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  1. Respiratory Module Lower Respiratory Tract Infections Lecture 6

  2. Atelectasis • Definition • Closure or collapse of alveoli

  3. Atelectasis: Pathophysiology • Can occur as a result of i alveolar ventilation or • any type of blockage • that impedes the passage of air to and from the alveoli

  4. Atelectasis: Etiology • #1 post-op • hsecretions or mucus plug • Chronic airway obstruction • i.e. lung CA • Excessive pressure on the lungs

  5. Atelectasis: Risk Factors • Altered breathing patterns • Retained secretions • Pain • i LOC • Immobility • Prolonged supine position • Post-op

  6. Atelectasis: Clinical Manifestations • “The development of Atelectasis usually is insidious” • Cough • sputum production • low-grade fever

  7. Atelectasis: Clinical Manifestations • If Atelectasis involves a large amount of lung tissue S&S include • Marked resp. distress • Dyspnea (orthopnea) • Pulse? • Tachycardia • Respiratory rate? • Tachypnea • Pleural pain • Central cyanosis

  8. Atelectasis: Assessment and Diagnostic Findings • breath sounds • i • Crackles • Chest X-ray • patchy infiltrates • consolidated area

  9. Atelectasis: Assessment and Diagnostic Findings • SpO2 • < 90% • PaO2 • i < 80 • PaCO2 • h > 45 • HCO3- • h to compensate • ABG analysis • Resp. acidosis

  10. Atelectasis: Prevention • Frequent turning • Early mobilization • Strategies to expand the lungs • Deep breathing • Incentive Spirometry (IS)

  11. Atelectasis: Prevention • Strategies to manage secretions • Directed cough • Suctioning • Nebulizer • Chest physical therapy • h fluids

  12. Atelectasis: Management • Goal: • to hventilation and isecretions • Frequent turning • Early amb. • Lung volume expansion maneuvers

  13. Atelectasis: Management • Coughing • PEEP • Bronchoscope

  14. Atelectasis: Management • If due to bronchial obstruction • Coughing • Suctioning • Chest physiotherapy • Nebulizers • Bronchodilators • Endotracheal intubation & mechanical ventilation

  15. Atelectasis: Management • If due to compression of the lung tissue • Decrease the compression • Thoracentesis • Chest tubes

  16. Small Group Questions • What can a nurse due to prevent a patient from acquiring Atelectasis? • Which patients are most likely to acquire Atelectasis? • How is Atelectasis treated? • Describe the ABG’s of a patient with Atelectasis. • Name 4 S&S of Atelectasis.

  17. Acute Tracheobronchitis AKA • Bronchitis • Acute Bronchitis

  18. Acute Tracheobronchitis Pathophysiology • Inflammation of the mucous membranes of the trachea & bronchial tree • Follows URI

  19. Acute Tracheobronchitis • What pathogen is most commonly responsible for tracheobronchitis? • Bacteria • Virus • Fungus • Parasite

  20. Acute Tracheobronchitis Etiology/Contributing factors • Infection • Inhalation of irritants • Sulfur dioxide • Nitrogen dioxide • Air pollutants • May be a complication of bronchial asthma

  21. Acute Tracheobronchitis Clinical Manifestations • Usually self limiting • Durations • Several days • Sputum • Mucopurulent • Cough • Dry, irritation, dyspnea • Pain • Sternal soreness • Fever / chills • Headache / gen. malaise

  22. Acute Tracheobronchitis Diagnostic findings • Sputum C&S • Chest x-ray • Breath sounds • Sonorous wheezes • Stridor • Symptoms

  23. Acute Tracheobronchitis Treatment • Symptomatic • Bed rest • Cool vapor • Steam • Moist heat to chest • If bacterial • Antibiotics

  24. Acute Tracheobronchitis Nursing interventions • Enc bronchial hygiene • Enc TCDB / h fluids • Position • HOB h • Caution against over exertion  relaps • Auscultate BS • Check V/S

  25. Acute Tracheobronchitis Prevention • Treat URI Complications • Bronchopneumonia

  26. Small group questions??? • Describe the pathophysiology of tracheobronchitis? • What is the usual causative agent for tracheobronchitis? • What does self-limiting mean? • What breath sounds are associated with Tracheobronchitis? • Identify a nursing diagnosis for tracheobronchitis? • Name for nursing comfort measures for a pt. with tracheobronchitis?

