Respiratory
Structure and Function
The primary function- bring oxygen into the body so that it can reach all body tissues via the
blood stream
To remove carbon dioxide
To maintain acid-base balance
To protect the airway from infection
Upper Respiratory System
Mouth
Nose
Pharynx
Larynx
Epiglottis closes during swallowing to prevent aspiration and opens to allow air passage
Trachea (can be upper or lower) - protected by hard cartilage- Carinaii at the bottom of
the trachea where it splits. If hit during suctioning will have to back out
Lower Respiratory System
Trachea
Lungs
Bronchi and bronchioles
Alveoli- basic functioning units of the lung
Pulmonary capillary network- brings deoxygenated blood from the right ventricle of the
heart to the tip of the alveoli and the oxygen will diffuse into the capillary bed and
carbon dioxide will go out of the capillary into the alveoli. This newly oxygenated blood
will go into the pulmonary vein back into the left atria of the heart to be sent out of the
aorta to the body.
Plural membranes
Outside- parietal
Inside- visceral
Alveolus
Basic functioning unit of the lung and are more than 300 million per lung
Outer layer contains surfactant that helps keep the alveoli open and elastic- surfactant missing
in preemies, alveoli will not stay open, can’t breathe on their own
Chemo-receptors
Aortic and Carotid bodies (computer chips)
Detect Carbon Dioxide and when level is too high it sends chemical stimulus to the medulla
oblongata and is the stimulus breathe in most people
Intact nervous system required to work
In COPD, Oxygen is the stimulus to breath and is called the oxygen deprivation drive. Oxygen
therapy must be limited to 2-4 LPM.
External Respiration
Ventilation: air moves in and out of the lungs
External Respiration: Oxygen and carbon dioxide are exchanged- alveoli and blood
Perfusion: Transportation through the blood
Internal Respiration
When the oxygen and carbon dioxide are exchanged between the blood cell and the target
body cell
Diaphragm and Atmospheric Pressure
When the diaphragm contracts and pushes downward causing the lung space to become larger
and facilitating inspiration. When the diaphragm relaxes, it moves upward and decreases the
lung space and causes exhalation.
Slight negative pressure- sub atmospheric- exists in the pleural space- just enough to keep the
lungs open
Inspiration increases the vacuum or negative pressure- inhale
When pressure is equal or slightly greater, then the diaphragm contracts
Greater pressure must be exhaled
Tests for oxygenation
Arterial Blood Gases
Watch for signs of bleeding, apply at least 3 minutes of pressure
About 3% of inspired oxygen is absorbed into the plasma
PaO2- 80-100 mmHg
PaCo2- 34-45 mm Hg
pH= 7.35-7.45
Oxygen Saturation- O2 sats
95-100% below 70 life is threatened
Oxygen Saturation
Room Air: 21% oxygen- 78% nitrogen- 1% other gases
fiO2- 21%
97% oxygen bound to hemoglobin
SaO2- 94-95% if below 90% then PaO2 less than 60 mmHg- hypoxia
Oxygen Supplementation
Low flow and High Flow- low flow is less accurate delivery than a high flow system
Low:
Nasal cannula- most commonly used- 2-4 LPM COPD patients- only 40-44% at 6 lpm,
maybe
Simple face mask
Non-rebreather- has disk that allows CO2 to escape so that it is not breathed back instill influenceable and low flow
High:
Venturi mask- accurate delivery flow at 24% or 44%.
Hypoxemia
Decreased amount of oxygen in the blood
Results in decreased oxygen at the cellular level (called hypoxia)
Also results in increased levels of carbon dioxide (hypercapnia or hypercarbia) and may progress
to respiratory acidosis
Onset may be rapid or gradual
Patient is post op and appears to be sleeping. Respiratory rate is 6. – Hypoventilation leading
to hypoxia and respiratory acidosis and respiratory arrest.
