Respiratory Illnesses: Signs and Symptoms, Diagostic Tests, Treatments

Respiratory Illnesses: Signs and Symptoms, Diagostic Tests, Treatments



Respiratory Illnesses Worksheet by Tsewang Rinzin

Pathophysiology Typical signs and Symptoms of this disease process Any labs and diagnostic tests. What results indicated the problem Non-pharmacologic treatment that maybe ordered Nursing responsibilities related specifically to this problem
Tuberculosis (TB)

An infectious disease caused by Mycobacterium tuberculosis organism. It is spread from an infected person via droplets (not contact) from activities such as coughing, laughing and sneezing. It has a potential to affect any part of the body but usually only affects the lungs, as the macrophages in the lungs pick up the inhaled pathogens.

Loss of appetite, weight loss, fatigue, fever, night sweats, chills, chest pain, pain with breathing or coughing, and coughing blood or for more than three weeks. PPD (purified protein derivative) skin test: if skin swells up more than 15mm, it is considered positive. However, it doesn’t necessarily mean the patient has TB; it only means that the patient was once exposed to the Mycobacterium tuberculosis.

Sputum test: to find out if any active tuberculin organism is present.  Chest X-ray: It helps to figure out how the lung is affected. Any abnormalities could be due to infection.

Healthy eating, exercise and living conditions to strengthen the immune system to fight of symptoms of weak feelings. Provide respiratory isolation for at least a couple of weeks during the start of the therapy.

Direct Observed Therapy might be necessary to make sure the compliance and accuracy for taking the combination of meds. Help minimize the adverse reactions, such as offering probiotic yogurt to ward off antibiotic side effects of stomach distress.

Pneumonia

An inflammatory process involving lungs due to infection of bacteria, virus or fungi within the upper respiratory tract. Pneumonia can also be caused by aspiration of food or gastric contents. Lung tissues swell and alteration in lungs ability to maintain oxygenation takes place.

Abrupt fever, cough, sputum is purulent, blood tinged or rust-colored, malaise, breathlessness, chills, sweats, chest pain, tachypnea, abnormal lungs sounds of crackles, wheezing or rhonchi and dullness on chest percussion. Chest x ray to find out lung inflammation occurrences. CBC for white blood cell count, abnormal values indicate infection. Arterial Blood Gas, ABG, to find out if normal oxygenation is taking place. Pleural fluid culture to see if the fluids are present in the lungs. Sputum culture to look for the pathogen. Drink fluids to loosen up the secretions. Get rest so that the tired body doesn’t have to work harder. Artificial oxygenation device might need to be started. Assess for respiratory distress and oxygen saturation rate. Position semi-fowler to optimize lung expansion. Schedule activities to prevent respiratory depreciation.
Atelactasis

It is a collapse of part or all of lung due to either block of the respiratory passage or pressure on outside the lung.

Breathing difficulty, cough and chest pain. Bronchoscopy will help doctor know whether or not the lung expansion has been affected and can clear up the blockages very easily. Chest x ray could also tell the size of the lungs. Encourage deep and pursed lip breathing and coughing. Suction the mucus out. Postural drainage of head positioning lower than the chest to drain mucus. Monitor and assist patient with positioning in and out of the bed. Provide reassurance to relieve anxiety.
Lung Cancer

Our surrounding are full of respiratory irritants which when breathe into our lungs can change the mucociliary lining of the lungs. The repeated exposure to these carcinogens results in malignant lung tisse.

Coughing, shortness of breath, stridor or wheezing, hemoptysis, swelling in face, next and extremities. Confusion and decreased reflexes. Tumors could result in sodium loss and water retention. X ray, CT scan, MRI and PET scan of chest to see how lung looks. Bronchoscopy and biopsy are also possible diagnostic tests to get samples of the lung tissue. Avoid suspected food allergens, take proper nutrition and hydration. Keep the head of the bed high to maintain good airway to the lung. Keep away from cigarette smoke, monitor oxygenation and gas exchange, keep the air cool and moist, prevent from any new infection, and encourage patient to report any pain or discomfort with breathing.
COPD – chronic bronchitis

Excessive production of mucus happens with a chronic cough that lasts more than 3 months of the year for 2 consecutive years. It is usually caused by exposure to respiratory irritants such as tobacco smoke, air pollution, toxic flames and dust. This eventually causes inflammation that result in swelling and thickening of the bronchiole linings.

Persistent and productive cough, usually after a night’s sleep. Purulent mucus. Chest congestion and shortness of breath, as disease progresses. With progressive disease, clubbed fingers and barrel-shaped chest are common. Scarring of the bronchiole walls. Pulmonary function tests with spirometry and peak flow monitoring devices. ABGs to measure lungs ability to provide blood with oxygen and remove carbon dioxide. Pulse oximetry to measure oxygen saturation rate. X ray and CT scan images to view how the lung looks. Auscultate lungs for wheezing or abnormal sounds. Stop smoking to slow down lung damage. Oxygen therapy if the oxygen saturation is too low. Pulmonary rehabilitation regiment, including exercises. Avoid very cold air. Eat healthy diet of fish, meat, poultry along with fruits and vegetables. Assist in performing breathing and coughing maneuvers. Instruct the optimal position of sitting up and importance of ambulation. Use humidifier and encourage oral intake of fluids to loosen secretions.
COPD – asthma

A respiratory disorder with three main hyper-responsiveness characteristics of recurring airway obstruction episodes, hypersensitive airways that narrow in response to certain stimuli and inflammation of the airways. It is often caused by agents such as dust, animal dander, pollen, perfume, respiratory viruses, GERD, and chronic sinusitis. Cytokines prolong the inflammation and collagen gets deposited in the bronchial membrane, and causes thickening of the walls.

