Care of The Clients With Respiratory Disorders: Sam Joseph C. Cirilo, MD

Sam Joseph C.
Cirilo, MD
CARE OF THE CLIENTS

WITH RESPIRATORY
DISORDERS
Common Respiratory Diagnostic Studies and
Therapies
 Mantoux Test
 PPD
 Intradermal
 Read 72 hours after the injection
 (+) Mantoux Test is induration of 10 mm or more
 5 mm is considered + for HIV patients
 Signifies exposure to Mycobacterium tubercle
bacilli
Common Respiratory Diagnostic Studies and
Therapies
 Fluoroscopy
 Bronchography
 Bronchoscopy
 Lung scan
 Sputum examination
 Biopsy
 Pulmonary function studies
 Vital Capacity
 Tidal Volume
 Inspiratory Reserve Volume
 Expiratory Reserve Volume
 Functional Residual Capacity
 Residual Volume
 ABG
 Thoracentesis
Common Respiratory Interventions
 Oxygen therapy
 Bronchial hygiene measures
 Suctioning]
 Steam Inhalation
 Aerosol Inhalation
 Medimist Inhalation
 Chest Physiotherapy
 Postural drainage
 Percussion
 Vibration
Common Respiratory Interventions
 Incentive Spirometry
 Closed Chest Drainage (Thoracostomy Tube)
 One-bottle system
 Two-bottle system
RESPIRATORY/PULMONARY
DISORDERS
Epistaxis
 Causes:
 Trauma
 Hypertension
 Rheumatic Heart Disease
 Cancer
 Nursing Interventions
 Instruct the client to sit-up, lean forward, head
tipped.
 Put pressure over the soft tissues of the nose for at
least 5 minutes.
 Cold compress
 Nasal pack with neosenephrine (3-5 days)
 Liquid, then soft diet
Sinusitis
 Clinical Manifestations
 Pain
 Maxillary: pain on cheek, upper teeth
 Frontal: pain above eyebrows
 Ethmoid: pain in and around the eyes
 Sphenoid: pain behind eye, occiput, top of the head
 General malaise
 Stuffy nose
 Headache
 Post-nasal drip
 Persistent cough
 Fever
Sinusitis. . .
 Collaborative Management:
 Rest
 Increase fluid intake
 Hot wet packs
 Avoid ASA
 Antibiotics, as prescribed.
 Nasal Decongestants
 Irrigation of maxillary sinus with warm NSS
 Functional Endoscopic Sinus Surgery (FESS)
 Calwell-Luc Surgery (Radical Antrum Surgery)
 Ethmoidectomy
 Sphenoidectomy/ethmoidectomy
 Osteoplastic flap surgery for frontal sinusitis
Tonsillitis and Adenoiditis
 Assessment
 Sore throat  Frequent had colds
 Fever  Bronchitis
 Snoring  Foul breath
 Dysphagia  Voice impairment
 Mouth-breathing  Noisy respiration
 Earache  Draining ears
Collaborative Management
 Promote rest
 Increase fluid intake
 Warm saline gargle
 Analgesic, as ordered.
 Antibiotics, as ordered.
 Tonsillectomy/Adenoidectomy (if tonsillitis
recurs 5 to 6 times a year)
Tonsillectomy
 PreOp Care
 Assess for URTI.
 Monitor PTT
 PostOp care
 Prone, head turned to side
 Monitor for hemorrhage
 Frequent swallowing
 Bright red vomitus
 Increased PR
 Promote comfort
 Ice collar
 Acetaminophen/analgesics
 No ASA
 Ice-cold fluids
 Bland foods
Laryngeal Cancer
 Risk factors
 Cigarette smoking
 Alcoholism
 Voice abuse
 Pollutants
 Chronic laryngitis
 Family history
Assessment of Laryngeal CA
 Persistent hoarseness
 Mass on anterior neck
 Dyspnea
 Dysphagia
 Chronic laryngitis
 Burning sensation with hot/acidic beverages
 Halitosis
 Hemoptysis
 Severe anorexia, anemia, weight loss
 Surgery: Total/Subtotal Laryngectomy

 Subtotal: retains voice
 Total: absolute loss of voice
 Provide support and client education!
 Tracheostomy care
 Establish means of communication
Chronic Obstructive
Pulmonary Disease (COPD)
 Chronic bronchitis
 The hypoxic
“blue bloater”
Online Image Courtesy:

Fédération Girondine de Lutte contre les Maladies
Respiratoires (FGLMR) (2006)
http://www.respir.com/doc/abonne/semeiologie/ins
pection/SemeioInspectionBlueBloater.asp
Chronic Obstructive
 Emphysema
 The
“pink puffer”

