SOME OF THE MOST COMMON RESPIRATORY DISEASES

Here are some of the most common Respiratory Diseases from Dr Dan HortonSzar BSc(Hons) MBBS(Hons), Northgate Medical Practice, Canterbury , UK . Reproduced with kind premission ofwww.studentconsult.com Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease is a common condition occurring in 17% of men and 8% of women between the ages of 45 and 64 years. It could perhaps more correctly be called chronic bronchitis and emphysema because both conditions coexist in all patients with COPD, to varying degrees. Virtually confined to smokers, mortality from COPD is related to the number of cigarettes smoked per day. What to learn

Diagnostic definitions clinical history for bronchitis and pathological for emphysema. Symptoms and signs, and the two subtypes of patient: pink puffers and blue bloaters. Management of acute exacerbations and long-term prophylaxis. Interpretation of arterial blood gas results.

Nursing Diagnosis for COPD NANDA Chronic Obstructive Pulmonary Disease Ineffective Airway Clearance related to bronchoconstriction, increased sputum production, ineffective cough, fatigue / decreased energy and bronkopulmonal infection. Ineffective Breathing Pattern related to shortness of breath, mucus, bronchoconstriction and airway irritants. Impaired Gas Exchange related to ventilation perfusion inequality. Activity Intolerance related to imbalance between supply with oxygen demand. Imbalanced Nutrition: Less than Body Requirements related to anorexia. Disturbed Sleep Pattern related to discomfort, the setting position.

Self-Care Deficit Bathing / Hygiene, Dressing / Grooming, Feeding, toileting related secondary fatigue due to increased respiratory effort and the insufficiency of ventilation and oxygenation. Anxiety related to threat to self-concept, the threat of death, unmet needs. Ineffective Individual Coping related to lack of socialization, anxiety, depression, low activity levels and inability to work. Knowledge Deficit related to lack of information, do not know the source of information.

Asthma Asthma is a common chronic inflammatory condition of the airways that causes reversible obstruction. The airways are characteristically hyperresponsive to a wide range of stimuli. Edema, smooth muscle hypertrophy, and mucous plugging cause obstruction. What to learn

Classification into extrinsic and intrinsic asthma, and the triggering, exacerbating and relieving factors Structural changes that occur in the airway, and their clinical features Emergency management of acute asthma Medical management of chronic asthma and inhaler technique

Nursing Care Plan for Asthma : Nanda Nursing Diagnosis and Interventions 1. Ineffective airway clearance related to airway spasm, secretion retention, amount of mucus. Goal: The patient showed the ability to maintain the cleanliness of the airway, with the expected outcomes: There is no secret Lungs clear sound Intervention: 1. Airway menagement: Free the airway (suction) Monitor the chest wall retraction Monitor respiration rate Give a semi-Fowler position 2. Clear the airway:

Listen to lung sounds Encourage the patient to drink warm Do suction

Monitor oxygen delivery Evaluation of lung sounds after suction

2. Ineffective breathing pattern related to spasm of the airway, respiratory muscle fatigue. Goal: Adequate patient's respiratory status, with the result criteria: Respiration rate is within normal limits Not seen the use of additional respiratory muscles No complaints of pain in breathing Intervention: 1. Airway management: Monitor respiratory patients Monitor the use of additional respiratory muscles (chest wall retraction) Monitor Vitas signs; respiration, pulse, blood pressure, temperature Position the patient in semi-Fowler position 2. Oxygen Therapy: Provide oxygen according to program Give oxygen through a nasal or face mask canul The flow of 1-6 liters / minute oxygen concentration produces 24-44% The flow of 5-8 liters / minute oxygen concentration produces 40-60% The flow of 8-12 liters / min oxygen concentration produces 60-80% The flow of 8-12 liters / min oxygen concentration producing 90% 3. Collaboration for bronchodilator therapy. 3.Impaired gas exchange related to bronchospasme, damage to the alveoli. Goal: effective gas exchange, with expected outcomes: Free from symptoms of respiratory failure, cianosis, nostril breath Blood gas analysis results within normal limits. Intervention: 1. Airway management: Position the patient in a position semifowler Auscultation of breath sounds of patients Patient's fluid balance Monitor respiration rate Clear the airway of secretions (Suction) Teach the client to use an inhaler 2. Acid-base management:

