NurseReview.Org Respiratory System

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Published on November 8, 2007

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Medical and Surgical Nursing Review The Respiratory System Nurse Licensure Examination Review

 

Outline Of Review Concepts: Review of the relevant respiratory anatomy Review of the relevant respiratory physiology The respiratory assessment Common laboratory examinations

Review of the relevant respiratory anatomy

Review of the relevant respiratory physiology

The respiratory assessment

Common laboratory examinations

Outline Of Review Concepts: Review of the common respiratory problems and the nursing management Review of common respiratory diseases Upper respiratory conditions Lower respiratory conditions

Review of the common respiratory problems and the nursing management

Review of common respiratory diseases

Upper respiratory conditions

Lower respiratory conditions

Respiratory Anatomy & Physiology The respiratory system consists of two main parts - the upper and the lower tracts

The respiratory system consists of two main parts - the upper and the lower tracts

Respiratory Anatomy & Physiology The UPPER respiratory system consists of: 1. nose 2. mouth 3. pharynx 4. larynx

The UPPER respiratory system consists of:

1. nose

2. mouth

3. pharynx

4. larynx

Respiratory Anatomy & Physiology The LOWER respiratory system consists of: 1. Trachea 2. Bronchus 3. Bronchioles 4. Respiratory unit

The LOWER respiratory system consists of:

1. Trachea

2. Bronchus

3. Bronchioles

4. Respiratory unit

Upper Respiratory Tract

The Nose This is the first part of the upper respiratory system that contains nasal bones and cartilages There are numerous hairs called vibrissae There are numerous superficial blood vessels in the nasal mucosa

This is the first part of the upper respiratory system that contains nasal bones and cartilages

There are numerous hairs called vibrissae

There are numerous superficial blood vessels in the nasal mucosa

The Nose The functions of the nose are: 1. To filter the air 2. To humidify the air 3. To aid in phonation 4. Olfaction

The functions of the nose are:

1. To filter the air

2. To humidify the air

3. To aid in phonation

4. Olfaction

The Pharynx The pharynx is a musculo - membranous tube that is composed of three parts 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx

The pharynx is a musculo - membranous tube that is composed of three parts

1. Nasopharynx

2. Oropharynx

3. Laryngopharynx

The Pharynx The pharynx functions : 1. As passageway for both air and foods (in the oropharynx) 2. To protect the lower airway

The pharynx functions :

1. As passageway for both air and foods (in the oropharynx)

2. To protect the lower airway

The Larynx Also called the voice box Made of cartilage and membranes and connects the pharynx to the trachea

Also called the voice box

Made of cartilage and membranes and connects the pharynx to the trachea

The Larynx Functions of the larynx: 1. Vocalization 2. Keeps the patency of the upper airway 3. Protects the lower airway

Functions of the larynx:

1. Vocalization

2. Keeps the patency of the upper airway

3. Protects the lower airway

The Paranasal sinuses These are four paired bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium Named after their location - frontal, ethmoidal, sphenoidal and maxillary

These are four paired bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium

Named after their location - frontal, ethmoidal, sphenoidal and maxillary

The Paranasal sinuses The function of the sinuses: Resonating chambers in speech

The function of the sinuses:

Resonating chambers in speech

The Lower Respiratory System The lower respiratory system consists of 1. Trachea 2. Main bronchus 3. Bronchial tree 4. Lungs- 3R/ 2L The trachea  to the terminal bronchioles is called the conducting airway The respiratory bronchioles  to the alveoli is called the respiratory acinus

The lower respiratory system consists of

1. Trachea

2. Main bronchus

3. Bronchial tree

4. Lungs- 3R/ 2L

The trachea  to the terminal bronchioles is called the conducting airway

The respiratory bronchioles  to the alveoli is called the respiratory acinus

The Trachea A cartilaginous tube measures 10-12 centimeters Composed of about 20 C-shaped cartilages, incomplete posteriorly

A cartilaginous tube measures 10-12 centimeters

Composed of about 20 C-shaped cartilages, incomplete posteriorly

The Trachea The function of the trachea is to conduct air towards the lungs The mucosa is lined up with mucus and cilia to trap particles and carry them towards the upper airway

The function of the trachea is to conduct air towards the lungs

The mucosa is lined up with mucus and cilia to trap particles and carry them towards the upper airway

The Bronchus The right and left primary bronchi begin at the carina The function is for air passage

The right and left primary bronchi begin at the carina

The function is for air passage

The Primary Bronchus RIGHT BRONCHUS Wider Shorter More Vertical LEFT BRONCHUS Narrower Longer More horizontal

RIGHT BRONCHUS

Wider

Shorter

More Vertical

LEFT BRONCHUS

Narrower

Longer

More horizontal

The Bronchioles The primary bronchus further divides into secondary, then tertiary then into bronchioles The terminal bronchiole is the last part of the conducting airway

The primary bronchus further divides into secondary, then tertiary then into bronchioles

The terminal bronchiole is the last part of the conducting airway

The Respiratory Acinus The respiratory acinus is the chief respiratory unit It consists of 1. Respiratory bronchiole 2. Alveolar duct 3. alveolar sac

The respiratory acinus is the chief respiratory unit

It consists of

1. Respiratory bronchiole

2. Alveolar duct

3. alveolar sac

The Respiratory Acinus The respiratory acinus is the chief respiratory unit The function of the respiratory acinus is gas exchange through the respiratory membrane

The respiratory acinus is the chief respiratory unit

The function of the respiratory acinus is gas exchange through the respiratory membrane

The Respiratory Acinus The respiratory membrane is composed of two epithelial cells 1.The type 1 pneumocyte - most abundant, thin and flat. This is where gas exchange occurs 2. The type 2 pneumocyte - secretes the lung surfactant

The respiratory membrane is composed of two epithelial cells

1.The type 1 pneumocyte - most abundant, thin and flat. This is where gas exchange occurs

2. The type 2 pneumocyte - secretes the lung surfactant

The Respiratory Acinus A type III pneomocyte is just the macrophage that ingests foreign material and acts as an important defense mechanism

A type III pneomocyte is just the macrophage that ingests foreign material and acts as an important defense mechanism

Accessory Structures The PLEURA Epithelial serous membrane lining the lung parenchyma Composed of two parts- the visceral and parietal pleurae The space in between is the pleural space containing a minute amount of fluid for lubrication

The PLEURA

Epithelial serous membrane lining the lung parenchyma

Composed of two parts- the visceral and parietal pleurae

The space in between is the pleural space containing a minute amount of fluid for lubrication

Accessory Structures The Thoracic cavity The chest wall composed of the sternum and the rib cage The cavity is separated by the diaphragm, the most important respiratory muscle

The Thoracic cavity

The chest wall composed of the sternum and the rib cage

The cavity is separated by the diaphragm, the most important respiratory muscle

Accessory Structures The Mediastinum The space between the lungs, which includes the heart and pericardium, the aorta and the vena cavae.

The Mediastinum

The space between the lungs, which includes the heart and pericardium, the aorta and the vena cavae.

