Upper respiratory disorders and nursing mangement

1. Nursing management
of patients (adults
including elderly) with
respiratory problems
ANILKUMAR BR
LECTURER
MEDICAL-SURGICAL NURSING

2. * Nursing assessment – History and
physical assessment
* Etiology, Pathophysiology, clinical
manifestations, diagnosis, treatment
modalities and medical, surgical, dietetics
and nursing management of various
respiratory disorders.

3.  Upper respiratory tract infections
 Bronchitis
 Asthma
 Emphysema
 Empyema
 Atelectasis

4.  Chronic obstructive pulmonary
diseases ( COPD)
 Bronchiectasis
 pneumonia
 Pulmonary Tuberculosis (TB)
 Lung abscess

5.  Pleural effusion
 Cysts and Tumors
 Chest injuries
 Respiratory arrest and insufficiency
 Pulmonary embolism

6. Review of anatomy and physiology of
respiratory system

7.  The respiratory system is
composed of the mainly
1) Upper respiratory tracts
2) Lower respiratory tracts

8.  Together, the two tracts are
responsible for ventilation
(movement of air in and out of
the airways).

9.  The upper respiratory tract,
known as the upper airway,
warms and filters inspired air so
that the lower respiratory tracts
(the lungs) can accomplish gas
exchange.

10. Conti
Gas exchange involves delivering
oxygen to the tissues through
bloodstream and expelling waste
gases, such as carbon dioxide,
during expiration.

11. Anatomy of the upper respiratory
Tract
 Upper airway structures consist of
Nose
Sinuses and nasal passages
Pharynx
Tonsils and adenoids
Larynx and trachea

12. Lower respiratory tract
 The lower respiratory tracts
consist of the
1) Lungs (two) which contain the
bronchial and alveolar
structures needed for gas
exchange

13. Structures of lungs

14.  The lungs are paired elastic
structures enclosed in the
thoracic cage, which is an airtight
chambers with distensible walls.

15. Continue
 PLEURA : The lungs and wall of the
thorax are lined with a serious
membrane called pleura.
MEDIASTINUM : The mediastinum is in
the middle of the thorax, between the
pleural sac that contains the two lungs.

16.  LOBES : Each lung is divided into
lobes . The left lung consists of
an upper and lower lobe,
whereas the right lung has an
upper, middle and lower lobe

17. Nursing assessment – History and
physical assessment
 History collection
• Personal history
• Reason for seeking care
• Past health history
• Present illness /problems
• Previous illness

18. Conti
 Family history
 Occupational history
 Medications

19. Physical examination
 Skin – cyanosis, Pallor
 Nail clubbing
 cough and sputum production
 Inspect – palpate – Percussion - &
auscultate the thorax.

20. Common respiratory sings and
symptoms
 Dyspnea or SOB
 Wheezing
 Chest pain
 Cough
 Hemoptysis
 Sputum production

21. Common diagnostic evaluation
 Pulmonary functions test (PFT)
PFT is non-invasive diagnostic test.
In this test the volume and capacity
test aid diagnosis in patients with
suspected pulmonary dysfunction.

22. PFT
 PFT evaluates ventilatory
functions
 Determine whether obstructive
or irritative disease
 Can be utilize as screening test

23. ABGs (Arterial blood gas analysis)
 ABGs analysis is a diagnosis
procedure it involves measurement of
blood pH and arterial oxygen and
carbon dioxide tensions are obtained
when managing patients with
respiratory problems and adjusting
oxygen as needed.

24. ABGs normal valves
 Pao2 – 80 to 100 mm hg
 Paco2- 35 to 45 mm hg
 pH - 7.35 to 7.45
 O2 saturation - 95 to 99 %

25. Suptum analysis
 The suptum test analysis
involves a sample of sputum to
diagnose respiratory disease,
identify organsim and identify
abnormal cells and also identify
pathogenic organisms.

26. Pulse oximetry
 Pulse oximetry is a non-invasive
method of continously monitoring
the oxygen saturation of hemoglobin
(sao2)
 A sensor or probe is attached to the
ear lobe, forehead, fingertip or the
bridge of the nose.

27. Imaging studies
 Chest x-ray
 Computed tomography (CT)
 MRI
 Fluroscopic studies
 Bronchoscopy

28. Bronchoscopy
 Bronchoscopy is the using for
diagnostic and therapeutic
purpose. It’s involves a direct
inspection of the trachea and
bronchi through a flexible fiber
optic or a rigid Bronchoscopy

29.  Bronchoscopy using for to
determine location of pathologic
lesions, to remove foreign
objects, to collect tissues
specimen and remove secretions
or any aspirated materials.

30. Thoracentesis
 Pleural fluid aspiration for
obtaining a specimen of pleural
fluid for analysis, relief of lung
compression and biopsy specimen
collection.

31. Common Diagnostic Tests for Respiratory
Disorders
1. Laboratory Tests (Hemoglobin; Arterial blood
gases; Pulmonary Function Tests; “Sputum
Analysis& culture”).
2. Radiologic Studies (Chest X-ray; Ventilation-
perfusion scan; CAT scan; Pulmonary
angiography).
3. Other (Pulse oximetry; Bronchoscopy;
Thoracentesis; MRI).

