m6_pp02l029_acute respiratory disorders (v 1.4)

8/4/2019 M6_PP02L029_Acute Respiratory Disorders (v 1.4)

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Acute Respiratory Disorder

NP02L029

Terminal Learning Objective

Given a patient with an acute respiratory

disorder, determine approaches for patient

care by correctly responding to written,oral and experiential assessment measures.

Enabling Learning Objectives

A: Examine the etiology/pathophysiology, clinicalmanifestations, assessment diagnosis, medical

management and nursing interventions of a

patient with a pneumothorax.

B: Describe the pathophysiology, clinical

manifestations, assessment diagnosis, medical

management and nursing interventions of lungcancer.

C: Describe the pathophysiology, clinical

manifestations, assessment diagnosis, medical

management and nursing interventions of

pulmonary edema.

D. Examine the etiology/pathophysiology,

clinical manifestations, assessmentdiagnosis,

medical management and nursing

interventions of

E: Describe the etiology/pathophysiology,

clinical manifestations, assessment diagnosis,

medical management and nursing interventions of

a patient with Acute Respiratory DistressSyndrome.

F. Explain the pharmacological and nursingimplications of mucolytic agents

Pneumothorax

Etiology/Pathophysiology Air or gas in the pleural space, causing the lung

to collapse

Causes

Chest trauma

Ruptured bleb

Pleural lining injury

Spontaneous

Interrupts the normal negative pressure, keeping thelung from remaining inflated

Pneumothorax

Tension pneumothorax

Build up of air in the pleural space, causing

interference with the ability of the heart and lungs

to fill

Life threatening

Pneumothorax

Clinical Manifestations- patient may present with arecent chest injury

Decreased breath sounds on affected side

Sharp pleuritic pain, dyspnea

Diaphoresis, tachycardia

Tachypnea

Abnormal chest movement

Possible sucking chest wound on inspiration Hypoxia

Shifting of mediastinum

Hypotension

Pneumothorax

Assessment

Inquire to a recent injury or coughing

episode

May c/o shortness of breath, anxiety,

hypoxia

Breath sounds unequal, or diminished

Pneumothorax

Assessment (cont)

Penetrating or blunt wounds to the chest,unequal movement with flail segements

Assess respiratory and cardiac, rate andrhythm

Monitor vital signs frequently

Note color characteristics, and amount of sputum

Pneumothorax

Diagnostic tests

Chest x-ray

Medical management

Needle thoracostomy

Chest Tube

Heimlich valve/water-seal suction

Pneumothorax

Nursing interventions- maintain airway

patency and oxygenation

Assess and document patency of chest tube

Provide analgesics

Assist with coughing and deep breathing

Splint or support Observe

Pneumothorax

Nursing interventions(cont)

Patient teaching

Increase fluid intake

Avoid fatigue

Report signs and symptoms of recurrence

Pneumothorax

Nursing diagnosis

Breathing pattern ineffective r/tnonfunctioning lung

Fear related to feeling of air hunger

Check on Learning

List three signs of a pneumothorax:

a.----------------------

b.----------------------

c.----------------------

Check on Learning :

List three signs of a pneumothorax:

Decreased breath sounds on

the affected side

Sharp, pleuritic pain withdyspnea

Diaphoresis, tachycardia

Tachypnea

Hypoxia

Abnormal chest movement

If penetrating injury may

hear sucking sounds on

inspiration

Shifting of the mediastinum

to the unaffected side with

compression of the great

vessels

Hypotension - due to

decrease in venous return to

the heart and poor cardiac

filling

Lung Cancer

Etiology/Pathophysiology Leading cause of cancer related death in men and

women Accounts for 28% of all cancer deaths

Tumors, 80-90% r/t cigarettes

Second hand smoke, asbestos and air pollution

Mortality

Treatment

Lung Cancer

Types of lung cancer

Small cell

Non-small cell

Squamous cell carcinoma

Large cell

Lung Cancer

Assessment

Chronic hoarseness

Chronic cough

History of smoking or environmental

exposure

Weight loss

Lung Cancer

Assessment(cont) Hemoptysis

Shortness of breath, wheeze Pleural effusion

Edema of face or neck

Friction rub Clubbing of fingers

Pericardial effusion

Lung Cancer

Diagnostic tests Chest X-Ray

MRI Bronchoscopy

Needle aspiration

Biopsy Mediastinoscopy

Scalene lymph node biopsy

Lung Cancer

Medical management- depends on type and

stage of lung cancer

Estimated 1/3 of patients inoperable when first

diagnosed

Another 1/3 found inop during exploratory

thoracotomy Surgical treatment-1/3 experience tumor

spread

Lung Cancer

Surgical treatment Pneumonectomy

Lobectomy

Segmental resection

Video assisted thorascopic surgery

Radiation and chemotherapy

SCLC chemotherapy

Lung Cancer

Nursing interventions- directed at improvingquality of life

General nursing measures Monitor antineoplastic side effects

Reduce exertion

Maintain body weight

Relieve pain, administer analgesics

Encourage patient to stop smoking

American Cancer Society resourses

Lung Cancer

Nursing diagnosis and interventions Airway clearence ineffective r/t lung

surgery Facilitate optimal breathing

Encourage ambulation

Position changes Cough deep breathe

Assess breath sounds

Lung Cancer

Nursing diagnosis and interventions(cont) Fear r/t cancer treatment and prognosis

Explain treatments and procedures

Listen to the patient, accept feelings of anger

Encourage verbalization of feelings Supportive services

Monitor for signs and symptoms of worthlessness,anxiety, powerlessness

Prognosis-10-15% live 5 years or longer Survival rate- 40% for cancers identified in localstage

Pulmonary Edema

Etiology/Pathophysiology Accumulation of serous fluid in interstitial lung

tissue and alveoli Results from Severe left ventricular failure

Inhalation of irritating gases

Rapid administration of I.V. fluids

Barbiturate and opiate overdose

Pulmonary Edema

Serous fluid forced into alveoli

Gas diffusion severely affected

Can lead to death if untreated

Pulmonary Edema

Clinical manifestations Dyspnea

Tachypnea Tachycardia

Hypoxia, cyanosis

Pink frothy sputum

Restlessness, agitation

Pulmonary Edema

Assessment Note c/o dyspnea

May express feeling of impending death Assess for signs and symptoms of resp distress

Wheezing and crackles

Weight gain Decreased urinary output

Productive cough with frothy pink sputum

Pulmonary Edema

Diagnostic tests

Medications

Oxygen therapy

Morfine sulfate

Nipride

Digoxin

Pulmonary Edema

Nursing interventions

Assess respiratory status frequently

O2 therapy

Volume status

Patient teaching

Prognosis

Pulmonary Embolus

Clinical manifestations Chest pain

Dyspnea

Tachypnea

Hemoptosis

Diminished lung sounds

Elevated temperature

Hypotension

Regional bronchoconstriction, Atelectasis

Pulmonary edema, decreased surfactant

Pulmonary Embolus

Diagnostic tests ABG’s

CXR CT angiogram

V/Q scan

Pulmonary arteriogram

D-dimer

Venous ultrasound

Pulmonary Embolus

Nursing interventions Assess sensorium

Monitor cardiorespiratory status DVT treatment

Assess for signs of bleeding

Patient teaching

Prognosis- 30% mortality rate if untreated.

5% mortality with early diagnosis and treatment

Etiology/Pathophysiology Also called non-cardiogenic pulmonary edema

Secondary to an acute disease process, asyndrome of pulmonary shunting , hypoxemia,reduced lung compliance and parenchymal lungdamage

