Transcript Clinical Manifestations

NCM 203
NURSING CARE
MANAGEMENT: THE
RESPIRATORY
SYSTEM
Respiratory System

Its primary function is delivery of oxygen
to the lungs and removal of carbon
dioxide from the lungs.
Thoracic Cavity
The inside of the chest cage is called the
thoracic cavity.
 Contained within the thoracic cavity are
the lungs, cone-shaped, porous organs
encased in the pleura, a thin, transparent
double-layered serous membrane lining
the thoracic cavity.

The Physiology of the Lungs
The right lung is larger than the left and is
divided into three sections or lobes:
upper, middle, and lower.
 The left lung is divided into two lobes:
upper and lower.
 The upper portion of the lungs is the
apex; the lower portion is the base.

Conducting Airways
The conducting airways are tubelike
structures that provide a passageway for
air as it travels to the lungs.
 The conducting airways include the nasal
passages, mouth, pharynx, larynx,
trachea, bronchi, and bronchioles.

Pharynx Larynx Trachea



The conducting airways that connect nasal
passages and mouth to the lower parts of the
respiratory tract.
The passageway for air entering and leaving
the trachea and containing the vocal cords.
Commonly known as the windpipe, this tube is
composed of connective tissue mucosa and
smooth muscle supported by C-shaped rings of
cartilage.
Bronchi, Bronchioles
Two tubes, the right and left primary
bronchi, that each pass into its respective
lung.
 Within the lungs, the bronchi branch off
into increasingly smaller diameter tubes
until they become the terminal
bronchioles.

Respiration
A process of gas exchange necessary to
supply cells with oxygen for carrying on
metabolism, and to remove carbon
dioxide produced as a waste by-product.
 Two types of respiration: external and
internal.

External & Internal Respiration
The exchange of gases between the
inhaled air and the blood in the pulmonary
capillaries.
 The exchange of gases at the cellular
level between tissue cells and blood in
systemic capillaries.

Signs & Symptoms
1.
2.
3.
4.
5.
6.
Dyspnia
Cough
Sputum Production
Chest Pain
Wheezing
Hemoptesis
Assessment
Health History
(allergies, occupation, lifestyle, health habits)
Inspection
(client's color, level of consciousness, emotional state)
(Rate, depth, quality, rhythm, effort relating to respiration)
Palpation and Percussion
Auscultation
(Listening for Normal and Adventitious Breath Sounds)
Adventitious Breath Sounds
Abnormal sounds and some conditions associated
with them:
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

Fine crackles (dry, highpitched popping…COPD,
CHF, pneumonia)
Coarse crackles (moist,
low-pitched
gurgling…pneumonia,
edema, bronchitis)
Sonorous wheezes (lowpitched
snoring…asthma,
bronchitis, tumor)

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
Sibilant wheezes (highpitched, musical …
asthma, bronchitis,
emphysema, tumor)
Pleural friction rub
(creaking, grating…
pleurisy, tuberculosis,
abscess, pneumonia)
Stridor (crowing…croup,
foreign body obstruction,
large airway tumor).
Common Diagnostic Tests for
Respiratory Disorders
1.
2.
3.
Laboratory Tests (Hemoglobin; Arterial
blood gases; Pulmonary Function Tests;
“Sputum Analysis& culture”).
Radiologic Studies (Chest X-ray; Ventilationperfusion scan; CAT scan; Pulmonary
angiography).
Other (Pulse oximetry; Bronchoscopy;
Thoracentesis; MRI).
Respiratory Care Modilities
O Therapy
The administration of O in concentration
greater than that found in environmental
atmosphere
 Indications
-change in respiratory rate
- hypoxemia
- hypoxia

O Therapy

1.
2.
3.
4.

Cautions
O toxicity
Suppression of ventelation
Source of Cross infection
Fire Danger
Method of Oxygen Administration
Chest Physiotherapy

The Goal of chest physiotherapy is :
1.
Remove bronchial secretion
Improve Ventilation
Increase efficiency of respiratory muscles
Postural Drainage
Chest Percussion &vibration
Breathing exercise &retraining
2.
3.
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Air Way Management
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
1.
2.
3.
4.

