Respandreas 151104055647 Lva1 App6891

Nursing Intervention of
Patients with
Respiratory Tract Disorders
By: Rochelle D. Ortillo, RN,
MAN
12/1/16
Nursing Interventions for Patients with

Respiratory Disorders
Learning Objectives
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At the end of the topic the learners will be

able to:
Assess and diagnose a patient with
respiratory disorders
Differentiate URTI and LRTI diseases.
State pathophysiology of patients with
respiratory diseases
Mention the clinical manifestation of
each respiratory problems.
Provide nursing care for a patient with
Nursing disorders
Interventions for Patients
with
respiratory
using
nursing
2
Review of the Anatomy & Physiology of

the Respiratory System
Upper and lower respiratory tracts.
Responsible for Ventilation
Upper airway, warms and filters inspired air
LRT (lungs) can accomplish gas exchange.
Gas exchange involves delivering oxygen to the tissues
through the bloodstream and expelling waste gases.
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Respiration includes four distinct

processes
Pulmonary ventilation (Breathing )
Gas exchange
External respiration
Gas exchange between the respiratory membrane

and the lungs
Internal respiration
Refers to gas exchange across the respiratory
membrane in the metabolizing tissues, like your
skeletal muscles.
Oxygen utilization by tissues

Cellular respiration
Takes place inside cells
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Transport of respiratory gases
Anatomy of the respiratory

system
Lower respiratory
division
Upper respiratory division
Mouth /Nose Pharynx

Larynx Trachea
bronchus bronchioles.
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Respiratory
bronchioles
Alveolar ducts
alveolar sacs
alveoli

Lung
Right Lung has three

lobes
Left lung has two
lobes
The structures of the
chest wall (ribs,
pleura, muscles of
respiration)
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Lung.
Pleura
Parietal pleura
Visceral pleura
What is located between

the two membranes?
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Movement of the Chest
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Lung volume and Lung capacities
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Assessment of the Respiratory System
Health history
Obtained by interviewing
Provides data why the patient
needs Nursing care, what kind of
care is required to maintain a
sufficient intake of air
Helps to prioritize the problem and
to plan interventions
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Assessment.
The assessment
includes;
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Reason the pt is
seeking health care
could be
Dyspnea (SOB)
Pain
Any respiratory
problems
Accumulation of
mucus
Onset of the problems
Wheezing
Aggravating factors
Hemoptysis
Relieving factors
Edema of the ankles
Any measures that
& feet
was taken
Cough
Effects on daily living
activity
Fatigue and
weakness. 11
Assessment.
Risk factors
Major Clinical
Manifestations
Cough
Sputum production
Chest pain
Wheezing
Clubbing of the
fingers
Cyanosis
Smoking
Pack years = (number
of packs of cigarette
per day) X (the number
of years the person has
smoked)
Exposure to smoke
History of attempts to
quit, methods, results
Sedentary lifestyle
Age
Environmental exposure
Dust, chemicals, etc.
Obesity
Family history
TB, Lung CA, Asthma
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Assessment.
Cough
Type
Dry, Moist,
Productive
Onset
Duration
Pattern
Activities, time of
day
Severity
Effect on ADLs
Wheezing
Associated symptoms
Rx and effectiveness
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Sputum
Amount
Color
Presence of blood
(hemoptysis)
odor
consistency
pattern of production

13
Assessment.
Past Health History

URI
Trauma
Surgery
Chronic conditions of
other systems
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Family Health History
Tuberculosis
Emphysema
Lung Cancer
Allergies
Asthma

14
Physical Examination
The nurse should proceed in well organized

manner with a sequence of
Inspection
Palpation
Percussion
Auscultation
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Inspection
The nurse should inspect
Any abnormality in the

chest
Movement of the chest
Skin color of the thoracic
area
Respiratory rate and
rhythm
Uses of accessory
muscles
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Inspection
Tracheal deviation
Barrel Chest
Pectus Excavatum
Cyanosis
Pigeon Chest
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Pectus Excavatum
Barrel
Chest

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Tracheal
Deviation
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Inspection
Pigeon Chest

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Palpation
The nurse should palpate

Skin temperature
Any mass, edema,
Tenderness
Vocal Fremitus
Chest expansion
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Palpation
Tactile
Fremitus Exam
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Percussion
Identify the consistency of the tissue
under the thoracic cavity (air, fluid or
solid).
The sounds that are heard on
percussion are;
Resonance
Dullness
Hyper resonance
Tympanic
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Percussion
Percussion
notes on the
posterior chest
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Percussion
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Percussion .
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Auscultation
The nurse should move from the apex

to the base with the stethoscope by
comparing and contrasting one side
with the other.
It helps to hear normal breath sounds
and added breath sounds.
There are three classified sounds
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Auscultation
Vesicular Breath Sounds
low pitch and soft intensity
long inspiration phase than expiration
phase
heard over most lung area
no clear gap between inspiration and
expiration
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Auscultation
Bronchial Breath Sounds
high pitch and loud intensity
long expiration phase than inspiration
phase
have clear gap between expiration and
inspiration
heard over the trachea
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Auscultation
Bronchovesicular Breath Sounds
Medium pitch
equal expiration and inspiration phase
heard posteriorly between the scapula &
anteriorly in the first and second
intercostals space
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Auscultation
Normal Auscultatory
Sounds
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Auscultation.
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Abnormal
Decreased air entry - Pneumothorax,
Atelectasis, Effusion.
BBS in areas of VBS - Pneumonia, TB
Added sounds
Wheezing - Asthma, Emphysema
Cryptation Crackles - Pneumonia, TB ,
CHF
Ronchii secretion in large airway,
fluid in bronchial tubes.
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Auscultation.
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Inspection
posture, shape, movement, dimensions
of chest, flared nostrils, use of accessory
muscles, skin color, and rate, depth, &
rhythm of respiration
Palpation
respiratory excursion, masses,
tenderness
Percussion
flat, dull, resonant, hyper resonant
sounds
Auscultation
breath sounds,
voice
sounds,
crackles,
Nursing Interventions
for Patients
with
32
wheezes
Diagnostic Procedures
Sputum Studies
Arterial Blood Gases
measurements of blood pH , arterial O2 &
CO2 tensions, acid-base balance
Pulse Oximetry
Chest X-ray
Bronchoscopy
Thoracentesis
Laryngoscopy
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Diagnostic Procedure
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Diagnostic Procedures
Thoracentesis
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Upper Airway Infections (URTI)
Viral Rhinitis (Common Cold)
The term common cold often is used

when referring to an URTI.
The term cold refers to an afebrile,
infectious, acute inflammation of the
mucous membranes of the nasal cavity.
Caused by a virus (viral rhinitis).
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Viral Rhinitis
Clinical Manifestations
Nasal congestion
Runny nose
Sneezing
Nasal discharge, Nasal itchiness
Tearing watery eyes, scratchy or sore throat
General malaise, low-grade fever, chills, and
often headache and muscle aches.
The symptoms last from 1 to 2 weeks.
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Viral Rhinitis - Management

