Respiratory disorders and conditions:

Question 1

Respiratory disorders and conditions:

Answer 1

• upper respiratory tract - acute conditions e.g. tonsillitis
• lower respiratory tract - acute infections and exacerbations of chronic conditions
• infections e.g. chest infections, pneumonia
• inflammatory conditions e.g. asthma
• chronic conditions e.g. COPD
• neoplasms e.g. lung cancer
• injury to respiratory tract

Question 2

Bronchitis:

Answer 2

• an extension of an upper respiratory infection involving the trachea
• usually viral in origin - may be acute enough to require hospitalisation in compromised patients
• early symptoms are similar to those of the common cold
• treatment includes humidification with warm or cool moist air, cough mixtures or bronchodilators

Question 3

Influenza:

Answer 3

• an acute, high infectious disease of the upper and lower respiratory tracts
• caused by three major types (A, B, and C) and numerous subtypes
• spread directly and indirect contact

Question 4

Influenza S&S and treatment:

Answer 4

• appears 2-3 days after exposure
• headache, fever, chills and muscle aches
• sore throat, hacking cough, runny nose, and nasal congestion
• antiviral medications may be used in specific patient populations
• uncomplicated influenza usually is managed more effectively by nursing intervention than by drugs or other forms of medical treatment

Question 5

Pneumonia:

Answer 5

• an extensive inflammation of the lung with either consolidation of the lung tissue as it fills with exudate or interstitial inflammation and oedema
• bacteria or viruses may cause pneumonia
• also can result from inhalation or irritating gases

Question 6

S&S and diagnosis of pneumonia:

Answer 6

• usually a high fever accompanied by chills
• a cough that produces rusty or blood-flecked sputum
• sweating and chest pain that is made worse by respiratory movement
• a general feeling of malaise and aching muscles
• diagnosis is confirmed by chest x-ray, which reveals densities in the affected lung

Question 7

Nursing management of pneumonia:

Answer 7

• promote oxygenation
• control elevated temperature
• maintain nutritional and fluid intake
• provide adequate rest
• monitor vital signs and respiratory status
• relieve pain and discomfort
• provide good oral hygiene
• prevent irritation of the lungs by smoke and other irritants
• avoid secondary bacterial infections

Question 8

Diagnosis of respiratory conditions:

Answer 8

• Sputum samples:
• chest x-ray
• Nasopharyngeal swabs:
• pulmonary studies
• arterial blood gases

Question 9

Older adults and respiratory infections:

Answer 9

• older adults are more at risk for influenza and pneumonia because of a less efficient immune system, decreased action of cilia and decreased elasticity and muscle tone
• confusion is often the most obvious sign
• it may take up to 6-12 weeks after a bout of pneumonia for the older adult to be able to resume normal activities without fatigue

Question 10

Obstructive pulmonary disorders:

Answer 10

Characterised by problems with moving air into and out of the lungs:
- narrowing of the openings in the tracheobronical tree increases resistance to the flow of air making it difficult for oxygen to enter, and contributes to air trapping because exhalation also is difficult
- such as chronic bronchitis, asthma, emphysema

Question 11

Asthma:

Answer 11

• Nursing managmen:
• smoking cessation
• psychosocial care
• patient and family teaching
• Goal of medical treatment:
• relieve obstruction by secretions, oedema or bronchospasm
• prevent or control infection and allergy
• increase the patient’s tolerance for activity
• bronchodilators (relievers) and steroids (preventers)

Question 12

Complications of chronic obstructive pulmonary disease:

Answer 12

• cor pulmonale
• acute respiratory failure
• peptic ulcer and gastro-oesophageal reflux disease
• spontaneous pneumothorax

Question 13

Monitoring oxygen saturation:

Answer 13

• the individuals capillary, venous or arterial blood gases are commonly measured during oxygen therapy
• the toe, earlobe or bridge of nose can be used if application to fingers is not possible
• sensors for infants and children can be applied to the palm or the sole of the foot

Question 14

Measuring oxygenation saturation:

Answer 14

• pulse oximetry measures of arterial blood oxygen saturation as pulse oxygen saturation (SpO2)
• it measures the amount of haemoglobin loaded with oxygen expressed as a percentage

Question 15

Conditions that may affect measurments:

Answer 15

• anaemia patients may have oxygen sats above 95%, less haemoglobin circulating the patient may still be hypoxic
• conditions that interfere with light transmission such as carbon monoxide poisoning, patient movement or jaundice, opaque nail polish
• circumstances that impact on pulse volume: peripheral vascular disease, hypothermia, medications that promote vasoconstriction, low cardiac output, peripheral oedema

Question 16

Signs of deoxygenation:

Answer 16

• first signs of decreasing oxygenation may be restlessness or confusion
• the patient may want to sit upright to allow for better chest excursion
• respiratory rate will increase, and later there will be flaring of the nares and then retraction of respiratory muscles if the condition worsens
• cyanosis is a very late sign

Question 17

Promoting efficient gas exchange:

Answer 17

• any disorder of the respiratory system may result in impaired gas exchange
• depending on the extent to which it interferes with ventilation and perfusion, hypercapnia, hypocapnia, and/or hypoxaemia may develop
• the aim of management of these conditions is to maintain adequate oxygenation and removal of carbon dioxide

Question 18

Oxygen therapy:

Answer 18

• oxygen may be administered to prevent or reverse hypoxia and to improve tissue oxygenation via a number of devises
• oxygen is a drug, it is prescribed by a medical officer determines the concentration, route and length of time that it is to be administered
• oxygen is prescribed in liters per minute of percentage as Fio2 (fraction of inspired oxygen)

Question 19

Principles and precaution of oxygen administration:

Answer 19

• hypoxaemia can result from insufficient oxygen flow or delivery
• equipment and connections must be checked at regular intervals to ensure it is functioning properly
• if signs and symptoms of hypoxaemia occur they must be reported immediately, as adjustment to the concentration being administered may be necessary, or alternative investigations or treatment implemented
• oxygen can dry and irritate mucous membranes. humidification is not routine but humidification system may be used when longer periods of oxygen administration are required

Question 20

Oxygen delivery devices:

Answer 20

• face mask
• tracheostomy collar
• face tent
• partial nonrebreathing mask
• venturi mask

Question 21

Oxygen delivery devices:

Answer 21

• Nasal cannula/catheter:
• well tolerated by most individuals. the fraction of inspired oxygen varies depending upon the flow of oxygen
• Simple face mask:
• high flow of oxygen is required to prevent the rebreathing of CO2
• Oxygen mask with reservoir bag (non-rebreather)
• allows for a higher FiO2 to be administered. a valve closes during expiration so that exhaled air does not enter the reservoir bag and be rebreathed. never remove the one-way valve
• Venturi mask:
• this device is one of the most accurate ways to deliver oxygen. different sized adapters are used to deliver a fixed or predicted FiO2

Question 22

Humidification:

Answer 22

• the normal passage of air through a healthy respiratory tract ensures that inspired air is warmed and moistened
• this provides the optimal conditions for gas-exchange, surfactant-producing cells and phagocytic activity as well as mucus production and sputum clearance
• when the normal passage of air is bypassed and or when medical gases are used, the airway and oxygenation can be compromised