2 Intro and Diagnostics Disorders of the Respiratory System

Assessment/Noticing, Recognizing Cues

• Family & Personal Data: Essential for understanding patient background

  • History of asthma

• Smoking: Influences respiratory health and history

  • Ex. weed, vape, cigars, cigs

  • Ask how long of use

• Drug Use: Potential impact on lung function and disease

• Allergies: Identify allergens that may affect respiratory condition (ex. pollen)

• Employment History: Occupational exposures that could result in respiratory disorders

  • Ex. coal miners + spouse = black lung disease (fatal)

• Travel/Area of Residence: Environmental factors contributing to respiratory issues

• Veterans: Special considerations for military-related respiratory conditions

  • Ex. veterans exposed to Agent Orange, burn pits

• Current Health Problems: Detailed patient health status

• Health History: Previous respiratory assessments critical for diagnosis

Bronchospasm

• Definition: Sudden constriction of bronchial muscles making breathing difficult

• Triggers: Family history of asthma, upper respiratory infections, exercise, and air pollution

• Symptoms:

  • Trouble breathing

  • Shortness of breath

  • Wheezing (most common)

• Medications: may help reduce swelling

  • Bronchodilators: Relax bronchial muscles

  • Inhaled steroids: Reduce inflammation

  • Anticholinergics: Open airways

Clinical Manifestations of Hypoxia (must know the difference)

• Early Signs:

  • Restlessness

  • Anxiety

    • Ex. sweating, can’t sit still, constantly call to the room

  • Tachycardia & tachypnea

  • Irritability

  • Abnormal breathing

    • use of accessory muscles

    • nasal flaring

    • adventitious lung sounds

  • Hypertension

  • Pallor

• Late Signs:

  • Bradycardia & bradypnea

  • Extreme restlessness

  • Severe dyspnea

  • Cyanosis

  • Change in level of consciousness (LOC)

  • Death

  • Lactic acidosis

  • Dysrhythmias

  • Hypotension

Assessment/Noticing: Recognizing Cues

• General Appearance: Observational clues about respiratory distress

• Skin, Mucous Membranes, Sputum: Indicators of oxygenation and hydration

  • Do they have a cough?

• Endurance: Evaluate ability to perform Activities of Daily Living (ADLs)

  • Do they get SOB while walking a short distance?

• Barrel Chest Recognition: Normal adult chest ratio is 1:2, while barrel chest approaches 1:1 due to enlarged anteroposterior diameter

  • Nasal flaring? Use of accessory muscles?

Diagnostic Tests (Interpreting, Analyze Cues)

• Blood Tests:

  • CBC (Complete Blood Count)

  • Arterial Blood Gas (ABGs): takes a sample of the arterial blood to analyze the gas exchange; it tells more than the O2 sats

    • Normal Values:

      • pH = 7.35-7.45

        • <7.35 = acidosis

        • >7.45 = alkalosis

        • Respiratory acidosis = an increase in carbon dioxide (CO2) levels in the blood, leading to a decrease in pH

      • PaCO2 = 35-45 mmHg

        • Partial pressure of carbon dioxide

        • >45 = retaining a lot of CO2

      • PaO2 = 80-100 mmHg

        • Partial pressure of oxygen

        • How well we are oxygenating

      • SaO2 = 95-100%

        • Oxygen saturation of the arterial blood

• Sputum Testing: culture & sensitivity to identify infections

  • Pnuemonia & TB need sputum cultures

  • Antibiotics started before getting a sputum culture

  • BLOOD CULTURES = GET CULTURE BEFORE ANTIBIOTIC

Noninvasive Diagnostic Imaging

• Chest X-ray: Initial imaging for respiratory conditions.

• Computed Tomography (CT): Detailed imaging for complex lung disorders.

• Ventilation/Perfusion (VQ) Scan: Assess blood flow and air flow in lungs.