No specific treatment
Symptomatic therapy
Adequate fluid intake
Encouraging rest
Increasing intake of vitamin C
Using expectorants as needed.
Warm salt-water gargles soothe the throat
NSAIDs
Antihistamines are used to relieve sneezing,
rhinorrhea, and nasal congestion.
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Viral Rhinitis - Management

Nursing Management
Patient teaching of self care & prevention of infection &
break chain of infection
Hand washing remains the most effective measure to
prevent transmission of organisms.
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Acute Sinusitis
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The sinuses, mucuslined cavities filled

with air that drain
normally into the
nose.
Acute sinusitis
frequently develops
as a result of an URTI
particularly a viral
infection or an
exacerbation of
allergic rhinitis.
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Acute Sinusitis
Pathophysiology
Acute sinusitis is an infection of the paranasal
sinuses.
Develops as a result of an URI, and an
exacerbation of allergic rhinitis.
Nasal congestion, caused by inflammation,
edema, and transudation of fluid, leads to
obstruction of the sinus cavities and result for
bacterial growth.
Bacterial organisms account for more than 60% of
the cases of AS, namely Streptococcus
Pneumoniae and Haemophilus Influenzae.
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Acute Sinusitis
Ear pain and
Clinical
Manifestations
Facial pain or
pressure
Nasal obstruction
Fatigue
Purulent nasal
discharge
Fever
Headache
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fullness
Dental pain
Cough
ed sense of
smell
Sore throat
Eyelid edema
Facial congestion
or fullness.

42
Acute Sinusitis
Medical management
Antibiotics (Amoxicillin & Ampicillin).
Decongestants may be administered.
Saline irrigation for opening blocked
passages, there by allowing drainage of
purulent discharge.
Topical decongestants should be
administered with the patients head back
to promote maximal drainage.
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Acute Sinusitis
Nursing intervention
The nurse can instruct the patient on
methods to promote drainage such
as
Inhaling steam (steam bath, hot
shower)
Increasing fluid intake
Applying local heat (hot wet packs)
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Acute Sinusitis
Complications
Meningitis
Brain abscess
Ischemic Infarction
Osteomyelitis
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Chronic Sinusitis
Chronic Sinusitis is an inflammation
of the sinuses that persists for
more than 3 weeks in an adult and
2 weeks in a child.
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Chronic Sinusitis
Pathophysiology
Narrowing or obstruction in the Ostia
(openings) of the sinuses.
Could be because of infection, allergy,
or structural abnormalities
Results in stagnant (non flowing)
secretions, an ideal medium for
infection.
The organisms are the same as those
implicated in acute sinusitis.
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Chronic Sinusitis
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Impaired mucociliary clearance and
ventilation
Cough
Chronic hoarseness
Chronic headaches in the periorbital
area
Facial pain.
Fatigue and nasal stuffiness.
Decrease in smell and taste and a
Interventions for Patients with
48
fullness Nursing
in the
ears.
Chronic Sinusitis
Diagnostic Findings
CT
scan
of
the Complications
sinuses
Severe orbital cellulites
MRI
Subperiosteal abscess
Nasal Endoscopy
Sinus thrombosis
Management
Meningitis
Almost the same as
Encephalitis
for Acute Sinusitis.
Ischemic Infarction.
The
course
of
treatment may be 3
to 4 weeks
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Chronic Sinusitis
Orbital Cellulites
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Subperiosteal Abscess

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Tonsillitis and Adenoiditis

Is the inflammation of
tonsils and adenoids.
Infection of the adenoids
frequently accompanies
acute tonsillitis.
Group A betastreptococcus is the
most common organism
associated with tonsillitis
and adenoiditis.
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Clinical
manifestation
Sore throat
Fever
Snoring
Difficulty in swallowing
Ear ache
Draining ears
Bronchitis
Foul smelling
Voice impairment
Noisy respiration
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Peritonsillar abscess
Is a collection of purulent exudate
between the tonsillar capsule and
the surrounding tissues, including
the soft palate.
Develop after an acute tonsillar
infection, progresses to a local
cellulitis & abscess
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C/M of Peritonsillar abscess
Odynophagia
Otalgia
Dysphagia
Thickening of the Voice
Drooling & local pain
Swelling of the soft palate
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Medical management
Antibiotics (usually penicillin)
Abscess must be drained
Abscess may also be incised and
drained
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Surgical Management
Tonsillectomy or Adenoidectomy
Tonsillectomy or Adenoidectomy is
indicated only if
Repeated period of illness of tonsillitis
Hypertrophy of the tonsils and adenoids
that could cause obstruction and
obstructive sleep apnea
Repeated attacks of purulent Otitis
media
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Patient Education
Advise adequate fluid intake
Frequent use of mouth washes and
gargles using saline solution
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Acute Pharyngitis
Is an inflammation in the throat.

Usually causing symptoms of a sore
throat.
Most cases caused by viral infection.
When group A beta-hemolytic
streptococcus, the most common
bacterial organism, causes Acute
Pharyngitis (Strep Throat).
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Acute Pharyngitis
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Acute Pharyngitis
Pathophysiology
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Infection
Inflammatory response in the pharynx
Pain, fever, vasodilation, edema, and
tissue damage
Manifested by redness and swelling in the
tonsillar pillars, uvula, and soft palate
A creamy exudate may be present in the
tonsillar pillars
If left untreated, leads to bacteremia,
pneumonia,
meningitis,
for Patients with rheumatic fever,
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Acute Pharyngitis
Clinical Manifestation
Affected pharyngeal membrane and
tonsils
Lymphoid follicles that are swollen with
exudates.
Enlarged and tender cervical lymph
nodes
Fever and malaise
Sore throat
Hoarseness cough and rhinitis
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Acute Pharyngitis
Complication
Sinusitis
Otitis media
Pneumonia
Peritonsilar abscess
Mastoiditis
Cervical Adenitis
Rheumatic fever
Nephritis
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Diagnostic Findings
Rapid screening
tests for
streptococcal
antigens
Streptolysin titers
Throat cultures
Nasal swabs and
blood cultures

62
Acute Pharyngitis
Medical management
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Viral pharyngitis is treated with

supportive measures.
Bacterial pharyngitis is treated with
Antibiotics.
Antibiotics are administered for at least
10 days
Liquid or soft diet is provided during the
acute stage of the disease.
In sever situations; fluids are
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administered
by intravenously.
Acute pharyngitis
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Patient education
Patient should stay in bed during the
febrile stage
Alcohol, tobacco, second-hand smoke,
and exposure to cold are avoided
Encourage the patient to drink plenty of
fluids.
Gargling with warm saline solutions may
relieve throat discomfort.
LozengesNursing
64
will
keep the throat moistened
Chronic Pharyngitis
persistent inflammation of the pharynx.
common in adults who work or live
surroundings
use their voice to excess
suffer from chronic cough, and
habitually use alcohol and tobacco.
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in
dusty
Chronic Pharyngitis .
Constant sense of irritation or fullness in the

throat
Mucus that collects in the throat and can be
expelled by coughing, and
Difficulty swallowing
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Chronic Pharyngitis .
Management
Is based on relieving symptoms,
Avoiding exposure to irritants, and
Correcting
any
upper
respiratory,
pulmonary, or cardiac condition that
might cause chronic cough.
Nasal congestion may be relieved by
short-term use of nasal sprays or
medications containing ephedrine
sulfate or phenylephrine hydrochloride.
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Chronic Pharyngitis ...
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Antihistamine
decongestant
medications, such as Drixoral or
Dimetapp, is taken orally every 4 to 6
hours.
Aspirin
or
Acetaminophen
is
recommended for its anti inflammatory
and analgesic properties.
Encourage the patient to drink plenty of
fluids.
Gargling with warm saline solutions
may relieve throat discomfort.
68
Lozenges
will
keep
the
throat
Chronic Pharyngitis
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Laryngitis
Is an inflammation of the larynx

