Transcript Respiratory
Anatomy of respiratory system 3/21/2017 Mr.Homood Alharbi Respiratory module 1 Function of respiratory system Oxygen transport: exchange of O2 &CO2 “diffusion” , increase O2 sat Ventilation: flow of air in &out of the lung, clear CO2, RR,TV Mechanism of spontaneous breathing : diaphragm movement& atmospheric pressure Inhalation (-ve pressure), exhalation (+ve pressure) 3/21/2017 Mr.Homood Alharbi Respiratory module 2 Airway resistance : any change on the airway diameter which effects airway flow to/ out the lung. Compliance :elasticity, expandability of the lung. Effected by age, disease, surfectant, lung tissue (collagen, elastin) Positioning &lung perfusion : Upper right position : lower part perfused more due to low PAP Lateral position: one side perfused more than other 3/21/2017 Mr.Homood Alharbi Respiratory module 3 Inhaled air consists of Nitrogen 78% Oxygen 21% CO2 .04% Vapor water .05% Helium Argon Oxygen carried in form of: Dissolved in the Plasma (PaO2) 70-80 mmhg With hemoglobin in RBC (O2 sat) 90% 3/21/2017 Mr.Homood Alharbi Respiratory module 4 Control of ventilation Central Chemoreceptors in Medulla & Pons which are sensivitive to PH, CO2, O2 controls rate &depth of ventilation through phrenic nerve. Pripheral : in Aortic Arch, carotid arteries. 3/21/2017 Mr.Homood Alharbi Respiratory module 5 Assessment of respiratory system Dyspnea Difficult breathing, shortness of breath Due to decreased lung compliance, high airway pressure Effect RV due to high resistance Sudden dyspea in a healthy person may indicate pneumothorax, ARDS, respiratory obstruction In immobilized person may indicate Pulmonary emboli Orthopnea indicates heart disease. Rx: treat causes, O2 administer 3/21/2017 Mr.Homood Alharbi Respiratory module 6 Cough : Irritation of mucus membrane in respiratory tract From infection, airborne irritants (smoke, dust) Serve as natural protection Night cough due to Lt side heart failure, bronchial asthma Morning cough due to brochitis Supine cough due to sunusitis Sputums production: Thick, (yellow, green) indicates bacterial infection Thin indicates viral infection Pink indicates lung tumour Fouel smelling indicates lung abscess Rx: if pt able to expactorate, hydation, inhalation of aerosolized solutions (spray to humidify air) 3/21/2017 Mr.Homood Alharbi Respiratory module 7 Wheezing RT bronchoconstriction, narrowing airways Rx: bronchodilators ASTHMA WHEEZE.wav Clubbing fingers RT hypoxia 3/21/2017 Mr.Homood Alharbi Respiratory module 8 Hemoptysis : blood in sputums, p.emboli, PA/PV diseases, heart disease Cynosis: indicate hypoxia, can be central or peripheral 3/21/2017 Mr.Homood Alharbi Respiratory module 9 Physical assessment of respiratory Nose/ Sinuses Inspect nose for color, bleeding, discharges Palpate sinuses for tender Phrynx/ Mouth: Inspect mouth for color, symmetry, exudates, ulceration Use tongue depression to inspect pharynx 3/21/2017 Mr.Homood Alharbi Respiratory module 10 Trachea Palpate and inspect for symetery or deviation (tension pneumotharx) Breathing patterns& respiratory rates Eupnea : normal breathing rate 12-18 bpm Bradypnea: slow breathing, less than 12bpm Tachypnea: fast breathing, more than 18bpm Hypoventilation: shallow breathing Hyperventilation: deep breathing, to correct acidosis, athelets Apnea: cessation of breathing 3/21/2017 Mr.Homood Alharbi Respiratory module 11 Thoracic palpataion Palpate for tenderness Respiratory excursion To determine symmetry Of expirartion Pulse oximeter To determine O2 sat 3/21/2017 Mr.Homood Alharbi Respiratory module 12 Thoracic auscultation 3/21/2017 Mr.Homood Alharbi Respiratory module 13 Adventitious Breath Sounds Abnormal sounds and some conditions associated with them: Sibilant wheezes (highpitched, musical … asthma, Fine crackles (dry, highbronchitis, emphysema, pitched popping…COPD, tumor) CHF, pneumonia) Pleural friction rub (creaking, grating… Coarse crackles (moist, lowpleurisy, tuberculosis, pitched abscess, pneumonia) gurgling…pneumonia, Stridor (crowing…croup, edema, bronchitis) foreign body obstruction, Sonorous wheezes (lowlarge airway tumor). pitched snoring…asthma, bronchitis, tumor) FINE RALES.wav Fric_rub.wav MEDIUM RALES.wav STDR MUTH.wav ASTHMA WHEEZE.wav Upper respiratory tract Rhinitis 1. 2. 3. Inflammation of nose by viral , obstructive ,allergic reaction. Clinical manifestations Rhinorrhea “ excessive nasal drainage” Nasal congestion, Itching ,& sneezing Headache may occur 1. 2. 3. 