CARE OF CLIENT WITH

RESPIRATORY SYSTEM
DISORDERS
FUNCTION OF THE RESPIRATORY SYSTEM
• 1. Enhance Gas exchange
• 2. Oxygen transport
• 3. Relationship between
Ventilation and Perfusion
• 4. Regulation of Acid-base
balance
DIAGNOSTIC TEST:
• Mantoux Test
• PPD (purified protein derivatives
• Intradermal
• Read 48-72hours
• + Montoux test= induration of 10mm
• HIV positive= induration of 5mm
• (+) = exposure to Mycobacterium tubercle
• Chest X-ray*
• Flouroscopy
• - studies lungs in motion
DIAGNOSTIC TEST:
• Bronchography*
• Nursing Intervention before:
• Secure written consent
• Check for allergies to iodine/seafood
• NPO for 6-8hrs
• Pre-op meds—Atropine sulfate, Valium, topical
anesthesia sprayed, local anesthesia injected to larynx.
• Have O2 and antispasmodic available
• Nursing Intervention after:
• Side lying
• NPO until gag reflex return
• Cough and deep breathe
• Low grade fever common
DIAGNOSTIC TEST:
• Bronchoscopy*
• Nursing Intervention before:
• Informed consent
• Pre-op meds—Atropine sulfate, Valium, Topical
anesthesia sprayed, local anesthesia injected to larynx.
• NPO 6-8hrs
• Remove dentures, prosthesis, contact lenses
• Nursing Intervention after:
• Side lying
• NPO until gag reflex return
• Watch for signs of bronchial tree perforation*
DIAGNOSTIC TEST:

• Lung Scan
• injection of radioisotope, scans are taken with
scintillation camera
• measure blood perfusion to lungs
• confirm pulmonary embolism*
 DIAGNOSTIC TEST:
• Sputum Exam
• C&S
• AFB staining
• Cytologic examination
• Nursing Consideration:
• Early morning
• Rinse mouth with plain water
• Use sterile container
• Sputum exam for C&S is collected before first dose of antibiotic
• AFB stain: collect for 3 connected mornings.
DIAGNOSTIC TEST:

• Biopsy of Lungs
• Transbronchoscopic biopsy – done during bronchoscopy
• Percutaneous needle biopsy
• Open lung biopsy

• Lymph node biopsy*

• Assess metastasis of lung cancer
DIAGNOSTIC TEST:

• Pulmonary Function Test

• Vital capacity *
• Tidal volume*
• Inspiratory reserve volume*
• Expiratory reserve volume*
• Functional Residual capacity*
• Residual Volume*
• Total Lung Capacity*
DIAGNOSTIC TEST:

• Arterial blood gases*

• Radial artery is common site for blood withdrawal
• Allen’s test*
• Use 10ml pre-heparinized syringe to prevent clotting of
specimen
• Container with ice to prevent hemolysis of specimen
• Pulse Oximetry*
DIAGNOSTIC TEST:
• Thoracentesis *
• Nursing Intervention before:
• Secure consent
• Take initial v/s
• Position: Upright leaning over bed table
• Instruct to remain still, avoid coughing during insertion
• Pressure sensation is felt on insertion of needle
• Nursing Intervention after:
• Turn on affected side
• Bed rest until v/s is stable
• Check for expectoration of blood, notify doctor
ASSESSMENT OF CLIENTS WITH RESPIRATORY DXS
• CHIEF COMPLAINT
• DYSPNEA
• COUGH
• SPUTUM PRODUCTION
• HEMOPTYSIS
• WHEEZING
• STRIDOR
• CHEST PAIN
ASSESSMENT OF CLIENTS WITH RESPIRATORY DXS
• Past medical history
• Family History
• Psychosocial History & lifestyle
• Occupational or environmental exposure
• geographic location
• Persona Habit - Smoking
• Years of smoking x packs/day = pack years
PHYSICAL EXAMINATION
• INSPECTION
• Note signs of respiratory distress
• Note client’s speech pattern
• Head and neck*
• Chest wall*
• CHEST DEFORMITIES*
• Fingers and toes*
PHYSICAL EXAMINATION

• PALPATATION
• Trachea
• Chest wall
• Thoracic excursion
• Tactile fremitus
PHYSICAL EXAMINATION
• Percussion
• Resonance
• Hyperesonance
• Dullness
• Auscultation
• Normal breath sounds
1.Bronchial (tracheal)
2.Bronchovesicular
3.Vesicular
PHYSICAL EXAMINATION
Adventitous breath sounds
1.Crackles/rales fine
2.Crackles/rales coarse
3.Pleural friction rub
4.Wheeze high-pitched, squeaking sound (sibilant
rhonchi)
5.Wheeze low- pitched, musical snoring, moaning sound
(sonorous rhonchi)