Often occurs as a result of voice abuse or
exposure to dust, chemicals, smoke &
other pollutants, or as part of an URTI.
It also may be caused by isolated
infection involving only the vocal cords.
The cause of infection is almost always a
virus.
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Laryngitis
Usually associated with allergic

rhinitis or pharyngitis.
The onset of infection may be
associated with exposure to sudden
temperature changes, dietary
deficiencies, malnutrition, and an
immune suppressed state.
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Laryngitis
Hoarseness
Aphonia (complete loss of voice)
Severe cough
Chronic laryngitis is marked by
persistent hoarseness
May be a complication of URTI
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Laryngitis
Medical Management
Resting the voice
Avoiding smoking
Avoiding second-hand smoke
Inhaling cool steam or an aerosol
Appropriate antibacterial therapy
Topical corticosteroids, such as Vanceril
inhalation
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Laryngitis
Nursing Management
The nurse instructs the patient
To rest the voice
To maintain a well-humidified
environment.
Expectorant agents are suggested
Along with a daily fluid intake of 3 L to
thin secretions.
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Laryngitis
COMPLICATIONS
Sepsis
Meningitis
Peritonsillar abscess
Otitis media
Sinusitis
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Management of Patients
With Chest and Lower
Respiratory Tract Disorders
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Acute Bronchitis
Is a common acute inflammation of the

mucous membrane lining the inside of
the bronchi
Often follows URTI and often occurs in
people with chronic lung disease.
Causes
Bacteria (Streptococcus Pneumonia and
Hemophilus Influenza)
Virus and chemical and smoke irritants
also can cause inflammation
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Acute Bronchitis
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Pathophysiology
Colonization of bacteria to the
bronchi
Inflammation of the bronchi
As inflammation progresses there
is increased blood flow to the
bronchi
Causing an increase in pulmonary
secretions (so goblet cell produces
mucus)
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Acute Bronchitis
Dry, irritating cough
Scanty amount of
mucoid sputum
Sternal soreness
Fever (low grade)
Chills
Night sweats
Headache
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General malaise
Shortness of
breath
Physical
Examination
Rhonchi and
Wheezes
Diagnosis
Hx
P/E
CXR to R/o
Pneumonia

79
Acute Bronchitis
Medical Management
Antibiotic treatment
Usually dont prescribe Antihistamines
Expectorants may be prescribed
Increase fluid intake
Suctioning
Moist heat to the chest may relieve the
soreness and pain.
Mild analgesics or antipyretics may be
indicated.
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Pneumonia
An inflammation of the lower respiratory

tract that involves the lung parenchyma.
Causes:
bacteria
virus
fungus
chemical or radiations
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Pneumonia.
Mode of transmission
Pathogens can be introduced into the
lungs by 3 primary routs
Aspiration:- transmitted micro-organisms
from the oropharynx and GIT to the lungs
by direct-contact
Causes
Glottis disorder
Pts with NGT
Unconscious patients
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Pneumonia
Inhalation:
It is an important MOT for organisms
suspended in water droplets and spread
into the air with coughing, sneezing and
talking.
Circulatory spread:
Spread of infection occurs when
pathogens are transmitted through the
circulatory system to lung from preexisting infection in other parts of the
body.
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Pneumonia
Pathophysiology
Invasion of microorganisms
Inflammatory reaction occurs in the alveoli
Exudates production that interferes with the
diffusion of oxygen and carbon dioxide.
Migration of WBC, mostly neutrophils and filling
of the normal air containing space.
Reduced ventilation of the lung b/c of secretions
& mucosal edema that cause partial occlusion of
the bronchi or alveoli
Decreased alveolar oxygen tension
Hypoxia
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Classification of Pneumonia
Based on the place where its acquired
Community acquired pneumonia
Pneumonia that occurs in the community

CAP occurs either in the community setting or
within the first 48 hours of hospitalization.
Usually begins as common respiratory infections
Streptococcus Pneumonia is the most common
cause
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Classification of Pneumonia
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Common agents are S. Pneumoniae, H.

Influenzae, Legionella, Pseudomonas
Aeruginosa, and other gram negative
rods
Influenzae is another cause of CAP
Mycoplasma Pneumonia, occurs most
often in older children and young adults
Viruses are the most common cause of
pneumonia in infants and children but are
relatively uncommon causes of CAP in
adults. Nursing Interventions for Patients with
86
Classification
Hospital acquired pneumonia

HAP, also known as nosocomial
pneumonia, is defined as the onset of
pneumonia symptoms more than 48
hours after admission to the hospital
Results from exposure to potentially
infectious agents, such as P.
Aeruginosa, S.Aurous in the hospital
setting
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Classification ...
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These bacilli colonize in the

Oropharyngeal region and are
aspirated to the lungs
Common organisms: Enterobacter
species, Escherichia coli, Klebsiella
species, Proteus, Serratia
marcescens, P. aeruginosa, and
methicillin-sensitive or methicillinresistant Staphylococcus aureus.
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Classification
Anatomical
Classification
Bronchopneumo
Lobar pneumonia nia
A substantial portion
of one or more lobes
is involved.
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Describes pneumonia
that is distributed in a
patchy fashion

89
Classification...
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According to causative agents

Bacterial Pneumonia
Can be caused by both from ve
and from +ve bacteria.
Streptococcus Pneumonia is the
most common bacteria & causative
agent
Most prevalent during the winter
and spring when URTIs are more
frequent
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Classification
Viral pneumonia
Influenza virus type A is the most
type of causative agent in a
healthy person
CMV is the most common cause of
viral pneumonia in
Immunosuppressed patient with
high mortality rate
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Classification .
Fungal pneumonia
Most common in immune compressed

and neurogenic patients
Histoplasmosis is caused by Histoplasma
Capsulatum
Other pneumonia
Protozoa and Helminths
PCP which caused by Pneumocystic
Carini has high incidence with AIDS
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Classification
Pneumonia classified as based of

C/M
Typical
(The most causative agents;

