Transcript 08.Respiratory.Pritamx

RESPIRATORY
STRESSORS
Pritam Pandit, RN, BSN, CCRN
ASTHMA
It is a chronic condition in which your airways
narrow and swell and produce extra mucus.
Pathophysiology



Allergen → Mast Cells
IgE (Immunoglobulin –
antibody that identifies
and neutralizes foreign
objects).
Mediators: a) Histamine –
dilation of blood vessels,
↑ mucus production, and
bronchoconstriction.
Pathophysiology
b) Leukotrienes – trigger
contractions in smooth
muscle lining in the
bronchioles.
 Eosinophils – WBC;
produces the mucus.
Pathophysiology


a)
b)
c)
d)
Bronchial lining is
affected.
Airway constriction:
Thickening of wall
Plasma leakage
Mucus buildup
Inflammation
Signs/Symptoms







Wheezing
Cough
Tightness in chest
SOB
Intensifies at night
Sweating
Orthopnea
Signs/Symptoms





Anxiety/ restlessness
Inability to speak
Cyanosis/ Hypoxemia
No audible breath
sounds
Diminishing level of
consciousness
Breath sounds




Dependent on
degree of
bronchospasm
Audible
Diminished
Absent
Vital Signs



Tachypnea
Tachycardia
Hypoxia
Asthma Attack Triggers





Specific allergens
Pollen
Mold
Dust
Animal dander
Asthma Attack Triggers







Chemicals
Forestry – Foliage
Fishing
Cigarette smoke
Medications – beta
blockers
Pregnancy
Exposure to cold
Asthma Attack Triggers




Smoke
Food
Sudden changes in the
weather
Environment
Classes of Asthma
1. Mild Intermittent
 Symptoms < 2/week
 Brief exacerbations
 Night symptoms < 2/mo
 Asymptomatic with normal function between
exacerbations
Classes of Asthma
2. Mild Persistent
 Symptoms > 2/week, < 1/day
 Exacerbation affects ADLs
 Night symptoms > 2/mo
Classes of Asthma
3. Moderate Persistent
 Daily symptoms
 Exacerbations >2 or more/week
 Exacerbations affects ADLs
 Night symptoms > 1/week
 Daily use of short term beta-agonists
Classes of Asthma
4. Severe Persistent
 Continuous symptoms
 Frequent exacerbations
 Frequent night symptoms
 Activity limited
Status Asthmaticus

Severe episode of bronchospasm that does
not respond to standard treatment
Adult Onset – Risk Factors




Obesity
Allergies
Exposure to latex
Occupational
hazards
Exercise Induced Asthma



Strenuous activity
Decreased heat and
moisture in lungs
Inhaling large amounts
cold, dry air
Strenuous activities





Playing in the cold
Hyperventilating
Laughing
Crying
Exercise requiring
breathing through
the mouth
Signs/Symptoms





Usually occurs 5-20 min
into activity
Tightness in chest
Coughing
Wheezing
SOB or rapid shallow
breaths
Prevention




Warm up exercise
Meds prior to activity
Cooling down post
exertion
Limit participation
during high trigger
days
Occupational Asthma







Triggers in the job
Chemicals
Vapors
Allergens in the
environment
People
Higher during “flu”
season
Bacteria & viruses
Nocturnal Asthma




Defined - as asthma from 12 midnight till 8am
Wheezing
SOB when lying down
Usually awaken 2am-4am
Miscellaneous Asthma



Cough variant (chronic
cough)
Seasonal
Aspirin induced
(overproduction of
leukotrienes)
Diagnostics



PFT – pulmonary
function test
CXR – chest x-ray
Peak flow measurement

Measures highest airflow
during forced expiration
Peak flow rate: The highest speed
you can blow air out from your lungs
Asthma Guidelines
Asthma Guidelines
Treatment – Quick-Relief

Short-acting beta2adrenergics




Proventil
Xopenex
Maxair
Anticholinergics

Atrovent
Treatment – Long-Acting

Corticosteroids




Qvar
Flovent
Azmacort
Mast Cell Stabilizers

Intal
Treatment – Long-Acting

Long-acting beta2-adrenergics



Serevent
Foradil
Xanthine derivatives


Slo-bid
Theodur
Treatment – Long-Acting

Leukotriene modifiers
(inhibitors)