4. Medical Management Treatment of cause “antibiotics” Decongestant agents Antihistamine In severe cases corticosteroids 3/21/2017 Mr.Homood Alharbi Respiratory module 15 common cold Often is used when referring to a symptoms of an upper respiratory tract infection ch.ch.by nasal congestion ,sore throat , & cough Cold referred to a febrile, infectious, acute inflammation,of the mucus membranes of the nasal cavity Clinical manifestations 1. Nasal congestion 2. Scratchy or sore throat 3. Sneezing & cough 4. Headache & muscle ache 5. Herpes simplex sore (cold sore ) common cold Medical Management (symptomatic management) Fluid intake ,rest ,prevention of chills. Aqueous decongestant,anti histamin, Vit. C. Expectorant as needed Analgesic for aches ,pain , & fever. Antimicrobial to reduce incidence of complications Nursing Management Patient teaching of self care & prevention of infection & break chain of infection Acute Sinusitis It is inflammation of sinuses , it is resolved promptly if their opening into nasal cavity . Clinical Manifestations Pressure , pain over the sinus area Tenderness Purulent nasal secretions Medical Management Antimicrobial agent “Amoxicillin” Oral & Topical Decongestant Heated mist or Saline irrigation Nursing management Teaching pt. to promote drainage “inhaling steam, more intake, applying local heat” Teaching pt. about rebound effect of nasal decongestant. Complications Meningitis &osteomylitis Brain abscess Ischemic infarction 3/21/2017 Mr.Homood Alharbi Respiratory module 19 Acute Pharyngitis It is a febrile inflammation of throat ,caused by virus about 70% , uncomplicated viral infection usually subsided promptly within 3-10 days Clinical Manifestations Fiery red pharyngeal membrane& tonsils Lymphoid follicles that are swollen Enlarge tender cervical lymph node Fever & malaise Sore throat , hoarseness,& cough Medical Management 3/21/2017 Supportive measures for viral infection Pharmacologic therapy antibiotics for 10 days “cephalosporin”analgesic for severe sore anti tussive medications Nutritional therapy liquid or soft diet “If liquid can’t tolerated IV fluid administered “ Nursing Management (bed rest ,skin assessment, mouth care &normal saline gargle & self care teaching Mr.Homood Alharbi Respiratory module 21 Chronic Pharyngitis Common in adults who work or live in dusty surrounding ,use the voice too excess , suffer from chronic cough , & habitually use alcohol & tobacco Types of pharyngitis 1. Hypertrophic :ch.ch.by general thickening& congestion of pharyngeal mucus membrane 2. Atrophic : probably late stage of first type 3. Chronic Granular : ch.ch.by numerous swollen lymph follicles on the pharyngeal wall Clinical Manifestations Constant sense of irritation or fullness in throat Mucus expelled by coughing Difficulty in swallowing Medical Management 3/21/2017 Relieving symptoms Avoiding exposure to irritant Correct respiratory & cardiac conditions Mr.Homood Alharbi Respiratory module 23 Antihistamine drugs Decongestant Controlling malaise Nursing Management 3/21/2017 Patient teaching of self care Avoid alcohol , tobacco , exposure to cold Face mask to avoid pollutant Warm fluids,&warm saline gargle Mr.Homood Alharbi Respiratory module 24 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 Medical Management For recurrent tonsillitis “tonsillectomy” Conservative or symptomatic therapy Antimicrobial therapy “penicillin” for 7 days Nursing Management Provide post op. care :V/S ,hemorrhage , position head turned to side,water or ice chips Teaching patient :S&S of hemorrhage Avoid too much talking or coughing Liquid or semi liquid diet for several days Alkaline mouth washing with warm saline 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 Hoarseness or aphonia Severe cough Medical Management Resting voice & avoid smoking Inhale cool steam or an aerosol Conservative treatment Antibiotics for bacterial organisms Nursing Management Rest voice Maintain a well humidified environment Daily fluid intake Sleep apnea Can be obstructive, central, or mixed Manifestations : Excessive daytime sleepiness, morning headache, personality change, mentality changes, loud snoring, restless sleep Need sleep test “cardiopulmonary status monitored during sleeping” Cause hypoxia, hypoventilation, MI, HTN, dysrythmias 3/21/2017 Mr.Homood Alharbi Respiratory module 29 Medical treatment: +ve airway pressure with O2 nasal canula OR to correct obstruction Tracheostomy to be open during sleep Triptil at bed time to increase airway diameter Epistaxis Bleeding from the nose Due to rupture of tiny vessels Caused by trauma, infections, some medications Treatment: nasal packing, suctioning 3/21/2017 Mr.Homood Alharbi Respiratory module 30 Nursing process: pt with upper respiratory tract Assessment Diagnosis Planning & goals Interventions Evaluation 3/21/2017 Mr.Homood Alharbi Respiratory module 31 Conclusion Any question 3/21/2017 Mr.Homood Alharbi Respiratory module 32