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Nursing of Adults With Medical & Surgical Conditions. Respiratory Disorders (Lower Airway). Acute Bronchitis. Etiology/Pathophysiology Inflammation of the trachea and bronchial tree Retention of secretions causes high risk of bacterial growth Usually secondary to upper respiratory infection

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nursing of adults with medical surgical conditions

Nursing of AdultsWithMedical & Surgical Conditions

Respiratory Disorders

(Lower Airway)

acute bronchitis
Acute Bronchitis
  • Etiology/Pathophysiology
    • Inflammation of the trachea and bronchial tree
    • Retention of secretions causes high risk of bacterial growth
    • Usually secondary to upper respiratory infection
    • Exposure to inhale irritants
acute bronchitis1
Acute Bronchitis
  • Signs & Symptoms
    • Productive cough
    • Rhonchi/wheezes
    • Dyspnea
    • Chest pain
    • Lowgrade temperature
    • Malaise
    • Headache
acute bronchitis2
Acute Bronchitis
  • Treatment
    • Cough suppressants
      • Codeine
    • Antitussives
      • Pertussin
    • Antipyretics
      • Tylenol
    • Bronchodilators
    • Brethine
    • Antibiotics
    • Vaporizer
    • Encourage fluids
legionnaires disease
Legionnaires’ Disease
  • Etiology/Pathophysiology
    • Legionella pneumophila
    • First identified in 1976 at the American Legion convention in Philadelphia
    • Thrives in water reservoirs
      • Air conditioners and humidifiers
    • Causes life-threatening pneumonia
    • Leads to respiratory failure, renal failure, bacteremic shock, and ultimately death
legionnaires disease1
Legionnaires’ Disease
  • Signs & Symptoms
    • Elevated temperature
      • 102 – 105 degrees
    • Headache
    • Nonproductive cough
    • Difficult and rapid respirations
    • Crackles or wheezes
    • Tachycardia
    • Signs of shock
    • Hematuria
legionnaires disease2
Legionnaires’ Disease
  • Treatment
    • Oxygen
    • Mechanical ventilation, if necessary
    • IV therapy
    • Antibiotics
      • Erythromycin
      • Rifampin
    • Antipyretics
    • Vasopressors
      • For shock
tuberculosis
Tuberculosis
  • Etiology/Pathophysiology
    • Tubercle bacillus (Mycobacterium tuberculosis)
    • Chronic pulmonary and extrapulmonary infectious disease
    • Inhalation of droplet containing tubercle bacillus
    • Infection
      • Presence of mycobacteria in the tissue of a person who has no s/s of TB
      • Positive TB skin test
      • 10% will become active disease
    • Active Disease
      • S/S of TB are present
    • NOT easily transmitted
      • Most inhaled TB organisms are destroyed by the upper resp. system
tuberculosis1
Tuberculosis
  • Signs & Symptoms
    • Fever
    • Weight loss
    • Weakness
    • Productive cough
    • Chills
    • Night sweats
    • Hemoptysis
tuberculosis2
Tuberculosis
  • Diagnostic Tests
    • Presumptive Diagnosis
      • Mantoux Tuberculin Skin Test
        • Read 48 – 72 hours after given
        • Enduration (raised hardened tissue)
        • <5mm negative
        • >5mm positive
      • Chest X-ray
      • Acid-fast bacilli smear x 3
    • Confirmed Diagnosis
      • Sputum culture
        • Positive for TB bacilli
tuberculosis3
Tuberculosis
  • Treatment
    • Tuberculosis Isolation (AFB)
      • Isolation room
      • Negative air pressure
      • Particulate respiration masks
    • Medications
      • 6-9 months
      • First Line:
        • isoniazid (INH), rifampin, rifampin and isoniazid (Rifamate), pyrazinamide, ethambutol, streptomycin
      • Second Line:
        • Ethionamide, para-aminosalicylate sodium (PAS), cycloserine, capreomycin, kanamycin, amikacin
pneumonia
Pneumonia
  • Etiology/Pathophysiology