Monitor blood gas analysis Monitor electrolyte levels Monitor oxygen saturation Collaboration of medication to maintain the acid-base balance (sodium bicarbonate) Monitor hemodynamic status

4. Activity intolerance related to imbalance of oxygen supplied to the needs Goal: The patient showed tolerant state of activity, with the expected outcomes:

No shortness of breath on exertion Able to move up

Intervention: 1. Energy management: Determine the causes of fatigue Monitor respiratory (respiration, dyspnoea, pallor) Help clients choose the activities that can be done Recommended to increase the intake of nutrients 2. Monitor response of breathing during activity, assess abnormal response in respiration, blood pressure, pulse. 5. Knowledge deficit: about asthma, related to lack of information sources. Goal: increase patient knowledge about asthma, the expected outcomes: Knowing trigger asthma Knowing about the things that need to be avoided Knowing the handling of the attack. Intervention: 1. Assess the things that have been known to patients 2. Assess the patient's condition before health education, do not provide health education, while patients in the state of attack. 3. Education:

Explain the meaning of asthma Explain the trigger factor Describe the things that need to be avoided: elergan factors, stress, excessive cold weather activity Explain how the handler during an asthma attack at home Evaluate what has been delivered.

6. Anxiety related to crisis situations: changes in health status Goal: The patient can control anxiety and increase coping, with expected outcomes: Patient's expression relaxed Vital signs are within normal limits Intervention: 1. Lower levels of anxiety: Listen to their patients Explain each will perform maintenance procedures Instruct the patient to accompany the family as a support system during an asthmaattack 2. Teach termination worried if stress can not be avoided:

Turning his attention upward Respiratory control by drawing a deep breath (relaxation) Position your body relax Make a relaxed mood, relaxed facial expression.

7. Imbalanced Nutrition, Less Than Body Requirements related to an increase in shortness of breath, intolerance to activity Goal: Nutrition clients adequate, with expected outcomes:

Increased oral input

Intervention: 1. Environmental Management: Provide a relaxed dining atmosphere Limit visitors during mealtimes 2. Manage your nutrition:

Assess the client's food preferences and diet recommended Monitor oral intake, if not enough add parenteral nutrition Anjurrkan eat small meals but often Anjurrkan for clients favorite meals Collaboration with the nutrition.

Lung cancer Bronchogenic carcinoma is the most common cause of death from cancer in the UK, affecting 30,000 people per year. Males are affected more often than females, but an increasing incidence is occurring in women. Peak incidence is between 40 and 70 years of age. The UK has the highest incidence of this disease in the world. What to learn

The four main histological types: squamous cell (50%), small cell (20%), adenocarcinoma (20%) and large cell anaplastic (10%). Risk factors, clinical features and prognosis for each type. Symptoms and signs of pulmonary involvement, local spread, metastatic spread, and endocrine and neurological syndromes. Management and palliation.

Pneumonia Pneumonia is defined as the consolidation of lung tissue caused by formation of intraalveolar inflammatory exudates as a result of a lung infection. This must be visible on X-ray to be properly called pneumonia, as opposed to chest infection. Pneumonia is the fifth most common cause of death, according to US data. What to learn

Predisposing factors to chest infection and pneumonia. Common causative organisms and the distinction between community-acquired and hospital-acquired pneumonia.

Diagnostic and pathological features of bronchopneumonia, lobar pneumonia and atypical pneumonia. The special features of pneumonia in immunocompromised patients. Appropriate antibiotic use for the various types of pneumonia.

NANDA Pneumonia

1. Impaired Gas Exchange related to impaired oxygen delivery. 2. Risk for Infection related to inadequate primary defenses. 3. Ineffective airway clearance related to the formation of edema. 4. Activity Intolerance related to insufficiency of oxygen for everyday activities.

Pulmonary tuberculosis (TB) This is a chronic granulomatous infection of the lung caused by Mycobacterium tuberculosis. It is uncommon in the UK, with an incidence of 7 per 100,000 per year, but is extremely common worldwide. Pulmonary TB is a very common exam topic because of the increasing incidence in elderly, immunocompromised, and homeless people, and the emergence of drug-resistant strains. What to learn

Risk factors for infection and routes by which the organism can be spread. Pathogenesis: primary and secondary TB; the histopathological sequence of events that leads to granuloma formation. Symptom, signs and diagnosis of TB. Nonpulmonary TB.

