Respiratory Final Presentation

7/28/2019 Respiratory Final Presentation

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P R E P A R E D B Y :

M A R I S O L J A N E T . J O M A Y A

I N S T R U C T O R

THE RESPIRATORY SYSTEM


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L A B O R A T O R Y A S S E S S M E N T

Diagnosis of Pulmonary

Function


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Routine Radiography

Integral part of the diagnostic evaluation ofdiseases involving the pulmonary

parenchyma, the pleura, and to a lesser extent,the airways and the mediastinum.

Usually involves a postero-anterior view and alateral view.

Lateral decubitus views are often useful fordetermining whether pleural deformitiesrepresent freely flowing fluid.


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Chest Radiography


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Computed Tomography

Offers several advantages over conventionalradiographs.

Use of cross-sectional images makes itpossible to distinguish between densities.

Better at characterizing tissue densities andproviding accurate size of lesions.


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Computed Tomography


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Computed Tomography


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Magnetic Resonance Imaging


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Pulmonary Function Tests

Objectively measure the ability of therespiratory system to perform gas exchange by

assessing ventilation, diffusion andmechanical properties.

Composed of the spirometry test andventilation-perfusion (V/Q) test.


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Indications:

Evaluation of the type and degree of pulmonarydysfunction (obstructive or restrictive)

Evaluation of dyspnea, cough and other symptoms Early detection of lung dysfunction

Surveillance in occupational settings

Follow-up or response to therapy

Preoperative evaluation

Disability assessment


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Spirometry Allows for the

determination of thepresence and severity ofobstructive and restrictive

pulmonary dysfunction. The hallmark of

obstructive pulmonarydysfunction is reduction ofairflow rates.

Restrictive pulmonarydysfunction ischaracterized by reductionin pulmonary volumes.


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Ventilation-PerfusionLung Scan (V/Q scan)

Measures the degree ofventilation of the individual

lung segments and theperfusion of respectivesegments to detect anyshunting or mismatch.

Finds utility in settingswhere possible pulmonaryembolism is suspected.


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Arterial Blood Gases

Measure of acid andbase balance in theblood.

Also check thesaturation of blood withoxygen.


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Biologic Specimen Collection

Sputum collection

Spontaneous expectorationor sputum induction

Percutaneous needleaspiration

Usually carried out underCT or ultrasound guidance.

Potential risks includeintrapulmonary bleedingand creation of apneumothorax.


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Thoracentesis

Sampling of pleuralfluid or for palliation ofdyspnea in patients with

pleural effusion.

Analysis of the fluid forcellular compositionand chemical

constituents likeglucose, protein andLDH.


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Bronchoscopy Provides for direct

visualization of thetracheobronchial tree.

Rigid bronchoscopy is

performed in an operatingroom on a patient undergeneral anesthesia.

Flexible bronchoscopy maybe done under localanesthesia / sedation.

Diagnostic uses includehistologic identification orneoplasms and identificationof sources of hemoptysis.


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Bronchoscopy

Therapeuticindications areretrieval of foreignbodies and control

of bleeding. Bronchoalveolar

lavage has beenused for the

recovery oforganisms that aredifficult to isolate inthe usual sputumrecovery methods.


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N E O N A T A L

C H I L D

Y O U N G A D U L T

A C R O S S T H E L I F E S P A N

Diseases of the Respiratory

System


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CHOANAL ATRESIA

Choanal atresia iscongenital obstructionof the posterior nares byan obstructingmembrane or bonygrowth, preventing anewborn from drawing

air through the nose anddown into thenasopharynx.


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CHOANAL ATRESIA

ASSESSMENT

Signs of respiratory distress at birth or immediatelyafter they quiet for the first time and attempt to

breathe through their nose. Failure of the catheter to pass bilaterally through the

nares to the stomach immediately after birth.

Air hunger when mouth is closed color improves

when mouth opens Cyanosis at feedings because the baby cannot suck

and breath through the mouth simultaneously


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CHOANAL ATRESIA


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CHOANAL ATRESIA

Management and Treatment

Local piercing of the obstructing membrane

Surgical removal of the bony growth.

Intravenous fluid to maintain their glucose and fluidlevel until surgery can be performed.

Oral airway inserted so they can continue to breathethrough their mouths.

Following surgery, children have no further difficultyor symptoms.


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LARYNGOTRACHEOBRONCHITIS (LTB)

ACUTELARYNGOTRACHEOBRONCHITIS (LTB)ANDSPASMODIC CROUP

Acute LTB is characterizedby inflammation andnarrowing of the laryngealand tracheal areas. It isthe most common form of

croup and usually affectschildren younger than 5

years old


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Spasmodic croup is similar to acute LTB, but it tendsto occur at night and recurs with respiratory tractinfection

Acute LTB is usually caused by virus Spasmodic croup is not caused by a virus, but may

have associated genetic, allergic, or emotionalpredisposing factors


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Acute LTB Gradual onset from URTI,

which progresses to signs ofdistress

Hoarseness Inspiratory stridor

Retractions

Severe respiratory distress

Low-grade fever Restlessness and irritability

Wheezing


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Spasmodic croup

Is characterized by S/S similar to acute LTB, but thechild is afebrile, the onset is sudden, and the child isawakened at night with a barklike cough


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INTERVENTIONS

Assess respiratory status, monitoring for nasal flaring,sternal retraction, and inspiratory stridor.

