Respiratory Disorders

• Review Table 26-10 page 526
• Describe exam findings associated with the following disorders:
• COPD
• Pneumonia=Percussion
• Dull over gunk/Frem Inc
• Atelectasis
• Pulmonary Edema
• Pleural Effusion
• Pneumothorax
• Pulmonary Fibrosis

Fremitus more vibration than air

Pneumoth/Absent breath sounds/Percuss=hyperressonant-trap air but no mvmt

Connect Patho

Evaluates function of airways, diffusion, lung compliance.

• Values calculated on percent of predicted by age-lose volume,
• height-taller more volume, gender

• Decreased Forced Expiratory Volume in 1 second (FEV-1)
• indicative of obstructive lung disease (Asthma or COPD)

• Decreased Vital Capacity indicates restrictive lung disease
• (Pulmonary fibrosis or neuromuscular disorders)

Obstr-dead space in lungs/trapping/narrowing/ability to blow out hard quick diminished

Restr-Low volumes

Etiology

¨Trauma

• ¨Nasal
• Sprays

• ¨Street
• Drugs

• ¨Coagulopathy-
• Ex. INR of 10

First Aid

• ¨Sit
• patient up

• ¨Direct
• pressure to soft tissue X 10-15 minutes

• ¨Apply
• ice

• ¨Assess
• V/S and bleeding risks

Medical Management

¨Cauterization

• ¨Vasoconstrictive
• agents

• ¨Packing
• to Tamponaud the bleed

• Assess
• airway and oxygenation

Nasal Mucosa react to allergens

• ¨IgE
• mediated

• ¨Mast
• Cells and basophils release histamine, prostaglandins and leukotrienes
• (mediators that cause symptoms

Identify Triggers

Medications

• ¨Nasal
• corticosteroids

• ¨1st generation antihistamines: Diphenhydramine
• (Benadryl®)

• ¨2nd
• generation non-sedating : Loratadine (Claritin®)

• ¨Leukotriene
• inhibitors: Montelukast
• (Singulair®)

Viral Respiratory Infection

• ¨36,000
• annual deaths

Vaccination

• ¨Annual
• reformulation

• ¨Target
• high risk groups

Anti-virals

• ¨Oseltamivir
• (Tamiflu®)

Complications

• ¨Bacterial
• pneumonia

• ¨Viral
• pneumonia

• Apnea results in hypoxemia
• Risk Factors

¨Obesity

• ¨Age
• > 65

Symptoms

¨Snoring

• ¨AM
• headache

¨Somnolence

¨Hypertension

Diagnosis

• ¨Polysomnography
• (Sleep Study)

Management

• ¨Weight
• loss

• ¨Avoid
• sedatives

• ¨CPAP(continuous)
• or BiPAP(responds to bleeding)

• HTN,CAD, higher r/o stroke bc of catecholamine
• surge/startling

• ¨Set
• gauge at 6-10 L

¨Uncomfortable

• Delivers
• 24-55%

• ¨Ensure
• valves are patent

¨If needs or more than 6L

• Allows
• CO2 to escape

Up to 100% O2

Intake Valves

Reservoir Bag

Short-term mechanical ventilation, not more than week

Long-term mechanical ventilation

Upper airway obstruction

• Equipment at bedside
• Ambu bag
• Suction
• Oxygen
• Obturator-Use to insert trach tube if de-cannulated
• Trach tube

Humidification-Collar on to deliver

Cuff

• Communication
• Passy-Muir-inserting into trach, cuff deflated before use

• Suctioning
• Limit attempts
• 10 seconds per attempt
• Pre-oxygenate
• Assessment (Pre and Post) lungs sounds/HR for tachycardias
• and arrhthy/PO2/ouputs

Capping

Sterile procedure for suctioning

¨Chronic lung disease

¨Immunocompromised

¨Immobility

¨Altered LOC-aspirate

¨Intubation-vent req. pneumo

¨Tube Feeding- if large aspirate than not digesting

Infection in lung tissue

Pneumo-Chlorhexodone mixes for prevention

• Typical Organisms
• Strep Pneumoniae
• Haemophilus Influenzae

• Atypical Organisms
• Mycoplasma-walking pnemonia
• Chlamydia-not STD
• Legionella-Ventilation sx. transmission

• ¨Second
• most common nosocomial infection

• ¨Ventilator-Associated
• Pneumonia

Prevention (Oral flora, HOB, closed circuit, subglottic suctioning)

• Infectious Disease
• ¨Signs and symptoms
• ¨Diagnosis
• ¨Patient complication risk
• ¨Resistance-Strep Pneumo/Amox. resistant
• ¨Core Measure
• Antibiotic administration within 4 hours
• Blood cultures for ICU admission

• Bronchophany, etc?
• Can hear her talking through lung sounds=Wispered Pect
• Sepsis bacteria in blood- Septic shock=hypotension/toxins vasodilating/dec. perfusion/Decr. LOC/ can be afebrile

Diagnosis by CXR

• S/S-Hemoptysis, fever spike late pm,Weight Loss, exposure?,
• homelessness?, jails?, healthcare workers

Sputum pos for AFB

N95 Respirator- fitted for

Treated minimum 6 mo. Up to 2 yrs./ drugs taken for 1 yr.

Home when no coughing up sputum

• 
• SIADH= Too much ADH. Na goes down=hyponatremic

Part of lung collapses bc air in pleural space, less expansion/tension

Spontaneus- Blebs tissue rupture, tall, thin white men

Absent breath sounds, hyperresonance, pain, etc

Drainage should slow down- mark drainage and character

Serial Xray Qday

Beta-SNS

• B2 in lungs
• Tachycardia, tremors with B2

• Tachycardia
• Angina
• Tremors
• Palpitations
• Anxiety
• Stimulation heart

Ashtma exacer= dec frem, hyperrres, breath sounds diminshed… pg. 526 chart, second slide

Ideal=Albuterol 1-2/week

CO2 retainer=driven by hypoxia to breath