Drug treatments for TB, public health measures to prevent spread and the problems of ensuring compliance with treatment.
Nursing - NANDA Tuberculosis Nursing Diagnosis for Tuberculosis

1. Ineffective Airway Clearance 2. Risk for impaired Gas Exchange

3. Imbalanced Nutrition: Less than Body Requirements 4. Risk for Infection 5. Fatigue 6. Ineffective Coping 7. Risk for Injury 8. Deficient Knowledge [Learning Need] regarding condition, treatment, prevention.

Cystic fibrosis Cystic fibrosis is a hereditary disease characterized by the production of abnormally thick mucus due to the presence of an abnormal transmembrane chloride ion transporter. It primarily affects the lung and pancreas. It is the most common autosomal recessive disorder, affecting 1 in 2000 newborns. Cystic fibrosis is a common exam topic. What to learn

Pathogenesis: learn the genetic and molecular mechanisms and the physiological effects that produce the clinical features of the disease. Symptoms, signs and methods of diagnosis.

Prognosis and management of the pulmonary and pancreatic effects of the disease Nursing Diagnosis Impaired gas exchange associated with increased production of mucus. Expected results Children will increase the movement of mucus secretion is characterized by a decrease in respiratory disorders and decrease cyanosis, and cough. Intervention 1. Perform chest physiotherapy as needed, every 4 hours 2. Give oxygen using a humidifier with lid; do not use a tent with humidity. 3. Assess the respiratory status of children every 4 hours 4. Instruct children to do deep breathing exercises every 4 hours 5. Give bronchodilators by mouth, nebulizer, or metered-dose inhaler with a spacer, as directed. Rational 1. Chest physiotherapy to help mobilize secretions, maintain lung capacity, and improve oxygenation.

2. Moisturizers will issue and thin the secretions and increase the filling of oxygen to the tissues. Because stimulation of breathing in children often depend on the level of humility oxygen, high oxygen concentration can not be used. Warm, moist environment of the tent moisturizers can increase bacterial growth. 3. Assessment of breathing that often allows early detection of changes in the child's condition. 4. Practice deep breathing to increase lung expansion. 5. Bronchodilators help thin mucus and improve lung expansion. Spacer devices allow the child to breathe in the full drug. Nursing Diagnosis Risk of infection associated with mucous product. Expected results Children will show no signs of infection characterized by fever and chills do not exist, and the reduction in respiratory distress Intervention 1. Give antibiotics as directed. 2. Assess vital signs to assess the increase in respiratory rate, dyspnea, and cyanosis. 3. Monitor the number of white blood cells. Rational 1. Antibiotics can be recommended to help fight infections. 2. These changes indicated the infection gets worse 3. Increased white blood cell count indicated an infection. Nursing Diagnosis Nutritional deficiencies: lack of demand is characterized by decreased absorption of nutrients. Expected results Children will demonstrate improved nutritional status characterized by a minimal weight loss, good skin turgor, and increased intake (eat more than 80% of the food provided) Intervention 1. Weigh the child's weight at the same time every day, and use the same scales scale. 2. Give pancreatic enzymes before each meal and snack provided, give supplements of vitamins A, D, E, and K, as directed. 3. Provide a diet high in calories, protein, and carbohydrates. If necessary,

