1 / 172

King saud university nursing collage master degree 1431-1432H

King saud university nursing collage master degree 1431-1432H. Nursing management for acute disease in : Respiratory system Endocrine system Hematology system Immunology system Done by : maha alonazi. Objective. At the end of the lecture the master student well be able to :

keshiaw
Download Presentation

King saud university nursing collage master degree 1431-1432H

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. King saud university nursing collage master degree1431-1432H Nursing management for acute disease in: Respiratory system Endocrine system Hematology system Immunology system Done by : mahaalonazi

  2. Objective • At the end of the lecture the master student well be able to : • Know the most common of acute respiratory disease . • Identify nursing management for RD . • Know the most common of acute endocrine disease . • Identify nursing management for ED . • Know the most common of acute hematology & immunology disease . • Identify nursing management for HD & ID .

  3. Outline • RESPIRATORY DISEASE : • Anatomy of respiratory system . • Croup. • Acute epiglottitis • Broncholitis . • Pneumonia. • Aspiration pneumonia . • ARDS • Asthma. • ENDOCRINE DISEASE : • Anatomy of endocrine system .

  4. Diabetes Mellitus • Diabetic ketoacidosis . • Diabetes Insipidus. • SIADH . • Hyperthyroidism. • Hypothyroidism. • Gigantism • HEMATOLOGY & IMMUNOLOGY DISEASE : • Anatomy of immune & hemato system .

  5. Anemia • Sickle cell disease • DIC • Hemophilia • Leuckemia • Thalasmia

  6. Pulmonary System

  7. Anatomy of respiratory system • Upper airway . • Lower airway . • Thoracic cavity .

  8. Upper Airway • Ideally above larynx is the upper airway • Practically speaking Nose, Larynx (Glottic opening and vocal cords) and trachea (Up to Carina). The upper airway is responsible for warming, humidifying and filtering air before it reaches the trachea. • Nose • Pharynx • Larynx

  9. Lower Airway (Lung) • Trachea • Lung • Conducting Airways • Gas exchange units (Alveoli)

  10. Thoracic Cavity • Diaphragm • The chest wall

  11. Spectrum of Resp. diseases Upper AW - Stridor, croup, laryngomalacia Lower AW - Asthma, bronchiolitis Lung Parenchymal- Pneumonia, Pulmonary edema Pleural - Empyema, Pneumothorax

  12. When will you suspect UAW dis.? • Stridor • Neck retraction • Suprasternal retraction • Sniffing position

  13. Acute Laryngotracheobronchitis (Croup) • Definition : inflammatory swelling of the submucosa in the subglottic area & trachea ,bronchi ,bronchioles • Commonest cause of acute stridor usually occure for child from age 3 month to 5 yrs . • causes : Viruses: Parainfluenza. RSV . • Sing & symptoms: • barking cough. • Hoarseness. • stridor. • Low fever.

  14. (Croup) management • Mild: Stridor at rest, cough - Minimal handling • Moderate to severe: Stridor at rest. - Racemic epinephrine nebulization Dexamethazone IV or IM, also oral or Nebulized Budesonide • Severe: Impending respiratory failure Intubation for 2-3 days. Improves in a week. • Majority may not need intubation

  15. X-ray Neck in croup Sharpened pencil appearance

  16. Nursing management • provide medication as order . • Provide cool & humidified oxygen as needed • Check vital sign . • Monitor pulse oximetry. • Minimal handling. • Provide quit environment . • Enteral feeding may be considered in pt. with respiratory distress .

  17. Definition :Is severe life threatening rapidly progressive infection of the epiglottis &aryepiglottic folds & surrounding tissue . • Usually occurs in children aged 2-6 yrs but can occurs any any age. • Caused: before the use of the HiB vaccine • ( haemophilus influanzae type B) was the moust commonly identified cause of acute epiglotittis ,the usual cause in the vaccinated child is now streptococcus pyogenes, S.pneumoniae ,or staphylococcus aureus .