Emergency management of upper airway
obstruction
Causes
foreign body
Secretions
Vomiting or food particles
Enlarged tissue “edema, Ca, &abscesses”
Assessment
Inspection , palpation,& Auscultation
Airway Management

1.
2.
3.
4.
5.
Emergency Measures
Opening airway by extend Pt neck back
Observe airway
Cross finger to clear airway
If no passage “Abd thrust”
Use resuscitation bag
guide lines p 499
Endotracheal Intubation

Passing endotracheal tube through mouth
or nose into the trachea
It is a method of choice in emergency
 Providing airway for specific patients
 For mechanical ventilation

Tracheastomy

It is a procedure in which an opening is made into
the trachea and indwelling tube is inserted into
the trachea

Indication
To bypass an upper airway obstruction
2.
To allow removal of tracheobroncheal secretions
3.
For long term ventilation
4.
To prevent aspiration
Complications “bleeding, pneumonia, air embolism
emphysema pneumothrax
1.
Upper Respiratory Tract
Infections/Inflammatory Disorders

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Rhinitis (coryza,
common cold)
Allergic rhinitis
Sinusitis

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
Pharyngitis
Tonsillitis
Laryngitis
Upper Respiratory Tract
Infections/Inflammatory Disorders

Are the common conditions that affect
most people on occasion, some infections
are acute and other are chronic
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

common cold

1.
2.
3.
4.
5.
Clinical manifestations
Nasal congestion
Scratchy or sore throat
Sneezing & cough
Headache & muscle ache
Herpes simplex sore (cold sore )
common cold

Medical Management (symptomatic management)
1.
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
2.
3.
4.
5.

Nursing Management
1.
Patient teaching of self care & prevention of
infection & break chain of infection
Rhinitis

Inflammation of nose by viral ,
obstructive ,allergic reaction.

Clinical manifestations
1.
Rhinorrhea “ excessive nasal drainage”
Nasal congestion, Itching ,& sneezing
Headache may occur
2.
3.
Rhinitis

1.
2.
3.
4.
Medical Management
Treatment of cause “antibiotics”
Decongestant agents
Antihistamine
In severe cases corticosteroids
Acute Sinusitis


1.
2.
3.
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
Acute Sinusitis

Medical Management
1.
Antimicrobial agent “Amoxicillin”
Oral & Topical Decongestant
Heated mist or Saline irrigation
2.
3.
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1.
2.
3.
Nursing management
“Teaching patient self care”
Complications
Meningitis &osteomylitis
Brain abscess
Ischemic infarction
Chronic Sinusitis


1.
2.
3.
4.
It is an inflammation of sinuses that
persists for more than 8 weeks in adult
& or 2 weeks in children
Clinical Manifestations
Impaired mucociliary clearness & ventilation
Chronic hoarseness & cough
Chronic Headache
Facial pain
Chronic Sinusitis

Medical Management
1.
2.
Strong antibiotics (for 21 days )
Surgical intervention to remove obstruction cause
that cause block of drainage passage

Nursing Management
1.
Increase humidity
Increase fluid intake
Early signs of sinusitis
2.
3.
Acute Pharyngitis


1.
2.
3.
4.
5.
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
Acute Pharyngitis

Medical Management
1.
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
2.
3.
4.
Chronic Pharyngitis


1.
2.
3.
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
Hypertrophic :ch.ch.by general thickening&
congestion of pharyngeal mucus membrane
Atrophic : probably late stage of first type
Chronic Granular : ch.ch.by numerous swollen
lymph follicles on the pharyngeal wall
Chronic Pharyngitis

Clinical Manifestations
1.
3.
Constant sense of irritation or fullness in throat
Mucus expelled by coughing
Difficulty in swallowing

Medical Management
1.
Relieving symptoms
Avoiding exposure to irritant
Correct respiratory & cardiac conditions
2.
Chronic Pharyngitis
2. Antihistamine drugs
3. Decongestant
4. Controlling malaise

Nursing Management
1.
Patient teaching of self care
Avoid alcohol , tobacco , exposure to cold
Face mask to avoid pollutant
Warm fluids,&warm saline gargle
2.
3.
4.
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
Tonsillitis

Medical Management
1.
3.
For recurrent tonsillitis “tonsillectomy”
Conservative or symptomatic therapy
Antimicrobial therapy “penicillin” for 7 days

Nursing Management
1.
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
2.
2.
3.
4.
5.
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
Severe cough


2.
Laryngitis

Medical Management
1.
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
2.
3.
4.

