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50 Cards in this Set
- Front
- Back
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RESPIRATORY SYSTEM
ASSESSMENT: History |
– smoking, second hand smoke
– environmental exposure, occupation – family history of atopic conditions or inherited respiratory diseases (CF) – medications – atopic conditions – respiratory disorders – infant- term?, maternal history of infection – exposure to TB or other respiratory infections – living conditions – travel – pets – effect of symptoms on normal activities – Vaccination history -- Flu (yearly) -- Pneumococcal vaccine 1x (all clients with chronic illnesses of the resp system should have been vaccinated and those over 65) |
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Respiratory System: Subjective Data
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– dyspnea, orthopnea
-- How many pillows do they sleep on or where do they sleep? – Cough -- Do they cough when they lay down at night? --- Might be due to GERD --- Might be due to sinus draining into throat – sputum production -- Check for color of sputum -- Is there blood in sputum, and HOW MUCH – hemoptysis – wheezing – chest pain – nasal discharge, sneezing – watery, itching eyes - facial pain, headache, teeth pain -- Teeth pain can actually be a respiratory issue – change in voice, hoarseness -- If change in voice or hoarsness lasts for more than two weeks, consult physician |
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Respiratory System: Objective Data
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– respiratory rate
– pulse oximetry – appearance -- color of skin, nails -- nails for clubbing --- Only see clubbing in chronic respiratory problems, not acute -- level of apprehension, respiratory effort, use of accessory muscles, nasal flaring -- audible wheezing, grunting |
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Respiratory Assessment: Head
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- eyes, nose, mouth breathing, Denny’s lines (darkened eye sacs,
palate, facial tenderness, allergic shiners - Allergic salute |
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Respiratory Assessment: Lungs and Chest
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- shape and symmetry
- trachea midline - auscultation –- quality of air entry –- crackles --- Heard in periphery of lungs due to air moving through fluid --- Heard in inspiration –- Rhonchi --- Caused by air passing through secretions in larger bronchioles --- Can be heard in inspiration and expiration -- Wheezing --- Air passing through narrow airway --Always listen to breath sounds directly on skin, never with shirt on |
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Rhinitis/ Sinusitis Etiologies
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allergies, virus, bacteria (regular sinusitis is bacterial in origin, acute is viral in origin)
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Sinusitis treatment
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antihistamines, steroid NS, cromolyn NS (mast cell inhibitor)
antibiotics, avoidance of triggers, irrigation of the sinuses, OR |
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Sinusitis Education
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Avoid sinusitis triggers
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Carcinoma of the Larynx Etiology
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– increasing in incidence
–> in men than women –> in people over 60 – associated with smoking, alcohol, chronic laryngitis, vocal abuse, family history |
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Signs and Symptoms of Carcinoma of the Larynx
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– grows slowly due to limited lymphatic supply
– persistent hoarseness with or without ear pain and difficulty swallowing --hoarse longer than 2 weeks, see a HCP |
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Diagnosis of Carcinoma of the Larynx
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– endoscopy
– biopsy – CT |
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Treatment of Larynx Carcinoma
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- Surgical resection
–- hemilaryngectomy- 1/2 of larynx removed –- subtotal laryngectomy- >1/2 removed –- supraglottic laryngectomy –- total laryngectomy - Surgical resection without total removal of the larynx –- Some voice remains but will be altered –- Temporary trach, cuffed tube may be used to prevent aspiration –- Swallowing is a problem, nutrition –- Aspiration a major concern - Surgical resection –- total laryngectomy --- used in advanced cases --- larynx and surrounding tissues removed --- permanent trach --- permanent loss of voice –-radical neck dissection |
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Pre-operative care for Larynx Carcinoma
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–Prepare for voice changes, swallowing problems, trach and the care involved, diet changes
– how the patient will communicate – Lost Cord Club |
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Post-operative Larynx Carcinoma
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– position
-- semi-fowlers, neck flexed -- up first post-op day – airway -- trach tube in 5-10 days for partial, until stoma heals for total -- extra trach tube available -- sterile suctioning, oxygen, humidification -- cuffed tube if on mechanical ventilation then changed to uncuffed -- watch for dyspnea due to edema, secretions -- monitor for signs of aspiration – wound care -- drain to prevent fluid accumulation ---max 300cc in first 16 hours -- monitor for air leak -- monitor for infection – nutrition -- NG tube may be used for nutrition or patient may be on hyperalimentation until able to swallow -- monitor for signs of aspiration -- adequate fluids to keep secretions thin -- protein necessary for wound healing – body image – communication -- speech therapy, new techniques available for speech |
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General information about Obstructive Lung Disease
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- Disease state characterized by airflow obstruction