  18. Sing & symptom : • Sudden onset of high fever. • dysphagia. • drooling,. • muffled voice. • soft stridor. • inspiratory retractions.

  19. Normal Lateral neck

  20. Acute epiglottitis - Management • Intubation by a skilled person • IV Ceftriaxone • O2 and other supportive management • Usually extubatable in 3-4 days • Antibiotics for 10 days.

  21. Nursing management • Close monitoring . • Arm restraint to prevent self extubation . • Decreased movement of the ETT in the larynx . • Deliver oxygen as necessary .

  22. Croup Epiglottitis • Age: Younger infants • No fever • Harsh stridor • Parainfuenza virus • Usually no antibiotics, no intubation • Age: older children • High fever, toxic • Soft stridor, Drooling, muffled • H influenza(Bacteria) • Needs antibiotics and intubation

  23. DO and DON’T in UAW dis. • Allow the patient in his position of comfort • Do not separate the child from mother • Do not force the child to lie down • Do not make the child cry? • Do not send the child for X-ray without accompanied by medical team • Continuously monitor for the need for intubation.

  24. Broncholitis • Definition : acute inflammatory disease of the lower tract that result in obstruction of small airways . • Causeas : viral infection . • Sing & symptom : • Cough. • Wheezing . • Prolong expiration. • Irritability . • Low grade fever . • Tachypnea . • Retraction .

  25. Nursing management • Maintained fluid & nutritional requirement • Monitor child closely for respiratory failure. • provide medication as order . • Provide oxygen as needed or M.V if respiratory failure ,hypoxemia or apnea are developed . • Check vital sign . • Monitor pulse oximetry • Prevent nosocomial infection by good HW.

  26. Pneumonia • Pneumonia is infection of the lung caused most often by bacteria or viruses . • Mode of transmission: 1-Inspiration. 2-Aspiration. 3-Circulation. • Bypass of nasal defense • Pulmonary aspiration (CNS, GER, TEF) • Abnormal secretions or mucociliary clearance • Underling chronic disease/nutrition • Defect in the immune system

  27. Sign & symptom : • Chills, fever and cough • Stuffy nose • Irritability • Resp distress: expiratory grunting, nasoflaring, retraction, tachypnea, tachycardia. • Cyanosis, air hunger, and occasionally apnea

  28. Nursing management • Monitor V\S ,ABG level ,oxygen saturation . • Administered nebulization & oxygen at concentration as prescribed . • Placed in high fowler position . • Rendered chest physiotherapy . • Encourage pt. to deep breathing & cough . • Encourage pt. to increased fluid intake to liquefy secretion . • Assess lung sound . • Administered antibiotic as ordered . • Avoid contact with people with URTI .

  29. Aspiration pneumonia • Definition :inflammation caused by pulmonary aspiration of gastric fluid produced direct injury to the mucosal surface of the respiratory tract . • Causes :see table • Sing & symptom : • Cough ,fever . • acute dyspnea. • wheezing , crackles or absent breathing sound in the effected lobes , • cyanosis, retraction , tachypnea .

  30. Causes of Aspiration Pneumonia

  31. Nursing management • Monitor V\S ,ABG level ,oxygen saturation . • Administered nebulization & oxygen at concentration as prescribed . • Placed in high fowler position . • Rendered chest physiotherapy . • Encourage pt. to deep breathing & cough . • Encourage pt. to increased fluid intake to liquefy secretion . • Assess lung sound . • Administered antibiotic as ordered .

  32. ARDS • Definition :acute lung injury & noncardiogenic pulmonary edema . • Causes : • Gastric aspiration. • Toxic inhalation . • Pulmonary infection . • FBA .

  33. Sing & symptom : • Stage 1 :(1-2 day) : mild tachypnea, hypoxemia,anxiety or restlessness. • Stage2 :(2-3 day) :cyanosis in room air ,tachycardia,retraction . • Stage 3:(3-10 day ):symptom change from distress to failure (inability to oxygenate & ventilate,alveolar collapse desaturation ,high oxygen requirement . • Stage 4 : (after 10 day ):development of pulmonary fibrosis & progressive impairment of oxygenation are observed .

