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

2. Normal Breath Sounds

3. 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

4. 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

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

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

7. 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

8. 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

9. 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

10. 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

11. Bronchoscopy

12. 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

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

14. 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

15. Thoracentesis

16. 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

17. Pulse Oximetry

18. 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

19. Diagnostic Tests Normal Values pH 7.35-7.45 PaCO2 35-45 mm Hg
PaO mm Hg
HCO mEq/L
SaO %

20. 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

21. 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

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

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

24. 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

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

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

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

28. 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

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

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

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

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

33. Tracheostomy

34. Tracheotomy Tubes

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

36. Squamous Cell Carcinoma of the Larynx

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

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

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

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

41. 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

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

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

44. Acute Follicular Tonsillitis

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

46. 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

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

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

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

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

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

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

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

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

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