Transcript Nursing of Adults With Medical & Surgical Conditions

Nursing of Adults
With
Medical & Surgical Conditions
Respiratory Disorders
(Lower Airway)
Acute Bronchitis
• Etiology/Pathophysiology
– Inflammation of the trachea and bronchial tree
– Retention of secretions causes high risk of
bacterial growth
– Usually secondary to upper respiratory
infection
– Exposure to inhale irritants
Acute Bronchitis
• Signs & Symptoms
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Productive cough
Rhonchi/wheezes
Dyspnea
Chest pain
Lowgrade temperature
Malaise
Headache
Acute Bronchitis
• Treatment
– Cough suppressants
• Codeine
– Antitussives
• Pertussin
– Antipyretics
• Tylenol
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Bronchodilators
Brethine
Antibiotics
Vaporizer
Encourage fluids
Legionnaires’ Disease
• Etiology/Pathophysiology
– Legionella pneumophila
– First identified in 1976 at the American Legion
convention in Philadelphia
– Thrives in water reservoirs
• Air conditioners and humidifiers
– Causes life-threatening pneumonia
– Leads to respiratory failure, renal failure,
bacteremic shock, and ultimately death
Legionnaires’ Disease
• Signs & Symptoms
– Elevated temperature
• 102 – 105 degrees
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Headache
Nonproductive cough
Difficult and rapid respirations
Crackles or wheezes
Tachycardia
Signs of shock
Hematuria
Legionnaires’ Disease
• Treatment
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Oxygen
Mechanical ventilation, if necessary
IV therapy
Antibiotics
• Erythromycin
• Rifampin
– Antipyretics
– Vasopressors
• For shock
Tuberculosis
• Etiology/Pathophysiology
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Tubercle bacillus (Mycobacterium tuberculosis)
Chronic pulmonary and extrapulmonary infectious disease
Inhalation of droplet containing tubercle bacillus
Infection
• Presence of mycobacteria in the tissue of a person who has no
s/s of TB
• Positive TB skin test
• 10% will become active disease
– Active Disease
• S/S of TB are present
– NOT easily transmitted
• Most inhaled TB organisms are destroyed by the upper resp.
system
Tuberculosis
• Signs & Symptoms
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Fever
Weight loss
Weakness
Productive cough
Chills
Night sweats
Hemoptysis
Tuberculosis
• Diagnostic Tests
– Presumptive Diagnosis
• Mantoux Tuberculin Skin Test
– Read 48 – 72 hours after given
– Enduration (raised hardened tissue)
– <5mm negative
– >5mm positive
• Chest X-ray
• Acid-fast bacilli smear x 3
– Confirmed Diagnosis
• Sputum culture
– Positive for TB bacilli
Tuberculosis
• Treatment
– Tuberculosis Isolation (AFB)
• Isolation room
• Negative air pressure
• Particulate respiration masks
– Medications
• 6-9 months
• First Line:
– isoniazid (INH), rifampin, rifampin and isoniazid
(Rifamate), pyrazinamide, ethambutol, streptomycin
• Second Line:
– Ethionamide, para-aminosalicylate sodium (PAS),
cycloserine, capreomycin, kanamycin, amikacin
Pneumonia
• Etiology/Pathophysiology
– Inflammatory process of the bronchioles and
the alveolar spaces due to infection
– Bacteria, viruses, mycoplasma, fungi, and
parasites
– Aspiration
– Retained secretions become infected
– Inflammation of respiratory tract occurs
– Decreased oxygen/carbon dioxide exchange
Pneumonia
• Signs & Symptoms
– Productive cough
• Sputum depends on cause
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Severe chills
Elevated temperature
Increased heart rate
Increased respiratory rate
Dyspnea
Pneumonia
• Treatment
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Oxygen
Chest percussion and postural drainage
Encourage to cough and deep breathe
Antibiotics
• Penicillin, erythromycin, cephalosporin, and
tetramycin
– Analgesics
• Tylenol or aspirin
– Expectorants
– Bronchodilators
– Humidifier or nebulizer
Pleurisy
• Etiology/Pathophysiology
– Inflammation of the visceral and parietal pleura
– Bacterial or viral
Pleurisy
• Signs & Symptoms
– Sharp inspiratory pain
• Usually radiates to the shoulder or abdomen
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Dyspnea
Cough
Elevated temperature
Pleural friction rub
Pleurisy
• Treatment
– Antibiotics
– Analgesics
• Demerol or morphine
– Antipyritics
• Tylenol
– Oxygen
– Anesthetic block for intercostal nerves
Pleural Effusion/Empyema
• Etiology/Pathophysiology
– Pleural Effusion
– Accumulation of fluid in
the pleural space
– Usually secondary
– Empyema
• Fluid accumulation with