GENERAL FUNCTIONS OF THE Respiratory System Gas exchange through ventilation, external respiration and cellular respiration Oxygen and carbon dioxide transport

Gas exchange through ventilation, external respiration and cellular respiration

Oxygen and carbon dioxide transport

The Assessment HISTORY Reason for seeking care Present illness Previous illness Family history Social history

HISTORY

Reason for seeking care

Present illness

Previous illness

Family history

Social history

The Assessment PHYSICAL EXAMINATION Skin- cyanosis, pallor Nail clubbing Cough and sputum production Inspect - palpate - percuss - auscultate the thorax

PHYSICAL EXAMINATION

Skin- cyanosis, pallor

Nail clubbing

Cough and sputum production

Inspect - palpate - percuss - auscultate the thorax

The Assessment LABORATORY EXAMINATION 1. ABG analysis 2. Sputum analysis 3. Direct visualization - bronchoscopy 4. Indirect visualization - CXR, CT and MRI 5. Pulmonary function test

LABORATORY EXAMINATION

1. ABG analysis

2. Sputum analysis

3. Direct visualization - bronchoscopy

4. Indirect visualization - CXR, CT and MRI

5. Pulmonary function test

ABG Analysis This test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample

This test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample

ABG Analysis Pre-test: choose site carefully, perform the Allen’s test, secure equipments- syringe, needle, container with ice Intra-test: Obtain a 5 mL specimen from the artery (brachial, femoral and radial) Post-test: Apply firm pressure for 5 minutes, label specimen correctly, place in the container with ice

Pre-test: choose site carefully, perform the Allen’s test, secure equipments- syringe, needle, container with ice

Intra-test: Obtain a 5 mL specimen from the artery (brachial, femoral and radial)

Post-test: Apply firm pressure for 5 minutes, label specimen correctly, place in the container with ice

ABG Analysis ABG normal values PaO2 80-100 mmHg PaCO2 35-45 mmHg pH 7.35- 7.45 HCO3 22- 26 mEq/L O2 Sat 95-99%

ABG normal values

PaO2 80-100 mmHg

PaCO2 35-45 mmHg

pH 7.35- 7.45

HCO3 22- 26 mEq/L

O2 Sat 95-99%

Sputum Analysis This test analyzes the sample of sputum to diagnose respiratory diseases, identify organism, and identify abnormal cells

This test analyzes the sample of sputum to diagnose respiratory diseases, identify organism, and identify abnormal cells

Sputum Analysis Pre-test: Encourage to increase fluid intake Intra-test: rinse mouth with WATER only, instruct the patient to take 3 deep breaths and force a deep cough, steam nebulization, collect early morning sputum Post-test: provide oral hygiene, label specimen correctly

Pre-test: Encourage to increase fluid intake

Intra-test: rinse mouth with WATER only, instruct the patient to take 3 deep breaths and force a deep cough, steam nebulization, collect early morning sputum

Post-test: provide oral hygiene, label specimen correctly

Pulse Oximetry Non-invasive method of continuously monitoring the oxygen saturation of hemoglobin A sensor or probe is attached to the earlobe, forehead, fingertip or the bridge of the nose

Non-invasive method of continuously monitoring the oxygen saturation of hemoglobin

A sensor or probe is attached to the earlobe, forehead, fingertip or the bridge of the nose

Bronchoscopy A direct inspection of the trachea and bronchi through a flexible fiber-optic or a rigid bronchoscope Done to determine location of pathologic lesions, to remove foreign objects, to collect tissue specimen and remove secretions/aspirated materials

A direct inspection of the trachea and bronchi through a flexible fiber-optic or a rigid bronchoscope

Done to determine location of pathologic lesions, to remove foreign objects, to collect tissue specimen and remove secretions/aspirated materials

Bronchoscopy Pre-test: Consent, NPO x 6h, teaching Intra-test: position supine or sitting upright in a chair, administer sedative, gag reflex will be abolished, remove dentures Post-test: NPO until gag reflex returns, position SEMI-fowler’s with head turned to sides, hoarseness is temporary, CXR after the procedure, keep tracheostomy set and suction x 24 hours

Pre-test: Consent, NPO x 6h, teaching

Intra-test: position supine or sitting upright in a chair, administer sedative, gag reflex will be abolished, remove dentures

Post-test: NPO until gag reflex returns, position SEMI-fowler’s with head turned to sides, hoarseness is temporary, CXR after the procedure, keep tracheostomy set and suction x 24 hours

Thoracentesis Pleural fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection

Pleural fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection

Thoracentesis Pre-test: Consent Intra-test: position the patient sitting with arms on a table or side-lying fowler’s, instruct not to cough, breathe deeply or move Post-test: position unaffected side to allow lung expansion of the affected side, CXR obtained, maintain pressure dressing and monitor respiratory status

Pre-test: Consent

Intra-test: position the patient sitting with arms on a table or side-lying fowler’s, instruct not to cough, breathe deeply or move

Post-test: position unaffected side to allow lung expansion of the affected side, CXR obtained, maintain pressure dressing and monitor respiratory status

Pulmonary Function Tests Volume and capacity tests aid diagnosis in patient with suspected pulmonary dysfunction Evaluates ventilatory function Determines whether obstructive or restrictive disease Can be utilized as screening test

Volume and capacity tests aid diagnosis in patient with suspected pulmonary dysfunction

Evaluates ventilatory function

Determines whether obstructive or restrictive disease

Can be utilized as screening test

Pulmonary Function Test Lung Volumes Tidal volume Inspiratory reserve volume Expiratory reeve volume Residual volume

Lung Volumes

Tidal volume

Inspiratory reserve volume

Expiratory reeve volume

Residual volume

Pulmonary Function Test Lung capacities Inspiratory capacity Vital capacity Functional residual capacity Total lung capacity

Lung capacities

Inspiratory capacity

Vital capacity

Functional residual capacity

Total lung capacity

Pulmonary Function Test Pre-test: Teaching, no smoking for 3 days, only light meal 4 hours before the test Intra-test: position sitting, bronchodilator, nose-clip and mouthpiece, fatigue and dyspnea during the test Post-test: adequate rest periods, loosen tight clothing

Pre-test: Teaching, no smoking for 3 days, only light meal 4 hours before the test

Intra-test: position sitting, bronchodilator, nose-clip and mouthpiece, fatigue and dyspnea during the test

Post-test: adequate rest periods, loosen tight clothing

Common Respiratory Problems and the common interventions

Dyspnea Breathing difficulty Associated with many conditions- CHF, MG, GBS, Muscular dystrophy, obstruction, etc…

Breathing difficulty

Associated with many conditions- CHF, MG, GBS, Muscular dystrophy, obstruction, etc…

Dyspnea General nursing interventions: 1. Fowler’s position to promote maximum lung expansion and promote comfort. An alternative position is the ORTHOPNEIC position 2. O2 usually via nasal cannula 3. Provide comfort and distractions

General nursing interventions:

1. Fowler’s position to promote maximum lung expansion and promote comfort. An alternative position is the ORTHOPNEIC position

2. O2 usually via nasal cannula

3. Provide comfort and distractions

Cough and sputum production Cough is a protective reflex Sputum production has many stimuli Thick, yellow, green or rust-colored  bacterial pneumonia Profuse, Pink, frothy  pulmonary edema Scant, pink-tinged, mucoid  Lung tumor

Cough is a protective reflex

Sputum production has many stimuli

Thick, yellow, green or rust-colored  bacterial pneumonia

Profuse, Pink, frothy  pulmonary edema

Scant, pink-tinged, mucoid  Lung tumor

Cough and sputum production General nursing Intervention 1. Provide adequate hydration 2. Administer aerosolized solutions 3. advise smoking cessation 4. oral hygiene

General nursing Intervention

1. Provide adequate hydration

2. Administer aerosolized solutions

3. advise smoking cessation

4. oral hygiene

Cyanosis Bluish discoloration of the skin A LATE indicator of hypoxia Appears when the unoxygenated hemoglobin is more than 5 grams/dL Central cyanosis  observe color on the undersurface of tongue and lips Peripheral cyanosis  observe the nail beds, earlobes

