Respiratory System - PowerPoint PPT Presentation

Loading...

PPT – Respiratory System PowerPoint presentation | free to download - id: 3b78ba-ZjFiN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Respiratory System

Description:

Respiratory System * Sentences and phrases * Sarcoidosis may affect the skin, eyes, lungs, liver, spleen, bones, salivary glands, joints, and heart. – PowerPoint PPT presentation

Number of Views:341
Avg rating:3.0/5.0
Slides: 160
Provided by: pptfunCom3
Learn more at: http://pptfun.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Respiratory System


1
Respiratory System
2
Respiratory System Learning Objectives
  • Define terms associated with the respiratory
  • system.
  • Describe diagnostic tests for respiratory
  • system alterations.
  • Describe upper and lower respiratory
  • alterations.
  • Interpret clinical manifestation to determine
  • necessary care for respiratory alterations.

3
Respiratory Objectives cont..
  • Utilize the nursing process in the care and
  • treatment of a client with a respiratory
  • alteration.
  • Describe the process of tracheotomy care,
  • suctioning, and chest physiotherapy.
  • Describe the pharmacological agents and
  • treatments for respiratory system
  • alterations.

4
Respiratory System Objectives cont...
  • Describe nutritional considerations for
  • treating respiratory system alterations.

5
Anatomy and Physiology Review
  • Upper Respiratory Tract
  • Nose and Sinuses
  • Pharynx
  • Larynx
  • Lower Respiratory Tract
  • Trachea
  • Mainstem Bronchi
  • Lobar, Segmental, and Subsegmental Bronchi
  • Bronchioles
  • Aveolar Ducts and Aveoli

6
  • Accessory Muscles of Respiration
  • Respiratory Changes Associated With Aging
  • Physiologic Changes
  • Muscle atrophy of the pharynx and
  • larynx
  • Slackening of the vocal cords
  • Loss of elasticity of the laryngeal
    muscles and
  • cartilages

7
Physiological Changes cont
  • Difficulty in respirations due to loss of and
    lung
  • elasticity and enlargement of the
  • bronchioles, and decrease in the number
  • of aveoli.
  • Respiratory muscles atrophy, rib cage
  • becomes more rigid, and the diaphragm
  • flattens resulting in reduced chest
    movement
  • and ability to inhale and exhale, less
    effective
  • cough, increased work of breathing.

8
Assessment Techniques
  • Collect history of client data on family,
  • personal, smoking, drug use, allergies,
  • place of residence, dietary history,
  • occupational history, and socioeconomic
  • level.
  • Assess current health problems such as
  • cough, sputum production, chest pain, and
  • dyspnea.

9
Physical Assessment
  • Assessment of the Nose and Sinuses
  • Assessment of the pharynx, trachea, and
  • larynx.
  • Assessment of the lung and thorax
  • Inspection
  • Palpitation
  • Percussion
  • Auscultation

10
  • Normal Breath Sounds include bronchial,
  • bronchialvescicular, and vescicular.
  • Adventitious breath sounds include, crackle,
    wheeze, rhonchus, and pleural
  • friction rub.

11
  • Other assessment include, voice sound,
  • bronchophony, whispered pectoriloguy,
  • egophony, skin and mucous membranes,
  • general appearance, and endurance.

12
Psychosocial Assessment
  • Some respiratory problems may be worsened by
    stress.
  • Chronic respiratory disease may cause changes in
    family roles, social isolation, and financial
    problems due to unemployment or disability.
  • Discuss coping mechanism and offer access to
    support systems

13
  • Laboratory Test
  • Blood Test
  • RBC provide data about oxygen transport to
    arterial
    blood the tissues. If hemoglobin deficient,
    hypoxemia results.
  • Arterial Blood Gases measured to determine
    the effectiveness of gas exchange ( PaO2 and
    PaCO2 and acid-base balance
  • Sputum Tests the mucous membrane
  • lining of the lower respiratory tract
    responds to acute
    inflammation by increasing the
    production of secretions, which may contain
    bacterial or malignant cells.

14
Diagnostic Test
  • Radiographic examination
  • Chest radiographic to assess progression of
    disease and response to treatment.
  • Digital chest radiography uses less
  • radiation and useful to assess lung and
  • chest lesions.
  • Fluoroscopy radiograph- used to observe deep
    structures in motion.

15
  • Imaging Procedures
  • CT scan dye is injected to each layer of
    lung is photographed.
  • Magnetic Resonance Imaging (MRI) similar to
    CAT scan without harmful radiation.
  • Pulmonary Function Studies evaluate volumes and
    capacities, flow rates, diffusion, capacity gas
    exchange, airway resistance, and distribution of
    ventilation.
  • Pulse oximetry permits the non-invasive
    measurement of arterial oxygen saturation.

16
  • Pulmonary Angiography an x-ray exam of the
    pulmonary vessels after intravenous
  • administration of a radiopaque dye.
  • Ventilation-Perfusion Scan (Lung Scan) a
    radioactive dye is injected IV and scan is done
  • to view blood flow to the lungs (perfusion).
  • Exercise Testing increases metabolism and gas
    transport as energy is used.
  • Skin Test used to identify infectious, virus
    and fungal.

