Nursing care Management of Respiratory disorders for nursing students

## **Presentation Description**

**Title:** Respiratory System: Anatomy, Physiology, and Nursing Care

**Overview:**

This comprehensive presentation provides a detailed overview of the respiratory system, including its anatomy, physiology, common disorders, and nursing management. It covers key concepts such as gas exchange, respiratory assessment, and treatment modalities.

**Key Topics:**

* **Terminology:** Definition of key respiratory terms (apnea, bronchoscopy, dyspnea, hypoxia, hemoptysis, orthopnea, tachypnea).
* **Anatomy and Physiology:**
- Upper and lower respiratory tracts
- Gas exchange process
- Pleural membranes
* **Health History and Assessment:**
- Eliciting symptoms (dyspnea, cough, sputum, chest pain)
- Cardinal signs of respiratory dysfunction
* **Laboratory and Diagnostic Studies:**
- Radiographic studies (chest X-ray, CT, MRI)
- Bronchoscopy, thoracoscopy, thoracentesis
- Pulmonary function tests, sputum culture, ABG, pulse oximetry
* **Nursing Diagnosis:**
- Ineffective breathing patterns, impaired gas exchange, altered tissue perfusion, activity intolerance, pain, anxiety, risk for infection
* **Implementation:**
- Respiratory assessment and monitoring
- Improving breathing patterns (positioning, fluid intake, incentive spirometer)
- Promoting gas exchange (oxygen therapy, nebulizer treatment, effective coughing)
- Enhancing activity tolerance and pain management
- Preventing infection
* **Respiratory Disorders:**
- Upper Respiratory Tract Infection (URTI)
- Pneumonia (types, causes, clinical manifestations, management)
- Chronic Obstructive Pulmonary Disease (COPD)
- Pleural Effusion
- Pulmonary Tuberculosis

**Target Audience:**

This presentation is suitable for healthcare professionals, medical students, and individuals interested in understanding the respiratory system and its associated disorders.

**Purpose:**

To provide a comprehensive resource for understanding the anatomy, physiology, and nursing care related to the respiratory system. The presentation aims to educate viewers on common respiratory disorders, their assessment, and effective management strategies.

1. Nursing care of Respiratory Disorders Dr. Mysara Mogahed Professor of Internal medicine. Benha University

2. Terminology Apnea : temporary cessation of breathing. Bronchoscopy : direct examination of the larynx, trachea, and bronchi using an endoscope. Dyspnea : difficulty/ shortness of breath. Hypoxemia : decrease in arterial oxygen tension in the blood. Hypoxia : decrease in oxygen supply to the tissue and cells. Hemoptysis : expectoration of blood from the respiratory tract. Orthopnea : inability to breathe easily except in an upright position. Tachypnea : abnormal rapid respiration.

3. Anatomy and physiology Respiratory system is responsible for ventilation (movement of air in and out of the airways). It composes of upper and lower respiratory tracts. Upper airway warm and filter the inspired air.

4. Anatomy and physiology (cont.) Gas exchange : delivering oxygen to the tissue through the blood steam (inspiration) and expelling waste gases, such as carbon dioxide, (expiration).

5. Anatomy and physiology (cont.) Pleural: Covers the lungs. Has two layers and fluid to lubricate the lungs and thoracic cavity.

6. I- Health history Elicit a description of the present illness and chief complaint , including onset, course, duration, location, and precipitating and alleviating factors. Cardinal signs and symptoms of respiratory dysfunction include:- Dyspnea Orthopnea Cough which may be productive or non productive Increased sputum, which may be purulent (yellow or green),rusty, bloody, or mucoid sputum Chest pain Wheezing and crackles Clubhing of fingers Hemoptysis Cyanosis (e.g. buccal , peripheral)

7. Laboratory and diagnostic studies Radiographic and scanning studies are done to visualize respiratory system structures. The studies include: Chest radiography, Computed tomography (CT) scan Magnetic Resonance Imaging(MRI).

8. Bronchoscopy studies are invasive techniques performed to visualize pulmonary structures and obtain tissue specimens.

9. Thoracoscopy : used to examine thoracic structure

10. Thoracentesis involves needle aspiration of pleural fluid for diagnostic and therapeutic purposes.

11. Needle biopsy is an invasive technique that involves entering the lung or pleura to obtain tissue for analysis. Pulmonary function test(PFT) : it is done to measure functional ability of the lung through measuring lung volumes and capacities. Sputum culture determines the presence of pathogenic organisms. Arterial blood gas (ABG) studies determine O 2 and CO 2 content and evaluate the body's acid-base balance Pulse Oximetry : Monitoring oxygen saturation of hemoglobin (SpO2 or SaO2). .

