Doc's Pulmo

8/8/2019 Doc's Pulmo

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CARE OF THE CLIENTSWITH RESPIRATORY

DISORDERS

Sam Joseph C. Cirilo, MD



Common Respiratory Diagnostic

Studies and Therapies MantouxTest

PPD

Intradermal Read 72 hours after the injection

(+) MantouxTest is induration of 10 mm or more

5 mm is considered + for HIV patients

Signifies exposure to Mycobacterium tubercle

bacilli



Common Respiratory Diagnostic

Studies and Therapies F luoroscopy

Bronchography

Bronchoscopy

Lung scan

Sputum examination Biopsy

Pulmonary function studies Vital Capacity

Tidal Volume

Inspiratory Reserve Volume Expiratory Reserve Volume

Functional Residual Capacity

Residual Volume

ABG

Thoracentesis



Common Respiratory Interventions

O xygen therapy

Bronchial hygiene measures

Suctioning] Steam Inhalation

Aerosol Inhalation

Medimist Inhalation

Chest Physiotherapy P ostural drainage

P ercussion

Vibration



Common Respiratory Interventions

Incentive Spirometry

Closed Chest Drainage (Thoracostomy

Tube) One-bottle system

Two-bottle system



RESPIRATORY/PULMONARY

DISORDERS



Epistaxis

Causes: Trauma

Hypertension

Rheumatic Heart Disease

Cancer

Nursing Interventions

Instruct the client to sit-up, lean forward,

head tipped. Put pressure over the soft tissues of the nose

for at least 5 minutes.

Cold compress

Nasal pack with neosenephrine (3-5 days)

Liquid, then soft diet



S inusitis

Clinical Manifestations

Pain

Maxillary: pain on cheek, upper teeth

F rontal: pain above eyebrows

Ethmoid: pain in and around the eyes

Sphenoid: pain behind eye, occiput, top of the head

General malaise

Stuffy nose

Headache

Post-nasal drip

Persistent cough

Fever



Sinusitis. . .

Collaborative Management: Rest

Increase fluid intake

Hot wet packs

Avoid AS A Antibiotics, as prescribed.

Nasal Decongestants

Irrigation of maxillary sinus with warm NSS

Functional Endoscopic Sinus Surgery (FESS) Calwell-Luc Surgery (Radical Antrum Surgery )

Ethmoidectomy

Sphenoidectomy/ethmoidectomy

Osteoplastic flap surgery for frontal sinusitis





Collaborative Management

Promote rest


Warm saline gargle

Analgesic, as ordered.

Antibiotics, as ordered.

Tonsillectomy/Adenoidectomy (if tonsillitisrecurs 5 to 6 times a year)



Tonsillectomy

PreOp Care

Assess for URTI.

Monitor PTT

PostOp care

Prone, head turned to side

Monitor for hemorrhage Frequent swallowing

Bright red vomitus

Increased PR

Promote comfort Ice collar

Acetaminophen/analgesics

NoASA

Ice-cold fluids

Bland foods



Laryngeal Cancer

Risk factors

Cigarette smoking

Alcoholism

Voice abuse

Pollutants

Chronic laryngitis

F amily history



Assessment of Laryngeal CA

Persistent hoarseness

Mass on anterior neck

Dyspnea

Dysphagia

Chronic laryngitis

Burning sensation with hot/acidic beverages

Halitosis Hemoptysis

Severe anorexia, anemia, weight loss




Surgery: Total/Subtotal Laryngectomy

Subtotal: retains voice

Total: absolute loss of voice Provide support and client education!

Tracheostomy care

Establish means of communication



Chr o nic Obst r uctive

Pulm o na ry Disease ( C OPD)

Chronic bronchitis

The hypoxic

´blue bloaterµ

Online Image Courtesy:Fédération Girondine de Lutte contre les

MaladiesRespiratoires (FGLMR) (2006)

http://www.respir.com/doc/abonne/semeiologie/inspection/SemeioInspectionBlueBloater.asp





Emphysema

The

´pink pufferµ

Online Image Courtesy:Fédération Girondine de Lutte contre les

MaladiesRespiratoires (FGLMR) (2005)

http://www.respir.com/doc/abonne/semeiologie/inspection/SemeioInspectionPinkPuffer.asp





Asthma

May be due to allergy (extrinsic) or

inflammation (intrinsic) Histamine, bradykinin, prstaglandin, serotonin,

leukotrienes, ECF-A , and SRS-A are mobilised

Characterized by bronchospasm and

bronchoconstriction May lead to hypoxia and respiratory acidosis

if not treated



General Assessment for COPD

Cough Dyspnea

Chest pain

Sputum production

Adventitious breathsound

Pursed lip-breathing

Upright, leaningforward position

Changes in LOC

Changes in skin color Changes in body

temperature

Voice changes

Weakness Fatigue

Anorexia

Weight loss

Alteration in thoracicanatomy

Clubbing

Polycythemia



Collaborative Management for

COPD Promote rest


Promote oral care

Diet: high calorie, high protein, low

carbohydrates

Oxygen therapy: not high concentration Stop cigarette smoking

CPT: percussion, vibration, postural

drainage




COPD Bronchial hygiene measures

Expectorants

Antitussives Bronchodilators

Antihistamines

Steroids Antibiotics



Pleu r al Effusi o n

Accumulation of fluids in the pleural space

Types

Hemothorax

Pyothorax or Empyema Hydrothorax

Causes:

