MSII Upper/Lower Respiratory Tract Disorders

Ch.9 Care of the pt w/ a Respiratory Disorder Upper Respiratory Tract o Nose/nasal cavity/sinuses o pharynx o Larynx o Trachea Epistaxis (Nose Bleed) Etiology/pathophysiology o bright red coming from the nose from injury or irritation o congestion of the nasal membranes leading to capillary rupture o HTN o Primary or secondary Clinical Manifestations/assessments o bright red bleeding from one or both nostrils o can lose as much as 1 L/hr Medical management/nursing interventions o Fowlers position o direct pressure by pinching nose X15 min o ice compresses to nose o nasal packing o cauterize o balloon tamponade o silver nitrate Nasal Polyps o Tumors that look like small bunches of tiny grapes o Nasal polyps are tissue growths usually due to prolonged inflammation o Obstruct breathing and sinus drainage o removed via surgery under local anesthesia o nasal polypectomy Deviated Septum Etiology/pathophysiology o congenital abnormality o Injurymost likely cause o Nasal septum deviates from the midline and can cause a partial obstruction Diagnostic Studies o x-rays Clinical Manifestations/assessments o stertorous respirations o dyspnea o postnasal drip Medical management/nursing interventions o Medications: corticosteroids, antihistamines, antibiotics, analgesics o post-op nasal epinephrine to reduce bleeding o nasoseptoplasty o maintain airway Allergic Rhinitis & Allergic Conjunctivitis Etiology/pathophysiology antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens Clinical Manifestations/assessments o edema o excessive tearing o photophobia o blurring vision o pruritus o excessive nasal secretions and/or congestion o sneezing o cough o headache Medical management/nursing interventions o antihistamines- to relieve congestion o hot baths o avoid allergen o topical or nasal corticosteroids o analgesics o Obstructive Sleep Apnea (OSA) o is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep o Apnea o Hypopnea o PaO2/hypoxemia o PaCO2 o some of these ppl are cranky. lack of sleep, H/A from too much CO2 o Risk Factors: obesity, age, being male, allergies, this can and does go away if the person loses weight, if its not from a deformity Hypoxia o Subjective data o SOB o Objective data o restlessness, anxious facial expression, fatigue, impaired coordination o respiratory distress, wheezes, or orthopnea o adventitious breath sounds o CPAP- nasal continuous positive airway pressure o BiPAP Bi-level positive airway pressure Upper Airway Obstruction Etiology/pathophysiology o aspiration o inflammation of tissue o dentures that dont fit well o tongue o Laryngeal spasm which can cause closure of the larynx Clinical Manifestations/assessments o well they will not be able to talk o Cyanosis o Stridor is a high pitched sound resulting from turbulent gas flow in the upper airway

MSII Upper/Lower Respiratory Tract Disorders

o Sterorous respirations-snoring sounds o altered respiratory rate and character o apneic periods o Hypoxia o wheezing- most obvious when exhaling Medical management/nursing interventions o Open the airway o abdominal thrusts o head tilt/chin left o remove obstruction o artificial airway tracheostomy: position mid-fowlers Cancer of the Larynx Etiology/pathophysiology o Squamous cell carcinoma o heavy smoking & ETOH use o Chronic laryngitis o vocal abuse o Family hx o Mal o Age 60+ Clinical Manifestations/assessments o persistent hoarseness more than 2 weeks o atalgia o Dyspnea o Hemoptysis Medical management/nursing interventions o Radiation o Surgery o Partial laryngectomy: temp. trach, can learn to talk, 90% recovery o Total laryngectomy: perm. trach, harder time learning to talk, mechanical voice, poor prognosis o Radical neck dissection: permanent trach, poor prognosis Nursing Interventions o suction/maintain airway o watch for S/S infection o Temp tube feedings o I&O o Emotional support b/c of facial & neck disfigurement and aphonia Acute Rhinitis (common cold) Etiology/pathophysiology o inflammation of the mucous membranes of the nose and accessory sinuses o viral Clinical Manifestations/assessments o thin, serous nasal exudates o productive cough o sore throat o fever Medical management/nursing interventions o no specific tx o o o o o o analgesic antipyretic cough suppressant/antitussive expectorant antibiotic, if secondary bacterial infection present only encourage fluids

