Respiratory

GALEN College of Nursing - Respiratory Study Notes

General Overview

  • Course: Pure Nursing NUR 170/171

Infection Review

  • Most common signs and symptoms (s/s) of an infection:
      - Fever: Controlled with antipyretics.

Inflammation Review

  • Common s/s of inflammation:
      - Treated with NSAIDs or Steroids.

Overall Respiratory Assessment

  • Key assessment components include:
      - Respiratory Rate: observation of rate to assess respiratory health.
      - Dyspnea: difficulty in breathing.
      - Tachypnea: an increased respiratory rate.   - Lung Sounds: auscultation for abnormal sounds.
      - Client Color: checking skin color (cyanosis may indicate low oxygen).
      - Cough: noting characteristics (dry, productive).
      - Sputum: observation of sputum color and consistency.
      - Level of Consciousness: vital as changes can indicate hypoxia.
      - Skin: noting any abnormalities or signs of distress.

Other Factors Influencing Respiratory Health

  • Important factors include:
      - Aging: effects on lung function and respiratory efficiency.
      - Smoking: leads to reduced lung capacity and increased disease risk.
      - Allergies: can exacerbate respiratory issues.
      - Vaccinations: importance of flu and pneumonia shots.   - Hobbies: exposure to dust, chemicals, etc., can affect lung health.
      - Occupational exposure: professions may expose individuals to harmful pollutants.   - Travel: potential exposure to diseases.

Respiratory Diagnostics

  • Common diagnostic tools include:
      - CBC: Complete Blood Count to check for infection and inflammation.
      - ABG: Arterial Blood Gas to assess oxygenation and acid-base balance.
      - Sputum Culture: to identify pathogens.
      - Chest X-ray: visual assessment of lung structures.
      - Pulse Oximetry: measuring oxygen saturation.
      - Pulmonary Function Tests: to evaluate lung function.
      - Bronchoscopy: direct visualization of airways.
      - Thoracentesis: procedure to remove fluid from the pleural space.

Nursing Communication with Respiratory Clients

  • Effective strategies include:
      - Clear Communication: maintaining a calm tone to ease client anxiety.
      - Avoid False Hope: not making unrealistic statements to clients.
      - Provide Reassurance: affirming the commitment of the care team.
        - Example Statements:
          - “Your care team is committed to helping you.”
          - “I can only imagine how scared you might feel, I am here to help.”
      - Interactive Communication: involving significant others, with consent.

Rhinosinusitis

Definition

  • Combination of the prefix Rhin- (nose), Sinus- (sinus), and -itis (inflammation).

Pathophysiology

  • Inflammation leading to fluid buildup and pressure potentially causing infection, indicated by:
      - Pain: over cheeks radiating to teeth.
      - Tenderness: on percussion of sinuses.   - Referred pain: to temples or back of head.   - General facial pain: exacerbated when bending forward.

Medical Management

  • Evidence-based practices include:
      - Antihistamines
      - Decongestants
      - Intranasal Steroid sprays
      - Analgesics
      - Antibiotics

Patient Teaching

  • Key points for preventing infection:
      - Avoid allergens
      - Maintain proper health protocols.

Monitoring Inflammation and Infection

  • Important s/s to monitor:
      - Use of humidifiers.
      - Applying warm compresses.   - Advising to stop smoking.   - For prescribed antibiotics: educate on proper medication adherence.   - Teach nursing interventions.

Obstructive Sleep Apnea (OSA)

Definition

  • Characterized by pauses in breathing for 10 seconds or more.

Pathophysiology

  • Common Cause: Soft tissue in the upper airway collapses, blocking airflow. Dysfunction in the CNS also disrupts ventilation leading to poor oxygenation and circulation.

Types of Sleep Apnea

  • Obstructive: Airflow blocked by pharyngeal tissues, most prevalent.

  • Central: Cessation of airflow and respiratory movements simultaneously.

  • Mixed: Combination of central and obstructive events.

Clinical Manifestations

  • Notable signs and symptoms of OSA include:
      - Snoring: frequent and loud.
      - Breathing Cessation: 5 or more episodes per hour.
      - Linked Health Issues: Atrial fibrillation, cognitive decline, personality changes, etc.