Monitor for pallor or cyanosis.

Elevate the head of the bed and provide bed rest.

Assesses for airway obstruction

Keep emergency equipment near the bedside

Administer oxygen and increase atmospheric humidity

Promote desired fluid intake Administer prescribed medications

Minimize fear and anxiety


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INTERVENTIONS

Provide humidified oxygenvia cool-mist tent for thehospitalized child.

Instruct the parents to use

a cool-air vaporizer orhumidifier at home; othermeasures include havingthe child breathe in thecool night air or the air

from an open freezer ortaking the child to a cool

basement or garage.


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BRONCHIOLITIS

is a disorder most commonly caused in infantsbyviral lower respiratory tract infection.

It is the most commonlower respiratory infection

in this age group. It is the inflammation of thebronchioles, the

smallest air passages of the lungs.

It is characterizedby acute inflammation, edema,

and necrosis of epithelial cells lining small airways,increased mucus production, and bronchospasm.
http://en.wikipedia.org/wiki/Bronchiolehttp://en.wikipedia.org/wiki/Bronchiole


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BRONCHIOLITIS

Causes - most commonly

caused byrespiratorysyncytial virus (RSV, alsoknown as human

pneumovirus). - Other viruses

which may cause thisillness include

meta pneumovirus,influenza, parainfluenza,coronavirus, adenovirusand rhinovirus.


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BRONCHIOLITIS

Signs and symptoms are typically rhinitis,

tachypnea, wheezing, cough, crackles, use ofaccessory muscles,and/or nasal flaring

Treatment There is no effective specific treatment for

bronchiolitis. Therapy is principally supportive.


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INTERVENTIONS

Conservative measures Frequent small feeds are encouraged to maintain

hydration as evidenced by good urine output, andsometimes oxygen may be required to maintain bloodoxygen levels.

Suction of the nasopharynx is often performed tomaintain a clear airway.

In severe cases the infant may need to be fed via anasogastric tube or it may even need intravenous fluids.

In extreme cases, mechanical ventilation might benecessary. Bronchodilators Handwashing/Immunization (PALIVIZUMAB)
http://en.wikipedia.org/wiki/Nasopharynxhttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasopharynx


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TONSILLITIS

Tonsillitis is aninfection (usuallyviral) of the tonsils

If a child has many

infections, the tonsilsare surgicallyremoved


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TONSILLITIS

It is believed thattonsils help preventbacteria and other

pathogens fromentering the bodytherefore a removalmay increase the

number of illnesseslater in life


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TONSILLITIS

CAUSES In tonsillitis, structures that are already large become

inflamed due to an infectious agent and cause airway

obstruction, decreased appetite, and pain.

Infection is caused by bacterial or viral organisms, withviral organisms most commonly implicated.

Group A beta-hemolytic Streptococcus is the most

common bacterial cause.


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TONSILLITIS

CLINICAL MANIFESTATIONS

OBSTRUCTIVE SLEEP APNEA

LOUDSNORINGORNOISYBREATHINGINSLEEP EXCESSIVEDAYTIMESLEEPINESS

MOUTHBREATHING


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TONSILLITIS

CHRONIC INFECTIONOF TONSILS

MOUTHBREATHINGORDIFFICULTYBREATHING

FREQUENTSORETHROAT

ANOREXIA, DECREASEDGROWTHVELOCITY FEVER

OBSTRUCTIONTOSWALLOWING/BREATHING

NASAL, MUFFLEDVOICE NIGHTCOUGH

OFFENSIVEBREATH


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Diagnostic Evaluation

Thorough ears, nose, and throat examination andappropriate cultures to determine presence and

source of infection; Preoperative blood studies to determine risk of

bleeding-clotting time, smear for platelets,prothrombin time, partial thromboplastin time


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SURGICAL MANAGEMENT

INDICATIONSFORTONSILLECTOMY

RECURRENTORPERSISTENTTONSILLITISWITHDOCUMENTEDSTREPTOCOCCALINFECTIONFOURTIMESIN

1YEAR

MARKEDHYPERTROPHYOFTONSILS,WHICHDISTORTS

SPEECHCAUSESSWALLOWINGDIFFICULTIES,ANDCAUSESSUBSEQUENTWEIGHTLOSS

TONSILLARMALIGNANCY


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Treatment - tonsillectomy


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INTERVENTIONS

Reducing fear Relieving parental anxiety Assess frequently for

bleeding postoperatively.Check all secretions andemesis for presence of fresh

blood.

Indications of hemorrhageinclude the following: Increased pulse Frequent swallowing Pallor

Restlessness Clearing of throat and

vomiting ,of blood Continuous slight oozing of

blood over a number of

hours Oozing of blood in back of

throat


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INTERVENTIONS

HAVESUCTIONEQUIPMENTANDPACKINGMATERIALREADILYAVAILABLEINCASEOFEMERGENCY.

PROVIDEADEQUATEFLUIDINTAKE.

GIVEICECHIPS 1 TO 2 HOURSAFTERAWAKENINGFROMANESTHESIA.

WHENVOMITINGHASCEASED,ADVANCETOCLEARLIQUIDCAUTIOUSLY.


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INTERVENTIONS

OFFERCOOLFRUITJUICESWITHOUTPULPATFIRSTBECAUSETHEYAREBESTTOLERATED; THENOFFERPOPSICLES, COOLWATERFORFIRST 12 TO 24 HOURS.