17
  • Other Invasive Diagnostic Test
  • Endoscopic Examinations
  • Bronchogram radiopaque dye is
  • instilled into the bronchial tree and
  • xrays are taken.
  • Broncoscopy scope inserted to allow
  • visualization of the bronchial tree and
  • biopsy of tissue can be done.

18
  • Thoracentesis aspiration of pleural fluid or
    air from the pleural space.
  • Client preparation for stinging sensation
  • feeling of pressure.
  • Correct position instruct client not to
  • move or cough during procedure.
  • After procedure, sterile dressing applied
  • to puncture site and client positioned on
  • unaffected side.
  • Monitor for complications air embolism,
    hemothorax, pneumothorax, and pulmonary edema.

19
  • Lung Biopsy Performed to obtain tissue for
    histologic analysis, culture, or cytologic exam.
  • Percutnaneous lung biopsy may be done at
    bedside or in radiology. Fluoroscopy, CT, or
    ultrasound often done to visualize area of
    biopsy.
  • Thoracotomy can be done to open the lung to
    obtain tissue specimens.

20
  • Care after biopsy include
  • Assess VS, breath sounds at least q4h
  • for 24hrs
  • Assess for respiratory distress
  • Report reduced or absent breath imme.
  • Monitor for hemoptysis

21
  • Breathing Exercises
  • Deep breathing and coughing
  • Pursed-lip breathing
  • Chest Physiotherapy chest percussion,
    vibration, and postural drainage.
  • Suctioning
  • Humidification and Aerosol Therapy
  • Oxygen Therapy
  • Intermittent Positive-Pressure Breathing
    Treatment
  • Mechanical Ventilation

22
  • Oxygen Therapy
  • Delivered in L/min or FIO2
  • Low Flow Oxygen Therapy
  • Nasal Cannula 24-44 FIO2 _at_ 1- 6
  • liters/min
  • Simple Face Mask 40 - 60 FIO2
  • 5-8L/min
  • Partial Rebreather Mask 60-75 _at_
  • 6-11L/min
  • Non-Rebreather Mask 80 95 FIO2 _at_

23
  • High-flow o2 Delivery System
  • Venturi Mask (Venti Mask)
  • Aerosol Mask
  • Face Mask
  • Tracheostomy Collar
  • T-piece

24



  • High-flow 02 Delivery System
  • Venturi Mask (Venti Mask)
  • Aerosol Mask
  • Face Mask
  • Tracheostomy
  • Collar
  • T-piece

25

  • Drug Therapy
  • Antihistamines
  • Expectorants
  • Antitussives
  • Bronchodilators
  • Corticosteroids
  • Mast Cell Stabilizers

26
  • Fractured Nose resulting from injury.
  • Tx
  • Rhinoplasty removal of excess
  • cartilage and tissue from nose with
  • correction of septal defect if needed.
  • Packing following surg.
  • Place pt in semi-fowlers position to
  • decrease local swelling.
  • Ecchymosis and swelling around eyes/nose
  • Apply cool mist, ice compresses

27
  • Tx cont..
  • Limit Valsava movement
  • Laxative or stool softners
  • Avoid ASA, and NSAIDS
  • Prophylatic antibiotics
  • Humidifiers
  • SMR Submucous (Nasoseptoplasty) -
  • the deviated the nasal mucosa removed (an
    incision is made in the nasal mucosa).

28
  • Epistaxis bleeding from nose.
  • First aid Pt sit down and lean
  • forward. Direct pressure applied for
  • 3 to 5 minutes



29
  • Nasal Polyps Swollen masses of sinus or nasal
    mucosa and connective tissue.
  • Tend to grow and recur
  • Exact cause unk
  • TX
  • Surgical removal
  • Caldwell-Luc procedure or
    ethmoidectomy-
  • an incision is made in the upper gum
    line above the teeth. An opening
    is made between both the sinus
    and the nose to remove the polyps.
  • Polypectomy -
  • Inhaled Steroids
  • Nursing Care monitor for bleeding
  • Pt will usually have a packing for 24
    hrs.

30
  • Cancer of the Nose and Sinuses
  • _ Cancer of the nose or sinuses is rare
    and can be
  • benign or malignant.
  • _ Onset is slow and manisfestations
    resemble sinusitis.
  • _ Local lymph enlargement often occurs
  • on the side with the tumor mass.
  • _ Radiation therapy is the main
    treatment surgery is also form of treatment.

31
  • Facial Trauma
  • _ La Fort I nasoethmoid complex fracture
  • _ Le Fort II maxillary and nosethmoid
  • complex fracture
  • _ Le Fort III combination of I and II plus
  • an orbitalzygoma fracture, often called
  • craniofacial disjunction
  • _ First assessment airway

32
  • Facial Trauma Interventions
  • _ Anticipate the need for emergency
  • intubation, tracheotomy, and
  • cricothyroidotomy.
  • _ Control hemorrhage.
  • _ Assess for extent of injury.
  • _ Treat shock.
  • _ Stabilize the fracture.

33
  • Obstructive Sleep Apnea
  • _ Breathing disruption during sleep that
  • last 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 and change of sleep
  • position.