Bluish discoloration of the skin

A LATE indicator of hypoxia

Appears when the unoxygenated hemoglobin is more than 5 grams/dL

Central cyanosis  observe color on the undersurface of tongue and lips

Peripheral cyanosis  observe the nail beds, earlobes

Cyanosis Interventions: Check for airway patency Oxygen therapy Positioning Suctioning Chest physiotherapy Check for gas poisoning Measures to increased hemoglobin

Interventions:

Check for airway patency

Oxygen therapy

Positioning

Suctioning

Chest physiotherapy

Check for gas poisoning

Measures to increased hemoglobin

Hemoptysis Expectoration of blood from the respiratory tract Common causes: Pulmo infection, Lung CA, Bronchiectasis, Pulmo emboli Bleeding from stomach  acidic pH, coffee ground material

Expectoration of blood from the respiratory tract

Common causes: Pulmo infection, Lung CA, Bronchiectasis, Pulmo emboli

Bleeding from stomach  acidic pH, coffee ground material

Hemoptysis Interventions: Keep patent airway Determine the cause Suction and oxygen therapy Administer Fibrin stabilizers like aminocaproic acid and tranexamic acid

Interventions:

Keep patent airway

Determine the cause

Suction and oxygen therapy

Administer Fibrin stabilizers like aminocaproic acid and tranexamic acid

Epistaxis Bleeding from the nose caused by rupture of tiny, distended vessels in the mucus membrane Most common site- anterior septum Causes 1. trauma 2. infection 3. Hypertension 4. blood dyscrasias , nasal tumor, cardio diseases

Bleeding from the nose caused by rupture of tiny, distended vessels in the mucus membrane

Most common site- anterior septum

Causes

1. trauma

2. infection

3. Hypertension

4. blood dyscrasias , nasal tumor, cardio diseases

Epistaxis Nursing Interventions 1. Position patient: Upright, leaning forward, tilted  prevents swallowing and aspiration 2. Apply direct pressure. Pinch nose against the middle septum x 5-10 minutes 3. If unrelieved, administer topical vasoconstrictors, silver nitrate, gel foams 4. Assist in electrocautery and nasal packing for posterior bleeding

Nursing Interventions

1. Position patient: Upright, leaning forward, tilted  prevents swallowing and aspiration

2. Apply direct pressure. Pinch nose against the middle septum x 5-10 minutes

3. If unrelieved, administer topical vasoconstrictors, silver nitrate, gel foams

4. Assist in electrocautery and nasal packing for posterior bleeding

CONDITIONS OF THE UPPER AIRWAY Upper airway infections 1. Rhinitis- allergic, non-allergic and infectious 2. Sinusitis- acute and chronic 3. Pharyngitis- acute and chronic

Upper airway infections

1. Rhinitis- allergic, non-allergic and infectious

2. Sinusitis- acute and chronic

3. Pharyngitis- acute and chronic

CONDITIONS OF THE UPPER AIRWAY Upper airway infections 1. Rhinitis- Assessment findings Rhinorrhea Nasal congestion Nasal itchiness Sneezing Headache

Upper airway infections

1. Rhinitis- Assessment findings

Rhinorrhea

Nasal congestion

Nasal itchiness

Sneezing

Headache

CONDITIONS OF THE UPPER AIRWAY Upper airway infections 2. sinusitis- Assessment findings Facial pain Tenderness over the paranasal sinuses Purulent nasal discharges Ear pain, headache, dental pain Decreased sense of smell

Upper airway infections

2. sinusitis- Assessment findings

Facial pain

Tenderness over the paranasal sinuses

Purulent nasal discharges

Ear pain, headache, dental pain

Decreased sense of smell

CONDITIONS OF THE UPPER AIRWAY Upper airway infections 3. Pharyngitis- Assessment findings Fiery-red pharyngeal membrane White-purple flecked exudates Enlarged and tender cervical lymph nodes Fever malaise ,sore throat Difficulty swallowing Cough may be absent

Upper airway infections

3. Pharyngitis- Assessment findings

Fiery-red pharyngeal membrane

White-purple flecked exudates

Enlarged and tender cervical lymph nodes

Fever malaise ,sore throat

Difficulty swallowing

Cough may be absent

CONDITIONS OF THE UPPER AIRWAY Upper airway infections- Laboratory tests 1. CBC 2. Culture

Upper airway infections- Laboratory tests

1. CBC

2. Culture

CONDITIONS OF THE UPPER AIRWAY Upper airway infections: Nursing Interventions 1. Maintain Patent Airway Increase fluid intake to loosen secretions Utilize room vaporizers or steam inhalation Administer medications to relieve nasal congestion

Upper airway infections: Nursing Interventions

1. Maintain Patent Airway

Increase fluid intake to loosen secretions

Utilize room vaporizers or steam inhalation

Administer medications to relieve nasal congestion

CONDITIONS OF THE UPPER AIRWAY Upper airway infections: Nursing Interventions 2. Promote comfort Administer prescribed analgesics Administer topical analgesics Warm gargles for the relief of sore throat Provide oral hygiene

Upper airway infections: Nursing Interventions

2. Promote comfort

Administer prescribed analgesics

Administer topical analgesics

Warm gargles for the relief of sore throat

Provide oral hygiene

CONDITIONS OF THE UPPER AIRWAY Upper airway infections: Nursing Interventions 3. Promote communication Instruct patient to refrain from speaking as much as possible Provide writing materials

Upper airway infections: Nursing Interventions

3. Promote communication

Instruct patient to refrain from speaking as much as possible

Provide writing materials

CONDITIONS OF THE UPPER AIRWAY Upper airway infections: Nursing Interventions 4. Administer prescribed antibiotics Monitor for possible complications like meningitis, otitis media, abscess formation 5. Assist in surgical intervention

Upper airway infections: Nursing Interventions

4. Administer prescribed antibiotics

Monitor for possible complications like meningitis, otitis media, abscess formation

5. Assist in surgical intervention

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis Infection and inflammation of the tonsils Most common organism- Group A- beta hemolytic streptococcus (GABS)

Upper airway infection: Tonsillitis

Infection and inflammation of the tonsils

Most common organism- Group A- beta hemolytic streptococcus (GABS)

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis ASSESSMENT FINDINGS Sore throat and mouth breathing Fever Difficulty swallowing Enlarged, reddish tonsils Foul-smelling breath

Upper airway infection: Tonsillitis

ASSESSMENT FINDINGS

Sore throat and mouth breathing

Fever

Difficulty swallowing

Enlarged, reddish tonsils

Foul-smelling breath

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis Laboratory test 1. CBC 2. throat culture

Upper airway infection: Tonsillitis

Laboratory test

1. CBC

2. throat culture

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis MEDICAL management 1. Antibiotics- penicillin 2. Tonsillectomy for chronic cases and abscess formation

Upper airway infection: Tonsillitis

MEDICAL management

1. Antibiotics- penicillin

2. Tonsillectomy for chronic cases and abscess formation

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis NURSING INTERVENTION for tonsillectomy 1. Pre-operative care Consent Routine pre-op surgical care

Upper airway infection: Tonsillitis

NURSING INTERVENTION for tonsillectomy

1. Pre-operative care

Consent

Routine pre-op surgical care

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis NURSING INTERVENTION for tonsillectomy 2. POST-operative care Position: Most comfortable is PRONE, with head turned to side Maintain oral airway, until gag reflex returns

