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Respiratory System

In the United States, there are currently more than 35 million people living with a respiratory disorder; and each year, more than 400,000 people die as a result (American Lung Association, 2012). The prevalence and impact of these disorders makes it essential for advanced practice nurses to have a solid understanding of the respiratory system. In clinical settings, you must be able to appropriately diagnose, treat, and manage care for patients with common disorders such as asthma, bronchitis, and pneumonia. This poses several questions: What are symptoms of respiratory disorders? How are they diagnosed? Are some disorders more prevalent in one patient group over another?

This week you explore the pathophysiology of alterations associated with respiratory disorders. You also explore the impact of patient factors on these disorders.

Reference
American Lung Association. (2008). Lung disease data: 2008. Retrieved from http://www.lung.org/assets/documents/publications/…

Learning Objectives

Students will:

Analyze the pathophysiology of respiratory alterations

Evaluate the impact of patient factors on respiratory disorders

Analyze pathophysiological mechanisms of chronic asthma and acute asthma exacerbation

Evaluate the impact of patient factors on chronic asthma and acute asthma exacerbation

Evaluate clinical considerations of chronic asthma and acute asthma exacerbation

Understand and apply key terms, concepts, and principles related to alterations of the respiratory system

Photo Credit: Science Photo Library/Brand X Pictures/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Chapter 26, “Structure and Function of the Pulmonary System”

This chapter provides information relating to the structure and function of the pulmonary system to illustrate normal pulmonary function. It focuses on gas transport to build the foundation for examining alterations of pulmonary function.
 Chapter 27, “Alterations of Pulmonary Function”
This chapter examines clinical manifestations of pulmonary alterations and disorders of the chest wall and pleura. It covers the pathophysiology, clinical manifestations, evaluation, and treatment of obstructive lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema.
 Chapter 28, “Alterations of Pulmonary Function in Children”

This chapter focuses on alterations of pulmonary function that affect children. These alterations include disorders of the upper and lower airways.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Chapter 9, “Pulmonary Disease”

This chapter begins with an overview of normal structure and function of the lungs to provide a foundation for examining various lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).
Required Media

Laureate Education, Inc. (Executive Producer). (2012e). Mid-course review. Baltimore, MD: Author.

This media is an interactive mid-course review covering course content.

Optional Resources

American Lung Association. (2012). Retrieved from http://www.lung.org/

Asthma and Allergy Foundation of America. (2012). Retrieved from http://www.aafa.org

Cystic Fibrosis Foundation. (2012). Retrieved from http://www.cff.org/

RESPIRATORY ALTERATIONS

In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.

CONSIDER THE FOLLOWING 3 SCENARIOS:

Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

To Prepare

Review the three scenarios, as well as Chapter 27 and Chapter 28 in the Huether and McCance text.

Select one of the scenarios and consider the respiratory disorder and underlying alteration associated with the type of cough described.

Identify the pathophysiology of the alteration that you associated with the cough.

Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the disorder.

ASSIGNMENT 1a

WRITE a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how the factors you selected might impact the disorder.

ASSIGNMENT 1b: Asthma

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.

To Prepare

Review “Asthma” in Chapter 27 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.

To Complete

WRITE a 2- to 3-page paper that addresses the following:

Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.

Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.

Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Reference
Briscoe, K. (2012, May 12). Thetford: mother of Bradley Wilson, who died of asthma attack, told there was nothing she could have done. East Anglian Daily Times. Retrieved fromhttp://www.eadt.co.uk/news/thetford_mother_of_brad… 
Glissman, B. (2012, May 21). Girl’s death puts focus on asthma’s broader grip. Omaha World-Herald. Retrieved from http://www.omaha.com/article/20120521/LIVEWELL01/3…

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