RespiratoryDisorders for nursingstudent.ppt.pptx

Nursing College

1. Respiratory Disorders Nursing 203

2. Pulmonary Edema Medical emergency! Abnormal accumulation of fluid in the lung(s) Causes: LV failure, rapid administration of IVF’s Clinical Manifestations: Increasing respiratory distress/ dyspnea, air hunger Anxious/agitated/confusion Cough/Frothy pink sputum Crackles/ Rales Tachycardia Jugular vein distention

3. Diagnostic Findings: Chest X-ray show increased interstitial markings ABGs show increasing hypoxia BNP Elevated

4. Medical Management GOAL: Correct underlying disorder Medications: Oxygen/ Endotracheal intubation Morphine Diuretics (Lasix is DOC) Vasodilators (Nitroglycerin) Dobutamine Milrinone Digoxin Nesritide ( Natrecor)

5. Hemodynamic monitoring: Arterial line Central venous pressure (CVP) Swan-Ganz (PAP monitoring)

6. Nursing Management Assist with intubation (if necessary), monitor mechanical ventilation Administer oxygen by mask (40-60%) HOB elevated, legs dangling if possible Administering and monitoring medications Provide psychological support CVP/ hemodynamic monitoring Vital signs frequently

7. Nursing Management Continued Low-Na+ diet Fluid restrictions Strict I&O’s Daily weights Home Care

8. Adult Respiratory Distress Syndrome Also called ARDS Characterized by sudden progressive pulmonary edema Increasing bilateral infiltrates Hypoxemia regardless to oxygen therapy Decreased lung compliance

9. Pathophysiology Result of inflammatory trigger that damages/collapses alveolar interstitial spaces Direct injury to lungs Trauma, Smoke inhalation Aspiration, infection DIC, Indirect Shock Major surgery

10. Clinical Manifestations Severe dyspnea occurring 12-48 after insult Arterial hypoxemia regardless of O2 amount Lungs are “Stiff” Assessment findings Diagnostic findings

11. Medical Management Identify and treat underlying cause Intubation/Mechanical ventilation Will see PEEP Goal: PaO2 > 60mm Hg or O2 sat 90% Hemodynamic monitoring Meds Human recombinant interleukin-1 receptor antagonist Neutrophil inhibitors Surfactant, Pulmonary vasodilators Corticosteroids Nutritional support: 35-45kcal/kg/day

12. Nursing Management Monitor and implement medical plan of care Patient positioning Psychological support Ventilator considerations Do not turn off alarms Hypotension Fighting ventilator Suction frequently Bite block Sedation Neuromuscular blockade

13. Pulmonary Embolism Thrombi most often arise from deep veins in the legs, the right side of the heart or pelvic area and travel to the pulmonary circulation. Can also be air, fat, amniotic Medical Emergency! Risk Factors: Immobility, bed-rest, history of previous DVT, pre-post op, trauma, pregnancy, obesity, BC pills

14. Assessment Findings Severity of symptoms depend on the size and location Acute onset of chest pain , dyspnea, tachypnea Anxious, feelings of impending doom Tachycardia Rales / Crackles / Diminished breathe sounds/ cough Death can occur within 1 hr of onset of symptoms May have history of DVT

15. Diagnostic Findings Ventilation-Perfusion (V-Q) scan Pulmonary angiography CXR ABGs Peripheral vascular studies

16. Prevention Active leg exercise Early ambulation Pneumatic/elastic compression stockings Avoid sitting/ leg crossing Teach signs/symptoms of DVT/PE Low dose anticoagulant for those undergoing surgery

17. Medical Management Emergency management Stabilize Cardiopulmonary system Nasal oxygen ABGs IV Lung perfusion scan or spiral CT scan Continuous cardiac monitoring/Vital signs/Hemodynamic monitoring Treat hypotension using Dobutamine or Dopamine

18. Medical Management Cont.. IV morphine Compression stockings Anticoagulants Heparin bolus/drip Low molecular weight heparin (Lovenox) Coumadin Thrombolytics Urokinase, streptokinase, alteplase, reteplase,tPA

19. Medical Management Cont… Surgical management if PE is severe Embolectomy Umbrella filter (Greenfield filter)

20. Nursing Management Minimize the risk of PE Always suspect PE Prevent formation of thrombus Major nursing responsibility Leg exercise, early ambulation No sitting or lying for long period of time Legs should not be in a dependent position Monitor IV sites

21. Nursing Management Cont.. Monitoring anticoagulant/thrombolytic therapy During infusion—bedrest, vital signs, O2 sats, limit invasive procedures, monitor PT, and PTT, monitor for bleeding… Pain management Anxiety management Monitor for complications Cardiogenic shock Right ventricular failure Education