Upper airway infection: Tonsillitis

NURSING INTERVENTION for tonsillectomy

2. POST-operative care

Position: Most comfortable is PRONE, with head turned to side

Maintain oral airway, until gag reflex returns

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis NURSING INTERVENTION for tonsillectomy 2. POST-operative care Apply ICE collar to the neck to reduce edema Advise patient to refrain from talking and coughing Ice chips are given when there is no bleeding and gag reflex returns

Upper airway infection: Tonsillitis

NURSING INTERVENTION for tonsillectomy

2. POST-operative care

Apply ICE collar to the neck to reduce edema

Advise patient to refrain from talking and coughing

Ice chips are given when there is no bleeding and gag reflex returns

CONDITIONS OF THE UPPER AIRWAY Upper airway infection: Tonsillitis NURSING INTERVENTION for tonsillectomy 2. POST-operative care Notify physician if a. Patient swallows frequently b. vomiting of large amount of bright red or dark blood c. PR increased, restless and Temp is increased

Upper airway infection: Tonsillitis

NURSING INTERVENTION for tonsillectomy

2. POST-operative care

Notify physician if

a. Patient swallows frequently

b. vomiting of large amount of bright red or dark blood

c. PR increased, restless and Temp is increased

Laryngeal Cancer A malignant tumor of the larynx More frequent in men 50-70 years old RISK FACTORS 1. Smoking 2. Alcohol 3. Exposure to chemicals 4. Straining of voice 5. chronic laryngitis 6. Deficiency of Riboflavin 7. family history

A malignant tumor of the larynx

More frequent in men

50-70 years old

RISK FACTORS

1. Smoking

2. Alcohol

3. Exposure to chemicals

4. Straining of voice

5. chronic laryngitis

6. Deficiency of Riboflavin

7. family history

Laryngeal Cancer Growth can be anywhere in the larynx 1. Supraglottic- above the vocal cords 2. glottic- vocal cord area 3. infraglottic- below the vocal cords Most tumors are found in the glottic area

Growth can be anywhere in the larynx

1. Supraglottic- above the vocal cords

2. glottic- vocal cord area

3. infraglottic- below the vocal cords

Most tumors are found in the glottic area

Laryngeal Cancer ASSESSMENT FINDINGS Hoarseness of more than TWO weeks duration Cough and sore throat Burning and pain in the throat especially after consuming HOT liquids and citrus foods Neck lump Dysphagia, dyspnea, foul breath, CLAD

ASSESSMENT FINDINGS

Hoarseness of more than TWO weeks duration

Cough and sore throat

Burning and pain in the throat especially after consuming HOT liquids and citrus foods

Neck lump

Dysphagia, dyspnea, foul breath, CLAD

Laryngeal Cancer LABORATORY FINDINGS 1. Indirect laryngoscopy 2. direct laryngoscopy 3. Biopsy 4. CT and MRI Most commonly- squamos carcinoma

LABORATORY FINDINGS

1. Indirect laryngoscopy

2. direct laryngoscopy

3. Biopsy

4. CT and MRI

Most commonly- squamos carcinoma

Laryngeal Cancer MEDICAL MANAGEMENT Radiation therapy Chemotherapy Surgery Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy

MEDICAL MANAGEMENT

Radiation therapy

Chemotherapy

Surgery

Partial laryngectomy

Supraglottic laryngectomy

Hemilaryngectomy

Total laryngectomy

Laryngeal Cancer NURSING MANAGEMENT: PRE-operative 1. Provide the patient pre-operative teachings Clarify misconceptions Tell that the natural voice will be lost Teach communication alternatives Collaborate with other team members

NURSING MANAGEMENT: PRE-operative

1. Provide the patient pre-operative teachings

Clarify misconceptions

Tell that the natural voice will be lost

Teach communication alternatives

Collaborate with other team members

Laryngeal Cancer NURSING MANAGEMENT 2. reduce patient ANXIETY Provide opportunities for patient and family members to ask questions Referrals to previous patients with laryngeal cancers and cancer groups

NURSING MANAGEMENT

2. reduce patient ANXIETY

Provide opportunities for patient and family members to ask questions

Referrals to previous patients with laryngeal cancers and cancer groups

Laryngeal Cancer NURSING MANAGEMENT: POST-op 3. Maintain PATENT Airway Position patient: Semi or High Fowler’s Suction secretions Encourage to deep breath, turn and cough

NURSING MANAGEMENT: POST-op

3. Maintain PATENT Airway

Position patient: Semi or High Fowler’s

Suction secretions

Encourage to deep breath, turn and cough

Laryngeal Cancer NURSING MANAGEMENT: POST-op 4. Administer care of the laryngectomy tube Suction as needed Cleanse the stoma with saline Administer humidified oxygen Laryngectomy tube is usually removed within 3-6 weeks after surgery

NURSING MANAGEMENT: POST-op

4. Administer care of the laryngectomy tube

Suction as needed

Cleanse the stoma with saline

Administer humidified oxygen

Laryngectomy tube is usually removed within 3-6 weeks after surgery

Laryngeal Cancer NURSING MANAGEMENT: POST-op 5. Promote alternative communication methods Call bell or hand bell Magic Slate Hand signals Collaborate with speech therapist

NURSING MANAGEMENT: POST-op

5. Promote alternative communication methods

Call bell or hand bell

Magic Slate

Hand signals

Collaborate with speech therapist

Laryngeal Cancer NURSING MANAGEMENT: POST-op 6. Promote adequate Nutrition NPO after operation No foods or drinks per orem for 10 days IVF, TPN are alternative nutrition routes Start oral feedings with thick liquids, avoid sweet foods

NURSING MANAGEMENT: POST-op

6. Promote adequate Nutrition

NPO after operation

No foods or drinks per orem for 10 days

IVF, TPN are alternative nutrition routes

Start oral feedings with thick liquids, avoid sweet foods

Laryngeal Cancer NURSING MANAGEMENT: POST-op 7. Promote positive body image and self-esteem Encourage verbalization of feelings Allow independence in self-care

NURSING MANAGEMENT: POST-op

7. Promote positive body image and self-esteem

Encourage verbalization of feelings

Allow independence in self-care

Laryngeal Cancer NURSING MANAGEMENT: POST-op 8. Monitor for COMPLICATIONS Respiratory Distress Suction Coughing and deep breathing Humidified oxygen Alert the surgeon

NURSING MANAGEMENT: POST-op

8. Monitor for COMPLICATIONS

Respiratory Distress

Suction

Coughing and deep breathing

Humidified oxygen

Alert the surgeon

Laryngeal Cancer NURSING MANAGEMENT: POST-op 8. Monitor for Complications Hemorrhage Monitor for bleeding Monitor vital signs Apply direct pressure over the bleeding artery Summon assistance and alert the surgeon

NURSING MANAGEMENT: POST-op

8. Monitor for Complications

Hemorrhage

Monitor for bleeding

Monitor vital signs

Apply direct pressure over the bleeding artery

Summon assistance and alert the surgeon

Laryngeal Cancer NURSING MANAGEMENT: POST-op 8. Monitor for COMPLICATIONS Wound infection and breakdown Monitor for increased temperature, purulent drainage and increased redness/tenderness Administer antibiotics Clean and change dressing OD

NURSING MANAGEMENT: POST-op

8. Monitor for COMPLICATIONS

Wound infection and breakdown

Monitor for increased temperature, purulent drainage and increased redness/tenderness

Administer antibiotics

Clean and change dressing OD

Laryngeal Cancer NURSING MANAGEMENT: HOME CARE Humidification system at home is needed AVOID swimming Cover the stoma with hands or plastic bib over the opening Advise beauty salons to avoid hair sprays, powders and loose hair near the opening Oral hygiene frequently