pleural effusion becomes
infected
Pleural Effusion/Empyema
• Signs & Symptoms
– Dyspnea
– Air hunger
– Respiratory distress
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Nasal flaring
Tachypnea
Dyspnea
Decreased breath sounds
– Fever
Pleural Effusion/Empyema
• Treatment
– Thoracentesis
– Chest tube with closed
water seal drainage
system
• Glass bottle system
• Pleur-evac
• (Pg. 385 Box 9-6
Maintaining chest tubes
and closed chest
drainage bottles)
– Antibiotics
– Cough and deep breath
Atelectasis
• Etiology/Pathophysiology
– Abnormal condition characterized by the
collapse of lung tissue
– Due to occlusion of air to a portion of the lung
– Postoperative complication
– Secretions
– Foreign body
– Mucous plug
– Emphysema, pneumothorax, tumor
Atelectasis
Atelectasis
• Signs & Symptoms
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Dyspnea
Tachypnea
Pleural friction rub
Restlessness
Hypertension > hypotension
Elevated temperature
Decreased breath sounds
Crackles
Atelectasis
• Treatment
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Cough and deep breath
Analgesia
Early ambulation
Incentive spirometery
Intermittent positive pressure breathing
Oxygen
Chest percussion and postural drainage
Bronchodilators
• Proventil
– Antibiotics
– Mucolytic agents
• Mucomyst - Decrease viscosity of secretions
– Chest tube
Pneumothorax
• Etiology/Pathophysiology
– A collection of air or gas in the pleural space,
causing the lung to collapse
– Penetrating chest injury
– Coughing
– Ruptured bleb
– Spontaneous
Pneuomothorax
Pneumothorax
• Signs & Symptoms
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Decreased breath sounds
Sudden, sharp chest pain with dyspnea
Diaphoretic
Increased heart rate
Tachypnea
No chest movement on affected side
Sucking chest wound
Mediastinal shift
Pneumothorax
• Treatment
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Chest tube to water seal drainage system
Oxygen
Analgesics
Encourage fluids
Chest Tube Placement
Chest Tube Drainage System
Lung Cancer
• Etiology/Pathophysiology
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Primary tumor or metastasis
Small cell lung cancer
Non-small cell lung cancer
Squamous cell carcinoma
Large-cell carcinoma
80% linked to smoking
Lung Cancer
• Signs & Symptoms
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Hemoptysis
Dyspnea
Fever
Chills
Wheezing
Pleural effusion
Lung Cancer
• Treatment
– Surgery
– Most are not diagnosed early enough for
curative surgical intervention
– Segmental resection
– Lobectomy
– Pneumonectomy
– Radiation
– Chemotherapy
Pulmonary Edema
• Etiology/Pathophysiology
– Accumulation of serous fluid in interstitial
tissue and alveoli
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Left ventricular failure
Inhalation of irritating gases
Rapid administration of IV fluids
Barbiturate or opiate overdose
Pulmonary Edema
• Signs & Symptoms
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Dyspnea
Tachypnea
Tachycardia
Cyanosis
Pink or blood tinged, frothy sputum
Restlessness
Agitation
Wheezing
Crackles
Sudden weight gain
Decreased urinary output
Pulmonary Edema
• Treatment
– Oxygen
– Mechanical ventilation, if necessary
– Diuretics
• Lasix
– Narcotic analgesics
• Morphine will help decrease resp rate
– Nipride
• Vasodilator that improves myocardial contraction
and reduces pulmonary congestion
– Strict I&O; Daily weight
– Low sodium diet
Pulmonary Embolus
• Etiology/Pathophysiology
– Foreign substance in the pulmonary artery
• Blood clot, fat, air, or anmiotic fluid
– High risk
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Prior thrombophlebitis
Recent surgery, pregnancy, or given birth
Taking contraceptives long-term
Hx of CHF, obesity, or immobilization from fracture
Pulmonary Embolus
• Signs & Symptoms
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Sudden, unexplained dyspnea
Rapid respiratory rate
Hemoptysis
Chest pain
Elevated temperature
Increased WBC
Pulmonary Embolus
• Treatment
– Oxygen
– HOB up 30 degrees
– Anticoagulants
• Heparin (IV)
– Gradually tapered
• Coumadin (oral)
– Initiated as Heparin is tapered
– Continued at home for up to 1 year
– Fibrinolytic agents
Adult Respiratory Distress Syndrome
(ARDS)
• Etiology/Pathophysiology
– Complication of other disease processes
– Direct or indirect pulmonary injury
– Viral or bacterial pneumonia, chest trauma,
aspiration, shock, drug over doses, renal failure,
pancreatitis, COPD, Guillain-Barre’ syndrome,
and myasthenia gravis