22. Chest Trauma: Blunt More common, harder to determine extent Cause: Sudden compression or positive pressure to the chest wall MVA, steering wheel, seat belt, falls , bicycle crashes Types Fractured sternal and ribs, flail chest, pulmonary contusion

23. Chest Trauma: Penetrating Cause: A foreign object enters the chest wall Gunshot and stabbings (most common)

24. Pathophysiology Why is it life-threatening? Hypoxemia Hypovolemia Cardiac failure

25. Assessment Assessment immediately--- When, how injury occurred? LOC, other injuries, EBL, Drugs or ETOH involved, pre-hospital treatment How is the airway? Inspect airway, thorax, neck veins, and breathing Auscultation Palpation

26. Assessment Cont.. Vital signs and skin color Labs (CBC, clotting studies, type and cross, Lytes, ABG’s CXR, CT scan/ EKG

27. Medical Management Establish/secure airway Intubation/Ventilation Re-establish chest wall integrity Occluding open chest wounds Correct fluid volume and negative intrapleural pressure or drain intrapleural fluid Control bleeding

28. Sternal And Rib Fractures Rib fractures most common type of chest trauma Most are benign but can be life-threatening 5 th – 9 th most common site Usually heal in 3-6 weeks Conservative treatment Pain control Avoid excessive activity Deep breathing exercise Rib belt Surgical if gross deformity only

29. Flail Chest CAUSATIVE: BLUNT CHEST TRAUMA OFTEN ASSOCIATED WITH MULTIPLE RIB FRACTURES PATHOPHYSIOLOGY “PARADOXICAL MOVEMENT” RESULT: HYPOXEMIA, RESPIRATORY ACIDOSIS, HYPOTENSION, THEN METABOLIC ACIDOSIS

30. TREATMENT GOALS CONTROL PAIN CLEAR SECRETIONS VENTILATORY SUPPORT TREATMENT DEPENDS ON DEGREE OF RESPIRATORY DYSFUNCTION

31. Treatment Cont.. CLEAR AIRWAY: COUGH AND DEEP BREATH, POSITIONING, SUCTIONING SECRETIONS VENTILATORY SUPPORT: PULMONARY PHYSIOTHERAPY, EMDOTRACHEAL INTUBATION, MECHANICAL VENTILATION

32. NURSING INTERVENTIONS MONITOR ABG’S PULMONARY FUNCTION MONITORING PULSE OXIMETRY PAIN ASSESSMENT/CONTROL SERIAL CHEST X-RAYS

33. PNEUMOTHORAX PNEUMOTHORAX: ACCUMULATION OF AIR OR GAS IN THE PLEURAL CAVITY, RESULTING IN COLLAPSE OF THE LUNG ON THE AFFECTED SIDE “BREACH IN PARIETAL OR VISCERAL PLEURA=EXPOSURE TO POSTIIVE ATMOPSHERIC PRESSURE”

34. TYPES OF PNEUMOTHORAX SPONTANEOUS (OR SIMPLE) TRAUMATIC TENSION

35. SPONTANEOUS PNEUMOTHROAX ETIOLOGY RUPTURE OF A BLEB RUPTURE OF A BRONCHOPLEURAL FISTULA RUPTURE OF AIR FILLED BLISTER IN A HEALTHY PERSON MAY BE ASSOCIATED WITH SEVERE EMPHYSEMA OR INTERSTITIAL LUNG DISEASE

36. TRAUMATIC PNEUMOTHORAX WOUND IN THE CHEST WALL ALLOWS AIR TO ESCAPE; ENTERS THE PLEURAL SPACE CAUSES: BLUNT TRAUMA, PENETRATING CHEST TRAUMA, ABDOMINAL TRAUMA, DIAPHRAGMATIC TEARS, INVASIVE THORACIC PROCEDURES,

37. HEMOTHORAX COLLECTION OF BLOOD IN THE PLEURAL SPACE RESULTING FROM TORN INTERCOSTAL VESSELS, LACERATIONS OF THE GREAT VESSELS AND LACERATION OF THE LUNGS HEMOPNEUMOTHORAX: AIR AND BLOOD

38. SUCKING CHEST WOUND (OPEN PNEUMOTHORAX) TYPE OF TRAUMATIC PNEUTHORAX ALLOWS AIR TO PASS FREELY IN AND OUT RUSH OF AIR THROUGH THE HOLE PRODUCES A SUCKING SOUND CONSEQUENCE: MEDIASTINAL FLUTTER