NURSING MANAGEMENT: HOME CARE

Humidification system at home is needed

AVOID swimming

Cover the stoma with hands or plastic bib over the opening

Advise beauty salons to avoid hair sprays, powders and loose hair near the opening

Oral hygiene frequently

Acute Respiratory Failure Sudden and life-threatening deterioration of the gas-exchange function of the lungs Occurs when the lungs no longer meet the body’s metabolic needs

Sudden and life-threatening deterioration of the gas-exchange function of the lungs

Occurs when the lungs no longer meet the body’s metabolic needs

Acute Respiratory Failure Defined clinically as: 1. PaO2 of less than 50 mmHg 2. PaCO2 of greater than 5o mmHg 3. Arterial pH of less than 7.35

Defined clinically as:

1. PaO2 of less than 50 mmHg

2. PaCO2 of greater than 5o mmHg

3. Arterial pH of less than 7.35

Acute Respiratory Failure CAUSES CNS depression- head trauma, sedatives CVS diseases- MI, CHF, pulmonary emboli Airway irritants- smoke, fumes Endocrine and metabolic disorders- myxedema, metabolic alkalosis Thoracic abnormalities- chest trauma, pneumothorax

CAUSES

CNS depression- head trauma, sedatives

CVS diseases- MI, CHF, pulmonary emboli

Airway irritants- smoke, fumes

Endocrine and metabolic disorders- myxedema, metabolic alkalosis

Thoracic abnormalities- chest trauma, pneumothorax

Acute Respiratory Failure PATHOPHYSIOLOGY Decreased Respiratory Drive Brain injury, sedatives, metabolic disorders  impair the normal response of the brain to normal respiratory stimulation

PATHOPHYSIOLOGY

Decreased Respiratory Drive

Brain injury, sedatives, metabolic disorders  impair the normal response of the brain to normal respiratory stimulation

Acute Respiratory Failure PATHOPHYSIOLOGY Dysfunction of the chest wall Dystrophy, MS disorders, peripheral nerve disorders  disrupt the impulse transmission from the nerve to the diaphragm  abnormal ventilation

PATHOPHYSIOLOGY

Dysfunction of the chest wall

Dystrophy, MS disorders, peripheral nerve disorders  disrupt the impulse transmission from the nerve to the diaphragm  abnormal ventilation

Acute Respiratory Failure PATHOPHYSIOLOGY Dysfunction of the Lung Parenchyma Pleural effusion, hemothorax, pneumothorax, obstruction  interfere ventilation  prevent lung expansion

PATHOPHYSIOLOGY

Dysfunction of the Lung Parenchyma

Pleural effusion, hemothorax, pneumothorax, obstruction  interfere ventilation  prevent lung expansion

Acute Respiratory Failure ASSESSMENT FINDINGS Restlessness dyspnea Cyanosis Altered respiration Altered mentation Tachycardia Cardiac arrhythmias Respiratory arrest

ASSESSMENT FINDINGS

Restlessness

dyspnea

Cyanosis

Altered respiration

Altered mentation

Tachycardia

Cardiac arrhythmias

Respiratory arrest

Acute Respiratory Failure DIAGNOSTIC FINDINGS Pulmonary function test- pH below 7.35 CXR- pulmonary infiltrates ECG- arrhythmias

DIAGNOSTIC FINDINGS

Pulmonary function test- pH below 7.35

CXR- pulmonary infiltrates

ECG- arrhythmias

Acute Respiratory Failure MEDICAL TREATMENT Intubation Mechanical ventilation Antibiotics Steroids Bronchodilators

MEDICAL TREATMENT

Intubation

Mechanical ventilation

Antibiotics

Steroids

Bronchodilators

Acute Respiratory Failure NURSING INTERVENTIONS 1. Maintain patent airway 2. Administer O2 to maintain Pa02 at more than 50 mmHg 3. Suction airways as required 4. Monitor serum electrolyte levels 5. Administer care of patient on mechanical ventilation

NURSING INTERVENTIONS

1. Maintain patent airway

2. Administer O2 to maintain Pa02 at more than 50 mmHg

3. Suction airways as required

4. Monitor serum electrolyte levels

5. Administer care of patient on mechanical ventilation

COPD These are group of disorders associated with recurrent or persistent obstruction of air passage and airflow, usually irreversible.

These are group of disorders associated with recurrent or persistent obstruction of air passage and airflow, usually irreversible.

COPD The most common cause of COPD is cigarette smoking. Asthma, Chronic bronchitis, Emphysema and Bronchiectasis are the common disorders.

The most common cause of COPD is cigarette smoking. Asthma, Chronic bronchitis, Emphysema and Bronchiectasis are the common disorders.

COPD The general pathophysiology: In COPD there is airflow limitation that is both progressive and associated with abnormal inflammatory response of the lungs to stimuli, usually smoke, particles and dust

The general pathophysiology:

In COPD there is airflow limitation that is both progressive and associated with abnormal inflammatory response of the lungs to stimuli, usually smoke, particles and dust

ASTHMA The acute episode of airway obstruction is characterized by airway hyperactivity to various stimuli that results in recurrent wheezing brought about by edema and bronchospasm

The acute episode of airway obstruction is characterized by airway hyperactivity to various stimuli that results in recurrent wheezing brought about by edema and bronchospasm

Asthma Pathophysiology Immunologic/allergic reaction results in histamine release, which produces three main airway responses a. Edema of mucous membranes b. Spasm of the smooth muscle of bronchi and bronchioles c. Accumulation of tenacious secretions

Immunologic/allergic reaction results in histamine release, which produces three main airway responses

a. Edema of mucous membranes

b. Spasm of the smooth muscle of bronchi and bronchioles

c. Accumulation of tenacious secretions

Asthma Assessment Findings Assessment findings 1. Family history of allergies 2. Client history of eczema

Assessment findings

1. Family history of allergies

2. Client history of eczema

Asthma Assessment Findings Assessment findings 3. Pulmonary signs and symptoms- Respiratory distress: slow onset of shortness of breath, expiratory wheeze , prolonged expiratory phase, air trapping (barrel chest if chronic), use of accessory muscles, irritability (from hypoxia), diaphoresis, cough, anxiety, weak pulse, diaphoresis and change in sensorium if severe attack

Assessment findings

3. Pulmonary signs and symptoms- Respiratory distress: slow onset of shortness of breath, expiratory wheeze , prolonged expiratory phase, air trapping (barrel chest if chronic), use of accessory muscles, irritability (from hypoxia), diaphoresis, cough, anxiety, weak pulse, diaphoresis and change in sensorium if severe attack

Asthma Assessment Findings Assessment findings 4. Use of accessory muscles of respiration, inspiratory retractions, prolonged I:E ratio 5. Cardiovascular symptoms: tachycardia, ECG changes, hypertension, decreased cardiac contractility, pulsus paradoxus 6. CNS manifestations: anxiety, restlessness, fear and disorientation

Assessment findings

4. Use of accessory muscles of respiration, inspiratory retractions, prolonged I:E ratio

5. Cardiovascular symptoms: tachycardia, ECG changes, hypertension, decreased cardiac contractility, pulsus paradoxus

6. CNS manifestations: anxiety, restlessness, fear and disorientation

Emphysema There is progressive and irreversible alveolocapillary destruction with abnormal alveolar enlargement causing alveolar wall destruction. The result is INCREASED lung compliance, DECREASED oxygen diffusion and INCREASED airway resistance!

There is progressive and irreversible alveolocapillary destruction with abnormal alveolar enlargement causing alveolar wall destruction. The result is INCREASED lung compliance, DECREASED oxygen diffusion and INCREASED airway resistance!

