Respiratory Disorders

Respiratorysystem review &physiology

100

Respiration and Ventilation

Respiration: process of gas exchange between air and blood (cellular level)

 Pneumonia/flu/covid

 Anemia

 PE

 malnutrition

Ventilation: movement of air in and out via diaphragm

 pneumonia/flu/covid

 COPD

 Asthma

 Emphysema

 Cancer/tumor

200

Pulmonary diffusion and perfusion 

Systemic perfusion

Pulmonary diffusion and perfusion

 Oxygen and CO2 diffusion across alveolar membrane

 Blood flow in lungs

Systemic perfusion

 Blood flow to body

 Want ventilation to equal perfusion

300

Hypoxia & hypoxemia: early and late signs/symptoms

Hypoxemia: decreased O2 in blood

o Early: increased resp., HR, BP, resp distress, restlessness, pale

skin

o Late: decreased resp, HR, BP, become confused

 Hypoxia: decreased O2 in tissues

o Results from prolonged hypoxemia

o Acute: headache, fatigue, SOB, dyspnea

o Chronic: altered LOC

400

Ventilation: Perfusion ratio: causes of low & high ratios

High: ventilation greater than perfusion: not enough blood for gas

exchange (MI, PE)

 Low: perfusion greater than ventilation: not enough air for gas exchange

(atelectasis)

 Silent: no blood blow, no air flow (pneumothorax)

500

Oxyhemoglobin dissociation curve concepts in general

impact of low

hemoglobin on oxygenation

 Normal level: greater than 70

 Relatively safe: 45-70

 Dangerous: less than 40

Assessment

100

Steps

 History

 Describe symptom

 Rate and rhythm

 Posture

 Shape and symmetry

 Sounds

 Palpation

200

Risk Factors

Smoking

 Family history

 Exposure to allergens, environmental hazards, occupation hazards

 Dietary

 HIV

Diagnostics

100

ABG interpretation, including causes, lab values, signs/symptoms

Respiratory acidosis

o Causes: pulmonary edema, aspiration, pneumothorax, OD on

sedatives

o S/S: elevated HR/RR/BP, confusion, decreased LOC

o Treat the cause

 Respiratory alkalosis

o S/S: seizures, deep rapid resp, confusion, hyperventilation,

hypokalemia

o Causes: hyperventilation, PE, mechanical ventilation

200

Sputum culture & sensitivity collection

Patient should rinse mouth with water, clear nasal mucus, take 2-3 deep

breaths and cough deeply from diaphragm, expectorate into a sterile

specimen container

300

Ventilation: Perfusion lung scan: uses

PFT: Measure arterial blood oxygen saturation

 X-ray: detects densities produced by fluid, tumors, foreign bodies, and

other pathologic conditions

 CT: can distinguish fine tissue densities and detect abnormalities not

seen with x-ray

 MRI: better able to distinguish normal vs abnormal

 Ventilation perfusion scan: assesses air flow and blood flow of the lungs,

used to rule out a PE

400

Bronchoscopy: nursing care pre- and post-procedure, expected assessment vs. s/s complications

Diagnose and treat lung conditions

 Preprocedure: informed consent, NPO, meds to sedate and suppress

gag reflex

 Post op: NPO until gag reflex returns, VS till stable

 Monitor for complications: infection, pneumothorax, aspiration,

laryngospasm

Oxygen therapy & Atelectasis andpneumonia

100

Oxygen therapy: Goal and Discontinue

Goal

 Saturation of 90-93

Discontinue

 Only 100% O2 is used in code situations

 Discontinue gradually

 Avoid oxygen toxicity

Nasal cannula: 1-6L

Simple mask: 5-8

Non-rebreather: 10-15

Venturi: 10-12

200

Atelectasis: collapse of alveoli

Causes: foreign body, tumor, retained secretions

 Assessment

o Diminished breath sounds, fine crackles, low O2

o Severe: dyspnea, cyanosis, tachypnea

 Nursing interventions

o Use measure to expand lungs: turn, cough, deep breathe,

incentive spirometry

o Early ambulation

o Pain management

o Avoid excessive sedation

o Encourage fluids

300

Pneumonia: affects ventilation and diffusion

Assessment: tachypnea, chills, dyspnea, cough

 Nursing interventions

o Antibiotics

o Airway clearance

o Nutrition

o Positioning

o Prevention with vaccines

Pulmonaryembolism & Lung Cancer

100

Pulmonary embolism

Obstruction of pulmonary artery or branch by an embolus

Causes:

 Blood clot, air, fat, amniotic fluid, sepsis, normally originates from DVT

Assessment

 Sudden onset of dyspnea, chest pain, tachypnea

Nursing interventions

 Oxygen therapy, fluids, assess bleeding risk, monitor for complications

200

Lung Cancer: causes, small cell and non-small cell

Inhaled carcinogens

 Risks: asbestos, heavy metals, family history

Non-small cell

 Most common

 Occurs in peripheral masses or nodules and often metastasizes

Small cell

 Very aggressive, grows quickly, early metastasis to lymph and blood,

very poor prognosis

300

Lung Cancer: Symptoms 

Often asymptomatic till late

 Cough or chronic cough

 Dyspnea

 Chronic upper resp infections

 Hemoptysis

 Recurrent fever

 Chest or shoulder pain

400

Lung Cancer: Nursing Interventions 

Managing symptoms

 Support

 Prevent complications

 Promote deep breathing and pursed lip breathing

 Encourage smoking cessation