AVOIDRED/BROWNFLUIDS.

THEREISSOMECONTROVERSYREGARDINGINTAKEOFMILKANDICECREAMTHEEVENINGOFSURGERY.

EXPLAINANDWRITEINSTRUCTIONSCONCERNINGTHECAREOFTHECHILDATHOMEAFTERDISCHARGE.

DIETSHOULDSTILLCONSISTOFLARGEAMOUNTSOFFLUIDSANDSOFT, COOL, NONIRRITATINGFOODS.(SUPPLYLISTOFSUGGESTIONS.)


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INTERVENTIONS

EATINGHELPSPROMOTEHEALINGBECAUSEITINCREASESTHEBLOODSUPPLYTOTISSUES.

BEDRESTSHOULDBEMAINTAINEDFOR1 TO 2 DAYSANDTHENDAILYRESTPERIODSFORABOUT 1WEEK. RESUME

NORMALEATINGANDACTIVITIESWITHIN 2WEEKSAFTERSURGERY.

AVOIDCONTACTWITHPEOPLEWITHINFECTIONS.

DISCOURAGETHECHILDFROMFREQUENTCOUGHINGANDCLEARINGOFTHROAT.

AVOIDGARGLING. MOUTHODORMAYBEPRESENTFORAFEWDAYSAFTERSURGERY; ONLYMOUTHRINSINGISACCEPTABLE.


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LARYNGITIS

Laryngitis is aninflammation of thelarynx (vocal cords)

CAUSES: virus

allergiesstraining

of voice


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LARYNGITIS

When the larynx is inflamed, the vocal cordscant vibrate properly therefore the voice ishoarse or even non-existent

TREATMENT rest, fluids, no talking!!

i f i


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Upper Respiratory Tract Infections:Common Cold (Infectious Rhinitis)

Viral (rhinovirus) Spread through respiratory droplets Highly contagious Initially mucous membranes of nose,

pharynx swollen, increased secretions Signs Nasal congestion and watery discharge Mouth breathing

Change in tone of voice Sore throat, headache, slight fever Cough


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COMMON COLD

Treatment rest,fluids NOTantibiotics it is a

virus Presently, there is

no cure or vaccine


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COMMON COLD

The cold virus isspread eitherthrough droplets inthe air or direct

contact with aninfected person orcontaminated surface(1 day before

symptoms appearand up to 5 daysafter)

The best way to reduce the chances
http://en.wikipedia.org/wiki/Image:Aerosol_from_Sneeze.jpg


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The best way to reduce the chancesof getting a cold

WASH HANDS!


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CYSTIC FIBROSIS

Genetic condition An abnormal gene

causes the cells liningthe alveoli to secrete

a thick, sticky mucus Mucus attracts

bacteria andnumerous infections

result


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CYSTIC FIBROSIS - treatments

There is no cure lifeexpectancy is usuallylow early 30s

Medicines are used to

thin the mucus Antibiotics are given

for infections


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Diagnostic Tests Pilocarpine iontophoresis sweat

chloride test

Pulmonary function tests

ABG and oxygen saturation levels


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Quantitative Sweat Chloride Test The production of sweat is stimulated (pilocarpine

iontophoresis), the sweat is collected, and thesweat/electrolytes are measured (a minimum of 50mg of is needed).

Normally, sweat chloride concentration is less thanpositive test result.

Chloride concentrations of 40 to 60 mEq/L arehighly suggestive of cystic fibrosis and require arepeat test.


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Medications Immunizations against respiratory infections,

influenza vaccine

Bronchodilators Antibiotics

Dornase alfa, as aerosol breaks down excess DNA insputum


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INTERVENTIONS

RESPIRATORYSYSTEM GOALSOFTREATMENTINCLUDEPREVENTINGAND

TREATINGPULMONARYINFECTIONBYIMPROVINGAERATION, REMOVINGSECRETIONS,ANDADMINISTERINGANTIMICROBIALMEDICATIONS.

CHESTPHYSIOTHERAPY(PERCUSSIONANDPOSTURALDRAINAGE) ONAWAKENINGANDINTHEEVENING (MORE

FREQUENTLYDURINGPULMONARYINFECTION). CHESTPHYSIOTHERAPYSHOULDNOTBEPERFORMED

BEFOREORIMMEDIATELYAFTERAMEAL.


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ILLUSTRATIONS FORPOSTURAL DRAINAGE

UPPER LOBES FRONT

ILLUSTRATIONS FORPOSTURAL DRAINAGE

UPPER LOBES BACK

O S


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INTERVENTIONS

BRONCHODILATORMEDICATIONBYAEROSOLOPENSTHEBRONCHIFOREASIEREXPECTORATION (ADMINISTEREDBEFORETHECHESTPHYSIOTHERAPYWHENTHECHILDHASREACTIVEAIRWAYDISEASEORISWHEEZING).

ADMINISTRATIONOFRECOMBINANTHUMANDEOXYRIBONUCLEASE

(DNASE), KNOWNGENERICALLYASDORNASEALFA(PULMOZYME),WHICHDECREASESTHEVISCOSITYOFMUCUS.


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INSTRUCTTHEPARENTSNOTTOGIVECOUGHSUPPRESSANTS, FORTHEYWILLINHIBITEXPECTORATIONOFSECRETIONSANDPROMOTEINFECTION.