Fédération Girondine de Lutte contre les Maladies
Respiratoires (FGLMR) (2005)
http://www.respir.com/doc/abonne/semeiologie/ins
pection/SemeioInspectionPinkPuffer.asp
Chronic Obstructive
 Asthma
 May be due to allergy (extrinsic) or
inflammation (intrinsic)
 Histamine, bradykinin, prstaglandin, serotonin,
leukotrienes, ECF-A, and SRS-A are mobilised
 Characterized by bronchospasm and
bronchoconstriction
 May lead to hypoxia and respiratory acidosis if
not treated
General Assessment for COPD
 Cough  Changes in skin color
 Dyspnea  Changes in body
temperature
 Chest pain
 Voice changes
 Sputum production
 Weakness
 Adventitious breath
 Fatigue
sound
 Anorexia
 Pursed lip-breathing
 Weight loss
 Upright, leaning
 Alteration in thoracic
forward position
anatomy
 Changes in LOC  Clubbing
 Polycythemia
Collaborative Management for
COPD
 Promote rest
 Promote oral care
 Diet: high calorie, high protein, low
carbohydrates
 Oxygen therapy: not high concentration
 Stop cigarette smoking
 CPT: percussion, vibration, postural drainage
COPD
 Bronchial hygiene measures
 Expectorants
 Antitussives
 Bronchodilators
 Antihistamines
 Steroids
 Antibiotics
Pleural Effusion
 Accumulation of fluids in the pleural space
 Types
 Hemothorax
 Pyothorax or Empyema
 Hydrothorax
Causes:
 Trauma
 Thoracic surgery
 PPV
 CVP line insertion
 Emphysema
Assessment for Pleural Effusion
 Sudden, sharp chest pain
 SOB
 Anxiety
 Restlessness
 Absent breath sounds
 Tachypnea
 Chest tightness and asymmetry
 Cyanosis
 Tympanitic sound on chest percussion
Nursing Management for
Pleural Effusion
 Encourage the patient to stay calm
 High-Fowler’s position
 Pain management
 Chest tube/thoracentesis
 CXR
 ABG
 Assess for shock
Lung Cancer
(Bronchogenic Cancer)
 Risk factors
 Cigarette smoking
 Asbestosis
 Emphysema
 Smoke from burnt wood

TPI NEWS Daily (2010)
http://toppayingideas.com/blog/2010/04/08/inositol-
lung-cancer/
Assessment of Lung Cancer
 Cough:
 Hacking  Edema around the neck
 Nonproductive  Pleural effusion
 Thick, purulent, blood-
 Late signs (WAWA!)
tinged sputum
 Weakness
 Chest tightness
 Anorexia
 Chronic RTI
 Weight loss
 Hoarseness
 Anemia
 Hypoxia
Lung CA
 Maintain patent airway
 Oxygen/aerosol therapy
 Deep breathing exercises
 Pain relief
 Protection from infection
 Chemotherapy
 Radiation Therapy
Lung CA
 Surgeries as recommended
 PNEUMONECTOMY
 LOBECTOMY
 SEGMENTECTOMY
 WEDGE RESECTION
 DECORTICATION
 THORACOPLASTY
 Health Promotion and Illness Prevention for
risky individuals!
Adult Respiratory Distress
Syndrome (ARDS)
 Causes
 Shock
 Aspiration
 Toxic agents
 Oxygen toxicity
 Near-drowning
 Trauma
 Infection
 DIC
 Fat emboli
Adult Respiratory Distress
Syndrome (ARDS)
 Assessment
 Tachypnea
 Retractions
 Central cyanosis
 Dry cough
 Fine crackles
 Fever
 Changes in LOC and ABGs
for ARDS
 Oxygen therapy
 Semi-high-Fowler’s Position
 CPT
 Eye care
 Positive End Expiratory Pressure (PEEP)
TUBERCULOSIS
 A popular communicable lung infection
caused Mycobacterium tubercle bacilli.
 Can actually occur in some other parts of the
body (extrapulmonary/miliary) but the pair of
lungs is the most common site!
 PTB management through the new DOH TB-
DOTS guidelines
 Massive information dissemination, infection
control, and health education must be done.
Important Points on
Primary TB Drugs
 Pyrazinamide
 Isoniazid (INH)
 Hepatotoxicity,
 Peripheral Neuritis
 Fatal hemoptysis
 Hepatotoxicity
 Vitamin B6  Rifampicin
(PYRIDOXINE)  Red-orange color of
bodily secretions
 Streptomycin
 Ototoxicity  Ethambutol
 Nephrotoxicity  Optic neuritis and skin
rash
Pneumonia
 Assessment  Chest pain
 Increased sputum  Pleural effusion
production  Dullness
 Wheezing  Decreased breath sounds
 Dyspnea  Decreased vocal fremitus
 Cough  Decreased chest
 Rales expansion
 Rhonchi  Increase in WBC count
 Fluid in the ISC  Tachypnea
 Consolidation  Fever
 Hypoxemia
Pneumonia
 Promote rest  Splint chest when
 Encourage fluid intake coughing
 Incentive spirometry  Sputum examination,
 Oxygen therapy CXR, Temperature
monitoring
 Semi-Fowler’s position
 Antibiotics, as
 Bronchial Hygiene
prescribed
 Oral hygiene  Diet: high in calorie
 Humidifier and protein
Pulmonary Embolism
 Causes
 Fat embolism
 Multiple trauma
 PVDs
 Abdominal surgery
 Immobility
 Hypercoagulabity

New York University (FGLMR) (2007)
http://www.clinicalcorrelations.org/?p=93
Assessment for P.E.
 RESTLESSNESS
(the first sign)  Apprehension
 Dyspnea  Diaphoresis
 Stabbing chest  Dysrythmias
pain  Hypoxia
 Cyanosis
 Tachycardia
 Dilated pupils
 Oxygen therapy STAT

 Early postop
ambulation  Heparin (2 weeks)
 Obese patient  Then Coumadin (3-6
monitoring months)
 DO NOT MASSAGE
legs
 Pain relief
 HOB elevated
Reference
 Udan, J.Q. (2002). Medical-surgical nursing:

Concepts and clinical application. 1st edition.
Manila: Educational Publishing House.
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Sam Joseph C.

CARE OF THE CLIENTS

 Surgery: Total/Subtotal Laryngectomy

Online Image Courtesy:

Online Image Courtesy:

Online Image Courtesy:

Online Image Courtesy:

 Oxygen therapy STAT

 Udan, J.Q. (2002). Medical-surgical nursing:

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