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Respiratory System Disorders

Respiratory System Disorders. HLTAP501A Analyse Health Information. Pneumonia. Types. Aspiration Lobar Bronchial Viral Bacterial - most common Atypical - mycobacterium. Aspiration pneumonia.

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Respiratory System Disorders

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  1. Respiratory System Disorders HLTAP501A Analyse Health Information

  2. Pneumonia

  3. Types • Aspiration • Lobar • Bronchial • Viral • Bacterial - most common • Atypical - mycobacterium

  4. Aspiration pneumonia • Is an inflammatory condition of the lungs and bronchi caused by the inhalation of food/fluid or vomitus • The affects of this type will depend on • The substance inhaled • The amount • The resulting inflammation and/or destruction of lung tissue

  5. Infective pneumonia • The body’s defences fail to prevent inhaled or airborne microbes reaching and colonising in the lungs • This can be achieved by • Inhalation of infective organisms • Aspiration of infective organisms from • The upper respiratory tract • From gastric contents • Haematogenous – common in bacteraemia or secondary to UTI

  6. Causes • Lowered resistance • URTI • Depression of CNS (head injuries, drugs) • Alcohol abuse • Cardiac failure • Debilitating illness • Super-infection in hospitalised patients • Exposure to intense cold, dampness • Any bronchial obstruction • Prolonged immobilisation • Pulmonary oedema and congestion • Impaired coughing

  7. Treatment • Mouth / skin care • Encourage fluids • Nurse client sitting upright • Encourage cough / physiotherapy • Analgesia (pleuritic pain) • O2 therapy

  8. Prevention • Natural resistance should be maintained • Avoid contact with people with URTIs • Obliteration of cough reflex and aspiration should be avoided • Highly susceptible people should be immunised • Immobilised patients should be turned every two hours and encouraged to deep breath and cough

  9. Complications • Pleuritis – may lead to pneumothorax, empyema • Pleural fibrosis • Abscess formation • Chronic lung disease – leading to interstitial fibrosis • Bronchiectasis (bronchial dilation)

  10. Chronic Obstructive Airway Disease (COAD)

  11. Exemplified by chronic bronchitis and obstructive emphysema and asthma • Patients may have a history of: • Smoking • Dyspnoea, where labored breathing occurs and gets progressively worse • Coughing and frequent pulmonary infections • People with COPD may develop respiratory failure accompanied by hypoxaemia, carbon dioxide retention, and respiratory acidosis

  12. Pathogenesis of COAD

  13. Asthma • Characterized by shortness of breath, wheezing, and chest tightness • Active inflammation of the airways precedes bronchospasm • Airway inflammation is an immune response caused by release of IL-4 and IL-5, which stimulate antibodies and recruit inflammatory cells • Airways thickened with inflammatory mucus magnify the effect of bronchospasm

  14. http://www.dentalgentlecare.com/new_page_31.htm

  15. Other Respiratory Diseases • Tuberculosis • Infectious disease caused by the bacterium Mycobacterium tuberculosis • Symptoms include fever, night sweats, weight loss, a racking cough, and splitting headache • Treatment entails a 12-month course of antibiotics

  16. Other Respiratory Diseases • Lung Cancer • Squamous cell carcinoma (20-40% of cases) arises in bronchial epithelium • Adenocarcinoma (25-35% of cases) originates in peripheral lung area • Small cell carcinoma (20-25% of cases) contains lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize

  17. Incidence and mortality rates: national • Lung cancer is the fifth most common registerable cancer in Australia. • Around 8,200 Australians are diagnosed with lung cancer each year. • More than 7,000 Australians die from lung cancer each year. • One in 33 Australians will develop lung cancer by the age of 75. http://www.cancercouncil.com.au

  18. Risk factors/Prevention • Smoking is a major cause of lung cancer. • Smokers and workers exposed to industrial substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons and chloromethyl ether have a significantly higher risk of developing lung cancer. • Research has also demonstrated a link between passive smoking and lung cancer.

  19. Symptoms • Lung cancer is very difficult to detect at an early stage, some symptoms may include: • A new or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion. • Recurring episodes of lung infection, weight loss and swelling of the face or arms are also common symptoms.

  20. Treatment • There are a few different types of treatment for lung cancer (with different aims): • Surgery - This is used to remove all the cancer in the hope of a cure. • Chemotherapy - This is a course of drugs given to kill or control the cancer cells. • Radiotherapy - This is a course of x-rays given to kill or control the cancer. • Laser treatment - This is used to control the cancer cells. It is used to unblock airways full of tumour, but it does not cure the cancer. http://www.cancercouncil.com.au

  21. Lung Cancer

  22. Pneumothorax Is the accumulation of air or gas in the pleural cavity, resulting in the collapse of the lung on the affected side Haemothorax – blood in pleural cavity Haemopneumothorax – blood and air in the pleural cavity

  23. Pneumothorax http://www.virtualrespiratorycentre.com/HumanAtlas/flash_content/clientNF.asp?anid=207

  24. Types • Closed • Open – sucking wound • Tension

  25. Causes • Spontaneous • Chest trauma • Surgery • Central line insertion • Positive pressure ventilation

  26. Spontaneous pneumothorax • May occur in healthy individuals and is often due to a rupture of a sub pleural bleb (often affects tall, thin men between 20-40 yrs) • May be a complication of underlying pulmonary disease such as COAD, asthma, cystic fibrosis, TB, pertussis

  27. Sudden sharp chest pain - made worse by deep breath or cough Dyspnoea – sudden onset Chest tightness Easily fatigued Tachycardia Cyanosis Unilateral pleuritic pain Tachypnoea Subcutaneous emphysema Pallor Diaphoresis Reduced movement on affected side Open pneumothorax may reveal obvious haemorrhage or foreign body in chest wall Clinical manifestations

  28. Treatment • If small then it may require no intervention • More extensive • Insertion of an intercostal catheter (ICC) • Connection to underwater seal drainage (UWSD) system • Non resolution or reoccurrences may need surgical intervention

  29. Thoracic drainage • This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural space • Air • Fluids such as blood, pus, chyle, serous fluid, gastric juices • Solids such as blood clots

  30. Thoracic drainage • This system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural space • Air • Fluids such as blood, pus, chyle, serous fluid, gastric juices • Solids such as blood clots

  31. Thoracic drainage • Tube placement • Is placed in the 2nd, 3rd, or 4th intercostal space. • The tube is sutured in and has an occlusive dressing applied to prevent air leaks • Determined by the substance to be drained • Smaller gauge tubes for air • Larger gauge tubes for fluids • Pneumothorax – usually one tube • Haemothorax – usually two tubes

  32. Under water seal drainage • This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to reenter.

  33. Under water seal drainage system • This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to re-enter. • A chamber containing water • A chamber for collection of fluids or solids • May be connected to suction

  34. Nursing care • Patient may be nursed in semi Fowlers position • Oxygen and analgesia may be needed • Allay anxiety • Encourage deep breathing and coughing • Patient to splint the affected side when coughing • Check respirations – noting chest movement • Report increase in respiratory rate or distress, increase in pain or abnormally large increase in drainage to RN Div 1 • Check dressing daily – maintain asepsis

  35. Nursing care • Tubing • Clamping – to be achieved with two clamps (rubber clipped forceps) above the connection to the UWSD when • It is necessary to lift system above the level of the bed • Changing the system • Observe for • Kinks • Dependent loops • Flattening • Loosening of connections • Blockage • Tube dislodgement

  36. Nursing care • Drainage system • Check the character, consistency and quality of drainage • Mark the drainage level – noting time and date (usually done each shift) • Check for oscillation (swinging of the fluid in rhythm with the patient’s breathing) may be as much as 5-10cm • Check for intermittent bubbling of air (pneumothorax) • Ensure suction is maintained at ordered pressure

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