39. CLINICAL MANIFESTATION PLEURITIC PAIN TACHYPNEA ANXIETY DYSPNEA WITH AIR HUNGER USE OF ACESSORY MUSCLES DECREASED OR ABSENT BREATH SOUNDS; DECREASED MOVEMENT IN THE AFFECTED SIDE SUBCUTANEOUS EMPHYSEMA

40. MANAGEMENT GOAL: EVACUATE THE AIR OR BLOOD FROM THE PLEURAL SPACE PNEUMOTHORAX: SMALL CHEST TUBE/2 ND ICS HEMOTHORAX: LARGE CHEST TUBE/2ND OR 5 TH ICS SUCTION: 20mm HG SUCTION

41. MANAGEMENT ANTIBIOTIC THERAPY HEIMLICH CHEST TUBE TO WATER SEAL DRAINAGE EMERGENCY THORACOTOMY

42. NURSING CARE OF CHEST DRAINAGE SYSTEM Fill the water seal with sterile water to the specified level Fill the suction control chamber with sterile water to the 20-cm level Attach CT’s to collection chamber and tape Suction: dry system turn regulator dial to 20cm H2O Suction: wet system turn on suction unit until steady bubbling appears in suction control chamber IMMEDIATE PETROLATUM GAUZE

43. INTERVENTIONS/CHEST TUBE DRAINAGE MARK DRAINGE FROM CT CHECK FOR KINKS, LOOP IN CT’S WHAT’S “MILKING THE TUBES” WHAT IS “TIDALING” OBSERVE FOR “AIR LEAKS” DO NOT CLAMP THE CT FOR TRANSPORT INCENTIVE SPIROMETER/COUGH AND DB OBSERVE AND REPORT CHANGE IN STATUS

44. CHEST TUBE REMOVAL VALSALVA MANEUVER PER CLIENT CHEST TUBE CLAMPED/QUICKLY REMOVED PRESSURE DRESSING TO CT SITE

45. TENSION PNEUMOTHORAX AIR ENTERS WOUND IN THE CHEST WALL AND BECOMES TRAPPED WITH EACH BREATH, TENSION INCREASES IN THE PLEURAL SPACE LUNG COLLASPES MEDIASTINAL STRUCTURES SHIFT TO THE OPPOSITE SIDE

46. TENSION PNEUMOTHORAX

47. CLINICAL MANIFESTATIONS PROFUSE DIAPHORESIS AGITATION AIR HUNGER CENTRAL CYANOSIS TACHYCARDIA/HYPOTENSION EMERGENCY!!

48. TENSION PNEUMOTHORAX MANAGEMENT SUPPLEMENTAL OXYGEN MONITOR PULSE OXIMETRY DECOMPRESSION CHEST TUBE MAINTENANCE

49. PLEURAL EFFUSION COLLECTION OF FLUID IN THE PLEURAL SPACE, USUALLY SECONDARY TO OTHER DISEASES CAUSES: HEART FAILURE, TB, NEOPLASTIC TUMORS, PE, CONNECTIVE TISSUE DISEASE CLEAR, BLOODY OR PURULENT TRANSUDATE VS.EXUDATE

50. CLINICAL MANIFESTATIONS DYSPNEA PLEURITIC CHEST PAIN DECREASED OR ABSENT BREATH SOUNDS DIAGNOSTIC FINDINGS: TRACHEAL DEVIATION,CHEST X-RAY, CHEST CT, THORACENTESIS (CONFIRMS DX) PLEURAL FLUID ANALYASIS PLEURAL BIOPSY

51. EFFUSION TREATMENT THORACENTESIS PLEURODESIS CHEST TUBES SURGICAL PLEURECTOMY WITH CATHERTER INSERTION PLEUROPERITONEAL SHUNT

52. PAIN MANAGEMENT PAIN NFUSION PUMP (OPIOIDS) THORACIC EPIDURAL BLOCK INTERCOSTAL NERVE BLOCK INTERMITTANT ANALGESIC INTRAPLEURAL ADMINISTRATION OF OPIOIDS

53. CANCERS OF THE RESPIRATORY SYSTEM LARYNGEAL CANCER LUNG CANCER TUMORS OF THE MEDIASTINUM

54. CANCER OF THE LARYNX RISK FACTORS CARCINOGENS (MULTIPLE) HX OF ETOH ABUSE STRAINING THE VOICE FAMILIAL TENDENCY CHRONIC LARYNGITIS GENDER, AGE, RACE NUTRITIONAL DEFICIENCIES

55. CLINICAL MANIFESTATIONS HOARSENESS>3 WEEKS LUMP IN THE THROAT PAIN OR BURNING SENSATION DYSPHAGIA DYSPNEA COUGH ENLARGED CERVICAL NODES