12. Incentive spirometer : provide visual feedback to encourage the patient to maximize lung inflation and prevent atelectasis

13. Nursing diagnosis Ineffective breathing pattern Impaired gas exchange Altered tissue perfusion (peripheral) Activity intolerance Pain Anxiety Risk for infection

14. Implementation Assess respiratory status and tissue perfusion, including respiratory rate, depth and effort; level of consciousness; lung sounds; peripheral cyanosis; cap­illary refill time; color and consistency or sputum; and pulse oximetry. Improve breathing patterns. a. Encourage upright position (semi-Fowler or high-Fowler position) b. Encourage the client to increase fluid intake to at least 2 to 3 liters of fluid each day, unless contraindicated as in congestive heart failure. c. Use of incentive spirometer

15. Promote gas exchange Administering oxygen therapy. Analyze ABG values and pulse oximetry to determine need for oxygen therapy. Assist in administering nebulizer treatment. Encourage effective coughing. Instruct client to take three deep breaths in through the nose and out through the mouth, and on the third breath pull in the abdominal muscles and cough twice forcefully with mouth open. Encourage the client to lie on the affected side to splint the area if there is pain when coughing. Encourage the client to eliminate or minimize exposure to all pulmonary irritants and advise the client to quit smoking.

16. Improve activity tolerance. Encourage client to alternate rest with activity to prevent overexertion that may exacerbate symptoms and to increase activity gradually. Provide pain management. Assess the client for pain and exclude other potential complications. Instruct the client about splinting when the client has chest pain, Promote infection control measures. Instruct the client to avoid crowds or people with known colds, flu, or respiratory infection. Implement standard precautions and droplet or airborne precautions as indicated.

17. Upper respiratory Tract Infection(URTI ) URTI follows invasion of the upper respiratory organs by microbes. Upper respiratory organs include the : Nose, sinuses, throat Common cold is an example of an upper respiratory infection. Common cold is caused by a virus Symptoms :- Elevated temperature (fever) Runny nose Watery eyes Treatment of common cold: Use of antipyretic such as paracetamol Rest Increased fluid intake Upper respiratory infections sometimes move down into the chest and develop into bronchitis or even pneumonia.

18. Pneumonia Description. Pneumonia is an inflammatory process involving the respiratory bronchioles, alveolar space and walls, and lobes, caused primarily by chemical irritants or by specific bacterial, viral, fungal, mycoplasmal , or parasitic organisms. Pneumonia is the fifth leading cause of death among the elderly.

19. Types of pneumonia: Community Acquire Pneumonia: (CAP) occurs either in the community setting or within the first 48 hours of hospitalization. The organisms that most frequently cause CAP are Streptococcus pneumonia, Haemophilus influenza, and atypical organisms ( Legionella, Mycoplasma, Chlamydia& viral) Hospital Acquire Pneumonia :(HAP) also known as Nasocomial infection Occurring 48 hours or longer after admission to the hospital. Bacteria are responsible for the majority of HAP infection, including Pseudomonas and Enterobacter, Staphylococcs aureus and Streptococcus pneumonia.

20. Pneumonia in Immunocompromized Host: E.g. pneumocystic carinii , fungal & tuberculosis. It is occur most commonly in patient with AIDS , nutritional depletion , use of broad –spectrum antimicrobial agent, corticosteroids, chemotherapy, and long term life- support technology (mechanical ventilation) Aspiration Pneumonia : refers to entry of endogenous or exogenous substance into the lower air way such as gastric content.

21. Causes of and contributing 1- Smoking and air pollution 3- Altered consciousness: alcohalizm , head injury, seizure, anaesthesia , drug overdose 4- Tracheal intubations (endotracheal intubations, trachestomy ) 5- Upper respiratory tract infection 6- Chronic diseases: chronic lung disease, diabetes mellitus, heart disease, uremia, cancer, 7- Immunosuppressant 8- Malnutrition 9- Inhalation or aspiration of noxious substances 10- Bed rest and prolonged immobility 11- Depress cough reflex

22. Clinical manifestations A- Typical pneumonia syndrome is characterized by: Sudden onset fever over 40 C , chills, cough productive with Purulent sputum and pleurisy chest pain, dullness with consolidation on percussion of chest , dyspnea , respiratory grunting, and nasal flaring ,Flushed cheeks; cyanotic lips and nail beds ,anxiety and confusion. In the elderly, the only signs may be mental status change and dehydration. B- Atypical Pneumonia syndrome : is characterized by gradual onset, dry cough and extrapulmonary manifestations as headach , fatigue, sore throat, nausea, vomiting and diarrhea. Crackles are heard.

