Upper respiratory consists of?

1. Nose

2. Larynx

3. Pharynx

Lower respiratory consists of?

1. Trachea

2. Lungs

3. Bronchi

4 sets of paranasal sinuses

1. Maxillary

2. Frontal

3. Sphenoid

4. Ethnoid

Functions of the nose

1. Filter & passageway of air

2. Warm & humidify air

3. Smell

Functions of the paranasal sinuses

1. Release mucus & lessen weight of skull

2. Provides resonance for the voice

Oropharynx

-Space b/w soft palate & base of tongue

Laryngopharynx

-Connects to esophagus

Nasopharynx

-Extends from posterior nares to soft palate & has openings for eustachian tubes

Functions of tonsils & adenoids

1. Filter microorganisms to protect

lungs from infection

Structure of larynx

-Airway b/w pharynx & trachea

-Houses vocal cords & produces sound that forms into speech

-Epiglottis @ top of larynx

Structure of trachea

-Descends from larynx to primary bronchi

-Lies in front of esophagus & is a rigid tube w/ C-shaped rings of cartilage encircling it to reinforce trachea to keep it from collapsing during inhalation

What part of the body regulates respirations?

-Medulla

What would you include in the assessment

of pt. w/ resp. disorders?

-Hx. of resp. problems

-Resp. status

-Nose (deviated, broken)

-Ability to swallow (hoarse, tonsils)

-Cough/Sputum

-Nodes

-LOC

-Pain/vs

-Shape of chest/skin color

CBC

-Blood test that checks for anemia & ^ wbc

-↓CBC:dyspnea d/t ↓ O2 delivery

-↑ WBC: infection

-↑ RBC: chronic lung disease; dehydration

-↓ RBC: anemia, hemorrhage, overhydration

D-dimer

-Blood test

-Presence of pulmonary embolism

-Test for fibrin degradation

Throat cx

-Cx of throat

-Use tongue blade to hold tongue down

-Swab red area or lesion for @ least 10 sec.

Pulmonary Angiography

-Xray of pulmonary arteries using dye

-Cath. inserted into femoral, brachila, or jugular artery

-Checks for embolism or vessel disorders

-Check for allergies to dye,etc.

-NPO 4-8 hrs.

-Cath. going through heart

-Will feel warm sensation when injecting dye

-Remain flat in bed 3-8 hrs. after

-Check insertion site for bleeding & encourage fluids

Arterial Blood Gases

(ABG's)

-Radial artery blood obtained

-Measures ph of blood

-Amt. of 02, C02, CHO3

TB skin test

(PPD)

-Screening test for tb

-Doesn't differentiate b/w active or dormant tb

-Must be read 48-72 hrs. after adm.

-ID injection

-10 mm or greater induration = positive

do not measure redness

-Pos. PPD= pt. needs further testing such as sputum cx or CXR

CXR

-Noninvasive test

- Tells size, shape & position of lungs & other structures

-Can be done lying, sitting, or standing

Laryngoscopy

-NPO before, anesthetic spray to throat, sedation given

-Done w/ lighted scope to visualize larynx

-Bx of lesions, dilate strictures, evaluate fx

-Assess gag reflex after NPO (2-8 hrs)

Bronchoscopy

-NPO before, anesthetic spray to throat & sedation given till gag reflex returns

-Done w/ lighted scope to directly visualize larynx, trachea, bronchi

-Dx lung disease, bx, abn. tissue, obtain specimen or sputum, remove foreign object, pulmonary cleansing

Complications: Dyspnea, Hemoptysis; Pneumothorax

-May be given atropine to dry up secretions

-Sputum may be red tinged & sore throat

Pulmonary function tests

-Measures lung ventilation volume

-Measures lung capacity, volume, & flow rate

-Used to help dx & monitor restrictive or obstructive lung disease

- Handheld test given to asthma pts. (PEFR)

-Normal value: 450 L/M

Thoracentesis

-Aspiration of fluid from pleural space

-Can instill medicine into space

-Bedrest & lay on side for @ least 1 hr. after

Lung Scan

-Perfusion: blood flow through lungs

-Ventilation: Air flow through lungs

-Radio-isotoped used (IV or inhaled)

-If area well ventilated but no blood supply= pulm. embolism

CT SCAN

-Before scan: remove all metal objects & dentures

-May get contrast so check allergies & NPO 2 hrs

-Scan shows: CA, PN, emphysema

-Gives you more info if you have abn. CXR

Acute Bronchitis

-Isolated episode of inflammation of bronchial lining

Pneumonia

-Acute inflammation/infection of lungs

-Can be confined to one lobe or spread throughough lungs

Sx of Pneumonia

-Fever/chills

-Shaking

-Chest pain

- Dyspnea

-Fatigue

-Productive cough

-Crackles/wheezes

-Rust colored or blood tinged sputum

2 most common complications of PN

1. Pleurisy

2. Pleural effusion

(Usually resolve within 1-2 wks)

Tx of Pneumonia

-May be hosp. w/ IV fluids

-Abx

-Rest

-Expectorants

-Bronchodilators

-Analgesics

-O2

-Mist tx

What is TB?