TEACHTHECHILDFORCEDEXPIRATORYTECHNIQUE(HUFFING) TOMOBILIZESECRETIONS.


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DEVELOPAPHYSICALEXERCISEPROGRAMWITHTHEAIMOFESTABLISHINGAGOODHABITUALBREATHINGPATTERN.

ADMINISTERANTIBIOTICSASPRESCRIBED,WHICHMAYBEPRESCRIBEDPROPHYLACTICALLYORWHENPULMONARYSYMPTOMSDEVELOP.

ADMINISTEROXYGENASPRESCRIBEDDURINGACUTE

EPISODES; MONITORCLOSELYFOROXYGENNARCOSIS.


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MONITORFORHEMOPTYSIS; GREATERTHAN 300 MLIN 24 HOURSFORTHEOLDERCHILD (LESSFORA

YOUNGERCHILD) NEEDSTOBETREATEDIMMEDIATELY.

HEMOPTYSISMAYBECONTROLLEDBYBEDREST,COUGHSUPPRESSANTS,ANTIBIOTICS,ANDVITAMINK; IFHEMOPTYSISPERSISTS, THESITEOFBLEEDINGMAYBECAUTERIZEDOREMBOLIZED.

LUNGTRANSPLANTATIONISAFINALTHERAPEUTICOPTIONFORTHECHILDWITHEND-STAGEDISORDER.

INTERVENTIONS


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INTERVENTIONS

GASTROINTESTINALSYSTEM THEGOALOFTREATMENTFORPANCREATIC

INSUFFICIENCYISTOREPLACEPANCREATICENZYMES;ADMINISTEREDWITHMEALSANDSNACKS (ORWITHIN

30 MINUTESOFEATINGMEALSANDSNACKS) TOENSURETHATDIGESTIVEENZYMESAREMIXEDWITHFOODINTHEDUODENUM.

THEAMOUNTOFPANCREATICENZYMESADMINISTERED

ISADJUSTEDTOACHIEVENORMALGROWTHANDADECREASEINTHENUMBEROFSTOOLSTOTWOORTHREEPERDAY.

INTERVENTIONS


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INTERVENTIONS

ENTERIC-COATEDPANCREATICENZYMESSHOULDNOTBECRUSHEDORCHEWED.

PANCREATICENZYMES

SHOULDNOTBEGIVENIFTHECHILDISTORECEIVENOTHINGBYMOUTH.

ENCOURAGEAWELL-BALANCED, HIGH-

PROTEIN, HIGHCALORIEDIET; MULTIVITAMINSANDVITAMINS A, D E,AND KAREALSOADMINISTERED.

INTERVENTIONS


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INTERVENTIONS

ASSESSWEIGHTANDMONITORFORFAILURETOTHRIVE. MONITORFORCONSTIPATIONANDINTESTINALOBSTRUCTION.

ENSUREADEQUATESALTINTAKEDURINGEXTREMEHOTWEATHERORIFTHECHILDHASAFEVER; INCLUDEFLUIDSSUCHAS GATORADEOREXCEED,WHICHPROVIDEANADEQUATESUPPLYOFELECTROLYTES.

CYSTIC FIBROSIS


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CYSTIC FIBROSIS

New treatmentsinclude gene therapy

An inhaler is used tospray healthy

versions of theabnormal gene thehealthy genes canthen make propermucus

PULMOZYME

NOSE FRACTURE


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NOSE FRACTURE

A fractured nose is the mostcommon facial fracture.

It usually results from ablunt injury and is often

associated with other facialfractures. The bruisedappearance usuallydisappears after 2 weeks.

Nose injuries and neckinjuries are often seentogether


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Serious nose injuriescause problems that

require immediateprofessional attention.However, for minornose injuries, thedoctor may prefer to

see the victim after theswelling subsides. Occasionally, plastic

surgerymay benecessary to correct a

deformity of the noseor nasal septum causedby a trauma.

NOSE FRACTURE


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NOSE FRACTURE

First Aid Reassure the patient and try to keep the patient

calm.

Have the patientbreathe through the mouth and

lean forward in a sitting position in order tokeep blood from going down the back of the throat.

Applycold compresses to the nose to reduceswelling. If possible, the patient should hold the

compress so that excessive pressure is not applied. To help relieve pain, acetaminophen is

recommended.

NOSE FRACTURE


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NOSE FRACTURE

DO NOT try to straighten a broken nose. DO NOT move the person if there is reason to

suspect a head or neck injury.

Call immediately for emergency medicalassistance if

You suspect a neck or head injury

Bleeding will not stop

Clear fluid keeps draining from the nose

The person is having difficulty breathing

NOSE FRACTURE


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NOSE FRACTURE

Prevention Protective headgear should be worn while playing

contact sports, riding bicycles, skateboards, roller-skates, or roller blades.

Seat belts and appropriate car seats should be used.

DEVIATED SEPTUM


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DEVIATED SEPTUM

Definition The nasal septum

is a thin structure,separating the twosides of the nose.If it is not in themiddle of the nose,then it is deviated.


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It is common for apatient to complainthat he/she can

breathe through only

one nostril. Then thediagnosis is easy.

A deviated septummay also contribute

to snoring, sleepapnea, and other

breathing disorders.


