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CARE OF THE CLIENTSWITH RESPIRATORY
DISORDERS
Sam Joseph C. Cirilo, MD
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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
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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
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Common Respiratory Interventions
O xygen therapy
Bronchial hygiene measures
Suctioning] Steam Inhalation
Aerosol Inhalation
Medimist Inhalation
Chest Physiotherapy P ostural drainage
P ercussion
Vibration
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Common Respiratory Interventions
Incentive Spirometry
Closed Chest Drainage (Thoracostomy
Tube) One-bottle system
Two-bottle system
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RESPIRATORY/PULMONARY
DISORDERS
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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
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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
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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
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Collaborative Management
Promote rest
Increase fluid intake
Warm saline gargle
Analgesic, as ordered.
Antibiotics, as ordered.
Tonsillectomy/Adenoidectomy (if tonsillitisrecurs 5 to 6 times a year)
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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
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Laryngeal Cancer
Risk factors
Cigarette smoking
Alcoholism
Voice abuse
Pollutants
Chronic laryngitis
F amily history
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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
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Collaborative Management
Surgery: Total/Subtotal Laryngectomy
Subtotal: retains voice
Total: absolute loss of voice Provide support and client education!
Tracheostomy care
Establish means of communication
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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
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Chr o nic Obst r uctive
Pulm o na ry Disease ( C OPD)
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
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Chr o nic Obst r uctive
Pulm o na ry Disease ( C OPD)
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
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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
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Collaborative Management for
COPD Promote rest
Increase fluid intake
Promote oral care
Diet: high calorie, high protein, low
carbohydrates
Oxygen therapy: not high concentration Stop cigarette smoking
CPT: percussion, vibration, postural
drainage
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Collaborative Management for
COPD Bronchial hygiene measures
Expectorants
Antitussives Bronchodilators
Antihistamines
Steroids Antibiotics
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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
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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
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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
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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/
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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
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Collaborative Management for
Lung CA Maintain patent airway
Oxygen/aerosol therapy
Deep breathing exercises Pain relief
Protection from infection
Chemotherapy Radiation Therapy
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Collaborative Management for
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!
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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
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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
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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)
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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.
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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
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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
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Collaborative Management for
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
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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
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Assessment for P.E.
RESTLESSNESS (the first sign )
Dyspnea
Stabbing chest pain
Cyanosis
Tachycardia
Dilated pupils
Apprehension
Diaphoresis
Dysrythmias
Hypoxia
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Collaborative Management
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 )
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Reference
Udan, J.Q. (2002). Medical-surgical nursing:
Concepts and clinical application. 1st edition.
Manila: Educational Publishing House.
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