Week 3 - Respiratory Health 2 Flashcards
What are Upper Respiratory Conditions?
- Involve nose, sinuses, pharynx, and larynx
- Affect QoL (sleep, nutrition, sensory impairment, energy level)
-Spread by droplet or contact
Common Symptoms of Upper Respiratory Conditions?
- Nasal congestion, rhinorrhea (runny nose)
- Cough
- Sneezing
- Low grade fever
- Malaise, myalgia (muscle aches), headache
- Sore throat
- Generally self-limiting & mild
- Symptoms last up to approx.10 days
- Cough lasts for 2-3 weeks
Nursing Interventions for Upper Respiratory Conditions?
- Dx based on symptoms in the absence of other identifiable causes (strep, pharyngitis, influenza, allergic rhinitis)
- Encourage increased amounts of fluid to liquify secretions
- Antihistamine or decongestant therapy reduced post nasal drip, cough, nasal obstruction, and nasal discharge
- Antipyretic (acetaminophen), NSAID (ibuprofen) for discomfort
- Cough medicine - no scientific evidence it works
- Hand hygiene
- Influenza vaccine - 70% effective if given before flu season (fall)
Lower Respiratory Conditions
- Acute respiratory tract infections (e.g. pneumonia)
- Chronic obstructive pulmonary disease (e.g. asthma, emphysema,
chronic bronchitis) - Respiratory disease common cause of hospitalization
What is Pneumonia?
- Acute inflammation of the lung parenchyma (alveoli & bronchioles) caused by a microbial agent
- Inflammation = edema = ↓ compliance (stiff lungs) = difficulty breathing = hypoxemia (↓ O2 in blood)
Risk Factors of Pneumonia
- Decreased Level of consciousness (LOC)
○ Pneumonia patients are immobile so sections pool - Tracheal intubation
- Air pollution
- Smoking
- Upper respiratory infections
- Chronic diseases (↓ immune system
- Stroke
○ Some lose gag reflex
○ If they have secretions they are unable to cough up, it will go into the lungs - > 65 years old
- Prolonged bedrest
- Malnutrition
- Aspiration
- Enteral feeds (tube feeds)
○ Food given can end up sitting in the lungs, rather than going to the GI tract which can cause pneumonia - Decreased ability to cough & clear secretions
What are the 4 Types of Pneumonia?
1) Community Acquired pneumonia
2) Hospital Acquired pneumonia
3) Aspiration pneumonia
4) Opportunistic pneumonia
Community Acquired pneumonia
○ Onset in the community
○ Highest incidence in winter months
○ Smoking is a predisposing factor
○ Strep pneumonia is most common
Hospital Acquired pneumonia
○ Pneumonia associated with hospitalization or treatment
○ Usually caused by bacteria
Aspiration pneumonia
○ Abnormal entry of secretions/substances into lower airway
○ Usually follows aspiration of material from the mouth or the stomach into the trachea and then the lungs
Opportunistic pneumonia
- People with compromised immune systems, chronic illnesses, malnutrition are at greater risk of developing pneumonia
S & S Of Pneumonia
- Sudden onset of fever, chills, cough producing purulent sputum, +pleuritic chest pain, malaise, myalgia
- Fatigue, weakness, malaise
- Anorexia, nausea, vomiting
S & S Of Pneumonia in Elderly or Immunocompromised
- Stupor
- Confusion
- Hypothermia
- Diaphoresis
- Fatigue
- Poor appetite
- Confusion from hypoxia is
common in elderly - Pneumonia must be treated as soon as diagnosed high risk of developing sepsis
Physical Assessment for Pneumonia
- Tachypnea
- Dullness on percussion, increased fremitus (more vibration as sound is
better conducted in solid & fluid mediums than air) - ↑ density within the lung tissue due to edema and exudate (fluid that leaks out of blood vessels into nearby tissues b/c inflammation)
- Crackles (rales) in lung bases
- Fever, tachycardia
What bloodwork and tests should be done for pneumonia?
