1. Chapter 86 Respiratory Disorders

2. The Respiratory System
Respiration requires a patent airway for oxygen to reach the lungs, and lungs that are physically capable of exchanging oxygen for carbon dioxide.
The respiratory system consists of the upper and lower respiratory tracts.
Pulmonologist
Respiratory therapy
Respiratory therapists
Respiratory technicians

3. Laboratory Tests Sputum specimen Lavage specimen Throat culture
Blood gas determinations
Level of arterial blood gases (ABGs)
Partial pressure of oxygen (PaO2)
Partial pressure of carbon dioxide (PaCO2)
Hydrogen ion concentration (pH) of the blood

4. X-ray and Fluoroscopy Examinations
Chest x-ray (CXR)
Computed tomography (CT) scan
Lung scan
Lung perfusion scan
Pulmonary angiography

5. Other Diagnostic Tests
Magnetic resonance imaging (MRI)
Pulmonary function test (PFT)
Bronchoscopy
Skin and blood tests
Skin tests
Purified protein derivative (PPD) tuberculin test
Blood tests

6. Question Is the following statement true or false?
The spirometer can be used interchangeably with the incentive spirometer.

7. Answer
False
The spirometer should not be confused with the incentive spirometer. The spirometer measures pulmonary function.
The incentive spirometer also measures pulmonary function, in a sense, but it is used by the client. The incentive spirometer helps the client, such as after surgery, to perform respiratory exercises to maintain lung function.

8. Common Medical Treatments
Postural drainage
Chest physiotherapy (CPT)
Inhalations

9. Common Surgical Treatments
Thoracentesis
Paracentesis
Thoracotomy
Caring for the client after chest surgery
Chest suction
Closed water-seal drainage
Nursing implications

10. Question Is the following statement true or false?
During paracentesis or thoracentesis, the nurse must take the client’s blood pressure and pulse immediately after the procedure and every 15 minutes until readings are stable.

11. Answer
True
A large amount of fluid withdrawn (>1,000 mL) during paracentesis or thoracentesis can result in vasodilation and hypovolemia (decreased circulating fluid volume). These situations can cause syncope (temporary loss of consciousness, fainting) and shock.
The nurse should take the client’s blood pressure and pulse immediately after paracentesis or thoracentesis and every 15 minutes until readings are stable and within acceptable levels.

12. Question Is the following statement true or false?
It is perfectly safe for a client with a respiratory system disorder to receive a narcotic.

13. Answer
False
If a person with any disorder of the respiratory system is receiving a narcotic, be particularly watchful for respiratory depression.
Depressed respirations can be an undesirable side effect in anyone, but the situation is most dangerous for the client whose respiratory function is already compromised.

14. Nursing Process Data collection
Noting alterations in respiratory status
Aspiration
Hyperventilation
Hypoxia
Hypoxemic hypoxia
Circulation hypoxia
Anemic hypoxia
Histotoxic hypoxia

15. Nursing Process (cont’d)
Planning and implementation
Relieving respiratory distress
Orthopneic position
Turning, coughing, and deep breathing
Administering respiratory treatments
Postural drainage
Breathing exercises and incentive spirometer
Breathing treatments, oxygen

16. Nursing Process (cont’d)
Administering nasal treatments
Suctioning to remove oral–nasal secretions
Dysrhythmia and desaturation
Evaluation

17. Possible Alterations in Respiratory Status
Dyspnea
Orthopnea
Tachypnea
Hyperpnea
Bradypnea
Hypoventilation
Hyperventilation
Cheyne-Stokes breathing
Biot’s respirations
Apnea
Central apnea
Obstructive apnea
Mixed apnea
Adult sleep apnea
Kussmaul’s respirations

18. Infectious Respiratory Disorders
The common cold or acute rhinitis
Streptococcal sore throat
Influenza
Laryngitis
Bronchitis
Lung abscess

19. Infectious Respiratory Disorders (cont’d)
Pneumonia
Bacterial pneumonia
Viral pneumonia
Pneumocystis carinii pneumonia
Chemical pneumonia
Aspiration pneumonia
Pleurisy
Histoplasmosis

20. Infectious Respiratory Disorders (cont’d)
Tuberculosis (TB)
Latent and active TB
Pulmonary TB
Pott’s disease and miliary TB
Atypical TB
Multidrug-Resistant TB
Empyema
Acute empyema
Chronic empyema

21. Question Is the following statement true or false?
The number of cases of TB has decreased dramatically during the last several decades because of the developments in science and medicine.

22. Answer
False
The number of cases of TB has increased dramatically during the last several decades because of the increase in multidrug-resistant TB organisms, increasing numbers of persons with HIV infection, substance abuse, homelessness, and poor compliance with medication treatment plans.

23. Chronic Respiratory Disorders
Snoring
Sleep apnea syndrome
Allergic rhinitis
Pneumoconioses
Chronic obstructive pulmonary disease
Bronchial asthma, bronchiectasis, chronic bronchitis, pulmonary emphysema
Acute respiratory distress syndrome

24. Question Is the following statement true or false?
The continuous positive airway pressure apparatus is commonly used to assist persons with allergic rhinitis.

25. Answer
False
The continuous positive airway pressure (CPAP) apparatus is commonly used to assist persons with sleep apnea.
This machine looks like an oxygen-delivery system and is used at night so the person can sleep. It delivers air, and sometimes oxygen, to the person at a continuous positive pressure that holds the alveoli open. This positive pressure prevents respiratory obstruction, increases oxygenation, and reduces breathing effort.

26. Trauma Absence of air exchange Chest trauma
Respiratory complications in drug poisoning
Drowning/near drowning
Pneumothorax

27. Neoplasms
Benign neoplasms
Lung cancer

28. Disorders of the Nose Inflammatory disorders Sinusitis Acute sinusitis
Chronic sinusitis
Structural disorders
Deviated septum
Nasal polyps
Plastic surgery (rhinoplasty)
Care of the client undergoing nasal surgery

29. Disorders of the Nose (cont’d)
Nasal trauma
Fractures
Epistaxis

30. Disorders of the Throat
Trauma
Aspiration of foreign bodies
Cancer of the larynx
Nursing considerations
Communication and speech
Identification as a laryngectomee
Supportive resources
Water dangers

31. End of Presentation