Streptococcus pneumonia,
staphylococcus pneumonia, klebsella
pneumonia, pseudomonas
pneumonia, H. influenza)
Atypical
(Pneumonia associated with mycoplasma
pneumonia, influenza virus, legionella
pneumonia, Pneumocystis carinii , fungal
pneumonia )
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For Typical
Pneumonia
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Physical Examinations
Dullness to percussion
on the affected area of
lung
Increased fremitus on
palpation
Bronchophony,
Egophony, Crackles on
auscultation
WBC generally elevated
Chills
Abrupt onset of
fever
Cough with
purulent sputum
Chest pain
Tachypnea
Granting
Nasal flare
accessoryNursing
muscles
use
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C/M
For Atypical Pneumonia
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Gradually many patients have had

symptoms of URTI (nasal congestion,
sore throat)
Symptom are headache, low-grade
fever, pleuritic pain, myalgia, rash and
pharyngitis
Dry cough and sub-mucoid sputum
Physical examination reveal scattered
wheeze and crackles WBC commonly <
10,000 Nursing Interventions for Patients with
95
Pneumonia
Diagnoses
History
Chest X-Ray
Blood culture
Sputum examination
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Pneumonia
Treatment
Administration of appropriate antibiotic

as determined by the result of Gram
Stain.
Supportive therapy
Bed rest, maintenance of adequate fluid
and nutritional intake
Warm, moist inhalation to relieve
bronchial irritation, mild analgesic to
relieve pain, and administration of O2 if
hypoxia develops.
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Pneumonia
Potential complications
Hypotension and shock
Respiratory failure
Atelectasis
Pleural Effusion
Delirium
Superinfection
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Pneumonia
Nursing care
Improving airway potency
Removing secretion
High level of fluid intake (2-3 L/d) is encouraged
that thins and loosens pulmonary secretion and
also replace fluid losses resulting from fever,
diaphoresis .
Chest Physiotherapy :- important in loosening and
mobilization secretions
Promote rest and conserving energy
Promoting fluid intake
Monitoring and managing potential complications
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Chronic Obstructive Pulmonary Disease (COPD )
A disease state characterized by airflow

limitation that is not fully reversible
COPD may include diseases that cause
airflow obstruction (e.g., Emphysema,
Chronic Bronchitis) or a combination of
these disorders
Common during the middle adult years,
and the incidence of COPD increases with
age.
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COPD
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Pathophysiology
Exposure to noxious particles or gases
Progressive abnormal inflammatory
response of the lungs throughout the
airways, parenchyma and pulmonary
vasculature
Narrowing occurs in the small peripheral
airways
Over time, this injury-and-repair process
causes scar tissue formation and
narrowing of the airway lumen
101
And also Parenchymal destruction
Chronic Bronchitis
A disease of the airways, defined as the

presence of cough and sputum production
for at least 3 months in each of 2
consecutive years.
Causes
Cigarette smoking
Exposure to pollution
A wide range of viral, bacterial and
mycoplasma infection can produce acute
episodes.
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Chronic Bronchitis
Pathophysiology
Smoke irritates the airways ,resulting in
hyper secretion of on mucus and
inflammation
Because of this constant irritation, the
mucus secretion glands and goblet cells
increase in number, cilia function is
reduced and more mucus is produced.
Bronchial walls become thickened, the
bronchial lumen is narrowed, and mucus
may plug the airway
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Chronic Bronchitis
Alveoli adjacent to the bronchioles may
become damaged and fibrosed, resulting
in altered function of the alveolar
macrophages.
The patient becomes more susceptible to
respiratory infection.
Further bronchial narrowing occurs,
possibly resulting in emphysema and
bronchiectasis
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104
Chronic Bronchitis
Pathophysiology of Chronic Bronchitis
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105
Chronic Bronchitis
A chronic productive cough in the winter
month is the earliest sign of chronic
bronchitis
The cough may be exacerbated by cold
weather dampness and pulmonary
irritants
The patient usually has a history of
cigarette smoking and frequent
respiratory infections
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106
Chronic Bronchitis
Diagnostic Evaluation
A complete history of exposure to irradiating
substances and occupational history is taken
including smoking habits (number of packs per
day)
The pulmonary function studies - decrease in vital
capacity and forced expiratory volume
Hematocrit and Hemoglobin may be slight
increased
The blood gas analysis may reveal hypoxia with
hypercapnia
The CXR may reveal an enlarged heart with normal
or flattened diaphragm
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107
Chronic Bronchitis
Medical management
Recurrent bacterial infections are
treated with antibiotic therapy
To help removing bronchial secretion
Bronchodilators are prescribed to relieve
bronchospasm
Postural drainage and Chest Percussion
Fluid administration
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108
Chronic Bronchitis
Prevention
Preventing its occurrence

Avoids respiratory irritants (tobacco
smoke)
Treat infection
Immunize against Influenza and
Pneumonia etc.
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109
Pulmonary Emphysema
Is abnormal distention of air spaces
beyond the terminal bronchioles with
destruction of the walls of the alveoli.
In emphysema, impaired gas exchange
results from destruction of the walls of
over distended alveoli.
Is the end stage a process that has
progressed slowly for many years
By the time the patient develops
symptoms, pulmonary function is
irreversibly impaired
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110
Pulmonary Emphysema...
12/1/16
The walls of the alveoli are destroyed

The alveolar surface area continually
decreases
Increase in dead space and impaired
oxygen diffusion, leads to hypoxemia.
As the alveolar walls continue to break
down, the pulmonary capillary bed is
reduced
Pulmonary blood flow is increased
forcing the right ventricle to maintain a
higher blood
pressure in the pulmonary
111
artery
Pulmonary Emphysema.
CO2 elimination is impaired
Hypercapnia
Hypoxemia
Increased Pulmonary Artery Pressure.
RHF (Cor-Pulmonale)
Congestion, Dependent edema,
Distended neck veins.
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112
Types
of
Emphysema
Panlobular
Centrilobular
The pathologic changes

take
place mainly in the
Emphysema
center of secondary lobule,
while the peripheral
portions of the acinus are
preserved.
Derangement of ventilationperfusion ratios, producing
chronic hypoxemia,
hypercapnia, polycythemia
& episodes of RHF.
Leads to central cyanosis,
peripheral edema and
respiratory failure.
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Destruction of
Emphysema
respiratory
bronchiole,
alveolar duct, and
alveoli.
All the air spaces
within the lobule
are enlarged.
Patient has a barrel
chest, marked
dyspnea on
exertion and
weight loss Nursing
113
Types of Emphysema
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114
Pulmonary Emphysema
Risk Factors
Environmental exposures
Cigarette smoking - major
Antitrypsin
deficiency
(enzyme
inhibitor)
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115
Pulmonary Emphysema
C/Ms
12/1/16
Dyspnea and insidious onset.