34
  • Disorders of the Larynx
  • _ Vocal cord paralysis
  • _ Vocal cord nodules and polyps
  • _ Laryngeal trauma

35
  • Upper Airway Obstruction
  • _ Life-threatening emergency in which an
  • interruption in airflow through the
  • nose, mouth, pharynx, or larynx
  • occurs.
  • _ Early recognition is essential to prevent
  • further complications, including
  • respiratory arrest.

36
  • Upper Airway Obstruction Interventions
  • _ Interventions include
  • - Assessment for cause of the
  • obstruction.
  • _ Maintenance of patent airway and
  • ventilation.
  • - Cricothyroidotomy
  • - Endotracheal intubation
  • - Tracheostomy

37
  • Neck Trauma
  • _ Neck trauma may be caused by a knife,
  • gunshot, or traumatic accident.
  • _ Assess for other injuries including
  • cardiovascular, respiratory, intestinal,
  • and neurologic damage.
  • _ Assess for patent airway.
  • _ Assess carotid artery and esophagus.
  • _ Assess for cervical spine injuries and
    prevent
  • excess neck movement.

38
  • Head and Neck Cancer
  • _ Head and neck cancer can disrupt
  • breathing, eating, facial appearance,
  • self-image, speech, and
  • communication.
  • _ In laryngeal cancer, hoarsness may
  • occur because of tumor bulk and
  • inability of the vocal cords to come
  • together for normal phonation.

39
  • Ineffective Breathing Pattern
  • _ Interventions include
  • - Treatment goal to remove or
  • eradicate the cancer while preserving
  • as much normal function as possible.
  • - Nonsurgical management
  • - Chemotherapy

40
  • Surgical Management
  • _ Laryngectomy (total and partial)
  • _ Tracheostomy
  • _ Oropharyngeal cancer resection
  • _ Cordal stripping
  • _ Cordectomy

41
  • Preoperative Care
  • _ Client and family teaching about the
  • tumor
  • _ Self-care of airway
  • _ Methods of communication
  • _ Suctioning
  • _ Pain control methods
  • _ Critical care environment
  • _ Nutritional support
  • _ Goals for discharge

42
  • Postoperative Care
  • _ Monitor airway patency, vital signs,
  • hemodynamic status, comfort level.
  • _ Monitor for hemorrhage.
  • _ Assess for complications.
  • - Airway obstruction
  • - Hemorrhage
  • - Wound breakdown
  • - Tumor recurrence

43
  • Pain Management
  • _ Morphine
  • _ Acetaminophen with codeine
  • _ Acetaminophen alone
  • _ Nonsteroidal anti-inflammatory drugs

44
  • Nutrition
  • _ Nasogastric
  • _ Gastrostomy
  • _ Jejunostomy
  • _ Parenteral nutrition until the
  • gastrointestinal tract recovers from the
  • effects of anesthesia
  • _ No aspiration after total laryngectomy
    because
  • the airway and esophagus are completely
  • separated.

45
  • Speech Rehabilitation
  • _ Writing or using picyure board
  • _ Artificial larynx
  • _ Esophageal speech sound produced by
  • burping the air is swallowed or
  • injected into the esophageal pharynx
  • and shaping the words in the mouth.
  • _ Mechanical devices ( electrolaynges)
  • _ Traceoesophageal fistula

46
  • Risk for aspiration
  • _ Interventions include
  • _ Dynamic swallow study
  • _ Enteral feedings
  • _ Routine reflux precautions
  • - elevation of the head of bed
  • - Strict adherence to tube feeding
  • regimen
  • - No bolus feeding at night
  • - Checking residual feeding

47
  • Obstructive Sleep Apnea breathing disruption
    during sleep lasting 10 sec. occurring at least 5
    times in an hr.
  • Contributing Factors include obesity, a large
    uvula, short neck, smoking, enlarged tonsils or
    adenoids, and edema of oropharyngeal.

48
  • S/S Pt c/o persistent daytime sleepiness or
    c/o waking up tired. Irritability and personality
    changes.
  • Diagnostic test include a PSG which is a study
    of sleep at night.
  • Tx include nonsurgical and surgical management.
  • Nonsurgical NPPV, BiPAP, CPAP

49
  • Drug Therapy Xyrem, a CNS depressant inducing
    sleep.
  • Provigil promotes daytime wakefulness.
  • Surgical Tx Adenoidectomy, Uvulectomy,
    Remodeling of the entire posterior oropharynx
    called a Uvulopalatopharyngoplasty (UPP)
  • Tracheostomy may be done if needed.

50
  • Vocal Cord Nodules and Polyps
  • Tx aimed at educating the pt and family about
    smoking hazard and smoking-cessation programs and
    the importance of voice rest.
  • No whispering and avoid straining.
  • Speech therapy
  • Laser or surgical resection to remove nodules
    and polyps.