Signs
Restless, irritability, confusion in the beginning
Dyspnea
Tachypnea, stridor (normal 12-20)
Abnormal lungs sounds
Cyanosis, retractions, arrhythmias
Acid-base balance disturbances
Orthopnea
Decreased O2 sats
Clubbing of the fingers
Lung Sounds
Rales- heard on inspiration generally- bubbly
Rhonchi- better heard on expiration- more musical crackles
Tracheostomy Reasons
Tube inserted in the trachea to provide and maintain a patent airway
To remove secretions from clients unable to cough
Replace endotracheal tubes
Use positive pressure ventilation
Prevent aspiration
Signs that Suction is Needed
Restlessness, gurgling/rattling sounds
Unable to expectorate secretions
Unable to swallow
Adventitious breath sounds when auscultated
Change in LOC
Skin color- cyanotic/dyspneic
Rate and pattern of respirations Pulse rate/rhythm
Parts of Tracheostomy
Outer cannula with flange- placed by Md. Will be held in place with straps.
Inner cannula- goes inside the outer cannula. Can be removed and cleaned
Obturator- helps get it through the skin. Will want to hang on to it
Tracheostomy Tubes
Curved tube inserted into a tracheostomy, a surgical incision in the trachea just below the first
or second tracheal cartilage
The tube extends through the tracheostomy stoma
Metal-plastic-foam
Outer cannula-inner cannula-Obturator
Single cannula
Cuffed Tracheostomy
Have an inflatable cuff that produces an airtight seal between the tube and the trachea
Seal prevents aspiration of oropharyngeal secretions and air leakage between the tube and the
trachea
Limit to 20 cm. of pressure in the cuff to prevent tissue necrosis of the trachea. Uncuff policy
must be followed
Procedure
Wash hands and gather supplies. Don gloves and mask with eye shield
Check suction at 80-120 mm Hg. Pressure
Hyper-oxygenate by:
100% O2 flush- 15 lpm
Deep breaths 3-5
Prepare 2-5 mL of sterile saline for lavage if needed
Open sterile suction tray first and keep it closest to your patient #12-14 Fr
Open cleaning tray
Open sterile saline and Hydrogen Peroxide
Fill suction container with sterile saline
Lubricate and insert catheter without suction approximately 5-6 inches in the adult
Meet resistance at carina- pull back 1 centimeter
Suction 5-10 seconds
Remove and rotate catheter with suction
If not successful use 2 mL of saline and suction again (infants- 0.5 mL)
Suction stat with saline lavage
If not using the saline allow 2-3 minutes between suctions
Hyper-oxygenate
Remove dressing and inner cannula and put cannula in hydrogen peroxide
Documentation: Excessive, white thin mucous from the tracheostomy, cyanotic lips, jerking at
covers, trying to sit up in bed. Crackles notes in right upper love, dyspnea, RR28 and shallow.
Suctioned large amount of with thin mucous from trach X2 Trach care done. Hyperoygenation
and hyperventilation done. LS clear bilaterally, skin pink, RR 24 and regular
Other assessment tests
Pulmonary function test:
Breathe through a machine with nose pinched by clamp
Measures lung capacity
Tidal volume: total air exchange with normal breathing
Total lung capacity: total volume of lungs at a maximum inflation pg. 509
Chest Drainage Tubes
Used to remove air from the patient with a pneumothorax or hemothorax or after chest surgery
Connected to a drainage device that allows air or drainage to escape and not enter the cavity
May require suction to operate or may use gravity drainage
Tubes are removed and an occlusive dressing is applied when the air is removed from the plural
space.
Tall, skinny, young adults may spontaneously have pneumothorax
This drains the cavity of air, blood, fluid, whatever, so that the negative pressure can be
reestablished, the lungs can reinflate, and oxygen exchange can resume
Water Seal Drainage
1st part will be drainage collection- no more than 100 cc per 24 hour period, but can be more
2nd part will be the water seal- tip end of tube needs to be under 2 cm of water at all time- keeps
air from reentering the chest cavity
3rd part will be for suction- will fill with Md. Prescribed water to create the amount of suction.
When you have water seal, when the patient breathes the water will move up and down with
each breath.
But, you should never see bubbling in the 2nd chamber, because that is a leak and has to be
found before the lung collapses again
If two tubes, the upper tube will be to drain air, the lower tube will be to drain fluid or blood.
NO dependant loops, kinks or clamps (clamp only for seconds changing bottles or looking for
leaks) as can cause tension pneumothorax and Mediastinal shift
Empymea
Pus in the pleural space caused by bacteria
Do thoracentesis not chest drainage
Thoracentesis: removal of fluid or pus by needle aspiration in the pleural space
Over the bedside table
Hold breath
Antibiotics and chest x-ray needed
Respiratory Acidosis- Hypercapnia
Abnormal decrease in the pH of the blood due to decreased ventilation of the alveoli leading to
elevated CO2
Hypoventilation- decreased ventilation- holding the CO2 in. Decreased respirations.
