Nursing of Adults With Medical & Surgical Conditions Respiratory Disorders (Diagnostic Tests & Upper Airway Disorders)

Normal Breath Sounds

Adventitious Breath Sounds Crackles (Rales) Fine, Medium,Coarse Sound Sounds like hair being rolled between the fingers close to the ear Cause Fluid, mucous, or pus in the small bronchi, bronchioles, and alveoli

Adventitious Breath Sounds Rhonchi Sound Low-pitched, loud, coarse, snoring sounds Cause Narrowing of the tracheobronchial passages due to secretions, tumors, spasms May clear with coughing if due to secretions

Adventitious Breath Sounds Wheezes Sound High-pitched, musical, whistlelike sound during inspiration or expiration Cause Narrowed bronchioles due to tumor, bronchospasm, or foreign matter

Adventitious Breath Sounds Pleural Friction Rub Sound Dry, creaking, grating, low-pitched sound Cause Inflammation of pleural surfaces

Diagnostic Tests Chest X-ray Computed Tomography (CT) Provides visualization of the lungs, ribs, clavicles, humeri, scapulae, vertebrae, heart, and major thoracic vessels Nursing Interventions Hospital gown No metal such as pins, bra hooks, jewelry Computed Tomography (CT) Pictures of small layers of pulmonary tissue Diagonal or cross-sectional

Diagnostic Tests Pulmonary Function Testing (PFT) Lung Volume Assess the presence and severity of disease in the large and small airways Lung Volume Volume of air that can be completely and slowly exhaled after a maximum inhalation Ventilation Evaluate the volume of air inhaled or exhaled in each respiratory cycle Pulmonary Spirometry Evaluate the amount of air that can be forcefully exhaled after maximum inhalation Gas Exchange Determines the degree of function in the pulmonary capillary beds in contact with functioning alveoli

Diagnostic Tests Mediastinoscopy Laryngoscopy Indirect Direct Surgical endoscopic procedure Endoscope is passed into the upper mediatinum to gather lymph nodes for biopsy Laryngoscopy Indirect Use of a laryngeal mirror to view the larynx Direct Local or general anesthesia Laryngoscope passed over the tongue to view the larynx

Diagnostic Tests Bronchoscopy Nursing Interventions Performed by passing a bronchoscope into the trachea and bronchi Rigid or flexible bronchoscope Local anesthetic and IV general anesthetic Used to observe for abnormalities, tissue biopsy, and secretions collected for exam Nursing Interventions NPO for 6-8 hours NPO until gag reflex returns Semi-Fowler’s position and turned to side Assess for signs of laryngeal edema or laryngospasms Assess for signs of hemorrhage

Bronchoscopy

Diagnostic Tests Sputum Specimen Nursing Interventions Obtained for microscopic examination Nursing Interventions Must be brought up from the lungs Collect before meals Rinse mouth with water before collection Inhale and exhale deeply three times, cough forcefully, and expectorate into sterile cup Early morning samples are ideal

Diagnostic Tests Cytology Studies To detect the presence of abnormal or malignant cells in sputum, pleural fluid, etc.

Diagnostic Tests Thoracentesis Nursing Interventions The surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid Diagnostic or therapeutic Nursing Interventions Informed consent Pt sits on the edge of the bed; arms resting on a pillow on overbed table Monitor vital signs, general appearance, and respiratory status during and after procedure Place on unaffected side after procedure

Thoracentesis

Diagnostic Tests Pulse Oximetry Monitoring of SaO2 Measures the amount of light being absorbed by oxygenated and deoxygenated hemoglobin Clothespin type probe is applied to finger, toe, earlobe or nose

Pulse Oximetry

Diagnostic Tests Arterial Blood Gases PaO2 Amount of oxygen dissolved in the plasma (mmHg) SaO2 Amount of oxygen bound to the hemoglobin compared to the amount of oxygen the hemoglobin can carry (%) PaCO2 Partial pressure of CO2 in the blood HCO3 Bicarbonate

Diagnostic Tests Normal Values pH 7.35-7.45 PaCO2 35-45 mm Hg PaO2 80-100 mm Hg HCO 21-28 mEq/L SaO2 95-100%

Diagnostic Tests Respiratory vs Metabolic Acidosis vs alkalosis PaCO2 Elevated with acidosis; decreased in alkalosis Metabolic HCO3 Elevated with alkalosis; decreased in acidosis Acidosis vs alkalosis Acidosis pH of 7.35 and lower Alkalosis pH of 7.45 and higher

Epistaxis Etiology/Pathophysiology Bleeding from the nose Congestion of the nasal membranes, leading to capillary rupture Primary Seconday Hypertension Irritation of nasal mucosa Dryness, chronic infection, trauma

Epistaxis Signs & Symptoms Bright red bleeding from one or both nostrils Can lose as much as 1 liter per hour