History of cigarette smoking
Long history of chronic cough
Wheezing
Rapid breathing
Anorexia
Weight loss
Weakness
Neck veins may be distended during
expiration
116
Pulmonary Emphysema
P/E
Hyper-resonance
Barrel chest
Dyspnea
Prolonged wheezing on
expiration
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Dx
Hx.
P/E
CXR
Pulmonary Function
Test
CBC

117
Pulmonary Emphysema
Management
Goal of treatment
To improve the quality of life
To slow the progression of the disease process
To treat the obstructed air ways to relive hypoxia
Rx
Bronchodilators
Aerosol therapy
Corticosteroids
Oxygen supplement
Antibiotics
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118
Bronchiectasis
Chronic, irreversible dilatation of the
bronchial tree.
Associated with chronic infection and
inflammation of these passageways.
Causes
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Airway obstruction
Diffuse airway injury
Pulmonary infection
Obstruction of the bronchus
Genetic disorder such as Cystic Fibrosis
119
Abnormal
host
defense
Respiratory
Disorders
Bronchiectasis
Pathophysiology
Infection damages the bronchial wall
Causing a loss of its supporting structures
Producing thick sputum
It may obstruct the bronchi
The walls permanently distended by
severe coughing
The lower lobes are most frequently
involved
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120
Bronchiectasis
Retention of secretion and subsequent

obstruction ultimately causes the distal
alveoli to obstruct and collapse
(Atelectasis)
Inflammatory scarring or fibrosis replaces
functioning lungs tissue
Patient develops respiratory insufficiency
with reduced vital capacity, decreased
ventilation and an increase ratio of
residual volume to total lungs capacity.
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121
Bronchiectasis
There is impaired milking of inspired

gas, Ventilation perfusion imbalance and
hypoxemia.
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122
Bronchiectasis
Clinical
manifestation
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Chronic productive
cough, with sputum
Hemoptysis
Clubbing of the
fingers
Repeated episodes of
respiratory infection
Dx is established on
the basis of
Bronchography.
123
Bronchiectasis
Bronchographyis a
radiological technique,
which involves x-raying
the respiratory tree after
coating the airways with
contrast.
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124
Bronchiectasis
Medical management
The objectives of RX are to prevent and control
infection and to promote bronchial drainage
Infection is controlled with anti-microbial therapy
Postural drainage of the bronchial tube
Patient should be vaccinated against Influenza &
Pneumococcus
The affected chest area may be percussed
Brochodilator (Ventolin, Xopenex )
Increase oral fluid intake
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125
Bronchiectasis
Surgical management
It may be necessary to remove

A segment of a lobe (segmental
resection)
A lobe (lobectomy)
An entire lungs (pneumonectomy)
Bronchography aids in delineating the
segment.
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126
Bronchial Asthma
Asthma is an intermittent, reversible,

obstructive airway disease in which the
trachea and bronchi responds in a
hyperactive way of certain stimuli.
It is characterized by bronchial
hyperactivity to various stimuli causing;
Narrowing of airways or reversible
bronchospasm
Edema of the muscular surface of bronchioles
Increased mucous production
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127
Bronchial Asthma
Etiology and Classification

1. Allergic /Extrinsic/ Atopic
asthma
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It is caused by known allergens e.g. dust,

pollen, food, animals, perfumes, etc...
The patient usually has a family history of
allergies & a past medical history of
eczema or allergic rhinitis.
It is more common than other types and is
responsible for most of the childhood
asthma but
often
out
grow
the diseases
by
Nursing
Interventions
for Patients
with
128
Bronchial Asthma
2. Non-Allergic /Intrinsic/ Non-Atopic

Asthma
12/1/16
It is not related to specific allergen.

It occurs, in adults and becomes more
severe and frequent with time
Can progress to Chronic Bronchitis and
Emphysema
Factors such as respiratory infections,
exercise, emotional stress, cold,
environment pollutants, some
pharmacologic agents such aspirin and
129
Respiratory hair
Disorders dye etc may also
other NSAIDs,
Bronchial Asthma
Pathophysiology
Exposure to allergens
IG-E attach with mast cells
release several chemical mediators
Inflammation
mucosal edema, bronchospasm and increased mucus
production
alveoli hyperinflate
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130
Bronchial Asthma
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131
Bronchial Asthma
Clinical Manifestation
Dyspnea
Cough and wheezing
Sensations of chest tightness
Slow, laborious or forceful, wheezing
breathing
Expiration is always, much more strenuous
and prolonged than inspiration, which forces
the patient to sit upright and use every
accessory muscle of respiration
Obstructed airway causes Dyspnea
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132
Bronchial Asthma
Initially coughing is tight and dry but
soon becomes productive
The attack may last from 30 minutes to
several hours and may subside
spontaneously, occasionally a more
severe continues reaction called status
Asthmaticus occurs
12/1/16
An acute,severe asthma attackthat doesn't

respond to usual use of inhaled
bronchodilatorsand is associated with
symptoms of potential respiratory failure is
called Status
Asthmaticus.
for Patients with
133
Bronchial Asthma
Later signs
Cyanosis secondary to severe hypoxia
Symptoms of CO2 retention including
sweating, tachycardia, and widened
pulse pressure
Related reactions like eczema, rash
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134
Bronchial Asthma
Diagnosis
12/1/16
No single test confirm the diagnosis of

asthma
A complete history, including family,
environmental and occupational history
Sputum - clear and foamy (allergic
asthma) and thick and white(non
allergic asthma)
CXR during the attacks
Increased serum IgE in Allergic asthma
gasforanalysis
(PCO2) 135
Arterial blood
Patients with
Bronchial Asthma
Management
1. Prevention of the attack
Avoidance of the causative agent and the

situation that precipitate an attack
Cromolyn Sodium prevents release of
inflammatory mediators but has no benefit
if taken during the attack.
2. Treating or managing the attack

There are 5 categories of medication used
in the treatment of asthma.
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136
Bronchial Asthma
1. B-Agonist/Adrenergic agents
It includes adrenaline, metaproterenol,
terbutaline etc...
They are initial medication used because
they dilate bronchial smooth muscles and
increase cilliary movement, decrease the
chemical mediators.
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137
Bronchial Asthma
2. Methylxanthin
Aminophyllin (IV injection) and Theopyilline (PO),
are used because of their bronchodilating effects.
They relax bronchial smooth muscle, increase
movement of mucus in the airways, and increase
the contraction of the diaphragm
Methaylxanthins are not used in acute attacks b/c
they have slower effect than beta agonists
Caution should be given when administering, if
given too rapid tachycardia or cardiac arrhythmia
may result.
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138
Bronchial Asthma
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139
Bronchial Asthma
3. Anticholinergics
Includes Atropine Methyl-Nitrate,

Ipratopium Bromide.
They have excellent bronchodilatory
effect with minimal side effects
Act by reducing inflammation
and bronchoconstriction.
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140
Bronchial Asthma
4. Corticosteroids
It includes Hydrocortisone (IV),

Prednisolone (orally), Dexamethasone
(inhalation).
They may be used for acute attacks that
do not respond to bronchodilators.
They are particularly beneficial for those
who are not candidates for B-Agonists
and Methaylxanthin because of their
underling cardiac disease
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141
Bronchial Asthma
5. Mast cell inhibitors
Cromolyn Sodium (inhalational), a mast cell

inhibitor prevents the release of chemical
mediators of anaphylaxis there by resulting
bronchodilation and decrease airway
inflammation .
most beneficial between attacks or while the
asthma is in remission.
Oxygen administration
Monitoring arterial blood gases
Fluid administration
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142
Bronchial Asthma
Status Asthmatics
It is severe and persistence asthma that
does not respond to conventional therapy.
The attack lasts longer than 24 hours.
C/M
The same as asthma but severe
Laboured breathing
Prolonged expiration
Engorged neck vein, wheezing
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143
Bronchial Asthma
Rx
Beta-Agonists and Corticosteroids
Oxygen administration
IV fluid administration
Frequent monitoring
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144
Lung Abscess
It is localized necrotic lesion of the lung
parenchyma containing purulent
material, the lesion collapse and forms
a cavity.
It is generally caused by aspiration of
anaerobic bacteria.
CXR will demonstrate a cavity of at
least 2cm.
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145
Lung Abscess
Risky clients for aspiration