Acute: CO2 over 47 mm Hg and pH <7.35
Chronic- near normal pH (renal compensation) and elevated CO2 and elevated Na Bicarb
Or HCO3 > 30 mm Hg- this is the body trying to compensate
Respiratory Alkalosis
Caused by hyperventilation of the alveoli resulting in CO2 being blown off by the lungs
Acid is lost resulting in respiratory alkalosis
pH is higher end of spectrum 7.45
Disrupts the calcium balance
Causes:
Anxiety
Labor
Hysteria
Fever
Caffeine
Symptoms
Numbness and tingling
Tetany or twitching/convulsions
Person faints
Pneumonia
Three Groups:
1. Community Acquired, due to a number of organisms, namely Streptococcus pneumonia
2. Hospital or nursing home acquired (nosocomial) due to a gram negative (Klebsiella) bacilli and
staphylococci
3. Immunocompromised person like person on chemo or steroids- increases likelihood of
overwhelming infection.
Factors
Any condition that interferes with normal drainage of the lung- example: cancer
Postoperative patients may develop pneumonia since anesthesia impairs respiratory defenses
and decreases diaphragmatic movement
Depression of the CNS examples: drugs, heart trauma, alcohol
Person over 65 have a high mortality rate, even with appropriate antimicrobial therapy
Natural resistance should be maintained: nutrition, rest, exercise
Avoid people with URT infections
Avoid obliteration of the cough reflex and aspiration of secretions prevented.
Immobilized clients should be turned every 2 hours
Susceptible persons (elderly and chronically ill) should be immunized against influenza and
pneumonia
Signs and Symptoms
Sudden Onset
Shaking chills
Leukocytosis- WBC’s increased
Rapidly rising fever- 101-105F
Cough productive of purulent sputum
Color sputum depends on infectious agent- Brown, rusty colored sputum in 48 hours if
Streptococcus
Pleuritic chest pain, aggravated by respiration or coughing
Tachypnea (25-45/min) accompanied by grunting, nasal flaring, use of accessory muscles
Rapid, bounding pulse
Skin is hot and dry
Mucous membranes dry
N/V/D
Restless
Delirium
Streptococcal Pneumonia
May be Hx of previous respiratory infection
Sudden onset with shaking and chills
Rapidly rising fever Tachypnea
Productive rusty brown or green purulent sputum
Pleuritic pain aggravated by cough
Chest sounds dull to percussion
Chest sounds: crackles, bronchial breath sounds
Confusion may be the only symptom presenting in the elderly
Herpes simplex lesions often present on face or lips
Penicillin G or Erythromycin, clindamycin, cephalosporins, trimethoprim-sulfa-methoxazole
Complications:
Septic shock
Pleural Effusion: escape of fluid into the pleural linings of the lungs
Pericarditis
Otitis Media
Staphylococcal Pneumonia
Often prior history of viral respiratory tract infection
Insidious onset of cough with yellow, blood streaked mucous
Fever, pleuritic chest pain, progressive dyspnea
Pulse varies may be slow in proportion to temperature
Must be isolated!
