Respiratory Disorders

By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Upper Respiratory Airways
1. Nose
• Humidifies
• Filter
• Warms
• Smell
• Sneezing
2. Paranasal sinuses
• Air-filled or fluid-filled cavities
• Speech
3. Pharynx
• Nasopharynx
• Oropharynx
• Laryngopharynx

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 Upper Respiratory Airways
4. Larynx
• Epiglottis

• Glottis

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 Lower Respiratory Airway
1. Trachea 4. Alveoli
2. Bronchi • Gas exchange
• Cilia • Type 1
• Beta 1 or 2 • Type 2
• • Type 3
•
3. Bronchioles

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 Sinusitis

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 Obstruction of nasal passage

Bacterial growth (infection) Fever & Inflammation

• Pain
Purulent nasal discharge • Anosmia

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 Pain
• May worsen by bending and lying down.

• Cheeks & Toothache.

• back of the head

• forehead.

• mastoid

• between or behind the eyes.

• Vertex

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 Management:

1. Fluid intake 5. Medications:

2. Compress • Bacterial

3. Irrigation • Pain

4. Heat mist

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 Tonsillitis and Adenoiditis
• Diagnostic test:

• Most common causative agent:

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 Management:
• Fluid intake

• Gargle

• Tonsillectomy and adenoidectomy

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 Tonsillectomy and Adenoidectomy
Pre-Op:
• Assess for signs of active infection.

• Assess for any loose teeth.

• Check labs:

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 Tonsillectomy and Adenoidectomy
Post Op:
• Position:
• Signs of bleeding:
• Avoid:
• anything that may cause clearing of the throat or blowing of the nose.
• Dark colored beverages.
• Collar

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 Tonsillectomy and Adenoidectomy
• Apple juice
• Ice pops
• Clear liquids
• Cranberry juice
• Ice cream
• Pudding
• Crashed ice
• Soda
• Sorbet
• Citrus flavored drinks
• Soft foods for 1-2 days.

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 Bronchial Asthma
Cause
• Intrinsic
• Extrinsic

• Exercise • Molds
• URTI • Anger
• Spores • Animal dander
• Cold air • Stress

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 Pathophysiology:

Allergens

Oxygen
Bronchus Goblet cell 1. Early:
• Mucus
• RR
WBC
• ___________
• Prostaglandins
2. Late
• Leukotrienes
• ___________
IgE & Mast Cells
• Histamine

Inflammation Narrowing of airway

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 Fast Acting:
1.Short-acting Beta2-adrenoceptor Agonist (SABA)
• Albuterol

2. Anticholinergic
• Ipratropium bromide

3. Adrenergic Agonist
• Epinephrine

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 Long Term:
1. Corticosteroids
• Beclomethasone

2. Long-acting Beta-adrenoceptor Agonist (LABA)

3. Antileukotriene
• Montelukast

4. Antihistamine
• Diphenhydramine

5. Monoclonal Antibody
• Omalizumab

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 Important!!!
Two orders
• 1st
• 2nd

Different
• Wait for ____

Same Medication
• Wait for ____

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 Spacer:

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 Chronic Obstructive Pulmonary Disease
Types:
1. Presence of over distended and non-functional alveoli.

2. A productive cough that lasts 3 months in each of 2 consecutive years, in

Cause:
•
•
•

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 Emphysema

Smoke Air trapping:

Destruction of Elastin & Collagen

• Breathing Food intake

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 Chronic Bronchitis

Smoke Goblet cell mucus productive cough

Irritation
Inflammation
Cilia

___________ Airway:
• Breath sounds RBC
• Air trapping
• O2
• CO2 Acid base imbalance

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 Management:
• Avoid causes
• Rest
• Teach client to do _____________breathing
• Fluid intake
• Diet:
• Calorie
• Protein
• Foods that may cause difficulty breathing
• O2 Therapy
• Medications:
• Bronchodilators
• Corticosteroids
• Diuretics
• Vaccines

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 Acute Respiratory Distress Syndrome (ARDS)
• A form of acute respiratory failure that occurs as a complication of
some other condition; it is caused by a diffuse lung injury and leads to
extravascular lung fluid.