    • Inflammatory process of the bronchioles and the alveolar spaces due to infection
    • Bacteria, viruses, mycoplasma, fungi, and parasites
    • Aspiration
    • Retained secretions become infected
    • Inflammation of respiratory tract occurs
    • Decreased oxygen/carbon dioxide exchange
pneumonia1
Pneumonia
  • Signs & Symptoms
    • Productive cough
      • Sputum depends on cause
    • Severe chills
    • Elevated temperature
    • Increased heart rate
    • Increased respiratory rate
    • Dyspnea
pneumonia2
Pneumonia
  • Treatment
    • Oxygen
    • Chest percussion and postural drainage
    • Encourage to cough and deep breathe
    • Antibiotics
      • Penicillin, erythromycin, cephalosporin, and tetramycin
    • Analgesics
      • Tylenol or aspirin
    • Expectorants
    • Bronchodilators
    • Humidifier or nebulizer
pleurisy
Pleurisy
  • Etiology/Pathophysiology
    • Inflammation of the visceral and parietal pleura
    • Bacterial or viral
pleurisy1
Pleurisy
  • Signs & Symptoms
    • Sharp inspiratory pain
      • Usually radiates to the shoulder or abdomen
    • Dyspnea
    • Cough
    • Elevated temperature
    • Pleural friction rub
pleurisy2
Pleurisy
  • Treatment
    • Antibiotics
    • Analgesics
      • Demerol or morphine
    • Antipyritics
      • Tylenol
    • Oxygen
    • Anesthetic block for intercostal nerves
pleural effusion empyema
Pleural Effusion/Empyema
  • Etiology/Pathophysiology
    • Pleural Effusion
    • Accumulation of fluid in the pleural space
    • Usually secondary
    • Empyema
      • Fluid accumulation with pleural effusion becomes infected
pleural effusion empyema1
Pleural Effusion/Empyema
  • Signs & Symptoms
    • Dyspnea
    • Air hunger
    • Respiratory distress
      • Nasal flaring
      • Tachypnea
      • Dyspnea
      • Decreased breath sounds
    • Fever
pleural effusion empyema2
Pleural Effusion/Empyema
  • Treatment
    • Thoracentesis
    • Chest tube with closed water seal drainage system
      • Glass bottle system
      • Pleur-evac
      • (Pg. 385 Box 9-6 Maintaining chest tubes and closed chest drainage bottles)
    • Antibiotics
    • Cough and deep breath
atelectasis
Atelectasis
  • Etiology/Pathophysiology
    • Abnormal condition characterized by the collapse of lung tissue
    • Due to occlusion of air to a portion of the lung
    • Postoperative complication
    • Secretions
    • Foreign body
    • Mucous plug
    • Emphysema, pneumothorax, tumor
atelectasis2
Atelectasis
  • Signs & Symptoms
    • Dyspnea
    • Tachypnea
    • Pleural friction rub
    • Restlessness
    • Hypertension > hypotension
    • Elevated temperature
    • Decreased breath sounds
    • Crackles
atelectasis3
Atelectasis
  • Treatment
    • Cough and deep breath
    • Analgesia
    • Early ambulation
    • Incentive spirometery
    • Intermittent positive pressure breathing
    • Oxygen
    • Chest percussion and postural drainage
    • Bronchodilators
      • Proventil
    • Antibiotics
    • Mucolytic agents
      • Mucomyst - Decrease viscosity of secretions
    • Chest tube
pneumothorax
Pneumothorax
  • Etiology/Pathophysiology
    • A collection of air or gas in the pleural space, causing the lung to collapse
    • Penetrating chest injury
    • Coughing
    • Ruptured bleb
    • Spontaneous
pneumothorax1
Pneumothorax
  • Signs & Symptoms
    • Decreased breath sounds
    • Sudden, sharp chest pain with dyspnea
    • Diaphoretic
    • Increased heart rate
    • Tachypnea
    • No chest movement on affected side
    • Sucking chest wound
    • Mediastinal shift
pneumothorax2
Pneumothorax
  • Treatment
    • Chest tube to water seal drainage system
    • Oxygen
    • Analgesics
    • Encourage fluids
lung cancer
Lung Cancer
  • Etiology/Pathophysiology
    • Primary tumor or metastasis
