Respiratory Disorders for Nurses 2024 PDF

Internal medicine Respiratory system Prof: Shazly Baghdadi Ali Assist. Prof. OF PULMONOLOGY ASWAN UNIVERSITY  "Respiratory Disorders: Essential Knowledge for Nurses" "Understanding, Management, and Care" Anatomy of the Respiratory System Brief overview...

Internal medicine Respiratory system Prof: Shazly Baghdadi Ali Assist. Prof. OF PULMONOLOGY ASWAN UNIVERSITY  "Respiratory Disorders: Essential Knowledge for Nurses" "Understanding, Management, and Care" Anatomy of the Respiratory System Brief overview of the respiratory system's structure (lungs, bronchi, alveoli, etc.) Function of the respiratory  Common Respiratory Disorders Asthma Chronic Obstructive Pulmonary Disease (COPD) Pneumonia Tuberculosis (TB) Acute Respiratory Distress Syndrome (ARDS) Lung Cancer  Asthma Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty in breathing. It is marked by episodes of wheezing, shortness of breath, chest tightness, and coughing, particularly at night or early in the morning.  Pathophysiology: Airway Inflammation: The airways become inflamed and produce excess mucus. Bronchoconstriction: Smooth muscles around the airways tighten, narrowing the passage. Triggers: Include allergens, cold air, exercise, stress, smoke, and respiratory infections.  Symptoms Wheezing: High-pitched sound during breathing. Dyspnea: Shortness of breath or difficulty breathing. Chest tightness: Feeling of pressure in the chest. Coughing: Often worse at night or early morning.  Diagnosis Spirometry: Measures lung function and the degree of airway obstruction. Peak flow meter: Assesses airflow limitation and can be used for monitoring at home.  Treatment Reliever medications (Bronchodilators): Short- acting beta-agonists (SABAs) like albuterol to relax airway muscles during acute attacks. Controller medications: Inhaled corticosteroids (ICS) to reduce inflammation, long-acting beta- agonists (LABAs), and leukotriene modifiers for long-term management. Education: Ensure patients know how to use inhalers correctly and recognize early signs of exacerbation.  Nursing Care Monitor: Vital signs, lung sounds, and oxygen saturation. Administer: Prescribed medications and monitor for side effects. Educate: On medication adherence, avoiding triggers, and proper inhaler use. Develop action plans: Help patients with individualized asthma management plans.  Complications Asthma Exacerbation: A severe asthma attack that may require hospitalization. Status Asthmaticus: A life- threatening condition where the usual medications do not alleviate symptoms, requiring emergency intervention.  COPD Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease characterized by airflow limitation and difficulty breathing. It includes two main conditions: emphysema (damage to the alveoli) and chronic bronchitis (inflammation of the bronchial tubes).  Pathophysiology: Chronic Inflammation: Causes narrowing of the airways and destruction of lung tissue. Airflow Limitation: Air is trapped in the lungs, making exhalation difficult. Triggers: Include smoking (1ry cause), air pollution, occupational dusts, and genetic factors (e.g.,↓ alpha-1 antitrypsin ).  Symptoms Chronic cough: Often productive, with mucus. Dyspnea: Shortness of breath, especially with exertion. Wheezing: May occur in some cases. Fatigue: Due to ↑ work of breathing. Frequent respiratory infections: Especially in advanced stages  Diagnosis Spirometry: Confirms airflow limitation by measuring FEV1 (Forced Expiratory Volume in one second) and FVC (Forced Vital Capacity). Chest X-ray: Shows hyperinflated lungs and signs of emphysema. Arterial Blood Gas (ABG): Assesses oxygen and CO2 levels in severe cases.  Treatment Bronchodilators: (SABAs) and (LABAs). Inhaled corticosteroids: To ↓inflammation in more severe cases. Oxygen therapy: For patients with advanced COPD and low oxygen levels. Smoking cessation: The most critical intervention to slow disease progression. Pulmonary rehabilitation: exercise training, education, and support to ↑ quality of life.  