1.
2.
3.
Pleurisy/Pleural Effusion
Pleurisy is a painful condition that arises
from inflammation of the pleura, or sac
that encases the lung.
 Pleural effusion occurs when the inflamed
pleura secretes increased amounts of
pleural fluid into the pleural cavity.

Atelectasis


1.
2.
3.
4.
5.
Collapse or airless condition of the alveoli
caused byhypoventilation,obstruction of
airway or compression
Clinical Manifestations
Cough & sputum production
Dyspnea ,tachypnea ,tachycardia
Sings of pulmonary infection may present
Fever
Central cyanosis
Atelectasis

1.
2.
3.
4.
5.
Management
First line measures :(turning , early
ambulation , lung volume expansion ,
coughing, spirometry ,breathing exercises
If there is no response : (PEEP , IPPB)
Bronchoscopy
Postural Drainage & percussion
If cause is compression remove the cause
Acute Tracheobronchitis

An inflammation of the mucus membrane of
the trachea & the bronchial tree , often follow
upper respiratory tract infection

Clinical Manifestations
1.
Dry irritating cough “expectorate sputum”
Sternal soreness from coughing
Fever ,stress , night sweating
Headache & general malaise
As the infection progress the patient develop
(shortness of breath, noisy breath ,&purulent
sputum
2.
3.
4.
5.
Acute Tracheobronchitis

Medical Management
1.
5.
Antibiotics depend on symptoms & culture
Expectorant may be prescribed
Increase fluid intake
Rest & cool therapy
Suctioning & Bronchoscopy

Nursing Management
1.
Patient teaching
Encourage fluid intake
Coughing exercises to remove secretions
Complete antibiotics course,
Prevent over exertion
2.
3.
4.
2.
3.
4.
5.
Pneumonia

An inflammation of the lung tissue that is caused
by microbial agent

Community Acquired Pneumonia (CAP)
1.
Occurs either in community setting or within the
first 48 hrs of hospitalization
Most common in people younger than 60 yrs
Most prevalent during winter & spring
Caused by pneumococcus & H influenza
Virus the cause in infants & children
2.
3.
4.
5.
Pneumonia






Hospital Acquired Pneumonia (HAP) the
onset of pneumonia symptoms more than 48
hrs after admission to hospital. Also called
nosocomial infection
Common organism E.colli ,Klebsiella ,S.aurious
It occurs when host defense impaired in certain
conditions
Pneumonia in the Immuno compressed host
Caused by organisms also observed in
CAP,HAP.
Has subtle onset with progressive dyspnea ,
fever , &productive cough
Pneumonia

Clinical Manifestations
1.
Sudden onset of shaking chills
Rapidly increase in body temperature 38-40 C
Chest pluratic pain increased by deep
breathing
Patient looks severely ill with marked
tachypnea
Shortness of breath
Orthopnea
Poor appetite
Diaphoresis &tires easily
Purulent sputum
2.
3.
4.
5.
6.
7.
8.
9.
Pneumonia

Medical Management
1.
Appropriate antibiotics depend on culture
result
Hydration (increase fluid intake )
Antipyretic for fever & Headache
Warm moist inhalation to relieve irritation
Antihistamine to relieve sneezing & rhinorrhea
Oxygen & respiratory supportive measures
Complications : Shock & respiratory failure ,
Atelectasis & plural effusion
Super infection
2.
3.
4.
5.
6.