- Increased by 60% over the last decade |
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Diseases that cause Obstructive Lung Disease
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– * chronic bronchitis
– Bronchiectasis -- Collapse of small areas in the lung – asthma – * emphysema -- Has a problem getting air out of the lungs – cystic fibrosis |
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Etiology of Obstructive Lung Disease
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– 90% associated with smoking
-- 30x more likely to develop if you smoke – exposure to inhaled irritants –recurrent infections – alpha1-antitrypsin deficiency -- 3% of COPD, usually undiagnosed |
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Obstructive Lung Disease: Chronic Bronchitis
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- blue bloater
-- usually are cyanotic - thickening of the mucous membrane - increased number of goblet cells - tissue irritation - excessive mucous production - airflow obstruction |
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Obstructive Lung Disease: Emphysema
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- "pink puffer" due to being chronically hypoxic)
- air trapping on expiration - enlarged air spaces - loss of elasticity of the airways - destruction of alveolar septum |
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Prevention of Obstructive Lung Disease
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– smoking cessation
– measures to protect workers with occupational exposure to irritants -- Wear masks -- Increase workplace ventilation – treatment of respiratory infections |
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Signs and Symptoms of Obstructive Lung Disease
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– usually middle age or older
– cyanosis, plethoric in appearance – barrel shaped chest – dyspnea and exercise intolerance – wheezing, crackles, rhonchi – decreased breath sounds – prolonged expiration (very common characteristic) – Orthopnea -- Breathing difficulty when laying down – se of accessory muscles for breathing – cough with sputum esp in the am – weight loss -- Eating sometimes can wear them out – high hematocrit – cor pulmonale- right heart failure -- JVD, edema, hepatomegaly |
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Diagnostic tests for Obstructive Lung Disease
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– PFT
– chest x-ray – ABG |
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Nursing Concerns for Obstructive Lung Disease
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– gas exchange
– airway clearance – nutrition, hydration – infection – activity intolerance – sleep disturbance – knowledge deficit |
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Definition of Pneumonia
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- Acute inflammation of the lung tissue which affects gas exchange
- Leading cause of infectious disease in the US |
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Etiologies of Pneumonia
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– bacteria
– virus – aspiration – stasis |
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Types of Pneumonia
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– Community acquired pneumonia (CAP)
-- 70% with chronic disease -- mortality 6-13% – Hospital acquired pneumonia (HAP) --mortality 30-70% --- Hospital infections are more virulent -- coexisting disease -- gram negative bacteria with drug resistance |
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Prevention of Pneumonia
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– influenza (flu) vaccination every Oct/Nov
– pneumococcal vaccination – treatment of upper airway infections/bronchitis – suctioning – TCDB, ambulation, spirometer – hand washing – respiratory treatments |
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Signs and Symptoms of Pneumonia
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– fever, chills
– altered mental status – tachypnea, tachycardia – chest pain – cough, sputum production – crackles, decreased breath sounds |
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Diagnosis of Pneumonia
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– chest x-ray
– sputum cultures – ABG – WBC |
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Treatment of Pneumonia
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– may or may not be hospitalized
– antibiotics, bronchodilators – oxygen, respiratory support – TCDB, activity as tolerated – suctioning, spirometer, resp treatments – diet high in protein, calories, fluids – do not suppress a productive cough -- Only give cough suppresants during night to allow better sleep – should improve in 48-72 hrs -- Clinical presentation will get better before chest x-rays will get better |
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Tuberculosis: General Information
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- Number one cause of infectious disease deaths in the world
- On the increase –- immigrants from third world countries –- HIV –- MDR-TB |
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Etiology of Tuberculosis
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mycobacterium tuberculosis
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Pathophysiology of Tuberculosis
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– respiratory acquired infection
– body’s reaction depends on susceptibility, size of dose, virulence of the organism – inflammation occurs within the alveoli and the body’s defense tries to counteract the infection – T lymphocytes and macrophages wall off the organism producing a firm nodule called a primary tubercle which contains the tubercle bacilli – material may become calcified or be coughed up leaving a cavity or hole both of which are visible on x-ray – organism remains in the host for a lifetime and may become active if compromised -- Only way to get rid of TB is drug therapy for 6-9mos – usually pulmonary but can affect other parts of the body (extrapulmonary) - Do not allow TB tests on people who have TB because it can cause major blisters |
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Risk factors for Tuberculosis