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As a palliative, saline drops and sprays are veryhelpful in loosening mucus in the obstructed side andpreventing drying in the other side, where all the air

blows.

Hot peppers, such as jalapenos, can produce enoughtears and discharge to flush out a stopped-up nose.

An even more effective treatment is called a nasallavage, often done using a small pot with a spout.

Nasospecific, a procedure where a deflated balloon is

inserted in the nostril and inflated to a large enoughdegree to adjust the septal deviation, can be analternative to surgery.


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Treatment The definitive treatment is surgical repositioning of

the septum, accomplished by breaking it loose andfixing it in a proper place while it heals.

Decongestants likepseudoephedrine orphenylpropanolamine will shrink the membranesand thereby enlarge the passages.

Antihistamines, nasal cortisone spray, and otherallergy treatments may also be temporarily

beneficial.

NASAL POLYPS


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NASAL POLYPS

NASALPOLYPSAREPOLYPOIDALMASSESARISINGMAINLYFROMTHEMUCOUSMEMBRANESOFTHENOSEANDPARANASALSINUSES.THEYAREOVERGROWTHSOFTHEMUCOSATHATFREQUENTLYACCOMPANYALLERGICRHINITIS. THEYAREFREELYMOVEABLEANDNON-TENDER.

NASAL POLYPS
http://en.wikipedia.org/wiki/Polyp_(medicine)http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Polyp_(medicine)


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NASAL POLYPS

SYMPTOMS NASALBLOCK SINUSITIS ANOSMIAORLOSSOFSMELL

SECONDARYINFECTIONLEADINGTOHEADACHE. CAUSE: UNKNOWNBUTARECOMMONLYTHOUGHTTOBECAUSEDBY ALLERGY ASIGNIFICANTNUMBERAREASSOCIATEDWITHNON-

ALLERGICADULTASTHMAORNORESPIRATORYORALLERGICTRIGGERTHATCANBEDEMONSTRATED.
http://en.wikipedia.org/wiki/Sinusitishttp://en.wikipedia.org/wiki/Anosmiahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Anosmiahttp://en.wikipedia.org/wiki/Sinusitis


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TREATMENT STEROIDSTOPICALOR

ORAL

SURGICAL

METHODS

.

FUNCTIONAL ENDOSCOPIC SINUS SURGERY


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FUNCTIONAL ENDOSCOPIC SINUS SURGERY

PHARYNGITIS


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PHARYNGITIS

PHARYNGITISISANINFLAMMATIONOFTHE

PHARYNX, INCLUDINGPALATE,

TONSILS,ANDPOSTERIORWALL

OFTHEPHARYNX, MOST

COMMONLYCAUSEDBYACUTE

INFECTION, USUALLYTRANSMITTEDTHROUGH

RESPIRATORYSECETIONS.

STREPTOCOCCALPHARYNGITIS

(STREPTHROAT)ANDRHINOVIRUSES (COMMONCOLD)

AREFREQUENTCAUSES.

PHARYNGITIS


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PHARYNGITIS

Acute bacterial pharyngitis is usually caused bygroup A beta-hemolytic streptococci (streptococcalpharyngitis/strep throat).

Peak age group for streptoccocal pharyngitis is 5 to

18, but it may occur in all age groups.

PHARYNGITIS


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PHARYNGITIS

Other bacterial causes includeH. influenzae,,Corynebacterium diphtheriae (diphtheria),

Neisseria gonorrhoeae (gonorrhea), and othergroups of streptococcus.

Transmission ofN. gonorrhoeae is through oralcontact with genital secretions;

More chronic causes are irritation from postnasal

drip of allergic rhinitis and chronic sinusitis,chemical irritation, and systemic diseases

PHARYNGITIS


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PHARYNGITIS

For acute bacterial infections, abrupt onset of sorethroat and fever (usually above 38.2 0C instreptococcal pharyngitis.

Throat pain

Pharynx appears reddened with edema of uvula;pharynx and tonsils may be covered with exudate

Varying degrees of sore throat, nasal congestion,

fatigue, and fever with other bacterial and viralcauses.


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DIAGNOSTICS Throat culture or rapid streptococcal antigen

detection test to rule out streptococci. Rapid streptests provide results within 5 minutes.

TREATMENT

ANTIBIOTICS


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Encourage compliance with full course ofantibiotic therapy, despite feeling better in severaldays, to prevent complications.

Advise lukewarm saline gargles and use

antipyretic/analgesics as directed to promotecomfort.

Encourage bed rest with increased fluid intake

during fever.

SINUSITIS


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SINUSITIS

Sinusitis is aninflammation of

the mucous

membranes of one

or more paranasal

sinuses.


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It is usually precipitated bycongestion from viral upperrespiratory infection and/ornasal allergy.

Obstruction of the sinus

ostia (resulting frommucosal swelling and/ormechanical obstructionleads to retention ofsecretions and is the usualprecursor to sinusitis.


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Acute Sinusitis Pain stabbing or aching, over the infected sinus

and referred to face and head

Nasal congestion and discharge; may or maynot be present

Anosmia (lack of smell): inspired or expired aircannot reach the olfactory groove

Red and edematous nasal mucosa May have fever


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Chronic Sinusitis Persistent nasal obstruction; chronic nasal discharge

clear or purulent when infected

Cough produced by constant dripping of dischargeback into nasopharynx

Feeling of facial fullness/pressure

Headache may be vague or in same pattern as

acute sinusitis, more noticeable in the morning;fatigue


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Topical decongestant sprayor drops orsystemic decongestants for mucosal shrinkage toencourage drainage from sinus.

