Transition Respiratory

Chapter 22Management of Patients with Upper Respiratory Tract Disorders : 

Chapter 22Management of Patients with Upper Respiratory Tract Disorders

Specific Disorders : 

Specific Disorders Rhinitis Sinusitis Pharyngitis Tonsillitis Peritonisillar abscess Laryngitis

Obstructive Sleep Apnea : 

Obstructive Sleep Apnea Breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum of five times in an hour Excessive daytime sleepiness, inability to concentrate, and irritability Nonsurgical management and change of sleep position Surgical management

Obstructive Sleep Apnea : 

Obstructive Sleep Apnea

Cancer of the Larynx : 

Cancer of the Larynx Categories: Supraglottic: false vocal cords above the vocal cords Glottic: true vocal cords Subglottic: below the vocal cords

Symptoms : 

Symptoms Hoarseness Persistent cough Sore throat or pain and burning in the throat Lump in the neck Later symptoms: dysphagia, dyspnea, unilateral nasal obstruction, persistent hoarseness, persistent ulceration, foul breath Generalized symptoms: weight loss, debilitation, lymphadenopathy, and radiation of pain to the ear

Medical Diagnosis : 

Medical Diagnosis Diagnosis is made by history, physical exam, and laryngoscopic exam and biopsy. CT, MRI, and PET to assess tumor extent and stage and to determine recurrence.

Medical Treatment : 

Medical Treatment Radiation therapy Chemotherapy Surgery Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy

Tracheostomy : 

9 Tracheostomy An opening through the neck into the trachea through which an indwelling tube may be inserted

Potential Collaborative Problems : 

Potential Collaborative Problems Respiratory distress Hemorrhage Infections Aspiration

Preoperative Teaching : 

Preoperative Teaching Instruction regarding the type of procedure and the resultant changes such as changes in speech or permanent loss of speech and changes in airway. Include instruction regarding tubes used postoperatively such as drainage tubes and feeding tubes, and provide general preoperative teaching to prevent postoperative complications. Include planning for postoperative communication and long-term speech rehabilitation. Include the physician, speech therapy, dietary, social work, clinical nurse specialist, and others as required.

Anxiety and Depression : 

Anxiety and Depression Allow asking of questions and provide information. Permit verbalization of feelings. Interventions to reduce anxiety and promote comfort Reassuring manner. Stay with the patient during episodes of anxiety. Relaxation techniques

Maintaining a Patent Airway : 

Maintaining a Patent Airway Semi-Fowler’s or high Fowler’s position to decrease edema Monitor for sign and symptoms of respiratory distress Tracheostomy or laryngectomy tube assessment and care Care of the stoma Suctioning Humidification of air Patient teachingSee Chart 22-9

Communication : 

Communication Plan communication preoperatively Immediate postoperative communication Magic slate Communication board Speech rehabilitation

Management of Chest and Lower Respiratory Tract Disorders : 

Management of Chest and Lower Respiratory Tract Disorders Chapter 23

Pneumonia : 

Pneumonia Inflammatory process Multiple causes Types Community-acquired Nosocomial or hospital-acquired Aspiration

Pneumonia : 

Pneumonia Interventions include: Help client to cough and deep breathe at least every 2 hours. Administer incentive spirometer—chest physiotherapy if complicated. Oxygen therapy (see table 25-1)

Pneumonia : 

Pneumonia Antibiotics Prevent dehydration. Monitor intake and output of fluids. Use bronchodilators, especially beta2 agonists.

Pneumonia Complications : 

Pneumonia Complications Shock Respiratory failure May need hemodynamic and ventilatory support. Atelectasis Pleural effusion.

Pulmonary Tuberculosis : 

Pulmonary Tuberculosis Highly communicable disease caused by Mycobacterium tuberculosis Most common bacterial infection Transmitted via airborne route Initial infection multiplies freely in bronchi or alveoli Increase related to the onset of HIV

Assessment : 

Assessment Diagnosis considered: based on symptoms and result of PPD Bacillus Calmette-Guerin vaccine: Produces positive PPD skin test if received within 10 years Complicates interpretation of TB test CXT+/or screening is the recommendation for know BCG vaccination

PPD Skin Test Procedure : 

PPD Skin Test Procedure Intradermal administration of PPD forearm Must be “read” between 48 and 72 hours To accurately “read” Visual inspection for erythema Tactile inspection to monitor size of induration 10 mm or > area of induration 5mm or > in immunocompromised Consider positive and must be referred

PPD Placement : 

PPD Placement

Confirmation of Disease : 

Confirmation of Disease Positive reaction does not necessarily mean active disease. May indicate exposure to TB or dormant disease Diagnosis confirmed by: Chest X-ray Positive smear for AFB and Sputum culture of Mycobacterium tuberculosis

Interventions : 

Interventions Combination drug therapy Isoniazid Rifampin Pyrazinamide Ethambutol or streptomycin Education Must follow exact drug regimen Proper nutrition Reverse weight loss and lethargy About disease

Pulmonary Emboli : 

Pulmonary Emboli The obstruction of a pulmonary artery or branch by blood clot (thrombus). Most thrombi are blood clots from the veins of the legs. The obstructed area has diminished or absent blood flow. Although this area is ventilated, no gas exchange takes place. Manifestations: Dyspnea, chest pain, tachypnea, tachycardia, anxiety, cough, diaphoresis

Risk Factors for Pulmonary Emboli : 

Risk Factors for Pulmonary Emboli See Chart 23-7 Venous stasis Thrombophebitis Oral contraceptives Constrictive clothing Trauma Foreign bodies

Diagnostics : 

Diagnostics Low to moderate index of suspicion CXR ECG ABGs V/Q scan Peripheral vascular studies High index of suspicion D-dimer Spiral CT Pulmonary angiography

Prevention and Treatment of Pulmonary Emboli : 

Prevention and Treatment of Pulmonary Emboli PreventionSee Chart 23-8 Exercises to avoid venous stasis Early ambulation Anticoagulant therapy Sequential compression devices (SCDs) Treatment Measures to improve respiratory and CV status Anticoagulation and thrombolytic therapy

Umbrella Filter : 

Umbrella Filter

Lung Cancer : 

Lung Cancer A leading cause of cancer deaths worldwide Metastasizes at late-stage diagnosis Staged to assess size and extent of disease Etiology and genetic risk Incidence and prevalence make lung cancer a major health problem. Health promotion and illness prevention is primarily through education strategies and reduced tobacco smoking.