Nursing Care Monitor: Respiratory status, oxygen saturation, and signs of respiratory distress. Administer: Medications (bronchodilators, corticosteroids) and oxygen therapy as prescribed. Educate: On smoking cessation, proper inhaler use, and energy conservation techniques. Support: Pulmonary rehabilitation and teach breathing techniques (e.g, pursed-lip breathing).  Complications Exacerbations: Acute worsening of symptoms, often triggered by infections, requiring intensified treatment. Respiratory failure: In advanced stages, where oxygen levels become critically low or carbon dioxide levels dangerously high. Cor pulmonale: Right-sided heart failure due to chronic lung disease.  Nursing Role Nurses are essential in monitoring COPD progression providing education on lifestyle changes promoting adherence to treatment to reduce symptoms and improve quality of life  Pneumonia is an infection that inflames the air sacs (alveoli) in one or both lungs, causing them to fill with fluid or pus. It can range from mild to life- threatening, especially in vulnerable populations such as the elderly, infants, and those with weakened immune systems.  Pathophysiology Infection: Bacteria, viruses, or fungi enter the lungs, causing an inflammatory response. Alveolar Filling: Air sacs fill with fluid or pus, impairing gas exchange.  Causes Bacterial: Streptococcus pneumoniae is the most common. Viral: Influenza, respiratory syncytial virus (RSV), or COVID-19. Fungal: Common in immunocompromised patients.  Symptoms Fever and chills: Often with sweating. Cough: Productive or dry. Dyspnea: Difficulty breathing or rapid, shallow breathing. Chest pain: Sharp, especially when breathing or coughing. Fatigue: General weakness and body aches. Confusion: Especially in elderly patients.  Diagnosis Chest X-ray: Shows areas of consolidation (fluid-filled spaces) in the lungs. Sputum culture: Identifies the causative pathogen. Blood tests: May reveal elevated white blood cell count (indicating infection). Pulse oximetry: Assesses oxygen levels in the blood  Treatment Antibiotics: For bacterial pneumonia, e.g., amoxicillin, macrolides. Antivirals: For viral pneumonia (e.g., oseltamivir for flu). Supportive care: Includes oxygen therapy, fluids, rest, and fever reducers. Chest physiotherapy: Helps to clear secretions in some cases  Nursing Care Monitor: Vital signs, especially respiratory rate, oxygen saturation, and temperature. Administer: Prescribed antibiotics/antivirals, antipyretics, and oxygen therapy. Assess: Lung sounds (crackles, wheezes) and signs of respiratory distress. Encourage: Hydration, deep breathing exercises, and use of an incentive spirometer. Positioning: Keep the patient in a semi-Fowler's position to aid breathing.  Complications 1. Sepsis: Severe infection that spreads to the bloodstream. 2. Pleural effusion: Fluid accumulation between the lungs and chest wall. 3. Acute respiratory distress syndrome (ARDS): Severe form of lung failure. 4. Lung abscess: Pus-filled cavity in the lung tissue  Prevention 1. Vaccinations: Pneumococcal vaccine, flu vaccine to prevent common causes of pneumonia. 2. Hand hygiene: To reduce the spread of infections. 3. Smoking cessation: Smoking damages the lungs and increases the risk of pneumonia.  Nurses roles 1. early detection 2. treatment support 3. monitoring for complications, 4. educating patients on preventive measures and recovery strategies.  Tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs but can spread to other organs. It is transmitted through airborne droplets when an infected person coughs or sneezes.  Pathophysiology Infection: The bacteria enter the lungs and can either be contained (latent TB) or become active and multiply (active TB). Spread: TB can spread to other parts of the body, such as the kidneys, spine, and brain. Latent TB: The person is infected but asymptomatic and not contagious. Active TB: The person has symptoms and can spread the disease.  Symptoms Persistent cough: Lasting 3 weeks or longer, often with blood-tinged sputum. Fever: Low-grade, especially in the afternoon or evening. Night sweats: Profuse sweating during sleep. Weight loss: Unexplained weight loss and loss of appetite. Fatigue: General weakness and tiredness. Chest pain: Can occur with breathing or coughing  Diagnosis Tuberculin skin test (TST)/Mantoux test: Injects tuberculin under the skin to check for immune response. Interferon-Gamma Release Assays (IGRAs): Blood tests to detect TB infection. Chest X-ray: Shows lung lesions, cavitations, or infiltrates. Sputum test: Acid-fast bacillus (AFB) smear and culture to confirm TB bacteria.  