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Respritory Disorders: Viral infections
-smallest of all microorganisms
-the scope of infections run from the common cold to AIDS
-antibiotics have no effect on viral infections
-antiviral medications are available for some viral infections
Common cold
-most contagious 1-4 days before symptoms and through first 3 days
-transmission occurs most frequently from contact with contaminated surfaces
-Rhinorrhea, nasal congestion, cough, increas mucosal secretions
Cold Medications
-most are sympathomimetic
-may contain pseudoephiedrine, analgesic, antihistamine
-generally safe for children older then 6 years old
-call dr. before taking if:
a) heart disease
b) HTN
c) thyroid disease
Cold medications (side effects)
Side effects of sympathomimetic:
-increased blood pressure
Side effects of antihistamine:
2nd generation antihistamines
-"non-sedating antihistamines"
-zyrtec, claritin
-little or no effect on sedation
Cough medication
-act on medulla to suppress cough
-increased effect with other CNS depressants (like alcohol)
-loosen bronchial secretions
-found in combination with antitussives analgesics
-can cause nasea/vomiting
Nasal & Systemic decongestants
-produce vascular constriction within the nasal mucosa -> decrease in fluid secretion
-nasal sprays, drops (afrin): "rebound" nasal congestion
-tablet, capsule & liquid (allergic rhinitis)
-may cause the client to be "jittery" or restless
-avoid caffeine
-check with physician if on beta-blocker med
Valley Fever
-fungal (mold/spore)
-grows in soil of the southwest
-often asymptomatic or...
-symptoms similar to influenza
-usually resolves without treatment
-worst case-pleuritic pai, arthritis of knees, ankles, systemic infection of skin, and menin ges of the brain (<1%)
Lower respiratory tract disorders
Etiology & pathology
-inflammation of lung tissue
-usually caused by an infectious agent (bacterial, viral, fungal, parasitic)
-Can also be caused by inhalation of chemicals & aspiration of gastric contects
S&S of Pneumonia
-chest pain that increases on inspiration
-fever, chills, increased WBC's
-cough, purulent sputum, crackles, bronchial sounds
Diagnostics of Pneumonia
-Positive CXR (Chest xray)
-positive sputum culture
Collaborative care pneumonia
-drug therapy, antibiotics based on C&S
-oxygen therapy (due to decreased gas exchange)
Nursing Care pneumonia
-VS; breathing patterns
-color, amount, consistency of sputum
-adventatious lung sounds
-mental status changes
Nursing care pneumonia
-ineffective airway clearance R/T copious tracheobronchial secretions
-activity intolerance R/T oxygenation/perfusion mismatch
-risk for deficent fluid volume R/T fever & dyspnea
Nursing care pneumonia
Planning and Implementation
-encourage coughing & deep breathing after CPT; splint chest as needed
-collect sputum for C&S
-increase fluid intake to 3L/day
-maintain semi-fowler's position
-monitor for S/S respiratory distress
-plan rest periods
-instruct pt to cover nose & mouth when coughing
-administer abx, as ordered
-teach preventative measures: nutrition/fluids, avoid respiratroy irritants, vaccinations
Lower respriratory tract disorders
Pulmonary Tuberculosis
Etiology & pathophysiology
lung infection caused by Mycobacterium tuberculosis
-acid-fast bacillus
-spread via airborne droplets
Predisposing factors include debilitating diseases like alcoholism, diabetes, HIV infection.
Causes fibrosis and calcification of lungs.
Resistant strains.
Pulmonary Tuberculosis
-malaise, pleuritic pain, fatigue
-fever, night sweats, wt loss
-cough, becoming more persistent, productive or non-productive
-sputum - green, purulent, yellowish mucoid, or blood tinged
Pulmonary Tuberculosis
-skin test (PPD)
-CXR (chest xray)
-sputum for AFB
Pulmonary Tuberculosis
Collaborative Care
Drug therapy
-long term, 6-9 monthes (1st phase 2 months, 2nd phase 4-7 months)
-combination therapy required
a) Isoniazid & rifampin or
b)Isoniazid, rifampin, & ethambutol
c)Isoniazid, rifampin & pyrazinamide
Must comply with the drug regime!