Manifestations of Lung Cancer : 

Manifestations of Lung Cancer Often nonspecific, appearing late in the disease process Chills, fever, and cough Dyspnea Blood-tinged sputum

Treatment : 

Treatment Surgery Lobectomy Pneumonectomy Chemotherapy Radiation

Chest Trauma : 

Chest Trauma Blunt Sternal and Rib fractures Flail chest Pulmonary contusion Penetrating GSW and Stabbing Pneumothorax Cardiac tamponade Subcutaneous emphysema

Chest Drainage : 

Chest Drainage Used to treat spontaneous and traumatic pneumothorax Used postop to re-expand the lung & remove excess air, fluid, blood Types of drainage systems: See Table 25-3 Management: See Chart 25-18 Prevention of cardiopulmonary complications: See Chart 25-19 Patient management Chest drainage management

Chest Tube Drainage System : 

Chest Tube Drainage System

CARE OF PATIENT WITH COPD AND ASTHMA : 

CARE OF PATIENT WITH COPD AND ASTHMA

Chronic Obstructive PulmonaryDisease (COPD) : 

Chronic Obstructive PulmonaryDisease (COPD) Chronic obstructive pulmonary disease (COPD) is a group of conditions causing the chronic or recurrent obstruction of airflow. It can result from the combination of symptoms associated with: Chronic bronchitis Emphysema

Causes : 

Causes The leading cause of COPD is smoking, which can lead to the two most common forms of this disease, emphysema and chronic bronchitis. Rarely, an enzyme deficiency called alpha-1 anti-trypsin deficiency can cause emphysema in non-smokers.

Chronic Bronchitis : 

Chronic Bronchitis Chronic inflammation of the airways Results in overproduction of thick, sticky sputum The walls of bronchi thicken (up to 2x normal thickness) Thickening + excessive sputum = blocked smaller airways & narrowed large airways Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes and patient is more susceptible to respiratory infections.

BronchitisClinical Manifestations : 

BronchitisClinical Manifestations Frequent productive cough, URI, bronchospasm Dyspnea on exertion ? O2 & ?CO2 ? Hypoventilation Cyanosis, Polycythemia Wheezes, rhonchi

Emphysema : 

Emphysema Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion.

Emphysema – Clinical Manifestations : 

Emphysema – Clinical Manifestations Dyspnea Minimal coughing Barrel chest Increased respiratory effort Decreased breath sounds Weight loss

In emphysema, chronic inflammation damages the walls of the alveoli (tiny air spaces in your lungs). Chronic bronchitis is a permanent inflammation and thickening of the walls of your bronchial tubes. Eventually, the tubes narrow, causing shortness of breath and a constant cough that brings up large amounts of mucus. : 

In emphysema, chronic inflammation damages the walls of the alveoli (tiny air spaces in your lungs). Chronic bronchitis is a permanent inflammation and thickening of the walls of your bronchial tubes. Eventually, the tubes narrow, causing shortness of breath and a constant cough that brings up large amounts of mucus.

Diagnostic Procedures : 

CXR Pulmonary Function studies ABG - decreased pao2; Increased pco2 Example for a person with COPD pH 7.36 CO2 55 HCO3 36 (Kidneys compensate by retaining more HCO3) CBC Sputum cultures Diagnostic Procedures

COPD - Complications : 

COPD - Complications Exacerbation of Dx – ? symptoms Acute Respiratory Failure Pneumonia Cor-pulmonale

Cor-Pulmonale : 

Cor-Pulmonale Hypertrophy of the right side of the heart with or without heart failure results from pulmonary hypertension Right side of the heart must work harder S/S-JVD, hepatomegaly, ascities, peripheral edema, weight gain Treated with low flow O2, salt restriction, diuretics

Nursing Interventions : 

Nursing Interventions Health Promotion – stop smoking; Flu & Pneumovax vaccines Drug Tx Bronchodilators Anticholinergic Corticosteroids

Nursing Interventions : 

Nursing Interventions Allow the patient to assume a position of comfort for easiest breathing. Continuously monitor vital signs, including oxygen saturation. O2 therapy Prepare for more aggressive measures in case the patient's condition worsens. Greater ventilatory support may become necessary.

Asthma : 

Asthma Chronic inflammatory disorder of the airway Most common chronic illness Second-hand smoke, contaminants in indoor air, pollutants, viruses, and allergens contribute to asthma Also may be genetic

Asthma : 

Asthma Fast, labored breathing Cough Wheezing Dyspnea Chest tightness

Asthma : 

Asthma Peak expiratory flow rate (PEFR)- identifies when an obstruction is occurring

Asthma : 

Asthma Rescue Medications: Albuterol Xopenex Controller Medications: Serevent Cromolyn Sodium Inhaled corticosteroids (Flovent, Vanceril, Azmacort) Oral leukotriene inhibitors

Status Asthmaticus : 

Status Asthmaticus Life threatening episode of airway obstruction Unresponsive to common treatment Placed in ICU and may require mechanical ventilation