Risk Factors

  • Includes but not limited to:
      - Familial predispositions, Obesity, Short neck circumference, Adenoid size, and Gender differences (men higher risk than women).

Complications

  • Potential complications include:
      - Cardiac problems: hypertension, arrhythmias.
      - Pulmonary: hypoxia.

Diagnostic and Planning Tools for OSA

  • Utilized diagnostic tools include:
      - STOP BANG Questionnaire, the Epworth Sleepiness Scale.
      - Sleep Studies: such as polysomnography.

Interventions for OSA

  • Lifestyle Modifications:   - Weight reduction, cessation of sedatives (including alcohol), and smoking.   - Sleep positioning: side sleeping and elevating HOB.

  • Medical Equipment:
      - CPAP: Continuous Positive Airway Pressure device.   - Oral Devices: to maintain airway openness.

Surgical Interventions

  • Include:
      - Tonsillectomy, adenoid removal, and reconstruction.

Patient Education

  • Teach patients about treatment adherence and maintenance of equipment, specifically CPAP.

Asthma

Definition

  • Characterized by chronic inflammation and hyper-responsiveness of airways leading to bronchoconstriction.

Pathophysiology

  • Key pathophysiological changes:
      - Reversible airway obstruction.
      - Increased mucus production and chemical mediator production.

Risk Factors and Causes

  • Includes factors such as:
      - GERD, allergen exposure, certain medications (aspirin, antibiotics), irritants, and family history.

Clinical Manifestations

  • Symptoms observed may include:
      - Chest tightness, dyspnea, wheezing, coughing, and decreased breath sounds.

  • Advanced symptoms: diaphoresis, tachycardia, hypoxemia, central cyanosis.

Assessment

  • History taking: family, environmental, and occupational histories are critical.

Nursing Diagnoses

  • Common diagnoses include risks for ineffective airway clearance, impaired gas exchange, and knowledge deficiencies regarding asthma management.

Medical Management

  • Includes use of beta-agonists:
      - SABA: short-acting (e.g., Albuterol)
      - LABA: long-acting (e.g., Formoterol, Salmeterol)
      - Corticosteroids: to reduce inflammation.

Patient Education

  • Instruction on the use of inhalers and methods to avoid triggers.

  • Importance of maintaining a peak flow meter and adherence to medication.

Chronic Obstructive Pulmonary Disease (COPD)

Definition

  • Includes diseases such as emphysema and chronic bronchitis, characterized by irreversible airflow obstruction.

Pathophysiology

  • Focuses on inflammation and destruction of lung tissue leading to increased retention of air.

Clinical Manifestations

  • May present with:
      - Dyspnea, use of accessory muscles, barrel chest appearance, and hypoxia.

  • Cognitive signs: fatigue and weight changes.

Diagnostics for COPD

  • Key assessments include PFTs, CBC, ABGs showing respiratory acidosis, and infection risk via culture studies.

Management

  • Combined therapies: bronchodilators, corticosteroids, oxygen therapy as prescribed.

  • Surgical options considered in advanced cases: lung transplant, or lung volume reduction surgery.

Influenza

Definition

  • Acute viral respiratory illness resulting from multiple strains of the influenza virus (A, B, C).

Pathophysiology

  • Transmission through droplets with symptoms including fever, body aches, eventually progressing to cough and sore throat.

Medical Management

  • Antivirals proposed for symptomatic relief: oseltamivir, zanamivir.

Prevention

  • Importance of annual vaccinations and education on hygiene practices to prevent transmission.

Tuberculosis (TB)

Definition

  • Infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs.

Transmission and Pathophysiology

  • Airborne transmission; lung infiltration can lead to systemic infection if untreated.

Common Symptoms

  - Night sweats, bloody cough, weight loss, fever, fatigue, and chest pain asymptomatic presentations.

Diagnostic Testing

  • Tests utilized include Mantoux test, sputum mycobacterial culture, and chest X-ray.

Treatment and Management

  • Prolonged antituberculotic therapy, typically requiring 6–12 months with medications such as Isoniazid and Rifampin.

Nursing Interventions and Patient Education

  • Importance of monitoring for exacerbations, compliance with medications, and preventative measures against airborne transmission.