51
  • Airway Obstruction Disorders
  • Tongue edema
  • Occlusion of the tongue
  • Laryngeal edema
  • Peritonsillar and laryngeal abscess
  • Head and neck cancer
  • Thick secretions
  • Stroke and cerebral edema
  • Smoke inhalation edema
  • Facial, tracheal, or laryngeal trauma
  • Foreign-body aspiration
  • Burns of head and neck
  • Anaphylaxis

52
  • Management include observe for signs of
    respiratory distress such as hypoxia,
    hypercarbia, restlessness, increasing anxiety,
    sternal retractions, a seesawing chest,
    abdominal movements, or a feeling of impending
  • doom related to air hunger
  • Pulse oximeter 02 sat monitoring

53
  • Management cont
  • Assess cause of obstruction
  • May require emergency procedure
  • Cricothyroidotomy a stab wound at
  • the cricothyroid membrane between
  • the thyroid

54
  • Interventions for Clients with Noninfectious
    Problems of the Lower Respiratory Tract

55
Chronic Airflow Limitation
  • Chronic lung diseases of chronic airflow
    limitation include
  • Asthma
  • Chronic bronchitis
  • Pulmonary emphysema
  • Chronic obstructive pulmonary disease includes
    emphysema and chronic bronchitis characterized by
    bronchospasm and dyspnea.

56
Asthma
  • Intermittent and reversible airflow obstruction
    affects only the airways, not the alveoli.
  • Airway obstruction occurs due to inflammation and
    airway hyperresponsiveness.

57
(No Transcript)
58
Aspirin and Other NonsteroidalAnti-Inflammatory
Drugs
  • Incidence of asthma symptoms after taking aspirin
    and other nonsteroidal anti-inflammatory drugs
    (NSAIDs)
  • However, response not a true allergy
  • Results from increased production of leukotriene
    when other inflammatory pathways are suppressed

59
Collaborative Management
  • Assessment
  • History
  • Physical assessment and clinical manifestations
  • No manifestations between attacks
  • Audible wheeze and increased respiratory rate
  • Use of accessory muscles
  • Barrel chest from air trapping

60
Laboratory Assessment
  • Assess arterial blood gas level.
  • Arterial oxygen level may decrease in acute
    asthma attack.
  • Arterial carbon dioxide level may decrease early
    in the attack and increase later indicating poor
    gas exchange.
  • (Continued)

61
Laboratory Assessment (Continued)
  • Atopic asthma with elevated serum eosinophil
    count and immunoglobulin E levels
  • Sputum with eosinophils and mucous plugs with
    shed epithelial cells

62
Pulmonary Function Tests
  • The most accurate measures for asthma are
    pulmonary function tests using spirometry
    including
  • Forced vital capacity (FVC)
  • Forced expiratory volume in the first second
    (FEV1)
  • Peak expiratory rate flow (PERF)
  • Chest x-rays to rule out other causes

63
Interventions
  • Client education asthma is often an intermittent
    disease with guided self-care, clients can
    co-manage this disease, increasing symptom-free
    periods and decreasing the number and severity of
    attacks.
  • Peak flow meter can be used twice daily by
    client.
  • Drug therapy plan is specific.

64
Drug Therapy
  • Pharmacologic management of asthma can involve
    the use of
  • Bronchodilators
  • Beta2 agonists
  • Short-acting beta2 agonists
  • Long-acting beta2 agonists
  • Cholinergic antagonists
  • (Continued)

65
Drug Therapy (Continued)
  • Methylxanthines
  • Anti-inflammatory agents
  • Corticosteroids
  • Inhaled anti-inflammatory agents
  • Mast cell stabilizers
  • Monoclonal antibodies
  • Leukotriene agonists

66
Other Treatments for Asthma
  • Exercise and activity is a recommended therapy
    that promotes ventilation and perfusion.
  • Oxygen therapy is delivered via mask, nasal
    cannula, or endotracheal tube in acute asthma
    attack.

67
Status Asthmaticus
  • Status asthmaticus is a severe, life-threatening
    acute episode of airway obstruction that
    intensifies once it begins and often does not
    respond to common therapy.
  • If the condition is not reversed, the client may
    develop pneumothorax and cardiac or respiratory
    arrest.
  • Emergency department treatment is recommended.

68
Emphysema
  • In pulmonary emphysema, loss of lung elasticity
    and hyperinflation of the lung
  • Dyspnea and the need for an increased respiratory
    rate
  • Air trapping, loss of elastic recoil in the
    alveolar walls, overstretching and enlargement of
    the alveoli into bullae, and collapse of small
    airways (bronchioles)

69
(No Transcript)
70
Classification of Emphysema
  • Panlobular destruction of the entire alveolus
  • Centrilobular openings occurring in the
    bronchioles that allow spaces to develop as
    tissue walls break down
  • Paraseptal confined to the alveolar ducts and
    alveolar sacs

71
Chronic Bronchitis
  • Inflammation of the bronchi and bronchioles
    caused by chronic exposure to irritants,
    especially tobacco smoke
  • Inflammation, vasodilation, congestion, mucosal
    edema, and bronchospasm
  • Affects only the airways, not the alveoli
  • Production of large amounts of thick mucus

72
Complications
  • Chronic bronchitis
  • Hypoxemia and acidosis
  • Respiratory infections
  • Cardiac failure, especially cor pulmonale
  • Cardiac dysrhythmias

73
Physical Assessment and Clinical Manifestations
  • Unplanned weight loss loss of muscle mass in the
    extremities enlarged neck muscles slow moving,
    slightly stooped posture sits with forward-bend
  • Respiratory changes
  • Cardiac changes

