NCM 112 LEC 1  Lungs

SIR ARNEL - Paired elastic structures enclosed in the

thoracic cage, which is an airtight chamber
RESPIRATORY SYSTEM with distensible walls

-
-

- 5-15 MINS NO BREATHING > MEDULLA

OBLONGATA> IRREVERSIBLE BRAIN
DAMAGE = neurons wont replicate, and
sensitive to oxygen lacking.

ANATOMY AND PHYSIOLOGY

Comprised of the upper airway and lower airway
structures.

UPPER RESPIRATORY TRACT

- Filters, moistens and warms air during  Pleura
inspiration. - Serous membrane that lined the lungs and
- nose; paranasal sinuses; pharynx, tonsils, wall of the thorax
and adenoids; larynx; and trachea.  Bronchi and Bronchioles
 Alveoli
 Nose - Basic gas-exchange unit of the respiratory
- Serves as a passageway for air to pass to system is the alveoli.
and from the lungs. It filters impurities and - Alveolar stretch receptors respond to
humidifies and warms the air as it is inhaled inspiration by sending signals to inhibit
 Paranasal Sinuses inspiratory neurons in the brainstem to
- Prominent function of the sinuses is to prevent lung over distention
serve as a resonating chamber in speech

-
 Pharynx
- Throat, is a tube-like structure that
connects the nasal and oral cavities to the
larynx
 Larynx
- Voice organ, is cartilaginous epithelium
lined structure that connects the pharynx
PA = ONLY ARTERY THAT CARRY UNOXYGENATED
and the trachea. The major function is for
BLOOD
vocalization
PV = ONLY VEIN CARRIES O2 BLOOD
 Trachea (Windpipe)
AORTA = BIGGEST ARTERY
- Serves as the passage between the larynx
and the bronchi
DIFFUSION= high concn to lower concn
UPPER RESPIRATORY TRACT
- Enables the exchange of gases to regulate
serum PaO2, PaCO2 and pH.
 Nursing Intervention
- Instruct the patient with allergic rhinitis to
avoid or reduce exposure to allergens and
irritants
- Instructs the patient in correct
administration of nasal medications
- To achieve maximal relief, the patient is
instructed to blow the nose before applying
any medication into the nasal cavity

 VIRAL RHINITIS (COMMON COLD)

- Most frequent viral infection in the general
population caused by coronavirus
- Highly contagious because virus is shed for
about 2 days before the symptoms appear
and during the first part of the symptomatic
phase

Clinical Manifestation
- Low-grade fever
- Nasal congestion
- Rhinorrhea and nasal discharge
- Halitosis, sneezing
- Tearing watery eyes
- "Scratchy" or sore throat
- General malaise, chills
- Headache and muscle aches
Management
- Symptomatic therapy
- Adequate fluid intake and rest
- Prevention of chilling
DISORDERS OF THE UPPER RESPIRATORY SYSTEM - Warm salt-water gargles to soothe the sore
throat
RHINITIS - NSAIDs to relieve aches and pains
- A group of disorders characterized by - Antihistamines are used to relieve sneezing,
inflammation and irritation of the mucous rhinorrhea, and nasal congestion Inhalation
membranes of the nose of steam or heated, humidified air