- Chest radiograph
- Gram stain examination of sputum
- Sputum C & S (if medication resistant pathogen/organism not covered by standard therapy)
- Pulse oximetry or ABGs (if
indicated) - Complete blood cell count,
differential - Blood cultures
- Hemoglobin and electrolytes should be within normal range
- In pneumonia, you would expect elevated WBC count
Nursing Interventions for Pneumonia
Health promotion - prevention is key
- Immunization - influenzas vax, Pneumovax
- Encourage smoking cessation
- Healthy lifestyle, diet, exercise, rest
- Good oral hygiene
- Oxygen therapy to treat hypoxemia
- DB & C
- Antibiotic therapy (depending on causative organism)
- Analgesics for patient comfort and antipyretics (acetaminophen)
- Bronchodilators
- Rest
- Hydration (2.5-3mL/day) to loosen secretions
- Small frequent meals (150 calories/day)
- Reposition q2h to mobilize secretions
Nursing Interventions for those at risk of aspiration
- Elevate HOB minimum 30 degrees when performing care
- Side-lying position to prevent aspiration (altered LOC)
- Check enteral tube placement before each use
- Be present for meals and meds
- Monitor closely for subtle changes in resp status
Nursing Interventions to decreases risk of hospital acquired pneumonia
- Proper hand hygiene
- DB & C exercises
- Mobilize as much as possible
- Reposition q2h to prevent secretions from pooling
- Avoid overmedicating with sedatives/opioids *suppress cough reflexes, pools secretions)
What is Asthma?
- Chronic inflammatory disorder intermittent airway obstruction
- Changes in airway: inflammation, extra mucous production, bronchoconstriction (tightening of muscles)
- Hyper-responsiveness of airways caused by triggers e.g. allergens, smoke, cold
- Key characteristic: intermittent & reversible
- Exact mechanism unknown
Healthy Airway VS. Asthmatic Airway
Healthy
- pink and clear
- muscle bands are not tight
- no swelling
Asthmatic
- muscles tighten
- airway opening reduced
- bronchoconstriction
Signs & Symptoms of Asthma
- worse at night & early morning
- Wheezing
- Cough
- Dyspnea, tachypnea
- Chest tightness
- Tachycardia
S&S Of Severe Asthma Attack
- Intercostal retractions (muscles bw rbs retract when breathng)
- Increased wheezing
- Nasal flaring
- Pale or blue lips and fingernails
Physical Assessment for Asthma
- ↓ SpO2, tachypnea, hyperventilation
- Use of accessory muscles
- Hyperresonance on percussion (due to air trapping within the lungs)
- ↓ breath sounds
- Wheezing
- Diaphoresis
- Anxiety
- If in obvious distress but NO wheezing heard: life threatening
- Obstruction in airflow can lead to respiratory failure if
untreated
What type of acid-base imbalance is caused by an asthma attack?
Respiratory alkalosis
- Due to airflow limitation and hyperventilation
- Unresolved asthma can progress into hypoventilation - respiratory acidosis
What is Status Asmathticus?
- extreme form of asthma caused by hypoxemia
- Severe asthma
- Unresponsive to regular treatment
- Potential respiratory failure
- Hypoxemia
- Hypercapnia (too much CO2 in blood)
- Acidosis
Interventions
* Drug therapies
* Endotracheal intubation
* Mechanical ventilation
How is Asthma Diagnosed?
Spirometry: breathing test that measures how much air you can inhale, and how quickly you can exhale
- Preferred method
- Assesses for airflow obstruction & reversibility
- Cannot go by S & S or history alone
- Important for proper diagnosis- other conditions can cause asthma-like symptoms
2 Types of Medications used for Asthma
1) Relievers
- Ease symptoms
- Used intermittently RPN
- Most common: B2 adrenergic agonists (sympathetic NS)
- May be short acting (SABA) or long acting (LABA)- Bind to B2 receptors to relax bronchial smooth muscles to open airways
S:E tachycardia, HTN, tremors, anxiety
2) Controllers
- Maintenance therapy
- Block response
- Used daily pn fixed schedule
- Corticosteroids - anti-inflammatory to hyper-responsiveness
- S.E: oropharyngeal candidiasis, hoarseness (changes in voice that make it sound breathy or raspy), dry cough, easy bruising, accelerates bone loss (high dose)
A patient is prescribed two inhalers, a steroid to reduce inflammation (controller) & a bronchodilator (reliever). They are both due at the same time. Which one should be given first?