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 Atelectasis
Refractory Hypoxemia
Decreased lung compliance
Surfactant cells decreased

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 Management:
1. V/S
2. ABG
3. X-ray
4. Treat underlying cause.
5. Position
6. Fluid intake
7. Medications
8. Mechanical Ventilator

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 Pleural Effusion
Types:
1. Hemothorax
2. Pyothorax / Empyema
3. Hydrothorax

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 Clinical Manifestations:
1. Pleuritic chest pain
2. Shortness of breath
3. Restlessness
4. Tachycardia
5. Diminished breath sounds
6. Chest asymmetry
7. Decreased fremitus
8. Dull or flat sound
9. Hyperresonance

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 Management:
1. Position:
2. Oxygen therapy
3. Chest X-ray
4. Arterial Blood Gas
5. Thoracentesis
6. Chest tube

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 Closed Chest
Drainage
(Thoracostomy tube)
Purpose:
1. To remove air and fluid from
pleural space.
2. To re-establish negative
pressure and re-expand the
lungs.

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 1. Tube:
• Ensure patency of tubing.
• Milking or clamping of tube.
2. Drainage Bottle:
• Serosanguineous
• Drainage

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 3. Water Seal
• Bubbling
•
•
•
• Tidaling/fluctuation/oscillation
•
•
•
4. Suction control
• Wet - Bubbling
• Dry - Bubbling
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 Disconnection
• Bottle
• Dirty tip
• Client

Broken Bottle
•

Removal
•
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 Hematologic Disorders
By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Iron Deficiency Anemia
• Pregnancy
• Diet
• Bleeding
• Alcoholism
• Malabsorption

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 Diagnostic Test:
1. Bone marrow aspiration

2. Ferritin

3. Serum iron

4. RBC, reticulocyte, hematocrit, Hgb

5. Mean corpuscular volume (MCV)

6. Transferrin

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 Clinical Manifestations:
1. Appearance
2. Breathing
3. Energy
4. Mucus membrane
5. Lips
6. Nails
7. Pica

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 Management:
1. Ferrous Sulfate
- With meal or empty stomach
- milk, tea, coffee & antacids
- Vit. C
- May cause GI irritation
- May darken stool
- May cause constipation

2. Iron dextran
-

3. Oral liquid form

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 Aplastic Anemia
• An autoimmune disorder characterized by hypoplastic marrow.

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 Management:
1. BMT
2. Cyclosporine
3. BT
4. Precautions:
- anemia
- Bleeding
- Infection

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 Bleeding:
• Provide hard foods that are cool to warm.
• Avoid injections if possible.
• Avoid rectal suppositories, enemas, and thermometers.
• Instruct the client to avoid blowing the nose.
• Instruct the client to use a soft toothbrush and dental floss.
• Instruct the client to use an electric razor for shaving.
• Encourage the client from engaging in activities like contact sports.
• Use aspirin for pain.
• High fiber diet.

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 Infection:
• Common sites of infection are the skin, respiratory tract, and
gastrointestinal tract.
• Initiate protective isolation procedures.
• Go to crowded places.
• Avoid ill person.
• Place the client in a private room.
• Give fresh or raw fruits ,vegetables and flowers.
• Low fiber diet.
• Avoid invasive procedures.
• Client can do activities such as changing a pet’s litter box or working
with house plants or in the garden.

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 Megaloblastic Anemia
• B12 or Folic acid deficiency
• Needed in synthesis of DNA and myelin (B12).

Cause:
1. Malnutrition
2. Alcoholism
3. Pregnancy
4. Surgery – gastrectomy & resection of ileum

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 Schilling’s Test:
• IM B12 and Oral B12
• 24-hour urine specimen
• Normal finding

• Pernicious Anemia

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 Sickle Cell Anemia
• Presence of______; sickle shaped with ______
• Sickling Crisis - _____________
• Problems arises at _________after birth due to ____________.

Aggravating/triggering factors:
1. Cold temperature
2. Dehydration
3. Stress
4. High altitudes
5. Infection – human parvovirus

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 Hgb __ Spleen Bilirubin
Reticulocyte
____O2
1. Lungs – Chest pain
Sickling 2. Brain– CVA
3. Kidney – renal failure
4. Eye – loss of vision
Obstruction 5. Penis – priapism

Hypoxia ________

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 Management:
1. BMT
2. Hydroxyurea
3. BT
4. Fluid intake
5. O2 therapy
6. Pain meds:
- aspirin, NSAID, Opioid analgesics

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 Hemophilia
• ______linked traits
• Male
• Female

Types:
• A
• B

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 Signs & Symptoms:
1. Most common site of bleeding:
2. Ankylosis
3. Hematomas
4. Nosebleed
5. Intracranial bleeding

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 Interventions:
1. Fresh frozen plasma: _______ volume
• WOF
2. Factor VIII & IX transfusion
3. Aminocaproic Acid
4. Desmopressin
5. Bleeding precautions

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