Nursing of Adults With Medical

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Nursing of Adults WithMedical Surgical
Conditions

• Respiratory Disorders(Diagnostic Tests Upper
  Airway Disorders)

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Normal Breath Sounds
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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

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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

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Adventitious Breath Sounds

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

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Adventitious Breath Sounds

• Pleural Friction Rub
• Sound
• Dry, creaking, grating, low-pitched sound
• Cause
• Inflammation of pleural surfaces

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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

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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

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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

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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-Fowlers position and turned to side
• Assess for signs of laryngeal edema or
  laryngospasms
• Assess for signs of hemorrhage

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Bronchoscopy
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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

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Diagnostic Tests

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

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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

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Thoracentesis
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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

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Pulse Oximetry
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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

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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

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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

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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

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Epistaxis

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

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Epistaxis

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

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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

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Deviated Septum and Nasal Polyps

• Signs Symptoms
• Stertorous respirations (snoring)
• Dyspnea
• Postnasal drip

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Deviated Septum and Nasal Polyps

• Treatment
• Medications
• Corticosteroids
• Antihistamines
• Antibiotics
• Analgesics
• Nasoseptoplasty
• Nasal polypectomy

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Allergic Rhinitis and Allergic Conjunctivitis
(Hay Fever)

• Etiology/Pathophysiology
• Antigen/antibody reactions in the nasal
  membranes, nasopharynx, and conjunctiva due to
  allergens

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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

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Allergic Rhinitis and Allergic Conjunctivitis
(Hay Fever)

• Treatment
• Avoid allergen
• Antihistamines
• Decongestants
• Topical or nasal corticosteroids
• Vancenase, Beconase
• Analgesics
• Hot packs over facial sinuses

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Upper Airway Obstruction

• Etiology/Pathophysiology
• Inflammation of tissue
• Dentures
• Aspiration
• Tongue
• Laryngeal spasm

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Upper Airway Obstruction

• Signs Symptoms
• Stertorous respirations
• Altered resp. rate and character
• Apneic periods
• Hypoxia
• Cyanosis
• Wheezing
• Stridor

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Upper Airway Obstruction

• Treatment
• Open the airway
• Remove obstruction
• Artificial airway
• Pharyngeal, endotracheal, and tracheal
• Tracheostomy

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Tracheostomy
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Tracheotomy Tubes
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Cancer of the Larynx

• Etiology/Pathophysiology
• Squamous cell carcinoma
• Heavy smoking and alcohol use
• Chronic laryngitis
• Vocal abuse
• Family history

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Squamous Cell Carcinoma of the Larynx
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Cancer of the Larynx

• Signs Symptoms
• Progressive or persistent hoarseness
• Pain radiating to the ear
• Difficulty swallowing
• Hemoptysis

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Cancer of the Larynx

• Treatment
• Radiation
• Surgery
• Partial laryngectomy
• temporary tracheostomy
• Total laryngectomy
• Permanent tracheostomy
• No voice
• Radical neck dissection

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Acute Rhinitis(Common Cold, Acute Coryza)

• Etiology/Pathophysiology
• Inflammation of the mucous membranes of the nose
  and accessory sinuses
• Virus(es)

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Acute Rhinitis(Common Cold, Acute Coryza)

• Signs Symptoms
• Thin, serous nasal exudate
• Productive cough
• Sore throat
• Fever

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Acute Rhinitis(Common Cold, Acute Coryza)

• Treatment
• No specific treatment
• Analgesic
• NO Aspirin for infants, children and adolescents
  (Reyes Syndrome)
• Antipyretic
• Cough suppressent
• Expectorant
• Antibiotic, if infection present
• Encourage fluids

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Acute Follicular Tonsillitis

• Etiology/Pathophysiology
• Inflammation of the tonsils
• Bacterial infection (streptococcus)
• Viral

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Acute Follicular Tonsillitis

• Signs Symptoms
• Enlarged, tender, cervical lymph nodes
• Sore throat
• Fever
• Chills
• Enlarged, purulent tonsils
• Elevated WBC

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Acute Follicular Tonsillitis
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Acute Follicular Tonsillitis

• Treatment
• Antibiotics
• Analgesics
• Antipyretics
• Warm saline gargles
• Tonsillectomy and adenoidectomy
• 4-6 weeks after infection has subsided

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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

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Laryngitis

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

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Laryngitis

• Signs Symptoms
• Hoarseness
• Voice loss
• Scratchy and irritated throat
• Persistent cough

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Laryngitis

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

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Pharyngitis

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

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Pharyngitis

• Signs Symptoms
• Dry cough
• Tender tonsils
• Enlarged cervical lymph glands
• Red, sore throat
• Fever

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Pharyngitis

• Treatment
• Antibiotics
• Penicillin, erythromycin
• Analgesics
• Antipyretics
• Warm or cool vaporizor

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Sinusitis

• Etiology/Pathophysiology
• Inflammation of the sinuses
• Usually begins with an upper respiratory
  infection
• Chronic or acute
• Viral or bacterial

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Sinusitis

• Signs Symptoms
• Constant, severe headache
• Pain and tenderness in involved sinus region
• Purulent exudate
• Malaise
• Fever

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Sinusitis

• Treatment
• Antibiotics
• Analgesics
• Antihistamines
• Vasoconstrictor nasal spray (Afrin)
• Warm mist vaporizor
• Warm, moist packs
• Nasal windows