Trauma

Thoracic surgery

PPV

CVP line insertion

Emphysema



Assessment for Pleural Effusion

Sudden, sharp chest pain

SOB

Anxiety

Restlessness

Absent breath sounds

Tachypnea

Chest tightness and asymmetry

Cyanosis

Tympanitic sound on chest percussion



Nursing Management for

Pleural Effusion Encourage the patient to stay calm

High-Fowler·s position

Pain management

Chest tube/thoracentesis

CXR ABG

Assess for shock



L ung C ance r

(B r o nc h o genic C ance r )

Risk factors

Cigarette smoking

Asbestosis

Emphysema

Smoke from burnt wood

Online Image Courtesy:TPI NEWS Daily (2010)

http://toppayingideas.com/blog/2010/04/08/inositol-

lung-cancer/



Assessment of Lung Cancer

Cough:

Hacking

Nonproductive

Thick , purulent, blood-

tinged sputum

Chest tightness

Chronic RTI

Hoarseness Hypoxia

Edema around the neck

Pleural effusion

Late signs (WAWA!) Weakness

Anorexia

Weight loss

Anemia




Lung CA Maintain patent airway

Oxygen/aerosol therapy

Deep breathing exercises Pain relief

Protection from infection

Chemotherapy Radiation Therapy




Lung CA Surgeries as recommended

PNEUMONECT O MY

LOBECT O MY SEGMENTECT O MY

WEDGE RESECT ION

DECORT IC AT ION

THOR ACOPL ASTY

Health Promotion and Illness Prevention for

risky individuals!



Adult Respi r at o ry Dist r ess

S y nd r o me (ARD S ) Causes

Shock

Aspiration

Toxic agents

O xygen toxicity

Near -drowning

Trauma Infection

DIC

F at emboli



Adult Respi r at o ry Dist r ess

S y nd r o me (ARD S ) Assessment

Tachypnea

Retractions Central cyanosis

Dry cough

F ine crackles

F ever

Changes in LOC and ABGs



C o llab o r ative Management

f o r ARD S O xygen therapy

Semi-high-F owler·s Position

CPT Increase fluid intake

Eye care

Positive End Expiratory Pressure (PEEP)



TU BER C U L O SIS

A popular communicable lung infection caused Mycobacterium tubercle bacilli.

Can actually occur in some other parts of the

body (extrapulmonary /miliary ) but the pairof lungs is the most common site!

PTB management through the new DOH

TB-DOTS guidelines

Massive information dissemination, infection

control, and health education must be done.



Important Points on

Primary TB Drugs

Isoniazid (INH)

Peripheral Neuritis Hepatotoxicity

Vitamin B6

(PYRIDOXINE)

Streptomycin Ototoxicity

Nephrotoxicity

Pyrazinamide

Hepatotoxicity,

Fatal hemoptysis

Rifampicin

Red-orange color of

bodily secretions

Ethambutol

Optic neuritis and skin

rash



Pneum o nia

Assessment Increased sputum

production

Wheezing

Dyspnea

Cough

Rales

Rhonchi

Fluid in the ISC

Consolidation

Hypoxemia

Chest pain

Pleural effusion

Dullness

Decreased breath

sounds

Decreased vocal

fremitus

Decreased chest

expansion

Increase in WBC count

Tachypnea

Fever




Pneumonia P romote rest

Encourage fluid intake

Incentive spirometry O xygen therapy

Semi-Fowler·s position

Bronchial Hygiene

Oral hygiene

Humidifier

Splint chest when

coughing

Sputum examination,CXR, Temperature

monitoring

Antibiotics, as prescribed

Diet: high in calorie and protein



Pulm o na ry Emb o lism

Causes Fat embolism

Multiple trauma

PVDs

Abdominal surgery

Immobility

Hypercoagulabity

Online Image Courtesy:New York University (FGLMR) (2007)

http://www.clinicalcorrelations.org/?p=93



Assessment for P.E.

RESTLESSNESS (the first sign )

Dyspnea

Stabbing chest pain

Cyanosis

Tachycardia

Dilated pupils

Apprehension

Diaphoresis

Dysrythmias

Hypoxia




O xygen therapy STAT

Early postop ambulation

Obese patient monitoring DO NOT MASS AGE legs

P ain relief

HOB elevated

Heparin (2 weeks ) Then Coumadin (3-6

months )



Reference

Udan, J.Q. (2002). Medical-surgical nursing:

Concepts and clinical application. 1st edition.

Manila: Educational Publishing House.



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