• Pulmonary Function Test (PFTs)

  • Purpose: Helps determine lung efficiency

  • Monitor: Nose clip, spirometer

  • Pulse oximetry: Measure oxygen saturation

  • Capnometry & capnography: Assess CO2 levels

  • Exercise Testing: Evaluate lung function under stress

  • Skin Testing: Identify allergens

Bronchoscopy

• Insertion of a tube into the patient’s airways that allows for visualization of that airway and the collection of specimen

  • Can be diagnostic & therapeutic

    • Diagnostic = a procedure that helps identify the presence of disease or abnormalities within the respiratory system.

    • Therapeutic = treats conditions affecting the respiratory system

      • Ex. removing obstructions or delivering medication directly to the lungs, can remove foreign bodies (especially in kids)

• Equipment: Flexible bronchoscopic tube with connected lighting and suction.

• Nursing Care:

  • Pre-procedure: INVASIVE PRODECURE

    • NPO (4-8 hours)

    • IV access

    • Patient education

    • Informed consent

    • Meds, sedatives

    • Designated driver

      • When sedation is used in any procedure = you must have a designated driver

  • Post-procedure:

    • NPO until gag reflex returns

    • Frequent vitals

    • Safety

    • Auscultate lungs

    • Monitor for complications

      • Aspiration

      • Perforation

      • Bleeding

      • Bronchospasm

Thorencentesis

• It is the insertion of a needle into the pt’s posterior chest to remove fluid or air in the pleural space, which relieves pressure and improves breathing

• Advise the pt to sit upright and their arms should be supported on their bedside table or on pillows; pt must remain perfectly still

  • advise pt to not talk, move, or cough

• Pre-Procedure: Patient education, informed consent

  • Pt is awake and not sedated

  • Invasive procedure

• Post-Procedure:

  • Chest X-ray to check for pneumothorax or other complications

  • Monitor

    • Vital signs

    • Respiratory assessment

    • Puncture site

  • Monitor for complications

    • Pneumothorax = accumulation of air in the pleural space, which can lead to lung collapse and requires immediate medical intervention

    • Infection

    • Bleeding

    • Hypotension

    • Tension pneumothorax

      • air becomes trapped in that pleural cavity and exerts pressure on the lung

        • leading to respiratory distress and decreased venous return

        • which can rapidly result in cardiovascular collapse if not treated promptly

    • Subcutaneous emphysema = where air becomes trapped under the skin

  • Have pt take big deep breaths to help expand the lungs after the procedure

Sleep Apnea

• Breathing disruption that occurs during sleep that lasts at least 10 seconds and occurs 5 or more times per hour

  • Causes of Sleep Apnea:

    • Obstructive Sleep Apnea = upper airways become blocked by overly relaxed airway muscle of the tongue or soft palate

    • Central Sleep Apnea = brain doesn’t send proper signals to muscles that control breathing

• Risk Factors:

  • Excessive weight, obesity

  • Thick necks

  • Large tonsils

  • Neuromuscular/Endocrine Disorders

  • HTN

  • Smoking

  • Hx of asthma

• Signs & Symptoms:

  • Excessive daytime sleepiness

  • Inability to concentrate

  • Irritability

  • Headache in the morning

• Diagnostic Test: Sleep Study

• Treatment:

  • CPAP (Continuous Positive Airway Pressure):

    • ONLY for exhale

    • Provides a constant, single set pressure throughout sleep

    • Affordable, but less adaptive to breathing changes

    • Pressure relief during exhale

  • BiPAP (Bilevel Positive Airway Pressure):

    • Constant pressures for inhale & exhale

    • Suitable for more complex sleep & breathing disorders

      • More advanced, only used in hospital setting

    • Used prior to intubation

      • if it doesn’t work within 24 hours, you should intubate

    • Don’t use if the pt is restrained

    • Typically pt is in the ICU

  • Get adenoids out

  • Tonsillectomy

• Management:

  • Nonsurgical:

    • Change of sleep position

    • Weight loss

    • Positive-pressure ventilation (CPAP)

    • Oral appliance

  • Surgical:

    • Adenoidectomy

    • Uvulectomy

    • Tonsillectomy

    • Implanted stimulators