Infections often lead to necrosis and destruction of lung tissue
Treatment must be vigorous and prolonged
May develop drug resistance
Penicillin
Staph Complications
Effusion/Pneumothorax
Lung Abscess
Empymea
Meningitis
Viral Pneumonias
Viral Pneumonia- influenza viruses
Viral sx: cough, severe headache, anorexia, fever, and myalgia
Often begins as acute coryza, bronchitis, pleurisy, or GI symptoms
Treat symptomatically- Amantadine relieves symptoms
Use vaccines if client is at risk
Complications: Risk of secondary bacterial pneumonia
Pericarditis
Endocarditis
Pneumocystis Carinii pneumonia
Lowly virulent fungal pneumonia
Fungal Pneumonia
High mortality rate- destroys lung tissues
Complications:
Pleural Effusion
Hypotension and shock
Superinfection: Pericarditis, Bacteremia, meningitis
Delirium- this is considered a medical emergency
Atelectasis- due to mucous plugs (pockets of dead air space)
Assessment
History of recent respiratory illness- symptoms
Presence of chills
Description of chest pain
Any family illness
Any recent antimicrobial drugs
Alcohol, tobacco, drug abuse
Splinting of the affected side
Confusion/Disorientation
Shallow respirations/dyspnea
Flushed appearance/Anxious
Auscultate crackles over affected region and bronchial breathing when consolidation is present
Interventions- lots of questions on these
Allow client to sit upright for greater lung expansion and more oxygen
Administer oxygen per order- low level for client for COPD
Obtain sputum culture and sensitivity
Encourage fluids to 3-4,000 mL/day if within limits for client’s cardiac reserve- thins the mucous
Encourage coughing
Humidify air to loosen secretions
Employ chest wall percussion- “cupping” and postural drainage- cupping comes first and then have them
upside down to drain the mucous
Continue to auscultate lung sounds
Relieve pleuritic chest pain by semi-Fowler’s position, splinting of chest with pillows
Coughing- do not suppress productive cough- only dry hacking nocturnal cough
Sedatives, narcotics, and cough suppressants are generally contraindicated for the elderly. These meds
suppress cough, gag reflex, and respiratory drive
Apply heat to the chest as prescribed
Watch for paralytic ileus or abdominal distention from swallowing too much air- NG possible
Patient Education
Fatigue, weakness, and depression may be prolonged after pneumonia
Encourage gradual increase in activities
Explain need for follow up exams and x-rays
It is wise to stop smoking. Smoking destroys cillial action which is one of the first lines of
defense for the lungs
Smoking irritates lung tissue which is already irritated by the infection
Smoking inhibits the function of lung macrophages which seek out any bacteria that enters the
lung and tries to destroy it
Take antibiotics as prescribed
Any itching or rash, contact physician
Other Conditions
Care of a client with Pleurisy
Inflammation of the pleura
Can occur from pneumonia, TB, Pulmonary embolism, URT infections, Pulmonary neoplasms
Chest pain-Pleuritic, char, knifelike on inspiration
Intercostal tenderness
Pleural friction rub- grating or leathery sounds heard on both phases of respiration
Evidence of an infection: fever, malaise, increased WBC’s especially with empyema- pus in the
linings
Interventions for Pleurisy
Treat cause of pleurisy like cancer or pneumonia
Relieve the pain by auto splint on the affected side, apply prescribed heat and analgesics
Watch for pleural effusion which is a collection of fluid in the pleural space
Shortness of breath
Pain
Local decreased excursion of the chest wall
Cough absent breath sounds
Treatment of Pleural effusion
Treat underlying cause
Same as pleurisy
Thoracentesis- aspiration for fluid removal and relief of dyspnea- chest x-ray post
procedure
Pleurodesis- production of adhesions between the parietal and visceral pleura by use of
tubes and tetracycline for sclerosing agent
COPD
COPD is a term that refers to a group of conditions characterized by continued increased
resistance to expiratory airflow
Emphysema
Chronic Bronchitis
Chronic asthma
Excessive secretion of mucous and chronic infection within the airways
Increase in size of air spaces as terminal bronchioles with loss of alveolar walls and elastic recoil
Distention of the alveoli with mixture of oxygen and carbon dioxide
Causes:
Cigarette smoking
Air pollution
Occupational exposure
Allergy
Autoimmunity
Infection
Genetic predisposition and aging
Pulmonary Emphysema
Slowly progressive deterioration of lung function for many years before development of the
illness
1 out of 4 wage-earners are disabled due to the disease
More common in men
Oxygen is inhaled but CO2 is retained
Symptoms of Emphysema
Dyspnea
Cough
Sputum expectorant
Digital Clubbing
Weight loss and anorexia
Abnormal lung sounds
Barrel shaped chest- increased anterior-posterior diameter
Respiratory acidosis- nervous, headaches, confusion
Cyanosis
Weakness
Management of Emphysema
Smoking Cessation
Bronchodilators
Sympathomimetics: albuterol-Alupent-Buterol-Proventyl-protect against bronchospasm
Methylxanthines-theophylline-TheoDur- is given orally- don’t give if pulse is over 100
Theoophylline- Breathine- aminophylline- very important in treating- will make jittery,
and nervous, elevates pulse- check pulse and do not give if pulse under 100
Antimicrobial agents for infections
Steroids for acute exacerbations- Prednisone
Chest therapy- cupping and postural drainage
IPPB treatments- intermediate positive pressure breathing, nebulizer treatment
Low-flow oxygen by nasal cannula
Complications of Emphysema
Respiratory failure
Pneumonia
Right sided heart failure called Cor Pulmonale
Nursing Interventions for emphysema
Eliminate all pulmonary irritants- perfumes, cooking foods, cigarette smoke, etc.