    • Small cell lung cancer
    • Non-small cell lung cancer
    • Squamous cell carcinoma
    • Large-cell carcinoma
    • 80% linked to smoking
lung cancer1
Lung Cancer
  • Signs & Symptoms
    • Hemoptysis
    • Dyspnea
    • Fever
    • Chills
    • Wheezing
    • Pleural effusion
lung cancer2
Lung Cancer
  • Treatment
    • Surgery
    • Most are not diagnosed early enough for curative surgical intervention
    • Segmental resection
    • Lobectomy
    • Pneumonectomy
    • Radiation
    • Chemotherapy
pulmonary edema
Pulmonary Edema
  • Etiology/Pathophysiology
    • Accumulation of serous fluid in interstitial tissue and alveoli
      • Left ventricular failure
      • Inhalation of irritating gases
      • Rapid administration of IV fluids
      • Barbiturate or opiate overdose
pulmonary edema1
Pulmonary Edema
  • Signs & Symptoms
    • Dyspnea
    • Tachypnea
    • Tachycardia
    • Cyanosis
    • Pink or blood tinged, frothy sputum
    • Restlessness
    • Agitation
    • Wheezing
    • Crackles
    • Sudden weight gain
    • Decreased urinary output
pulmonary edema2
Pulmonary Edema
  • Treatment
    • Oxygen
    • Mechanical ventilation, if necessary
    • Diuretics
      • Lasix
    • Narcotic analgesics
      • Morphine will help decrease resp rate
    • Nipride
      • Vasodilator that improves myocardial contraction and reduces pulmonary congestion
    • Strict I&O; Daily weight
    • Low sodium diet
pulmonary embolus
Pulmonary Embolus
  • Etiology/Pathophysiology
    • Foreign substance in the pulmonary artery
      • Blood clot, fat, air, or anmiotic fluid
    • High risk
      • Prior thrombophlebitis
      • Recent surgery, pregnancy, or given birth
      • Taking contraceptives long-term
      • Hx of CHF, obesity, or immobilization from fracture
pulmonary embolus1
Pulmonary Embolus
  • Signs & Symptoms
    • Sudden, unexplained dyspnea
    • Rapid respiratory rate
    • Hemoptysis
    • Chest pain
    • Elevated temperature
    • Increased WBC
pulmonary embolus2
Pulmonary Embolus
  • Treatment
    • Oxygen
    • HOB up 30 degrees
    • Anticoagulants
      • Heparin (IV)
        • Gradually tapered
      • Coumadin (oral)
        • Initiated as Heparin is tapered
        • Continued at home for up to 1 year
    • Fibrinolytic agents
adult respiratory distress syndrome ards
Adult Respiratory Distress Syndrome(ARDS)
  • Etiology/Pathophysiology
    • Complication of other disease processes
    • Direct or indirect pulmonary injury
    • Viral or bacterial pneumonia, chest trauma, aspiration, shock, drug over doses, renal failure, pancreatitis, COPD, Guillain-Barre’ syndrome, and myasthenia gravis
      • .increased permeability of capillary membrane
      • .allows fluid to leak into interstitial spaces and alveoli
      • .pulmonary edema and hypoxia
      • .alveoli lose their elasticity and collapse
      • .capillaries allow plasma and RBC’s to leak out, resulting in hemorrhage
adult respiratory distress syndrome ards1
Adult Respiratory Distress Syndrome(ARDS)
  • Signs & Symptoms
    • Respiratory distress
      • Dyspnea
      • Restlessness
    • Tachycardia
    • Hypotension
    • Decreased urinary output
adult respiratory distress syndrome ards2
Adult Respiratory Distress Syndrome(ARDS)
  • Treatment
    • Treat cause
    • Oxygen
    • Corticosteroids
    • Diuretics
    • Morphine
    • Lanoxin
    • Antibiotics
chronic obstructive pulmonary disease
Chronic Obstructive Pulmonary Disease
  • Chronic airflow limitation
  • Includes
  • Emphysema
  • Chronic Bronchitis
  • Asthma
  • Bronchiectasis
emphysema
Emphysema
  • Etiology/Pathophysiology
    • The bronchi, bronchioles and alveoli become inflamed as a result of chronic irritation