- Give bronchodilator first (to open airways) and then the anti-inflammatory
Nursing Interventions for Asthma
During an asthma attack:
- Assess airway patency and respiratory status, LOC
- Position in high fowlers
- Administer O2 to maintain SpO2 > 93%
- Administer medications - bronchodilators 9SABA), corticosteroids
- May require IV access
- Instruct breathing technique
- Purse-lip breathing to maintain open airways
- Abdominal breathing to increase lung expansion
- Relaxation techniques to decrease anxiety
- Client teaching re: use of an inhaler
- Controllers - maintenance medication, usually corticosteroid
- Relievers - rescue, bronchodilator, used intermittently
- Risk of candidiasis infection with use of corticosteroids - rinse mouth, gargle after use
- Teaching re: identification of triggers and ways to minimize exposure
- Involve family or friends (S&S, where inhalers located, how to use them, emergency numbers)
What is Chronic Obstructive Pulmonary Disease (COPD)?
- Persistent airflow limitation that is irreversible & progressive
- Associated with an enhanced chronic inflammatory response in the
airways & lungs with alveolar damage - ↓ gas exchange & tissue changes irreversible damage to lung tissue airflow obstruction chronic air trapping & retaining of
CO2 - Symptoms include dyspnea, shortness of breath, & limitations in
activity
What are the 2 Types of COPD?
Emphysema: Destruction of elastin in
connective lung tissues
- Breakdown of alveolar walls
- Reduced lung elasticity
- Ineffective gas exchange
- Alveolar problem
Chronic Bronchitis: Constant bronchial
irritation & inflammation
- Too much mucus production
- Narrowing of airway
- Airway problem
Both types cause:
- Obstructed airway
- Dyspnea (difficulty getting air in)
- Hypoxemia (low O2 in blood)
- Respiratory Acidosis (cant get enough CO2 out)
What are the Causes of COPD?
- Primary cause of COPD- exposure to tobacco smoke
- Other causes: occupational toxins, recurrent respiratory infections,
heredity (AAT deficiency)
S&S Of COPD
- Fatigue
- Weight loss
- Productive cough (Chronic bronchitis)
- Crackles, wheezes, rhonchi
- Dyspnea, tachypnea
As COPD progresses:
- skeletal muscle involvement
- right-sided heart failure
- secondary polycythemia
- depression
- altered nutrition
- cyanosis
Physical Assessment for COPD
- Progressive dyspnea (SOB), cough +/- sputum production
- Pursed-lip breathing
- Use of accessory muscles
- ↓ chest expansion, flat diaphragm causes barrel chest
- Hyperresonance on percussion = ↑ lung volumes & ↓ lung elasticity caused by air trapping overinflation of the lungs & ↑ resonance upon
percussion) - ↓ breath sounds, wheezing, crackles
- Weight loss
- Upright position/tripod position
2 Signs of Physical Assessment
1) Clubbing
2) Barrel Chest (emphysema)
Complications of COPD
- Cor pulmonale- hypertrophy of right side of heart + heart failure
- Dysrhythmia (electrolyte imbalance due to acidosis)
- Acute exacerbation of COPD- worsening of symptoms from baseline
- risk for respiratory infection ( mucus production, clearing ability, inadequate
perfusion - Acute respiratory failure
- Depression, anxiety
How is COPD Diagnosed?
1) Arterial Blood Gas (ABG) Testing
- Test repeated over time so results can be compared to baseline
- Results can be compared to identify disease progression
- Individuals with COPD will show respiratory acidosis
2) Blood Tests
- Hemoglobin, hematocrit levels = polycythemia
- Elevated WBC if infection is present
- Electrolyte levels may be altered by acidosis
3) Pulmonary Function Tests (PFT)- level of airway obstruction
- Tracks progression of disease by comparing results overtime
4) Chest X-Ray
- Rules out other diseases of the lungs
- Determines progress of disease
- Hyperinflation of lungs is indicative of COPD
Sputum Culture
- Identifies cause if infection is present
Goal of COPD Treatment
- Manage dyspnoeic episodes
- Promote mucous elimination
- Maintain O2 saturation > 88%
- Provide support and comfort
- Quality of life
- They will never reach a high Spo2 bec their lungs do not have that capacity
Nursing Interventions for COPD
- Monitor vitals - SpO2 lower tan expected (88-94%)
- Respiratory assessment
- Oxygen 1-2/minute via nasal prongs
- Administer medication - bronchodilator, corticosteroids
- Careful use of sedatives, opioids (suppress respirations, which increases CO2)
- Small frequent meals (2-3L/day)
- Allow for rest periods
Patient Teaching for COPD
- Pursed lip breathing (inhale through nose for 2 seconds and exhale through mouth for 4 seconds to reduce trapped air)
- Pneumonia, COVID, influenza vaccines
- Promote smoking cessation
- Home oxygen use
- Refer to pulmonary rehab program