  27. Pneumonia Pathophysiology • An inflammatory process in which there is consolidation • caused by exudates filling the alveolar spaces. • Gas exchange cannot take place in consolidated area

  28. Pneumonia Causative agents • Viral pneumonia • Bacterial Pneumonia • Streptococcus pneumoniae • Pneumocystis Pneumonia • Fungal pneumonia • Radiation pneumonia • Chemical pneumonitis • Aspiration pneumonia • Hypostatis pneumonia

  29. Pneumonia Which of the following components of respiration would pneumonia affect? (there may be more than one answer) • Ventilation • Perfusion • Diffusion

  30. Pneumonia FYI • Most common cause of death from infectious agents • 66,000 deaths / year • $$$

  31. Pneumonia Progression of events • Inflammation  • h Exudate  • i movement of O2 and CO2  • WBC migrate into the alveoli  • Fill air-containing spaces • i ventilation • PaO2 ? • i

  32. Pneumonia - Classifications • Community-acquired pneumonia • CAP • Community or < 48 hr after hospitalization • Hospital-acquired pneumonia • HAP • Nosocomial • (CDC: 15-20% all pt get HAP) • Immuno-compromised host • Pneumocystis pneumonia (PCP) • Aspiration

  33. Mrs. Sickly is admitted to Sierra View District Hospital on Wednesday Morning at 0930 AM for severe back pain and general declining state. She is 82 years old. On Friday morning at 0600 AM the nurse notes decreased breath sounds in the left lung, a productive cough and crackles. The doctor orders a chest x-ray which shows consolidation in the base of the left lung. She has pneumonia. What type of pneumonia does she have? • Community acquired pneumonia • Nosocomial pneumonia • Immuno-compromised host • Aspiration

  34. Pneumonia: Risk factors • Immunosuppressant • Smoking • Prolonged immobility • Depressed cough reflex • NPO • Alcohol intoxication • Gen. anesthetic or opiod • Advanced age

  35. Pneumonia S&S: bacterial • Onset: • Sudden • Pain: • Severe chest pain • sharp • Guarding • i mobility (affected side) • Temperature • High temp (>106) • Chills • Cough • Painful • Sputum • Rust colored • Breathing • Shallow • Rapid rate • Wheezing & crackles • Decreased BS • Peristaltic activity • Slows down • PaO2 • i • Cyanotic

  36. Pneumonia: S&S: viral pneumonia • Blood cultures: • Sterile • Sputum • Copious • Temperature • Seldom chills • Respirations • Slow • Wheezing & crackles • Diminished BS • Pulse • Slow • PaO2 • i • Cyanotic • Viral less severe than bacterial • Mortality is low

  37. Pneumonia S&S Elderly • General deterioration • Weakness • Abd. Symptoms • Anorexia • Confusion • Tachycardia • Tachypnea • Do Not C/O • Cough • Pain • Fever • Sputum

  38. Pneumonia Dx • Sputum C&S • CBC / WBC • h • Bacteria • i • Viral • ABG’s • Chest x-ray • What is a normal WBC count? • 5,000 – 10,000 mm3

  39. Pneumonia • What would you expect the ABG’s of a person with bacterial pneumonia to have? • PaO2? • PaCO2? • pH • HCO3- ? - Why? • Analysis?

  40. Pneumonia Treatment • Antibiotics? • Rest • Fluids • h • Humidifier • Antipyretic • Anti-tussive? • Analgesics • Anti-histamines • Nasal Decongestants • O2 • Mucolytic drug • Alivaire • Via – nebulizer

  41. Pneumonia: Nrs. diagnosis • Ineffective airway clearance: r/t copious secretions • Activity intolerance: r/t impaired resp. function • Risk for deficient fluid volume: r/t fever & dyspnea • Imbalanced nutrition: less than body requirement • Deficit knowledge: about the treatment regimen and preventive health measures

  42. Pneumonia – Nursing Interventions • Improve airway patency • Hydration • 2-3 L/day • Humidifier • TCDB • Lung expansion maneuvers • Incentive spirometer • Chest physiotherapy • O2

  43. Pneumonia – Nursing Interventions • Promoting rest & conserving energy • Position • Semi-fowler • Affected side for pain • Turn frequently • Moderate activity only • Promoting fluid intake • 2 L/day

  44. Pneumonia – Nursing Interventions • Maintaining nutrition • Gatorade • Ensure • Promoting the patients knowledge

  45. Pneumonia Prevention • Vaccine • Pneumonia • Flu • Treat URI • Avoid irritants

  46. Pneumonia Complications • Shock • Respiratory failure • Atelectasis • Pleural effusion • Superinfection

  47. Pneumonia: Small Group Questions • Describe the pathophysiology of pneumonia. • What is the difference btw bacterial and viral pneumonia? • What causes pneumocystis carinii? • What leads to hypostatis pneumonia? • What lab values are associated with bacterial pneumonia? / viral pneumonia?

  48. Pneumonia: Small Group Questions 6. What is Nosocomial pneumonia 7. Identify 5 risk factors for developing pneumonia 8. What medications might be administered to treat a pt. with pneumonia? 9. What nursing education would you give to a patient with pneumonia? 10. What ABG’s are associated with pneumonia? 11. What are the gerontological considerations of caring for the elderly in regards to pneumonia?

  49. SARS • Severe Acute Respiratory Syndrome • Viral respiratory illness • Caused by a coronavirus

  50. SARS • FYI • First reported in Asia 2003 • 8098 people worldwide dx with SARS in 2003 • 774 died!