Patients with impaired cough reflexes
Patients with swallowing difficulty
Patients with altered state of
consciousness
Drug addiction, Alcoholism or Esophageal
disease, as well as patients fed by NGT
Immunocompromised patients
Patients with Pneumonia
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146
Lung Abscess
Etiology
Staphylococcus Aurous
Klebsiella
Anaerobic bacteria (more prevalent)
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147
Lung Abscess
Pathophysiology
It is a complication of bacterial
pneumonia or aspiration of oral
anaerobes into the lung.
May occur secondary to
mechanical or functional
obstruction of the bronchi by a
tumor, foreign body, bronchial
stenosis, necrotizing pneumonias,
TB, pulmonary embolism etc.
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148
Lung Abscess
The site of the lung abscess is
related to gravity and is determined
by the pts position.
For pts who are confined to bed, the
posterior segment of an upper
lobe and the superior segment
of the lower lobe are the most
common areas in which lung abscess
occurs.
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149
Lung Abscess
Initially, the cavity in the lung may or may

not extend directly into a bronchus.
Eventually the abscess becomes
encapsulated.
The necrotic process may extend until it
reaches the lumen of a bronchus or the
pleural space and establishes
communication with the respiratory tract,
the pleural cavity.
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150
Lung Abscess
If the bronchus is involved, the purulent

contents are expectorated continuously
in the form of sputum.
If the pleura is involved, an Empyema
results.
A communication between the bronchus
and pleura is known as a bronchopleural
fistula.
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151
Lung Abscess
Clinical manifestations
Productive cough which is foul smelling sputum that
often bloody sputum
Pleurisy, or dull chest pain
Dyspnea, weakness, anorexia and weight loss
Fever & cough may develop insidiously & may have
been present for several weeks before diagnosis.
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152
Lung Abscess
Diagnosis
History
Physical examination
12/1/16
Dullness
Decreased or absent breath sound
Pleural friction rub
Crackles
CXR and culture of sputum are confirmatory
of the diagnosis

153
Lung Abscess
Medical management
12/1/16
Antibiotic parentrally
Cloxacillin for Ataph. Aureus
Clindamycin or Penicillin +
Metronidazole
Large dose is needed to pass the
necrosis & followed by long-term
therapy with an oral agents (6-16
weeks)
Adequate drainage by postural drainage
154
and chest
physiotherapy
Lung Abscess
Diet: high protein and calories should

be given
Surgical intervention
Prevention
12/1/16
Before tooth extraction if there is

infection give antibiotics.
Adequate dental and oral hygiene
Appropriate Rx for patients with
Pneumonia
155
Lung Abscess
Prescribed antibiotic
Chest physiotherapy
Nutrition
Emotional support pt. education on
homecare
Wound care if surgery is performed
Deep breath and coughing every 2 hrs.
Postural drainage
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156
Lung Cancer
Lung cancer (broncho-carcinoma) is a

malignant tumor arising from the
bronchus.
Evidences indicate that carcinoma tends
to rise at site of previous scaring (TB,
Fibrosis) in lung.
Most causes are preventable if smoking is
controlled.
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157
Lung Cancer
Risk factors include:

Tobacco smoking (active and passive
smoking)
Air pollutions (Sulfur, Pollutants)
exposure - Industrial carcinogens such as
Arsenics and Radiation
Genetics predispositions
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158
Lung Cancer
12/1/16
Chronic cough
Wheezing
Chest pain and tightness
Hoarseness
Dysphagia
Head and neck edema
Pleural or pericardial
effusions
Anorexia
Weight loss
Anemia
Fatigue
Clubbing of fingers
Hemoptysis
Shortness of breath
Frequent lung infections

159
Lung Cancer
Diagnosis
History
P/E
CXR
Sputum for malignant cell
detection
Lung Scans (liver, bone scans to
detect metastases)
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160
Lung Cancer
Management
Surgery
Radiation therapy
Chemotherapy
Immunotherapy
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161
Empyema
Empyema is a collection of purulent

liquid pus in the pleural cavity.
It may occur if a long abscess extends
through to the pleural cavity.
It is an unusual complication of a
pulmonary infection, may occur if Rx is
delayed
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162
Empyema
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163
Empyema
Fever
Night sweats
Pleural pain
Dyspnea
Anorexia
Weight loss
Decreased or absence of
breath sounds
Decreased Fremitus
Flatness on Percussion
Diagnostic evaluation
Thoracentesis
CXR
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164
Empyema
Medical management
Drainage of the pleural fluid depends on
the stage of the disease
Needle aspiration, if the fluid is not too
thick
Chest drainage using large diameter
intercostals tube attached to water seal
drainage
Large dose of antibiotic depending on the
causative agent is given
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165
Pleurisy
Inflammation of both layers of the

pleura
Pathophysiology
Pleurisy may develop in conjunction with
pneumonia or an URTI, TB, after trauma
to the chest, pulmonary infarction, or
pulmonary embolism; in patients with
primary and metastatic cancer; and after
thoracotomy.
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166
Pleurisy
The parietal pleura have nerve endings;
the visceral pleura does not.
When the inflamed pleural membranes
rub together during respiration
(intensified on inspiration), the result is
severe, sharp, knifelike pain.
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167
Pleurisy
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168
Pleurisy
Pleuritic pain is related to respiratory
movement.
Taking a deep breath, coughing, or
sneezing worsens the pain.
The pain may become minimal or
absent when the breath is held, or it
may be localized or radiate to the
shoulder or abdomen.
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169
Dx
Pleurisy
CXR
Sputum
Thoracentesis
Pleural biopsy
Medical Management
12/1/16
Treat the underlying cause, i.e

Pneumonia
Indomethacin
Follow for signs of Pleural Effusion, i.e
SOB, Pain
170
Pneumothorax
Air in the chest
Partial or complete collapse of the
lung.
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171
Pneumothorax.
Closed Pneumothorax
12/1/16
Is when air or gas gets in the pleural

space without any outside wound
Occurs spontaneously
Occurs mostly in tall, thin individuals
and in smokers
Patients who have had one spontaneous
pneumothorax are at greater risk for a
recurrence.
If untreated can become a tension
pneumothorax
172
Pneumothorax.
Causes of Closed
Pneumothorax
Blunt chest trauma
Air leakage from
ruptured
Emphysematous Bleb
Tubercular or Cancerous
lesions
Severe bouts of coughing
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173
Pneumothorax
Open pneumothorax
Air enters the pleural space through an
opening in the chest wall
Air sucking wound
It is a life treating condition
Can cause Tension Pneumothorax
There is a possibility of developing
Hemothorax
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174
Pneumothorax
Causes of Open
Pneumothorax
Penetrating chest injury