74
(No Transcript)
75
Laboratory Assessment
  • Status of arterial blood gas values for abnormal
    oxygenation, ventilation, and acid-base status
  • Sputum samples
  • Hemoglobin and hematocrit blood tests
  • Serum alpha1-antitrypsin levels drawn
  • Chest x-ray
  • Pulmonary function test

76
Impaired Gas Exchange
  • Interventions for chronic obstructive pulmonary
    disease
  • Airway management
  • Monitoring client at least every 2 hours
  • Oxygen therapy
  • Energy management

77
Drug Therapy
  • Beta-adrenergic agents
  • Cholinergic antagonists
  • Methylxanthines
  • Corticosteroids
  • Cromolyn sodium/nedocromil
  • Leukotriene modifiers
  • Mucolytics

78
Surgical Management
  • Lung transplantation for end-stage clients
  • Preoperative care and testing
  • Operative procedure through a large midline
    incision or a transverse anterior thoracotomy
  • Postoperative care and close monitoring for
    complications

79
Ineffective Breathing Pattern
  • Interventions for the chronic obstructive
    pulmonary disease client
  • Assessment of client
  • Assessment of respiratory infection
  • Pulmonary rehabilitation therapy
  • Specific breathing techniques
  • Positioning to help alleviate dyspnea
  • Exercise conditioning
  • Energy conservation

80
Ineffective Airway Clearance (Continued)
  • Postural drainage in sitting position when
    possible
  • Tracheostomy

81
Imbalanced Nutrition
  • Interventions to achieve and maintain body
    weight
  • Prevent protein-calorie malnutrition through
    dietary consultation.
  • Monitor weight, skin condition, and serum
    prealbumin levels.
  • Address food intolerance, nausea, early satiety,
    loss of appetite, and meal-related dyspnea

82
(No Transcript)
83
Anxiety
  • Interventions for increased anxiety
  • Important to have client understand that anxiety
    will worsen symptoms
  • Plan ways to deal with anxiety

84
Health Teaching
  • Instruct the client
  • Pursed-lip and diaphragmatic breathing
  • Support of family and friends
  • Relaxation therapy
  • Professional counseling access
  • Complementary and alternative therapy

85
Activity Intolerance
  • Interventions to increase activity level
  • Encourage client to pace activities and promote
    self-care.
  • Do not rush through morning activities.
  • Gradually increase activity.
  • Use supplemental oxygen therapy.

86
Health Teaching
  • Instruct the client
  • Pursed-lip and diaphragmatic breathing
  • Support of family and friends
  • Relaxation therapy
  • Professional counseling access
  • Complementary and alternative therapy

87
Activity Intolerance
  • Interventions to increase activity level
  • Encourage client to pace activities and promote
    self-care.
  • Do not rush through morning activities.
  • Gradually increase activity.
  • Use supplemental oxygen therapy.

88
Potential for Pneumonia or Other Respiratory
Infections
  • Risk is greater for older clients
  • Interventions include
  • Avoidance of large crowds
  • Pneumonia vaccination
  • Yearly influenza vaccine

89
Cystic Fibrosis
  • Genetic disease affecting many organs, lethally
    impairing pulmonary function
  • Present from birth, first seen in early childhood
    (many clients now live to adulthood)
  • Error of chloride transport, producing mucus with
    low water content
  • Problems in lungs, pancreas, liver, salivary
    glands, and testes

90
Nonpulmonary Manifestations
  • Adults usually smaller and thinner than average
    owing to malnutrition
  • Abdominal distention
  • Gastroesophageal reflux, rectal prolapse,
    foul-smelling stools, steatorrhea
  • Vitamin deficiencies
  • Diabetes mellitus

91
Pulmonary Manifestations
  • Respiratory infections
  • Chest congestion
  • Limited exercise tolerance
  • Cough and sputum production
  • Use of accessory muscles
  • Decreased pulmonary function
  • Changes in chest x-ray result
  • Increased anteroposterior diameter of chest

92
Exacerbation Therapy
  • Avoid mechanical ventilation
  • Airway clearance
  • Increased oxygenation
  • Antibiotic therapy
  • Heliox (50 oxygen, 50 helium) therapy
  • Bronchodilator and mucolytic therapies

93
Surgical Therapy
  • Lung and/or pancreatic transplantation do not
    cure the disease the genetic defect in chloride
    transport and the thick, sticky mucus remain.
  • Transplantation extends life by 10 to 20 years.
  • Single-lung transplant as well as double-lung
    transplantation is possible.

94
Primary Pulmonary Hypertension
  • The disorder occurs in the absence of other lung
    disorders, and its cause is unknown although
    exposure to some drugs increases the risk.
  • The pathologic problem is blood vessel
    constriction with increasing vascular resistance
    in the lung.
  • The heart fails (cor pulmonale).
  • Without treatment, death occurs within 2 years.

