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1Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1
Care of the Patient with a Respiratory Disorder
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2
Overview of Anatomy and Physiology
External respiration• Exchange of oxygen and carbon dioxide
between the lung and the environment
Internal respiration• Exchange of oxygen and carbon dioxide at
the cellular level
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 3
External Respiration
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4
Internal Respiration
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 5
Overview of Anatomy and Physiology
Upper respiratory tract• Nose• Pharynx• Larynx• Trachea
Lower respiratory tract• Bronchial tree
• Bronchioles, alveolar ducts, alveoli
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 6
Upper Respiratory track
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7
Lower respiratory track
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8
Mechanics of breathing• Thoracic cavity
• Lungs • Visceral pleura and parietal pleura• Diaphram
Regulation of respiration• Nervous control—medulla oblongata and
pons of the brain; chemoreceptors—in the carotid and aorta
Overview of Anatomy and Physiology
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 9
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11
Assessment of the Respiratory System
• Shortness of breath, dyspnea, cough• Labored breathing • Respiratory distress• Orthopnea• Adventitious breath sounds
• Wheezes• Crackles
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12
Laboratory and Diagnostic Examinations
Chest roentgenogram Computed tomography (CT) Pulmonary function testing Mediastinoscopy Laryngoscopy Bronchoscopy Sputum specimen Cytological studies Thoracentesis Arterial blood gases Pulse oximetry
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13
Figure 49-7
Fiberoptic bronchoscope.
(A, Courtesy of Olympus America, Melville, New York. B, from Meduri, G.U., et al. [1991]. Protected bronchoalveolar lavage, American Review of Respiratory Disease, 143:855, official journal of the
American Thoracic Society, © American Lung Association.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14
Figure 49-8
Thoracentesis.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 15
Figure 49-9
Portable pulse oximeter with spring-tension digit probe displays oxygen saturation and pulse rate.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16
Disorders of the Upper Airway
Epistaxis• Bleeding from the nose• Clinical manifestations/assessment
• Bright red bleeding from one or both nostrils• Can lose as much as 1 liter per hour
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17
Disorders of the Upper Airway
Epistaxis (continued)• Medical management/nursing interventions
• Sitting position, leaning forward• Direct pressure by pinching nose• Ice compresses to nose• Nasal packing• Cautery• Balloon tamponade
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18
Disorders of the Upper Airway
Allergic rhinitis and allergic conjunctivitis• Etiology/pathophysiology
• Antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19
Disorders of the Upper Airway
Allergic rhinitis and allergic conjunctivitis Medical management/nursing interventions
• Avoid allergen• Antihistamines• Decongestants• Topical or nasal corticosteroids• Analgesics• Hot packs over facial sinuses
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20
Figure 49-3
Projections of paranasal sinuses and oral nasal cavities on the skull and face.
(From Thibodeau, G.A., Patton, K.T. [2004]. Structure and function of the body. [12th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21
Respiratory Infections
Acute rhinitis (common cold)• Etiology/pathophysiology
• Inflammation of the mucous membranes of the nose and accessory sinuses
• Virus(es)• Clinical manifestations/assessment
• Thin, serous nasal exudate• Productive cough• Sore throat• Fever
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22
Respiratory Infections
Laryngitis• Etiology/pathophysiology
• Inflammation of the larynx due to virus or bacteria• May cause severe respiratory distress in children
under 5 years old• Clinical manifestations/assessment
• Hoarseness• Voice loss• Scratchy and irritated throat• Persistent cough
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23
Disorders of the Lower Airway
Acute bronchitis• Etiology/pathophysiology
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 24
Disorders of the Lower Airway
Acute bronchitis (continued)• Medical management/nursing interventions
• Cough suppressants• Antitussives• Antipyretics• Bronchodilators• Antibiotics• Vaporizer• Encourage fluids
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25
Disorders of the Lower Airway Tuberculosis
• Etiology/pathophysiology• Inhalation of tubercle bacillus (Mycobacterium
tuberculosis)• Presumptive diagnosis
• Mantoux tuberculin skin test• Chest x-ray• Acid-fast bacilli smear x 3
• Confirmed diagnosis• Sputum culture; positive for TB bacilli
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 26
Disorders of the Lower Airway
Tuberculosis (continued)• Clinical manifestations/assessment
• Fever• Weight loss; weakness• Productive cough; hemoptysis• Chills; night sweats
