RESPIRATORY NOTES III

PNEUMONIA

-inflammation of alveolar lung spaces resulting into consolidation of the lung as exudates fill alveoli

CAUSES:

-infections

-aspiration of food

-inhalation of toxic or caustic substances

Common Infecting Organisms:

GRAM POSITIVE

-Strep pneumonia: community acquired pneumonia (cap)

-Staph. Aureus:DM, drug users, patient's on hemodialysis

GRAM NEGATIVE

-H. influenza: children

-P.aeroginosa:hospital acquired

-L.pneumophila:inhalation with airconditioning units

FUNGAL

-P. carinii:AIDS, transplanted, chemotherapy or corticosteroid therapy, malnourished infants

Tx: cotrimoxazole

-H. capsulatum:bird & bat manure

S/SX:

-cough with sputum -respiratory distress -rales/crackles

-fever & chills -cyanosis -pleuritic chest pain

-tachycardia -hemoptysis

Diagnosis:

- CXR-->hazy infiltrates on lower lung fields -CBC (increase WBC)

-Dullness on percussion -definitive: sputum c & s

Nursing Care:

a. facilitate adequate ventilation

b.facilitate removal of secretions

c. isolation precautions

-MRSA: contact precaution--private room

d. administer medications as ordered

e. deep breathing exercises

Chest Physiotherapy -used to mobilize secretions

Techniques:

a.postural drainage :uses gravity & various positions

b.percussion :clapping with cupped hands

c.vibration :flat hand firmly pressed over affected segment with use of isometric contraction

Nursing Care:

a. done before meals or 2-3 hours after meals to decrease the risk of aspiration

b. dilators given about 20-30 mins prior

c. remove all tight / constricting clothings

d. postural drainage position:3-5 mins

e. percussion: 2-3 minutes duration

f. perform vibration during exhalation

Chronic Obstructive Pulmonary Disease (COPD)

aka.Chronic Airflow Limitation (CAL)

-group of disorders that affect movement of air in & out of lungs

-USA:1/14 people age >45

-RISK FACTORS:

-smoking

-air pollution

-aging

EMPHYSEMA

-enlargement & destruction of alveolar walls

-main problem:ELASTICITY

-there is difficult expiration due to destructed walls/septa between alveoli-->OBSTRUCTION

-aka. PINK PUFFERS due to their normal arterial oxygen levels and marked dyspnea

Causes:

-smoking -infection -inhaled irritants

-heredity -allergic factors -aging

S/SX:

-dyspnea on exertion -cough & sputum -signs of respiratory distress

-fatigue -weight loss -PE: hyper resonant on percussion

Nursing Care:

a. administer medications as ordered

b.O2 at 1-3LPM ONLY

c. facilitate removal of secretions

d. teach about pursed-lip breathing

e. diet: increase protein, carbohydrates & vitamin C

f. immunize against pneumonia & influenza

g. avoid smoking, abrupt changes in temperature

h. exercise: walking

i. plan activities with adequate rest

COMPLICATIONS;

-acute respiratory failure

- pneumothorax due to bleb rupture

-cor pulmonale due to increase cardiac workload

CHRONIC BRONCHITIS

-inflammation of the bronchi with excessive production of mucus accompanied by persistent cough

-chronic inflammation results to:

-hypertrophy & hyperplasia of

mucus secreting glands

-decrease ciliary activity

-narrowing of small airways

Diagnostic Criteria:

-symptoms must continue for 3 months for 2 consecutive years

S/SX:

- productive cough with copious sputum - dyspnea on exertion

- rales/rhonch -cyanosis

BRONCHIAL ASTHMA

-chronic inflammatory disorder of the airways where many cells play a role

-REVERSIBLE obstructive disease of the lower respiratory tract with 3 main airway responses

Categories:

a. Extrinsic (Allergic) -due to dust, pollen, insects, smoke, medications , food

b.Intrinsic (Non-allergic) -due to pathophysiologic conditions within the respiratoy tract

-->BOTH:AIRWAY IS HYPERACTIVE!

S/SX:

Cardinal:

-waxing & waning with nocturnal occurrence

-dyspnea

-expiratory wheeze

-cough

-chest discomfort/tightness

-irritability

-diaphoresis

-cyanosis (late)

DIAGNOSIS:

Spirometry:

-decrease VC

-increase FRC

-increase TLC

-increase RV

Hallmark: Reversibility of increase 200 ml FEV1 with bronchodilator

COMPLICATION: - Status Asthmaticus

Nursing Care:

a.administer medications as ordered

-reliever medications

-controller medications

-antibiotics

b.position: High Fowlers

c. oxygen as needed

d. chest percussion & postural drainage when bronchodilation improves

-Discharge Planning:

-well ventilated room -damp dusting, avoid rugs,stuffed animals, natural fibers

-moderate exercise: swimming -deep breathing exercises

-early treatment for URTI -avoid extremes of temperature

-avoid powerful odors