95
Interventions
  • Warfarin therapy
  • Calcium channel blockers
  • Prostacyclin agents
  • Digoxin and diuretics
  • Oxygen therapy
  • Surgical management

96
Interstitial Pulmonary Disease
  • Affects the alveoli, blood vessels, and
    surrounding support tissue of the lungs rather
    than the airways
  • Restrictive disease thickened lung tissue,
    reduced gas exchange, stiff lungs that do not
    expand well
  • Slow onset of disease
  • Dyspnea common

97
Sarcoidosis
  • Granulomatous disorder of unknown cause that can
    affect any organ, but the lung is involved most
    often
  • Autoimmune responses in which the normally
    protective T-lymphocytes increase and damage lung
    tissue
  • Interventions (corticosteroids) lessen symptoms
    and prevent fibrosis

98
Idiopathic Pulmonary Fibrosis
  • Common restrictive lung disease
  • Example of excessive wound healing
  • Inflammation that continues beyond normal healing
    time, causing extensive fibrosis and scarring
  • Mainstays of therapy corticosteroids, which slow
    the fibrotic process and manage dyspnea

99
Occupational Pulmonary Disease
  • Can be caused by exposure to occupational or
    environmental fumes, dust, vapors, gases,
    bacterial or fungal antigens, or allergens
  • Worsened by cigarette smoke
  • Interventions special respirators that ensure
    adequate ventilation

100
Lung Cancer
  • A leading cause of cancer deaths worldwide
  • Metastasizes at late-stage diagnosis
  • Paraneoplastic syndromes
  • Staged to assess size and extent of disease
  • Etiology and genetic risk
  • (Continued)

101
Lung Cancer (Continued)
  • Incidence and prevalence make lung cancer a major
    health problem.
  • Health promotion and illness prevention is
    primarily through education strategies and
    reduced tobacco smoking.

102
Manifestations of Lung Cancer
  • Often nonspecific, appearing late in the disease
    process
  • Chills, fever, and cough
  • Assess sputum
  • Breathing pattern
  • Palpation
  • Percussion
  • Auscultation

103
Surgical Management
  • Lobectomy
  • Pneumonectomy
  • Segmentectomy (wedge resection)

104
Chest Tubes
  • Placement after thoracotomy
  • Drainage system
  • Care required
  • Monitor hourly to ensure sterility and patency.
  • Tape tubing junctions.
  • Keep occlusive dressing at insertion site.
  • Position correctly to prevent kinks and large
    loops.

105
Interventions for Palliation
  • Oxygen therapy
  • Drug therapy
  • Radiation therapy
  • Laser therapy
  • Thoracentesis and pleurodesis
  • Dyspnea management
  • Pain management

106
  • Interventions for Clients with Infectious
    Problems of the Lower Respiratory Tract

107
Rhinitis
  • Inflammation of the nasal mucosa
  • Often called hay fever or allergies
  • Interventions include
  • Drug therapy antihistamines and decongestants,
    antipyretics, antibiotics
  • Complementary and alternative therapy
  • Supportive therapy

108
Sinusitis
  • Inflammation of the mucous membranes of the
    sinuses
  • S/S include pain or feeling of heaviness over the
    affected area.
  • Pain may seem like a toothache.
  • Headache is common.
  • (Continued)

109
Sinusitis (Continued)
  • Nonsurgical management
  • Broad-spectrum antibiotics
  • Analgesics
  • Decongestants
  • Steam humidification
  • Hot and wet packs over the sinus area
  • Nasal saline irrigations

110
Surgical Management
  • Antral irrigation
  • Caldwell-Luc procedure
  • Nasal antral window procedure
  • Endoscopic sinus surgery

111
Pharyngitis
  • Sore throat is common inflammation of the mucous
    membranes of the pharynx.
  • Assess for odynophagia, dysphagia, fever, and
    hyperemia.
  • Strep throat can lead to serious medical
    complications.
  • Epiglottitis is a rare complication of
    pharyngitis.

112
  • Treatment include rest, fluids, analgesics, and
    throat gargles or irrigations.
  • A soft diet may be ordered because of painful
    swallowing.
  • Humidifier to increase moisture in the room
    air.
  • Antibiotics, usually penicillin or
    erythromycin while awaiting results of cultures.

113
Tonsillitis
  • Inflammation and infection of the tonsils and
    lymphatic tissues located on each side of the
    throat
  • Contagious airborne infection, usually bacterial
  • Antibiotics therapy for 7 to 10 days.
  • Analgesics and anesthetic lozenges for pain
  • Warm saline gargles or irrigations
  • Surgical intervention

114
Peritonsillar Abscess
  • Complication of acute tonsillitis
  • Pus behind the tonsil, causing one-sided swelling
    with deviation of the uvula
  • Trismus and difficulty breathing
  • Percutaneous needle aspiration of the abscess
  • Completion of antibiotic regimen

115
Laryngitis
  • Inflammation of the mucous membranes lining the
    larynx, possibly including edema of the vocal
    cords
  • Acute hoarseness, dry cough, difficulty
    swallowing, temporary voice loss (aphonia)
  • Voice rest, steam inhalation, increased fluid
    intake, throat lozenges
  • Therapy relief and prevention

116
Influenza
  • Flu is a highly contagious acute viral
    respiratory infection.
  • Manifestations include severe headache, muscle
    ache, fever, chills, fatigue, weakness, and
    anorexia.
  • Vaccination is advisable.
  • Antiviral agents may be effective.

