Respiratory Disorders
examination of trachea, bronchi
 James R. Tekiko R.N.,M.A.N.
MAJOR FUNCTION: Gas Exchange
• During gas exchange, air is
taken into the body by
inhalation and travels through
respiratory passages to the
lungs. In the lungs, O2 diffuses
into the blood and CO2 is
removed by exhalation
• Sense of smell, speech, acid
base balance, body water levels
and maintains heat balance
DIAGNOSTIC TESTS
 Skin testing : mantoux test
( PPD)ID – read 48 -72 hrs,
+10mm up indurration exp.to
Myco T
 Chest X-ray
 Sputum examination- C &S AFB
3xAM
 Lung biopsy – needle biopsy,
open lung, VATS
• Computed Tomography permits
better visualization of layer or
plane of lungs “slices”; done to
check cavities, neoplasms, lung
densities, stereoscopic – 3D
• D. Ultrasound or echogram –
harmless, high frequency sound
wave emitted and penetrates
the thorax and bounces back to
transducer to picture image
Respi-threeBPage 1
• Bronchoscopy – direct
and larynx
Purposes:
 Inspect parts of
respiratory tract
b. Aspirate secretions and exudates n
air passage
c. Remove foreign body
d. Do biopsy
 Prep – consent,
topical anesthesia,
NPO 6-8 hours,
atropine sulfate,
sedation
 Post – head of bed
elevated, lateral
position, , check
gag reflex and
hoarseness,
Thoracentesis
– Aspiration of fluid and air from
pleural cavity;
site of insertion: for fluid – 7th to 8th
intercostal space mid-axillary; for air –
2nd or 3rd intercostal space mid-
clavicular
prep: consent, no moving, no
coughing, proper positioning, remoe
not more than 1500cc within 30 mins
(to prevent intravascular shift)
post: turned to unaffected side – seal
itself; to prevent seepage
Pulmonary Function Test
– non-invasive method of assessing
the functional capacity of the lungs;
ability of gas to diffuse across the
alveoli capillary membrane and ratio
of ventilated alveoli to perfused
capillaries.
 A. Pulse oximetry – non-
invasive technique that
measures the oxygen
 saturation (SaO2) of pCO2 pCO2
arterial blood (uses pulse Normal 24 Normal HCO3
oximeter) HCO3

 B. Spirometry – measures
lung capacity, volumes ABG PROFILE IN METABOLIC ACIDOSIS
and flow rates with the or ALKALOSIS
use of an instrument ACIDOSIS MET ALKALOSIS
called spirometer. Decreased pH <7.4> Increased pH
Decreased <24> Increased
 . Arterial Blood Gases – provides HCO3 HCO3
objective determination of Decreased BE <0> Increased BE
arterial blood oxygenation, gas Normal pCO2 40 Normal pCO2
exchange, alveolar ventilation
and acid-base balance;
Signs and Symptoms of Acid-
 use heparinized 2ml syringe. Base Imbalances:
Sites: radial, brachial, femoral artery  Acidosis – increased CO –
depression of CNS – decrease in
PaO2 – measures O2 dissolved in blood
mental capacity –delirium, coma
– shows efficiency of gas exchange
or death
ventilation and perfusion
 Alkalosis – increased O2 –
PaCO2 – determines the adequacy of
overexcitability or irritability of
ventilation; depends upon the amount
CNS – extreme nervousness,
of O2 produced and ability of lungs to
over excitability, tetany or
eliminate; shows effectiveness of
convulsions
ventilation

pH – measurement of hydrogen ion Common Upper Respiratory

concentration Problems

SaO2 – measures oxyhemoglobin Epistaxis (nosebleeding)

saturation
– usually originates from the blood
ACID BASE BALANCE vessels in the anterior part of the
septum
COMPARISON OF ARTERIAL or VENOUS
BLOOD GASES Causes:

ARTERIAL VENOUS 1. Trauma to nasal mucosa

pH 7.35-7.45 7.31-7.41 from foreign object
pO2 80-100 35-49 mmHg
mmHg 2. Picking of the nose
pCO2 35-45 41-51
3. Local irritation of the
SaO2 96-98% 70-75%
HCO3 22-26 23-25 mucous membrane from
Base ex -2+2 -2+2 lack of humidity in the air
(O2 cannula)