Accolate
Singulair
Combination products



Symbicort
Advair Diskus
Dulera
Nursing






Depends on severity of
symptoms – use of quick
relief meds
Educate on use of
inhalers (spacers, etc.)
Breath sounds
Pulse oximetry
Vital signs
Peak flow
Nursing



May need hospitalizations
for severe exacerbations
Educate on self-care and
follow-up
Importance of adhering to
regime and preventative
measures
ATELECTASIS

Complete or partial collapse
of a lung or lobe.
Causes



Airway Obstruction
Loss of surfactant
Pressure on lung tissue
Signs/Symptoms




SOB/dyspnea/
tachypnea
Tachycardia
Anxiety
Fever - not r/t
infection but
reaction to injury
Signs/Symptoms


Diminished/ absent
breath sounds over
collapsed area
Affected chest wall
moves little
Signs/Symptoms


Opposite chest wall
excursion appears
excessive
Tracheal shift away
from side of collapse
Pathology
Diagnostics



ABG’s/ O2 therapy
prn
Pulse oximetry
Elevate HOB
Interventions




Turn q2h or ambulate
TCDB and use IS
Treat cause
Primary/Tertiary
prevention
ACUTE BRONCHITIS



Inflammation of the
bronchial tubes
Aka – “Chest Cold”
Causes:



Virus
Bacteria
Irritating agents
Bronchitis
Signs/Symptoms



Fever/Malaise
Dry cough (most
common)
Rhonchi
Interventions





Maintain hydration
Prevent pooling of
secretions (TCDB)
Rest
ASA/Tylenol to ↓
fever/malaise
Expectorants vs
cough suppressants
Interventions





Inhaled bronchodilators
In hospital: sputum C&S
Treat with antibiotic
CXR to r/o pneumonia
Decongestant/ Antihistamine
PNEUMONIA


Infection that inflames
the air sacs in one or
both lungs. Fluid fills.
Causes:
 Bacteria, Viruses,
Fungi
 Food/Fluid
aspiration, or Emesis
 Toxic/caustic
chemical inhalation
Signs/Symptoms




Fever/ Chills/ Sweats/
Headache
Pleuritic chest pain
Cough/Sputum
production
Rales/ Crackles
Signs/Symptoms




Dsypnea/ Tachypnea
Increase tactile fremitus
Dull percussion
Unequal Chest
Expansion
Signs/Symptoms

Elderly
 weakness
 lethargy
 tachycardia
 confusion
Diagnostics


ABG’s
CXR for
consolidation
Diagnostics


Sputum gram stain,
C&S
WBC’s
Interventions




Raise HOB
Maintain hydration
Prevent pooling
Chest PT/Postural
draining
Interventions




Adequate rest
Good Nutrition
Mild analgesics (nonopiod)
Inhaled
bronchodilators
TUBERCULOSIS



Potentially serious
infection of the lungs.
Caused by acid-fast
bacillus
Mycobacterium
tuberculosis
Must be reported to
Health Department
Agencies
Communicability




Transmitted by
aerosolization only
Infectious, but brief
exposure doesn’t cause
infection
Risk of transmitting TB
reduced within 2-3
weeks after chemo
Inflammatory disease
may occur in any part of
the body
Pathophysiology



Inhaled organism gets past defense mechanism
and implants in lung tissue.
Immune system triggers formation of “tubercles”
around phagocytized bacilli and forms a
protective wall.
Forms into “hard” or “soft” tubercles.
Pathophysiology

Hard tubercles (primary
infection)
 Tubercles calcify and
keep bacilli in check.
 Client is infected, but
does not have active
disease
 Will have positive TB
skin test, but can’t
give to anyone
Pathophysiology

Soft tubercules
 Bacilli multiply
 Caseation: necrosis
into cheese-like mass
 Inflammation
subsides, lesions heal
to calcified areas OR
erode to bronchus
 Liquefied caseous
material coughed up
(full-blown disease)
Factors That Lower Resistance