56. PATHOPHYSIOLOGY INTRINSIC TUMOR: LOCATED ON THE TRUE VOCAL CORD (USUALLY DOES NOT SPREAD) EXTRINSIC TUMOR: LOCATED ON OTHER PART OF THE LARYNX (TENDS TO SPREAD EARLY) SUPRAGLOTTIS, GLOTTIS, SUBGLOTTIS

57. DIAGNOSTIC TEST LARYNGOSCOPY LARYNGEAL TOMOGRAPY CT SCAN / MRI CHEST X-RAY BIOPSY

58. STAGING LARYNGEAL CA TNM CLASSIFICATION SYSTEM: METHOD USED TO CLASSIFIY HEAD AND NECK TUMORS. DEVELOPED BY THE AMERICAN JOINT COMMITTEE ON CANCER “CLASSIFICATION OF THE TUMOR SUGGEST TREATMENT MODALITIES” (Pg. 507; chart 22-6)

59. PROGNOSIS OF LARYNGEAL CANCER TUMOR SIZE CLIENT’S AGE AND GENDER GRADE AND DEPTH OF TUMOR INITIAL DIAGNOSIS OR A RECURRENCE

60. LARYNGEAL CANCER TREATMENTS RADIATION THERAPY GOAL OF TREATMENT CRITERIA FOR RADIATION BENEFITS COMPLICATIONS

61. SURGICAL MANAGEMENT OF LARYNGEAL CANCER LARYNGECTOMY PARTIAL LARYNGECTOMY SUPRAGLOTTIC LARYNGECTOMY HEMILARYNGECTOMY TOTAL LARYNGECTOMY RADICAL NECK DISSECTION

62. NURSING INTERVENTIONS MONITOR AND MANAGE POTENTIAL COMPLICATIONS: RESPIRATORY DISTRESS, HEMORRHAGE INFECTION, WOUND BREAKDOWN MAINTAIN PATENT AIRWAY TRACHEOSTOMY/STOMA CARE ALTERNATIVE MEANS OF COMMUNICATION:

63. NURSING INTERVENTIONS REDUCING ANXIETY PROMOTE ADEQUATE NUTRITION HYGIENE AND SAFETY MEASURES REFERRAL TO SUPPORT GROUPS RESTORING SPEECH AFTER LARYNGECTOMY

64. LUNG CANCER NUMBER ONE CANCER KILLER IN UNITED STATES OCCURRENCE (60-70YR OLD) SURVIVAL RATE LOW 85% CAUSED BY INHALATION OF CARCINOGENIC CHEMICALS

65. LUNG CANCER SMALL CELL CARCINOMA LARGE CELL CARCINOMA BRONCHIOALVEOLAR CELL CANCER ADENOCARCINOMA SQUAMOUS CELL CARCINOMA

66. RISK FACTORS TOBACCO SMOKE SECOND-HAND SMOKE ENVIRONMENTAL AND OCCUPATIONAL EXPOSURE GENETICS DIETARY FACTORS

67. CLINICAL MANIFESTATION COUGH OR CHANGE IN A CHRONIC COUGH WHEEZING, DYSPNEA, HEMOPTYSIS REPEATED, UNRESOLVED URI’S CHEST PAIN, TIGHTNESS, HOARSENESS, WEIGHT LOSS, FEVER

68. DIAGNOSTIC FINDINGS CHEST X-RAY C.T. CHEST FIBEROPTIC BRONCHOSCOPY WITH BRONCHIAL WASHINGS BRONCHOSCOPIC BIOPSY POSITRON EMISSION TOMOGRAPHY MAGNETIC RESONANCE IMAGING

69. LUNG CA TREATMENT SURGICAL INTERVENTION CHEMOTHERAPY RADIATION THERAPY PALLIATIVE THERAPY “TREATMENT DEPENDS ON SIZE, LOCATION AND TYPE OF CANCER, AS WELL AS OVERALL HEALTH”

70. TREATMENT TERMINOLOGY SURGICAL: LOBECTOMY, BILOBECTOMY, PNEUMONECTOMY WEDGE RESECTION RADIATION: EXTERNAL, BRACHYTHERAPY CHEMOTHERAPY: ALKYLATING AGENTS, CISPLATIN, PACLITAXEL, VINBLASTINE, ETOPOSIDE

71. NURSING MANAGEMENT STRATEGIES FOR SYMPTOMS OF DYSPNEA, FATIGUE, NAUSEA AND VOMITING RELIEVING BREATHING PROBLEMS PSYCHOLOGICAL SUPPORT