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.increased permeability of capillary membrane
.allows fluid to leak into interstitial spaces and alveoli
.pulmonary edema and hypoxia
.alveoli lose their elasticity and collapse
.capillaries allow plasma and RBC’s to leak out, resulting in
hemorrhage
Adult Respiratory Distress Syndrome
(ARDS)
• Signs & Symptoms
– Respiratory distress
• Dyspnea
• Restlessness
– Tachycardia
– Hypotension
– Decreased urinary output
Adult Respiratory Distress Syndrome
(ARDS)
• Treatment
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Treat cause
Oxygen
Corticosteroids
Diuretics
Morphine
Lanoxin
Antibiotics
Chronic Obstructive Pulmonary
Disease
• Chronic airflow limitation
• Includes
•
Emphysema
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Chronic Bronchitis
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Asthma
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Bronchiectasis
Emphysema
• Etiology/Pathophysiology
– The bronchi, bronchioles and alveoli become
inflamed as a result of chronic irritation
– Air becomes trapped in the alveoli during
expiration, causing alveolar distention, rupture,
and scar tissue
– Cigarette smoking is primary irritant
– Complication:
• Cor pulmonale
– Right-sided congestive heart failure due to pulmonary
hypertension
Emphysema
Emphysema
• Signs & Symptoms
– Dyspnea on exertion
– Sputum
• Initially there is very little
• Eventually becomes copius
– Barrel chest
• Increased anteroposterior diameter caused by
overinflation
– Chronic weight loss
– Emaciation
– Clubbing of fingers
Barrel-Chest
Emphysema
• Treatment
– Oxygen (low-flow)
• 1-2 liters per NC
– Chest physiotherapy
– Bronchodilators
• Theophylline or aminophylline, Isuprel, Brethine, Alupent,
Proventil, Bronkosol
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Corticosteroids
Antibiotics
Diruretics
Humidifier
Pursed-lip breathing
High-protein, high-calorie diet
• Encourage fluids between meals rather than with meals
Chronic Bronchitis
• Etiology/Pathophysiology
– Hypertrophy of mucous gland causes
hypersecretion and alters cilia function
– Increases suseptibility to infection causing
airway scaring
– Increased airway resistance causes
bronchospasm
– Most common cause is cigarette smoking
Chronic Bronchitis
• Signs & Symptoms
– Productive cough
• Especially in the mornings
– Dyspnea
– Use of accessory muscles to breath
– Wheezing
Chronic Bronchitis
• Treatment
– Bronchodilators
• Theophylline, aminophylline, etc
– Mucolytics
• Mucomyst
– Antibiotics
• Erythromycin
– Oxygen (low-flow)
• 1-2 liters per NC
– Pursed-lip breathing
Asthma
• Etiology/Pathophysiology
– Narrowing of the airways due to various stimuli
– Extrinsic
• External factors
– Pollens, dust, feathers, animal dander, foods
– Intrinsic
• Internal causes
– Respiratory infection
– Influenced by secondary factors
• Mental or physical fatigue and emotional factors
– Antigen-antibody reaction
Asthma
• Signs & Symptoms
– Mild Asthma
• Dyspnea on exertion
• Wheezing
– Acute Asthma Attack
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Usually at night
Tachypnea
Expiratory wheezing
Use of accessory muscles
Nasal flaring
Cyanosis
Productive cough
– Status asthmaticus
• Severe, unrelenting attack that fails to respond to usual
treatment
• Leads to exhaustion and respiratory failure
Asthma
• Treatment
– Maintenance Therapy
• Serevent inhalant, prophylactic
• Corticosteroid inhalant
– Floevent
• Avoid allergens
– Acute or Rescue Therapy
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Proventil inhalant
Corticosteriod and epinephrine oral or sq
Aminophylline IV
Oxygen
– Monitor by pulse oximetry
Bronchiectasis
• Etiology/Pathophysiology
– Gradual, irreversible process that involves
chronic dilation of bronchi resulting in loss of
elaticity
– Repeated pulmonary infections
– Secondary causes may be cystic fibrosis,
foreign body, or tumor
Bronchiectasis
Bronchiectasis
• Signs & Symptoms
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Dyspnea
Cyanosis
Clubbing of fingers
Coughing
• Esp in the morning and when lying down
• Copious amounts of foul-smelling sputum
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Fatigue
Weakness
Loss of appetite
Wheezes and crackles
• Treatment
Bronchiectasis
– Oxygen (low-flow)
• 1-2 liters per NC
– Chest physiotherapy
– Hydration
– Mucolytic agents
• Mucomyst
– Antibiotics
– Bronchdilators
• Theophylline
– Cool mist vaporizer
– Surgery
• Lobectomy