Topical nasal corticosteroids are frequentlyused in chronic sinusitis, and may be used in acutecases.

Analgesics pain may be significant

Warm compresses; cool vapor humidity for comfort and topromote drainage

LEGIONNAIRES DISEASE


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LEGIONNAIRE S DISEASE

Causes The bacteria that cause

Legionnaire's disease have beenfound in water delivery systems.They can survive in thewarm,moist, air conditioning systems

of large buildings, includinghospitals. Spread of the bacteria from

person to person has not beenproven.

Most infections occur in middle-

aged or older people, although theyhave been reported in children.Typically, the disease is less severein children.


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Symptoms tend to get worseduring the first 4 - 6 days.They typically improve inanother 4 - 5 days.

Chest pain Coughing up blood Fever Gastrointestinal symptoms,

such as diarrhea, nausea,vomiting, and abdominalpain

General discomfort,uneasiness, or ill feeling(malaise)

Headache Joint pain

Loss of energy

Muscle aches andstiffness

Nonproductive cough

Shaking chills

Shortness of breath

DIAGNOSTICS
http://www.nlm.nih.gov/medlineplus/ency/article/003089.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003089.htm


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G OS CS

Tests that may be done include: Arterial blood gases

Chest x-ray

Complete blood count (CBC), includingwhite bloodcell count

Erythrocyte sedimentation rate

Liver function tests

Sputum culture for theLegionella bacteria

INTERVENTIONS
http://www.nlm.nih.gov/medlineplus/ency/article/003855.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003804.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003642.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003638.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003436.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003723.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003723.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003436.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003638.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003642.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003804.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003804.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003804.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003855.htm


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Antibiotics are used to fight the infection. Treatmentis started as soon as Legionnaire's disease issuspected, without waiting for confirmation by labtest.

Antibiotics commonly used to treat this conditioninclude:

Quinolones (ciprofloxacin, levofloxacin,

moxifloxacin, or gatifloxacin) Macrolides (azithromycin, clarithromycin, or

erythromycin)


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CHEST INJURIES

RIB FRACTURES


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Rib fracture results fromdirect blunt chesttrauma and causes apotential forintrathoracic injury,

such as pneumothorax orpulmonary contusion.

Pain with movementand chest splinting result

in impaired ventilation andinadequate clearance ofsecretions.


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Pain on inspiration,coughing

Voluntary splinting,rapid and shallow

breathing, inhibitedcough, diminished

breath sounds over area

Palpable crepitus overarea, bruising

INTERVENTIONS


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Note that ribs usually unite spontaneously. Position the client in high Fowler's position.

Administer pain medication as prescribed tomaintain adequate ventilatory status.

Monitor for increased respiratory distress.

Instruct the client to self-splint with hands and arms.

Managed at home


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FLAILCHEST

Flail chest is blunt chest trauma associated with accidents,

which may result in hemothorax and rib fractures. The loose segment of the chest wall becomes paradoxical to

the expansion and contraction of the rest of the chest wall.


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Pain and dyspnea oninspiration

Paradoxic chestmovement

Palpable crepitus

Diminished breathsounds

> high Fowler's position.

>humidified oxygen asprescribed.>Encourage coughing anddeep breathing.>Administer painmedication as prescribed.

>Maintain bed rest and limitactivity to reduce oxygendemands.>Prepare for intubationwith mechanicalventilation, with PEEP for

severe flail chest associatedwith respiratory failure andshock.

PULMONARY CONTUSION


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a. Often results from abruptchest compression: ruptureof alveoli and pulmonaryarterioles with hemorrhage

and interstitial and bronchialedema

b. May result in airwayobstruction, atelectasis,

impaired gas diffusionimpacting ability to clearsecretions and breathe


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Manifestations: Appear 12 -24 hours

after injury

Increasing shortness ofbreath, restlessness,chest pain

Copious sputum,

possibly blood tinged May lead to ARDS,

death

Significant pulmonarycontusion can result inlong-term insufficiencyrequiring home healthreferral Client and familyeducation regarding

care of chronicrespiratory problem


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PNEUMOTHORAX


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a. Pneumothorax is the accumulation of atmospheric air inthe pleural space, which results in a rise in intrathoracic

pressure and reduced vital capacity.b. The loss of negative intrapleural pressure results in

collapse of the lung.c. A spontaneous pneumothorax occurs with the rupture

of a bleb.d. open pneumothorax/secondary pneumothorax

occurs when an opening through the chest wall allows

the entrance of positive atmospheric pressure into thepleural space

e. TENSION PNEUMOTHORAX


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HEMOTHORAX


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Blood in pleural spaceresulting from chesttrauma, surgery,diagnostic procedures

Blood collection results in

impaired ventilation andgas exchange, risk ofshock

Manifestations are

similar to pneumothorax;diminished lung soundsand dull percussion tone


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Diagnosis is made by chest xray Treatment includes insertion of chest tube; blood

replacement if significant loss (may be replaced byautotransfusion in which blood collected in chest

tube and then reinfused within 4 hours as withplanned thoracic surgery)


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Dependent upon severity of problem 1. Small ones: may involve serial xrays to monitor

resolution without intervention 2. Symptomatic requires insertion of chest tubes

(thoracostomy)

Thoracostomy: placement of closed-chest catheter toallow lungs to re-expand

Pleurodesis - Creation of adhesions between parietaland visceral pleura to prevent recurrent pneumothorax

---Instillation of chemical agent (bleomycin, tetracycline,povidone iodine, doxycycline) to cause inflammation andscarring

Di f th R i t


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Diseases of the Respiratory

System

OBSTRUCTIVEAIRWAY DISEASES

Asthma


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Increased responsiveness of lower airways tomultiple stimuli.