Epistaxis Treatment Sitting postion, leaning forward Direct pressure by pinching nose Ice compresses to nose Nasal packing Cautery Balloon tamponade

Deviated Septum and Nasal Polyps Etiology/Pathophysiology Congenital abnormality Injury Nasal septum deviates from the midline and can cause a partial obstruction Nasal polyps are tissue growths usually due to prolonged inflammation

Deviated Septum and Nasal Polyps Signs & Symptoms Stertorous respirations (snoring) Dyspnea Postnasal drip

Deviated Septum and Nasal Polyps Treatment Medications Corticosteroids Antihistamines Antibiotics Analgesics Nasoseptoplasty Nasal polypectomy

Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Etiology/Pathophysiology Antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens

Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Signs & Symptoms Edema Photophobia Excessive tearing Blurring of vision Pruritus Excessive nasal secretions and/or congestion Sneezing Cough Headache

Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) Treatment Avoid allergen Antihistamines Decongestants Topical or nasal corticosteroids Vancenase, Beconase Analgesics Hot packs over facial sinuses

Upper Airway Obstruction Etiology/Pathophysiology Inflammation of tissue Dentures Aspiration Tongue Laryngeal spasm

Upper Airway Obstruction Signs & Symptoms Stertorous respirations Altered resp. rate and character Apneic periods Hypoxia Cyanosis Wheezing Stridor

Upper Airway Obstruction Treatment Open the airway Remove obstruction Artificial airway Pharyngeal, endotracheal, and tracheal Tracheostomy

Tracheostomy

Tracheotomy Tubes

Cancer of the Larynx Etiology/Pathophysiology Squamous cell carcinoma Heavy smoking and alcohol use Chronic laryngitis Vocal abuse Family history

Squamous Cell Carcinoma of the Larynx

Cancer of the Larynx Signs & Symptoms Progressive or persistent hoarseness Pain radiating to the ear Difficulty swallowing Hemoptysis

Cancer of the Larynx Treatment Radiation Surgery Partial laryngectomy temporary tracheostomy Total laryngectomy Permanent tracheostomy No voice Radical neck dissection

Acute Rhinitis(Common Cold, Acute Coryza) Etiology/Pathophysiology Inflammation of the mucous membranes of the nose and accessory sinuses Virus(es)

Acute Rhinitis(Common Cold, Acute Coryza) Signs & Symptoms Thin, serous nasal exudate Productive cough Sore throat Fever

Acute Rhinitis(Common Cold, Acute Coryza) Treatment No specific treatment Analgesic NO Aspirin for infants, children and adolescents (Reye’s Syndrome) Antipyretic Cough suppressent Expectorant Antibiotic, if infection present Encourage fluids

Acute Follicular Tonsillitis Etiology/Pathophysiology Inflammation of the tonsils Bacterial infection (streptococcus) Viral

Acute Follicular Tonsillitis Signs & Symptoms Enlarged, tender, cervical lymph nodes Sore throat Fever Chills Enlarged, purulent tonsils Elevated WBC

Acute Follicular Tonsillitis

Acute Follicular Tonsillitis Treatment Antibiotics Analgesics Antipyretics Warm saline gargles Tonsillectomy and adenoidectomy 4-6 weeks after infection has subsided

Acute Follicular Tonsillitis Post-op Assess for excessive bleeding Frequent swallowing Ice cold liquids – ice cream Avoid acidic juices Ice collar Avoid coughing, sneezing, or vigorous nose blowing

Laryngitis Etiology/Pathophysiology Inflammation of the larynx Acute or chronic Viral or bacterial May cause severe respiratory distress in children under 5 yrs

Laryngitis Signs & Symptoms Hoarseness Voice loss Scratchy and irritated throat Persistent cough

Laryngitis Treatment Viral; no specific treatment Bacterial; antibiotics Analgesics Antipyretics Antitussives Warm or cool mist vaporizer Limit use of voice

Pharyngitis Etiology/Pathophysiology Inflammation of the pharynx Chronic or acute Frequently accompanies the common cold Viral, most common Bacterial Gonococcal Streptococcus (strep throat)

Pharyngitis Signs & Symptoms Dry cough Tender tonsils Enlarged cervical lymph glands Red, sore throat Fever

Pharyngitis Treatment Antibiotics Analgesics Antipyretics Penicillin, erythromycin Analgesics Antipyretics Warm or cool vaporizor

Sinusitis Etiology/Pathophysiology Inflammation of the sinuses Usually begins with an upper respiratory infection Chronic or acute Viral or bacterial

Sinusitis Signs & Symptoms Constant, severe headache Pain and tenderness in involved sinus region Purulent exudate Malaise Fever

Sinusitis Treatment Antibiotics Analgesics Antihistamines Vasoconstrictor nasal spray (Afrin) Warm mist vaporizor Warm, moist packs Nasal windows