Emphysema These changes cause a state of carbon dioxide retention, hypoxia, and respiratory acidosis.

These changes cause a state of carbon dioxide retention, hypoxia, and respiratory acidosis.

Emphysema Cigarette smoking Heredity, Bronchial asthma Aging process Disequilibrium between ELASTASE & ANTIELASTASE (alpha-1-antitrypsin) Destruction of distal airways and alveoli Overdistention of ALVEOLI Hyper-inflated and pale lungs Air traping, decreased gas exchange and Retention of CO2 Hypoxia Respiratory acidosis

Cigarette smoking

Heredity, Bronchial asthma

Aging process



Disequilibrium between

ELASTASE & ANTIELASTASE (alpha-1-antitrypsin)

Destruction of distal airways and alveoli

Overdistention of ALVEOLI

Hyper-inflated and pale lungs

Air traping, decreased gas exchange and Retention of CO2



Hypoxia Respiratory acidosis

Emphysema Assessment 1. Anorexia, fatigue, weight loss 2. Feeling of breathlessness, cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea

1. Anorexia, fatigue, weight loss

2. Feeling of breathlessness, cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea

Emphysema Assessment 3. Decreased respiratory excursion, resonance to hyper-resonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus 4. Diagnostic tests: pCO2 elevated or normal; PO2 normal or slightly decreased

3. Decreased respiratory excursion, resonance to hyper-resonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus

4. Diagnostic tests: pCO2 elevated or normal; PO2 normal or slightly decreased

Chronic bronchitis Chronic inflammation of the bronchial air passageway characterized by the presence of cough and sputum production for at least 3 months in each 2 consecutive years. Excessive production of mucus in the bronchi with accompanying persistent cough.

Chronic inflammation of the bronchial air passageway characterized by the presence of cough and sputum production for at least 3 months in each 2 consecutive years.

Excessive production of mucus in the bronchi with accompanying persistent cough.

Chronic Bronchitis pathophysiology Characteristic changes include hypertrophy/ hyperplasia of the mucus-secreting glands in the bronchi, decreased ciliary activity, chronic inflammation, and narrowing of the small airways.

Characteristic changes include hypertrophy/ hyperplasia of the mucus-secreting glands in the bronchi, decreased ciliary activity, chronic inflammation, and narrowing of the small airways.

Chronic Bronchitis Assessment I. Productive (copious) cough, dyspnea on exertion, use of accessory muscles of respiration, scattered rales and rhonchi 2. Feeling of epigastric fullness, cyanosis, distended neck veins, ankle edema 3. Diagnostic tests: increased pCO2 decreased PO2

I. Productive (copious) cough, dyspnea on exertion, use of accessory muscles of respiration, scattered rales and rhonchi

2. Feeling of epigastric fullness, cyanosis, distended neck veins, ankle edema

3. Diagnostic tests: increased pCO2 decreased PO2

Bronchiectasis Permanent abnormal dilation of the bronchi with destruction of muscular and elastic structure of the bronchial wall

Permanent abnormal dilation of the bronchi with destruction of muscular and elastic structure of the bronchial wall

Bronchiectasis Caused by bacterial infection; recurrent lower respiratory tract infections; congenital defects (altered bronchial structures); lung tumors

Caused by bacterial infection; recurrent lower respiratory tract infections; congenital defects (altered bronchial structures); lung tumors

Bronchiectasis 1. Chronic cough with production of mucopurulent sputum, hemoptysis, exertional dyspnea, wheezing 2. Anorexia, fatigue, weight loss 3. Diagnostic tests a. Bronchoscopy reveals sources and sites of secretions b. Possible elevation of WBC

1. Chronic cough with production of mucopurulent sputum, hemoptysis, exertional dyspnea, wheezing

2. Anorexia, fatigue, weight loss

3. Diagnostic tests

a. Bronchoscopy reveals sources and sites of secretions

b. Possible elevation of WBC

COPD Management Independent and Collaborative Management 1. Rest- To reduce oxygen demands of tissues 2. Increase fluid intake -To liquefy mucus secretions 3. Good oral care- To remove sputum and prevent infection

Independent and Collaborative Management

1. Rest- To reduce oxygen demands of tissues

2. Increase fluid intake -To liquefy mucus secretions

3. Good oral care- To remove sputum and prevent infection

COPD Management Independent and Collaborative Management 4. Diet: High caloric diet provides source of energy High protein diet helps maintain integrity of alveolar walls Moderate fats Low carbohydrate diet limits carbon dioxide production (natural end product). The client has difficulty exhaling carbon dioxide.

Independent and Collaborative Management

4. Diet:

High caloric diet provides source of energy

High protein diet helps maintain integrity of alveolar walls

Moderate fats

Low carbohydrate diet limits carbon dioxide production (natural end product). The client has difficulty exhaling carbon dioxide.

COPD Management Independent and Collaborative Management 5. O2 therapy 1 to 3 lpm ( 2 lpm is safest ) Do not give high concentration of oxygen. The drive for breathing may be depressed.

Independent and Collaborative Management

5. O2 therapy 1 to 3 lpm ( 2 lpm is safest )

Do not give high concentration of oxygen. The drive for breathing may be depressed.

COPD Management Independent and Collaborative Management 6 . Avoid cigarette smoking, alcohol, and environmental pollutants-These inhibit mucociliary function. 7. CPT –percussion, vibration, postural drainage

Independent and Collaborative Management

6 . Avoid cigarette smoking, alcohol, and environmental pollutants-These inhibit mucociliary function.

7. CPT –percussion, vibration, postural drainage

COPD Management Independent and Collaborative Management 8. Bronchial hygiene measures Steam inhalation Aerosol inhalation Medimist inhalation

Independent and Collaborative Management

8. Bronchial hygiene measures

Steam inhalation

Aerosol inhalation

Medimist inhalation

COPD Management Pharmacotherapy 1. Expectorants (guaiafenessin)/ mucolytic (mucomyst/mucosolvan) 2. Antitussives Dextrometorphan Codeine Observe for drowsiness Avoid activities that involve mental alertness, e.g driving, operating electrical machines Cause decrease peristalsis thereby constipation

Pharmacotherapy

1. Expectorants (guaiafenessin)/ mucolytic (mucomyst/mucosolvan)

2. Antitussives

Dextrometorphan

Codeine

Observe for drowsiness

Avoid activities that involve mental alertness, e.g driving, operating electrical machines

Cause decrease peristalsis thereby constipation

COPD Management Pharmacotherapy 3. Bronchodilators Aminophylline (Theophylline) Ventolin (Salbutamol) Bricanyl (Terbutaline) Alupent (Metaproterenol) Observe for tachycardia

Pharmacotherapy

3. Bronchodilators

Aminophylline (Theophylline)

Ventolin (Salbutamol)

Bricanyl (Terbutaline)

Alupent (Metaproterenol)

Observe for tachycardia

COPD Management Pharmacotherapy 4. Antihistamine Benadryl (Diphenhydramine) Observe for drowsiness 5. Steroids Anti-inflammatory effect 6. Antimicrobials

Pharmacotherapy

4. Antihistamine

Benadryl (Diphenhydramine)

Observe for drowsiness

5. Steroids

Anti-inflammatory effect

6. Antimicrobials

Flail Chest Complication of chest trauma occurring when 3 or more adjacent ribs are fractured at two or more sites, resulting in free-floating rib segments.

Complication of chest trauma occurring when 3 or more adjacent ribs are fractured at two or more sites, resulting in free-floating rib segments.