Episodic and with reversible obstruction.

May range in severity from mild withoutlimitation of patients activity, to severe andlife-threatening.

Men and women are equally affected.Afflicts children more commonly than adults.

ASTHMA


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Asthma is a chronicrespiratory disorder

Bronchi andbronchioles are

affected bronchiolemuscles tighten,mucus is produced

breathing is difficult

Asthma


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Airway narrowing

results from: Smooth muscle

spasm

Airway edema and

inflammation

Mucus plugging


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Variants: Exercise-induced asthma

Triad asthma nasal polyps, asthma, aspirin intolerance

Cardiac asthma - An asthmatic attack due to

bronchoconstriction caused by pulmonary congestionand failure of the left ventricle.

Asthmatic bronchitis

Drug-induced asthma Aspirin/NSAIDs

ASTHMA - causes


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Generally it isthought that asthmais somewhatinherited

TRIGGERS includepollen, dust, smoke,pets, exercise,exercise, drugs,infectioin

ASTHMA - symptoms


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Chest tightness

Wheezing

Night-time cough

Restricted breathing

Labored breathing;flaring nares

Cough; increasedsecretions

Distended neck veins Pulsus paradoxus


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INTERVENTIONS


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Assess airway patency.

Continuously monitorrespiratory status, pulseoximetry, and color; bealert to decreased

wheezing or a silentchest, which may signalthe inability to move air.

Prepare the child for achest radiograph.

Initiate an intravenousline, and prepare tocorrect dehydration,acidosis, or electrolyteimbalances.

Administer humidifiedoxygen by nasal prongsor face mask.

Administer quick-relief (rescue)medications.


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1. Quick-Relief (RescueMedications)Short-acting B2-agonists

Anticholinergics (for relief ofacute bronchospasm)Systemic corticosteroids (for its

antiinflammatory action to treatreversible airflow obstruction)

ASTHMA - treatments


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IMMEDIATEbronchodilators give immediate reliefto tightened

bronchioles

Inhalers can bemetered - ie medicineis forced out by achemical propellant

powdered - nopropellant


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2. Long-term control (preventer medications): to achieve

and maintain control of inflammation

Leukotriene modifiers to prevent bronchospasm and

inflammatory cell infiltration

3. Nebulizer, metered-dose inhaler or peak expiratory flow

meters

4. Chest physiotherapy

5. Allergen control

Prevention and reduction of exposure to airborne and

environmental allergens

Chronic Obstructuve Pulmonary Disease


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FACTORS:

Cigarette smoking

Air pollution

Occupational exposure todusts and gases

Airway infection

Genetic and familialfactors

The Philippine Burden of

Lung Disease studyindicated that 12 percentor one in eightindividuals 40 years andabove living in MetroManila suffers fromCOPD

Top eight mortality causein RP

Affects middle-aged andolder adults

BRONCHITIS


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An infection of thebronchi

2 types:

1. Acute caused by abacteria

- treated withantibiotics

CHRONIC BRONCHITIS


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Bronchial Inflamation mucus ciliar.acidosis

Causes:

Smoking

Pollution

Allergens

CHRONIC BRONCHITIS


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Assessment:

1. Chronic Cough

2. Blue Bloater: cyanotic edema

chronic cough exertional dyspnea,RR

hypoxia polycythemia- RBC

hypercapnia cor pulmonale-RVH &

resp. acidosis dilatation

incidence in heavy cigarette smokers


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EMPHYSEMA


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A chronic respiratorydisorder

The alveolar wallsbreak down & lose

their elasticity Surface area is

greatly reduced breathing is difficult

EMPHYSEMA


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Destruction and Overdistension of the Alveoli

Air Trapping

Respi. Acidosis

Cigarette smokingHeredity, Bronchial asthma Aging process


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Disequilibrium betweenELASTASE & ANTIELASTASE (alpha-1-antitrypsin)

Destruction of distal airways and alveoli Overdistention of ALVEOLI

Hyper-inflated and pale lungs

Air trapping, decreased gas exchange and Retention of CO2

Hypoxia Respiratory acidosis

EMPHYSEMA


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CAUSES:

1. Smoking, Pollution and Allergens

2. alpha-antitrypsin causes expansion of the

alveoli

- strengthens the walls of the

alveoli(blebs)

EMPHYSEMA


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Assessment:

pink puffer:

mucus speaks in short & jerky sentence

coughing anxious

orthopneic pos. Frequently develop URTI

barrelled chest Prolonged expiratory time

SOB digital clubbing

wheezing

EMPHYSEMA


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ASSESSMENT:

1. Exertional Dyspnea

2. Barrelled chest

3. Hyperesonance

4. Spontaneous pneumothorax

EMPHYSEMA - treatments


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Low-flow oxygen tank delivers a higheroxygen concentration

Lung volumereduction surgery(LVR) removal ofdamaged tissue to lethealthy tissue workmore efficiently

INTERVENTIONS


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Monitor vital signs.

