1. Respiratory System Disorders

2. Objectives of the lecture
At the end of the lecture the students will be able to :
Realize the anatomical structure of respiratory system
Describe the main function of the respiratory system
List the general symptomatology of the respiratory system
Discuss the pathophysiology of the asthma
List the predisposing factors of pneumonia
Anticipate the clinical manifestations of asthma
Formulate the nursing care plan of asthmatic patients

3. Anatomical Structure of Respiratory System

4. Functions of Respiratory System
The major functions of the pulmonary system (lungs and pulmonary circulation ) is to deliver oxygen to cells and remove carbon dioxide from the cells
( gas exchanges )

5. General Symptomatology of Respiratory System Disorders
Dyspnea : is a subjective sensation associated with difficult breathing in any position .
Hemoptysis : is the bleeding from lung main symptom is coughing up blood .
Hypoxemia : Pao2 less than 80: 100 mmhg on room air , it means decrease the level of oxygen level in the blood .
Hypoxia : insufficient oxygenation at the cellular level

6. General Symptomatology of Respiratory System Disorders
Orthopnea : shortness of breath when in reclining position (lying position)
Paroxysmal nocturnal dyspnea : shortness of breathing with sudden onset occurs after going to sleep (at night ).
Chest pain : chest pain related to pulmonary causes usually felt at the site where as pathology arise

7. General Symptomatology of Respiratory System Disorders
Cough : dry irritative cough may indicate viral infection , cough at night related to left side heart failure , morning cough with sputum (reproductive cough )indicate bronchitis .Consider bacterial pneumonia if sputum is rusty

8. Physical Examination of Respiratory system
Perform a physical examination of the chest using inspection , palpation , percussion and auscultation .
Diagnostic tests :
Lab studies :as arterial blood gases (Pao2, Paco2 ,PH )
Sputum examination
Plural fluid analysis
Chest X-ray

9. Bronchial Asthma
Asthma is a chronic inflammatory disease of airways causing hypersensitivity , mucosal edema and mucus production
Patients with asthma may experience symptoms free periods alternating with acute exacerbations that lasts from minutes to hours or days .
Asthma , the most common chronic disease of childhood can occur at any age .

11. Risk Factors of Asthma Family history
Allergy to food , drugs ….(strongest factor )
Chronic exposure to airways irritants or allergens (grass, tree, weed pollens, dust animal dander )
Common triggers for asthma symptoms and exacerbation include :
Airway irritants (as: pollution , cold ,heat , weather changes strong odor , smoke )
Foods (shell , fish , nuts )
Exercise , stress, hormonal factors , medication , viral infection

12. Pathophesiology of Asthma
Asthma is a reversible diffuse airway inflammation that leads to long-term airway narrowing exacerbated by a variety of changes in the airway including:
Bronchoconstriction
Airway edema
Hyperresponsiveness
Airway remolding(thichened)

14. Clinical Manifestations (S&S)of Asthma
Most common symptoms of asthma are cough (dry or productive ), dyspnea , wheezing (first on expiration , then during inspiration as well )
Asthma attach frequently happened at night or early morning
Usually preceded by increasing symptoms over days but may being abruptly
Chest tightness and dyspnea occur
As exacerbation progress , diaphoresis, tachycardia,and widened pulse pressure and central cyanosis may occur

15. Assessment and Diagnostic Findings
Family history , environmental and occupational related factors are essential
Comorbid condition include gastro esophageal reflux, drug –induced asthma and allergic
Eczema , rashes , and temporary edema are allergic reaction that may accompany asthma
During acute episodes ,sputum and blood test including pulse oximetry , arterial blood gases should be tested .

16. Prevention of Asthma
Evaluation of workplace
Immediate treatment is aimed at removing or decreasing the exposure in the patient’s environment and follow up
Standard asthma medications may be prescribed to minimize bronchospasm and airway inflammation .

17. Complications of Asthma
Complications of asthma include :
Status asthmatics
Respiratory failure
Pneumonia
Atelectasis
Dehydration from diaphoresis

18. Medical Management of Asthma
Pharmacological Therapy :
there are 2 types of asthma medication :
Quick relief medications , short –acting beta 2 –adrenergic agonist as Ventoline used to relax smooth muscle
Long acting control medication : currently corticosteroids are the most potent anti-inflammatory medications effective in alleviating symptoms , improve airway functions
Antibiotics may be appropriate in treatment of acute asthma exacerbations in patients with comorbid conditions (fever , purulent sputum, pneumonia )

19. Nursing Management of patient with Asthma
The immediate nursing care of asthmatic patients depend on the severity of symptoms
A calm approach is an important aspect of care for successful treatment both as an outpatient for mild symptoms and as a hospital patient for acute and severe symptoms .The nurse usually perform the following :

20. Nursing Management
Assess the patient’s respiratory status by monitoring severity of symptoms , breath sounds , pulse oximetry and vital signs .
Obtains a history of allergic reactions to medication before administering medication .
Identifies the medications the patient’s currently taking .
Administer the prescribed medication
Administer fluids if patient is dehydrated
Assess with intubation procedure if needed .