  34. Nursing management • Encourage coughing & deep breathing in awake pt. • Frequent position change with CPT as needed . • Reduce abdominal distention by NGT if necessary . • Check vital sign . • Monitor pulse oximetry . • Do VBG & ABG analysis . • Provide supplemental oxygen for pt. with adequate ventilation . • Provide medication such as sedative ,analgesic ,neuromuscular blocking agents ,bronchodilator as ordered . • Provide high calories & high protein diet.

  35. Asthma (chronic disease ) • Definition :obstructive pulmonary disease characterized by airway inflammation with mucosal edema,thick secretion that cause plugging & hyperreactivity of the tracheobronchial tree that result in bronchospasm of the smooth muscle . • Causes :inflamatory mediators are thought to stimulate the vagus nerve ( cholinergic stimulation )causing smooth muscle constriction & increased production of mucus.

  36. Sing & symptom: Tachycardia. Tachypnea. Cynosis. Expiratory wheezing in severe case. Inspiratory & expiratory wheezing . Hypoxemia .

  37. Nursing management • Monitor pattern of breathing & V\S at regular interval . • Assess S & S of respiratory distress . • Administer oxygen & nebulization as indicated . • Assess lung sound . • Monitor pulse oximetry & ABG level as indicated . • Encourage rest in between activity to prevent fatigue & encourage deep breathing .

  38. Endocrine System

  39. 1- Endocrine glands : secrete hormones directly into the bloodstream ( adrenal , pancreas ,thyroid glands) • 2-Exocrine glands :secrete biochemical substances that are released into ducts to be delivered to target organs ( salivary ,sweat glands )

  40. Major glands : • 1-Hypothalamus-pituitary complex .(ACTH,TSH,ADH,Oxytocin ) • 2-Thyroid gland.(T3,T4) • 3-Parathyroid gland.(PTH) • 4-Adrenal gland.(sex hor. Cortisol,epinephrine,norepinephrine) • 5-Islets of langerhans in the pancreas.insullin-beta cell, glucagon-alpha cell, somatostatin-delta cells • 6-Gonads.estrogen,progesterone,testosterone .

  41. Fig 1. Pituitary Hormones and their target organs.

  42. Diabetes Mellitus • Definitions • Type I: Insulin-dependent mellitus (IDDM) • It is autoimmune disease that result in the T-cell-mediated destruction of the beta pancreatic cells .it is the most common form of diabetes in infants & children & requires insulin replacement therapy . • Type II: Non-insulin-dependent diabetes mellitus (NIDDM) • Is associated with obesity ,strong family history & older age .it is not autoimmune process but instead due to insulin resistance enough insulin is produced to prevent ketoacidosis. it can treated by oral hypoglycemia agents , diet.exercise .

  43. Diabetes Mellitus • Diabetic ketoacidosis • Is the absence of insulin & cellular uptake of glucose is inhibited & glucose production by the liver is increased & glucose utilization decreased resulting in hyperglycemia . • Etiology : • is related to inadequate endogenous insulin secretion . Acute stress, infection ,trauma , high dose of steroide .

  44. Table 1. Signs and symptoms

  45. Management • Fluid • Electrolytes • Insulin • Monitoring

  46. Nursing management • Monitor V\S & blood sugar level . • Provide 3 regular diabetic meals with in between snacks as tolerated . • Check weight daily \weekly as indicated . • Observed for circulation on feet . • Monitor intake & output . • Check urine for protein & ketones . • Monitor S\S of hypo & hyperglycemia . • Administered insulin regimen as prescribed .

  47. Table 3. Clinical observation in dehydration

  48. Table 4. Insulin preparation

  49. Syndrome of Inappropriate antidiuretic hormone • Characterized by inappropriate, excessive secretion of ADH • Occurs in the face of low serum Na and low serum osmolality • Clinical signs and symptoms are secondary to increased blood volume and hyponatremia.

More Related