Respiratory System Part Three

RESPIRATORY SYSTEM PART THREE 3- Disorders of Lower Respiratory

System

Disorders of Lower Respiratory System 

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Management  reduction of risks - tobacco smoking cessation or change in environment that has tobacco smoke  drugs  bronchodilators  corticosteroids  expectorants  supplemental oxygen therapy  pulmonary rehabilitation Nursing interventions  reinforce client and family teaching regarding:  diaphragmatic breathing  purse-lip breathing  inspiratory muscle training  controlled coughing  pacing of daily activities  physical conditioning  oxygen therapy: do not exceed two liters per minute via nasal cannula  avoid temperature extremes, air pollution, and high altitudes  monitor for complications of COPD  respiratory insufficiency  respiratory failure  pulmonary infections

Asthma 

Definition: a recurrent, reversible airway disease characterized by increased airway responsiveness to a variety of stimuli that produce airway narrowing and tenacious, thick, excess, mucous

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Etiology  extrinsic: when a specific allergy can be related to the attack  intrinsic: when the attack is seemingly unrelated to a specific allergen  respiratory infection  stress  exercise  gastroesophageal reflux  aspiration  disease waxes and wanes, has remissions and exacerbations

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Findings  Orthopnea, expiratory wheezing  Barrel chest, cyanosis, clubbing of fingers  Distention of neck veins  Edema of extremities  Increased PaCO2 and decreased PaO2  

Polycythemia accessory muscle use to breathe

Asthma 

Diagnostics  acute phase  physical examination and history  arterial blood gases  chest x-ray  complications in acute or remission phases  hypoxemia - too little oxygen in arterial blood  hypercapnia - too much carbon dioxide in blood  recurrence of other respiratory infections  Right-sided heart failure (cor pulmonale)  dysrhythmia  absence of wheezing may occur and be an indication of absence of airflow, which is a medical emergency

Asthma 

Management 

pharmacologic therapy 

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long-acting control medications  corticosteroids  mast cell stabilizers  long acting beta agonists  cholinergic antagonists  leukotrine modifiers quick-relief medications  short-term beta agonists  intravenous corticosteroids

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peak flow monitoring

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anti-allergy therapy

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Nursing interventions  monitor client's respiratory status (respiratory effort, rate, lung sounds, pulse oximetry  observe for subtle evidences of hypoxia (restlessness, other changes in level of consciousness)  administer medications as prescribed  reinforce client and family teaching regarding:  use of medications - expected effects, side effects, routine, when to notify health care provider  avoidance of triggers that cause asthmatic episodes  how to respond to emergency situations

Interstitial Lung Disorders 

Definition: Irritants such as toxic drugs, radiation, and industrial substances cause damaging inflammation of the alveoli and interstitial tissue of the lungs. The lungs become scarred, stiff, and non-compliant.

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Common interstitial lung disorders

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Silicosis

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Asbestos

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Black lung disease - also called pneumoconiousis

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Hypersensitive pneumonitis

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Sarcoidosis

Findings 

Difficulty inhaling

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Evidences of hypoxia

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Cough - chronic

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Hemoptysis

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Fatigue

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Anorexia

Weight loss

Interstitial Lung Disorders 

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Diagnostics  Chest X-rays  CT scan  Biopsy of lung Management  Avoidance of irritants  Oxygen therapy  Symptom relief with medications (antitussives, bronchodilators, corticosteroids) Nursing interventions  Prevent infections  Pace client's activities to reduce oxygen demands and dyspnea  Plan for small, frequent meals  Encourage client to have daily activity within pulmonary tolerance  Monitor for depression associated with disease and refer as indicated  Refer client to programs for quitting smoking if indicated

Disorders in which lung tissue collapses 

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Definition: There are a number of disorders in which the pleural space is abnormally occupied by air or fluid. The result is pressure on lung tissue reducing lung capacity. pneumothorax: air between the pleurae  open pneumothorax: hole in the chest wall, communicating with lung  closed pneumothorax: hole in lung, chest wall intact  tension pneumothorax - a medical emergency  closed pneumothorax  air is forced into pleural space, pressure builds up  shifts mediastinum and trachea away from affected side and compresses heart  treated with chest tube insertion

Disorders in which lung tissue collapses 

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pleural effusion - fluid (transudate or exudate) in the pleural space; treated with thoracentesis or chest tube hemothorax - blood in pleural space; treated with thoracentesis or chest tube empyema - purulent drainage in pleural space; usually after a pleural effusion  may be a chronic condition associated with lung cancers  treated with chest tube insertion chylothorax  lymphatic fluid in pleural space  treated with thoracentesis or chest tube  drainage is whitish in color

Disorders in which lung tissue collapses 

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Etiology  trauma: gunshot wounds, blunt trauma, rib fracture, stab wound  infection: pneumonia, pancreatitis, pleurisy  tumors  heart failure  antineoplastic medications Findings  asymmetrical chest movement  dyspnea  diminished lung sounds on affected side  subnormal hemoglobin saturation levels  fatigue and activity intolerance  tachycardia

Disorders in which lung tissue collapses 

Diagnostics - X-ray and cultures that support diagnosis

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Management

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removal of cause

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placement of chest drainage device

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thoracentesis in pleural effusion or hemothorax

Nursing interventions 

position client for comfort and improved oxygenation

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maintain / monitor chest tube and closed chest drainage system

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monitor respiratory status and effort

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nursing care of a client with a chest tube drainage system  ensure that the chest tube drainage system is closed, has no leaks, connections are taped with adhesive tape  keep the collection device below chest level or insertion site at all times  check tubes frequently for kinks or loops

Musculoskeletal diseases that hinder breathing 

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Guillain-Barre syndrome - an idiopathic peripheral polyneuritis; occurs one to three weeks after mild episode of fever associated with a viral infection  "ascending" paralysis that may affect muscles of respiration  muscles so weak that client cannot breathe deeply if high involvement  may progress to respiratory failure  may require intubation and mechanical ventilation during recovery period  recovery may take months to years  no specific treatment; only supportive care Myasthenia gravis  sporadic, progressive weakness of skeletal (voluntary) muscles  cause: lack of acetylcholine  often cannot swallow well, may aspirate and lose protective airway reflexes  medication requires adherence to schedule

Musculoskeletal diseases that hinder breathing 

Poliomyelitis  viral infection  asymptomatic, mild and paralytic forms  if disease strikes respiratory muscles, can lead to respiratory failure

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Amyotrophic lateral sclerosis (ALS; Lou Gehrig's Disease)  affects motor neurons; autonomic, sensory & mental function unchanged  chronic, progressive disease - usually causes death in two to five years  disease usually begins in distal ends of upper extremities  will eventually lead to respiratory failure  ethical issue is whether clients want mechanical ventilation, tube feedings, etc., or if they would rather die when disease becomes this severe  as disease progresses, cannot swallow well; may aspirate & lose protective airway reflexes, i.e. cough reflex

Musculoskeletal diseases that hinder breathing 

Nursing interventions common to musculoskeletal disorders  monitor carefully for changes in condition  regularly check swallowing and client's ability to protect upper airway  discuss chances of mechanical ventilation: does client wish it?  assist with coughing and secretion clearance as indicated  prevent infection  monitor for depression associated with disease, assist with needed referrals  administer medications specific to medical condition strict adherence to schedule  assist/provide physical therapy as indicated  maintain/promote adequate nutrition