monitor carbohydrate intake in children. 4. Give a breathing treatment before eating. Rational 1. Considering body weight every day to help assess the nutritional status of children. 2. Pancreatic enzymes allows food to digest and is absorbed in the gastrointestinal tract. High-carbohydrate diet can increase diarrhea. 3. Respiratory treatment given after a meal can cause coughing and vomiting, will increase the risk of aspiration. Nursing Diagnosis Anxiety (children) are associated with respiratory problems and stay patient in hospital. Expected results Children will decrease his anxiety is characterized by periods of rest and enough sleep respiratory status is stable. Intervention 1. Let the child in the position as comfortable as possible. 2. Delaying the procedure until all the tests and free airway. 3. Encourage parents to stay with the child and participate in nursing care. Rational 1. Allow the child at a given position will increase the anxiety and difficulty breathing 2. Examinations and procedures can increase the anxiety level of children, increasing respiratory distress 3. The presence of parents and participation in nursing care to provide security and reduce anxiety. Nursing Diagnosis Anxiety (parents) are associated with knowledge about the condition of the child. Expected results Parents of children will decrease their anxiety is characterized by the ability to provide support to children and explain the child's condition. Intervention 1. Assess understanding of parents about the child's condition and treatment provided. 2. Give an explanation of medical conditions, procedures, and treatment received.

3. Provide behavioral support, such as speech and touch the child. 4. Provide emotional support to parents during the child's stay in hospital. 5. Refer parents and children to such organizations Cystic Fibrosis Foundation; encourage them to work with the management center in order to gain experience in handling CF. Rational 1. The assessment will provide the basis for teaching 2. The explanation given before and during their stay in hospital care will increase knowledge and eliminate various misconceptions, reduce anxiety. 3. Strengthening of encouragement to parents to repeat some behaviors. 4. Hearing the concerns of parents and feelings help parents deal with the crisis hospitalization. 5. Organizations that can provide support and information. This center has been experienced in dealing with CF will be able to provide high quality service and up to date. Nursing Diagnosis Lack of knowledge related to home care. Expected results The parents will express pemahanannya about home-care instructions and demonstrate procedures for home care. Intervention 1. Teach parents about giving antibiotics and kemugkinan reaction, including rash, gastrointestinal disturbances, and difficulty breathing. 2. Explain the reasons for granting long-term antibiotics. 3. Teach parents signs and symptoms of respiratory disorders, including dyspnea, Tachypnoea, cyanosis, wheezing, and tachycardia. 4. the need to encourage children to drink two to four 8-oz (240-ml) glasses of fluid each day (depending on the circumstances of children renal and cardiovascular). 5. Teach parents how to give the children before eating enzyme-does not coincide with the food-and how to provide a diet high in calories, protein, and carbohydrates. Rational 1. Parents need to know how to give medication safely and consistently. Knowing what reaction that might occur and the parents as soon as possible memintak bantua doctor if necessary. 2. Long-term treatment to help limit the lung damage from recurrent infections.

3. Know the signs and symptoms of respiratory disorders would enable parents seek immediate medical assistance if necessary. 4. Adequate fluids will thin the mucus and restore fluid lost through the lungs, prevents dehydration which can cause an electrolyte imbalance. 5. Diet will help restore lost nutrients through no absorption of nutrients, enzymes given before meals will help digestion. Cel List documentation During his stay in hospital care, notes: The status of children and mengkajian have been made when admitted to hospital. Changes in health status of children Associated with the results of laboratory tests and diagnostic tests Fluid intake and output Nutrition Respiratory Medicine Response of children to treatment The reaction of children and parents to the disease and stay patient in hospital. Guidelines for teaching patients and their families Guidelines for follow-up plan. Diffuse interstitial diseases (alveolitis) These diseases comprise a group of noninfectious, nonmalignant disorders in which there is inflammation of the alveolar walls with a thickening of the interstitium between the alveoli, usually with fibrosis. Learning about the features of the general disease process and one or two of the conditions in more detail is worthwhile. What to learn

Histopathological changes for this general group of diseases, and management, which is similar for all of them. Symptoms, signs and diagnostic features of interstitial diseases. The three main causes of chronic pulmonary fibrosis: (1) idiopathic (sarcoidosis and cryptogenic fibrosing alveolitis); (2) dust inhalation, which might be inorganic (coal workers pneumoconiosis) or organic (farmers lung); and (3) iatrogenic (radiation pneumonitis or drug-induced by amiodarone or anticancer drugs).

Pneumothorax Pneumothorax is the presence of air in the pleural cavity. It is common and can be spontaneous or caused by trauma. The severity can range from mild to life threatening. What to learn

Causes of pneumothorax: spontaneous (idiopathic or secondary to underlying disease) and traumatic (accidental or iatrogenic). Diagnosis and assessment of severity.

Management and risks of recurrence.

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