117
Pneumonia
  • Excess of fluid in the lungs resulting from an
    inflammatory process
  • Inflammation triggered by infectious organisms
    and inhalation of irritants
  • Community-acquired infectious pneumonia
  • Nosocomial or hospital-acquired
  • Atelectasis
  • Hypoxemia

118
Laboratory Assessment
  • Gram stain, culture, and sensitivity testing of
    sputum
  • Complete blood count
  • Arterial blood gas level
  • Serum blood, urea nitrogen level
  • Electrolytes
  • Creatinine

119
Impaired Gas Exchange
  • Interventions include
  • Cough enhancement
  • Oxygen therapy
  • Respiratory monitoring

120
Ineffective Airway Clearance
  • Interventions include
  • Help client to cough and deep breathe at least
    every 2 hours.
  • Administer incentive spirometerchest
    physiotherapy if complicated.
  • Prevent dehydration.
  • (Continued)

121
Potential for Sepsis
  • Primary intervention is prescription of
    anti-infectives for eradication of organism
    causing the infection.
  • Drug resistance is a problem, especially among
    older people.
  • Interventions for aspiration pneumonia aimed at
    preventing lung damage and treating infection.

122
Severe Acute Respiratory Syndrome (SARS)
  • A virus from a family of virus types known as
    coronaviruses
  • Virus infection of cells of the respiratory
    tract, triggering inflammatory response
  • No known effective treatment for this infection
  • Prevention of spread of infection

123
Pulmonary Tuberculosis
  • Highly communicable disease caused by
    Mycobacterium tuberculosis
  • Most common bacterial infection
  • Transmitted via aerosolization
  • Initial infection multiplies freely in bronchi or
    alveoli
  • Secondary TB
  • Increase related to the onset of HIV

124
Assessment
  • Diagnosis of TB considered for any client with a
    persistent cough or other compatible symptoms
    (weight loss, anorexia, night sweats, hemoptysis,
    shortness of breath, fever, or chills)
  • Bacillus Calmette-Guerin vaccine within previous
    10 years produces positive skin test,
    complicating interpretation of TB test.

125
Clinical Manifestations of TB
  • Progressive fatigue
  • Lethargy
  • Nausea
  • Anorexia
  • Weight loss
  • Irregular menses
  • Low-grade fever, night sweats
  • Cough, mucopurulent sputum, blood streaks

126
Diagnostic Assessment
  • Manifestation of signs and symptoms
  • Positive smear for acid-fast bacillus
  • Confirmation of diagnosis by sputum culture of M.
    tuberculosis
  • Tuberculin test (Mantoux test) purified protein
    derivative given intradermally in the forearm
  • Induration of 10 mm or greater diameter
    indicative of exposure
  • (Continued)

127
Diagnostic Assessment (Continued)
  • Positive reaction does not mean that active
    disease is present, but does indicate exposure to
    TB or dormant disease.

128
Interventions
  • Combination drug therapy strict adherence
  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol or streptomycin
  • Negative sputum culture indicative of client no
    longer being infectious

129
Health Teaching
  • Follow exact drug regimen.
  • Proper nutrition must be maintained.
  • Reverse weight loss and severe lethargy.
  • Educate client about the disease.

130
Lung Abscess
  • Localized area of lung destruction caused by
    liquefaction necrosis, usually related to
    pyogenic bacteria
  • Pleuritic chest pain
  • Interventions
  • Antibiotics
  • Drainage of abscess
  • Frequent mouth care for Candida albicans

131
Health Promotion and Illness Prevention
  • Stop smoking.
  • Reduce weight.
  • Increase physical activity.
  • If traveling or sitting for long periods, get up
    frequently and drink plenty of fluids.
  • Refrain from massaging or compressing leg muscles.

132
Inhalation Anthrax
  • Bacterial infection is caused by the
    gram-positive, rod-shaped organism Bacillus
    anthracis from contaminated soil.
  • Fatality rate is 100 if untreated.
  • Two stages are the prodromal stage and the
    fulminant stage.
  • Drug therapy includes ciprofloxacin, doxycycline,
    and amoxicillin.

133
Pulmonary Empyema
  • A collection of pus in the pleural space
  • Most common cause pulmonary infection, lung
    abscess, and infected pleural effusion
  • Interventions include
  • Emptying the empyema cavity
  • Re-expanding the lung
  • Controlling the infection

134
  • Interventions for Critically Ill Clients with
    Respiratory Problems

135
Pulmonary Embolism
  • A collection of particulate mattersolids,
    liquids, or gasesenters venous circulation and
    lodges in the pulmonary vessels.
  • In most people with pulmonary embolism, a blood
    clot from a deep vein thrombosis breaks loose
    from one of the veins in the legs or the pelvis.