Keep client’s room dust free
Add moisture- humidifier or vaporizer
Control bronchospasm by bronchodilators- watch side effects
Monitor lung sounds
Do cupping and postural drainage before eating
Small frequent meals
Teach use of controlled coughing- exhaling through pursed lips or pursed lip breathing,
and “huffing”
Inhale slowly
Keep secretions liquid- avoid dairy products
Teach breathing exercises
Follow-up care
Avoid RTI- most frequent cause of emphysema attack
Relaxation exercises- avoid stress
Position of comfort
Discuss regular exercises like walking
Balance activity and sleep
Nocturnal oxygen use
Understand SOB and fatigue
Encourage verbalization of feelings
Sexual dysfunction is common
Avoid extremely hot/cold temperatures
Shower in warm not hot water
Obtain influenza and pneumococcal vaccines
Care of a Client with Pulmonary Embolism
The obstruction of one or more pulmonary arteries by a thrombus originating in the deep veins
of the legs
Predisposing factors:
Stasis; prolonged immobilization
Phlebitis
Previous heart or lung disease
Coagulation disorders
Metabolic, endocrine, vascular or collagen disorders
Malignancy
Advancing age
Estrogen therapy including birth control pills
Prevention and Health Maintenance of Pulmonary Embolism
Be aware of high risk clients- pelvic surgery, immobilization, trauma to the pelvis,
obesity, history of emboli, pregnancy, CHF, MI, malignancy, elderly, post-op client
Prevent stasis of blood in legs due to position, prolonged sitting or standing
Prevent wearing constrictive clothing
Encourage early mobility and weight bearing if allowed
Elevate legs 15-20 degrees at intervals to increase venous return to the heart
Apply TED if ordered
Instruct to wiggle toes, move feet, raise and lower legs frequently
Don’t let patients legs dangle without support to the back of the legs
Sequential Compression Device- SCD if ordered
Avoid crossing legs
Encourage fluids- avoid hemoconcentration
Avoid leaving IV catheter past 3 days
Examine client’s legs daily for evidence of thrombosis- Homan’s sign
Filters used or umbrellas
Signs and Symptoms of Pulmonary Embolism
Sudden pleuritic chest pain is the most common
Dyspnea- increased shallow respirations
Tachypnea
Apprehension
Sense of impending doom
Cyanosis
Arrhythmias
Syncope
Blood tinged sputum/hemoptysis
Circulatory collapse- shock
Pleural friction rub is heard on lung sounds
Presence of venous thrombosis in leg
Diagnosis of Pulmonary Embolism
Arterial blood gases
Radioscopic lung scans
Pulmonary angiogram is most definitive
CT scan
Treatment of Pulmonary Embolism
Oxygen
IV
Dopamine drip- Inotropic agent, for shock
Anti- arrhythmic drugs
Small doses of morphine
Thrombolytic agents-urokinase-streptokinase- and tpa- tissue plasminogen affector
Surgical intervention like vena cava filter or prevent migration of emboli
Embolectomy
Anticoagulation therapy by Heparin (IV) progressing to Warfarin or Coumadin- (PO)
Monitor Heparin by PTT- Partial Thromboplastin Time
PTT- 30-45 sec. >90 is critical
Antidote for Heparin is Protamine Sulfate 1% solution
Heparin’s effect unlike that of Warfarin is immediate.
Heparin can also be given SC after surgery to prevent leg clots
Warfarin or Coumadin is monitored by the PT- prothrombin time or protime
Warfarin may take 1-2 weeks to produce therapeutic effect
Normal is 11-12.5 seconds
Critical value is >20
Goal is 1 ½ times normal
Vitamin K: Synkavite is the antidote
Newer SC drug called Lovenox- enoxaparin- give SC only to prevent clots postHeparin and Lovenox are given deep SC with a tuberculin syringe
Give in the abd at a 90 degree angle
Do not aspirate or massage
Use ice to numb area before administration
Side effects with Anticoagulants
Hypersensitivity
Increased risk of bleeding from the gums, kidneys, GI tract, petechial on the skin or
ecchymosis, brain
Fever
N/V
Edema
Care with Anticoagulants
Soft bristle toothbrushes
Use and electric razor
Observation of bleeding
Observe for low back pain, melena, urine color
Instruction on not taking aspirin, NSAID, or other antiplatelet meds- Plavix
Monitor respiratory rate and watch for failure
Listen to lung sounds
Auscultate heart sounds- listen for splitting of second heart beat
Perform stool guaiac test
Monitor platelet count for DIC- decrease in the clotting platelet mechanism of the body.