23. Laboratory and diagnostic study findings Chest radiograph shows density changes, primarily in the lower lung fields. Sputum culture and sensitivity are positive for a specific causative organism. While blood cell (WBC ) count is elevated in pneumonia of bacterial origin; WBC count is depressed or normal in pneumonia of mycoplasma or viral origin.

24. Nursing management Administer prescribed medications , which may include: Antibiotics ( Penicillne , Erthromycine , Gentamicine ) Mucolytics . expectorants, or antitussive agents& antipyretic Promote infection control measures , especially droplet precautions as indicated. Prevent aspiration pneumonia in a client receiving tube feedings. Keep the client in an upright position during feedings and for 30 minutes afterward. Check for residual gastric contents; if more than 100 mL , stop feeding and reevaluate. Oxygen administer Warm, moist inhalation Increase fluid intake

25. Complication of pneumonia: 1- Pleurisy: inflammation of pleura 2- Pleural effusion: accumulation of fluid in pleural space 3- Empyema: accumulation of pus in pleural space 4- Atelectasis: collapsed, airless alveoli of one or part of one lobe may ocurr 5- Pericarditis: inflammation of pericardium 6- Arthritis: inflammation of joint 7- Meningitis: inflammation of brain layer 8- Lung abscess

26. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a group of disorders associated with persistent or recurrent obstruction of air flow, which include chronic bronchitis, emphysema, and asthma. These conditions frequently overlap. Most commonly, bronchitis and emphysema occur together. Asthma frequently occurs alone without the triad of bronchitis, emphysema, and asthma.

27. Etiology 1-Chronic bronchitis and emphysema . Major causes and contributing factors to these disorders, which are irreversible , include Smoking Air pollution Occupational exposure to respiratory irritants Allergies Autoimmunity Infection Genetic predisposition Aging

28. 2- Asthma is a reversible diffuse airway obstruction with a possible genetic component. It may be extrinsic or intrinsic. Extrinsic factors include external agents or specific allergens (e.g. dust, foods, mold spores, insecticides). Intrinsic factors include upper respiratory infection, exercise, emotional stress, cold, or other nonspecific factors. Status asthmatics is a severe and persistent asthma that lasts longer than24hours and does not respond to conventional therapy.

29. Clinical manifestations Chronic bronchitis (1) History of productive cough that lasts 3 months per year for 2 consecutive years (2) Persistent cough, known as smoker's cough, usually in the winter months (3) Persistent sputum production (4) Recurrent acute respiratory infections (5) "Pink puffer appearance

30. Emphysema (1) History of chronic bronchitis (2) Slow onset of symptoms (typically over several years), which can lead to right sided heart failure (i.e. cor pulmonale) (3) Progressive dyspnea, initially only on exertion and later also at rest (4) Progressive cough and increased sputum production, use of accessory muscles (5) Anorexia with weight loss and profound weakness (6) Dusky color leading to cyanosis (7) Clubbing of fingers

31. Asthma (1) Chest tightness and dyspnea (2) Cough (3) Wheezing (4) Expiration more strenuous and prolonged than inspiration (5) Use of accessory muscles of respiration & nasal flaring (6) Hypoxia with restlessness, anxiety, cyanosis, weak pulse, and diaphoresis

32. Nursing management Provide nursing care for the client with chronic bronchitis or emphysema. a. Administer prescribed medications, which may include antibiotics, bronchodilator, mucolytic agents, and corticosteroids. Antibiotics should be administered at the first sign of infection, such as a change in the sputum. Narcotics, sedatives, and tranquilizers, which can further depress respirations, should be avoided.

33. Clear airways with postural drainage, percussion (i.e. clapping) or vibrating, and suctioning as appropriate

34. Promote infection control . Encourage the client to obtain influenza and pneumonia vaccines at prescribed times. Improve breathing patterns . Demonstrate and encourage diaphragmatic and purse-lip breathing. Have the client take a deep breath and blow out against closed lips.

