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Upper respiratory disorders and nursing mangement

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Respiratory Disorders
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Upper respiratory disorders and nursing mangement

  1. 1. Nursing management of patients (adults including elderly) with respiratory problems ANILKUMAR BR LECTURER MEDICAL-SURGICAL NURSING
  2. 2. * Nursing assessment – History and physical assessment * Etiology, Pathophysiology, clinical manifestations, diagnosis, treatment modalities and medical, surgical, dietetics and nursing management of various respiratory disorders.
  3. 3.  Upper respiratory tract infections  Bronchitis  Asthma  Emphysema  Empyema  Atelectasis
  4. 4.  Chronic obstructive pulmonary diseases ( COPD)  Bronchiectasis  pneumonia  Pulmonary Tuberculosis (TB)  Lung abscess
  5. 5.  Pleural effusion  Cysts and Tumors  Chest injuries  Respiratory arrest and insufficiency  Pulmonary embolism
  6. 6. Review of anatomy and physiology of respiratory system
  7. 7.  The respiratory system is composed of the mainly 1) Upper respiratory tracts 2) Lower respiratory tracts
  8. 8.  Together, the two tracts are responsible for ventilation (movement of air in and out of the airways).
  9. 9.  The upper respiratory tract, known as the upper airway, warms and filters inspired air so that the lower respiratory tracts (the lungs) can accomplish gas exchange.
  10. 10. Conti Gas exchange involves delivering oxygen to the tissues through bloodstream and expelling waste gases, such as carbon dioxide, during expiration.
  11. 11. Anatomy of the upper respiratory Tract  Upper airway structures consist of Nose Sinuses and nasal passages Pharynx Tonsils and adenoids Larynx and trachea
  12. 12. Lower respiratory tract  The lower respiratory tracts consist of the 1) Lungs (two) which contain the bronchial and alveolar structures needed for gas exchange
  13. 13. Structures of lungs
  14. 14.  The lungs are paired elastic structures enclosed in the thoracic cage, which is an airtight chambers with distensible walls.
  15. 15. Continue  PLEURA : The lungs and wall of the thorax are lined with a serious membrane called pleura. MEDIASTINUM : The mediastinum is in the middle of the thorax, between the pleural sac that contains the two lungs.
  16. 16.  LOBES : Each lung is divided into lobes . The left lung consists of an upper and lower lobe, whereas the right lung has an upper, middle and lower lobe
  17. 17. Nursing assessment – History and physical assessment  History collection • Personal history • Reason for seeking care • Past health history • Present illness /problems • Previous illness
  18. 18. Conti  Family history  Occupational history  Medications
  19. 19. Physical examination  Skin – cyanosis, Pallor  Nail clubbing  cough and sputum production  Inspect – palpate – Percussion - & auscultate the thorax.
  20. 20. Common respiratory sings and symptoms  Dyspnea or SOB  Wheezing  Chest pain  Cough  Hemoptysis  Sputum production
  21. 21. Common diagnostic evaluation  Pulmonary functions test (PFT) PFT is non-invasive diagnostic test. In this test the volume and capacity test aid diagnosis in patients with suspected pulmonary dysfunction.
  22. 22. PFT  PFT evaluates ventilatory functions  Determine whether obstructive or irritative disease  Can be utilize as screening test
  23. 23. ABGs (Arterial blood gas analysis)  ABGs analysis is a diagnosis procedure it involves measurement of blood pH and arterial oxygen and carbon dioxide tensions are obtained when managing patients with respiratory problems and adjusting oxygen as needed.
  24. 24. ABGs normal valves  Pao2 – 80 to 100 mm hg  Paco2- 35 to 45 mm hg  pH - 7.35 to 7.45  O2 saturation - 95 to 99 %
  25. 25. Suptum analysis  The suptum test analysis involves a sample of sputum to diagnose respiratory disease, identify organsim and identify abnormal cells and also identify pathogenic organisms.
  26. 26. Pulse oximetry  Pulse oximetry is a non-invasive method of continously monitoring the oxygen saturation of hemoglobin (sao2)  A sensor or probe is attached to the ear lobe, forehead, fingertip or the bridge of the nose.
  27. 27. Imaging studies  Chest x-ray  Computed tomography (CT)  MRI  Fluroscopic studies  Bronchoscopy
  28. 28. Bronchoscopy  Bronchoscopy is the using for diagnostic and therapeutic purpose. It’s involves a direct inspection of the trachea and bronchi through a flexible fiber optic or a rigid Bronchoscopy
  29. 29.  Bronchoscopy using for to determine location of pathologic lesions, to remove foreign objects, to collect tissues specimen and remove secretions or any aspirated materials.
  30. 30. Thoracentesis  Pleural fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection.
  31. 31. Common Diagnostic Tests for Respiratory Disorders 1. Laboratory Tests (Hemoglobin; Arterial blood gases; Pulmonary Function Tests; “Sputum Analysis& culture”). 2. Radiologic Studies (Chest X-ray; Ventilation- perfusion scan; CAT scan; Pulmonary angiography). 3. Other (Pulse oximetry; Bronchoscopy; Thoracentesis; MRI).
