Respiratory

Assessment of the Respiratory System Anatomy and physiology review Upper respiratory tract Lower respiratory tract Lungs Accessory muscles of respiration Respiratory changes associated with aging

Role of the respiratory system Oxygenation and tissue perfusion

Organs/tissues important in meeting the need

Lungs Heart Blood vessels/RBC Patient history Target items for respiratory - Family, personal, smoking, drug use, allergies, travel, place of residence, dietary, occupational, and socioeconomic level Smoking pack years of smoking = number of packs smoked per day multiplied by the number of years the patient has smoked Current health problems cough, sputum production, chest pain, dyspnea Nutritional status

Physical assessment Lungs and thorax Other indicators clubbing, weight loss, unevenly developed muscles, skin & mucous membrane changes, general appearance, and endurance

Psychosocial Stress level Chronic issues family support, social activity, financial constraints, disability Coping mechanisms Access to support services

Care of Patients with Noninfectious Lower Respiratory Problems Chronic Airway Limitations (CAL) Asthma Chronic bronchitis Pulmonary emphysema Chronic Obstructive Pulmonary Disease (COPD) Emphysema & Chronic bronchitis Characterized by bronchospasm & dyspnea (what is this term?) Tissue damage is not reversible & increases in severity, eventually leading to respiratory failure

Asthma Intermittent disease Reversible airflow obstruction and wheezing

Pathophysiology Bronchial asthma is an intermittent and reversible airflow obstruction affecting only the airways, not the alveoli Airway obstruction occurs by: o Inflammation o Airway hyper-responsiveness Etiology Classified based on trigger events Inflammation response to specific o Allergens o General irritants o Microorganisms o Aspirin Hyper-responsiveness occurs with o Exercise o URI o Unknown reasons Genetic Genetic variation of a gene controls synthesis and activity of betaadrenergic receptors Inflammation caused by allergen binding to immunoglobulin E (IgE) Bronchospasm as a result of airway hyper-responsiveness ASA & other NSAIDS can trigger asthma in some people

Older adults Change in sensitivity of beta-adrenergic receptors Teach how to prevent asthma attacks Women 35% higher incidence Teach correct use of preventive and rescue drugs Collaborative management Assessment History Physical & clinical manifestations o Audible wheeze and increased resp rate o Increased cough o Use of accessory muscles o Barrel chest from air trapping o Long breathing cycle o Cyanosis o Hypoxemia Laboratory Assessment ABGs o Arterial oxygen level may be decreased in acute attack o Arterial carbon dioxide may decrease early in attach and increase later, indicating poor gas exchange Pulmonary Function Tests (PFTs) o Most accurate measures using spirometry Forced vital capacity (FVC) Forced expiratory volume in the first second (FEV1) Peak expiratory flow rate (PEFR) Interventions Patient education disease often intermittent; guided self-care to co-manage disease with goal of increasing symptom free periods and decreasing the number & severity of attacks Peak flow twice daily Personal drug therapy plan Drug therapy Based on the step category for severity and treatment Preventive Rx used daily regardless of symptoms Rescue drugs stop attack once it has started

Bronchodilators o Short-acting beta2 agonists o Long-acting beta2 agonists o Cholinergic antagonists o Methylxanthines

Anti-inflammatory o Corticosteroids o NSAIDS o Leukotriene antagonists o Immunomodulators

Other treatments Exercise and activity recommended Oxygen therapy acute attacks Status asthmaticus Life-threatening; acute May lead to pneumothorax, cardiac or respiratory arrest Treatment: IV fluids, potent systemic bronchodilator, steroids, epi, and O2 Emphysema

Pathophysiology loss of lung elasticity & hyperinflation of the lung Airtrapping caused by loss of elastic recoil in the alveolar walls, overstretching, & enlargement of the alveoli into bullae, and collapse of small airways (bronchioles) Dyspnea; increased respiratory rate

Chronic Bronchitis Inflammation of bronchi and bronchioles caused by chronic exposure to irritants (i.e. tobacco smoke) Inflammation, vasodilation, congestion, mucosal edema, and bronchospasm Airway only affected, not the alveoli Thick mucus production

COPD Etiology Tobacco smoke Alpha1-antitrypsin (AAT) deficiency Air pollution

Complications Hypoxemia Acidosis Respiratory infections Cardiac failure Cardiac dysrhythmias Physical assessment & clinical manifestations History General appearance Respiratory changes Cardiac changes

Laboratory assessment ABGs Sputum samples CBC/Hemoglobin & Hematocrit Serum electrolytes Serum AAT Chest X-ray PFTs Nursing dx Impaired Gas Exchange

Ineffective Breathing Pattern

Ineffective Airway Clearance

Imbalanced Nutrition < Body

Anxiety

Activity Intolerance

Surgical management

Risks, esp. for older adult Pneumonia

Community Based Care Home care management

Health teaching

Care of Patients with Infectious Respiratory Problems Influenza highly contagious acute illness

Pneumonia Pathophysiology Excess fluid, inflammatory process Inflammation triggered by infectious organisms & inhalation of irritants Community acquired infections pneumonia (types of individuals most at risk?) Nosocomial (hospital-acquired) (types of patients most at risk?) Atelectasis Hypoxemia

Assessment History Physical assessment Clinical manifestations Psychosocial Laboratory

Community-based Care Home care management Health teaching Health care resources

Severe Acute Respiratory Syndrome (SARS) Infection of cells of the respiratory tract, triggers inflammatory response No known effective treatment Prevention Avian Influenza Bird Flu Virus Prevention

Pulmonary Tuberculosis Highly communicable Transmitted via aerosolization HIV high risk individuals on developing TB

Clinical manifestations Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks

Assessment History Physical assessment Clinical manifestations

Diagnostics Manifestations of signs and symptoms Positive smear for acid-fast bacillus Confirmation of dx by sputum culture of M. tuberculosis Mantoux test (PPD) Induration of 10 mm or greater, indicative of exposure Does not mean active disease is present Interventions Combination drug therapy with strict adherence (education important) Negative sputum culture indicative of patient no longer being infectious (need results of three as negative)

Community-based Care Home care management Health teaching Health care resources