Advanced age/very
young
Immunodeficiency
Hormonal changes
Malnutrition
Alcoholism
Factors That Lower Resistance



Presence of other
disease states
Poverty (malnutrition and
overcrowding)
Certain ethnic groups –
ex: Native Americans,
Eskimos, immigrants
from Southeast Asia,
Mexico, Ethiopia, Latin
America
Assessment

History
 Recent/Past
exposure to TB
 Occupation
 Previous TB skin
test
 Received BCG
vaccine
Assessment: Systemic





Fatigue
Anorexia
Weight loss
Persistent low-grade
fever (afternoon temp
up)
Chills and sweats
(often at NIGHT)
Assessment: Respiratory





Dyspnea (usually in
advanced cases)
Persistent cough,
initially dry then
productive
Hemoptysis
Chest pain: dull,
aching, chest tightness
Non-resolving
bronchopneumonia
Diagnostics



Most definitive: AFB
smear and culture
CXR
Tuberculin test aka
PPD
Diagnostics
Interventions


Chemotherapy
First line drugs RIPES
Side Effects



Baseline studies prior
to start of RIPE
Liver - INH,
pyrazinamide
Kidney – Streptomycin
Side Effects


Hearing –
Streptomycin
Visual acuity (can’t
differentiate between
red/green) Ethambutol
Side Effects



Nausea - may need antinausea drugs
Anorexia – qhs
Peripheral neuropathies
(INH)
 r/t vit. B6 deficiency
 may need concurrent
use of PYRIDOXINE
(vit. B6)
Interventions


Check hospital
protocols: treatment
usually continues for
6-9 months
Social Service
Referral or Public
Health Department
follow-up at home for
regiment compliance
Interventions





Hospitalization = 1-2
weeks
Respiratory isolation
Fitted masks
Negative pressure
room ventilation
UV - germicidal
effect
Interventions

Pt. no longer considered a Health Hazard:




after 2-3 weeks of chemo
improvement in s/s
3 consecutive negative smears collected on
different days
maintenance of medication compliance at home
Patient/Family Education




Education assists
with compliance
Cover mouth
No need to wash
clothes/ dishes
separately
Handle used tissues
carefully
Prevention




TB screening of at-risk
populations
Early ID and treatment of
active cases
Report to Public Health
Department
Increase public awareness
EXTRA PULMONARY TB



TB occurring
anywhere outside
the lungs
Spreads from lung
via blood or lymph
Thrives in O2-rich
areas
Common Sites





Renal cortex
Bone growth plates
Meninges
Disseminated TB
Larynx/Mouth
Questions
1. Which of the following pathophysiological
mechanisms that occurs in the lung parenchyma
allows pneumonia to develop?
a) Atelectasis
b) Bronchiectasis
c) Effusion
d) Inflammation
Questions
2. A 24-year-old client comes into the clinic
complaining of right-sided chest pain and
shortness of breath. He reports that it started
suddenly. The assessment should include which of
the following interventions?
a) Auscultation of breath sounds
b) Chest x-ray
c) Echocardiogram
d) Electrocardiogram (ECG)
Questions
3. A client with pneumonia has a temperature
ranging between 101* and 102*F and periods of
diaphoresis. Based on this information, which of
the following nursing interventions would be a
priority?
a) Maintain complete bedrest
b) Administer oxygen therapy
c) Provide frequent linen changes
d) Provide fluid intake of 3 L/day
Questions
4. A client with acute asthma is prescribed shortterm corticosteroid therapy. What is the rationale
for the use of steroids in clients with asthma?
a) Corticosteroids promote bronchodilation
b) Corticosteroids act as an expectorant
c) Corticosteroids have an anti-inflammatory effect
d) Corticosteroids prevent development of
respiratory infections
Questions
5. Basilar crackles are present in a client’s lungs
on auscultation. The nurse knows that these are
discrete, non continuous sounds that are:
a) Caused by the sudden opening of alveoli
b) Usually more prominent during expiration
c) Produced by airflow across passages narrowed
by secretions
d) Found primarily in the pleura