35. Provide nursing care for the client with asthma Administer prescribed medications , which may include: Adrenergics( Adrenaline), Bronchodilators(aminophlline) Corticosteroids( Dexamethasone, Solu –cortef) for acute attack . Nebulized aerosol(Ventoline) relive bronchospasme. Oxygen therapy

36. Provide treatment during an acute asthmatic attack. (1) Stay with the client and keep him calm and in an upright position. (2) Do purse-lip breathing with the client; encourage relaxation techniques.

37. Implement measures to prevent asthmatic attacks. Teach the client the following skills: (1) Identify and eliminate or minimize exposure to pulmonary irritants. (2) Remove irritant from the home; change air filters frequently; keep the home as dust free as possible; and keep windows closed during windy and high pollen days. (3) Use an inhaler and take medications as prescribed and notify the physician when not gaining complete relief. (4) Notify the physician when a respiratory infection occurs. (5) Obtain influenza and pneumonia vaccines at prescribed times. (6) Monitor peak expiratory flow rate.

38. Pleural effusion Description . Pleural effusion is a collection of fluid in the pleural space, which is located between the visceral and parietal surfaces Etiology . Pleural effusion usually results from diseases such as neoplastic tumors (of which bronchogenic cancer is the most common malignancy), congestive heart failure, tuberculosis, pneumonia, pulmonary infection, and connective tissue disease. Pathophysiology . The pleural space contains a small amount of lubricating fluid that allows the pleural surfaces to move without friction. Excess fluid accumulates in the space until it becomes clinically evident. The effusion can be composed of a clear fluid, or it can be bloody or purulent.

39. Clinical manifestations Large pleural effusion (1) Shortness of breath (2) Minimal or no breath sounds (3) Dull, flat sound when percussed (4) Tracheal deviation away from the affected side may occur when significant accumulation of fluid occurs. Small to moderate pleural effusion (1) Respiratory difficulty or comprised lung expansion may not be evident. (2) Dyspnea may not be present.

40. Laboratory and diagnostic study findings Chest radiograph shows fluid in the pleural space. Pleural f1uid obtained by thoracentesis and treated with an acid-fast bacillus stain may reveal tuberculosis or red and white blood cells. Nursing management . Prepare the client for thoracentesis , which is performed to remove f1uid, obtain a specimen for analysis, and relieve dyspnea . Assist the physician with administering chemically irritating agents, which may be instilled to obliterate the pleural space and prevent further accumulation of f1uid. Provide pain relief. Position client to decrease pain and administer pain medication, as needed .

41. Pulmonary Tuberculosis Definition: Pulmonary tuberculosis (T.B) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to the other parts of the body including the meninges, kidney, bones and lymph nodes. The primary infectious agent mycobacterium tuberculosis or tubercle bacillus is an acid –fast, aerobic rod that grows slowly and is sensitive to heat and ultraviolet light

42. Transmission TB spreads from person to person by airborne transmission. An infected person release droplet through talking, coughing, sneezing, laughing, or singing Risk factors for TB 1- Close contact with an infected person. 2- Preexisting medical condition e.g. diabetics, malignancy or chronic renal failure, hemodialysis , malnourish 3- People living in overcrowded homes substandard living, with low, income i.e. low socioeconomic class. 4- Immunocompromised status (e.g. HIV, cancer, transplanted organ, high dose of corticosteroids 5- Immigration from countries with high prevalent TB

43. Clinical manifestation: 1-Low grade fever 2-Cough may be nonproductive or mucopurulent sputum 3-Night sweat 4-Fatigue 5-weight loss 6-Hemoptysis

44. Assessment and diagnostic studies Sputum testing: Positive Acid fast bacilli, Positive Mycobacterium tuberculosis Chest X-ray: Active or calcified lesion Blood tests: WBCS,ESR are increased  

45. Medical Intervention : TB is treated primarily with chemotherapeutic agent for 6 to 12 months. More than one drug of the following are used: Streptomycine Isoniazid(INH) Para amino salicylic acid Rifampin Ethambutol Pyrazinamide

46. Nursing Intervention Maintain patient diet high-carbohydrates, protein, vitamin B6&C, caloric and fluid intake. Provide small frequent meal Maintain bed rest Instruct the patient to cover nose and mouth when sneezing or coughing& use of disposable tissue papaer to prevent spread of infection Provide oral hygiene and hygiene Maintain infection control precautions Provide adequate air ventilation in room The nurse instruct medication, schedule and side effect to patient