🛌Adult Nursing Care Unit 5 – Respiratory Disorders

Key Concepts

• Respiratory system functions include gas exchange, acid-base balance, phonation, and olfaction
• Ventilation involves the movement of air in and out of the lungs (inspiration and expiration)
• Diffusion allows for gas exchange between the alveoli and pulmonary capillaries
  • Oxygen diffuses from the alveoli into the bloodstream
  • Carbon dioxide diffuses from the bloodstream into the alveoli
• Perfusion refers to the flow of blood through the pulmonary capillaries
• Ventilation/perfusion (V/Q) mismatch occurs when there is an imbalance between ventilation and perfusion
• Hypoxemia is a decreased partial pressure of oxygen in the blood
• Hypercapnia is an increased partial pressure of carbon dioxide in the blood

Anatomy and Physiology Review

• The respiratory system consists of the upper and lower respiratory tracts
• The upper respiratory tract includes the nose, pharynx, and larynx
  • The nose humidifies, filters, and warms inspired air
  • The pharynx is a passageway for both air and food
  • The larynx contains the vocal cords and prevents aspiration
• The lower respiratory tract includes the trachea, bronchi, bronchioles, and alveoli
• The lungs are divided into lobes (3 on the right, 2 on the left) and are surrounded by the pleura
• The diaphragm and intercostal muscles are responsible for inspiration and expiration
• Pulmonary surfactant reduces surface tension in the alveoli, preventing collapse

Common Respiratory Disorders

• Asthma is a chronic inflammatory disorder characterized by airway hyperresponsiveness and reversible airflow obstruction
• Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, leading to irreversible airflow limitation
• Pneumonia is an infection of the lung parenchyma caused by bacteria, viruses, or fungi
• Acute respiratory distress syndrome (ARDS) is a severe inflammatory response resulting in diffuse alveolar damage and hypoxemia
• Pulmonary embolism is a blockage of a pulmonary artery, usually by a blood clot originating from the deep veins of the legs
• Lung cancer can be classified as small cell or non-small cell and is often associated with smoking
• Tuberculosis is a bacterial infection that primarily affects the lungs and can spread to other organs

Diagnostic Tests and Procedures

• Pulse oximetry measures the oxygen saturation of hemoglobin using a non-invasive sensor
• Arterial blood gas (ABG) analysis provides information about oxygenation, ventilation, and acid-base balance
• Chest X-ray is used to visualize the lungs, heart, and other thoracic structures
• Computed tomography (CT) scan provides detailed cross-sectional images of the lungs
• Pulmonary function tests (PFTs) assess lung volumes, capacities, and airflow rates
  • Spirometry measures the volume and flow of air during inspiration and expiration
  • Peak expiratory flow rate (PEFR) is used to monitor asthma control
• Bronchoscopy allows direct visualization of the airways and enables biopsy and removal of foreign objects
• Thoracentesis involves the removal of fluid from the pleural space for diagnostic or therapeutic purposes

Treatment Approaches

• Oxygen therapy is used to treat hypoxemia and can be delivered via nasal cannula, face mask, or high-flow nasal cannula
• Bronchodilators (beta-2 agonists and anticholinergics) relax smooth muscles in the airways, improving airflow
• Corticosteroids reduce inflammation in the airways and are used to manage asthma and COPD exacerbations
• Antibiotics are used to treat bacterial respiratory infections, such as pneumonia and acute exacerbations of chronic bronchitis
• Mechanical ventilation provides ventilatory support for patients with respiratory failure
  • Non-invasive ventilation (NIV) delivers positive pressure via a face mask or nasal interface
  • Invasive mechanical ventilation requires endotracheal intubation or tracheostomy
• Pulmonary rehabilitation is a comprehensive program that includes exercise training, education, and psychosocial support for patients with chronic respiratory diseases
• Smoking cessation is crucial for preventing and managing respiratory disorders, particularly COPD and lung cancer

Nursing Interventions

• Assess respiratory rate, depth, and pattern, as well as the use of accessory muscles and presence of cyanosis
• Monitor oxygen saturation using pulse oximetry and titrate oxygen therapy to maintain target levels
• Administer medications (bronchodilators, corticosteroids, antibiotics) as prescribed and monitor for side effects
• Perform chest physiotherapy techniques (percussion, vibration, postural drainage) to mobilize secretions
• Encourage deep breathing and coughing exercises to prevent atelectasis and improve ventilation
• Provide oral care and suctioning as needed to maintain a patent airway
• Assist with non-invasive or invasive mechanical ventilation, monitoring for complications (e.g., ventilator-associated pneumonia)
• Promote early ambulation and mobility to prevent deconditioning and reduce the risk of venous thromboembolism

Patient Education and Self-Management

• Teach patients and families about their specific respiratory disorder, including signs and symptoms, triggers, and management strategies
• Demonstrate proper inhaler technique and ensure patient understanding of medication administration
• Encourage smoking cessation and provide resources for support (nicotine replacement therapy, counseling)
• Educate patients on the importance of regular exercise, a balanced diet, and stress management
• Teach patients to recognize signs of respiratory distress and when to seek medical attention
• Provide information on pulmonary rehabilitation programs and support groups
• Emphasize the importance of annual influenza vaccination and pneumococcal vaccination for high-risk patients
• Encourage patients to maintain a healthy home environment (e.g., reducing allergens, avoiding secondhand smoke)

Critical Thinking and Case Studies

• Case 1: A 65-year-old male with a history of COPD presents with increased dyspnea, cough, and purulent sputum. How would you assess and manage this patient?
  • Assess respiratory status, including vital signs, oxygen saturation, and lung sounds
  • Obtain a sputum sample for culture and sensitivity to guide antibiotic therapy
  • Administer bronchodilators and systemic corticosteroids as prescribed
  • Consider non-invasive ventilation if the patient has severe respiratory distress
• Case 2: A 28-year-old female with a history of asthma presents with acute shortness of breath and wheezing after exposure to a known trigger. What are the priority nursing interventions?
  • Assess the severity of the asthma exacerbation using the PEFR and clinical signs
  • Administer high-dose inhaled bronchodilators (short-acting beta-2 agonists) and oral corticosteroids
  • Monitor response to treatment and reassess frequently
  • Provide education on trigger avoidance and the importance of adhering to the asthma action plan
• Case 3: A 50-year-old male is admitted to the ICU with severe community-acquired pneumonia and septic shock. What are the key considerations in managing this patient?
  • Initiate broad-spectrum antibiotic therapy after obtaining blood and sputum cultures
  • Provide supportive care, including oxygen therapy, fluid resuscitation, and vasopressors as needed
  • Consider invasive mechanical ventilation if the patient develops respiratory failure
  • Monitor for complications, such as acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS)