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8/6/2019 Ms Respiratory
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RESPIRATORY SYSTEM
1.Pulmonary Function Test
Nursing Care
Carefully explain the procedure.
Perform tests before meals.
Withhold medication that may alter respiratory
function unless otherwise ordered.
After procedure assess pulse and provide for rest
period.
2. Sputum Culture and Sensitivity Test
Nursing Care
Explain the procedure to the client.
If the client is unable to cough,
heated aerosol will assist with
obtaining a specimen.
Collect the specimen in a sterile
container that can be capped
afterwards.
Volume need not exceed 1-3 ml.
Deliver specimen to the lab
immediately.
3. Thoracentesis
Nursing care (pre-test)
Informed consent
Instruct the client not to cough or talk
during the procedure.
Position the client appropriately at the
side of the bed. Assess vital signs.
Nursing care (post-test)
Observe for signs and symptoms of
pneumothorax, shock, leakage at the
puncture site.
4. Bronchoscopy
Nursing Care (pre-test)
Informed consent
Explain the procedure, remove
dentures, and provide good oral
hygiene
Keep the client NPO 6-12 hours pre-
test.
Nursing Care (post-test)
Position the client on the side or in
semi-Fowlers position
Keep NPO until the return of gag
reflex.
Assess for and report frank bleeding
Apply ice bags to sore throat for
comfort.
CLASSIFICATION OF PULMONARY
DISORDERS
Restrictive disorders
Chronic obstructive pulmonary disease
Pulmonary vascular disorders
RESTRICTIVE DISORDERS
A. PNEUMONIA
Classification
Community Acquired Pneumonia
occur either in the community or 48
hours before hospitalization
Streptococcus pneumoniae,
H. influenza, Mycoplasma
pneumoniae
Hospital Acquired Pneumonia also
called nosocomial infection, onset of
symptoms more than 48 hours after
hospitalization
P. aeruginosa,
Staphylococcus pneumoniae,
Klebsiella pneumoniae, E.
coli
RESTRICTIVE
DISORDERS
Aspiration Pneumonia pulmonary
consequences resulting from the entry
of endogenous or exogenous substances
into the lower airway.
Streptococcus pneumoniae,
H. influenza, Staphylococcus
pneumoniae, gastric contents
Risk Factors
Conditions that produce mucus or bronchial
obstruction
Smoking
Cancer, COPD
Immunosuppressed patients
Prolonged immobility
Depressed cough reflex
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Alcohol intoxication
Respiratory therapy with improperly cleaned
instruments
Aging
Laboratory Diagnostics
Complete Blood Count
Chest X-Ray
Blood culture
Sputum examination
Arterial Blood Gas (ABG)
Nursing Diagnosis
Ineffective airway clearance related to copious
tracheobronchial secretions.
Impaired gas exchange due to alveolocapillary
membrane changes.
Risk for fluid volume deficit related to fever and
dyspnea.
Altered nutrition: less than body requirements
related to increased metabolic needs
Nursing Interventions
Monitor for increased respiratory distress
Administer oxygen therapy via nasal cannula
Assist patient to cough effectively
Suction airway using sterile technique
Assist with nebulizer therapy
Chest physiotherapy
Antibiotics and bronchodilators as ordered
Adequate fluid intake
Assist with ADL
If comatose, reposition q 2 hours and do passive
ROM q 4 hours
Deep breathing exercises q 2 hours
Small frequent feedings, high CHO and CHON
Monitor for s/s of complications
Influenza vaccine for elderly.
RESTRICTIVE DISORDERS
B. PULMONARY TUBERCULOSIS
Caused by Mycobaterium tuberculosis
Spreads via droplet infection (generally particles
1 to 5 micrometers in diameter)
Risk Factors:
close contact with someone with active TB
immunocompromised status
substance abuse
any person without adequate health care
pre-existing medical conditions
living in overcrowded, substandard housing
health care providers
Pathophysiology
Inhalation of mycobacterium
Multiplication of bacteria in lower airways
Transmission of bacteria to other parts
(lymph nodes, kidneys, brain)
Immune system activated
Formation of Primary tubercle
Caseation necrosis
cavitation
RESTRICTIVE DISORDERS
Clinical Manifestations:
1. Anorexia
2. weight loss
3. fatigue
4. cough
5. low-grade fever
6. night sweats
7. hemoptysis
RESTRICTIVE DISORDERS
RESTRICTIVE DISORDERS
Diagnostics:
Chest X-ray
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Sputum smear and culture
Gastric aspirate
Tuberculin skin test
Medical Management:
First line drugs
INH and rifamipicin for 6months
PZA, ethambutol/streptomycin for 2 months
Second line drugs
Kanamycin
Amikacin
Quinolones
Cycloserine
Para-aminosalicylic acid
RESTRICTIVE DISORDERS
Nursing Interventions:
Administer medications as ordered.
Client should be in a well-ventilated private
room, with the door kept closed at all times.
All visitors and staff should wear masks when in
contact with patient.
Patient should cover nose and mouth when
coughing, sneezing and laughing.
Handwashing is required after direct contact with
patient.
Offer small, frequent feedings and nutritional
supplements.
Weigh client at least 2x/week.
Discuss client's feelings and assess for boredom,
depression, and anxiety and fatigue.
Advise client regarding necessity of patient's
compliance to medications.
Classification of TB
Class O no exposure, no infection
Class 1 with exposure, no infection
Class 2 infection, no disease (+PPD reaction
but no clinical evidence of active TB)
Class 3 disease, clinically active
Class 4 disease, not clinically active
Class 5 suspected disease, diagnosis pending
Stages of Tuberculosis
1. During the primary stage, the
bacteria reside in tissue in the lungs
and elsewhere in the body. During this
stage, most people have no symptoms.
The body's natural defenses areactivated to produce antibodies to
fight the infection. If the body's
defenses are successful, the bacteria
are walled off within a capsule, and the
infection doesn't progress. The person
is now in latency stage. However, the
bacteria are still alive and can escape
and become active later. This can
happen if the body's immune system
becomes impairedby illness, poor
nutrition, certain drugs, or infection
with AIDS.
2. The secondary stage (active stage
)
begins several months after the primary
stage if the body's defenses were not
successful. Bacteria begin destroying
body tissue, particularly lung tissue.
Symptoms include a slight fever,
weight loss, fatigue, and night sweats.
TB in the lungs causes a chronic cough
that is initially dry but eventually
produces sputum that contains blood
and pus. Symptoms will also appear in
other areas of the body where the
bacteria have spread.
There are three important ways to describe
the stages of TB. They are as follows:
1. Exposure: This occurs when a person has
been in contact, or exposed to, another person
who is thought to have or does have TB. The
exposed person will have a negative TB skin test,
a normal chest x-ray, and no symptoms of the
disease.
2. TB infection: This occurs when a person has
the TB bacteria in his/her body, but does not have
symptoms of the disease. This person would have
a positive skin test, but a normal chest x-ray and
no illness.
3. TB disease: This describes the person that has
symptoms of an active infection. The person
would have a positive skin test, a positive chest
x-ray, and might be ill.
The cause of TB is the bacterium Mycobacterium
tuberculosis (M. tuberculosis). Most people
infected with M. tuberculosis never developactive TB. However, in people with weakened
immune systems, including those with HIV
(human immunodeficiency virus), TB organisms
can overcome the body's defenses, multiply, and
cause an active disease.
Types of Tuberculosis
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1. Primary tuberculosis
the childhood form of tuberculosis. It
often occurs in the lungs, the back of
the throat, or the skin.
Infants are prone to infection. Theyalso are especially open to quick and
bodywide spread of the infection
through their bodies.
In childhood, the disease is often over
quickly. The tuberculin test will show
signs of having tuberculosis for the rest
of one's life.
Post-Primary Tuberculosis
2. Miliary tuberculosis
a form of tuberculosis with spreading
through the bloodstream of the germs
(tubercle bacilli).
In children it is linked to high fever,
night sweats, and, often, swelling of the
membranes covering the brain and
spinal cord (meningitis).
Other symptoms are fluid in the chest
cavity and inflammation of the stomach
and intestinal lining (peritonitis).
A similar illness may occur in adults.
Then there are weeks or months of mild
symptoms, such as weight loss,
weakness, and light fever.
Many small objects looking like millet
seeds may show up on chest x-ray
films.
The liver, spleen, bone marrow, and
membrane covering of the brain
(meninges) are often affected.
Miliary tuberculosis
Signs/Symptoms
Pulmonary
Weight loss, fatigue, generalized
weakness, anorexia; slight fever with
chills and night sweats; nonproductive
cough that eventually becomes
productive with mucopurulent sputum;
tachycardia; dyspnea on exertion;hemoptysis
Cardiovascular
Pericarditis with precordial chest pain,
fever, ascites, edema, and distention of
neck veins
Gastrointestinal
Peritonitis with acute abdominal pain,
abdominal distention, vomiting,
anorexia, weight loss, night sweats;
gastrointestinal bleeding, bowel
obstruction
Neurologic
Meningitis with headache, vomiting,
fever, declining consciousness, and
neurologic deficit
Musculoskeletal
Joint pain, swelling, tenderness,
deformities; limitation of motion
Genitourinary
Urgency, frequency, dysuria,
hematuria, pyuria; infertility,
amenorrhea, vaginal bleeding and
discharge; salpingitis with lower
abdominal pain
Lymphatics
Enlarged lymph nodes
Diagnostic Tests
1. Skin tests (purified protein
derivative/Mantoux) - Positive reaction
indicates past infection and presence of
antibodies; it is not indicative of active disease
2. Mantoux test - injecting a solution containing
a small amount of bacteria just under the skin on
the inside of the forearm.
skin reaction consists of a rash, blisters,
or swelling around the injection site.
An early reaction is not significant.Swelling in 48 to 72 hours may indicate
a positive reaction, depending on the
size of the swelling.
Mantoux Test
Intradermal
Read 48-72 hours after injection
(+) Mantoux Test is induration of 10mm or more
For HIV positive clients, induration of 5mm is
considered positive
(+) Mantoux Test signifies exposure to
Mycobacterium Tubercle Bacilli
If a skin test is positive, further
procedures are necessary to determine
whether the TB is active.
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3. Sputum culture - Positive for causative agent
within 2 to 3 weeks of onset of active disease; it
is not positive during latency
4. Acid-fast sputum smear - Positive for acid-
fast bacillus
5. Pleural needle biopsy - Positive for causative
agent
6. Tissue biopsy/culture - Positive for causative
agent
7. Chest x-rays - May reveal cavitation,
calcification, parenchymal infiltrate; not
diagnostically definitive
PPD Test
TB Chest X-ray
Immediate testing:
If the child is thought to have been exposed in the
last five years.
If the child has an x-ray that indicates possible
TB.
If the child has any symptoms of TB.
A child that is coming from countries where TB
is prevalent.
Yearly skin testing:
Children with HIV.
Children that are in jail.
Testing every 2 to 3 years:
Children that are exposed to high-risk people.
Consider testing in children from ages 4 to 6
and 11 to 16 if:
A child's parent has come from a high-risk
country.
A child has traveled to high-risk areas.
Children who live in densely populated areas.
Treatment
1. Anti- Tubercular Agents
R-ifampin
I-soniazid
P-yrazinamide
E-thambutol
S-treptomycin
prescribed for a period of time up to six
months or more for the medication to
be effective. Patients usually begin to
improve within a few weeks of the start
of treatment. The patient is not usuallycontagious once treatment begins,
provided that treatment is carried
through to the end, as prescribed by a
physician.
2. Surgery
Drainage of pulmonary abscesses;
correction of complications such as
intestinal obstruction or urethral strictur
3. General
Sputum precautions until negative
sputums are evident (10 to 14 days
after start of drug therapy);
management usually on an outpatient
basis unless the disease is in an
advanced state with complications;
instruction about the importance of
uninterrupted drug therapy and the
need for periodic recultures of sputum
throughout drug therapy, which may
last a year or longer; skin testing and
examination of close contacts at the
time of initial diagnosis and again in 2
to 3 months; long-term medical follow-
up to prevent recurrence
Potential Complications
massive destruction of lung tissue, leading to
pneumothorax, pleural effusion, pneumonia, and
respiratory failure;
brain abscess; cardiac tamponade; vertebral
collapse and paralysis; liver failure; renal failure;
and generalized, massive dissemination of
disease that usually is fatal.
New drug-resistant strains of tuberculosis are
emerging, leading to more frequent progression
to complications.
Patient Teaching
Avoid alcohol while taking isoniazid
and rifampin because this can cause
serious liver problems.
Take both drugs on an empty stomach
with a full glass of water.
If stomach upset is a problem, take
them with a small amount of food.
Avoid taking antacids that contain
magnesium or aluminum within 1 hour
of taking isoniazid, since this can
interfere with drug absorption.
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Rifampin can make oral contraceptives
less effective, so if you are on the pill,
use another method of birth control.
Rifampin gives a reddish or brownish
color to urine, saliva, sputum, stools,
sweat, and tears and will discolor softcontact lenses.
Other possible side effects are
dizziness, stomach upset, diarrhea, or
rash.
Report to the doctor blurred vision, eye
pain, chills, joint pain and swelling,
breathing difficulty, fever, weakness,
vomiting, or yellowing of the skin or
eyes.
Client Education: Preventing the spread of TB
TB is not extremely contagious, but
you need to protect close contacts.
Bacteria is spread by coughing, so
cover your nose and mouth and dispose
of soiled tissues properly and wash
hands thoroughly.
Good room ventilation helps to reduce
the amount of bacteria in the air.
Sometimes household members are
required to take antituberculosis drugs
for 6 to 9 months (as a precaution).
Client Education
Cover nose and mouth when coughing, sneezing
and laughing
TB is transmitted by droplet infection
Wash hands after any contact with body
substances, masks or soiled tissues
Wear masks when advised
Anti-TB drugs must be taken in combination to
avoid bacterial resistance
Drugs to be taken on empty stomach for
maximum absorption
Restrictive Disorder
Medical Management:
1. Radiation
2. Chemotherapy
3. Surgery
Restrictive Disorder
Nursing Interventions:
1. Suction nose frequently.
2. Promote pain relief.
3. Promote wound drainage.
4. Administer monitor tube feedings as ordered.
5. Observe stoma/structure lines for signs of
infection.
6. Enhance communication.
7. Support client during adaptation to altered
physical status.
Restrictive Disorder
8. Provide client teaching:
Tracheostomy/laryngectomy and stoma care
Control of dryness and crusting of the tongue.
Need for a humidifier at home.
Protect stoma while showering.
Use electric razors for the first 6 months after
the operation.
Cover stoma when coughing or sneezing.
Necessity of installing smoke detectors.
Restrictive Disorder
D. Lung Cancer
May be metastatic or primary
#1 cause of mortality
Associated with smoking
Poor prognosis
Adenocarcinoma- most prevalent type
Small cell carcinoma- poorest prognosis
Signs and Symptoms
Asymptomatic
Cough
Hemoptysis
Pain on inspiration
Dyspnea
Pleural effusion
Easy fatigability
Clubbing of fingers
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Weight loss
Diagnostics
Chest X-ray
Fiberoptic bronchoscopy
CT Scan
MRI
Thoracentesis
Pulmonary function tests
Medical Management
Surgery
Pneumonectomy
Lobectomy
Segmentectomy
Wedge resection
Decortication
Radiation
Chemotherapy
Nursing Management
Administer O2 as ordered
Post-op: flat on bed until BP is stable, after
which semi-fowlers position
Position on unoperated side, but for
pneumonectomy on operated side
Coughing and deep breathing exercises
Assist patient in abdominalbreathing
Mist therapy
Nursing Management
Suctioning as needed
Pain medications as ordered
Assist patient in performing arm exercises
Check dressings periodically
Check for presence of subcutaneous emphysema,
report to MD if worsening
Nursing Management
Care of chest tube
Keep all tubing as straight as possible.
Keep all connections tight
Observe for air bubbles and
fluctuations
Monitor V/S and breath sounds
regularly
Never elevate the drainage system at
the level of the patients chest.
1. Atelectasis- an abnormal condition marked by the
collapse of lung tissue. This collapse prevents the exchange
of carbon dioxide and oxygen by the blood. Symptoms
include lessened breath sounds, fever, and difficulty
breathing. The condition may be caused by obstruction of
the major airways and bronchioles. It may also be caused
by pressure on the lung from fluid or air in the area around
the lungs (pleural space), or by pressure from a tumor
outside the lung. Loss of lung tissue may cause increased
heart rate, higher blood pressure, and faster breathing.
Causes, incidence, and risk factors
Anesthesia, prolonged bed rest with few changes
in position, shallow breathing, and underlying
lung diseases are risk factors for atelectasis.
Secretions that plug the airway, foreign objects
(common in children) in the airway, andtumors
that obstruct the airway may lead to atelectasis.
In an adult, small regions of atelectasis are
usually not life-threatening, because unaffected
parts of the lung compensate for the loss of
function in the affected area. Large-scale
atelectasis, especially in someone who has
another lung disease or illness may be life-
threatening. In a baby or small child, lung
collapse due to a mucus obstruction or other
causes can be life-threatening.
Massive atelectasis may result in the collapse of a
lung.
Symptoms
Breathing difficulty
Chest pain
Cough
Signs and tests
Chest x-ray
Bronchoscopy
Fluoroscope
X Ray-
penetrating electromagnetic radiation,
having a shorter wavelength than light,
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and produced by bombarding a target,
usually made of tungsten, with high-
speed electrons (Cathode Ray;
Electromagnetic Radiation; Electron;
Light; Radiation).
Despite the fact that the tube was
encased in a black cardboard box,
Roentgen noticed that a barium-
platinocyanide screen, inadvertently
lying nearby, emitted fluorescent light
whenever the tube was in operation.
After conducting further experiments,
he determined that the fluorescence
was caused by invisible radiation of a
more penetrating nature than ultraviolet
rays (Luminescence; Ultraviolet
Radiation). He named the invisible
radiation X ray because of its
unknown nature. Subsequently, X rayswere known also as Roentgen rays in
his honor. more...
Fluoroscope-
apparatus for examining internal organs, used
especially in diagnosis. The essential parts of the
fluoroscope are an X-ray tube and a fluorescent
screen. The subject to be diagnosed is placed
between the X-ray tube and the fluorescent
screen. Wherever the X-ray radiations fall on the
screen, it glows vividly; where the X rays are
reflected or absorbed, shadows are cast on thescreen. Bones cast heavy shadows, and fleshy
organs such as the heart cast light shadows. In
abdominal analysis barium salts are administered
either orally or rectally before examination.
Because these salts are opaque to X rays, their
passage through the alimentary canal can be
traced.
Fluoroscopy can reveal cancer of the bones or
digestive tract; ulcers of the digestive tract; and
osteoporosis, a condition in which the bones are
reduced in mass. See also X Ray.
Treatment
The goal of treatment is to remove pulmonary
(lung) secretions and re-expand the affected lung
tissue.
The following treatments may be implemented:
Aerosolized respiratory treatments
Positioning on the unaffected side to
allow re-expansion of lung
Removal of the obstruction, if
present, by bronchoscopy or another
procedure
Deep breathing exercises (incentive
spirometry)
Percussion of the chest to loosen
secretions (clapping)
Positioning so that secretions drain
by gravity where they can be
coughed up (postural drainage)
Treatment oftumor or underlying
condition, if present
Expectations (prognosis)
The collapsed lung usually re-inflates
gradually once the obstruction has been
removed, although some residual
scarring or damage may be present.
Complications
Pneumonia may develop rapidly after
atelectasis.
Calling your health care provider
Call your health care provider if you
develop symptoms of atelectasis.
Prevention
Keep small objects out of the reach
of young children.
Maintain deep breathing after
anesthesia.
Encourage movement and deep
breathing in anyone who is
bedridden for long periods.
2. Pleurisy
An inflammation of the visceral and
parietal pleurae that envelop the lungs.
Causes and Incidence
Pleurisy arises from a pleural injury,
which may be caused by an underlying
lung disease (e.g., pneumonia,
asbestosis, or infarction); an infectious
agent, neoplastic cells, or irritants that
invade the pleural space (e.g., amebic
empyema, tuberculosis, pleural
effusion, systemic lupus erythematosus,
pleural carcinomatosis, rheumatoid
disease); or pleural trauma (e.g., rib
fracture).
Disease Process
The pleura becomes edematous and
congested, cellular infiltration ensues,
and fibrinous exudate forms on the
pleural surface as plasma proteins leak
from damaged vessels.
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This causes the visceral and parietal
pleural surfaces to rub together rather
than sliding over each other during
respiration.
The pleura becomes increasingly
inflamed and stretched, causing pain oneach breath.
Symptoms
The primary symptom is sudden onset
of pain in the chest or abdominal wall
that may vary from vague to an intense
stabbing sensation.
The pain is aggravated by breathing
and coughing.
Respirations are rapid and shallow,with guarding and decreased motion on
the affected side.
Potential Complications
Permanent adhesions that restrict lung
expansion may develop.
Diagnostic Tests
Auscultation reveals a friction rub,
along with the characteristic
presentation of pain. A chest x-ray mayreveal pleural effusion.
Treatments
Surgery (None)
Drugs
Narcotic analgesic to relieve
pain during deep breathing
and coughing exercises;
analgesics and antipyretics
General
Treatment of underlying
disease; positioning and
splinting of chest; coughing
and deep breathing to prevent
atelectasis and infection
Painkillers
3. Pleural effusion
an abnormal buildup of fluid in thelungs.
Symptoms
are fever, chest pain,
breathing difficulty, and a dry
cough. The fluid comes from
swollen lung surfaces caused
by many things, as a blood
clot in the lung, an injury, a
tumor, or an infection.
Diagnostic tests
Thoracentesis
Thoracocentesis
also called thoracentesis.
Surgery to break into the chest wall and
lung membrane space with a needle to
remove fluid for diagnostic or
therapeutic purposes. It may also be
done to remove a specimen for biopsy.
The procedure is usually done usinglocal anesthesia. The patient is seated
leaning forward over a table that is
chest high.
Puncture of a cavity of the chest wall
may be used to treat pleural effusion, as
may occur in cancer of the lung
(bronchogenic carcinoma).
Fluid samples may be examined for
erythrocyte, leukocyte, and differential
white cell counts, protein, glucose, and
amylase concentrations. They may becultured for studies of microorganisms
that may be present.
Treatment
The cause is
treated, and the
fluid may be
removed by suction
or drained.
Other treatment
may include givingdrugs to get rid of
fluids and other
drugs
giving oxygen
using mechanical
breathing.
Chest tube insertion
Chest tube
Figure 1
Normal anatomy.
The pleural space is
the space between
the inner and outer
lining of the lung.
It is normally very
thin, and lined only
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with a very small
amount of fluid.
Figure 2
Indication
If fluid, such as blood, or air, gets into the pleural
space, the lung can collapse, preventing adequate
air exchange.
Chest tubes are used to treat conditions
that can cause the lung to collapse, such
as:
air leaks from the lung into the chest
(pneumothorax)
bleeding into the chest (hemothorax)
after surgery or trauma in the chest
(pneumothorax or hemothorax)
lung abscesses or pus in the chest
(empyema).
Figure 3
Procedure
Chest tubes are inserted to drain blood, fluid, or
air and allow full expansion of the lungs.
The tube is placed in the pleural space.
The area where the tube will be
inserted is numbed (local anesthesia).
The patient may also be sedated.
The chest tube is inserted between the
ribs into the chest and is connected to a
bottle or canister that contains sterile
water.
Suction is attached to the system to
encourage drainage.
A stitch (suture) and adhesive tape is
used to keep the tube in place.
The chest tube usually remains in place
until the X-rays show that all the blood,
fluid, or air has drained from the chest
and the lung has fully re-expanded.
When the chest tube is no longer
needed, it can be easily removed,
usually without the need for
medications to sedate or numb thepatient.
Medications may be used to prevent or
treat infection (antibiotics).
Figure 4
Recovery from the chest tube insertion and
removal is usually complete, with only a small
scar.
The patient will stay in the hospital
until the chest tube is removed.
While the chest tube is in place, the
nursing staff will carefully check for
possible air leaks, breathing difficulties,
and need for additional oxygen.
Frequent deep breathing and coughing
is necessary to help re-expand the lung,
assist with drainage, and prevent
normal fluids from collecting in the
lungs.
4. Pneumothorax
a collection of air or gas in the chest
(pleural space) causing the lung to
collapse.
Cause/Etiology
It may be the result of an
open chest wound that
permits air to enter
the break of an air-filled
blister (vesicle) on the lung's
surface
or a severe bout of coughing.
Signs/Symptoms
may begin with a sudden, sharp chest
pain
It is followed by difficult, rapid
breathing,
normal chest movements stopped on
the affected side.
There may be rapid heart beat
a weak pulse
low blood pressure
Sweating
Fever
pale skin
dizziness.
Nursing/Medical Intervention
patient should stay quiet in bed, in a
halfway upright position.
Oxygen may be given. The air should
be taken from the chest space at once.
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Thoracostomy tube- cut made into the
chest wall to provide an opening for
draining.
To remove the air, a tube is
put in, and not removed until
the air is no longer comingout through a water-seal
draining system.
Pain may be controlled with painkillers,
but drugs that can cause slowed
breathing are not used.
Mechanical breathing may be given.
The patient must learn how to turn,
cough, breathe deeply
passive exercises without making the
condition worse.
For example, stretching,
reaching, or sudden
movements must be not be
done
Treatment of Tension Pneumothorax Insertion of
Drainage Tubes
5. Hemothorax
-a buildup of blood and fluid in the
chest cavity, usually because of injury.
- Hemothorax may also be caused by
small blood vessels that break as a result of
swelling from pneumonia,
tuberculosis, or tumors.
-Shock from hemorrhage, pain, and
breathing failure follows if emergency
care is not available.
In this disorder, blood from damagedintercostal , pleural , mediastinal, and
sometimes lung parenchymal vessels
enters the pleural cavity.
Depending on the amount of bleeding
and the underlying cause, hemothorax
may be associated with varying
degrees of lung collapse and
mediastinal shift.
Pneumothorax (air in the pleural
cavity) commonly accompanies
hemothorax.
Normal Pleural Space
Anterior Relations of the Heart
Hemotho
rax
Cause:
Usually results from blunt or
penetrating chest trauma.
Hemothorax may result from thoracic
surgery, pulmonary infarction,
neoplasm, dissecting thoracic aneurysm
anticoagulant therapy.
Symptoms:
Percussion reveals dullness, and
auscultation reveals decreased to absent
breath sounds over the affected side.
Chest pain
Tachypnea
Mild to severe dyspnea (difficultybreathing) may be present
If respiratory failure results, the patient
may appear anxious, restless, possibly
stuporous, and cyanotic.
Marked blood loss produces
hypotension and shock.
The affected side of the chest expands
and stiffens, while the unaffected side
rises and falls with the patient's gasping
respirations
Treatment:
Goal: to stabilize the patient's
condition, stop the bleeding, evacuate
blood from the pleural space, and
reexpand the underlying lung.
Mild hemothorax usually clears in 10 to
14 days, requiring only observation for
further bleeding.
In severe hemothorax, thoracentesis
may be performed, (not only use as a
diagnostic tool, but also as a method of
removing fluid from the pleural cavity.)
Chest tube
Suction may be used to prevent clot
blockage
Thoracotomy may be done to evacuate
blood and clots and to control bleeding.
Autotransfusion of Pleural Blood Under-Water-
Seal Drainage
Respiratory Infections
Acute tracheobronchitis
Pneumonia
Shock and respiratory failure
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6. Acute tracheobronchitis
-swelling of the windpipe and bronchi.
-It is a common form of breathing infection.
croup, acute
laryngotracheobronchitis, exudative
angina /krp/, also called acute
laryngotracheobronchitis, angina
trachealis, exudative angina,
laryngostasis.
Compare acute epiglottitis.-
croupous, croupy. A virus infection of
the upper and lower breathing tract that
occurs mostly in infants and young
children aged 3 months to 3 years of
age.
Cause:
Croup occurs after another upper
breathing tract infection
Parainfluenza viruses
respiratory syncytial viruses (RSV)
influenza A and B viruses are the usual
causes
Inhalation of physical and chemical
irritants, gases and other air
contaminants
Signs/Symptoms:
hoarseness
fever and chills
Night sweats, headache,
general malaise
a distinct "barking" cough
many degrees of breathing
distress from blockage of the
windpipe.
Irritability
Pale or blue skin
DIAGNOSIS:
Infection is carried by
airborne particles or by
contact with infected fluids.
The acute stage starts rapidly,
most often occurs at night,
and may be triggered by
exposure to cold air.
The child becomes irritable,
gets a barking cough, and, in
severe cases, a pale or blue
skin.
The child's condition often
gets better in the morning,
but it may get worse at night.
TREATMENT:
Treatment is bed rest,
drinking a lot of fluids, and
relieving airway blockage.
Antibiotic treatment
depending on the symptoms,
sputum purulence and
sputum culture
Expectorants
Suctioning and
Bronchoscopy
Cool vapor therapy or Steam
inhalation
Mild analgesics or
antipyretics
Humidity and oxygen are
often given.
FOR CHILDREN:
Drugs are not given. To
prevent chilling, many
changes of clothing and bed
linen are needed because of
the humid air.
In most children the
condition is mild and runs its
course in 3 to 7 days.
The infection may spread to
other areas of the breathing
tract, causing problems, as
bronchiolitis, pneumonia, and
ear infections
Sputum culture
7. Pneumonia
-is an infection of the lungs that can be
caused by many different organisms.
-The symptoms can vary
considerably, depending on the cause.
Facts about pneumonia:
Pneumonia can occur year round, but is usually
seen in the winter and spring.
Boys are affected by pneumonia more often than
girls.
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There is an increased chance of developing
pneumonia in a crowded area.
Ten to 15 percent of children with a respiratory
infection have pneumonia.
Types of Pneumonia
A. Viral pneumonia
Upper respiratory viral infections and
influenza sometimes spread to the
lungs.
In addition to influenza-type symptoms
(fever, headache, general aching, and
loss of appetite), viral pneumonia is
marked by an irritating cough that may
produce sputum, shortness of breath,
and chest pain.
The so-called "walking pneumonia"
can cause very mild symptoms.
Viral pneumonia is usually treated at
home with bed rest, plenty of liquids,
and cough medicine that contains an
expectorant to clear the lungs of mucus.
A humidifier to add moisture to the air
also helps loosen the mucus.
Antibiotics or other drugs are not
effective in treating viral pneumonia.
Most otherwise healthy people recover
within a week or so.
However, viral pneumonia can lead to
bacterial infection in certain people.
For this reason, doctors may prescribe
antibiotics for people with chronic lung
diseases or other chronic illnesses to
prevent this complication.
viral pneumonia - caused by various viruses,
including the following:
respiratory syncytial virus, or RSV
(most commonly seen in children under
age 5)
parainfluenza virus
influenza virus
adenovirus
Early symptoms of viral pneumonia are the same
as those of bacterial pneumonia. However, withviral pneumonia, the respiratory involvement
happens slowly. Wheezing may occur and the
cough may worsen.
Viral pneumonias may make a child susceptible
to bacterial pneumonia.
B. Bacterial pneumonia
Bacterial pneumonia is usually caused
by eitherStreptococcus,
Staphylococcus, orHaemophilus.
The infection can start from an upper
respiratory infection such as "strep"
throat, from inhaling fluid or otherforeign substance into the lungs, or
from viral pneumonia.
The symptoms include fever, shortness
of breath, chest pain, coughing, and
sputum that is yellowish or greenish
and often has a foul odor.
It is a serious infection that often
requires hospitalization.
Treatment consists of antibiotics, bed
rest, fluids, humidified air, and anexpectorant cough medication.
Oxygen and chest physiotherapy may
be necessary for hospitalized patients.
Legionnaires' disease is a serious type
of bacterial pneumonia that occurs in
older people and people who smoke or
who have chronic diseases such as
emphysema, chronic bronchitis,
diabetes, renal disease, and cancer.
It is treated with erythromycin.
bacterial pneumonia - caused by various
bacteria. The streptococcus pneumoniae is the
most common bacterium that causes bacterial
pneumonia.
Many other bacteria may cause bacterial
pneumonia including:
Group B streptococcus (most common
in newborns)
Staphylococcus aureus
Group A streptococcus (most common
in children over age 5)
Bacterial pneumonia may have a quick onset and
the following symptoms may occur:
productive cough
pain in the chest
vomiting or diarrhea
decrease in appetite
fatigue
c. Other types of pneumonia
Mycoplasma pneumonia is caused by
one of the Mycoplasma bacteria.
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It most often infects children and young
adults, and it is a common cause of
"walking pneumonia."
Mycoplasmapneumonia is treated with
the antibiotic erythromycin or
doxycycline.
mycoplasma pneumonia - presents somewhat
different symptoms and physical signs than other
types of pneumonia. It is caused by
mycoplasmas, the smallest free-living agents of
human disease, which have the characteristics of
both bacteria or viruses, but which are not
classified as either. They generally cause a mild,
widespread pneumonia that affects all age
groups.
Symptoms usually do not start with a cold, and
may include the following:
fever and cough are the first to develop
cough that is persistent and may last
three to four weeks
a severe cough that may produce some
mucus
Other less common pneumonias may be caused
by the inhaling of food, liquid, gases or dust, or
by fungi.
Pneumocystis pneumonia is caused by the
protozoaPneumocystis carinii. This serious
infection occurs in patients with AIDS and those
whose immune systems are deficient.
A chronic fungus infection of the lungs can lead
to pneumonia.Histoplasma, Blastomyces,
Cryptococcus, Aspergillus, andCandida are
fungi that can establish themselves in the lungs.
This type of pneumonia is rare and occurs mainly
in patients whose immune systems are deficient.
Lobar pneumonia - affects one or more sections
(lobes) of the lungs.
Bronchial pneumonia (or bronchopneumonia)
- affects patches throughout both lungs.
Photomicrograph of Pneumonia
Bronchopneumonia
Lobar Pneumonia
What are the symptoms of pneumonia?
In addition to the symptoms listed above, all
pneumonias share the following symptoms.
However, each child may experience symptoms
differently. Symptoms may include:
fever
chest or stomach pain
decrease in appetite
chills
breathing fast or hard
vomiting
headache
not feeling well
fussiness
The symptoms of pneumonia may resemble other
problems or medical conditions. Always consult
your child's physician for a diagnosis.
How is pneumonia diagnosed?
Diagnosis is usually made based on the
season and the extent of the illness.
Based on these factors, your physician
may diagnose simply on a thorough
history and physical examination, but
may include the following tests to
confirm the diagnosis:
chest x ray - a diagnostic test which
uses invisible electromagnetic energy
beams to produce images of internaltissues, bones, and organs onto film.
blood tests - blood count for evidence
of infection; arterial blood gas to
analyze the amount of carbon dioxide
and oxygen in the blood.
sputum culture - a diagnostic test
performed on the material that is
coughed up from the lungs and into the
mouth. A sputum culture is often
performed to determine if an infection
is present.
pulse oximetry - an oximeter is a small
machine that measures the amount of
oxygen in the blood. To obtain this
measurement, a small sensor (like a
Band-Aid) is taped onto a finger or toe.
When the machine is on, a small red
light can be seen in the sensor. The
sensor is painless and the red light does
not get hot.
Specific treatment for pneumonia will be
determined by your child's physician based
on:
your child's age, overall health, and medical
history
extent of the condition
cause of the condition
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your child's tolerance for specific medications,
procedures, or therapies
expectations for the course of the condition
your opinion or preference
Treatment may include antibiotics for bacterial
pneumonia.
Antibiotics may also speed recovery from
mycoplasma pneumonia and some special cases.
There is no clearly effective treatment for viral
pneumonia, which usually resolves on its own.
Other treatment may include:
appropriate diet
increased fluid intake
cool mist humidifier in the child's room
acetaminophen (for fever and
discomfort)
medication for cough
Some children may be treated in the hospital if
they are having severe breathing problems.
While in the hospital, treatment may include:
intravenous (IV) or oral antibiotics
intravenous (IV) fluids, if your child is
unable to drink well
oxygen therapy
frequent suctioning of your child's nose
and mouth (to help get rid of thick
secretions)
breathing treatments, as ordered by
your child's physician
bronchodilator
a drug that relaxes contractions of the
bronchioles to improve breathing.
Bronchodilators are given for asthma,
bronchiectasis, bronchitis, and
emphysema.
Commonly used bronchodilators
include steroids, ephedrine,
isoproterenol hydrochloride,
theophylline, and many relatedcombinations of these drugs.
The steroids beclomethasone
dipropionate and triamcinolone can be
used in aerosol form.
11. 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
forms a cavity
Lung Abscess
Patients who are at risks
Causes of lung abscess
Site of abscess
Signs and Symptoms
Assessment and Diagnostic Findings
Prevention
Medical Management and Nursing Management
Pharmacologic Therapy
12. Empyema
a collection of pus in a body cavity, especially the
space between the lung and the membrane that
surrounds it (pleural space).
It is caused by an infection, as pleurisy or
tuberculosis.
It is a life-threatening condition requiring surgical
drainage and prolonged antibiotic treatment.
Empyema- Description
- It is a collection of pus within the pleural cavity
- The fluid is thin, opaque and foul smelling
- The most common cause is pulmonary infection
and lung abscess caused by thoracic surgery or
chest trauma, in which bacteria are introduced
directly into the pleural space
- Treatment focuses on emptying the empyema
cavity, re expanding the lung and controlling the
infection
Empyema - Assessment
Recent febrile illness or trauma
Chest pain, cough, dyspnea
Anorexia and weight loss
Malaise
Elevated temperature and chills
Night sweats
Diminished chest wall movement on the affected
side
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Pleural exudate on chest x-ray film
Empyema Nursing Interventions
Monitor breath sounds
Position client on a semi fowlers or high fowlers
position
Encourage coughing and deep breathing
Administer antibiotics as prescribed
Instruct the client to splint the chest as necessary
Assist with chest tube insertion to promote
drainage and lung expansion
If marked pleural thickening occurs, prepare the
client for decortication; if prescribed; this is a
surgical procedure that involves removal of the
restrictive mass or fibrin and inflammatory cells
DECORTICATION
Carried out when thickening of the visceral
pleura prevents re expansion of the lung as
may occur in chronic empyema. Visceral
pleura is peeled off the lung, which is then re
expanded by positive pressure thru an
anesthetic apparatus
Surgical removal of cortex or outer covering
of an organ such as the lungs
13. Pulmonary Edema
fluid in lung tissues
Most often occurs as result of abnormal cardiac
function
Crackles
Orthopnea
Treat underlying disease
Cause
congestive heart failure but also occurs as a side
effect of drugs, infections, inflammation of the
pancreas, or kidney failure.
Pulmonary edema also may follow a stroke, skull
fracture, near drowning, the breathing in of
poisonous gases, the rapid transfusion of whole
blood or fluids into the veins.
Signs/Symptoms
breathes quickly, shallowly, and with difficulty.
restless and hoarse and have pale or bluish skin.
cough up frothy, pink sputum.
veins of the neck, arms, and legs are usually
swollen.
Severe pulmonary edema is an emergency.
Treatment
place person in bed in a sitting position
give narcotic painkillers to relieve pain, slow
breathing, anxiety
heart tonic, drug that acts quickly to increase the
passing of urine (diuretic),
drug to enlarge the breathing tubes may be given.
Mechanical breathing help may be ordered by the
doctor.
Tourniquets placed on one arm or leg at a time
and then moved to a different arm or leg after a
short time, to pool blood in the arms and legs,
reducing the load on the heart.
The patient should exercise moderately, rest
often, report any symptoms, avoid smoking, and
follow the prescribed routines for drugs, diet, and
return checkups.
14. Acute Respiratory Failure
the inability of the heart and lung
systems to keep enough of a transfer ofoxygen and carbon dioxide in the
lungs.
Decreased respiratory drive
Dysfunction of the chest wall
Dysfunction of lung parenchyma
Inadequate ventilation
Treat underlying cause
Cause
lack of oxygen (hypoxemic failure) or a
transfer of gases problem (ventilatory
failure).
A sign of hypoxemic failure is excess
breathing (hyperventilation).
This occurs in diseases that affect the
air sacs (alveoli) or supporting tissues
of the lobes of the lungs, as alveolar
edema, emphysema, fungus infections,leukemia, pneumonia, lung cancer, or
tuberculosis.
Ventilatory failure occurs in conditions
in which fluids remaining in the lungs
cause more airway resistance and
lowered lung use, as in bronchitis and
emphysema.
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lowered if the breathing center is slowed by
barbiturates or opiates
Other factors slowing breathing are oxygen
problems, brain diseases, injury, or tumors of the
nerve and muscle system or the chest
long-term caused by added stress, as heart failure,
surgery, anesthesia, or upper breathing tract
infections.
Treatment
clearing the airways by suction
giving lung drugs (bronchodilators)
making an airway (tracheostomy)
antibiotics for infections
drugs that stop blood clotting to avoid
clots in the lungs
electrolyte replacements for fluid
imbalance.
Oxygen may be given in some cases
15. Acute/Adult Respiratory Distress Syndrome
An emergency
Sudden and progressive pulmonary edema,increasing bilateral infiltrates, hypoxemia
refractory to oxygen supplementation and
reduced lung compliance
Result of inflammatory trigger
Treat underlying condition
Ventilator considerations
Cause
failure of the lungs to work.
This may follow heart and lung bypass surgery
severe infection
blood transfusions
too much oxygen
trauma, pneumonia, or other lung infections.
It may also occur in Guillain-Barre syndrome,
muscular dystrophy, myasthenia gravis,
emphysema, asthma, or polio.
Signs/Symptoms
shortness of breath
quick breathing
Confusion
skin getting red, and changes in actions may be
caused by too much carbon dioxide
Oxygen levels that are too high can cause the
heart to race and the blood pressure to rise
Breathing failure brings falling blood pressure
and a blue tinge to the skin
cyanosis
DIAGNOSIS
Blood Tests show low amounts of oxygen and
more carbon dioxide in the blood
The changes that occur within the lungs may
include damage to the very small blood vessels,
bleeding, and swelling
TREATMENT
mechanical assistance with breathing
Oxygen
Mist
respiratory therapy
PATIENT CARE
constant and careful care
Confusion
The patient is weighed often
x-ray films of the chest are taken
and secretions are checked.
16. Pulmonary Hypertension
a condition of abnormally high pressure within
the arteries and veins of the lungs.
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
Manage underlying disease
17. Pulmonary Heart Disease
(Cor Pulmonale)
swelling of the right lower chamber (ventricle) of
the heart. This results from high blood pressure
(hypertension) of the lung circulation
Right ventricle enlarges with or without right-
sided heart failure
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Caused by severe COPD
Improve ventilation with supplemental oxygen,
chest physical therapy, and bronchial hygiene
Signs/Symptoms
constant cough
difficulty breathing
fatigue, and weakness
As the disease grows worse, breathing difficulty
may become more severe
water retention
swollen neck veins
rapid heart beat
A weak pulse and low blood pressure may result
from decreased heart function. awake or drowsy
TREATMENT
increase oxygen
increase exercise tolerance
correct the defect if possible
bed rest
digitalis
Oxygen
drugs to fight lung infection
low-salt diet
a small amount of fluids
Diuretics
anticlotting drugs.
PATIENT CARE
careful diet of many small meals
The amount of fluids drunk daily must be limited
Digitalis poisoning is often a danger
The patient must be alert to the symptoms. These
include appetite loss, nausea, vomiting, and
seeing yellow halos around images.
The cor pulmonale patient must avoid mixing
with crowds and taking drugs that can harm
breathing, as sedatives
Cor Pulmonale Chronic Cor
Pulmonale
18. Pulmonary Embolism
Obstruction of pulmonary artery or one of its
branches by a thrombus or embolus
Dyspnea,tachypnea, and chest pain occur
suddenly
Prevention of deep vein thrombosis
Emergency management
Anticoagulation therapy
Thrombolytic therapy
Description
Occurs when a thrombus that forms in the deep
vein detaches and travels to the right side of the
heart and then lodges in a branch of the
pulmonary artery
Clients prone to pulmonary embolism are those at
risk for deep vein thrombosis, including those
with prolonged immobilization,surgery, obesity,
pregnancy, congestive heart failure, advanced
age, or history of thromboembolism
Fat emboli can occur as a complication following
a fracture of a flat long bone
Treatment is aimed at preventing venous status
and includes ROM exercises and early
ambulation following surgery, the use of
antiembolism stockings and preventing pressure
under the popliteal space
Causes and Incidence
thrombus, which typically forms in the leg or
pelvic vein but may be seen in other locations
Fat, amniotic fluid
Air, gas, thrombophlebitis
major surgery
pregnancy and childbirth
fractures
myocardial infarction
congestive heart failure
venous insufficiency
polycythemia vera
prolonged immobility
chronic illness.
It is estimated that up to 5% of hospital deaths are
attributable to pulmonary emboli.
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Pathophysiology
Emboli travel through bloodstream, lodge in
pulmonary arteries
affected artery becomes underperfused but is still
ventilated.
results in physiologic dead space or wasted
ventilation and contributes to hyperventilation
Histamine release from embolus produces reflex
bronchoconstriction, leading to further
hyperventilation
Depletion of alveolar surfactant results in
diminished lung volume and compliance.
If the clot is large enough and interferes greatly
with pulmonary perfusion, it may result in
pulmonary hypertension.
Symptoms
nonspecific and vary in degree and intensity,
depending on the size of the embolus
the extent of occlusion, the amount of collateral
circulation, and preexisting cardiopulmonary
function
Small emboli may be asymptomatic.
The chief manifestation is breathlessness
anxiety, restlessness, tachypnea, sweating, cough,
hemoptysis, chest pain, fever, and rales. Cyanosis
may be present with a massive embolus.
Assessment Findings:
Blood tinged sputum
Chest pain, cough, cyanosis
Distended neck veins
Dyspnea accompanied by anginal and pleuritic
pain, exacerbation by inspiration
Hypotension
Wheezes on auscultation
Shallow respirations, tachypnea and tachycardia
Diagnostic Tests
1. Pulmonary angiogram - Visualization of
intraarterial filling defects
2. Lung perfusion scan - To detect perfusion
defects
3. Ventilation scan - To detect altered ventilation
patterns
4. Blood gases - Arterial hypoxemia (decreased
PaO2 and PaCO2)
5. Electrocardiography - To rule out myocardial
infarction; PE is characterized by tall, peaked P
waves, depressed ST segments, T-wave
inversions, and supraventricular tachyarrhythmias
6. Chest x-ray - Unilateral elevation of the
diaphragm, enlarged pulmonary artery, and
pleural effusion 2 hours or longer after the event
Treatments
Surgery
Embolectomy for large emboli
unresponsive to treatment; umbrella
filter in inferior vena cava to trap
multiple emboli before they reach the
lung; interruption of blood flow
through the inferior vena cava by
ligation for multiple emboli
Drugs
Anticoagulants to halt clot propagation
(heparin is used in the acute phase and
is replaced by coumadin, which may be
administered for 6 months to life;
medications should overlap for 5 to 7
days to achieve effective blood levels
of coumadin); fibrinolytic enzymes
may be used in place of anticoagulants
for clot lysis, particularly of large clots;
analgesics for pain; vasopressors,
dopamine to treat hypotension
General
Oxygen therapy
bed rest in acute phase, followed by
progressive mobilization
hemodynamic and cardiac monitoring;
facilitation of breathing
intake and output measurements to
monitor renal function
observation for bleeding as a side effect
of anticoagulants
safety measures to prevent bleeding
information about long-term
anticoagulant therapy
antiembolism hose and instruction in
preventing pooled blood in the lower
extremities
Potential Complications
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Cardiac arrhythmias, cor pulmonale, atelectasis,
shock, hepatic congestion, and necrosis are
complications
Pulmonary infarction is an uncommon
complication of PE that results in hemorrhagic
consolidation and tissue necrosis distal to theocclusion
Death following a PE usually occurs within 1 to 2
hours of the initial event
Those with underlying cardiovascular or
pulmonary disease and those with a large
embolus are at greater risk of dying
Untreated individuals risk recurrent emboli and
about a 50% chance of death.
Nursing Interventions:
Administer O2 as prescribed
Position client in high fowlers position
Monitor lung sounds and maintain bed rest with
active/ passive ROM
Encourage use of incentive spirometry
Monitor pulse oximetry
Prepare for intubation or mechanical ventilation
for severe hypoxemia
Administer anticoagulation therapy intravenously
with Heparin sodium (bolus), followed by
continuous infusion during the acute phase
Administer Warfarin (Coumadin) orally, as
prescribed, when infusion is discontinued
Monitor prothrombin time and ptt
Prepare the client for embolectomy, vein ligation
or insertion of an umbrella filter as prescribed
Pulmonary Embolism
19. Sarcoidosis
Boeck's sarcoid, also called sarcoid of Boeck
Multisystem granulomatous disease of unknown
etiology
Involves lungs, lymph nodes, liver, spleen, CNS,
skin, eyes, fingers, and parotid glands
Hypersensitivity response
Corticosteroid therapy or other cytotoxic and
immunosuppressive agents may be used
CAUSE
A long-term disease of unknown origin marked
by small, round bumps in tissue
It may appear in organs of the body, such as the
lungs, spleen, liver, skin, mucous membranes,
and tear and salivary glands, usually along with
the lymph glands
The sores usually go away after a period of some
months or years, but lead to widespread grainyswelling and fibrosis.
Signs and Symptoms: Sarcoidosis
Night sweats, fever
Weight loss, cough
Skin nodules, polyarthritis
KVEIM TEST- sarcoid node antigen is injected
intradermally and causes a local nodular lesion in
about one month
Nursing Interventions:
Administer corticosteroids to control symptoms
Monitor temperature
Increase fluid intake
Provide frequent periods of rest
Encourage small, nutritious meals
Sarcoidosis Eruption affecting the nose
Sarcoidosis affecting the spleen
20. Occupational Lung Diseases:
Pneumoconioses
any of a group of unusual problems in the lungs
caused by breathing dusts, fumes, gases, or
vapors in a place where a patient works
A. Silicosis
B. Asbestosis
C. Coal Workers Pneumoconiosis
A. Silicosis
grinder's disease, quartz silicosis also called
grinder's disease, quartz silicosis
inhaling silicon dioxide continuously over a long
period of time.