32. Assessment
Auscultation
(Listening for Normal and Adventitious Breath Sounds)
Palpation and Percussion
Inspection
(client's color, level of consciousness, emotional state)
(Rate, depth, quality, rhythm, effort relating to respiration)
Health History
(allergies, occupation, lifestyle, health habits)

33. COMMON UPPER RESPIRATORY TRACT
INFECTIONS
 Rhinitis or common cold
 Allergic rhinitis
 Sinusitis
 Pharyngitis
 Tonsillitis
 Laryngitis

34.  Are the common conditions that affect
most people on occasion, some infections
are acute and other are chronic.

35. Viral rhinitis or common cold
 Often is used when referring to a symptoms of
an upper respiratory tract infection by nasal
congestion ,sore throat , & cough
 Cold referred to a febrile, infectious, acute
inflammation, of the mucus membranes of the
nasal cavity.

36. Rhinitis
 Rhinitis is a group of disorders
characterized by inflammation and
irritation of the mucous membranes of the
nose.
 It may be acute or chronic ,non-allergic or
allergic.

37. Causes of rhinitis
 Idiopathic
 Abuse of nasal decongestants
 Irritants e.g. smoke, air pollution etc.
 Forgin bodies

38.  Clinical manifestations
1. Rhinorrhea “ excessive nasal
drainage”
2. Nasal congestion, Itching ,& sneezing
3. Headache may occur

39.  Medical Management of rhinitis
1. Treatment of cause “antibiotics”
2. Decongestant agents
3. Antihistamine
4. In severe cases corticosteroids
5. Teaching patient self care

40. Acute Sinusitis
 It is inflammation of sinuses , it is resolved
promptly if their opening into nasal cavity .
 Clinical Manifestations
1. Pressure , pain over the sinus area
2. Tenderness
3. Purulent nasal secretions

41. Acute Sinusitis
 Medical Management
1. Antimicrobial agent “Amoxicillin”
2. Oral & Topical Decongestant
3. Heated mist or Saline irrigation
 Nursing management
“Teaching patient self care”

42.  Complications
1. Meningitis & osteomylitis
2. Brain abscess
3. Ischemic infarction

43. Chronic Sinusitis
 It is an inflammation of sinuses that persists for more
than 8 weeks in adult & or 2 weeks in children
 Clinical Manifestations
1. Impaired mucociliary clearness & ventilation
2. Chronic hoarseness & cough
3. Chronic Headache
4. Facial pain

44. Acute Pharyngitis
 Acute pharyngitis is sudden inflammation
of the pharynx.
 It is a febrile inflammation of throat ,caused by
virus about 70% , uncomplicated viral infection
usually subsided promptly within 3-10 days

45.  Clinical Manifestations
1. Fiery red pharyngeal membrane& tonsils
2. Lymphoid follicles that are swollen
3. Enlarge tender cervical lymph node
4. Fever & malaise
5. Sore throat , hoarseness,& cough

46. Acute Pharyngitis
 Medical Management
1. Supportive measures for viral infection
2. Pharmacologic therapy antibiotics for 10 days “cephalosporin
"analgesic for severe sore anti tussive medications
3. Nutritional therapy liquid or soft diet "If liquid can’t tolerated IV
fluid administered “
4. Nursing Management (bed rest ,skin assessment, mouth care
&normal saline gargle & self care teaching .

47. Chronic pharyngitis
 Chronic pharyngitis is a persistent
inflammation of the pharynx.
 Common in adults who work or live in
dusty surrounding ,use the voice too
excess , suffer from chronic cough , &
habitually use alcohol & tobacco.

48. Chronic Pharyngitis
 Clinical Manifestations
1. Constant sense of irritation or fullness in throat
2. Mucus expelled by coughing
3. Difficulty in swallowing
 Medical Management
1. Relieving symptoms
Avoiding exposure to irritant
Correct respiratory & cardiac conditions

49. Chronic pharyngitis
2. Antihistamine drugs
3. Decongestant
4. Controlling malaise
 Nursing Management
1. Patient teaching of self care
2. Avoid alcohol , tobacco , exposure to cold
3. Face mask to avoid pollutant
4. Warm fluids,& warm saline gargle

50. Tonsillitis
 The tonsils are composed of lymphatic tissue & situated
on each side of the oropharynx ,they frequently are the
site of acute infection (tonsillitis)
 Clinical Manifestations
 Tonsils : sore throat, fever , snoring & difficulty of
swallowing
 Adenoids : ear ache , mouth breathing , drainage ear
,frequent cold , bronchitis, noisy respiration, foul
smelling breath &voice impairment

51. Tonsillitis
 Medical Management
1. For recurrent tonsillitis “tonsillectomy”
2. Conservative or symptomatic therapy
3. Antimicrobial therapy “penicillin” for 7 days

52.  Nursing Management
1. Provide post op. care :V/S ,hemorrhage , position
head turned to side, water or ice chips
2. Teaching patient :S&S of hemorrhage
3. Avoid too much talking or coughing
4. Liquid or semi liquid diet for several days
5. Alkaline mouth washing with warm saline

53. Laryngitis
 It is an inflammation of larynx ,often occur as a result
of voice abuse or exposure to dust , chemicals ,
smoke , & other pollutants
 Common in winter & easily transmitted
 The cause of infection is almost virus
 Clinical Manifestations
1. Hoarseness or aphonia
2. Severe cough

54. Laryngitis
 Medical Management
1. Resting voice & avoid smoking
2. Inhale cool steam or an aerosol
3. Conservative treatment
4. Antibiotics for bacterial organisms

55.  Nursing Management
1. Rest voice
2. Maintain a well humidified environment
3. Daily fluid intake