Pathophysiology

Surface of alveolar capillary membrane becomes

altered Fluid leaks into the interstitial space and alveoli

Results in pulmonary edema and hypoxia

Alveoli lose elasticity and collapse Pulmonary artery hypertension

Clinical manifestations

Usually manifests in 12-24 hours post surgery

Respiratory distress with altered breath sounds

within 5-10 days

Altered sensorium

Tachycardia

Assessment

Obtain background information

Observe changes in patients condition Assess respiratory rate rhythm and effort

Assess for nasal flaring, retractions, or cyanosis

Assess for crackles and wheezing

Assess level of consciousness

Diagnostic tests

Pulmonary functions tests

ABG’s CXR

Medical management – focuses on supportave

treatment by maintaining adequate

oxygenation and treating the cause

Medications

Diuretics

Morphine sulfate

Digoxin

Antibiotics

Ventilatory support

Nitric oxide

Nursing interventions and patient teaching

Goal: Provide adequate oxygenation and

ventilation and treat multi system response to

ARDS Monitor respiratory status

Assess vital signs

Position patient to facilitate optimal ventilation Turn cough deep breath

Nursing diagnosis

Gas exchange impaired r/t tachypnea

Nursing interventions

Monitor ABG’s

Monitor for restlessness

Administer oxygen

Report v/s changes and L.O.C.

Nursing diagnosis Breathing pattern, ineffective r/t respiratory

distress Nursing interventions

Assess respiratory rate rhythm and effort

Proper positioning Maintain airway patency and promote

Mucolytics A mucolytic is a drug that loosens

respiratory secreations.

Use: Bronchitis.

Cystic Fibrosis.

COPD. Atelectasis.

Acetaminophen toxicity.

Mucolytics Con’t

Actions:

Decreases viscosity of secretions by breakingdisulfide links of mucoproteins.

Serves as a substrate in place of glutathione,which is necessary to inactivate toxicmetabolites in acetaminophen overdose.

Example: acetylcysteine (Acetadote, Mucomyst).

Mucolytics Con’t

Contraindications:

Hypersensitivity.

Increased intracranial pressure.

Status asthmaticus.

Precautions:

Pregnancy.

Hypothyroidism.

Addison’s Disease.

Mucolytics Precautions Con’t

CNS depression. Brain tumor.

Asthma.

Renal / heptic disease.

Psychosis.

Alcoholism. Convulsive disorders.

Breastfeeding.

Mucolytics Side Effects

CNS: dizziness, drowsiness.

CV: hypotension.

EENT: rhinorrhea. GI: nausea, stomatitis, constipation, vomiting,

anorexia, hepatotoxicity.

Integ: urticaria, rash, fever, clamminess, pruritus.

Resp: bronchospasm, hemoptysis, chesttightness.

Mucolytics Con’t

Interactions:

Do not use with iron, copper, rubber.

Do not mix with antibiotics. Increases the effects of nitrates.

Mucolytics Nursing Implications

Assessment: Cough: type, frequency, character, including

sputum.

VS: resp rate, rhythm, increased dyspnea.

CV: dysrthythmias.

Lab Tests: ABGs (increased CO2: asthma).

Mucolytics Nursing Implementation

Administration (PO):

Mix with soft drinks to disguise taste. (Give

within one hour). Give ½ - 1 hour before meals for better

absorption and to decrease nausea.

Assistance with inhaled dose: bronchodilator if

bronchospasm occurs.

Mucolytics Nursing Implementation Con’t

Antidotal: within 24 hours.

Store in refrigerator (up to 96 hours after

opening).

Gum, hard candy, frequent rinsing of mouth for

dryness of oral cavity.

Mucolytics Patient Teaching

About mucolytic use.

Unpleasant odor will decrease after repeated use.

Discoloration of solution after opening, does notaffect effectiveness of medication.

Report vomiting, since dose may need to berepeated.

Mucolytics Evaluation

Absence of purulent secretions.

Absence of hepatic damage in

acetaminophen toxicity.

View:videos.howstuffworks.com/discover

y-health/14598-human-atlas-mucolytics-video.htm

Check on Learning

Question: What is the action of

Mucolytics?

Answer:

Loosens respiratory secretions.

Reduces the viscosity of respiratory secretions by direct action on the mucus.

REVIEW

Pneumothorax

Lung cancer

Pulmonary edema

Pulmonary embolus

Mucolytics

m6_pp02l029_acute respiratory disorders (v 1.4)

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