ABG PROFILE IN RESPIRATORY 4. Violent sneezing or

ACIDOSIS or ALKALOSIS blowing of the nose

ACIDOSIS RESP ALKALOSIS

Decreased 7.4 Increased pH
pH
Increased 40 Decreased

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 Causes:

1. Viral – influenza,
adenovirus,
staphylococcus aureus

2. Bacterial – streptococcus
pneumonia, haemophilus
influenzae

3. Allergic – seasonal

Nursing Management:

1. Patient sits up leaning

forward with head tipped
downward

2. Compress soft tissues of

nose against septum with
fingers and maintain
pressure for at least five
Signs and Symptoms:
minutes
1. Fever and malaise
3. Apply ice or cold
compress to nose to 2. Stuffy nose
constrict blood vessels
3. Slowly developing
4. If bleeding does not stop pressure over the
with direct pressure, involved sinus
place cotton ball soaked
in topical vasoconstrictor 4. Persistent cough
(neo-synephrine) into
5. Post nasal drip
nose and apply pressure
(dependent nursing 6. Headache
function)
Sinusitis –URTI Allergic Rhinitis
5. Instruct not to blow nose
for several hours after  Rest
nose bleed
 increase fluid intake
6. Silver nitrate stick or
electrocautery  hot wet packs
(dependent nursing
 anti-infectives or antihistamines
function)
depending on the cause of
7. Post nasal pack sinusitis
(dependent nursing
function)  Nasal decongestants-
Dimetapp, Sudafed
SINUSITIS
 irrigation with warm NSS
 inflammation of air filled
Cald-wel-luc surgery (radical antrum
cavities that lines the mucous
operation) – incision made under the
membranes of the sinuses

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upper lip to treat chronic maxillary 1. Rest and increase fluid
sinusitis intake

Priority Nursing Care: 2. Warm saline throat

irrigation
a. Proper oral
hygiene done with 3. Ice collar to relieve
caution to avoid discomfort
injury to the
incision 4. Analgesic and
antipyretics
b. Don’t chew on
affected side 5. Antibiotics

c. No dentures for ten 6. Surgery – tonsillectomy

days 7. Avoid carbonated and
d. No blowing of nose citrus juices- irritate the
for two weeks incision

e. No sneezing (if you - Ice chips, small sips of cold

must sneeze, keep fluid, popsicles (1st day)
mouth open) - Soft foods on 2nd day
TONSILITIS Tonsillectomy
 Inflammation of the tonsils Pre-op Care:

a. Check for loose tooth

Post-op Care:

a. HOB to 45° elevated to reduce

e

b. Monitor for hemorrhage – frequent

swallowing, bright red vomitus, rapid
pulse, and restlessness

c. Comfort – apply ice collar to neck;

use acetaminophen in place of aspirin

d. Food and fluids – no milk.

Avoid carbonated and citrus

juices- irritate the incision
Signs and Symptoms:
- Ice chips, small sips of cold
1. Sore throat fluid, popsicles (1st day)

2. Pain on swallowing - Soft foods on 2nd day

3. Fever and chills Post Tonsillectomy

4. General muscle aching Patient teaching

and malaise
No clearing of throat
Nursing Management:

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No coughing, sneezing, vigorous nose  Head of bed
bleeding and vigorous exercise for one elevated 45o
to two weeks
 Assist patient in
Drink fluids two to three liters a day communicating –
provide writing
Avoid hard and scratchy foods such as
materials, etc
popcorn and pretzels
 Post partial
Expect stools to be black or dark for a
laryngectom
few days
y – patient
Laryngitis will be able
to talk
 Inflammation and swelling of
mucous membrane of larynx  Post total
laryngectom
 Cause: Infection, improper use y – no voice;
of voice, smoking artificial
larynx now
 Manifestations: available
Hoarse voice, throat irritation,  Practice swallowing
dry, non-productive cough
Chronic Obstructive Pulmonary
Treatment:
Disease
ATB
 disease state characterized by
Stop smoking airflow limitation that is
progressive and associated with
Removal of cause an abnormal inflammatory
response of the lungs to noxious
CANCER OF THE LARYNX
particle or gases ( smoking)
Risk factors – Carcinogens – smoking, that is not fully reversible
alcohol, cement/ wood
• Chronic Bronchitis
dust,petrol/paint fumes

Others – straining the voice, chronic • Emphysema

laryngitis,60 and up, men, african
• Risk Factors include
american, family history
environmental exposures and
S/S host factors

