Respiratory disorders

1. LOWER RESPIRATORY TRACT
INFECTIONS

2. • Infections of the lower respiratory tract includes –
– Acute bronchitis
– Pneumonia
– Pneumothorax
– Atelectasis
– Tuberculosis
– Pertussis
– Lung abscess
– Pulmonary embolism
– Plural effusion
LRTIs

3. Presented by –
SHUBHRIMA KHAN
RINMS, DURGAPUR

6. 1. According to the causative organisms
(a)Bacterial :-
• Pneumococcal pneumonia caused by Streptococcus pneumoniae*
• Staphylococcal pneumonia caused by Staphylococcus aureus
• Influenzal pneumonia caused by Haemophiles influenza
• Gram-negative bacterial pneumonia caused by Klebsiella
pneumonia
CLASSIFICATION

7. b) Viral:- Rhinovirus, coronaviruses, influenza virus, respiratory syncytial
virus (RSV), adenovirus and parainfluenza. People following organ
transplantation or immunocompromised present high rates of
cytomegalovirus pneumonia.
c) Fungal:- Fungal pneumonia caused by histoplasmosis, aspergillosis,
candidiasis, blastomycosis
d) Parasitic:- Parasitic pneumonia (caused by protozoa, nematodes,
Platyhelminthes)
CONT..

8. 2. According to the environment
a) Community-acquired pneumonia.
b) Hospital acquired pneumonia.
c) Ventilator acquired Pneumonia. (VAP)
d) Pneumonia in the immuno-compromised host (opportunistic
pneumonia).
e) Aspiration pneumonia
CONT..

9. 3. According to the areas of the lung involved/affected
a) Lobar pneumonia
b) Multilobed pneumonia
c) Bronchial pneumonia
d) Interstitial pneumonia
e) Alveolar (acinar) pneumonia
f) Segmental pneumonia
CONT..

10. • There are many causes of pneumonia including bacteria, viruses,
mycoplasmas, fungal agents and protozoa.
• It may also result from inhalation of toxic or caustic chemicals, smoke,
dusts or gases or aspiration of food, fluids, or vomitus.
• Pneumonia may complicate to chronic illnesses.
ETIOLOY

11. • Age 60 or older
• Smoking
• Air pollution, Inhalation of noxious substances.
• Altered consciousness : Alcoholism, head injury, anesthetic drug overdose
• Tracheal intubation
• Upper Respiratory Tract Infection
• Chronic Disease : Chronic lung disease, Diabetes mellitus, heart disease,
cancer
RISK FACTORS

12. • Immunosuppression
• Malnutrition
• Prolonged bed rest and immobility
• Aspiration of fluid, liquid, foreign or gastric content.
• Prolonged hospital stay.
• Residence in institutional areas where transmission is prone.
CONT..

15. • Fever
• Chills and sweating
• Productive cough
• Shortness of breath
• Chest pain
• Hypoxemia
• Fatigue
• Dyspnea, Tachypnea
CLINICAL MANIFESTATION

16. • Hemoptysis
• Headache
• Crackling sounds over affected area
• Dullness on percussion
• Decrease in breath sounds
• Unequal chest expansion
CONT..

17. • Physical examination.
• Chest X-ray.
• Gram stain and culture and sensitivity tests of sputum.
• Blood culture.
• Immunologic test to detect microbial antigens.
• CT Scan thorax.
• Fiberoptic bronchoscopy or transcutaneous needle aspiration [biopsy].
• ABG.
DIAGNOSTIC EVALUATION

18. • Appropriate antibiotic therapy
– Macrolide antibiotics: inhibitors of bacterial protein synthesis such as
azithromycin, clarithromycin
– Fluroquinolones: inhibitors of DNA synthesis such as moxifloxacin,
levofloxacin
–  lactams: inhibitors of bacterial cell wall synthesis (Penicillin,
amoxicillin, clavulanate (Augmentin), ceftriaxone, cefuroxime,
tazobactam, meropenem)
• Antipyretic
• Analgesic
• Bronchodilators medications: albuterol sulphate, metaproterenol or
methylxanthines.
MANAGEMENT

19. • Oxygen therapy
• Nutritional support
• Fluid and electrolyte management
• Deep breathing exercises and spirometry
• Chest physiotherapy
• Nasotracheal suctioning
CONT..