All clotting mechanisms will release and there will be a lack of the mechanism, they will
start clumping together and make microclots all over the body.
Normal platelet count 150,000- 400,000 in Heparin induced DIC they are reduced
RBC’s- 45-54 million- less in women
Medic alert bracelet
Follow up PT’s
Avoid sports/activities that injure
Lose weight
Lung Cancer
14% survival rate
85% caused by smoking
The more cigarettes smoked per day, the higher the risk
Genetic link not found
Diet low in Vitamin A, C, E
Antioxidants protect against cell change
Small Cell Lung Cancer
Small cell lung cancer occurs in 20% of patients
Aggressive and spreads bilaterally
Both sides affected at time of diagnosis in 75% of patients
Bones, Liver, Brain
Non small cell lung cancer
Adenocarcinoma- most common 40%
Squamous cell carcinoma- 30%- grows slower better to resect
Large cell carcinoma- 10%
Symptoms of Lung Cancer
Cough—hidden by chronic smoker cough
Blood tinged sputum- hemoptysis
Thick and purulent sputum
Recurrent RTI’s
Dyspnea
Hoarseness
Chest pain or tightness
Dysphagia
Head and neck swelling
Pleural Effusion
Weakness and anemia
Weight Loss and anorexia
Diagnosis- Lung Cancer
Bronchoscopy: NPO past midnight
Fiber optic bronchoscopy will enable doctor to view tracheobronchial tree
Biopsy by: bronchial washing or brushing cells to analyze
Numb throat and spray
Valium
NPO until gag reflex returns
Monitor sputum post procedure for blood
Lung Biopsy
Needed if tumor on lung periphery
Percutaneous fine needle aspiration guided by fluoroscopy or CAT
Complications: bleeding; pneumothorax, spread of cancer cells- metastasis
Chest X-ray
Treatment for Lung Cancer
Pneumonectomy- removes whole lung
Lobectomy- removes lobe of lung
Segmental Wedge Resection- takes a triangular section of the lung out
Chemotherapy
Radiation
Pneumonectomy
All post op care previously studied
Turn on affected/operative side only for fluid to drain down and not collapse lung to prevent
Mediastinal shift
Lobectomy- turn either side
Wedge resection: turn on unaffected/non operative side
Other measures for Lung Cancer Surgery
Splint incision for turn cough and deep breath
Leg exercises
Pain medication
Nicotine patch
Oxygen administration/patent airway
Chemotherapy side effects
Emotional support
Cancer of the Larynx
Permanent Tracheostomy
Loss of taste
Loss of speech
Dealing with emotional aspect
Symptoms of Laryngeal Cancer
Hoarseness/voice change most common
Lump/fullness in throat
Tickling in throat
Coughing on swallowing
Pain radiating to the ear
Dyspnea
Coughing
Smell to breath
Care of Client with Larynx Cancer
Trach care and suctioning
Suctioning will be required every 5 minutes due to large amounts of mucous from the throat
and lungs
Maintain patent airway and oxygenation
Speech Rehab
Client teaching regarding trach
Client with ARDS
Adult Respiratory Distress Syndrome
Emergency
Causes:
Near drowning experience
Flu
Shock
Overdose
Head or chest trauma
Cancer
Radiation
Definition of ARDS
Lung failure due to a noncardiogenic life threatening event
Lung capillaries and the alveoli cell wall membranes become weak and porous
Tiny lung blood vessels leak into the alveoli
Alveoli fill up with blood
Risk Factors for ARDS
Cigarette Smoking
Chronic Lung Disease
Age over 65 but can happen to anyone over the age of 1
Symptoms of ARDS
SOB- hypoxemia
Tachypnea
Cyanosis- skin and fingernails
Rapid pulse
Fever, chills, muscle aches
Headache
Dry cough
Treatment of ARDS
Usually develops 24-48 hours of the injury
Get help quickly!
