Acute Respiratory Disorders and How to Assess them: Diagnostics
Objectives Discuss 6 diagnostic tests or procedures used to assess lung disorders Name the parts of a focused assessment of a patient with a Respiratory disorder Describe 4 abnormal types of respiration from a given list Name 4 acute respiratory disorders and describe the pathophysiology of each Describe the symptoms, medical orders and nursing care for 4 acute respiratory disorders
Objectives List signs and symptoms of dyspnea. Describe common types of cough. List principles of nursing care for the dyspneic patient. Identify normal chest sounds List indications for listening to chest sounds. Discuss the role of the LVN in listening to and describing chest sounds. Identify some abnormal chest sounds.
Vocabulary Respiration Ventilation Vital capacity Residual volume Atelectasis Pneumothorax Hemothorax Homan s sign Hypoxia Orthopnea Tachypnea Bradypnea Eupnea Empyema
Physicial Examination General appearance: Facial expression posture Color Speech pattern Obvious signs of distress Respiratory rate
Assessment Trachea Thorax: Deformities Symmetry Regular, even respirations Lung sounds Rhonchi Crackles/ Rales Rubs Wheezes
Assessment Abdominal distension Homan s sign Clubbing Nasal flaring Use of accessory muscles Speech pattern
Diagnostic Tests Chest x-ray Fluoroscopy Ventilation-perfusion scan CT Pulmonary function tests Fiberoptic bronchoscopy Thoracentesis Pulse oximetry
Pulmonary Changes of Aging Loss of elasticity Enlargement of bronchioles Decreased number of functioning alveoli Decreased defense mechanisms Calcification of costal cartilage Increased rib cage rigidity Respiratory muscle strength decline Flattened diaphragm
Nursing care Aspiration precautions Monitor for dyspnea Post operative mobilization Turn, cough deep breathe Incentive spirometry Oral hygiene HAND HYGIENE
Thoracentesis Invasive procedure Performed at the bedside Nursing responsibilities Purpose
Pulmonary Toilet Cough and deep breathe Sustained maximal inspiration Chest physiotherapy Pursed lip breathing Suctioning
Oxygen Delivery
Common Cold Acute viral rhinitis Most prevalent infectious disease Spread via airborne droplets, hand to hand Prevention: Cover your cough HAND HYGEINE
Influenza Viral illness of respiratory tract and muscles More virulent than common cold Mortality rate 0.1% 1918 flu epidemic caused 40 to100 million deaths an estimated mortality rate of between 2 and 20%
Influenza Care Prevention: Immunization Reduces the risk of hospitaliztion (50%), pneumonia (60%) and death (75-80%) among elderly in nursing homes Generally supportive Rest Fluids Antipyretics Recovery generally 1-2 weeks
What about Bird Flu? The bird flu, also known as avian influenza, is an infection caused by avian influenza A. Bird flu can infect many bird species, including domesticated birds such as chickens. In most cases, the disease is mild; however, some subtypes can be pathogenic and rapidly kill birds within 48 hours. Rarely, humans can be infected by these bird viruses. People who get infected with bird flu usually have direct contact with the infected birds or their waste products. Depending on the viral type, the infections can range from mild influenza to severe respiratory problems or death. The major concern about bird flu is that it will change (mutate) its viral RNA enough to be easily transferred among people and produce a pandemic similar to the one of 1918.