 ALLERGIC RHINITIS TONSILITIS AND ADENOIDITIS

- Further classified as seasonal rhinitis (occurs - The tonsils are composed of lymphatic
during pollen seasons) or perennial rhinitis tissue and are situated on each side of the
(occurs throughout the year) oropharynx
- Commonly associated with exposure to - The adenoids or pharyngeal tonsils consist
airborne particles such as dust, dander, or of lymphatic tissue hear the center of the
plant pollens in people who are allergic to posterior wall of the nasopharynx
these substances - Acute inflammation/infection that is usually
caused by GABHS (group A beta-hemolytic
Clinical Manifestations streptococcus)
- Rhinorrhea (excessive nasal drainage, runny
nose) Clinical Manifestations
- Nasal congestion (barado) - Sore throat, fever, snoring and difficulty
- Sneezing swallowing
- Pruritus of the nose, roof of the mouth, - Enlarged adenoids may cause mouth-
throat, eyes, and ears breathing, earache, draining ears, frequent
Management head colds, bronchitis, (halitosis) foul
- Antihistamines smelling breath, voice impairment, and
- Corticosteroid nasal sprays noisy respiration
o When giving steroids, more side Management
effects will occur. - Penicillin (first-line therapy) or
o Cushing’s triad – moon face, buffalo cephalosporins
neck, hypertension - Tonsillectomy or adenoidectomy is
o Gastric irritant indicated if the patient has had repeated
- Desensitizing immunizations
 episodes of tonsillitis despite antibiotic - Corticosteroid therapy
therapy o Start from big dose [tapering] (1-3
- 5x a year days) then small dose (3-5 days)
- Rheumatic heart disease (complication) o Adrenal gland produce steroid,
o Mitral valve is affected when taking drugs w/ steroids, the
o Antigen mimicry - is the sharing of organ is underproduced from
antigenic sites releasing steroid.
between microorganisms and - Needle aspirations are performed to
mammalian tissue. An immune decompress the abscess
response can be directed both at the
microorganism and at the host site Nursing Interventions
that shares the antigenic - Assist in performing intubation,
determinant.  cricothyroidotomy, or tracheotomy to treat
airway obstruction
Nursing interventions (post-op) - Assist in needle aspiration when indicated
- In the immediate postoperative period, the - Gentle gargling after the procedure with a
most comfortable position is prone, with cool normal saline gargle may relieve
the patient's head turned to the side to discomfort
allow drainage from the mouth and pharynx
- Apply ice collar to the neck LARYNGITIS
- Assess for post op bleeding such as - An inflammation of the larynx, often occurs
frequent swallowing as a result of voice abuse or exposure to
- Instruct the patient to refrain from dust, chemicals, smoke and other pollutants
coughing and too much talking > impaired - Most common cause is virus, bacterial
surgical area invasion may be secondary
- Ice chips may be given to the patient
- Alkaline mouthwashes and warm saline Clinical manifestations
solutions are useful in coping with the thick - Hoarseness of voice - initial sign
mucus and halitosis that may be present - Aphonia (complete loss of voice)
after surgery - Severe cough
- Milk and milk products (ice cream and - Throat feels worse in the morning and
yogurt) may be restricted improves when the patient is in a warmer
- Provide soft, adequate diet climate
- Instruct the patient to avoid vigorous tooth Management
brushing or gargling - Instruct the patient to rest the voice and
- Encourage the use of a cool-mist vaporizer avoid irritants (including smoking)
or humidifier in the home - Inhaling cool steam or an aerosol is
- Instruct patient to avoid smoking and heavy provided
lifting or exertion for 10 days. - Administer antibacterial therapy as ordered
- Topical corticosteroids may be given by
PERITONSILLAR ABSCESS (QUINSY) inhalation
- Most common major suppurative - Increased oral fluid intake
complication of sore throat/tonsillitis.
- This collection of purulent exudates CANCER OF THE LARYNX
between the tonsillar capsule and the Etiology
surrounding tissues, including the soft - Most tumors of the larynx are squamous
palate, may develop after an acute tonsillar cell carcinoma
infection that progress to a local cellulitis - Men > women, age 60-70
and abscess - Cigarette smoking and alcohol consumption
are associated with laryngeal cancer
Clinical Manifestations
- Severe sore throat, fever trismus (inability Clinical Manifestations
to open the mouth), and drooling. - Hoarseness of voice for more than 2 weeks
- Severe pain, raspy voice - Persistent cough and sore throat
- Odynophagia (a severe sensation of - Dyspnea
burning, squeezing pain while swallowing) - Dysphagia
- Dysphagia (difficulty swallowing) - Pain radiating to ear and burning sensation
- Otalgia (pain in the ear), tender and in the throat
enlarged cervical lymph nodes - Weight loss
- Airway obstruction may occur - Enlarged cervical lymph nodes
- Unilateral nasal obstruction
Management
- Antimicrobial agents (Penicillin)
 Diagnostic Criteria: Cough of 3 months for 2
consecutive years

a. Chronic Bronchitis
- Chronic inflammation of the lower
respiratory tract characterized by excessive
mucous secretion, cough, and dyspnea
associated with recurring infections of the
lower respiratory tract characterized by
three primary symptoms:
BENIGN TUMOR – slow progress o chronic cough,
MALIGNANT TUMOR – cancerous, mabilis o sputum production,
magparami pag ginalaw kaya delikado o dyspnea on exertion