Insertion of a Central
Venous Catheter
Chest surgery
Transbronchial Biopsy
bronchoscope is inserted
through the nose or mouth
to collect several pieces of
lung tissue
12/1/16

Thoracentesis or Closed
175
Pneumothorax
Tension pneumothorax
is the progressive build-up of air within the
pleural space, usually due to a lung laceration
which allows air to escape into the pleural space
but not to return. Positive pressure ventilation
may exacerbate this 'one-way-valve' effect.
When air in the pleural space is under higher
pressure than air in the adjacent lung.
When air enters the pleural space on inspiration
but cannot leave it on expiration it produces a
positive pressure in the chest cavity => lung
collapse
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176
Pneumothorax
Causes of Tension
Pneumothorax
Penetrating chest wound
treated with an air-tight
dressing
Fractured ribs
Mechanical ventilation
Chest tube occlusion or
malfunction.
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177
Pneumothorax
Pneumotho Clinical Manifestations
rax
Smaller & slow
Closed
developing
Rapid sharp pain on
inspiration
Increased dyspnea
Diaphoresis
Hypotension
Tachycardia
Absence of chest
movement on the affected
side
Absence of breath
sounds on affected side.
12/1/16

Medical
Management
observation & treat
on outpatient setting
Needle aspiration
of air from pleural
space
Inspiration of chest
catheter closed
drainage system
178
Pneumothorax
Pneumothora
Clinical
Medical
x
manifestation
management
Open
Sucking sound occlusion of open
at wound site
wound
with respiration
Tracheal
deviation
12/1/16

Same as for
closed
179
Pneumothorax
Pneumothorax
Tension
12/1/16
Clinical manifestation
Medical management
True emergency
Sever Dyspnea
Sterile dressing on
Agitation
Tracheal deviation
the defect
Insertion of chest
Jugular venous
Distension
tube and closed
Breath sound absent
system
Subcutaneous
Emphysema
Ineffective ventilation
180
For closed
Place in semi-fowlers position
Administer oxygen
For outpatient or after chest tube
removal, instruct to
Report any increased dyspnea
Avoid strenuous exercise
Avoid holding breath
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181
For Tension
Life-threatening event
Closed monitoring of vital signs
Observe for Cardiac Dysrhythmias
Check for Subcutaneous Emphysema in upper
chest and neck.
For open
Occlude wound with Non-porous Covering
Same interventions as for closed pneumothorax.
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182
Pulmonary Embolism
PE is the blockage of pulmonary arteries by a thrombus,
fat, air emboli or tumor tissue.
Most PE arise from thrombi in the deep veins of the
legs.
Common risk factors for PE are Immobilization, Surgery,
Stroke, History of DVT and Malignancy.
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183
Risk Factors for Pulmonary Embolus
Hypercoagulability
Venous Stasis
Injury
Prolonged
Tumor
immobilization
Increased platelet
Prolonged
count
sitting/traveling Venous Endothelial
Disease
Varicose veins
Thrombophlebitis
Spinal cord injury
Vascular disease
Foreign bodies (IV)
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184
Risk Factors.
Certain Disease States
Heart disease
Trauma
Postoperative state
Diabetes Mellitus
COPD
12/1/16
Other
Predisposing
Advanced age
Obesity
Pregnancy
Oral contraceptive
Use
Constrictive
clothing

185
PE.
12/1/16
Pathophysiology
When a thrombus obstructs a pulmonary
artery
The alveolar dead space is increased.
Area to be ventilated receives little blood
flow.
Gas exchange is impaired in this area.
Various substances are released from the
clot and surrounding area
Causing regional blood vessels and
for Patients with
bronchioles
to constrict.
186
PE.
12/1/16
Causes an increase in pulmonary

vascular resistance.
Ventilation-Perfusion imbalance.
Results an increase in pulmonary
arterial pressure
Increase in right ventricular work to
maintain pulmonary blood flow.
Right ventricular failure occurs
Decrease in Cardiac Output followed by
a decrease in systemic BP
for Patients with
Development
of shock.
187
PE.
12/1/16
Symptoms are nonspecific
Dyspnea
Tachypnea
Chest pain is usually sudden and
pleuritic
It may be Substernal and mimic Angina
Pectoris or MI
Other symptoms include anxiety, fever,
tachycardia, apprehension, cough,
diaphoresis,
hemoptysis,
for Patients with and syncope.
188
PE.
Assessment and Diagnostic Findings
Ventilation-Perfusion scan
A lungventilation/perfusion scan, or VQscan, is a
test that measures air and blood flow in your lungs. A
VQscanmost often is used to help diagnose or rule
out a pulmonary embolism.
Pulmonary Angiography
Pulmonary angiographyis a test to see how blood
flows through the lung.Angiographyis an imaging
test that uses x-rays and a special dye to see inside
the arteries.
12/1/16
CXR
ECG
Impedance
Plethysmography
Respiratory
Disorders
189
PE.
Medical Management
Emergency management is of primary concern.

The treatment of PE may include a variety of
modalities:
Measures to improve respiratory and vascular
status
Anticoagulation therapy
Thrombolytic therapy
Surgical intervention
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190
Cor Pulmonale
Cor Pulmonale (also called right ventricular failure)
Hypertrophy and dilation of the right ventricle developing
secondary to disease affecting the structure or function of
the lungs or their vasculature.
It can occur at the end stage of various chronic disorders
of the lungs, pulmonary vessels, chest wall, and
respiratory control center.
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191
Cor Pulmonale
Causes
COPD
Bronchial Asthma
Pulmonary
Hypertension
Vasculitis
Pulmonary Emboli
12/1/16
Kyphoscoliosis
Pectus Excavatum
Muscular
dystrophy
Poliomyelitis
Obesity
High altitude

192
Cor Pulmonale
12/1/16
Pathophysiology
In Cor Pulmonale, pulmonary
hypertension increases the heart's
workload.
To compensate, the right ventricle
hypertrophies to force blood through the
lungs.
Severity of right ventricular enlargement
in Cor Pulmonale is due to increased
afterload.
An occluded
vessel
impairs
the heart's
for Patients
with
193
Cor Pulmonale.
Pulmonary hypertension results from the increased blood
flow needed to oxygenate the tissues.
In response to hypoxia, the bone marrow produces more
red blood cells, causing polycythemia.
The blood's viscosity increases, which further aggravates
pulmonary hypertension.
This increases the right ventricle's workload, causing
heart failure.
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194
Cor Pulmonale.
In chronic obstructive disease, increased airway
obstruction makes airflow worse.
The resulting hypoxia and hypercarbia can have
vasodilatory effects on systemic arterioles.
Hypoxia increases pulmonary vasoconstriction.
The liver becomes palpable and tender because it is
engorged and displaced downward by the low
diaphragm.
Hepatojugular reflux may occur.
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195
Cor Pulmonale.
Compensatory mechanisms begin to fail and larger
amounts of blood remain in the RV at the end of
diastole, causing ventricular dilation.
Increasing intrathoracic pressures impede venous
return and raise jugular venous pressure.
Peripheral edema can occur and right ventricular
hypertrophy increases progressively.
The main pulmonary arteries enlarge, pulmonary
hypertension increases, and heart failure occurs.
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196
Cor Pulmonale.
Symptoms of Cor Pulmonale are usually

related to the underlying
lung disease, such as COPD.
With right ventricular failure, the
patient may develop increasing edema
of the feet and legs
12/1/16