 Hoarseness for more than 2  Primary symptoms are cough,

weeks cough, Sore throat sputum production and dyspnea

 Lump on the throat. dysphagia COPD

 Pain in the Adam's apple that Chronic bronchitis

radiates to the ear
 Excessive mucous production
 Dyspnea, enlarged cervical and recurrent productive cough
nodes and cough for at least 3 months in each of
the two consecutive two years
TX – Radiation, Laryngectomy or more

Post Op Laryngectomy  Causes:

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  Smoking and pollutants irritants, control of
environmental
 Viral or bacterial temperature, proper
infections nutrition, adequate
hydration

EMPHYESEMA

• Destructive changes in alveolar

walls and enlargement of air
spaces distal to bronchioles;
loss of recoil and air trapping

• Over distended and non

functional alveoli leading to
rupture

Normal VS Chronic Bronchitis • retention of CO2 and hypoxia

leading to respiratory acidosis

Predisposing factors:

• Smoking

• Alpha1 antitrypsin
deficiency( enzyme
inhibitor that protects the
lung parenchyma from
injury) – for Caucasians

• Familial tendency
S/S Chronic Bronchitis
• the stimulus to breathe is
• Chronic productive cough
a low pO2 instead of an
“cigarette cough”
increased pCO2
• Grayish white sputum
Signs and symptoms:
• Dyspnea
• Uses accessory muscles
• Cyanosis, tachycardia to breathe

• Respiratory acidosis • Ruddy collor

• Ankle edema, distended • No cyanosis

neck vein
• Thin with “barrel-chest”
 “Blue bloaters” Nursing management:
Management of Chronic Bronchitis
 Pursed-lip breathing
• Pharmacotherapeutics –
 Forward – leaning
mucolytic, expectorants,
position
antitussives,
antihistamines  Low O2 concentration

• Supportive measures –
avoid smoking, inhaled

Respi-threeBPage 6

Assessment:
• Anatomic changes: barrel
chest and clubbing
• Cor pulmonale (R sided HF)
• Cough (character, frequency,
time of day) exertional
dyspnea
• Wheezing and crackles
• Weight loss
• Sputum production (amount,
color consistency)
• Use of accessory muscles for
breathing
• Posturing (leaning forward)
• Prolonged expiration
• Pursed lip breathing
Diagnostic Exams:
• CXR- congestion and
hyperinflation
• ABG- respiratory acidosis and
hypoxemia
Treatment:
• CPT, Postural drainage, IS
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• Fluid intake to 3L/day if not
contraindicated (What
condition?)
• O2 @ 2-3L/min
• Diet high in CHON, vitamin C,
calories, nitrogen
Nursing Management
• Monitor VS and respiratory
status. Administer low flow O2
(24-28%). Monitor pulse
oximetry
• Monitor CV status to detect
arrhythmias related to hypoxia
• Encourage to drink plenty of
fluids if not contraindicated
• Instruct in diaphragmatic or
abdominal and pursed lip
breathing techniques
• Suction if necessary to clear
airway of secretions
Position in high fowlers position
and leaning forward to aid in
breathing
• Encourage small, frequent
feedings to prevent dyspnea
• Encourage activity as tolerated
to prevent fatigue
• Encourage to stop smoking
• Avoid exposure to persons with
infections
• Avoid allergens and pollution
• Receive immunizations:
influenza (flu shot)
MEDICAL MANAGEMENT
 Risk reduction- smoking
cessation
 Bronchodilators
 Corticosteroids
  Influenza and pneumococcal  Environmental factors –
vaccination change in temperature or
humidity
 Oxygen therapy
 Atmospheric pollutants –
Medications cigarettes, industrial
smoke
- Bronchodilators- Salbutamol
and theophylline- Instruct on the use
 Strong odors – perfume,
of both oral and inhalant medications
insecticides
- Steroids- to reduce
 Allergens – feathers,
inflammation Pred.
dust, food, pollens,
- mast cell stabilizers (Cromolyn laundry detergents
Na)
 Exercise
- Mucolytics- to thin secretions
Carbocysteine  Stress or emotional upset

- Expectorants- Guaifenesin  Medications – aspirin,

(Robitussin) NSAIDs

- Antihistamine- Diphenhydramine Asthma \patho

- Antibiotics,

SURGICAL MNGMT

 Bullectomy- bullae are enlarged

airspace occupy space in the
thorax but do not help in
ventilation (emphysema)