Acute Follicular Tonsillitis Etiology/pathophysiology o inflammation of the tonsils o bacterial or viral infection o food/airborne infection Clinical Manifestations/assessments o enlarged, tender cervical lymph nodes o sore throat o fever; chill o enlarged, purulent tonsils o elevated WBC Medical management/nursing interventions o antibiotics; analgesics; antipyretics o warm saline gargles o tonsillectomy and adenoidectomy o Post-op assess for excessive bleeding ice cold liquids ice collar avoid coughing, sneezing, or vigorous nose blowing avoid coughing and clearing throat for the 1st week post-op Laryngitis Etiology/pathophysiology o inflammation of the larynx due to virus or bacteria o may cause severe respiratory distress in children under 5 yrs old Clinical Manifestations/assessments o hoarseness o voice loss o scratchy and irritated throat o persistent cough o sore throat and congestion Medical management/nursing interventions o viral o bacterial o analgesics o antipyretics o antitussives o warm or cool mist vaporizer o limit use of voice Pharyngitis Etiology/pathophysiology o inflammation of the pharynx o chronic or acute o frequently accompanies the common cold o viral

MSII Upper/Lower Respiratory Tract Disorders

o bacterial Clinical Manifestations/assessments o dry cough tender tonsils o enlarged cervical lymph glands o red, sore throat o fever Medical management/nursing interventions o antibiotics; analgesics; antipyretics o warm or cool mist vaporizer o encourage fluids Sinusitis Etiology/pathophysiology o inflammation of the sinuses o usually begins w/ an URI; viral or bacterial Clinical Manifestations/assessments o congestion o constant; severe H/A o pain and tenderness in involved sinus region o purulent exudates o malaise o fever Medical management/nursing interventions o antibiotics o analgesics o antihistamines o vasoconstrictor nasal spray o warm mist vaporizer o warm, moist packs LOWER RESPIRATORY TRACT Acute Bronchitis Etiology/pathophysiology o inflammation of the trachea and bronchial tree o usually secondary to upper respiratory infection o exposure to inhaled irritants Clinical manifestations/assessments o productive cough/wheezes o dyspnea; chest pain o low grade fever o malaise; headache Medical Management/nursing interventions o cough suppressants o antitussives o antipyretics o bronchodilators o antibiotics o vaporizer o encourage fluids Legionnaires Disease Etiology/pathophysiology o Legionelia pneumophilia o thrives in water reservoirs o causes life-threatening pneumonia o leads to respiratory failure; renal failure; bacteremic shock; and ultimately death Clinical manifestations/assessments o elevated temp o H/A o nonproductive cough o difficult and rapid respirations o crackles or wheezes o tachycardia o signs of shock o Hematuria Medical Management/nursing interventions o O2 o mechanical ventilation, if necessary o IV therapy o antibiotics o antipyretics o vasopressors Anthrax Etiology/pathophysiology o Bacillus anthracis o spread by direct contact w/ bateria or spores o 3 types: cutaneous, GI, inhalation Clinical manifestations/assessments o cold or flu-like symptoms o hemorrhage, tissue necrosis, and lymphedema Medical Management/nursing interventions o antibiotics Tuberculosis (TB) Etiology/pathophysiology o inhalation of tubercle bacillus (mycobacterium tuberculosis) o infection versus active disease o presumptive diagnosis o mantoux tuberculin skin test o chest x-ray o acid-fast bacilli smear x3 o confirmed diagnosis o sputum culture; positive for TB bacilli Clinical manifestations/assessments o fever o wt loss; weakness o productive cough; hemoptysis o chills; night sweats Medical Management/nursing interventions o TB isolation (acid fast bacilli (AFB) o multiple meds to which the organisms are susceptible Pneumonia Etiology/pathophysiology o inflammatory process of the bronchioles and the alveolar spaces due to infection o bacteria; viruses; mycoplasma; fungi; and parasites Clinical manifestations/assessments o productive cough o severe chills; elevated temp

MSII Upper/Lower Respiratory Tract Disorders

o increased heart rate and respiratory rate o dyspnea Medical Management/nursing interventions o antipyretics o bronchodilators o deep breathe; coughing o O2 o chest percussion and postural drainage o antibiotics o analgesics o expectorants o humidifier or nebulizer Pleurisy Etiology/pathophysiology o inflammation of the visceral and parietal pleura o bacterial or viral Clinical manifestations/assessments o sharp inspiratory pain o dyspnea o cough o elevated temp o pleural friction rub Medical Management/nursing interventions o antibiotics o analgesics o antipyretics o o2 o anesthetic block for intercostals nerves Pleural effusion/emphyema Etiology/pathophysiology o pleural effusion o accumulation of fluid in the pleural space o empyema-infection Clinical manifestation/assessment o dyspnea o air hunger o respiratory distress o fever Medical Management/nursing interventions o Thoracentesis o chest tube w/ closed water seal drainage system o antibiotics o cough and deep-breathe Atelectasis Etiology/pathophysiology o collapse of lung tissue due to occlusion of air to a portion of the lung Clinical manifestations/assessments o dyspnea o pleura friction rub; crackles o restlessness o elevated temp o decreased breath sounds Medical Management/nursing interventions o o o o o o o o cough and deep breathe analgesics early ambulation incentive spirometry; intermittent positive pressure breathing (IPPB) O2 chest percussion and postural drainage bronchodilators; antibiotics; mucolytic agents chest tube

