RESPIRATORY SYSTEM

Aran Neil G. Gallur, RN

ANATOMY AND PHYSIOLOGY

DIAGNOSTIC TESTS AND PROCEDURES

Bronchoscopy allows physicians for direct visualization of the trachea and bronchial tree ; allows to take biopsies and perform deep tracheal suctioning

Nursing interventions before the procedure

Withhold food and fluids Allay the patients anxiety Place obtained written informed consent in the patients chart

CONT.

Nursing interventions after the procedure

Check cough and gag reflex Assess sputum Assess respiratory status Check vasovagal response

CHEST X-RAY
Radiographic picture of lung tissue Nursing interventions

Determine pts ability to inhale and hold breath Ensure that the pt. removes jewelry Determine for pregnancy for female pt.

PULMONARY ANGIOGRAPHY
Radiographic examination of the pulmonary circulation Nsg.interventions prior to procedure:

Note allergies to iodine, seafoods and radiopaque dyes Instruct about possible flushing of the face or burning of the throat Consent

Nsg. Interventions post procedure:

Assess neurovascular status Check insertion site for bleeding Monitor for delayed allergic response

SPUTUM STUDIES

Microscopic evaluation of sputum that includes culture and sensitivity, gram stain, acid-fast bacillus Nsg. Interventions:

Obtain early morning sterile specimen from suctioning or expectoration

THORACENTESIS
Needle aspiration of intrapleural fluid for specimen examination Nsg.interventions before and during the procedure:

Place the pt.in proper position Prepare the site of puncture

Nsg. Interventions after the procedure:

Assess the pts respiratory status Position the pt. to the affected side Check the puncture site for fluid leakage Auscultate lungs for possible pneumothorax Monitor v/s and O2 saturation

ARTERIAL BLOOD GAS (ABG) ANALYSIS

Assessment of arterial blood for tissue oxygenation, ventilation, and acid-base status Nsg. Interventions prior to procedure:
Note temperature Document oxygen and assisted mechanical ventilation used

Nsg.interventions after the procedure:

Apply pressure to the site for 5 minutes Apply a pressure dressing

LUNG SCAN

Imaging of distribution and blood flow in the lungs Nsg. Interventions prior to procedure:
Allay the pts anxiety Determine pts ability to lie still during the procedure

Nsg.interventions after the procedure:

Check the catheter insertion site for bleeding Assess for allergies to injected radioisotopes Increase fluid intake

MANTOUX INTRADERMAL SKIN TEST

Administration of tuberculin in the detection of tuberculosis antibodies Nsg.interventions:

Document current dermatitis or rashes Document history of positive results in past skin testing Note history of receiving BCG vaccine Circle and record the test site Note date for follow-up reading

RESPIRATORY DISORDERS

RISK FACTORS OF ACQUIRING RESPIRATORY DISEASES

Modifiable:

Crowded living conditions Inadequate knowledge of risk factors Exposure to chemical and environmental pollutants Cigarette or pipe smoking Use of chewing tobacco Alcohol abuse Morbid obesity

Non-modifiable:
Aging History of allergies Previous respiratory illness Family history

PNEUMONIA

Bacterial, viral, parasitic, or fungal infection that causes inflammation of the alveolar spaces Causes:
Organisms Aspiration of food Aspiration of fluid Chemical irritants

PNEUMONIA

Assessment findings:
Cough Malaise Chills SOB Elevated temperature Crackles/ ronchi Pleural friction rub Pleuritic pain Yellow green sputum Rusty, green, or bloody sputum

MEDICAL MANAGEMENT:
Diet: High calorie, high protein, increased fluids O2 Therapy Intubation and mechanical ventilation Position: Semi-Fowlers Activity: bed rest, active and passive ROM and isometric exercises Monitoring: V/S, ABG values and I/O Laboratory studies: WBCs, sputum culture, blood culture, and throat culture Nutritional support: TPN Antibiotics, antipyretics, bronchodilators Pulse oximetry

NURSING INTERVENTIONS:
Maintain pts diet Fluids 3 to 4 L/ day Administer IV as ordered Suction and turn pt; encourage coughing and deep breathing Assess respiratory status Keep in Semi-Fowlers position Monitor & record v/s, I/O, lab.studies, and pulse oximetry Administer meds as ordered Encourage verbalization of feelings

CONT
Monitor/record color, consistency, and amount of sputum Provide oral hygiene Provide information about American Lung Association

Possible complications:
Heart failure Pulmonary edema Respiratory failure

PULMONARY EDEMA

abnormal build up of fluids in the air sacs of the lungs caused by heart failure, renal failure or direct damage to the lungs such as infection

ASSESSMENT

Anxiety Cough Difficulty breathing Excessive sweating "air hunger" or "drowning Grunting or gurgling sounds with breathing Pale skin Restlessness Shortness of breath Shortness of breath when lying down (orthopnea) Wheezing