Flail Chest Chest wall is no longer able to provide the bony structure necessary to maintain adequate ventilation; consequently the flail portion and underlying tissue move paradoxically (in opposition) to the rest of the chest cage and lungs.

Chest wall is no longer able to provide the bony structure necessary to maintain adequate ventilation; consequently

the flail portion and underlying tissue move paradoxically (in opposition) to the rest of the chest cage and lungs.

Flail Chest The flail portion is sucked in on inspiration and bulges out on expiration. Result is hypoxia, hypercarbia, and increased retained secretions. Caused by trauma (sternal rib fracture with possible costochondral separations).

The flail portion is sucked in on inspiration and bulges out on expiration.

Result is hypoxia, hypercarbia, and increased retained secretions.

Caused by trauma (sternal rib fracture with possible costochondral separations).

Flail Chest PATHOPHYSIOLOGY During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a “paradoxical” manner The chest is pulled INWARD during inspiration, reducing the amount of air that can be drawn into the lungs The chest bulges OUTWARD during expiration because the intrathoracic pressure exceeds atmospheric pressure. The patient has impaired exhalation

PATHOPHYSIOLOGY

During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a “paradoxical” manner

The chest is pulled INWARD during inspiration, reducing the amount of air that can be drawn into the lungs

The chest bulges OUTWARD during expiration because the intrathoracic pressure exceeds atmospheric pressure. The patient has impaired exhalation

Flail Chest This paradoxical action will lead to: Increased dead space Reduced alveolar ventilation Decreased lung compliance Hypoxemia and respiratory acidosis Hypotension, inadequate tissue perfusion can also follow

This paradoxical action will lead to:

Increased dead space

Reduced alveolar ventilation

Decreased lung compliance

Hypoxemia and respiratory acidosis

Hypotension, inadequate tissue perfusion can also follow

Flail Chest Assessment findings 1. Severe dyspnea; rapid, shallow, grunty breathing; paradoxical chest motion. The chest will move INWARDS on inhalation and OUTWARDS on exhalation. 2. Cyanosis, possible neck vein distension, tachycardia, hypotension 3. Diagnostic tests a. PO2 decreased b. pCO2 elevated c. pH decreased

Assessment findings

1. Severe dyspnea; rapid, shallow, grunty breathing; paradoxical chest motion. The chest will move INWARDS on inhalation and OUTWARDS on exhalation.

2. Cyanosis, possible neck vein distension, tachycardia, hypotension

3. Diagnostic tests

a. PO2 decreased

b. pCO2 elevated

c. pH decreased

Flail Chest Nursing interventions 1. Maintain an open airway: suction secretions, blood from nose, throat, mouth, and via endotracheal tube; note changes in amount, color, and characteristics. 2. Monitor mechanical ventilation 3. Encourage turning, coughing, and deep breathing. 4. Monitor for signs of shock: HYPOTENSION, TACHYCARDIA

Nursing interventions

1. Maintain an open airway: suction secretions, blood from nose, throat, mouth, and via endotracheal tube; note changes in amount, color, and characteristics.

2. Monitor mechanical ventilation

3. Encourage turning, coughing, and deep breathing.

4. Monitor for signs of shock: HYPOTENSION, TACHYCARDIA

Flail Chest Medical management: SUPPORTIVE 1. Internal stabilization with a volume-cycled ventilator 2. Drug therapy (narcotics, sedatives)

Medical management: SUPPORTIVE

1. Internal stabilization with a volume-cycled ventilator

2. Drug therapy (narcotics, sedatives)

Pneumothorax Partial or complete collapse of the lung due to an accumulation of air or fluid in the pleural space

Partial or complete collapse of the lung due to an accumulation of air or fluid in the pleural space

Pneumothorax Types a . Spontaneous pneumothorax : the most common type of closed pneumothorax; air accumulates within the pleural space without an obvious cause. Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.

Types

a . Spontaneous pneumothorax : the most common type of closed pneumothorax; air accumulates within the pleural space without an obvious cause. Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.

Pneumothorax Types b. Open pneumothorax : air enters the pleural space through an opening in the chest wall; usually caused by stabbing or gunshot wound.

Types

b. Open pneumothorax : air enters the pleural space through an opening in the chest wall; usually caused by stabbing or gunshot wound.

Pneumothorax Types c. Tension pneumothorax : air enters the pleural space with each inspiration but cannot escape; causes increased intrathoracic pressure and shifting of the mediastinal contents to the unaffected side (mediastinal shift ).

Types

c. Tension pneumothorax : air enters the pleural space with each inspiration but cannot escape; causes increased intrathoracic pressure and shifting of the mediastinal contents to the unaffected side (mediastinal shift ).

Pneumothorax Assessment findings 1. Sudden sharp pain in the chest, dyspnea, diminished or absent breath sounds on affected side , tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift) 2. Weak, rapid pulse; anxiety; diaphoresis

Assessment findings

1. Sudden sharp pain in the chest, dyspnea, diminished or absent breath sounds on affected side , tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift)

2. Weak, rapid pulse; anxiety; diaphoresis

Pneumothorax Assessment findings 3. Diagnostic tests a. Chest x-ray reveals area and degree of pneumothorax b. pCO2 elevated c. pH decreased

Assessment findings

3. Diagnostic tests

a. Chest x-ray reveals area and degree of pneumothorax

b. pCO2 elevated

c. pH decreased

Pneumothorax Nursing interventions 1. Provide nursing care for the client with an endotracheal tube: suction secretions, vomitus, blood from nose, mouth, throat, or via endotracheal tube; monitor mechanical ventilation.

Nursing interventions

1. Provide nursing care for the client with an endotracheal tube: suction secretions, vomitus, blood from nose, mouth, throat, or via endotracheal tube; monitor mechanical ventilation.

Pneumothorax Nursing interventions 2. Restore/promote adequate respiratory function. a. Assist with thoracentesis and provide appropriate nursing care. b. Assist with insertion of a chest tube to water- seal drainage and provide appropriate nursing care. c. Continuously evaluate respiratory patterns and report any changes.

Nursing interventions

2. Restore/promote adequate respiratory function.

a. Assist with thoracentesis and provide appropriate nursing care.

b. Assist with insertion of a chest tube to water- seal drainage and provide appropriate nursing care.

c. Continuously evaluate respiratory patterns and report any changes.

Pneumothorax Nursing interventions 3. Provide relief/control of pain. a. Administer narcotics/analgesics/sedatives as ordered and monitor effects. b. Position client in high-Fowler’s position.

Nursing interventions

3. Provide relief/control of pain.

a. Administer narcotics/analgesics/sedatives as ordered and monitor effects.

b. Position client in high-Fowler’s position.