Pneumothorax Etiology/pathophysiology o a collection of air or gas in the pleural space; causing the lung to collapse Clinical manifestations/assessments o decreased breath sounds o sudden; sharp chest pain w/ dyspnea o Diaphoresis; tachycardia; tachypnea o no chest movement on affected side o sucking chest wound o trachea shift Medical Management/nursing interventions o chest tube to water seal drainage system o O2 o analgesics o encourage fluids Lung Cancer Etiology/pathophysiology o primary tumor or metastasis o small cell, non small cell, squamous cell, and large cell carcinoma Clinical manifestations/assessments o hemoptysis o dyspnea; wheezing o fever; chills o pleural effusion Medical Management/nursing interventions o Surgery o most are not diagnosed early enough for curative surgical intervention o segmental resection o Lobectomy o Pneumonectomy o Radiation o Chemotherapy Pulmonary Edema Etiology/pathophysiology o Accumulation of serous fluid in interstitial tissue and alveoli Clinical manifestations/assessments o dyspnea; cyanosis o tachypnea; tachycardia o pink or blood-tinged, frothy sputum o restlessness; agitation o wheezing; crackles

MSII Upper/Lower Respiratory Tract Disorders

o decreased urinary output; sudden weight gain Medical Management/nursing interventions o O2 o mechanical ventilation; if necessary o diuretics o narcotic analgesics Nipride o Strict I&O; daily weight o Low sodium diet Pulmonary Embolus Etiology/pathophysiology o Foreign substance in the pulmonary artery o blood clot; fat; air; or amniotic fluid Clinical manifestations/assessments o sudden, unexplained dyspnea, tachypnea o Hemoptysis o chest pain o elevated temp o increased WBCs Medical Management/nursing interventions o O2 o HOB up to 30 degrees o Anticoagulants o Fibrinolytic Agents Adult Respiratory Distress Syndrome Etiology/pathophysiology o Complication of other disease processes o direct or indirect pulmonary injury Clinical manifestations/assessments o respiratory distress o tachycardia o Hypotension o decreased urinary output Medical Management/nursing interventions o Treat cause o O2 o Corticosteroids o Diuretics o Morphine o Lanoxin o Antibiotics Chronic Obstructive Pulmonary Disease (COPD) Emphysema Etiology/pathophysiology o the bronchi, bronchioles, and alveoli become inflamed as a result of chronic irritation o air becomes trapped in the alveoli during expiration causing alveolar distention, rupture, and scar tissue Complications o Cor Pulmonale o right sided congestive heart failure due to pulmonary hypertension (increased BP in the pulmonary artery) o PAP= 20-30/8-12 Clinical manifestations/assessments o dyspnea on exertion o sputum o barrel chest o chronic wt loss o emaciation o clubbing of fingers Medical Management/nursing interventions o O2 o chest physiotherapy o bronchodilators; corticosteroids; antibiotics; diuretics o humidifier o pursed-lip breathing o high-protein, high-calorie diet o REST Chronic Bronchitis Etiology/pathophysiology o hypertrophy of mucous glands causes hypersecretion and alters cilia function o increased airway resistance causes bronchospasm Clinical manifestations/assessments o productive cough o Dyspnea o use of accessory muscles to breathe o wheezing Medical Management/nursing interventions o bronchodilators o mucolytics o antibiotics o oxygen (low-flow) o pursed-lip breathing Asthma Etiology/pathophysiology o narrowing of the airways due to various stimuli o extrinsic or intrinsic factors o influenced by secondary factors o antigen-antibody reaction Clinical manifestations/assessments o Mild asthma o dyspnea on exertion o wheezing o Acute Asthma attack o tachypnea o expiratory wheezing; productive cough o use of accessory muscles; nasal flaring o cyanosis Medical Management/nursing interventions o maintenance therapy o severent inhalant; prophylactic o corticosteroid inhalant o avoid allergens o Acute or rescue therapy o proventil inhalant; aminophylline IV o corticosteroid and epinephrine oral or subQ