Diagnostic Procedures
- Virtual endoscopy
- Optical imaging
- CT scan MRI (more detail)
- Direct laryngoscopic examination
- Management
- Radiation therapy
- Chemotherapy
Surgery:
- Partial Laryngectomy - A portion of the
BAKIT NAGKAROON NG GANITONG ITSURA?
larynx is removed, along with one vocal
- EXPOSED TO PREDISPOSING FACTORS like
cord and the tumor
Smoking, polluted environment> once
inhaled> wall of bronchi are destroyed and
Complication: change in voice quality or
deprived> inflammation is present> body
hoarseness of voice
will release chemical activator (bradykinin,
- Total Laryngectomy - Laryngeal structures
histamine, prostaglandin) to fight these>
are removed, including the hyoid bone,
produces fluid or cellular exudate > edema
epiglottis, cricoid cartilage, and two or three
of the mucus membrane due to
rings of the trachea
hypersecretion of mucus> reflex of the body
is via coughing> continuously and severe>
Complication: permanent loss of voice, salivary
airway limitation> the wall becomes fibrotic
leak, wound infection, stomal stenosis and
that causes bronchial narrowing>
dysphagia
irreversible case> lead to more serious
EMPHYSEMA & BRONCHECTASIS
Nursing interventions
- Arrange for clients with laryngectomies to
Clinical Manifestations
meet with members of support groups
- Blue bloater (look cyanotic) decreased O2,
- Establish a method for communication
hindi nakakarating sa alveoli
before surgery
- Usually insidious, developing over a period
- Maintain airway; have suction equipment at
of years
bedside
- Presence of a productive cough lasting at
- Observe for signs of hemorrhage or
least 3 months a year for 2 successive years
infection
- Production of thick, gelatinous sputum;
- Teach about tracheostomy and stoma care
greater amounts produced during
- Assist with period of grieving
superimposed infections
- Wheezing and dyspnea as disease
DISORDERS OF THE LOWER RESPIRATORY SYSTEM
progresses (naiipit yung hangin)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
EMPHYSEMA
(COPD)
- Complex lung disease characterized by
- Refers to a disease characterized by airflow
destruction of the alveoli, enlargement of
limitation that is not fully reversible. The
distal airspaces, and a breakdown of
airflow limitations is generally progressive
alveolar walls. There is a slowly progressive
and is normally associated with an
deterioration of lung function for many
inflammatory response of the lungs due to
years before the development of illness
irritants, COPD includes chronic bronchitis
and pulmonary emphysema
2 TYPES:

PAN LOBULAR EMPHYSEMA - destruction of

respiratory bronchiole, alveolar duct and alveolus
- All air spaces within the lobule are
essentially enlarged, but there is little
inflammatory disease
- Hyperinflated (hyperexpanded) chest,
marked dyspnea on exertion, and weight
loss typically occur
- Negative pressure is required during
inspiration to move air into and out of the
lungs
- Expiration becomes active and requires
muscular effort

CENTRILOBULAR (CENTROACINAR) EMPHYSEMA -

pathologic changes take place mainly in the center
of the secondary lobule, preserving the peripheral
portions of the acinus
- There is a derangement of ventilation-
perfusion rations,
- producing chronic hypoxemia, hypercapnia,
polycythemia, and episodes of right-sided
heart failure
- Leads to central cyanosis and respiratory
failure, and patient also develops peripheral
edema.

Clinical Manifestations
- Pink puffer
- Dyspnea, decreased exercise tolerance
- Cough may be minimal, except with
respiratory infection
- Sputum expectoration

Dis equilibrium of alveoli> creates elastic recoil>

tendency is easily getting tired> interruption of 2
gasses> C02 will retain > respiratory acidosis > 02
will be lacking to cause hypoxia/emia