MEDICAL MANAGEMENT
O2 therapy Intravenous nitrates (glyceryl trinitrate) Loop diuretics (furosemide) digoxin Antibiotics Antihypertensives Pain control medications

NURSING INTERVENTIONS

Help the patient relax Place the patient in high Fowlers position Administer oxygen Carefully record the time morphine Assess the patients condition frequently. Watch for complications of treatment such as electrolyte depletion Explain all procedure to the patient and his family Emphasize reporting early signs of fluid overload. Review all prescribed medications with the patient. Discuss ways to observe physical energy

EMPHYSEMA

A long term progressive disease of the lungs due to over-inflation of the alveoli

CAUSES: Smoking Air pollution Abnormal airway reactivity

ASSESSMENT FINDINGS
Shortness of breath Cough Wheezing Decreased tolerance to exercise Pursed-lip breathing Barrel chest

MEDICAL MANAGEMENT:
O2 low flow Bronchodilating agents Steroids Antibiotics Pulse oximetry Protein therapy Diuretics

perform chest physiotherapy Schedule respiratory treatments at least 1 hour before and after meals. Provide high calorie-protein rich diet Make sure the patient receives adequate fluids Encourage daily activity and provide diversionary activities as appropriate. Monitor the patients respiratory function regularly. Include the patient and his family in care-related decision. Provide supportive care, and help the patient adjust to lifestyle changes imposed by a chronic illness.

ASTHMA

A heightened response to various stimuli that causes a widespread airway constriction

2 Forms: Extrinsic / atopic Intrinsic / nonatopic

ASSESSMENT FINDINGS:
Absent or diminished breath sounds during severe obstruction Chest tightness Productive cough with thick mucus Prolonged expiration Tachypnea Tachycardia Use of accessory muscles Wheezing primarily on expiration

MEDICAL MANAGEMENT:
Encourage fluids to 3L/ day O2 therapy of 2L/min Intubation or mechanical ventilation Position: High Fowlers Activity: as tolerated Turning, coughing, deep breathing, Desensitization to allergens Antibiotics, antiasthmatics, Bronchodilators, Corticosteroids, Beta-adrenergics

NURSING INTERVENTIONS
Maintain the pts diet Small, frequent feedings Encourage fluids Turning; pursed-lip and diaphragmatic breathing; coughing and deep breathing Keep in HF position Administer medications as prescribed Allow activity as tolerated Monitor and record the color, amount and consistency of sputum

BRONCHIECTASIS Localized irreversible dilation of part of the bronchial tree usually resulting in airflow obstruction and impaired clearance of secretions CAUSES: Acquired causes:

AIDS Tuberculosis Unusual complication of inflammatory bowel disease Aspiration of ammonia and other toxic gases

Congenital causes:

Cystic fibrosis

ASSESSMENT FINDINGS:
Green-yellow sputum recurrent cough Bad breath Diarrhea if associated with cystic fibrosis Shortness of breath fatigue

MEDICAL MANAGEMENT:
Antibiotics CPT, postural drainage Steroid therapy O2 Lab studies Intubation and mechanical ventilation Expectorants

NURSING INTERVENTIONS

Provide supportive care Administer antibiotics Give oxygen as needed. Perform chest physiotherapy Provide a warm, quiet, comfortable environment Give the patient well balanced, high calorie meals. Offer small, frequent meals or nutritional supplements. Make sure the patient receives adequate hydration Give frequent mouth care to remove foul-smelling sputum. Monitor the patients respiratory rate and pattern regularly. Assess gas exchange by monitoring ABG values as ordered. Observe the patients breath sounds and sputum production for changes that might indicate a respiratory infection or worsening condition

BRONCHITIS

Inflammation of the air passages of the lungs because of infection

CAUSES: Cold and flu viruses Bacterial cause Inhaled irritating fumes or dusts

ASSESSMENT FINDINGS
Fever with chills Muscle aches Nasal congestion and sore throat Cough Wheezing Chest discomfort Ankle, feet, and leg swelling

MEDICAL MANAGEMENT
Pain medications Mist vaporizer or humidifier Cough suppressant Bronchodilators Acetaminophen Fluids

NURSING INTERVENTION

Answer the patients questions and encourage As needed, perform chest. physiotherapy, Make sure the patient receives adequate fluids (at least 3 liters per day) to loosen secretions. Schedule respiratory therapy for the patient Provide mouth care after bronchodilator inhalation therapy. Encourage daily activity and provide diversional activities as appropriate. help him to alternate periods of rest and activity. Administer medications as ordered and note the patients response to them. Assess the patient for changes in baseline respiratory function. Monitor the patients weight by weighing him three times weekly. Assess for edema. Evaluate the patients nutritional status regularly. Watch the patient for signs and symptoms of respiratory infection Advise the patient to avoid crowds and people with known infections

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Group of diseases that results in persistent obstruction of bronchial airflow

CAUSES: Congenital weakness Respiratory irritants: smoke, polluted air, chemical irritants Respiratory tract infections Genetic predisposition

