RESPIRATORY DISORDERS
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NCM 103 = MEDICAL SURGICAL NURSING
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RESPIRATORY DISORDERS
- 1. RESPIRATORY DISORDERS UPPER RESPIRATORY TRACT
- 2. UPPER AIRWAY DISORDERS: INFECTIONS RHINITIS ACUTE & CHRONIC SINUSITIS ACUTE & CHRONIC PHARYNGITIS ACUTE & CHRONIC TONSILITIS LARYNGITIS
- 5. Causes of Rhinitis Idiopathic Abuse of nasal decongestants (rhinitis medicamentosa) Psychological stimulation (anger, sexual arousal) Irritants (smoke, air pollution, exhaust fumes, cocaine) Vasomotor Causes Category Tumor Deviated septum Crusting Hypertrophied turbinates Foreign body Cerebrospinal fluid leak Mechanical
- 6. CAUSES CATEGORY Pregnancy Use of oral contraceptives Hypothyroidism Hormonal Acute viral infection Acute or chronic sinusitis Rare nasal infections (syphilis, tuberculosis) Infectious Polyps (in cystic fibrosis) Sarcoidosis Wegener's granulomatosis Midline granuloma Chronic inflammatory
- 27. Acute Sinusitis
- 46. Acute and Chronic Pharyngitis
- 57. Acute and Chronic Tonsilitis Tonsillitis and Adenoiditis
- 65. LARYNGITIS
- 77. UPPER AIRWAY DISORDERS: OBSTRUCTION AND TRAUMA EPISTAXIS NASAL POLYPS DEVIATED NASAL SEPTUM & FRACTURE LARYNGEAL OBSTRUCTION
- 78. EPISTAXIS
- 87. Control of Epistaxis Packing to control bleeding from the posterior nose Catheter is inserted and packing is attached Packing is drawn into position as the catheter is removed. Strip is tied over a bolster to hold the packing in place with an anterior pack installed ‘accordion pleat’ style. Alternative method, using a balloon catheter instead of gauze packing.
- 92. NASAL POLYPS overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and nontender.
- 94. NASAL POLYPS
- 101. DEVIATED NASAL SEPTUM & NASAL FRACTURE
- 118. LOWER AIRWAY AND PULMONARY VESSEL DISORDERS: RESPIRATORY TRACT INFECTIONS
- 119. TRACHEOBRONCHITIS
- 128. BRONCHIECTASIS Dilation of bronchial airway
- 137. PNEUMONIA inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, chlamydiae, mycoplasma, fungi, parasites, and viruses.
- 143. PNEUMONIA CAUSATIVE FACTORS RISK FACTORS TREATMENTS S/SX DX TEST PATHOPHYSIOLOGY
- 144. Who are at risk??? RISK FACTORS OLD AGE TOBACCO/ ALCOHOL USE EXPOSURE TO VIRAL/ FLU MECHANICAL VENTILATION
- 145. CAUSATIVE FACTORS INFECTIOUS ORGANISMS NONINFECTIOUS HOSPITAL ACQUIRED COMMUNITY ACQUIRED Bacteria,viruses,fungi, rickettsiae, protozoa, helminths Aspiration of fluids, foods & vomitus Inhalation of toxic gases,chemicals,smoke environment people Equipment & supplies Invasive devices SETTING CAUSATIVE
- 148. Pathophysiology Fluid in lungs Inflammation in interstitial spaces, alveoli and bronchioles By surviving lung defenses (inflammation), organisms penetrate airway mucosa & multiply in alveolar spaces WBCs migrate to infection causing capillary leak,edema & exudate Fluids collect in & around alveoli & walls thicken reducing gas exchange Capillary leak spreads infection to other areas of lung & if + organisms in blood = SEPSIS Fibrin & edema stiffen lung ↓ vital capacity Alveolar collapse further reducing gas exchange to blood causing hypoxemia ↑ HR, ↑ RR, dyspnea Pain
- 151. Diagnostic test Culture & sensitivities CXR (early dx) Pulse oximetry CBC, electrolytes, BUN & creatinine
- 152. TREATMENTS Pain control Fluid & oxygen mgt Anti-infective drugs Health promotion Patent airway Bronchodilators = bronchospasm Cough & deep breathe q 2 hrs
- 161. SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
- 169. TUBERCULOSIS
- 174. Introduction
- 181. AFB
- 187. Transmission
- 188. Transmission
- 192. The allergic reaction and immunity of TB PATHOGEN Tubercle bacillus Through infective route (respiratory tract, alimentary canal, skin and placenta) Child The thymus-dependent LC be sensitized and proliferate Delayed allergic reaction Activating factors Inhibiting factors of Macrophage movement Activating macrophage Engulf and kill tubercle bacillus Eptheloid cells and tubercle Infection is focused TB is surrounded by sensitized TLC
- 193. Pathophysiology M. TUBERCULOSIS SUSCEPTIBLE HOST ALVEOLI 1. DEPOSITED & BEGIN TO MULTIPLY 2. TRANSPORTED THROUGH LYMPH SYSTEM TO DIFF PARTS OF THE BODY IMMUNE RESPONSE (INFLAMMATORY REACTION) NEUTROPHILS & MACROPHAGE ENGULF TB-SPECIFIC LC DESTROY BACILLI & NORMAL TISSUE ACCUMULATION OF EXUDATES IN ALVEOLI CAUSING BRONCHO-PNEUMONIA INTIAL INFECTION OCCUR 2-10 WKS AFTER EXPOSURE GRANULOMAS FORMED (NEW TISSUE OF NEW & DEAD BACILLI SURROUNDED BY MACROPHAGE) TRANSFORMED TO FIBROUS TISSUE MASS, CENTRAL PORTION IS GHON TUBERCLE