20. NURSING DIAGNOSIS
1. Impaired gas exchange related to presence of retained secretions at the
capillary alveolar membrane evidenced by cyanosis, dyspnea, confusion,
hypoxia
INTERVENTION
• Assess the respiratory status, skin colour, mental status, heart rhythm and
body temperature.
• Auscultate lung fields.
• Elevate head of bed.
• Suctioning is to be done as indicated.
• Encourage fluids to at least 2500 mL per day, unless contraindicated.
NURSING MANAGEMENT

21. • Assist with and monitor effects of nebulizer treatments and other.
• Perform chest physiotherapy, incentive spirometer.
• Administer medications, as indicated, for example, mucolytics,
expectorants, bronchodilators, and analgesics.
• Provide supplemental fluids such as IV infusion, humidified oxygen, and
room humidification.
• Monitor serial chest x-rays, ABGs, and pulse oximetry readings.
CONT..

22. NURSING DIAGNOSIS
2. Ineffective breathing pattern related to inflammation and pain evidenced
by Changes in respiratory rate, diminished/adventitious breath sounds,
Ineffective cough.
INTERVENTION
• Assess rate, depth of respirations and chest movement.
• Elevate head and encourage frequent position changes, deep breathing,
and effective coughing.
• Maintain bedrest
• Monitor ABGs and pulse oximetry.
• Administer oxygen therapy by appropriate
CONT..

23. NURSING DIAGNOSIS
3. Activity Intolerance relate to imbalance between oxygen supply and demand,
General weakness evidenced by report of weakness, fatigue, exertional
dyspnea or tachypnea, Abnormal heart rate response to activity.
INTERVENTION
• Evaluate client's response to activity.
• Note reports of dyspnea, increased weakness and fatigue, and changes in vital
signs during and after activities
• Provide a quiet environment and limit visitors during acute phase
• Encourage use of stress management and diversional activities.
• Explain importance of balancing activities with rest.
• Assist with self-care activities as necessary.
CONT..

24. NURSING DIAGNOSIS
4. Knowledge deficit regarding condition, treatment, self care, discharge
needs, related to lack of exposure , information misinterpretation as
evidenced by reports the problem, inaccurate follow-through of
instructions.
INTERVENTION
• Assess the level of understanding of the patient and knowledge.
• Explain about the disease condition, its signs and symptoms and
treatment modalities.
• Explain and demonstrate about the importance of effective coughing and
deep breathing exercises.
CONT..

25. • Emphasis necessity of continuing antimicrobial therapy.
• Explain about balanced rest and activity, avoiding smoking, well-rounded
diet, and avoidance of crowds during cold and flu season and of persons
with upper respiratory infections.
• Stress importance of continuing medical follow-up and obtaining
vaccinations and immunizations as appropriate for both children and
adults.
CONT..

26. NURSING DIAGNOSIS
5. Deficient fluid volume R/t fever, diaphoresis & mouth breathing.
6. Imbalanced nutrition: less than body requirements R/t dyspnea, poor
oral intake.
7. Pain R/t frequent coughing
8. Impaired oral mucous membrane R/t mouth breathing & frequent cough.
CONT..

28. • Advise patient to complete entire course of antibiotics.
• Once clinically stable, encourage gradual increase in activities to bring
energy level back to pre-illness stage.
• Encourage breathing exercises.
• Explain that a chest X-ray is usually taken 4 to 6 weeks after recovery.
• Advise smoking cessation and avoid excessive alcohol intake.
• Advise patient to keep up natural resistance with good nutrition and
adequate rest.
• Advice patient to practice frequent handwashing, especially after contact
with others.
PATIENT EDUCATION

30. Bronchitis is inflammation or swelling of the bronchial tubes (bronchi).
More specifically, bronchitis is when the lining of the bronchial tubes
becomes inflamed or infected.
DEFINITION

31. Acute bronchitis
Acute bronchitis is a shorter illness that commonly follows a cold or viral
infection, such as the flu. Acute bronchitis usually lasts a few days or weeks
Chronic bronchitis
Chronic bronchitis is characterized by a persistent, mucus-producing cough
on most days of the month, three months of a year for two successive years
in absence of a secondary cause of the cough.
TYPES