Intercostal retractions when breathing, audible wheezing/whistling while exhaling, abnormal breathing pattern of breathing out taking twice as long as breathing in, chest tightness, thick and tenacious mucus difficult to clear out, breathlessness, and paradoxical pulse Allergy testing to identify allergens responsible. Auscultation of lung sound for asthma-related sounds of wheezing. Blood test to measure eosinophil (a type of white blood cell) count and IgE to test inflammation. Stop smoking, perform breathing exercises, keep the environment cleans especially from the known allergens, and drink plenty of fluids to keep secretions loose. Encourage abdominal and pursed lip breathing. Maintain and support adequate respiratory function. Provide the patient with detailed explanation about the asthma management drugs and side effects. Evaluate the patient’s environment for allergens triggering the asthma. Elevate head of the bead for easier breathing.
COPD – emphysema

It’s an enlargement of distal air spaces in lung s and destruction of alveoli. It is primarily caused by smoking. Irritants in cigarette smoke damage epithelial lining. It also increases the activity of an enzyme elactase that digest lung tissue.

Gradually increasing breathlessness with exertion. Tends to be malnourished as eating increase their oxygen demands. Barrel chested. Cough with mucus. Fatigue. Frequent respiratory infections. Spirometer and other pulmonary function test to see how well lungs can hold and flow air. Sputum examination for any infections. Chest x ray and CT Scan can enable the view of internal organs with any abnormalities such as holes. ABG to see how well lungs transfer oxygen into and remove carbon dioxide from the bloodstream. Diaphragmatic breathing of pushing abdomen out as chest becomes filled with air. Pursed lip breathing, where breathing out against pursed lips increase pressure inside and minimize the collapse. Help SOB patients by spacing cares and activities over a long time period. Provide nutrient dense meals and snacks. Assist with ambulation if necessary.
Pulmonary Fibrosis

It is the thickening and scarring of the interstitial tissues, the walls between alveoli of the lungs. This condition makes it difficult for the oxygen to travel across the membrane into the bloodstream. It can result from inflammatory response to various agents.

Fever, fatigue, weight loss, diffuse muscle, joint pain, dry and non productive cough, tachypnea, clubbed finger tips, crackles on auscultation, dyspnea on exertion, honeycombed cyst appearance on lung tissues, and discomfort in chest. Bronchoscopy with transbronchial lung biopsy to get a lung tissue sample to identify any scarring and thickening. Chest x ray and CT scan can do the same, but in a less invasive manner. Measurement of lung function test with oximetery and ABG tests. Pulmonary rehabilitation program focusing teaching how to breath more efficiently, maintain good lung functioning, proper nutrition consumption, etc. Teach patients the proper way to safely and efficiently administer the medications and respiratory therapy devices. Assess respirations frequently. Organize activities to minimize oxygen demand and maximize comfort. Position for a good lung expansion when in resting.
Pulmonary Edema

This occurs when fluid builds up in the small air sacs of the lungs and makes breathing difficult. It can happen due to pneumonia, toxins, strenuous activity at high elevation, congestive heart failure, fluid overload from other organs, etc.

Extreme SOB, feeling of suffocation or drowning, wheezing, gasping, anxiety, weight gain, excessive sweating, pale skin, chest pain, arrhythmias, and sputum that is pink and frothy, Chest x ray may reveal fluid around lungs. ECG to identify any slowing of blood flow. Pulmonary artery catheterization helps identify pressure readings. Ultrasound (echocardiogram) to see if there weak sound or fluid surrounding the heart. Weighing daily to track any weight gains. Go on low salt diet. Get plenty of rest to bring lung heal and bring function back to normal. Monitor vital signs, especially blood pressure. Caution with hypotension medications. Encourage to follow the full therapy. Keep away from strenuous activities.

References:

Gutierrez, K. J. (2007). Saunders Nursing Survival Guide: Pathophysiology (2nd ed.). St. Louis, MO:

Saunders.

Mayo Clinic medical information and tools for healthy living. (n.d.). Retrieved February 20, 2010,
     from http://www.mayoclinic.com
Google Health Topics. (n.d.). Retrieved February 20, 2010,

from https://health.google.com/health/ref/

(2008). Mosby’s Dictionary of Medicine, Nursing & Health Professions (8th ed). St. Louis, MO: Mosby.


| Published on July 10th, 2010 at 10:00 pm | Article of: Health | Resource for: , |

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