Treatment First-line drugs: Combination therapy for 6-9 months with: Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), and Ethambutol (EMB). Directly observed therapy (DOT): Ensures patients take medications as prescribed to prevent drug resistance. Isolation: Patients with active TB should be isolated (negative pressure room) until no longer contagious.  Nursing Care Monitor: Respiratory status, weight, and signs of medication side effects (e.g., liver function). Administer: Anti-TB medications as prescribed, ensuring compliance. Infection control: Use personal protective equipment (PPE), including N95 masks, and ensure proper ventilation. Educate: On medication adherence, prevention of disease spread (e.g., covering mouth, proper disposal of tissues), and importance of follow-up care.  Complications Miliary TB: Spread of TB to other organs via the bloodstream. TB meningitis: Infection of the membranes around the brain and spinal cord. Drug-resistant TB: Resistance to standard medications due to incomplete treatment or inappropriate therapy  Prevention BCG vaccine: Given in countries with high TB prevalence to protect against severe forms in children. Screening: Regular screening in high-risk populations (e.g., healthcare workers, immunocompromised individuals). Infection control: Early identification, isolation, and appropriate treatment to prevent transmission.  Acute Respiratory Distress Syndrome (ARDS) (ARDS) is a life-threatening condition in which the lungs are severely inflamed, leading to fluid accumulation in the alveoli and impaired oxygen exchange. It often occurs in critically ill patients as a complication of trauma, infection, or other severe medical conditions.  Pathophysiology Inflammation: Causes increased permeability of the alveolar-capillary membrane, leading to fluid leakage into the alveoli. Impaired Gas Exchange: Fluid-filled alveoli cannot efficiently exchange oxygen and carbon dioxide, leading to hypoxemia (low blood oxygen). Causes: Sepsis, pneumonia, trauma, aspiration, pancreatitis, or inhalation injury.  Symptoms Severe dyspnea: Sudden onset of difficulty breathing, often requiring mechanical ventilation. Tachypnea: Rapid breathing. Hypoxemia: Low oxygen levels, even with oxygen therapy. Cyanosis: Bluish tint to skin, lips, and nails due to poor oxygenation. Crackles: Audible upon lung auscultation due to fluid in the alveoli.  Diagnosis Chest X-ray/CT scan: Shows bilateral lung infiltrates (white-out appearance). Arterial Blood Gas (ABG): Reveals low oxygen levels (PaO2) despite high oxygen delivery. Pulmonary function tests: Reduced lung compliance and difficulty in ventilating the patient. Exclusion of heart failure: Diagnosis is based on lung injury, excluding cardiac causes of fluid buildup (no evidence of left-sided heart failure).  Treatment Mechanical ventilation: Positive end-expiratory pressure (PEEP) is used to keep the alveoli open. Oxygen therapy: High-flow oxygen or ventilator support to maintain adequate oxygen levels. Prone positioning: Improves oxygenation by redistributing lung perfusion and ventilation. Fluid management: Conservative fluid therapy to avoid further lung edema. Treat the underlying cause: Such as antibiotics.  Nursing Care Monitor: Respiratory status, ABGs, vital signs, and oxygen saturation closely. Administer: Sedatives, paralytics (if on mechanical ventilation), and prescribed medications. Prevent complications: Such as ventilator-associated pneumonia (VAP), pressure ulcers, and deep vein thrombosis (DVT). Positioning: Regularly reposition the patient and assist in prone positioning if ordered. Support: Family and patient during critical care, offering emotional support and information.  Complications Multi-organ failure: Due to prolonged hypoxemia. Ventilator-associated lung injury: From long-term mechanical ventilation. Pulmonary fibrosis: Permanent scarring of lung tissue after recovery.  