rashes (may indicate communicable disease) Warm saline gargles Ice collar for severe sore throats. Mouth care. Full course of antibiotic therapy in patient with strep throat Avoid sharing of personal belongings. Instruct patient to replace toothbrush.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. Commonly a childhood disorder. TONSILLITIS Frequently serve as the site of acute infection. Etiology: GABHS Epstein-Barr virus  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CLINICAL MANIFESTATIONS Sore throat Fever Snoring Difficulty swallowing Enlarged adenoids Earache, draining ears Frequent head colds Bronchitis Voice impairment Foul-smelling breath  COLLEGE OF NURSING Calayan Educational Foundation, Inc. DIAGNOSTIC FINDINGS Clinical RAT Physical examination Culture  COLLEGE OF NURSING Calayan Educational Foundation, Inc. MEDICAL MANAGEMENT Increased fluid intake Analgesics Salt-water gargle Rest Penicillin for bacterial If chronic tonsillitis - tonsillectomy  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Providing Postoperative Care Monitor for hemorrhage and complications Position in prone with head turned to side Ice collar to the neck. Notify surgeon immediately – vomits large amount of dark or bright- red blood, increased pulse rate and temperature, restless May take water and ice chips if no bleeding Instruct to refrain from too much talking and coughing.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Educating on Self-Care Taking full course of antibiotic prescribed. Alkaline mouthwashes and warm saline solution Sore throat, stiff neck, minor ear pain, and vomiting is common in the first 24 hours. Soft foods must be eaten. Avoid spicy, hot, acidic, milk and milk products. Frequent fluid intake. Avoid smoking, heavy lifting, or exertion for 10 days. Avoid vigorous tooth brushing or gargling.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. May be associated with GERD LARYNGITIS Inflammation of the larynx usually due to voice abuse or exposure to pollutants. Etiology: Virus Associated with allergic rhinitis or pharyngitis Sudden temperature change Dietary deficiency Malnutrition Immunosuppressed state  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CLINICAL MANIFESTATIONS Hoarseness Aphonia Severe cough Throat feels worse in the morning Tickle in the throat made worse by cold air or liquids  COLLEGE OF NURSING Calayan Educational Foundation, Inc. MEDICAL MANAGEMENT Antibacterial therapy Beclomethasone for chronic laryngitis Omeprazole if due to reflux  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Rest the voice Humidified environment Expectorants if with secretions 2-3L daily fluid intake Religiously take medications Report if laryngitis persist for more than 5 days,  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING DIAGNOSES Ineffective airway clearance Acute pain Impaired verbal communication Deficient fluid volume Deficient knowledge  COLLEGE OF NURSING Calayan Educational Foundation, Inc. EPISTAXIS Hemorrhage from the nose due to rupture of tiny vessels. RISK FACTORS: Local infections Systemic infection Dry nasal mucous membranes Nasal inhalation of corticosteroids or drugs Trauma Arteriosclerosis Hypertension Tumor Aspirin use Thrombocytopenia Liver disease  COLLEGE OF NURSING Calayan Educational Foundation, Inc. MEDICAL MANAGEMENT Apply direct pressure Nasal decongestant as vasoconstrictors Cautery for visible bleeding sites Balloon-inflated catheter  COLLEGE OF NURSING Calayan Educational Foundation, Inc. NURSING MANAGEMENT Monitor vital signs Give tissue and emesis basin for excess blood. Assure patient in a calm manner. Assess airway and breathing LOWER RESPIRATORY DISORDERS COLLEGE OF NURSING Calayan Educational Foundation, Inc. Atelectasis TOPICS Acute LOWER RESPIRATORY TO DISCUSS Tracheobronc TRACT DISORDERS hitis  COLLEGE OF NURSING Calayan Educational Foundation, Inc. ATELECTASIS Collapse of alveoli as seen on x- ray. Acute atelectasis is common in postoperative and immobilized individuals.  COLLEGE OF NURSING Calayan Educational Foundation, Inc. ETIOLOGY Blockage such as mucus Foreign body Tumor Postoperative: anesthesia, analgesics, supine, splinting, abdominal distention  COLLEGE OF NURSING Calayan Educational Foundation, Inc. PATHOPHYSIOLOGY Etiology ↓ Obstruction of passage of air from and to alveoli ↓ Trapped alveolar air absorbed into bloodstream ↓ Affected portion of alveoli becomes airless ↓ Alveoli collapse  COLLEGE OF NURSING Calayan Educational Foundation, Inc. CLINICAL MANIFESTATIONS Increasing dyspnea in supine Cough Sputum production Marked respiratory distress if large lung tissue is affected Tachycardia Tachypnea Pleural pain Central cyanosis Pulmonary infection: chronic atelectasis  COLLEGE OF NURSING Calayan Educational Foundation, Inc. DIAGNOSTIC FINDINGS Decreased breath sounds Crackles Xray may reveal patchy infiltrates or consolidated areas