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6- Respiratory Disorders I.ppt disorders
- 1. Respiratory Disorders Respiratory Disorders Dr.Hasan Al-Omran Dr. Hasan Al-Omran AlGhad College- Najran AlGhad College- Najran 1
- 2. Objectives: 1. Understand bothmedical and nursing management of acute bronchitis, pneumonia, TB, COPD, & asthma 2. Differentiate between the clinical manifestations of Pneumonia and TB 3. Identify patients at risk for chronic obstructive pulmonary disease (COPD) 4. Use the nursing process as a framework for care of the patient with pneumonia, TB, asthma & COPD, 2
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- 4. Acute Bronchitis Acuteinflammation of the tracheobronchial tree. Generally, self-limiting and with eventual complete healing and return of function (comes on quickly and gets better after 2 to 3 weeks.). Though commonly mild, bronchitis may be serious in debilitated patients and those with chronic lung or heart disease. Pneumonia is a critical complication. 4
- 5. Types of AcuteBronchitis Acute infectious bronchitis (after a common cold or other viral infection of nasopharynx, throat, or tracheobronchial tree, often with secondary bacterial infection) Acute irritative bronchitis (caused by various irritants) Cough-variant asthma. 5
- 6. Acute Bronchitis: Pathophysiology Hyperemia ofthe mucous membranes desquamation, edema, & leukocytic infiltration of the submucosa production of sticky or mucopurulent exudate 6
- 7. Acute Bronchitis: Pathophysiology The protectivefunctions of bronchial cilia, phagocytes, and lymphatics are disturbed bacteria may invade the bronchi accumulation of cellular debris and mucopurulent exudate 7
- 8. Acute Bronchitis: S&S Acuteinfectious bronchitis is often preceded by symptoms of a URI: malaise chill slight fever back and muscle pain sore throat Dyspnea fever ~38,5ºC may be present for up to 3 to 5 days 8
- 9. Acute Bronchitis: S&S Onset of cough usually signals onset of bronchitis. The cough is initially dry & nonproductive small amounts of viscid sputum are raised after a few hours or days it may later become more abundant and mucoid or mucopurulent (bacterial infection) 9
- 10. Acute Bronchitis: Diagnostics VS CXR Arterial blood gases Sputum culture 10
- 11. Acute Bronchitis: Rx Antibiotic therapy for 7 to 10 days may be indicated for patients with underlying respiratory problems or chronic illness. Hydration and humidification. Secretion clearance interventions (controlled cough, positive expiratory pressure valve therapy, chest physical therapy). Bronchodilators for bronchospastic cough and bronchial irritation. Symptom management for fever, cough. 11
- 12. Acute Bronchitis: NsgMx Assist patients with prescribed therapies Use of antitussives, analgesics, and bronchodilator medications Encourage fluids Teach patients to cough effectively and avoid infections Offer mild analgesics for discomfort Offer patients deep breathing exercises, incentive spirometer 12
- 13. Acute Bronchitis: NsgMx Anticholinergics, antibiotic therapy (when indicated), IV corticosteroids or methylxanthines Antibiotics not shown to be effective except in patients with COPD Beta-2 agonists (brochodilators) such as albuterol (Ventolin), salbutamol, salmoterol, and formoterol) 13
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- 15. Pneumonia Pneumonia • Is aninflammation of the lung parenchyma caused by a microbial agent. •Classification: Classification: Community-acquired: in the community or in the first 48 hrs of hospitalization. Agents include streptococcal pneumoniae , hemophilus influenza, mycoplasma and viral pneumonia Hospital acquired: Nosocomial, e.g., ventilator associated pneumonia- staphylococcal aureus, pseudomonas, and klebsiella pneumonia 15
- 16. Pneumonia inthe immuno-compromised: e.g., pneumocystic carinii pneumonia, fungal pneumonia, & mycobacterium tuberculosis Aspirational pneumonia: results from entry of endogenous or exogenous substances in the airway. Common pathogens: S. pneumonia, H. influenza, and staphylococcus aureus * Pneumonia affects both ventilation and diffusion Pneumonia affects both ventilation and diffusion 16
- 17. Risk Factors Older,immunocompromised, or those who live in high-risk environments: vaccines against pneumococcal pneumonia. Chronic disorders such as CHF, DM, COPD, & AIDS Smoking Depressed cough reflex Prolonged NPO states 17
- 18. When themicroorganisms find their way into the lung, an inflammatory reaction may occur in the alveoli and produces exudates that interfere with the diffusion of oxygen and carbon dioxide. WBCs mostly neutrophils migrate into the alveoli and fill the normally air-containing spaces. Hypoventilation results from secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli lead to ventilation perfusion mismatch in the affected area. 18 Pathophysiology Pathophysiology
- 19. Venous bloodentering the pulmonary circulation passes through the hypoventilated area and exits to the left side of the heart poorly oxygenated blood, the mixing of oxygenated and poorly oxygenated blood results in arterial hypoxemia. Bacterial pneumonia usually affects one lobe leading to lobar pneumonia, while viral pneumonia usually cause multi-lobular infiltration. 19 Pathophysiology Pathophysiology
- 20. Clinical manifestations Dependson the organism S. pneumonia: sudden onset of chills, high- grade fever, pleuritic chest pain, & tachypnea & tachycardia – Cough, Sputum, & Dyspnea – Pleuritic chest pain – Crackles (auscultation) – Dullness (percussion) – Fever or hypothermia – Low or high WBC count 20
- 21. Diagnosis Health history(recent respiratory tract infection). Physical examination. Chest x-ray studies. Blood culture Sputum culture. Invasive procedures as naso- or orotracheal suction or bronchoscopy may be needed to collect specimens. 21
- 22. Management •Appropriate antibiotic: PenicillinG for S. pneumonia, erythromycin for Mycoplasma pneumonia •Treatment for viral is primarily supportive •Maintain oxygenation •Maintain airway clearance •Maintain adequate hydration •Monitor temperature Complications: •hypotension & shock, superinfection, Atelectasis because of an obstructed bronchus, pleural effusion 22
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- 24. Pulmonary tuberculosis Infectiousdisease affecting the parenchyma and may be transmitted to the meninges, kidneys, bones, and lymph nodes Primary agent:Mycobacterium tuberculosis World population ~ 6 billion ~ 1in 3 people in world infected ~ 9.4 million new cases of active TB/year; 1.7 million deaths/year 24
- 25. Transmission and riskfactors Airborne transmission Small droplets from talking, coughing, or sneezing 25
- 26. Tuberculosis Testing – PPD(Mantoux test) – CXR – Sputum for culture/Acid Fasting Bacillus Engineering Controls – Private room with negative pressure – >6 air exchanges – Respiratory Protection (N95 Mask) 26
- 27. Tuberculosis Patient Management Placeon Strict Isolation for suspected TB until: – One bronchial washing negative for TB OR – Three sputums (3 consecutive days) negative for AFB Place on Strict Isolation for confirmed TB until: – Three negative sputums and patient is on effective therapy with clinical improvement 27
- 28. Assessment & Diagnostic findings Hx & physical exam Tuberculin skin test: Mantoux test (Induration of 10 mm or more indicates exposure) Chest X-ray Acid-fast bacillus smear Sputum culture 28
- 29. Management 6 –12 months of chemotherapeutic agents Drug resistance especially mutidrug resistance is a major issue First-line meds: Isoniazide (INH), rifampin, pyrazinamide, and either streptomycin or ethambutol A person is considered noninfectious after 2 – 3 wks of continuous medication therapy INH as a prophylactic for those at risk 29