 Lung Volume Reduction

Surgery- removal of diseased
Signs and symptoms:
lung tissue allowing expansion
of the normal cell  Episodic dyspnea

 Lung Transplantation -  Accessory muscle

breathing
Asthma
 Inspiratory or expiratory
 Bronchial spasms and wheezing
constrictions characterized by
expiratory wheezing  Respiratory alkalosis

 Causes:  Status asthmaticus –

respiratory acidosis
 Genetic
Nursing management:
 Immunologic
 Bronchodilators –
 Allergic epinephrine,
theophylline,
 Environmental aminophylline, proventil,
Common Factors that Triggers an terbutaline
Attack:

Respi-threeBPage 8
  Corticosteroids –
solumedrol,
dexamethanol

BRONCHIECTASIS

 Chronic, irreversible dilation of

bronchi and bronchioles

 Pred. Fac – recurrent resp

inf.,PTB

 Inflam process with pulm infect,

damage the bronchial wall
result thick sputum obstructing
the bronchi
 S/S Chronic cough and purulent
sputum production
 TX -Postural drainage promotes
clearing of secretions.
Antibiotics may be prescribed.
Stop smoking
CYSTIC FIBROSIS
 Autosomal recessive disease
CF gene
 Viscous secretions in lungs,
intestine, reproductive tract,
pancreas. . Increase salt in
sweat.
 Airflow obstruction is key
feature
Medical Management:
 antibiotics, bronchodilators,
inhaled mucolytic agents
Nursing Management:
• Atelactasis
• Pneunonia - Refers to bacterial,
viral, parasitic or fungal
infection that causes
inflammation of alveolar spaces
& increase in alveolar fluid.
Ventilations decreases as
secretion thicken
Pneumonia
• The edema associated with
inflammation stiffens the lungs,
decreases lung compliance and
vital capacity and causes
hypoxemia
Causes:
Aspiration (NGT feedings) ,
chemical irritants, bacteria, virus
CLASSIFICATION
 Community Acquired
Pneumonia (CAP)1st 48hr
 Hospital Acquired
Pneumonia(HAP) after 48hr

chest physiotherapy, fluid and  Lobar and Broncho

dietary intake, reduce risk for
infection PNEUMONIA ASSESSMENT

 Chills, fever SOB, tachypnea,

CHEST AND LOWER
accessory muscle use
RESPIRATORY TRACT
DISORDERS  sputum (rusty, green or bloody
with pneumococcal pneumonia
and yellow green with
bronchopneumonia)

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  crackles, rhonchi, pleural
friction rub on auscultation,
cough, malaise
 restlessness (hypoxia)
Diagnostic exam:
- CXR shows diffuse patches
throughout the lungs or
consolidation in a lobe
- Sputum culture identifies the
organism
Treatment:
- CPT, ATB, IS
- Diet: High CHON, high calorie
(to offset hypermetabolic
state) , force fluids
- Administer O2 and respiratory
treatments
- Position in semi-fowler’s
position to facilitate breathing
and lung expansion
- Change position frequently and
ambulate as tolerated to
mobilize secretions
Tuberculosis
• Airborne, infectious,
communicable disease
• Poor nutrition, overworked,
overcrowded places with poor
ventilation, immunosuppressed
Assessment :
cough, hemoptysis, dyspnea,
low grade fever, night sweats, fatigue,
malaise, anorexia, weight loss
Diagnostic exam:
Mantoux test, Sputum culture
for AFB, CXR
Respi-threeBPage 10
Nursing management:
- Standard airborne precautions
- Diet high in CHO, CHON, B6, C
and calories
- No CPT, no PD and IS
- Provide negative pressure room
to prevent spread of infection
- Mask
TB Medications
- Administer medications (MDT) 6
months
- Rifampicin- reddish orange
secretions
- INH- peripheral neuritis-
paresthesia Vit B6
* Both hepatotoxic- avoid
ALCOHOL!
- PZA - inc. uric acid
- Ethambutol – optic neuritis --
blindness
- Streptomycin- ototoxic and
nephrotoxic
- Drugs to be taken on empty
stomach.
LUNG ABSCESS
 Complication of bacterial
pneumonia or caused by
aspiration or oral anaerobes
 Localized necrotic lesion of the
lung parenchyma containing
purulent material that collapses
and form cavity
 Productive cough with copious
amount of foul smelling sputum
  DX Chest X Ray,Sputum
MC&S,FOB