Administer a lowconcentration of oxygen (1to 2 L/min) al) prescribed;the stimulus to breathe is alow aeterial P02 instead of

an increased Pao2 Provide respiratory

treatments and CPT.

Instruct the client indiaphragmatic orabdominal and pursed lip

breathing techniques.

Suction fluids from the

client's lungs, if necessary,to clear the airway andprevent infection.

Monitor weight.

Encourage small, frequentmeals to prevent dyspnea.

Provide a high-calorie,high-protein diet withsupplements.

INTERVENTIONS


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Encourage fluid intake up

to 3000 mL/day to keepsecretions thin, unlesscontraindicated.

Position client in highFowler's position and

leaning forward to aid inbreathing.

Allow activity as tolerated.

Administer

bronchodilators asprescribed, and instruct theclient in the use of oral andinhalant medications.

Administer corticosteroids

as prescribed to reduceinflammation.

Administer mucolytics asprescribed to thinsecretions.

Administer antibiotics forinfection if prescribed.

OCCUPATIONAL LUNG DISEASES


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Asbestosis is a diffuse

interstitial fibrosis of thelung caused by inhalationof asbestos dust andparticles.

Found in workers involved inmanufacture, cutting and

demolition of asbestos-containing materials,

Asbestos mining andmanufacturing, construction,roofing, demolition work,brake linings, floor tiles,paints, plastics, shipyards,insulation

Fibrous pleural thickening

and pleural plaqueformation producerestrictive lung disease,decrease in lung volume,diminished gas transfer, andhypoxemia with subsequent

development of corpulmonale.

OCCUPATIONAL LUNG DISEASES


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SILICOSIS is a chronic

pulmonary fibrosis causedby inhalation of silica dust.

Exposure to silica dust isencountered in almost anyform of mining because the

earths crust is composed ofsilica and silicates (gold,coal, tin, copper mining);also stone cutting,quarrying, manufacture of

abrasives, ceramics,pottery, and foundry work.

When silica particles

(which have fibrogenicproperties) are inhaled,nodular lesions areproduced througout thelungs. These nodules

undergo fibrosis, enlarge,and fuse.

OCCUPATIONAL LUNG DISEASES COAL WORKERS


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COAL WORKERSPNEUMOCONIOSIS

(CWP; black lung) is a variety

of respiratory disease found in coalworkers in which there is anaccumulation of coal dust in thelungs, causing a tissue reaction inits presence.

Dusts (coal, kaolin, mica,silica) are inhaled and deposited

in the alveoli and respiratorybronchioles.

When normal clearancemechanisms no longer can handlethe excessive dust load, therespiratory bronchioles and alveolibecome cloged with coal dust,

dying macrophages, andfibroblasts, which lead to theformation of the coal macule, theprimary lesion of CWP.

ASSESSMENT


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Chronic cough; productive

in silicosis and CWP Dyspnea on exertion;

progressive and irreversiblein asbestosis and CWP

Susceptibility to lowerrespiratory tract infections

Bibasilar crackles inasbestosis.

Expectoration of varyingamounts of black fluid andCWP.

INTERVENTIONS


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There is no specific treatment; exposure is eliminated,

and the patient is treated symptomatically. Give prophylactic isoniazid (INH) to patient with positive

tuberculin test, because silocosis is associated with high risk ofTB

Persuade people who have been exposed to asbestos fibers tostop smoking to decrease risk of lung cancer.

Keep asbestosis worker under cancer surveillance; watch forchanging cough, hemoptysis, weight loss, melena, and so

forth. Bronchodilators may be of some benefit if any degree airway

obstruction is present

PNEUMONIA


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The alveoli become

inflamed and fill withliquid

Gas exchange isimpaired and the

body becomesstarved for oxygen


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X-RAY OF PNEUMONIA


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Patient haspneumonia inthe right lung(note white

mass = fluid)

Lungs shouldappear black onan x-ray

Lobular pneumonia


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Lobularpneumoniaaffects a lobeof the lungs(see x-ray),andbronchialpneumoniacan affectpatches

throughoutboth lungs.

TYPES OF PNEUMONIA


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LOBULAR BRONCHIAL

TREATMENT


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BACTERIAL

Caused by thebacterium

Streptococcuspneumoniae

Treated withantibiotics

Can be somewhatprevented with thepneumococcal

vaccine

VIRAL

Caused by a virus

Can be treated with

anti-viral medication They are usually less

severe however asecondary bacterial

infection can followwhich is then treatedwith antibiotics


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ASSESSMENT INTERVENTIONS

Chills

Elevated temperature

Pleuritic pain Rhonchi and wheezes

Use of accessory musclesfor breathing

Cyanosis Mental status changes

Sputum production

Administer oxygen as prescribed. Monitor respiratory status. Monitor for labored respirations,

cyanosis, and cold and clammy skin. Encourage coughing and deep

breathing and use of incentivespirometer.

Position client in semi-Fowlerposition to facilitate breathing andlung expansion.

Change client's position frequently

and ambulate as tolerated tomobilize secretions.

Provide CPT. Perform nasotracheal suctioning if

the client is unable to clear secretions


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END

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