-Infectious disease caused by Mycobacterium Tb & affects the lungs.

- Spread through the air from person to person

-Can also affect brain, kidneys, spine

Sx of TB

-Weak or sick

-Wt. loss

-Fever

-Night sweats

Can also have: Cough, chest pain, coughing up blood

Difference b/w TB infection

&

TB disease?

1. TB Infection: without disease; germ lies inactive in body & cannot spread germs to others

(REMEMBER I FOR INFECTION=I FOR INACTIVE)

2. TB Disease: With disease & are sick from germs that are active in body & can spread germs to others

How long does it take after exposure to a person w/ TB disease for skin test to react positive?

-2-10 weeks

3 Causes of nasal obstruction

1. Nasal polyps

(usually benign & controlled by controlling allergy s/s)

2. Deviated septum

(Common control: decongestants, antihistamines, & if chronic: surgery)

3. Hypertrophoid turbinates

Common causes of Epistaxis

-Trauma/Infection

-Nasal tumor

-Anticoagulation therapy

-Frequent picking

-Forceful nose blowing

-Cocaine use

-Foreign object

-Disease: Rh factor

-HTN

Tx for Epistaxis

-Direct

-Continuous pressure x5-10 min.

-Head slightly forward

-Ice packs

-Cauterizing w/ silver nitrate (electrocautery)

-Nasal packing w/ rhinorochets

-Pressure w/ balloon inflated cath

Post-op care & discharge instructions

for pt. after nasal surgery

-Do not swallow blood

-Nasal packing

-Check for bleeding

-Mouth care

-Do not blow nose, lift object >5-10 lbs.

-Nose will feel stuffy & may have drainage

-Drink fluids; ^HOB; cool mist vaporizer

-Ice packs & call dr if temp >101

Potential problems, causes to

upper airway obstructions

& tx for

-Swelling of mucous membrane lining (ex:allergies)

-Severe head & neck injuries

-Aspiration of foreign object

-Spasms of laryngeal muscles & swelling

(Ex. removal of ET tube)

-Audible sound:Stridor

-Tx: steroids, intubation, tracheostomy

Rhinitis

def, s/s & tx

-Inflammation of mucous membranes (common cold)

-Caused by >100 viruses

-S/S: Rhinorrhea; sneezing/coughing; nasal congestion & watery eyes; sore throat; Ha; malaise & muscle aches; low grade fever

-Tx: Rest; fluids; handwashing; meds

Sinusitis

Def, Serious complication is, causes, s/s, tx

-Inflammatin of sinuses

-Serious complication is middle ear or brain infection

-Cause: Organisms from nasal cavities & blockage of nasal cavity

-S/s: Ha; fever; pain over affected area; nasal congestion & discharge; malaise

-Tx: Abx; saline irrigation vasoconstricors; surgery (endoscopic sinus to promote drainage by opening infected meatus)

Pharyngitis, tonsilitis, adenoiditis, peritonsillar abscess

Def, causes, s/s & tx

-Inflammation of throat, adenoids, tonsils

-Localized collection of pus in tonsils

-Cause: virus; bacteria; streptococci (strep can lead to cardiac issues)

-S/s: Severe sore throat; snoring; fever; chills; ha; malaise

-Tx: Abx; analgesics; saline gargles; I&D; T&A

(Incision & drainage) (Tonsilectomy & adenoidectomy)

Laryngitis

def, cause, s/s, tx

-Infection & swelling of mucous membranes of larynx

-Cause: Spread of URI; excessive or improper use of voice; smoking; allergies

-S/s: hoarseness; inablility to speak above a whisper; throat irritation; dry non-productive cough (>2wks sx of ca)

-Tx: voice rest; stop smoking; abx if bacterial

Risk factors for Ca of the larynx

-Men 50-70 yo

-Tobacco use

-ETOH

-Industrial pollutants

-Chronic laryngitis

-Habitual overuse of voice

-Heredity

Common s/s of larynx ca

-Persistent hoarseness

-Sensation of swelling or lump in throat

-Dysphagia & pain when talking

-Burning in throat when swallowing hot or citric liquids

3 common tx for larynx ca

1. Laser surgery in early stages

2. Partial or total laryngectomy

3. Radical neck dissection

Some major needs for pt.

who has had total laryngectomy

-Airway: permanent trach

-Reconstruction of esophagus: tube feeding

-Loss of speech: call light in reach; other ways to communicate

- Trach care

-Moist O2

4 reasons for tracheostomy

1. Airway obstruction

2. Trauma

3. Allergic reaction

4. Laryngectomy

Trach care

- Clean inner cannula w/ hydrogen peroxide w/ saline rinse

-Mist collar- ^ humidity

-Scarf or gauze on loosely

-Cough & deep breathe; ^ HOB

-LOC, skin color

-Monitor lung sounds, temp, vs

-Secure ties to keep trach in

-Do not apply suction while cath inserted (<10sec)