Silicon dioxide is found in sands, quartzes,
flints, and many otherstones.
Silicosis is marked by the development of small
fiberlike growths in the lungs.
In advanced cases, severe shortness of breath
may develop.
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incidence of silicosis is highest among
industrial workers exposed to silica powder in
manufacturing processes, in those who work with
ceramics, sand, or stone, and in those who mine
silica
Assessment: Silicosis
Uncomplicated or simple: asymptomatic with
evidence of fibrosis on chest x-ray film
Chronic complicated: malaise, anorexia, weight
loss, severe dyspnea on exertion, evidence of
massive fibrosis on chest x-ray film
Nursing Interventions: Silicosis
Administer antitussive for cough
Adminster medication for tuberculosis as
prescribed (Tuberculosis is a complication)
Eliminate toxic substances
Administer Oxygen as prescribed
Encourage cough and deep breathing
Silicosis
B. Asbestosis
A diffuse, interstitial pulmonary fibrosis resulting
from inhalation of asbestos
Causes and Incidence
prolonged exposure to airborne asbestos
particles
Susceptibility increases with increasing length
and intensity of exposure.
The incidence is greatly increased by chronic
occupational exposure
Families of workers also at risk from fibers
carried home on clothing.
The general public is at risk from long-term
exposure to asbestos dust in old buildings in
which asbestos was used as insulation, or from
asbestos in shingling or building material.
Pathophysiology
Asbestos particles are deposited on bronchiole or
alveolar walls and are ingested by cells
leading to an edematous process in the wall thatresults in nonnodular alveolar and interstitial
fibrosis
reduced lung volume and compliance
and impaired gas transfer.
Asbestosis-lung biopsy specimen
Symptoms
exertional dyspnea
decreased exercise toleranc
as the disease progresses, dyspnea is chronic even
at rest and a dry cough may develop.
Diagnostic Tests
1. Clinical examination - History of long-term
exposure to asbestos
2. Radiology - Interstitial markings in lower
lung, thickening, plaques, calcification
3. Pulmonary function -Early: normal; later:
reduced lung capacity and compliance
4. Arterial blood gases -Early: normal; later:
decreased PO2, increased PCO2
Treatments
Surgery - None
Drugs - None
General
Eliminate exposure
chest physiotherapy
increased fluids
steam inhalation to loosen secretions
oxygen therapy
Potential Complications
Asbestos is a cocarcinogen with tobacco
asbestos workers who smoke are 90 times morelikely to develop lung cancer than smokers who
are not exposed to asbestos.
C. Coal Workers Pneumoconiosis
anthracosis, black lung, coal worker's
pneumoconiosis, miner's pneumoconiosis, also
called black lung, coalworker's
pneumoconiosis, miner's pneumoconiosis
A long-term lung disease of coal miners
caused by coal dust in the lungs
It forms black bumps on the bronchioles that
result in emphysema. The condition is made
worse by cigarette smoking. There is no real
treatment. The progress of the disease may be
halted by staying away from coal dust
Anthracosis
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21. Chest Trauma
A. Blunt trauma
B. Flail chest
C. Penetrating trauma
D. Pneumothorax
A. Blunt trauma
having a dull edge or point; not sharp
B. Flail chest
a chest in which many broken ribs cause the chest
wall to be unstable
The lung under the injured area contracts on
breathing in and bulges on breathing out
The condition, if uncorrected, leads to air hunger
Flail chest is marked by sharp pain; uneven chest
expansion; shallow, rapid breathing; and reduced
breath sounds
Problems are collapsed lung, shock, and the
stopping of breathing
The treatment is to stabilize the inside of the
chest wall with a mechanical lung
Chest tubes may be needed to remove air or fluid
stopping the affected lung from expanding, and a
tube may be used to provide food and fluids
through the nose
Traction may be applied by attaching a steel wire
to the ribs or breastbone and connecting the wire
to a rope, pulley, and weight.
C. Penetrating trauma
Entering, piercing, boring, going through,
puncturing
sticking into, permeating, infiltrating, forcing
passing through, punching into, edged, pointed
22. Cardiac Tamponade and Subcutaneous
Emphysema
1. Cardiac Tamponade - Compression of heart
as result of fluid within the pericardial sac
Cause - when a blood vessel in the heart breaks
or by a wound to the heart
Signs/Symptoms - neck veins that stand out, low
blood pressure, decreased heart sounds, fast
breathing, and weak or absent pulses
The patient can be anxious and restless, tending
to sit upright or lean forward.
The skin may be pale, gray, or blue.
2. Subcutaneous Emphysema- Air entering the
tissue planes and passing under skin
Also called aerodermectasia
Cause - The air or gas may come from the
bursting of an airway or small pocket in the lung
and move through the chest between the lungs
(mediastinum) up into the neck
Signs/Symptoms - face, neck, and chest appear
swollen. Skin tissues can be painful and may
produce a "crackling" sound as air moves under
them. (dyspnea) (cyanosis) if the air leak is
severe.
Treatment - may require a cut to release the
trapped air.
23. Smoker's Lung Tissue
lungs made up of approximately 350 million tiny
sacs called alveoli, where carbon dioxide from
the body is exchanged for oxygen from the air
Various diseases that affect the lungs either
destroy the alveoli directly, as does emphysema,
or impair the alveolis ability to exchange gases.
caused - smoking on lung
Symptoms - difficulty in breathing, chest pain,
coughing, and wheezing. Lung cancer, most
commonly caused by smoking tobacco, is the
deadliest lung disease, and each year it kills more
Americans than any other kind of cancer.
24. Severe Acute Respiratory Syndrome (SARS)
is a rapidly spreading, potentially fatal infectious
viral disease.
Cause - A virus known as SARS-associatedcoronavirus (SARS-CoV) causes the illness.
When viewed under a microscope, coronaviruses
are a group of viruses that look like they have
crowns or halos. Coronaviruses commonly cause
mild to moderate upper-respiratory illness in
humans, but can cause respiratory,
gastrointestinal, liver, and neurologic diseases in
animals.
Symptoms
SARS can be difficult to recognize because it
mimics other respiratory diseases, such asinfluenza.
It generally begins with a fever higher than
100.4 F (38 C) and one or more of the
following symptoms:
headache
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overall feeling of discomfort
body aches and chills
sore throat
cough
difficulty breathing
shortness of breath
hypoxia (insufficient oxygen in the blood)
diarrhea (for 10 percent to 20 percent of patients)
Transmission/Spread
SARS-CoV spreads from one person to another
mainly through close contact with a SARS
patient
When a person with SARS coughs or sneezes
without covering his or her mouth, respiratory
droplets containing living virus can spray up to 3
feet and invade the mucous membranes of
another person.
Individuals in close contact with someone with
SARS are most at risk, which means they live or
work with someone with SARS or have direct
contact with the person through kissing, hugging,
or sharing eating utensils.
The virus also can spread when an individual
touches an object with infectious droplets on it
and then touches his or her mouth, nose, or eyes.
It is not known whether SARS can spread more
broadly through the air.
Symptoms
fever or cough
They are most infectious during their second
week of illness
As a precaution, the CDC recommends that
SARS patients stay in isolation at home or in the
hospital to keep others from getting sick
They should stay home from work or school for
10 days after their symptoms have gone away.
Treatment
Research is currently underway to develop an
effective antiviral drug for SARS-CoV. Until
then, SARS patients may receive the same
treatment that any patient with severe atypicalpneumonia might receive.
This treatment is mainly supportive therapy, with
oxygen and fluids to help ease symptoms, and
antibiotics to help prevent or treat secondary
infections.
Preventing SARS
Currently, there is no vaccine available to prevent
SARS. The CDC recommends taking the
following steps toward prevention of SARS:
Wash your hands regularly with warm water and
soap.
Avoid touching your eyes, nose, and mouth.
Use a disposable tissue instead of your hands to
cover your mouth when you cough, and throw it
away immediately after use.
Follow public health recommendations if you are
in the area of an epidemic.
