Responses to Alterations in ❖ Purulent with bacterial ▪ subacute (4 to 12

rhinitis weeks), and

oxygenation and ventilation ❖ Sneezing ▪ chronic (more than 12
❖ Pruritus of the nose roof weeks
RISK FACTORS FOR RESPIRATORY of the mouth, throat, ▪ ABRS
DISEASE eyes and ears ▪ AVRS
➢ Smoking ❖ Headache ▪ Follows viral URI, or
➢ Use of chewing tobacco ❖ rhinosinusitis unresolved viral or
➢ Allergies bacterial infection
➢ Frequent respiratory Medical Management: ▪ Drainage obstruction
illnesses - depends on the cause ▪ Deviated septum,
➢ Chest injury - Hx and Physical Examination - hypertrophied
➢ Surgery Pharmacologic management: turbinates, spurs or nasal
➢ Exposure to chemicals & - allergic and nonallergic polyps, tumors or sinus
environmental pollutants — antihistamines and infection
➢ Family history of corticosteroids nasal sprays ▪ Suppurative process
infectious disease - Dimetapp ▪ Purulent discharge
➢ Geographic residence
& travel to foreign Viral Rhinitis/ Common Cold Assessment and Diagnostic
countries ▪ most common and self- Findings
limited -history and physical examination
- head and neck, nose, ears,
Management of Patients with ▪ Rhinoviruses- most
common teeth, sinuses, pharynx, and chest
URTD - Tenderness of the sinuses
▪ Coronavirus, adenovirus,
Upper Airway Infections/ URI RSV, - Transillumination
➢ Most common cause of ▪ influenza, parainfluenza Medical Management
illness ▪ Location varies - ✓ Antibiotics- to shrink the
➢ Acute or chronic? nasal mucosa, relieve
➢ Common cold (viral S/Sx: pain, and treat infection
rhinitis) - CA: viruses ❖ low-grade fever,
➢ Affect : •nasal cavity ❖ nasal congestion, Nursing Management
•sinuses rhinorrhea and nasal - Educating Patients About Self-
Incidence rate: 2 to 4 times per discharge, Care
year ❖ halitosis, sneezing, - Report symptoms of
❖ tearing watery eyes, complications
Rhinitis “scratchy” or sore - periorbital edema
throat, - severe pain on palpation
▪ inflammation and
❖ general malaise, - methods to promote drainage
irritation of the mucous
❖ chills, and often of the
membrane of the nose
headache and muscle sinuses
▪ Acute or chronic?
aches. - avoid swimming, diving, and air
▪ Allergic or nonallergic?
❖ Cough travel
▪ Seasonal or perennial?
❖ the virus exacerbates during the acute infection
Risk factors:
herpes simplex, - fever, severe headache, and
▪ Change in temperature
❖ cold sore nuchal
and humidity
rigidity—-potential complications
▪ Odors
▪ Infection; age; systemic Medical Management
disease; use of OTC -symptomatic therapy Acute Pharyngitis
-adequate fluid intake, rest, ▪ sudden painful
Allergens: prevention inflammation of the
Indoor of chilling pharynx
- dust mite feces -use of expectorants as needed ▪ adenovirus, influenza
- Dog dander -Warm salt-water gargles soothe virus,
- Cat dander the sore throat, ▪ Epstein–Barr virus, and
- Cockroach droppings - nonsteroidal antiinflammatory herpes
- Molds drugs (NSAIDs), such as aspirin or ▪ simplex virus - Bacterial
Outdoor ibuprofen,relieve aches and infection
- trees pains. ▪ GABHS
- Weeds - Antihistamines
- Grasses
-Molds Rhinosinusitis
▪ sinusitis
Signs/Symptoms: ▪ inflammation of the
❖ rhinorrhea paranasal S/Sx:
❖ nasal congestion ▪ sinuses and nasal cavity • fiery-red pharyngeal
❖ Nasal discharge ▪ acute (less than 4 membrane and tonsils,
weeks),
 • Swollen lymphoid • mucus that collects in • Trismus- inability to open
follicles flecked with the throat and can be the mouth
white-purple exudate expelled by coughing, • Drooling
• enlarged and tender • difficulty swallowing. • Intense pain
cervical lymph nodes, • intermittent postnasal • Rancid breath
and no cough. drip • raspy voice
• Fever (higher than *A sore throat that is worse with • odynophagia- pain in
38.3°C swallowing in the absence of swallowing
• malaise, and sore throat pharyngitis- thyroiditis • dysphagia- discomfort in
swallowing
Assessment and Diagnostic Medical Management • otalgia-ear pain
Findings ❖ relieving symptoms
▪ Rapid antigen detection ❖ avoiding exposure to Assessment and Diagnostic
testing irritants Findings
▪ (RADT) ❖ correcting any upper • aspiration
▪ swabs that collect respiratory, pulmonary, • Intraoral ultrasound
specimens gastrointestinal, or • transcutaneous cervical
▪ from the posterior cardiac condition—--- ultrasound
pharynx and tonsil chronic cough.