Stomach Flu Although nausea, vomiting, and diarrhea can sometimes accompany influenza infection, especially in children, gastrointestinal symptoms are rarely prominent. The term stomach flu" is a misnomer that is sometimes used to describe gastrointestinal illnesses caused by other microorganisms
Bronchitis Causes Viral Bacterial Inhalation of particulate matter or chemicals Especially smoking
Acute Bronchitis Viral Non productive cough Aggravated by dry, cold, or dusty air May have purulent sputum Chest pain from coughing Fever Chills Malaise CXR shows no infiltrates
Bronchitis Bacterial Productive cough Fever Pain behind sternum aggravated by cough Rare in healthy adults except after viral URI Common in COPD patients CXR needed to differentiate from pneumonia May progress to pneumonia
Pneumonia Acute infection of lower respiratory tract 6 th leading cause of death in US Incidence and mortality highest among elderly Risk factors: age, immunocompromised, lung disease, alcoholism, ALOC, smoking, ET intubation, malnutrition, immobilization
Pneumonia CAP cause: Strep pneumoniae. Relatively low mortality rate Mycoplasma pneumoniae: common cause in young people, esp in dorm situations, army barracks HIV patients: pneumocystis carinii, mycobacterium, fungal
Pneumonia--Pathophysiology Aspiration of oral/pharyngeal secretions Inhalation of airborne agents Bacterial invasion of lungs via blood Microorganisms overwhelm alveolar macrophage Defense mechanisms activated: inflammatory mediators, cellular infiltration, immune activation
Pneumonia---Pathophysiology Inflammatory mediators and immune complexes damage bronchial mucus membranes. Acini and terminal broncioles fill with infectious debris and exudate. Microorganisms release toxins Accumulation of debris leads to V/Q mismatch and dyspnea
Pneumonia S. pneumoniae microorganisms initiate inflammatory response. Inflammatory exudate causes alveolar edema. Viral pneumonia is self limiting
Pneumonia Pulmonary consolidation Dullness to percussion, inspiratory crackles, increased tactile fremitis, egophany. Elevated WBC (usually >10,000) CXR shows infiltrates Sputum cultures identify microorganism
Pneumonia
Pneumonia Treatment Increased fluid intake Rest Antipyretics Analgesics Antibiotics Oxygen Immunization HAND HYGEINE
Pluerisy Inflammation of the pleura Causes Symptoms Treatment
Pulmonary Embolism Occlusion of pulmonary vascular bed Third leading cause of death in the US Signs and symptoms Diagnosis Treatment
Pulmonary Embolism Nursing care Monitor cardio-pulmonary function Monitor respiratory rate, effort Elevate HOB Oxygen therapy Strict bed rest or as ordered I&O Prevent further thrombus formation Pain and anxiety control
Acute Respiratory Distress Syndrome Progressive pulmonary disorder 1-96 hours after lung trauma Pulmonary infiltrates, pulmonary edema Decreased lung compliance stiff lung Surfactant production decreases Atelectasis
Acute Respiratory Distress Syndrome (ARDS) is an acute, severe injury to most or all of both lungs. Patients with ARDS experience severe shortness of breath and often require mechanical ventilation (life support) because of respiratory failure. ARDS is not a specific disease; instead, it is a type of severe, acute lung dysfunction that is associated with a variety of diseases, such as pneumonia, shock, sepsis (a severe infection in the body) and trauma. ARDS can be confused with congestive heart failure, which is another common condition that can also cause acute respiratory distress. The term Acute Lung Injury "ALI" is sometimes used in the same setting as ARDS, but also includes less severe instances of generalized, acute lung injury.
Trauma Hemothorax Pneumothorax Flail chest
Traumatic injury: penetrating or blunt MVA 40% of deaths have blunt trauma from steering wheel Blunt trauma results in: rib fx, pneumothorax, pulmonary contusions, cardiac contusions Penetrating: GSW or stab wounds Result in pneumothorax, injuries to great vessels
Hemothorax
Hemothorax
Pneumothorax Signs & Symptoms: dyspnea, tachypnea, tachycardia restlessness, pain, anxiety, decreased CW movement, asymmetric CW movement, DBS on affected side, progressive cyanosis Nursing care: monitor respiratory status, position in Semi-Fowler's position, monitor VS, assess pain, Oxygen therapy, C&DB
Pneumothorax
Rib Fractures Most common chest injury Ribs 5 10 Six weeks to heal Treatment aimed at pain relief Prevention of pneumonia, atelectasis
Flail chest 2 or more adjacent ribs fracture in 2 or more segments Ribs move paradoxically Bruising of underlying tissue may cause fluid accumulation in alveoli Fx d ribs may cause hemo- or pneumothorax
Flail Chest Signs and symptoms Severe dyspnea Tachypnea Tachycardia Paradoxical chest wall movement
Flail Chest
Diagnostics CXR Pulmonary function test Lung scan CT scan ABG Oxygen saturation CBC Sputum
Respiratory patterns Cheyne-Stokes respirations have a pattern of decreasing rate and depth until apnea occurs, followed by increasing rate and depth. This pattern is usually seen with deep cerebral lesions and some cerebellar lesions
Central neurogenic hyperventilation exhibits very deep and rapid respirations. This pattern is usually seen with lesions of the midbrain and upper pons. The respirations are usually regular and the PaCO2 decreases due to the hyperventilation.
Apneustic respirations have prolonged inspiratory and/or expiratory pauses of 2-3 seconds. This pattern is usually seen with lesions of the mid to lower pons.
Cluster breathing is a groups or irregular breathing with periods of apnea that occur at irregular intervals. This pattern is usually seen with lesions in the low pons or upper medulla. Cluster breathing differs from Cheyne-Stokes pattern because there is no increasing and decreasing depth of respirations
Ataxic breathing (Biot's) has no pattern. The breaths vary in depth and rate with pauses. This pattern indicates a lesion in the medulla.