197
Cor Pulmonale.
Neck veins, an enlarged palpable liver,
pleural effusion, ascites, and a heart
murmur
Headache
Confusion, and Somnolence*
Hypercapnia
SOB
Wheezing, cough, and fatigue.
12/1/16

198
Cor Pulmonale.
Medical Management
Therapy of Cor Pulmonale has three aims:
Reducing hypoxemia and pulmonary vasoconstriction
Increasing exercise tolerance
Correcting the underlying condition when possible.
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199
Cor Pulmonale.
Bed rest to reduce myocardial oxygen demands
Digoxin to increase the strength of contraction of
the myocardium
Antibiotics to treat an underlying respiratory
tract infection
A potent pulmonary artery vasodilator, such as
Nitroprusside or Hydralazine*
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200
Cor Pulmonale.
Administration of low concentrations of oxygen
Mechanical ventilation to reduce the workload of
breathing in the acute disease
A low-sodium diet with restricted fluid to reduce edema
Small doses of Heparin
Tracheotomy, if the patient has an upper airway
obstruction
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201
Pulmonary Edema
Pulmonary edema is the abnormal

accumulation of fluid in the lungs.
Pulmonary edema represents the
ultimate stage of pulmonary congestion,
in which fluid has leaked through the
capillary walls and is permeating the
airways, giving rise to dyspnea of
dramatic severity.
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202
Pulmonary Edema
Pulmonary congestion occurs when the
pulmonary vascular bed has received
more blood from the right ventricle than
the left can accommodate and remove.
Non cardiac pulmonary edema has a
wide variety of cause like near
drowning, trauma, renal failure, drugs
and inhaled toxins.
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203
Pulmonary Edema
Medication overdose
Neurogenic etiologies
Cardiac cause (the most common)
Atherosclerosis
Hypertensive state
Valvular defects
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204
Pulmonary Edema
C/F
Sudden onset of breathlessness
Sense of suffocation
Hand becomes cold and moist
Nail beds cold and cyanotic
Skin color turns gray
Weak rapid pulse
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205
Pulmonary Edema
Distended neck vein
Productive cough
Anxiety
Confused, Stupor
Noisy breathing
Suffocation by the blood tinged, frothy
fluid pouring into the bronchi and
trachea
Immediate action is needed.
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206
Pulmonary Edema
Diagnostic evaluation: Hx , P/E, Chest x- ray
Management
Goal of medical management
To reduce total circulating volume
To improve respiratory exchange
Oxygenation concentration adequate to relive hypoxia
Morphin to reduce anxiety and dyspnea to decrease peripheral
resistance
Diuretics : Lasix (IV)
Digitalis
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207
Pulmonary Edema
Prevention
Placing the patient in an upright position
with the feet and legs dependent
Eliminating overexertion and emotional
stress to reduce the left ventricular load
Administering morphine to reduce anxiety,
dyspnea, and preload
Preventing circulatory overload IV fluids are
administered slowly
Surgical treatment: Minimize valvular
detect.
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208
Pulmonary Edema
Nursing Management
Administration of oxygen, intubation and mechanical
ventilation if respiratory failure occurs.
Adminstering medications (ie, morphine, vasodilators,
inotropic medications, preload and afterload agents) as
prescribed and monitors the patients response.
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209
Tuberculosis
Is a granulomatous inflammation.
Caused by M. Tuberculosis & M. Bovis.
M. tuberculosis is transmitted by
inhalation of infective droplets coughed or
sneezed.
12/1/16
M. Bovis is transmitted by milk from

210
infected Nursing
cows.
Respiratory
Disorders
Tuberculosis
12/1/16
TB can affect almost all parts of the

body, except the enamel of the
teeth.
TB is closely associated with
poverty, malnutrition,
overcrowding, substandard
housing, and inadequate health
care.
The leading cause of death from
infectious disease in the world.
211
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212
Tuberculosis
Pathophysiology
12/1/16
A susceptible person inhales

mycobacterium bacilli and becomes
infected
The bacteria are transmitted through
the airways to the alveoli, where they
are deposited and begin to multiply.
The bacilli also are transported via the
lymph system and bloodstream to other
parts of the body (kidneys, bones,
213
cerebralNursing
cortex)
and other areas of the
lungs (upper
lobes).
Tuberculosis
12/1/16
The bodys immune system responds by

initiating an inflammatory reaction
Phagocytes (neutrophils and
macrophages) engulf many of the
bacteria, and TB-specific lymphocytes
lyse (destroy) the bacilli and normal
tissue.
This tissue reaction results in the
accumulation of exudate in the alveoli,
causing bronchopneumonia, 2 to 10 214
weeks later.
Tuberculosis
Low-grade fever
Cough
Night sweats
Fatigue
Weight loss
The cough may be non-productive, or mucopurulent
sputum may be expectorated
Hemoptysis also may occur
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215
Tuberculosis
Assessment and Diagnostic Findings
A complete history
CXR
Acid-fast bacillus smear
Sputum culture
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216
Medical Treatment
First-line Drugs
Isoniazid
Rifampin
Streptomycin
Ethambutol
Pyrazinamide
12/1/16
Second-line
Drugs
Ethionamide
Kanamycin
Para-aminosalicylic
acid
Cycloserine

217
Tuberculosis
Assignments
Nursing Management for a patient with Tuberculosis
using the Nursing Process. (to be presented)
Read about Pulmonary TB on Brunner and Suddarth
textbook of MSN.
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218
Additional Reading Assignments

Postural Drainage
Chest Physiotherapy/Percussion
Tracheotomy
Thoracentesis
Water-Sealed Drainage
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219
The End
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220

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Nursing Intervention of

Nursing Interventions for Patients with

At the end of the topic the learners will be

Review of the Anatomy & Physiology of

Nursing Interventions for Patients with

Respiration includes four distinct

Gas exchange between the respiratory membrane

Oxygen utilization by tissues

Nursing Interventions for Patients with

Transport of respiratory gases

Anatomy of the respiratory

Mouth /Nose Pharynx

Nursing Interventions for Patients with

Right Lung has three

Nursing Interventions for Patients with

What is located between

Nursing Interventions for Patients with

Movement of the Chest

Nursing Interventions for Patients with

Lung volume and Lung capacities

Nursing Interventions for Patients with

Assessment of the Respiratory System

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Past Health History

Family Health History

Nursing Interventions for Patients with

The nurse should proceed in well organized

Nursing Interventions for Patients with

The nurse should inspect

Any abnormality in the

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

The nurse should palpate

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

The nurse should move from the apex

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Upper Airway Infections (URTI)

Viral Rhinitis (Common Cold)

The term common cold often is used

Nursing Interventions for Patients with

Nursing Interventions for Patients with

Viral Rhinitis - Management

Nursing Interventions for Patients with

Viral Rhinitis - Management

Nursing Interventions for Patients with

The sinuses, mucuslined cavities filled

Nursing Interventions for Patients with