ASSESSMENT FINDINGS:
Cough Dyspnea Sputum production Weight loss Barrel chest Hemoptysis Exertional dyspnea Clubbing of fingers Malaise Wheezes

Crackles Anemia Anxiety Diaphoresis Use of accessory muscles Orthopnea

MEDICAL MANAGEMENT
Diet: High in protein, vit.C, Calories, and nitrogen 02 of 2-3L/min Intubation/mechanical ventilation Position: High-Fowlers Activity: As tolerated Lab studies Antibiotics

Bronchodilators Corticosteroids Expectorant

NURSING INTERVENTIONS:
Maintain diet Small, frequent feeding Encourage fluids Administer low-flow oxygen CPT, postural drainage,IPPB, turning, suction Encourage coughing and deep breathing

Reinforce pursed-lip breathing Keep patient in highFowlers position Monitor & record v/s, I/O, and laboratory studies Sputum studies Weigh the pt daily

ACUTE RESPIRATORY DISTRESS SYNDROME

Clinical syndrome of respiratory insufficiency; a sudden, life-threatening lung failure involving the inflammation of alveoli causing them to fill with liquid and collapse

CAUSES: Viral pneumonia Fat emboli Sepsis Fluid overload Shock Trauma Neurologic injuries Oxygen toxicity

ASSESSMENT FINDINGS
Tachypnea Cyanosis Cough Crackles / Rhonchi Anxiety Restlessness Decreased breath sounds

MEDICAL MANAGEMENT:
Restrict fluid intake O2 therapy Intubation and mechanical ventilation using PEEP Position: High-Fowlers Lab studies TPN Antibiotics

Analgesics Diuretics Anticoagulant Steroids Neuromuscular blocking agents Pulse oximetry

NURSING INTERVENTIONS:
Maintain pts diet Small, frequent feedings Suctioning, turning, CPT, postural drainage Keep in High-Folwers position Administer TPN Allow rest periods

POSSIBLE COMPLICATIONS: Pulmonary edema Atelectasis

PULMONARY TUBERCULOSIS

Airborne, infectious, communicable disease that can occur acutely or chronically

CAUSES: Mycobacterium tuberculosis

ASSESSMENT FINDINGS

Fatigue Malaise Irritability Night sweats Tachycardia Weight loss Anorexia Cough Yellow and mucoid sputum Dyspnea Hemoptysis

Hemoptysis Crackles Elevated temperature

MEDICAL MANAGEMENT:
Diet: high carbohydrate, high protein, high vit.B6 & C Activity: bed rest, active ROM, isometric exercises Lab studies Airborne precautions Antibiotic Antituberculosis

NURSING INTERVENTIONS:
Maintain pts diet Small, frequent feeding Suction, turn, postural drainage, CPT, encourage coughing and deep breathing Encourage fluids Maintain bed rest Frequent oral hygiene Provide ultraviolet light, negative pressure room Inform about American Lung Association

PNEUMOTHORAX
a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall Can be spontaneous, open or tension

CAUSES: Blunt chest trauma Rupture of a bleb CVP line insertion Thoracentesis Penetrating chest injuries Thoracic surgery

ASSESSMENT FINDINGS:
Sharp pain that increases with exertion Diminished or absent breath sounds Dyspnea Tracheal shift Anxiety Diaphoresis Tachycardia Tachypnea

Decreased chest expansion unilaterally Subcutaneous emphysema Pallor Cough

MEDICAL MANAGEMENT:
O2 Position: High-Fowlers Activity: active ROM Lab studies Incentive spirometry Chest tube to water-seal drainage Thoracentesis Analgesic

NURSING INTERVENTIONS:
Administer oxygen Turn the pt; coughing & deep breathing exercises Maintain chest tube to water-seal drainage Keep patient in HF Administer meds as ordered Assess pts pain

POSSIBLE COMPLICATIONS: Mediastinal shift Respiratory insufficiency Infection

PULMONARY EMBOLISM

Undissolved substance in the pulmonary vasculature

CAUSES: Flat or long bone fractures Thrombophlebitis Venous stasis Hypercoagulability Abdominal surgery Malignant tumors Prolonged bed rest Obesity Trauma CVP line insertion

ASSESSMENT FINDINGS:
Dyspnea Tachycardia Elevated temperature Cough Chest pain Tachypnea Anxiety Crackles Hypotension Arrythmias Frothy,pink-tinged sputum

MEDICAL MANAGEMENT:
O2 Intubation and mechanical ventilation Position: High-Fowlers Activity: bed rest, active and passive ROM and isometric exercises Lab studies Analgesics Diuretics Anticoagulants Thrombolytics Pulse oximetry

NURSING INTERVENTIONS:
Administer IV fluids Administer O2 Suction and turning; coughing and deep breathing Keep in HF position Monitor and record v/s Administer meds as prescribed Assess for positive Homans sign Monitor PT and PTT