Nursing of Adults With Medical & Surgical Conditions

1. Nursing of Adults WithMedical & Surgical Conditions Respiratory Disorders(Diagnostic Tests & Upper Airway Disorders)

2. Normal Breath Sounds

3. Adventitious Breath Sounds • Crackles (Rales) • Fine, Medium,Coarse • Sound • Sounds like hair being rolled between the fingers close to the ear • Cause • Fluid, mucous, or pus in the small bronchi, bronchioles, and alveoli

4. Adventitious Breath Sounds • Rhonchi • Sound • Low-pitched, loud, coarse, snoring sounds • Cause • Narrowing of the tracheobronchial passages due to secretions, tumors, spasms • May clear with coughing if due to secretions

5. Adventitious Breath Sounds • Wheezes • Sound • High-pitched, musical, whistlelike sound during inspiration or expiration • Cause • Narrowed bronchioles due to tumor, bronchospasm, or foreign matter

6. Adventitious Breath Sounds • Pleural Friction Rub • Sound • Dry, creaking, grating, low-pitched sound • Cause • Inflammation of pleural surfaces

7. Diagnostic Tests • Chest X-ray • Provides visualization of the lungs, ribs, clavicles, humeri, scapulae, vertebrae, heart, and major thoracic vessels • Nursing Interventions • Hospital gown • No metal such as pins, bra hooks, jewelry • Computed Tomography (CT) • Pictures of small layers of pulmonary tissue • Diagonal or cross-sectional

8. Diagnostic Tests • Pulmonary Function Testing (PFT) • Assess the presence and severity of disease in the large and small airways • Lung Volume • Volume of air that can be completely and slowly exhaled after a maximum inhalation • Ventilation • Evaluate the volume of air inhaled or exhaled in each respiratory cycle • Pulmonary Spirometry • Evaluate the amount of air that can be forcefully exhaled after maximum inhalation • Gas Exchange • Determines the degree of function in the pulmonary capillary beds in contact with functioning alveoli

9. Diagnostic Tests • Mediastinoscopy • Surgical endoscopic procedure • Endoscope is passed into the upper mediatinum to gather lymph nodes for biopsy • Laryngoscopy • Indirect • Use of a laryngeal mirror to view the larynx • Direct • Local or general anesthesia • Laryngoscope passed over the tongue to view the larynx

10. Diagnostic Tests • Bronchoscopy • Performed by passing a bronchoscope into the trachea and bronchi • Rigid or flexible bronchoscope • Local anesthetic and IV general anesthetic • Used to observe for abnormalities, tissue biopsy, and secretions collected for exam • Nursing Interventions • NPO for 6-8 hours • NPO until gag reflex returns • Semi-Fowler’s position and turned to side • Assess for signs of laryngeal edema or laryngospasms • Assess for signs of hemorrhage

11. Bronchoscopy

12. Diagnostic Tests • Sputum Specimen • Obtained for microscopic examination • Nursing Interventions • Must be brought up from the lungs • Collect before meals • Rinse mouth with water before collection • Inhale and exhale deeply three times, cough forcefully, and expectorate into sterile cup • Early morning samples are ideal

13. Diagnostic Tests • Cytology Studies • To detect the presence of abnormal or malignant cells in sputum, pleural fluid, etc.

14. Diagnostic Tests • Thoracentesis • The surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid • Diagnostic or therapeutic • Nursing Interventions • Informed consent • Pt sits on the edge of the bed; arms resting on a pillow on overbed table • Monitor vital signs, general appearance, and respiratory status during and after procedure • Place on unaffected side after procedure

15. Thoracentesis

16. Diagnostic Tests • Pulse Oximetry • Monitoring of SaO2 • Measures the amount of light being absorbed by oxygenated and deoxygenated hemoglobin • Clothespin type probe is applied to finger, toe, earlobe or nose

17. Pulse Oximetry

18. Diagnostic Tests • Arterial Blood Gases • PaO2 Amount of oxygen dissolved in the plasma (mmHg) • SaO2 Amount of oxygen bound to the hemoglobin compared to the amount of oxygen the hemoglobin can carry (%) • PaCO2 Partial pressure of CO2 in the blood • HCO3 Bicarbonate

19. Diagnostic Tests • Normal Values • pH 7.35-7.45 • PaCO2 35-45 mm Hg • PaO2 80-100 mm Hg • HCO 21-28 mEq/L • SaO2 95-100%

20. Diagnostic Tests • Respiratory vs Metabolic • Respiratory • PaCO2 Elevated with acidosis; decreased in alkalosis • Metabolic • HCO3 Elevated with alkalosis; decreased in acidosis • Acidosis vs alkalosis • Acidosis • pH of 7.35 and lower • Alkalosis • pH of 7.45 and higher

21. Epistaxis • Etiology/Pathophysiology • Bleeding from the nose • Congestion of the nasal membranes, leading to capillary rupture • Primary • Seconday • Hypertension • Irritation of nasal mucosa • Dryness, chronic infection, trauma