• Medical management/nursing interventions• Tuberculosis isolation (acid fast bacilli [AFB])• Multiple medications to which the organisms are
susceptible
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 27
Treatment for TB
Isoniazid and Rifampicin x 6 months Rifabutin and Cycloserine given in
addition for first two months If drug combinations are not taken as
directed resistant forms of TB are likely to emerge
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 28
Disorders of the Lower Airway
Pneumonia• Etiology/pathophysiology
• Inflammatory process of the bronchioles and the alveolar spaces due to infection
• Bacteria, viruses, mycoplasma, fungi, and parasites
• Clinical manifestations/assessment• Productive cough• Severe chills; elevated temperature• Increased heart rate and respiratory rate• Dyspnea
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 29
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 30
Disorders of the Lower Airway
Pneumonia (continued)• Medical management/nursing interventions
• Oxygen• Chest percussion and postural drainage• Encourage to cough and deep-breathe• Antibiotics• Analgesics• Expectorants• Bronchodilators• Humidifier or nebulizer
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 31
Disorders of the Lower Airway
Lung cancer• Etiology/pathophysiology
• Primary tumor or metastasis• Small-cell, non-small–cell, squamous cell, and
large-cell carcinoma• Clinical manifestations/assessment
• Hemoptysis• Dyspnea; wheezing • Fever; chills• Pleural effusion
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 32
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 33
Disorders of the Lower Airway
Lung cancer (continued)• Medical management/nursing interventions
• Surgery• Most are not diagnosed early enough for curative
surgical intervention• Segmental resection• Lobectomy• Pneumonectomy
• Radiation• Chemotherapy
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 34
Disorders of the Lower Airway
Pulmonary embolus• Etiology/pathophysiology
• Foreign substance in the pulmonary artery• Blood clot, fat, air, or amniotic fluid
• Clinical manifestations/assessment• Sudden, unexplained dyspnea, tachypnea• Hemoptysis• Chest pain• Elevated temperature• Increased WBCs
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 35
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 36
Disorders of the Lower Airway
Pulmonary embolus (continued)• Medical management/nursing interventions
• Oxygen• HOB up 30 degrees• Anticoagulants• Fibrinolytic agents
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 37
Chronic Obstructive Pulmonary Disease (COPD)
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
• Complication• Cor pulmonale
• Right-sided congestive heart failure due to pulmonary hypertension
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 38
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 39
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 40
Emphysema (continued)• Clinical manifestations/assessment
• Dyspnea on exertion• Sputum• Barrel chest• Chronic weight loss• Emaciation• Clubbing of fingers
Chronic Obstructive Pulmonary Disease (COPD)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 41
Figure 49-17
Barrel chest. Note increase in AP diameter.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 42
Emphysema (continued)• Medical management/nursing interventions
• Oxygen (low-flow)• Chest physiotherapy• Bronchodilators; corticosteroids; antibiotics;
diuretics• Humidifier• Pursed-lip breathing• High-protein, high-calorie diet
Chronic Obstructive Pulmonary Disease (COPD)
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 43
Chronic bronchitis• Etiology/pathophysiology
• Hypertrophy of mucous glands causes hypersecretion and alters cilia function
• Increased airway resistance causes bronchospasm• Clinical manifestations/assessment
• Productive cough• Dyspnea• Use of accessory muscles to breathe• Wheezing
Chronic Obstructive Pulmonary Disease (COPD)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 44
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 45
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 46
Chronic bronchitis (continued)• Medical management/nursing interventions
• Bronchodilators• Mucolytics• Antibiotics• Oxygen (low-flow)• Pursed-lip breathing
Chronic Obstructive Pulmonary Disease (COPD)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 47
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 48
Asthma• Etiology/pathophysiology
• Narrowing of the airways due to various stimuli• Extrinsic or intrinsic factors• Influenced by secondary factors• Antigen-antibody reaction
Chronic Obstructive Pulmonary Disease (COPD)
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 49
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 50
Asthma (continued)• Clinical manifestations/assessment
• Mild asthma• Dyspnea on exertion• Wheezing
• Acute asthma attack• Tachypnea• Expiratory wheezing; productive cough• Use of accessory muscles; nasal flaring• Cyanosis
Chronic Obstructive Pulmonary Disease (COPD)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 51
Asthma (continued)• Medical management/nursing interventions
• Maintenance therapy• Serevent inhalant, prophylactic• Corticosteroid inhalant • Avoid allergens
• Acute or rescue therapy• Proventil inhalant; aminophylline IV• Corticosteroid and epinephrine oral or subcutaneous• Oxygen
Chronic Obstructive Pulmonary Disease (COPD)