- 194. BACTERIA & MP BECOMES NECROTIC FORMING CHEESY MASS CALCIFIED& COLLAGENOUS SCAR FORMED BACTERIA DORMANT INITIAL EXPOSURE & INFECTION
- 207. Recommended Category of Treatment Regimen Category Type of TB patient Treatment Regimen Intensive phase Continuation phase I New smear + PTB 2HRZE 4HR New smear - PTB with extensive parenchymal lesion on CXR as assessed by TBDC EPTB Severe concomitant HIV disease II Treatment Failure 2HRZES/ 1HRZE 5HRE Relapse Return After Default Other III New smear - PTB with minimal parenchymal lesions on CXR as assessed by the TBDC 2HRZE 4HR IV Chronic (still smear + after supervised re-treatment Refer to specialized facility or DOTS plus Center Refer to Provincial/City NTP Coordinator
- 214. LUNG ABSCESS
Editor's Notes
- Exudation the escape of fluid, cells, and cellular debris from blood vessels and their deposition in or on the tissues, usually as the result of inflammation.
- Other causes: disorders that prolong bleeding or clotting time, decreased platelet count all cause epistaxis.
- Nasal spray : Beclometasone, Fluticasone, Flunisolide and Budesonide Nasal drop: steroid medicines are used to reduce swelling in the nose. Nasal drop for 4-6 weeks
- Viruses are the most common cause of pneumonia in infants and children but are relatively uncommon causes of CAP in adults. In immunocompetent adults, the chief causes of viral pneumonia are influenza viruses types A and B, adenovirus, parainfluenza virus, coronavirus, and varicella-zoster virus. In immunocompromised adults, cytomegalovirus is the most common viral pathogen, followed by herpes simplex virus, adenovirus, and respiratory syncytial virus. The acute stage of a viral respiratory infection occurs within the ciliated cells of the airways.
- ACTIVITY: MAKE A CONCEPT MAP ON THE DIFFERENT TOPICS: PRESENT TO THE CLASS… THE GROUP WILL FACILITATE THE DISCUSSION BUT NOT DISCUSS THE TOPIC
- Upper airway characteristics normally prevent potentially infectious particles from reaching the sterile lower respiratory tract. Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx; patients often have an acute or chronic underlying disease that impairs host defenses. Pneumonia may also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Pneumonia affects both ventilation and diffusion. An inflammatory reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air-containing spaces. Areas of the lung are not adequately ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease in alveolar oxygen tension. Bronchospasm may also occur in patients with reactive airway disease. Because of hypoventilation, a ventilation–perfusion mismatch occurs in the affected area of the lung. Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated. The mixing of oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial hypoxemia. If a substantial portion of one or more lobes is involved, the disease is referred to as “lobar pneumonia.” The term “bronchopneumonia” is used to describe pneumonia that is distributed in a patchy fashion, having originated in one or more localized areas within the bronchi and extending to the adjacent surrounding lung parenchyma. Bronchopneumonia is more common than lobar pneumonia (Fig. 23-2).
- Restrictive lung disease (disease of the lungs that limits their ability to expand fully) and obstructive lung disease from secondary emphysema result.
- Atopy = term often used to describe immunoglobulin E–mediated diseases (ie, atopic dermatitis, asthma, and allergic rhinitis) with a genetic component
- The inflammation leads to obstruction due to the following factors: (1) swelling of the membranes that line the airways (mucosal edema), which reduces the airway diameter; (2) contraction of the bronchial smooth muscle that encircles the airways (bronchospasm), which causes further narrowing; and (3) increased mucus production, which diminishes airway size and may entirely plug the bronchi.
- Metaplasia = that conversion of tissue into an abnormal form Hyperplasia = excessive proliferation of cells
- Meconium ileus = caused by meconium obstruction in neonate Biliary cirrhosis = marked by prolonged jaundice, chronic retention of bile with inflammation of the ducts by tumors or calculus = hepatomegaly
- Steatorrhea = seborrhea – fatty stools of pancreatic disease. Increase in sebaceous gland secretion
- Trypsin = pancreatic enzyme; aids in protein digestion
- Resection = partial excision of a body part or organ
- Pulsus paradoxus = systolic BP of more than 10mmHg higher during exhalation than during inspiration; difference is normally less than 10mmHg