Avoid antacids, ETOH, sunlight
-airborne precautions
-well-ventilated room
-HEPA mask for staff
Prophylactic therapy for immediate contacts (6months-1year)
Nutrition: high-protein, high-vitamin, supplemental B-6 to counter INH side of effects
Antitubercular drugs
5 first line medications
INH: isoniazid (also used for prophylaxisw/exposure(take on empty stomach))
-peripheralneuropathy & hepatotoxicity, visual problems
-food decreased absorbtion rate
-may need B6 supplements
-turns body fluids orange colored
Pirazinamide (PZH)
-visual problems
Pulmonary Tuberculosis
Nursing Care
-Fatigue, anorexia, fever, night sweats
-color, amt/consistency of sputum
-adventitious lung sounds
Pulmonary Tuberculosis
Nursing Care
-Activity intolerance R/T impaired oxygenation
-noncompliace R/T long-term nature of therapy, medication side effects
Pulmonary Tuberculosis
Nursing Care
-provide for rest periods
-encourage coughing/deep breathing
-dietary teaching
-teaching importance of adhering to medication schedule & importance of follow-up
-teach prevention of infection
-teach S/S of hemorrhage (hemoptysis)
Chronic Obstructive Pulmonary Disease
Chronic Bronchitis
Etiology & Pathophysiology
-inflammation of the lower respiratory tract characterized by excessive mucous production and cough
-acute (usually viral or bacterial infection)
-chronic (without infection)
Chronic Obstructive Pulmonary Disease
Etiology & Pathophysiology
-obstruction caused by hyperinflation of alveoli (air trapping), loss of lung tissue elasticity, & narrowing of small airways
-pursed lip breathing especially helpful here
Chronic Obstructive Pulmonary Disease (COPD)
-fatigue & weakness, dyspnea, headache, impaired sensorium
-orthopnea, expiratory wheezing, cough
- barrel chest, cyanosis, clubbing of fingers, use of accessory muscles; pursed lip breathing
-ABGs: Increase PCO2 & decreased PO2
Chronic Obstructive Pulmonary Disease (COPD)
Pulmonary function tests
-RBCs (polycythemia)
Chronic Obstructive Pulmonary Disease (COPD)
Collaborative care
Pt's w/COPD become accustomed to a residual carbon dioxide level & do not respond to high CO2 concentrations as the normal respiratory stimulant; they respond, insteadm to a drop in oxygen concentration in the blood, therefore:
-watch O2 administration!
Hypoxemia becomes drive to breath; too much O2 will knock out this drive
-typically 1-2L/min
Drug Therapy
-mucolytics & expectorants
Oxygen therapy
Resporatory therapy (SVN's(small volume nebulizer), CPT)
Hi protein, soft diet, sml fequent amts
Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care:
-Hx of increase during early morning, in cold weather, when sleeping & smoking
-breathing patterns: abdominal, pursed lip, asynchronous, accessory muscles, adventitious breath sounds
-frequency of respiratory infections
-evidence of acute/chronic hypoxia
Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care:
-inffective airway clearance R/T bronchospasm and secretions
-activity intolerance R/T oxygenation/perfusion mismatch
-powerlessness R/T loss of self care capability
-anxiety R/T oxygen deprivation
Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care:
-advise smoking cessation/other external irritants
-resporatory excercises (pursed lip breathing)
-reach use of inhalers/spacers
-pace activities, avoid overexertion
-adequate rest, nutrition, fluids
-encourage close medical supervision
-maintain resistance, adequate nutrition/fluids, vacinations
-avoid exposure to infection
-avoid use of sedatives/hypnotics
-early S/S infection
Used in patients with COPD
Metered dose inhaler
-provides a fine mist to the lungs
-coordinating a quick puff from the inhaler and taking a deep breath can pose a problem for some clients
-spacer/holding chamber allows for the correct distance from the mouth and the taking in of a deep breath to get the medication in the clients lungs
-if the spacer is missing, a temporary one can be made by rolling a 6" to 8" piece of paper
MDI (metered dose inhaler) w/ spacer
1)Verify physican order
2)remove the plastic cap on the MDI and the cap on the spacer
3)insert the MDI into the back of the spacer
4)hold the two together and shake
5)monitor pulse and breath sounds before and after the therapy
6)instruct the patient to take a maximal inspiration and exhale completely, then place MDI and spacer near the patient's mouth and have the patient inspire slowly while activating the MDI.
-note: a maximum, slow deep breath held for 5-10 seconds (if possible) is important to proper usage of the MDI and to improve drug deposition
1) repeat steps 4 and 6 for each puff, waiting at least 1-2 minutes between puffs
Powder inhalents (Advair diskus)
management of asthma
client should rinse mouth after administering the medication
SVN (Small Volume Nebulizer)
Usually administered by R.T. but nurses need to know how to operate the SVN machines and related equipment
Lifespan variouations
-respiratory illnesses among the most frequent causes of illness and hospitalization
-lumens of child's respiratory tract are smaller and more likely to become obstructed with disease
-Less air exchange and more air and secretions remain in lungs
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