Mechanical ventilation- force oxygen into cells by pressure- PEEP
Monitor arterial blood gases and O2 sats
Monitor I&O
Sedation coma for intubation
Anasarca my develop- total body edema
TPN used for nutrition
Respiratory Distress in Children
Costal, sternal, Substernal retraction
Use of accessory muscles
Stridor
Pediatric Respiratory Conditions
Rhinitis- common cold- viral verses allergic rhinitis
Flu- influenza- virus transmitted by airborne droplets
Sinusitis- bacterial
Complications can be serious: meningitis, brain abscess, ear infections/hearing loss
Worse in morning, better in afternoon
Pharyngitis: viral verses streptococcal
If streptococcal must have Augmentin or Cefazolin if allergies to Penicillin
Untreated: Scarlet fever; Rheumatic Fever; or Glomerulonephritis
Treatment for Strep
Bacterial: antibiotics
Fluids, rest, analgesics/antipyretics, humidity
Best way to thin secretions in body so that they can be coughed up and out: encourage fluids
May need tonsillectomy
Watch for increased swallowing=bleeding
Croup
Acute respiratory distress in a child or infant
Nasal flaring
Retractions
Dyspnea
Barking cough/stridor
Tongue blade can cause respiratory arrest
Croup Care
Relieve hypoxia/O2 sats/ oxygen
Hold upright- crying makes worse- parents stay
Increase humidity- bathroom with hot water relieves laryngeal spasms
Croupette- cool air saturated with microdroplets
Keep children dry
Steroids if no chickenpoxEpinephrine will relax the smooth muscles of the bronchial tree
Asthma
Chronic inflammatory disorder with bronchial spasms or constriction alternating with relaxation
Results in narrowed bronchioles- less oxygen
Airways become edematous and infant’s tiny airways will close shut
Copious amounts of mucous produced during and after episode
Symptoms of asthma
Wheezing, abnormal lung sounds
SOB
Cyanosis
Coughing
O2 decreased
PCO2 increased
Perspires
Triggers of Asthma
RTI’s
Cigarette smoking
Stress
Dust/molds/allergens
Treatment of Asthma
If child sit up and over overbed table to breathe better
Bronchodilators- increased pulse
Steroids: Prednisone= Na retention with fluid retention and causes ulcers
IPPB with Isuprel or Bronkosol or Alupent
Emergency= Epinephrine 1:1000 sc
Child= 0.1-02 mL Adult: 0.3-0.5 mL
Cystic Fibrosis
Manifestations
Salty tears, saliva, and sweat
Heat prostration- very prone to heat stroke
Distended abdomen
Rectal prolapse
Meconium Ileus
Atrophy of thighs and buttocks
Sinusitis
Chronic cough, cyanosis
Dyspnea, wheezing
Barrel shaped chest
Obstructed pancreas
Deficiency of enzymes, poor digestion
Large, foul-smelling stools
Clubbing of fingers and toes
CF Patho
Lungs produce a layer of mucous that protects them. Mucous helps keep bacteria on the move
Clients with CF have thicker mucous and more mucous
Thick, sticky mucous obstructs the airway
Lung damage from dead neutrophils’ waste products
Inherited recessive gene disease- both parents
CF also affects:
Pancreas: thick secretions prevent pancreative and liver enzymes from flowing to aid digestion--poor growth, thin, anorexic, muscle wasting
Abnormal loss of electrolytes primarily NaCl in sweat due to abnormal chloride movement
Bulky foul smelling stools that are frothy because of undigested fat are classic
Thick impacted feces may cause rectal prolapse
Skin: loss of sodium and chloride in sweat gives salty skin surface--- electrolytes imbalance
Infertility: thick cervical mucus hinders sperm
Every mucous secreting cell in the body will be affected
Meconium ileus in newborns
Diagnosis of CF
Analyze sweat---sweat test for sodium chloride- 60 meq/L
Cor Pulmonale may develop
Treatment of CF
Oxygen
Antibiotics
Inhalers
Bronchodilators
Cupping and PP
IPPB
Humidity and liquids
Pancrelipase- Pancrease (Oral pancreatic preparation)- given with each meal and snack.
Give Vitamins A, D, E, K, iron, and zinc supplements
Watch for signs of heat stroke and exhaustion which occurs quickly