Transcript Caring for Individuals Experiencing Respiratory Health Challenges

Caring for Individuals
Experiencing Respiratory
Challenges
NURS2016
Upper Respiratory Tract
Self-Study
Common Cold
Acute/Chronic Sinusitis
Rhinitis
Acute/Chronic Pharyngitis
Tonsillitis and Adenoiditis
Clinical Manifestations &
Treatment
Sore throat, fever, snoring and difficulty
swallowing.
Mouth breathing, earaches, halitosis,
frequent colds.
Antibiotics
Surgical tonsillectomy (& adenoidectomy)
Nursing Care related to T&A
Pre-op assessment.
Pre-op teaching
Post-op
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Assess operative site
Ice collar
Analgesia
Ice chips/water
No straws, no
coughing, limit talking
Risk of Hemorrhage
Assess expectorant
Assessment swallowing
Assess VS
Restlessness
Hemorrhage at operative
site is an emergency.
Ostruction/Trauma of URT
Sleep apnea
Epistaxis
Obstructive
Pressure, Head tilt
Apnea>10sec. &
Chemical cautery or
>5x/hr
vasoconstrictors
Tx: +ve airway
Assess vital signs
pressure or surgery
Preventative
Nurse educate pt re tx
strategies
and use of oxygen
Cancer of Larynx
Glottic area, supraglottic area, subglottis
Risk factors: carcinogens & others
Radiation treatment
Surgical treatment
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Partial laryngectomy
Supraglottic laryngectomy
Hemilaryngectomy
Total laryngectomy
Airflow and Communication
Post-Laryngectomy
Primary Nursing Interventions:
Laryngectomy
Pre-operative teaching
Reducing anxiety and depression
Maintaining a patent airway
Promoting alternative communication
methods
Promoting adequate nutrition
Promoting home-based care
Primary Nursing Interventions:
Laryngectomy
Monitoring and managing potential
complications
– Respiratory distress and hpyoxia
– Hemorrhage
– Infection
– Wound breakdown
Lower Respiratory Tract
Atelectasis
Closure or collapse of alveoli
Prevention: Education and Reinforcement
Frequent position change
Early ambulation
DB&C
Incentive spirometer
Atelectasis
Management:
Positive expiratory pressure
Suctioning secretions, chest physical
therapy, bronchiodilators
Thoracentesis
Respiratory Infections
(lower RT)
Acute tracheobronchitis
Pneumonia
Pulmonary Tuberculosis
Acute Tracheobronchitis
Management
Antibiotic treatment
Expectorants
Deep suctioning and
ventilation support
Nursing Care
Increasing fluuid
intake
Breathing and
coughing exercises
Encourage rest
Education related to
medications
Pneumonia
Inflammation of Lung Parenchyma
Caused by microbial agent: Strep
pneumoniae, haemophilus influenzae,
legionella, pseudomonas aeruginosa
Community Aquired Pneumonia
Hospital Aquired Pneumonia
Immunocompromised
Aspiration Pneumonia
Medical Managment &
Complications
Management
Antibiotic according to
sensitivity and Gram
stain.
Supportive treatment
when viral
Oxygen if hypoxic
Complications
Shock and respiratory
failure
Atelectasis and
pleural effusion
(empyema)
Superinfection
Nursing Assessment
Pneumonia
T&P
Secretions/expectora
nt
Cough
Respirations
Chest assessment
Nursing Diagnoses
Nursing Interventions
Pneumonia
Improving airway
patency
Promoting rest and
conserving energy
Promoting fluid intake
Maintaining nutrition
Monitoring and
managing potential
complications
Pulmonary Tuberculosis
Infectious disease of the lung parenchyma
Mycobacterium tuberculosis
Worldwide public health problem
Common TB meds: isoniazid, rifampin,
streptomycin, pyrazinamide, ethamutol
Nursing Assessment
TB
Fever
Anorexia
Weight loss
Night sweats
Fatigue
Enlarged and painful
lymph nodes
Cough
Sputum
Ecophony, fremitus
Diminished bronchial
sounds & crackles
Nursing Diagnosis
Knowledge deficit about tx regimen
& preventative health measures
Medication regimen is complex
TB is highly communicable – meds are the
most effective means of preventing
transmission
Medication side effects are primary
reason for D/C
COPD
A disease state characterized by airflow
limitation that is not fully reversible
Often include diseases such as chronic
bronchitis and emphysema
Risk factors: active and passive smoking,
occupational exposure, air pollution and
genetic abnormalities
Chronic Bronchitis
Presence of cough and sputum for at least
3 months past 2 years.
Bronchial walls thicken and lumen narrows
Increased susceptability to RTI
Emphysema
Abnormal distention of the air spaces
beyond the terminal bronchioles with
destruction of the walls of the aveoli.
Usually long history of smoking
Dyspnea becomes the major symptoms
Nursing Care
COPD
Nursing Assessment
Focus on symptoms
Disease history
Become familiar with
chart pg 578
Nursing Diagnosis
Impaired gas exchange
Ineffective airway
clearance
Ineffective breathing
pattern
Self-care deficit
Activity intolerance
Ineffective coping
Knowledge deficit
Nursing Interventions
COPD
Breathing exercises
Inspiratory muscle training
Activity pacing
Self-care activities
Physical conditioning
Oxygen therapy
Nutritional therapy
Coping measures
Therapeutic Approach
COPD
Treatment to improve ventilation and
decrease work of breathing.
Prevention & tx of infection
Improve energy conservation techniques
Proper environmental conditions
Psychological support
Ongoing education
Oxygen therapy and COPD
Because hypoxemia, rather than high
carbon dioxide, drives respiration in
COPD, and
Because oxygen therapy can raise oxygen
levels in the blood
COPD patient receiving oxygen tx may
experience decreased stimulation to
breath
Asthma
Inflammatory disease of airways
– Hyper-responsiveness
– Mucosal edema
– Mucous production
– Reversible process
*Prevention: identify substances that precipitate
symptoms
Nursing Care
Asthma
Assess resp status
Severity of symptoms
Breath sounds
Peak flow
Pulse oxymetry
Vital signs
Hx of allergy to meds
Current med regimen
Admin and monitor
medication
Ensure hydration
Monitor S&S infection
Provide psychological
support
Pulmonary Embolism
Obstruction of
pulmonary artery by a
thrombus
Can also be air, fat, or
amniotic fluid emboli
Risk factors (p.472)
Venous stasis
Hypercoagulability
Venous endothelial
disease
Certain disease state
Other: age, obesity,
clothing, pregnancy.
Nursing Care
Pulmonary Embolism
Minimize the risk (know the risks)
Prevent thrombus formation
Monitor thrombolytic therapy
Manage pain
Oxygen therapy
Pulmonary Embolism
Often sudden
Painful: ischemia
Immediate SOB
Reminder
Self study upper respiratory track
Focus on promoting health through
– Preventative approaches
– Facilitate quality of life while living with
chronic respiratory challenges