22. Epistaxis • Signs & Symptoms • Bright red bleeding from one or both nostrils • Can lose as much as 1 liter per hour

23. Epistaxis • Treatment • Sitting postion, leaning forward • Direct pressure by pinching nose • Ice compresses to nose • Nasal packing • Cautery • Balloon tamponade

24. Deviated Septum and Nasal Polyps • Etiology/Pathophysiology • Congenital abnormality • Injury • Nasal septum deviates from the midline and can cause a partial obstruction • Nasal polyps are tissue growths usually due to prolonged inflammation

25. Deviated Septum and Nasal Polyps • Signs & Symptoms • Stertorous respirations (snoring) • Dyspnea • Postnasal drip

26. Deviated Septum and Nasal Polyps • Treatment • Medications • Corticosteroids • Antihistamines • Antibiotics • Analgesics • Nasoseptoplasty • Nasal polypectomy

27. Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) • Etiology/Pathophysiology • Antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens

28. Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) • Signs & Symptoms • Edema • Photophobia • Excessive tearing • Blurring of vision • Pruritus • Excessive nasal secretions and/or congestion • Sneezing • Cough • Headache

29. Allergic Rhinitis and Allergic Conjunctivitis (Hay Fever) • Treatment • Avoid allergen • Antihistamines • Decongestants • Topical or nasal corticosteroids • Vancenase, Beconase • Analgesics • Hot packs over facial sinuses

30. Upper Airway Obstruction • Etiology/Pathophysiology • Inflammation of tissue • Dentures • Aspiration • Tongue • Laryngeal spasm

31. Upper Airway Obstruction • Signs & Symptoms • Stertorous respirations • Altered resp. rate and character • Apneic periods • Hypoxia • Cyanosis • Wheezing • Stridor

32. Upper Airway Obstruction • Treatment • Open the airway • Remove obstruction • Artificial airway • Pharyngeal, endotracheal, and tracheal • Tracheostomy

33. Tracheostomy

34. Tracheotomy Tubes

35. Cancer of the Larynx • Etiology/Pathophysiology • Squamous cell carcinoma • Heavy smoking and alcohol use • Chronic laryngitis • Vocal abuse • Family history

36. Squamous Cell Carcinoma of the Larynx

37. Cancer of the Larynx • Signs & Symptoms • Progressive or persistent hoarseness • Pain radiating to the ear • Difficulty swallowing • Hemoptysis

38. Cancer of the Larynx • Treatment • Radiation • Surgery • Partial laryngectomy • temporary tracheostomy • Total laryngectomy • Permanent tracheostomy • No voice • Radical neck dissection

39. Acute Rhinitis(Common Cold, Acute Coryza) • Etiology/Pathophysiology • Inflammation of the mucous membranes of the nose and accessory sinuses • Virus(es)

40. Acute Rhinitis(Common Cold, Acute Coryza) • Signs & Symptoms • Thin, serous nasal exudate • Productive cough • Sore throat • Fever

41. Acute Rhinitis(Common Cold, Acute Coryza) • Treatment • No specific treatment • Analgesic • NO Aspirin for infants, children and adolescents (Reye’s Syndrome) • Antipyretic • Cough suppressent • Expectorant • Antibiotic, if infection present • Encourage fluids

42. Acute Follicular Tonsillitis • Etiology/Pathophysiology • Inflammation of the tonsils • Bacterial infection (streptococcus) • Viral

43. Acute Follicular Tonsillitis • Signs & Symptoms • Enlarged, tender, cervical lymph nodes • Sore throat • Fever • Chills • Enlarged, purulent tonsils • Elevated WBC

44. Acute Follicular Tonsillitis

45. Acute Follicular Tonsillitis • Treatment • Antibiotics • Analgesics • Antipyretics • Warm saline gargles • Tonsillectomy and adenoidectomy • 4-6 weeks after infection has subsided

46. Acute Follicular Tonsillitis • Post-op • Assess for excessive bleeding • Frequent swallowing • Ice cold liquids – ice cream • Avoid acidic juices • Ice collar • Avoid coughing, sneezing, or vigorous nose blowing

47. Laryngitis • Etiology/Pathophysiology • Inflammation of the larynx • Acute or chronic • Viral or bacterial • May cause severe respiratory distress in children under 5 yrs

48. Laryngitis • Signs & Symptoms • Hoarseness • Voice loss • Scratchy and irritated throat • Persistent cough

49. Laryngitis • Treatment • Viral; no specific treatment • Bacterial; antibiotics • Analgesics • Antipyretics • Antitussives • Warm or cool mist vaporizer • Limit use of voice

50. Pharyngitis • Etiology/Pathophysiology • Inflammation of the pharynx • Chronic or acute • Frequently accompanies the common cold • Viral, most common • Bacterial • Gonococcal • Streptococcus (strep throat)