136
Etiology
  • Prolonged immobilization
  • Central venous catheters
  • Surgery
  • Obesity
  • Advancing age
  • Hypercoagulability
  • History of thromboembolism
  • Cancer diagnosis

137
Clinical Manifestations
  • Assess the client for
  • Respiratory manifestations dyspnea, tachypnea,
    tachycardia, pleuritic chest pain, dry cough,
    hemoptysis
  • Cardiac manifestations distended neck veins,
    syncope, cyanosis, hypotension, abnormal heart
    sounds, abnormal electrocardiogram findings
  • Low-grade fever, petechiae, symptoms of flu

138
Interventions
  • Evaluate chest pain
  • Auscultate breath sounds
  • Encourage good ventilation and relaxation
  • (Continued)

139
Interventions (Continued)
  • Monitor the following
  • respiratory pattern
  • tissue oxygenation
  • symptoms of respiratory failure
  • laboratory values
  • effects of anticoagulant medications
  • Surgery

140
Decreased Cardiac Output
  • Interventions include
  • Intravenous fluid therapy
  • Drug therapy
  • Positive inotropic agents
  • Vasodilators

141
Anxiety
  • Interventions include
  • Oxygen therapy
  • Communication
  • Drug therapy antianxiety agents

142
Risk for Injury (Bleeding)
  • Interventions include
  • Protect client from situations that could lead to
    bleeding.
  • Closely monitor amount of bleeding.
  • Assess often for bleeding, ecchymoses, petechiae,
    or purpura.
  • Examine all stool, urine, nasogastric drainage,
    and vomitus and test for occult blood.

143
Acute Respiratory Failure
  • Pressure of arterial oxygen lt 60 mm Hg
  • Pressure of arterial carbon dioxide gt 50 mm Hg
  • pH lt 7.3
  • Ventilatory failure, oxygenation failure, or a
    combination of both ventilatory and oxygenation
    failure

144
Ventilatory Failure
  • Type of mismatch in which perfusion is normal but
    ventilation is inadequate
  • Thoracic pressure insufficiently changed to
    permit air movement into and out of the lungs
  • Mechanical abnormality of the lungs or chest wall
  • Defect in the brains respiratory control center
  • Impaired ventilatory muscle function

145
Oxygenation Failure
  • Thoracic pressure changes are normal, and air
    moves in and out without difficulty, but does not
    oxygenate the pulmonary blood sufficiently.
  • Ventilation is normal but lung perfusion is
    decreased.

146
Combined Ventilatory and Oxygenation Failure
  • Hypoventilation involves poor respiratory
    movements.
  • Gas exchange at the alveolar-capillary membrane
    is inadequatetoo little oxygen reaches the blood
    and carbon dioxide is retained.

147
Dyspnea
  • Encourage deep breathing exercises.
  • Assess for
  • Perceived difficulty breathing
  • Orthopnea client finds it easier to breathe when
    in upright position
  • Oxygen
  • Position of comfort
  • Energy-conserving measures
  • Pulmonary drugs

148
Acute Respiratory Distress Syndrome
  • Hypoxia that persists even when oxygen is
    administered at 100
  • Decreased pulmonary compliance
  • Dyspnea
  • Noncardiac-associated bilateral pulmonary edema
  • Dense pulmonary infiltrates seen on x-ray

149
Causes of Lung Injury in Acute Respiratory
Distress Syndrome
  • Systemic inflammatory response is the common
    pathway.
  • Intrinsically the alveolar-capillary membrane is
    injured from conditions such as sepsis and shock.
  • Extrinsically the alveolar-capillary membrane is
    injured from conditions such as aspiration or
    inhalation injury.

150
Diagnostic Assessment
  • Lower PaO2 value on arterial blood gas
  • Poor response to refractory hypoxemia
  • Ground-glass appearance to chest x-ray
  • No cardiac involvement on ECG
  • Low to normal PCWP

151
Interventions
  • Endotracheal intubation and mechanical
    ventilation with positive end-expiratory pressure
    or continuous positive airway pressure
  • Drug therapy
  • Nutrition therapy fluid therapy
  • Case management

152
Endotracheal Intubation
  • Components of the endotracheal tube
  • Preparation for intubation
  • Verifying tube placement
  • Stabilizing the tube
  • Nursing care

153
Mechanical Ventilation
  • Types of ventilators
  • Negative-pressure ventilators
  • Positive-pressure ventilators
  • Pressure-cycled ventilators
  • Time-cycled ventilators
  • Microprocessor ventilators

154
Modes of Ventilation
  • The ways in which the client receives breath from
    the ventilator include
  • Assist-control ventilation (AC)
  • Synchronized intermittent mandatory ventilation
    (SIMV)
  • Bi-level positive airway pressure (BiPAP) and
    others

155
Ventilator Controls and Settings
  • Tidal volume
  • Rate breaths per minute
  • Fraction of inspired oxygen
  • Sighs
  • Peak airway (inspiratory) pressure
  • Continuous positive airway pressure
  • Positive end-expiratory pressure

156
Nursing Management
  • First concern is for the client second for the
    ventilator.
  • Monitor and evaluate response to the ventilator.
  • Manage the ventilator system safely.
  • Prevent complications.

157
Complications
  • Complications can include
  • Lung
  • Cardiac
  • Gastrointestinal and nutritional
  • Infection
  • Muscular complications
  • Ventilator dependence

158
Chest Trauma
  • About 25 of traumatic deaths result from chest
    injuries
  • Pulmonary contusion
  • Rib fracture
  • Flail chest
  • Pneumothorax
  • Tension pneumothorax
  • Hemothorax
  • Tracheobronchial trauma

159
(No Transcript)
About PowerShow.com