Carbon Monoxide Poisoning
Description: carbon monoxide is a colorless,
odorless and tasteless gas that has an affinity for
hemoglobin 200 times greater than that of oxygen
Oxygen molecules are displaced, and carbon
monoxide reversibly binds to hemoglobin to form
carboxyhemoglobin; tissue hypoxia occurs
Carbon Monoxide Poisoning: Assessment
1% - 10% Impaired visual acuity
11% - 20% Flushing headache
21% - 30% Nausea and impaired
detrexity
31% - 40% Vomiting, Dizziness and
syncope
41% - 50% Tachypnea and tachycardia
Greater than 50% COMA
Nursing Interventions:
Remove victim from exposure
Administer oxygen
Assess need for basic life support
Monitor vital signs
Monitor carbon monoxide levels
Review:
1.Atelectasis - Closure or collapse of alveoli
2. Pleurisy
3. Pleural effusion
4. Pneumothorax
5. Hemothorax
6. Acute tracheobronchitis
7. Pneumonia
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8. Asthma
9. Respiratory Failure
10. ARDS
11. Pulmonary Tuberculosis
12. Lung Abcess
13. Empyema
14. Pulmonary Edema
16. Pulmonary Hypertension
17. Pulmonary Heart Disease
(Cor Pulmonale
18. Pulmonary Embolism
19. Sarcoidosis
20. Occupational Lung Diseases: Pneumoconioses
21. Chest Trauma
22. Cardiac Tamponade and Subcutaneous Emphysema
23. SARS
Restrictive Disorder
E. Pneumothorax
- A condition where there is air in the pleural
space between the lung and the chest wall.
TYPES:
1. Closed pneumothorax
Injury to the lungs from mechanical
ventilation
Perforation of the esophagus
Injury to the lungs from the broken ribs
Ruptured blebs or bullae in patients
with COPD
2. Open pneumothorax
Gunshot wounds
Stab wounds
Surgical thoracotomies
3. Tension pneumothorax
True medical emergency
Clinical Manifestations
Sharp pain on inspiration
Increasing dyspnea
Diaphoresis
Hypotension
Tachycardia
Mediastinal shift
Unequal chest movement
Absence of breath sounds on affected side
Diminished heart sounds
Restrictive Disorder
Clinical Manifestations:
1. Supraglottic
Localized throat pain
Burning when drinking hot liquids or orange
juice
Lump in the neck
Dysphagia
Dyspnea
2. Glottic
Hoarseness
dyspnea
Medical Management
Occlusion of open wound
Chest tube insertion
Pleurodesis
Nursing Management
Monitor V/S frequently. Report to MD if dyspneaworsens
Semi-Fowlers position
Occlude wound with non-porous covering
Care of chest tubes
Chronic Obstructive Pulmonary Disease
Includes diseases that cause airflow obstruction
Chronic Bronchitis
Emphysema
Risk Factors include environmental exposures
and host factors
Primary symptoms are cough, sputum production
and dyspnea
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1. Asthma
2. Chronic Bronchitis
3. Bronchiectasis
4. Emphysema
1. Asthma
Asthma is a chronic, inflammatory disease in
which the airways become sensitive to allergens
(any substance that triggers an allergic reaction).
Several things happen to the airways when a
child is exposed to certain triggers:
The lining of the airways become swollen and
inflamed.
The muscles that surround the airways tighten.
The production of mucus in increased, leading to
mucus plugs.
2. Chronic Bronchitis
a very common respiratory disease that causes
severe weakness.
The glands of the windpipe (trachea) and the
large airways of the lungs (bronchi) produce too
much mucus.
This results in a cough that produces mucus(expectoration).
The condition has a strong link to smoking and
air pollutants. The disease was formerly seen
almost only in men.
It is becoming more common in women who
smoke. A deep cough, often with wheezing, is
always found.
This is followed by breathing difficulty with
exercise.
The disease is noted for frequent pus-forming
infections of the lungs.
Difficult breathing results from narrow airways
and often brings lung failure.
Heart failure is a common result.
Some patients develop too many red blood cells
caused by lack of oxygen. Sharp attacks of
breathing distress with rapid, labored breathing,
long exhaling, intense cough, and bluish skin can
result.
Patients who suffer from these symptoms are
called "blue bloaters."
It is usual to give antibiotics during the acute
attack of symptoms.
Drugs that open the airways (bronchodilators) are
given to prevent the condition from getting
worse.
Heart failure is managed by restricting salt in the
diet, diuretics, and sometimes digitalis.
Patients with chronic bronchitis should be
vaccinated against influenza and lung infections.
Low-flow oxygen is often used in the home.
Exercise, especially walking, and therapy are
often given.
Medical Management
Risk reduction- smoking cessation
Bronchodilators
Corticosteroids
Influenza and pneumococcal vaccination
Oxygen therapy
Surgical Management
Bullectomy
Lung Volume Reduction Surgery
Lung Transplantation
Nursing Management
Patient education
Breathing exercises
Inspiratory muscle training
Activity pacing
Self-care activities
Physical conditioning
Oxygen and nutritional therapy
Coping measures
Bronchiectasis
Chronic, irreversible dilation of bronchi and
bronchioles
Chronic cough and purulent sputum production
Postural drainage promotes clearing of secretions
Antibiotics may be prescribed
Asthma
Chronic inflammatory disease of airways causing
airway hyperresponsiveness, mucosal edema, and
mucus production
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Reversible, either spontaneously or with
treatment
Allergy is strongest predisposing factor
Asthma (contd)
Long-Acting Control Medications:
corticosteroids and long-acting beta2-adrenergic
agonists, methylzanthines, and leukotriene
modifiers
Quick-Relief Medications: short-acting beta-
adrenergic agonists
Cystic Fibrosis
Autosomal recessive disease
Airflow obstruction is key feature
Medical Management: antibiotics,
bronchodilators, inhaled mucolytic agents
Nursing Management: chest physiotherapy, fluid
and dietary intake, reduce risk for infection
Chronic Obstructive Pulmonary Disease
Emphysema
Chronic Bronchitis
Bronchial Asthma
DIAGNOSTICS:
Chest X-ray
Pulmonary function tests
Sputum specimen
ABG
ECG
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
Medical Management
Antibiotics
Influenza vaccination
Bronchodilator therapy
B adrenergic agonists
Anticholinergic agents (Ipratropium
bromide)
Theophylline
Corticosteroids
Mucolytic expectorants
Oxygen therapy
Digitalis
Diuretics
Nursing Management
Teach patient on how to do diaphragmatic
breathing
Coughing exercises
Chest physiotherapy
Nebulize patient
Adequate hydration
Smoking cessation and avoidance of irritant
factors
Avoid contact with sick people
Low flow oxygen therapy
Relaxation training
Bronchial Asthma
- Characterized by airway obstruction,
inflammation and increased responsiveness toa variety of stimuli
- Status asthmaticus is a severe life-threateningcomplication that is refractory to treatment.
TRIGGER FACTORS
Allergens
Respiratory infections
Exercise
Drugs and food additives
Emotional stress
Clinical Manifestations
Wheezing
Cough
Dyspnea
Chest tightness
Severely diminished breath sounds
Pulsus paradoxus
Use of accessory muscles
Tachycardia
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Ventricular dysrythmias
Classification of Asthma
Diagnostics
Pulmonary function test
ABG
Sputum specimen
Medical Management
B-adrenergic drugs
metaproterenol, albuterol,
isoproterenol, epinephrine
Corticosteroids
hydrocortisone, beclamethasone,
prednisone, methylprednisolone, triamcinolone
Mast cell stabilizer
cromolyn sodium, nedocromil
Anticholinergics
ipratropium bromide, atropine
Nursing Management
Administer medications and monitor closely
High fowlers position; slow rhythmic breathing
Adequate fluid intake
Provide extra humidity
If with respiratory acidosis- O2 as prescribed
Calm, quiet environment
Instruct patient to recognize trigger factors
Teach importance of hydration, adequate
nutrition and exercise
Upper Airway Infections
Rhinitis vs. Viral Rhinitis
Acute Sinusitis vs. Chronic Sinusitis
Chronic Pharyngitis
Tonsillitis
Adenoiditis
Peritonsillar Abscess-
Laryngitis
Tracheitis
Epiglottitis, epiglottiditis
Dust mites
Child with sinusitis
Allergic Rhinitis as seen in Fiberoptic
Rhinoscope
Herpes Simplex blisters around mouth region-
One strain of the herpes simplex virus causes
cold sores (also known as fever blisters) in and
around the mouth, lips, pharynx, nose, face, and
ears. The causative agent remains in the cell
bodies of facial nerves, causing repeated attacks
of the blisters. No established therapy, beyond
topical lotions for pain relief, has been
developed.
Chronic Pharyngitis-The pharynx is su