 TX IV antibiotics high dose,

CPT,high CHON and calories

Pleural Conditions

 Pleurisy – inflammation of
visceral and parietal pleura

=secondary to pneumonia, infection

=plueritic pain(one lung)

aggravated by deep breathing,
coughing, sneezing then pain
decreases as fluid accumulates

DX – CXR, Ausculation

TX – analgesics, turn to affected

side to splint chest wall, splinting
chest when coughing, treat
underlying condition

EMPYEMA
 Accumulation of thick, purulent
fluid withing the pleural space.
 2 to lung abscess/bacterial
pneumonia
 s/s of pneumonia/ chest
infection
 DX – Chest CT, ausc – dec
breath sounds, thoracentesis
 TX – drain fluid( home on chest
drain), IV antibiotics(4-6wks)
PLEURAL EFFUSION
• Excess of fluid in the pleural
space
Assessment:
- Pleuritic chest pain that is sharp
and increases with inspiration
- Dyspnea, decreased breath
sounds, fever, malaise
- Dry, non-productive cough
caused by bronchial irritation or
mediastinal shift to unaffected
side
Treatment of Pleural Effusion
- Thoracentesis – UTZ guided
- Thoracotomy with chest drain
insertion- drain and re expand
the lungs

• Normally the pleural space - Talc pleurodesis – recurrent

contains small amount of
extracellular fluid to lubricate it-
increased production or
inadequate removal results in
effusion
• DX – CXR,CT, Pleural fluid C&S
effusion
- done when pleural space is
drained
- A chemical irritant eg talc is
instillled in the pleural space via
the chest drain. After instillling
the talc chest drain is clamp for
60 to 90 mins and client is

Respi-threeBPage 11
 asked to change positions to
promote distribution of the talc
and maximize contact with
pleural space. ( promote
adhesion of visceral and parietal
pleura)
Pneumothorax
 Occurs when there is
accumulation of air in the
pleural space
TYPES
 Simple/Spontaneous – rupture
of bleb
 Open – chest trauma
 Tension – wound in chest wall,
lacerated lung
Open VS Tension
Pneumothorax
Assessment of pneumothorax
• Dyspnea, diminished or absent
breath sounds unilaterally
• sharp pain that increases with
exertion, dullness on percussion
• tracheal shift to unaffected side
(tension)
• decreased chest expansion
unilaterally, diaphoresis,
subcutaneous emphysema,
sucking sound with open chest
wound
Respi-threeBPage 12
Nursing Management
-Pneumothorax
 Apply dressing over open chest
wound
 Position in high fowler’s position
 Prepare for chest tube
placement until the lung has
fully expanded
 Monitor for hypotension,
tachycardia and tachypnea
 Assess for pain and medicate as
ordered
 Administer O2
 Assist in turning, coughing,
deep breathing and IS to
prevent atelectasis and mobilize
secretions
 Monitor chest tube drainage
system
Chest Tubes
• Returns negative pressure to
intrapleural space
• Used to remove abnormal
accumulations of air and fluid
from pleural space
• Collection chamber – drainage
• Water seal chamber- tip of tube
is underwater allowing fluid and
air to drain and prevents air
from entering the pleural space
• Water oscillates (moves up
when patient inhales and moves
down as patient exhales)
• Suction control chamber- gentle
continuous bubbling normal
Placement of Tube