MSII Upper/Lower Respiratory Tract Disorders

o O2 Bronchiectasis Etiology/pathophysiology o gradual, irreversible process that involves chronic dilation of bronchi resulting in loss of elasticity Clinical manifestations/assessments o dyspnea; coughing; wheezes and crackles o cyanosis; clubbing of fingers o fatigue; weakness o loss of appetite Medical Management/nursing interventions o low flow O2 o chest physiotherapy o hydration o mucolytic agents o antibiotics o bronchodilators o cool mist vaporizer o surgery; lobectomy Influenza Etiology/pathophysiology o infectious disease of birds and mammals o caused by an RNA virus Clinical manifestations/assessments o more severe than the common cold and lasts longer o recovery takes about 1-2 weeks o chills o fever o body ache (esp. joints and throat) o fatigue o nasal congestion o coughing and sneezing Medical Management/nursing interventions o prevention included vaccination o rest o encourage fluids o avoid alcohol and tobacco o antipyretics o analgesics Severe Acute Respiratory Syndrome (SARS) o a respiratory illness caused by the coronavirus o spread by close person to person contact by direct contact w/ infectious material Clinical manifestations/assessments o begins w/ a fever o overall feeling of discomfort o body aches o mild respiratory symptoms o after 2-7 days. may develop a dry cough and dyspnea Interventions o supportive o antibiotics and antiviral agents are not able to kill the virus or prevent its replication Prevention o avoid contact w/ those suspected of having SARS o avoid travel to countries where an outbreak of SARS exits o Avoid close contact w/ crowds in area where SARS exists o frequent hand washing if in an area where SARS exists Respiratory Failure Etiology/pathophysiology o when the client cannot eliminate CO2 from the alveoli o the CO2 retention results in Hypoxemia o O2 reaches the alveoli but cannot be absorbed or used properly o the lungs can move air sufficiently but cannot oxygenate the pulmonary properly o occurs as a result of a mechanical abnormality of the lungs or chest wall, a defect in the respiratory control center in the brain, or an impairment in the function of the respiratory muscles o PaCO2 level is higher than 45mm Hg Clinical manifestations/assessments o dyspnea o H/A o restlessness o confusion o tachycardia o cyanosis o dysrhythmias o decreased level of consciousness o alternations in respirations and breath sounds Medical Management/nursing interventions o identify the cause and treat it o O2 to keep PaCO2 above 60-70mm Hg o high fowlers position o encourage deep breathing o Bronchodilators o mechanical ventilation if needed Interventions o check color and vital signs before and during treatment o Place an Oxygen in Use: sign at the clients bedside o Check for the presence of chronic lung problems o Humidify the oxygen Oxygen: Nasal Cannula o flow rate 1-6 L/min, providing concentration of 2444% o high than 6L/min do not significantly increase oxygenation b/c of dead space o used for the client w/ chronic airflow limitation and for long term oxygen use however the CAL client who is hypoxemia and also has chronic

MSII Upper/Lower Respiratory Tract Disorders

hypercapnia- increased CO2, requires lower levels of O2 o nose breathers and mouth breathers can benefit from nasal cannula Interventions o place the nasal prongs in the nostrils o add humidification as prescribed when the flow rate is higher than 2L/min o check the water level and change the humidifier as needed o monitor the client for changes in resp rate or depth o check mucosa b/c high flow rates cause drying increased mucosal irritation; epitaxis o monitor skin integrity bc of the O2; tubing can irritate the skin o provide water-soluble jelly to the nares prn Mechanical Ventilations o used to overcome the clients inability to ventilate or oxygenate adequately Interventions o assess the client 1st and the ventilator 2nd o monitor V/S, lung sounds, resp. status, and breathing patterns (the client will never breathe at a rate less than the rate set on the vent) o monitor skin color, particularly in the lips and nail beds o monitor chest for bilateral expansion o obtain pulse oximeter o monitor ABG results o monitor the need for suctioning and observe the type, color, and amt of secretions o check vent settings o monitor level of water in humidifier and temp of humidification o ensure that alarms are set o if alarm cause cannot be determined , manually ventilate w/ an ambu bag o empty vent tubing when moisture accumulates o turn q2h o have resuscitation equipment available Nursing Dx: o airway clearance; ineffective o breathing pattern; ineffective o gas exchange; impaired o Anxiety o Activity intolerance o Nutrition, Imbalanced: less than body requirements