32. • Viruses, bacteria, and other particles that irritate the bronchial tubes.
• Smokers: People who are exposed to a lot of secondhand smoke
• People with weakened immune systems
• The elderly and infants
• People with gastroesophageal reflux disease (GERD)
• People who are exposed to air pollution
ETIOLOGY

33. • Coughing
• Production of clear, white, yellow, grey, or green mucus (sputum)
• Shortness of breath
• Wheezing
• Fatigue
• Fever and chills
• Chest pain or discomfort
• Blocked or runny nose
CLINICAL MANIFESTATIONS

34. History collection
Physical examination
Chest x- rays
Sputum cultures
Pulmonary function test
Bronchoscopy
INVESTIGATIONS

35. • Antibiotics - these are effective for bacterial infections, but not for viral
infections. They may also prevent secondary infections.
• Cough medicine - one must be careful not to completely suppress the
cough, for it is an important way to bring up mucus and remove irritants
from the lungs.
• Bronchodilators - these open the bronchial tubes and clear out mucus
MEDICAL MANAGEMENT

36. • Mucolytics - these thin or loosen mucus in the airways, making it easier
to cough up sputum.
• Anti-inflammatory medicines and glucocorticoid steroids - these are
for more persistent symptoms.
• Pulmonary rehabilitation program - this includes work (DBE,
Spirometer exercises) with a respiratory therapist to help breathing.
CONT..

37. • Ineffective breathing pattern related to imbalance between supply and
demand of oxygen evidence by shortness of breath.
• Ineffective airway clearance related to broncho constriction.
• Self care deficit related to fatigue secondary to increased effort for
breathing evidence by poor personal hygiene.
• Activity intolerance due to fatigue and ineffective breathing patterns
evidenced by weakness, fatigue.
NURSING DIAGNOSES

38. • Assess the condition of patient.
• Assess the vital signs
• Provide comfortable position.
• Change the position periodically.
• Maintain personal hygiene.
• Use pulse oximetry & suction.
• Deep breathing exercise learn to patient.
NURSING INTERVENTIONS

39. • Refer to physiotherapist (if need).
• Provide oxygen according to physician order.
• Provide psychological support to patient.
• Provide knowledge about chronic bronchitis.
• Administer medication according to physician order bronchodilators,
antibiotics, mucolytics.
CONT..

40. • Asthma
• Bronchiectasis
• Tuberculosis
COMPLICATIONS

41. • Avoiding tobacco smoke and exposure to second hand smoke
• Quitting smoking
• Avoiding people who are sick with colds or the flu
• Getting a yearly flu vaccine
• Getting a pneumonia vaccine
• Washing hands regularly
• Avoiding cold, damp locations or areas with a lot of air pollution
• Wearing a mask around people who are coughing and sneezing
HEALTH EDUCATION

43. Bronchiectasis is a condition anatomically defined by chronic, irreversible
dilation and distortion of the bronchi caused by inflammatory destruction
of the muscular and elastic components of the bronchial walls.
OR
Bronchiectasis is defined as permanent, abnormal dilatation of one or
more large bronchi.
DEFINITION

45. • Cylindrical (fusiform)
• Saccular
• Varicose
CLASSIFICATION

46. 1. Cylindrical/tubular bronchiectasis
The luminal dilatation is uniform and
the wall thickening is smooth and there
is failure of normal tapering of the
bronchi.
CONT..

47. 2. Saccular or cystic bronchiectasis
Most severe form of bronchiectasis. The bronchi are severely dilated and
the bronchi end blindly in a dilated thick walled cyst.
CONT..

48. 3. Varicose bronchiectasis
The bronchi resemble like varicose veins.
The luminal dilation is characterized by
alternating areas of luminal dilation and
constriction, creating a beaded appearance,
and the wall thickening is irregular.
CONT..

49. • Bronchiectasis has both congenital and acquired causes.
1. CONGENITAL CAUSES
• Kartagener syndrome/ Immotile Ciliary Syndrome: autosomal
recessive disorder, defect in the action of cilia.
• Primary immunodeficiencies.
• Williams-Campbell syndrome: Also known as Broncho-malacia is a
disease of the airways where cartilage in the bronchi is defective.
ETIOLOGY

50. • Marfan 's syndrome: Disorder of connective tissue, resulting in
abnormally long and thin digits.
• Patients with alpha I-antitrypsin deficiency
CONT..