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– HIV, immunosuppression
– homeless – very young, very old – living in crowded, unsanitary conditions – poor nutrition – ETOH, drug abuse – From countries where disease is prevalent |
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Prevention for Tuberculosis
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– BCG vaccination
– isolation of infected persons – adequate housing and ventilation – screening high risk persons frequently – treating persons with positive skin tests with INH for 6 months (HIV 1 year) -- eradicates the organism -- concern is for complications associated with drug therapy, risk of noncompliance |
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Signs and Symptoms of Tuberculosis
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– cough, blood streaked sputum
– weight loss – fever, night sweats – positive skin test --indicative of antibodies to the organism |
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Diagnosis for Tuberculosis
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– tuberculin skin testing
– chest x-ray – sputum smear for AFB – sputum culture confirms the diagnosis -- takes 3-6 weeks to get results |
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Treatment for Tuberculosis
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– isolation until symptoms subside, 3 negative smears not infectious
– initial regimen is with 4 drugs – number can be altered when susceptibility testing is completed – DOT has increased success of treatment – Combined drugs in a single tablet improves compliance – patients can be held against their will for treatment if they do not comply – lifestyle changes to improve health |
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Pathophysiology of Tuberculosis
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– respiratory acquired infection
– body’s reaction depends on susceptibility, size of dose, virulence of the organism – inflammation occurs within the alveoli and the body’s defense tries to counteract the infection – T lymphocytes and macrophages wall off the organism producing a firm nodule called a primary tubercle which contains the tubercle bacilli – material may become calcified or be coughed up leaving a cavity or hole both of which are visible on x-ray – organism remains in the host for a lifetime and may become active if compromised -- Only way to get rid of TB is drug therapy for 6-9mos – usually pulmonary but can affect other parts of the body (extrapulmonary) - Do not allow TB tests on people who have TB because it can cause major blisters |
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Risk factors for Tuberculosis
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– HIV, immunosuppression
– homeless – very young, very old – living in crowded, unsanitary conditions – poor nutrition – ETOH, drug abuse – From countries where disease is prevalent |
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Prevention for Tuberculosis
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– BCG vaccination
– isolation of infected persons – adequate housing and ventilation – screening high risk persons frequently – treating persons with positive skin tests with INH for 6 months (HIV 1 year) -- eradicates the organism -- concern is for complications associated with drug therapy, risk of noncompliance |
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Signs and Symptoms of Tuberculosis
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– cough, blood streaked sputum
– weight loss – fever, night sweats – positive skin test --indicative of antibodies to the organism |
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Diagnosis for Tuberculosis
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– tuberculin skin testing
– chest x-ray – sputum smear for AFB – sputum culture confirms the diagnosis -- takes 3-6 weeks to get results |
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Treatment for Tuberculosis
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– isolation until symptoms subside, 3 negative smears not infectious
– initial regimen is with 4 drugs – number can be altered when susceptibility testing is completed – DOT has increased success of treatment – Combined drugs in a single tablet improves compliance – patients can be held against their will for treatment if they do not comply – lifestyle changes to improve health |
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Facts about Lung cancer
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– Smoking triples your risk of dying from CAD
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Lung Cancer PREVENTION
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– Don’t start, stop smoking
-- Nicotine replacement, Zyban, hypnosis -- Average person tries 7-10 times before successful -- It is never too late to quit – avoid second hand smoke – precautions with occupational exposure – periodic chest x-rays on those at risk have not been found to be helpful with early diagnosis – CT under study-can detect a 2mm lesion versus a 10mm for xray (no effect on mortality)` |
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Lung Cancer PATHOLOGY
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– most arise from the bronchi
– cell type determines aggressiveness and treatment |
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Lung Cancer SIGNS AND SYMPTOMS
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– * persistent cough unresponsive to treatment
– * hemoptysis – * dyspnea – * wheezing – pain – fatigue – weight loss |
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Lung Cancer DIAGNOSTIC TESTS
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– chest x-ray
– sputum cytology – bronchoscopy and biopsy – CT and MRI used for diagnosis and staging |
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Lung Cancer TREATMENT
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– patient evaluated with regard to surgical risk, age, pulmonary reserve, co-morbidity
– thoracic surgery -- pneumonectomy (entire removal of a lung lobe)- no chest tube post-op - lobectomy/segmental resection, wedge resection - chest tube post-op |