Chronic Obstructive pulmonary
Disease (COPD)


Disease state in which air flow is obstructed
by emphysema or bronchitis or both
The airway obstruction is usually progressive
& irreversible

Clinical Manifestations
1.
Cough
Increase work of breathing
Severe dyspnea that interfere with patient
activity
2.
3.
Chronic Obstructive pulmonary
Disease (COPD)

Medical Management
1.
Inhaled bronchodilators to improve airway
Oxygen therapy as prescribed
Pulmonary rehabilitation emotional &
physiologic needs ,breathing exercises
,&methods of symptoms elevation
2.
3.
Chronic Obstructive pulmonary
Disease (COPD)

Nursing Management

Patient Education About COPD
Breathing exercise
Inspiratory muscles training
Self care activity
Coping measures
1.
2.
3.
4.

1.
2.
3.
4.
Complications
Pneumonia
Atelectasis
Pneumothrax
Respiratory insufficiency & failure
Chronic Bronchitis


1.
2.
It is a productive cough that lasts in
each of 2 consecutive years in a patient
whom other causes of cough is
excluded
Clinical Manifestations
Chronic productive cough in winter
Increase frequency of respiratory
infection
Chronic Bronchitis

1.
2.
3.
4.
5.
6.
Medical Management the objective of
treatment are to keep the bronchioles opened
& functioning
Antibiotics therapy for recurrent infection
Bronchodilators to remove secretion
Postural Drainage & chest percussion
Hydration & fluid intake
Corticosteroid may be used
Smoker patient should stop smoking
Emphysema

A complex and destructive lung disease
wherein air accumulates in the tissues of the
lungs.
Smoking is the major cause of Emphysema

Classification
1.
Panlobular : destruction of the respiratory
bronchiole,alevular duct &alveoli
Centrilobular : pathogenic changes take
place mainly in the center of secondary
lobule

2.
Emphysema

1.
2.
3.
4.
5.
Clinical Manifestations
Increase dyspnea on exertion
Anoroxia & Weight loss
Weakness & Inactivity
Pursed –lip- breathing
Increase cough wheezing purulent
sputum & occasionally fever
Emphysema

1.
2.
3.
4.
5.
6.
Medical Management
Bronchodilators
Antimicrobial Agents
Oxygen therapy
Pulmonary rehabilitation
Smoking cessation
corticosteroids
Asthma
A condition characterized by intermittent
airway obstruction in response to a variety
of stimuli. “inflammatory”
 Asthma differ from COPD in that it is
reversible process either spontaneously
or with treatment
 Allergy is the strongest predisposing
factor for the development of asthma

Asthma

1.
2.
Clinical Manifestations
The most three common symptoms are:
a- coug
b- dyspnea
c- wheezing
Hypoxemia may occur along with
a- cyanosis
b- diaphoresis
c- tachycardia d- widened pulse pressure
Asthma


1.
2.
3.
4.
Prevention : allergic test to identify the
substances cause the symptoms and
avoid it as possible
Complications
Asthmaticus
Rib fracture
Pneumonia
Atelectases
Asthma

Medical Management

3.
Pharmacologic Therapy (long term)
Corticosteroid :most effective ant
inflammatory medication (inhaled form)
Long-acting beta2adrenergic agonist mild to
moderate bronchodilator (theophilline
Quick relive medications (short acting beta2
4.
adrenergic agonists
Peak flow monitoring
1.
2.
Asthma

1.
2.
3.
4.
5.
6.
Nursing Management
Immediate care based on severity of
symptoms
Assessment & Allergic History
Administer medication & observe patient
response
Antibiotics as prescribed for infection
Assist in intubations procedure if needed
Psychological support for patient & his family
Acute Respiratory Failure
Conditions wherein there is a failure of the
respiratory system as a whole.
 It is a sudden & life threatening
deterioration of gas exchange function of
the lung
 Acute : a fall in arterial PaO2 to less than
50mmHg &a rise in arterial PaCo2to
greater than 50mmHg

Acute Respiratory Failure

1.
2.
3.
4.
Causes
Decrease respiratory derive “brain”
Dysfunction of chest wall “nerves &
muscles”
Dysfunction of lung parenchyma
“expansion”
Postoperative & inadequate ventilation
Acute Respiratory Failure