  32. 32. Assessment Auscultation (Listening for Normal and Adventitious Breath Sounds) Palpation and Percussion Inspection (client's color, level of consciousness, emotional state) (Rate, depth, quality, rhythm, effort relating to respiration) Health History (allergies, occupation, lifestyle, health habits)
  33. 33. COMMON UPPER RESPIRATORY TRACT INFECTIONS  Rhinitis or common cold  Allergic rhinitis  Sinusitis  Pharyngitis  Tonsillitis  Laryngitis
  34. 34.  Are the common conditions that affect most people on occasion, some infections are acute and other are chronic.
  35. 35. Viral rhinitis or common cold  Often is used when referring to a symptoms of an upper respiratory tract infection by nasal congestion ,sore throat , & cough  Cold referred to a febrile, infectious, acute inflammation, of the mucus membranes of the nasal cavity.
  36. 36. Rhinitis  Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose.  It may be acute or chronic ,non-allergic or allergic.
  37. 37. Causes of rhinitis  Idiopathic  Abuse of nasal decongestants  Irritants e.g. smoke, air pollution etc.  Forgin bodies
  38. 38.  Clinical manifestations 1. Rhinorrhea “ excessive nasal drainage” 2. Nasal congestion, Itching ,& sneezing 3. Headache may occur
  39. 39.  Medical Management of rhinitis 1. Treatment of cause “antibiotics” 2. Decongestant agents 3. Antihistamine 4. In severe cases corticosteroids 5. Teaching patient self care
  40. 40. Acute Sinusitis  It is inflammation of sinuses , it is resolved promptly if their opening into nasal cavity .  Clinical Manifestations 1. Pressure , pain over the sinus area 2. Tenderness 3. Purulent nasal secretions
  41. 41. Acute Sinusitis  Medical Management 1. Antimicrobial agent “Amoxicillin” 2. Oral & Topical Decongestant 3. Heated mist or Saline irrigation  Nursing management “Teaching patient self care”
  42. 42.  Complications 1. Meningitis & osteomylitis 2. Brain abscess 3. Ischemic infarction
  43. 43. Chronic Sinusitis  It is an inflammation of sinuses that persists for more than 8 weeks in adult & or 2 weeks in children  Clinical Manifestations 1. Impaired mucociliary clearness & ventilation 2. Chronic hoarseness & cough 3. Chronic Headache 4. Facial pain
  44. 44. Acute Pharyngitis  Acute pharyngitis is sudden inflammation of the pharynx.  It is a febrile inflammation of throat ,caused by virus about 70% , uncomplicated viral infection usually subsided promptly within 3-10 days
  45. 45.  Clinical Manifestations 1. Fiery red pharyngeal membrane& tonsils 2. Lymphoid follicles that are swollen 3. Enlarge tender cervical lymph node 4. Fever & malaise 5. Sore throat , hoarseness,& cough
  46. 46. Acute Pharyngitis  Medical Management 1. Supportive measures for viral infection 2. Pharmacologic therapy antibiotics for 10 days “cephalosporin "analgesic for severe sore anti tussive medications 3. Nutritional therapy liquid or soft diet "If liquid can’t tolerated IV fluid administered “ 4. Nursing Management (bed rest ,skin assessment, mouth care &normal saline gargle & self care teaching .
  47. 47. Chronic pharyngitis  Chronic pharyngitis is a persistent inflammation of the pharynx.  Common in adults who work or live in dusty surrounding ,use the voice too excess , suffer from chronic cough , & habitually use alcohol & tobacco.
  48. 48. Chronic Pharyngitis  Clinical Manifestations 1. Constant sense of irritation or fullness in throat 2. Mucus expelled by coughing 3. Difficulty in swallowing  Medical Management 1. Relieving symptoms Avoiding exposure to irritant Correct respiratory & cardiac conditions
  49. 49. Chronic pharyngitis 2. Antihistamine drugs 3. Decongestant 4. Controlling malaise  Nursing Management 1. Patient teaching of self care 2. Avoid alcohol , tobacco , exposure to cold 3. Face mask to avoid pollutant 4. Warm fluids,& warm saline gargle
  50. 50. Tonsillitis  The tonsils are composed of lymphatic tissue & situated on each side of the oropharynx ,they frequently are the site of acute infection (tonsillitis)  Clinical Manifestations  Tonsils : sore throat, fever , snoring & difficulty of swallowing  Adenoids : ear ache , mouth breathing , drainage ear ,frequent cold , bronchitis, noisy respiration, foul smelling breath &voice impairment
  51. 51. Tonsillitis  Medical Management 1. For recurrent tonsillitis “tonsillectomy” 2. Conservative or symptomatic therapy 3. Antimicrobial therapy “penicillin” for 7 days
  52. 52.  Nursing Management 1. Provide post op. care :V/S ,hemorrhage , position head turned to side, water or ice chips 2. Teaching patient :S&S of hemorrhage 3. Avoid too much talking or coughing 4. Liquid or semi liquid diet for several days 5. Alkaline mouth washing with warm saline
  53. 53. Laryngitis  It is an inflammation of larynx ,often occur as a result of voice abuse or exposure to dust , chemicals , smoke , & other pollutants  Common in winter & easily transmitted  The cause of infection is almost virus  Clinical Manifestations 1. Hoarseness or aphonia 2. Severe cough
  54. 54. Laryngitis  Medical Management 1. Resting voice & avoid smoking 2. Inhale cool steam or an aerosol 3. Conservative treatment 4. Antibiotics for bacterial organisms
  55. 55.  Nursing Management 1. Rest voice 2. Maintain a well humidified environment 3. Daily fluid intake

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