Atelectasis Collapse of part or all of a lung due to bronchial obstruction May be caused by intrabronchial obstruction tumors, bronchospasm foreign bodies extrabronchial compression (tumors, enlarged lymph nodes); or endobronchial disease (bronchogenic carcinoma, inflammatory structures)

Collapse of part or all of a lung due to bronchial obstruction

May be caused by

intrabronchial obstruction

tumors, bronchospasm

foreign bodies

extrabronchial compression (tumors, enlarged lymph nodes); or

endobronchial disease (bronchogenic carcinoma, inflammatory structures)

Atelectasis Assessment findings 1. Signs and symptoms may be absent depending upon degree of collapse and rapidity with which bronchial obstruction occurs 2. Dyspnea, decreased breath sounds on affected side, decreased respiratory excursion, dullness to flatness upon percussion over affected area

Assessment findings

1. Signs and symptoms may be absent depending upon degree of collapse and rapidity with which bronchial obstruction occurs

2. Dyspnea, decreased breath sounds on affected side, decreased respiratory excursion, dullness to flatness upon percussion over affected area

Atelectasis Assessment findings 3. Cyanosis, tachycardia, tachypnea, elevated temperature, weakness, pain over affected area

Assessment findings

3. Cyanosis, tachycardia, tachypnea, elevated temperature, weakness, pain over affected area

Atelectasis Assessment findings 4. Diagnostic tests a. Bronchoscopy: may or may not reveal an obstruction b. Chest x-ray shows diminished size of affected lung and lack of radiance over atelectatic area c. pO2 decreased

Assessment findings

4. Diagnostic tests

a. Bronchoscopy: may or may not reveal an obstruction

b. Chest x-ray shows diminished size of affected lung and lack of radiance over atelectatic area

c. pO2 decreased

Pleural Effusion Defined broadly as a collection of fluid in the pleural space A symptom, not a disease; may be produced by numerous conditions

Defined broadly as a collection of fluid in the pleural space

A symptom, not a disease; may be produced by numerous conditions

Pleural Effusion General Classification Transudative effusion: accumulation of protein-poor, cell-poor fluid Exudative effusion: accumulation of protein rich fluid

General Classification

Transudative effusion: accumulation of protein-poor, cell-poor fluid

Exudative effusion: accumulation of protein rich fluid

Pleural Effusion Assessment findings 1. Dyspnea, dullness over affected area upon percussion, absent or decreased breath sounds over affected area, pleural pain, dry cough, pleural friction rub 2. Pallor, fatigue, fever, and night sweats (with empyema)

Assessment findings

1. Dyspnea, dullness over affected area upon percussion, absent or decreased breath sounds over affected area, pleural pain, dry cough, pleural friction rub

2. Pallor, fatigue, fever, and night sweats (with empyema)

Pleural Effusion Assessment findings 3. Diagnostic tests a. Chest x-ray positive if greater than 250 cc pleural fluid b. Pleural biopsy may reveal bronchogenic carcinoma c. Thoracentesis may contain blood if cause is cancer, pulmonary infarction, or tuberculosis; positive for specific organism in empyema.

Assessment findings

3. Diagnostic tests

a. Chest x-ray positive if greater than 250 cc pleural fluid

b. Pleural biopsy may reveal bronchogenic carcinoma

c. Thoracentesis may contain blood if cause is cancer, pulmonary infarction, or tuberculosis; positive for specific organism in empyema.

Pleural Effusion Nursing interventions: In general: 1. Assist with repeated thoracentesis. 2. Administer narcotics/sedatives as ordered to decrease pain. 3. Assist with instillation of medication into pleural space (reposition client every 15 minutes to distribute the drug within the pleurae). 4. Place client in high-Fowler’s position to promote ventilation.

Nursing interventions: In general:

1. Assist with repeated thoracentesis.

2. Administer narcotics/sedatives as ordered to decrease pain.

3. Assist with instillation of medication into pleural space (reposition client every 15 minutes to distribute the drug within the pleurae).

4. Place client in high-Fowler’s position to promote ventilation.

Pleural Effusion Medical management 1. Identification and treatment of the Underlying cause 2. Thoracentesis 3. Drug therapy a. Antibiotics: either systemic or inserted directly into pleural space b. Fibrinolytic enzymes: trypsin, streptokinase-. streptodornase to decrease thickness of pus and dissolve fibrin clots 4. Closed chest drainage 5. Surgery: open drainage

Medical management

1. Identification and treatment of the Underlying cause

2. Thoracentesis

3. Drug therapy

a. Antibiotics: either systemic or inserted directly into pleural space

b. Fibrinolytic enzymes: trypsin, streptokinase-. streptodornase to decrease thickness of pus and dissolve fibrin clots

4. Closed chest drainage

5. Surgery: open drainage

Pneumonia An inflammation of the alveolar spaces of the lung, resulting in consolidation of lung tissue as the alveoli fill with exudates The various types of pneumonias are classified according to the offending organism. Pneumonia can also be classified as COMMUNITY Acquired Pneumonia (CAP) and Hospital acquired pneumonia (HAP)

An inflammation of the alveolar spaces of the lung, resulting in consolidation of lung tissue as the alveoli fill with exudates

The various types of pneumonias are classified according to the offending organism.

Pneumonia can also be classified as COMMUNITY Acquired Pneumonia (CAP) and Hospital acquired pneumonia (HAP)

Pneumonia PATHOPHYSIOLOGIC FINDINGS ARE: HYPERTROPHY OF MUCOUS MEMBRANE Increased sputum production Wheezing Dyspnea Cough Rales Ronchi

PATHOPHYSIOLOGIC FINDINGS ARE:

HYPERTROPHY OF MUCOUS MEMBRANE

Increased sputum production

Wheezing

Dyspnea

Cough

Rales

Ronchi

Pneumonia PATHOPHYSIOLOGIC FINDINGS ARE: INCREASED CAPILLARY PERMEABILITY Increased Fluid Exudation Consolidation-tissue that solidifies as a result of collapsed alveoli Hypoxemia

PATHOPHYSIOLOGIC FINDINGS ARE:

INCREASED CAPILLARY PERMEABILITY

Increased Fluid Exudation

Consolidation-tissue that solidifies as a result of collapsed alveoli

Hypoxemia

Pneumonia PATHOPHYSIOLOGIC FINDINGS ARE: INFLAMMATION OF THE PLEURA Chest pain Pleural effusion Dullness Decreased Breath sounds Increased tactile fremitus

PATHOPHYSIOLOGIC FINDINGS ARE:

INFLAMMATION OF THE PLEURA

Chest pain

Pleural effusion

Dullness

Decreased Breath sounds

Increased tactile fremitus

Pneumonia PATHOPHYSIOLOGIC FINDINGS ARE: HYPOVENTILATION Decreased Chest expansion Respiratory acidosis Depressed PROTECTIVE MECHANISM Increased WBC (leukocytosis) Increased RR and Fever

PATHOPHYSIOLOGIC FINDINGS ARE:

HYPOVENTILATION

Decreased Chest expansion

Respiratory acidosis

Depressed PROTECTIVE MECHANISM

Increased WBC (leukocytosis)

Increased RR and Fever

Pneumonia Assessment findings Cough with greenish to rust-colored sputum production rapid, shallow respirations with an expiratory grunt nasal flaring; intercostal rib retraction; use of accessory muscles of respiration rales or crackles (early) progressing to coarse (later). Tactile fremitus is INCREASED!

Assessment findings

Cough with greenish to rust-colored sputum production

rapid, shallow respirations with an expiratory grunt

nasal flaring; intercostal rib retraction; use of accessory muscles of respiration

rales or crackles (early) progressing to coarse (later).

Tactile fremitus is INCREASED!

Pneumonia Assessment findings Fever, chills, chest pain, weakness, generalized malaise Tachycardia, cyanosis, profuse perspiration, abdominal distension Rapid shallow breathing

Assessment findings

Fever, chills, chest pain, weakness, generalized malaise

Tachycardia, cyanosis, profuse perspiration, abdominal distension

Rapid shallow breathing

Pneumonia Diagnostic tests a. Chest x-ray shows consolidation over affected areas b. WBC increased c. pO2 decreased d. Sputum specimen- culture reveal particular causative organism

Diagnostic tests

a. Chest x-ray shows consolidation over affected areas

b. WBC increased

c. pO2 decreased

d. Sputum specimen- culture reveal particular causative organism

Pneumonia 1. Facilitate adequate ventilation. a. Administer oxygen as needed and assess its effectiveness. b. Pl

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