1.
2.
3.
4.
5.
6.
7.
Clinical Manifestations
Impaired oxygenation & may be include
restlessness
Fatigue & headache
Dyspnea & air hunger
Tachycardia &hypertension
Confusion & lethargy
Diaphoresis …… Respiratory Arrest
Uses of accessory muscles
Acute Respiratory Failure
Medical management:
Intubations and mechanical ventilation may
be required to maintain adequate
ventilation and oxygenation while the
case corrected

Acute Respiratory Failure

1.
2.
3.
4.
5.
Nursing management:
Monitoring patient responses and
arterial blood gases
Monitoring vital sign
turning ,mouth car , skin care , and rang
of motion .
Teaching about the underlying disorders
Assists in intubations procedure
Pulmonary Embolism




1.
2.
3.
4.
Obstruction of a pulmonary artery by a
bloodborne substance.
Deep vein thrombosis is a common cause of
pulmonary embolism.
Other types (Air , Fat , Septic )
Clinical Manifestations
Dyspnea & Tachypnea
Sudden & pluretic chest pain
Fever & cough & hemoptesis
Apprehension Diaphoresis & syncope
Pulmonary Embolism

1.
i.
ii.
iii.
iv.
v.
vi.
Medical Management
Emergency Management
Nasal O2
IV infusion for Medication
Perfusion Scan
ABGs &ECG
Small dose of Morphine
Intubation & mechanical Ventilation
Pulmonary Embolism
Pharmacologic Management
i.
Anticoagulant therapy
heparin 5000-10000 bolus then 18u/kg/hrs
warfarin for three months
ii.
Thrombolytic therapy (STK , Actylase (TPA))
iii.
Surgical Management (Surgical Embolectomy)
Pulmonary Embolism

1.
2.
3.
4.
5.
6.
Nursing Management
Preventing thrombus formation
Monitoring thrombolytic therapy
Providing post operative nursing care
Managing O2 therapy
Preventing anxiety
Monitor for complications+
Pneumothorax/Hemothorax


1.
2.
3.
Traumatic disorders of the respiratory
tract wherein the underlying lung tissue
is compressed and eventually collapses.
Types
Simple Pnuemothrax
Traumatic Pnuemothorax
Tension
Pneumothorax/Hemothorax

1.
2.
3.
4.
5.
6.
7.
Clinical Manifestations
Sudden pluretic pain
Anxious patient , dyspnea & air hunger
Increase use of accessory muscles
Central cyanosis
Tympanic sound in percussion
Absent of breath sound & tactile fremetus
Agitation Diaphoresis & hypotension
Pneumothorax/Hemothorax

1.
2.
3.
4.
5.
6.
7.
Medical Management
High concentration supplemental O2
Chest tube for drainage
In emergency anything may be use to fill the
chest wound
Heavy dressing
Needle aspiration thoracenthesis
Connecting chest tube to water seal drainage
An emergency thoractomy may also
performed
Pulmonary Edema
A life-threatening condition characterized
by a rapid shift of fluid from plasma into
the pulmonary interstitial tissue and the
aveoli, resulting in markedly impaired gas
exchange.
 Can result from severe left ventrical
failure, rapid administration of I.v. fluids,
inhalation of noxious gases, or opiate or
barbiturate overdose.

Adult Respiratory Distress
Syndrome
A life-threatening condition characterized
by severe dyspnea, hypoxemia, and
diffuse pulmonary edema.
 Usually follows major assault on multiple
body systems or severe lung trauma.

Bronchiectasis
A chronic dilation of the bronchi.
 Main causes of this disorder are
pulmonary TB infection, chronic upper
respiratory tract infections, and
complications of other respiratory
disorders of childhood, particularly cystic
fibrosis.

Neoplasms of the Respiratory
Tract
Benign neoplasms.
 Lung cancer.
 Cancer of the larynx.

Epistaxis
A hemorrhage of the nares or nostrils.
 May be unilateral (most common) or
bilateral.
 Blood loss can be minimal to severe.

Smoking

Cigarette smoking is indicated as a major
causative factor in the development of
respiratory disorders, such as lung
cancer, cancer of the larynx, emphysema,
and chronic bronchitis.