Nursing Management
- Monitor for drainage (amount,
color)
- Keep tubes free of obstruction
- Change position frequently
- Do not strip or milk tubes
- Maintain the drainage system
below chest level to maintain
water seal and prevent reflux
Care of drain
• If drainage bottle accidentally
breaks, immerse tube in sterile
water , remove broken system
and replace with new one
• If chest tube accidentally pulled
out, pinch skin together, apply
sterile occlusive dressing and
CALL MD
When chest tube is removed,
patient asked to take a deep
breath and hold it and tube is
removed; a petrolatum dressing
or dry dressing is placed
LUNG CANCER
Respi-threeBPage 13
• Malignant tumor of the lungs
(primary/ metastatic)
• #1 type of cancer
Causes:
- Smoking ( 10 x prone) , 5 yrs
off smoking less risk
Pack year history- # of packs/day x
# years smoked
-exposure to environmental and
occupational pollutants ( more in
urban than rural places)
- genetics – 2-3x prone than general
population
- diet – low in fruit and veg. beta
carotene ? Important
ASSESSMENT
Cough, dyspnea, hoarseness,
hemoptysis, chest pain, anorexia and
weight loss, weakness
Diagnostics
CXR, CT(small nodules not seen by
CXR),FOB, MRI,VATS
Classification
Non small cell 75%– Squamous cell
central, Adenocarcinoma – peripheral
(most common)
Large cell ca- peripheral, grows fast
Small cell 25% - arise in major bronchi
Nursing Management:
• Assess for tracheal deviation
• Place in fowler’s position for
ease in breathing
• Administer O2 and
humidification to moisten and
loosen secretions
• Administer corticosteroids and
bronchodilators
• Provide high calorie, high CHON,
high vitamin diet
 Treatment/Mngmt
• Provide activity with rest
periods
• Radiation therapy
• Chemotherapy
• SURGERY
Lung resection
 Lobectomy
 Bilobectomy
 Pneumonectomy
 Segmentectomy – segment of
the lung is removed
 Wedge resection – removal of
pie shaped area of the segment
PULMONARY EDEMA
 Most often occurs as result of
abnormal cardiac function –
shifting of fluid bec of poor LV
 Crackles, dyspnea, central
cyanosis, frothy sputum(fluid
mix with air in the alveoli)
 Treat underlying disease.
Diuretics, O2
PULMONARY EMBOLISM
 Obstruction of pulmonary artery
or one of its branches by a
thrombus or embolus( DVT’s)
 Dyspnea,tachypnea, and chest
pain occur suddenly
 DX – CXR, D dimer assay,
Doppler UTZ
 Prevention of deep vein
thrombosis
Emergency management
 Thrombolytic therapy –
Streptokinase iv then ---
Respi-threeBPage 14
 Anticoagulation therapy –
Heparin iv
ACUTE RESPIRATORY FAILURE
Exists when gas exchange can not
keep up with rate of O2 consumption
Pa O2 – less 50 PaCO2 –less than 50
mm
 Decreased respiratory drive-
multiple sclerosis, sedatives,
severe hypothyroidism
 Dysfunction of the chest wall –
myasthenia gravis, guillain
barre
 Dysfunction of lung
parenchyma- pnemonia, Ptb,
asthma, pulm edema/embolism
 Treat underlying cause-
intubation
PULMONARY HYPERTENSION
 Systolic pulmonary artery
pressure > 30 mm Hg. or mean
pulmonary artery pressure >25
mm Hg.
 Primary is idiopathic
 Secondary results from existing
cardiac or pulmonary disease-
COPD, chronic
thrombotic/embolic dse.
 Manage underlying disease
 S/S – dyspnea with exertion
then at rest., chest pain,
weakness, right sided failure
 DX – Echo, Right Heart
Catheterization, PFT,CXR, ECG
 TX –treat underlying disease
Digoxin, Warfarin, Lung
Transplant, IVC filter then PTE
IVC Filter
  DX – CXR, D dimer assay,
Doppler UTZ

 Prevention of deep vein

thrombosis

Emergency management

 Thrombolytic therapy –
Streptokinase iv then ---
PAH Meds  Anticoagulation therapy –
Heparin iv
 Bosentan- vasodilator of
pulmonary artery.

S/E – hypotension. Monitor Liver

Func. test

 Prostacyclin- Epoprostenol
(Flolan) – relaxes vascular
smooth muscle(lungs),plt
deagregator

reduce pulmonary vascular

resistance & pressure

 half life is only 3 mins –

continous IV thru hickman line-
S/E hypotension, jaw pain,
redness, head-ache

 done every 12 hours.

 EPOPROSTENOL

 Trepostinil (Remodulin) –
prostacyclin analogue. Longer
half life than Flolan-

 Done every 48 hrs SC

 Iloprost (Ventavis) – inhaled,

synthetic form of prostacyclin.

 Done 7 times a day.

PULMONARY EMBOLISM

 Obstruction of pulmonary artery

or one of its branches by a
thrombus or embolus( DVT’s)

 Dyspnea,tachypnea, and chest

pain occur suddenly

Respi-threeBPage 15