Prognosis Mortality: High, especially in severe cases, but outcomes can improve with early treatment and supportive care. Recovery: Those who survive may experience long-term lung damage or reduced lung function.  Lung Cancer Lung cancer is the uncontrolled growth of abnormal cells in the lungs, which can form tumors and interfere with lung function. It is a leading cause of cancer- related deaths globally and is primarily associated with smoking, though non- smokers can also be affected. Key points for nurses:  Types Non-Small Cell Lung Cancer (NSCLC): The most common type, accounting for 85% of cases. Includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Small Cell Lung Cancer (SCLC): A more aggressive form that spreads quickly, usually linked to smoking.  Risk Factors Smoking: The leading cause, responsible for the majority of cases. Secondhand smoke: Increases risk in non-smokers. Exposure to carcinogens: Such as asbestos, radon, and air pollution. Genetic factors: Family history of lung cancer can increase risk.  Symptoms Persistent cough: Often worsening over time or changing in nature. Hemoptysis: Coughing up blood or rust-colored sputum. Dyspnea: Shortness of breath or difficulty breathing. Chest pain: Worsens with deep breathing, coughing, or laughing. Unexplained weight loss: Along with fatigue and general weakness. Hoarseness: Due to pressure on the laryngeal nerve.  Diagnosis Chest X-ray: Initial imaging to detect masses or nodules in the lungs. CT scan: Provides detailed images to locate tumors and assess spread. Bronchoscopy: Allows for visual inspection and biopsy of lung tissue. Biopsy: Tissue sample analysis to confirm the presence and type of cancer. PET scan: Detects cancer spread (metastasis).  Treatment Surgery: Removal of the tumor (lobectomy, pneumonectomy) if localized and operable. Radiation therapy: Targets and destroys cancer cells, especially in non-surgical cases. Chemotherapy: Systemic treatment to kill cancer cells or shrink tumors, often used for SCLC or advanced NSCLC. Targeted therapy: Uses drugs that target specific genetic mutations in cancer cells. Immunotherapy: Boosts the immune system to attack cancer cells.  Nursing Care Monitor: Respiratory status, signs of infection, pain levels, and nutritional status. Administer: Chemotherapy, radiation, or other treatments as prescribed. Symptom management: Control pain, manage side effects like nausea, and address anxiety or emotional distress. Educate: On smoking cessation, treatment plans, and potential side effects. Support: Provide emotional support and palliative care when needed, focusing on improving the patient’s quality of life.  Complications Metastasis: Lung cancer commonly spreads to the brain, bones, liver, and adrenal glands. Pleural effusion: Fluid buildup around the lungs, causing difficulty breathing. Superior vena cava syndrome: Tumor compression of the superior vena cava, leading to facial swelling and shortness of breath. Paraneoplastic syndromes: Symptoms caused by hormones or substances secreted by tumors, leading to complications such as hypercalcemia.  Prevention Smoking cessation: The most effective way to reduce the risk of lung cancer. Avoid exposure to carcinogens: Reduce contact with asbestos, radon, and harmful pollutants. Regular screenings: For high-risk individuals (e.g., smokers over 50), low- dose CT scans can detect early lung cancer.  Nursing Assessment of Respiratory Patients Assessment Components: Respiratory rate and pattern Oxygen saturation levels Auscultation of lung sounds Monitoring arterial blood gases (ABGs)  Oxygen Therapy in Respiratory Disorders Types of Oxygen Delivery: Nasal cannula Face mask Venturi mask Indications and nursing considerations  Airway Management Importance of maintaining a clear airway Techniques: Suctioning Intubation (in critical care settings) Tracheostomy care  Airway Management Airway Patent give high-flow oxygen  Airway Management Airway Patent give high-flow oxygen At risk suction & give high-flow oxygen  Airway Management Airway Patent give high-flow oxygen suction & give high-flow oxygen At risk OPEN Obstructed maintain asses Secure  Patient Education Smoking cessation Medication adherence (inhalers, nebulizers) Breathing exercises (e.g., diaphragmatic breathing) Recognizing early signs of exacerbation