    • Air becomes trapped in the alveoli during expiration, causing alveolar distention, rupture, and scar tissue
    • Cigarette smoking is primary irritant
    • Complication:
      • Cor pulmonale
        • Right-sided congestive heart failure due to pulmonary hypertension
emphysema2
Emphysema
  • Signs & Symptoms
    • Dyspnea on exertion
    • Sputum
      • Initially there is very little
      • Eventually becomes copius
    • Barrel chest
      • Increased anteroposterior diameter caused by overinflation
    • Chronic weight loss
    • Emaciation
    • Clubbing of fingers
emphysema3
Emphysema
  • Treatment
    • Oxygen (low-flow)
      • 1-2 liters per NC
    • Chest physiotherapy
    • Bronchodilators
      • Theophylline or aminophylline, Isuprel, Brethine, Alupent, Proventil, Bronkosol
    • Corticosteroids
    • Antibiotics
    • Diruretics
    • Humidifier
    • Pursed-lip breathing
    • High-protein, high-calorie diet
      • Encourage fluids between meals rather than with meals
chronic bronchitis
Chronic Bronchitis
  • Etiology/Pathophysiology
    • Hypertrophy of mucous gland causes hypersecretion and alters cilia function
    • Increases suseptibility to infection causing airway scaring
    • Increased airway resistance causes bronchospasm
    • Most common cause is cigarette smoking
chronic bronchitis1
Chronic Bronchitis
  • Signs & Symptoms
    • Productive cough
      • Especially in the mornings
    • Dyspnea
    • Use of accessory muscles to breath
    • Wheezing
chronic bronchitis2
Chronic Bronchitis
  • Treatment
    • Bronchodilators
      • Theophylline, aminophylline, etc
    • Mucolytics
      • Mucomyst
    • Antibiotics
      • Erythromycin
    • Oxygen (low-flow)
      • 1-2 liters per NC
    • Pursed-lip breathing
asthma
Asthma
  • Etiology/Pathophysiology
    • Narrowing of the airways due to various stimuli
    • Extrinsic
      • External factors
        • Pollens, dust, feathers, animal dander, foods
    • Intrinsic
      • Internal causes
        • Respiratory infection
    • Influenced by secondary factors
      • Mental or physical fatigue and emotional factors
    • Antigen-antibody reaction
asthma1
Asthma
  • Signs & Symptoms
    • Mild Asthma
      • Dyspnea on exertion
      • Wheezing
    • Acute Asthma Attack
      • Usually at night
      • Tachypnea
      • Expiratory wheezing
      • Use of accessory muscles
      • Nasal flaring
      • Cyanosis
      • Productive cough
    • Status asthmaticus
      • Severe, unrelenting attack that fails to respond to usual treatment
      • Leads to exhaustion and respiratory failure
asthma2
Asthma
  • Treatment
    • Maintenance Therapy
      • Serevent inhalant, prophylactic
      • Corticosteroid inhalant
        • Floevent
      • Avoid allergens
    • Acute or Rescue Therapy
      • Proventil inhalant
      • Corticosteriod and epinephrine oral or sq
      • Aminophylline IV
      • Oxygen
        • Monitor by pulse oximetry
bronchiectasis
Bronchiectasis
  • Etiology/Pathophysiology
    • Gradual, irreversible process that involves chronic dilation of bronchi resulting in loss of elaticity
    • Repeated pulmonary infections
    • Secondary causes may be cystic fibrosis, foreign body, or tumor
bronchiectasis2
Bronchiectasis
  • Signs & Symptoms
    • Dyspnea
    • Cyanosis
    • Clubbing of fingers
    • Coughing
      • Esp in the morning and when lying down
      • Copious amounts of foul-smelling sputum
    • Fatigue
    • Weakness
    • Loss of appetite
    • Wheezes and crackles
bronchiectasis3
Bronchiectasis
  • Treatment
    • Oxygen (low-flow)
      • 1-2 liters per NC
    • Chest physiotherapy
    • Hydration
    • Mucolytic agents
      • Mucomyst
    • Antibiotics
    • Bronchdilators
      • Theophylline
    • Cool mist vaporizer
    • Surgery
      • Lobectomy