51. 2. ACQUIRED CAUSES
• Infections caused by the staphylococcus, klebsiella, or the causative
agent of whooping cough, Tuberculosis, allergic bronchopulmonary
aspergillosis
• Chronic bronchitis
• Bronchial tumor
• Inhaled foreign bodies
• Alcoholism, heroin (drug use),
• Inflammatory bowel disease, especially ulcerative colitis.
• A Hiatal hernia can cause Bronchiectasis when the stomach acid
aspirated into the lungs.
CONT..

53. • The production of large quantities of purulent and often foul-
smelling sputum. The volume of sputum can be used for estimating
the severity of the disease.
• Mild < 10 mL
• Moderate 10-150 ml.
• Severe > 150 mL
CLINICAL MANIFESTATIONS

54. • Chronic cough
• Hemoptysis:
– Frequent.
– More commonly in dry variety.
– Usually mild
• Recurrent pneumonia: same segment
• Systemic manifestations: fever, weight loss
CONT..

55. • History and physical examination
• Chest x- rays
• Sputum cultures
• Blood test
• Pulmonary function test
• CT scan thorax
• ABG analysis
• Bronchoscopy
• Immunoglobulin
• Cilia function and structure — Kartagener syndrome.
INVESTIGATIONS

56. Goals:
l. Eliminate cause
2. Improve tracheobronchial clearance
3. Control infection
4. Reverse airflow obstruction
TREATMENT

57. • Immunoglobulin
• Antituberculosis drugs.
• Corticosteroids.
• Remove aspirated material
• Oxygen therapy
• Chest physio- therapy
• Postural drainage.
CONT..

58. • Mucolytics.
• Bronchodilators.
• Antibiotics: The choice of antibiotics should be accurately by the
results of sputum culture and drug sensitivity test.
CONT..

59. • Surgery
– Bronchial artery embolization
– Pneumonectomy
– Lobectomy
– Wedge resection
– Segmentectomy
– Sleeve lobectomy
– Lung transplantation
CONT..

60. Bronchial artery embolization:
A catheter is used to deliver small particles that block the blood supply
to the particular part of body. (Hemoptysis)
CONT..

61. Pneumonectomy: A surgical procedure in
which an entire lung is removed. A
pneumonectomy is an open chest technique
(thoracotomy).
Lobectomy: removes one lobe of the lung.
Removal of two lobes is called bilobectomy.
CONT..

62. Sleeve resection: Removing a lobe of
the lung along with part of the
bronchus.
Segment Resection (Segmentectomy):
Removal of the larger portion of the
lung but not the whole lobe .
CONT..

63. • Natural therapy
• Yoga
• Healthy lifestyle
• Emotional support
• Drug free salt therapy
PREVENTIVE MODALITIES

64. • The inhalation of natural pure sodium chloride (NaCl) in a
controlled environment (air temperature 18° to 24°C and relative
humidity 40% to 60%) is called halotherapy.
• Salt therapy is a gentle, non-invasive and drug free treatment
assisting the body to cleanse itself of toxins and naturally improve
general health and wellbeing.
• Salt has natural healing properties that help sufferers of respiratory
issues, skin problems and is also great for overall health.
Drug free salt therapy (halotherapy)

65. • A device called a halogenerator grinds salt into microscopic
particles and releases them into the air of the room. Once inhaled,
these salt particles are claimed to absorb irritants, including
allergens and toxins, from the respiratory system.
• The therapy involves sitting and relaxing in a specially designed
salt room and breathing in the microscopic salt particles.
• Sessions usually last for about 30 to 45 minutes.
Cont..

66. • Impaired gas exchange related to ventilation—perfusion inequality as
evidenced by decreased level of Sp02
Goal: Improvement in gas exchange
• Ineffective clearance related to increased production, ineffective
bronchopulmonary infection, and complications
Goal: Achievement of airway clearance airway mucus cough, other
NURSING DIAGNOSES

67. • Respiratory failure
• Atelectasis
COMPLICATIONS