▪ Negative results should Medical Management
be confirmed- culture Tonsillitis and Adenoiditis • Antimicrobial agents
• bacterial pathogens • penicillin
Medical Management include GABHS • corticosteroid therapy
▪ Viral pharyngitis- S/Sx:
supportive measures ➢ sore throat, fever, Surgical Management
▪ Bacterial pharyngitis- snoring, and difficulty • Needle aspiration
antimicrobial agents- swallowing • Incision and drainage
Penicillin V potassium ➢ Enlarged adenoids • Tonsillectomy
▪ Nutritional Therapy-liquid ➢ mouth breathing,
or soft diet earache, Nursing Management
➢ draining ears, , ✓ patient requires
Nursing Management bronchitis, foul-smelling intubation
✓ supportive measures breath, voice ✓ Cricothyroidotomy
✓ Watch out!!- dyspnea, impairment, and noisy ✓ Tracheotomy
drooling, inability to respiration ✓ Gentle gargling after the
swallow, and inability to procedure with a cool
fully open the mouth Assessment and Diagnostic normal saline gargle
Findings? Medical Management? ✓ The patient must be
Chronic Pharyngitis Nursing Management? upright and
• persistent inflammation Postoperative Care ✓ clearly expectorate
of the pharynx risk of hemorrhage forward.
Risk factors Position? ✓ patient requires
• dusty surroundings, ice collar to the neck - intubation
• use their voice to excess, Complications? ✓ Cricothyroidotomy
• suffer from chronic - fever, throat pain, ear pain, and ✓ Tracheotomy
cough, habitually use bleeding ✓ Gentle gargling after the
alcohol- tobacco procedure with a cool
Peritonsillar Abscess normal saline gargle
There are three types of chronic ▪ Quinsy- pus filled ✓ 1 or 2 hours for 24 to 36
pharyngitis: ▪ common major hours
Hypertrophic—char. by general suppurative ✓ The patient must be
thickening and congestion of the ▪ complication of sore upright and clearly
pharyngeal mucous membrane throat expectorate forward
Atrophic—probably a late stage ▪ 20 to 40 years ✓ Adequate fluid intake
of the first type (the membrane is ▪ collection of purulent
thin, whitish, glistening, and at exudate
times wrinkled) ▪ tonsillar capsule and the
Chronic granular—char. by surrounding tissues,
numerous swollen lymph follicles ▪ soft palate
on the pharyngeal wall ▪ acute tonsillar infection
▪ local cellulitis and Laryngitis
abscess Risk
S/Sx. ▪ voice abuse or exposure
• constant sense of S/Sx. to dust, chemicals,
irritation • severe sore throat smoke, and other
• fullness in the throat • fever, t pollutants or as part of a
URI
 ▪ gastroesophageal reflux Ventilation-Perfusion ▪ Macroatelectasis- affect
▪ Reflux laryngitis segment of a lung loss of
Relationships
▪ Pathogens? – segmental, lobar or
● Gas exchange relies on overall lung volume
S/sx: adequate perfusion of the alveoli. (visible on xray)
➢ hoarseness or aphonia ✓ Normally, the volume in
and severe cough the conducting airways, Pathophysiology
such as the trachea and ➢ nonobstructive
Medical Management bronchioles, do not atelectasis-caused by
resting the voice, participate in gas post op complications-
avoiding irritants (including exchange. reduced ventilation
smoking), resting, ● anatomical dead space ➢ obstructive atelectasis-
inhaling cool steam or an aerosol. ✓ because these obstruction in the
structures are not passage of air going to
Nursing Management designed for gas alveoli : blockage that
rest the voice and to maintain a exchange obstructs passage of air
well humidified environment ● Alveolar dead space unit to and from the alveoli -
✓ when an alveolus is not most common type.
NURSING PROCESS???? perfused ➢ reabsorption of gas
1. Assessment — enumerate!! (obstructed/collapsed), ➢ no additional air can
2. Diagnosis? Based on priority air did not arrive in enter into the alveoli
3. Planning alveolus. ➢ affected portion of the
4. Nursing Intervention ✓ because no gas lung becomes airless
a. MAINTAINING A PATENT exchange is occurring ➢ alveoli collapse:
AIRWAY ✓ ventilation exceeds obstructive
b. PROMOTING COMFORT perfusion
c. PROMOTING ■ pulmonary embolism- has dead Causes;
COMMUNICATION space ❖ foreign body, tumor
d. ENCOURAGING FLUID INTAKE ■ pulmonary infarct. ❖ altered breathing
e. MONITORING AND MANAGING patterns
POTENTIAL COMPLICATIONS ● shunt unit ❖ retained secretions,
✓ when an alveolus is pain,
inadequately ventilated ❖ alterations in small
Pulmonary Volumes and
in the presence of airway function,
Capacities perfusion (there’s a ❖ prolonged supine
1. Total Lung Capacity (TLC) supply of blood, but positioning,
✓ Max vol the lungs can alveolus is not ❖ increased abdominal
hold- 6000 mL ✓ perfusion exceeds pressure,
2. Tidal Volume (VT) ventilation ❖ reduced lung volumes
✓ Volume of one ■ pneumonia caused by:
inhalation/exhalation ■ atelectasis. Musculoskeletal,
cycle - 500 mL neurologic disorders,
3. Functional residual volume ● Silent unit restrictive defects
(FRC) ✓ when ventilation and ❖ specific surgical
✓ Vol remaining in the perfusion are impaired procedures (e.g., upper
lungs after a normal ✓ severe ARDS or abdominal, thoracic, or
exhalation- 2400mL pneumothorax open heart surgery
4. Inspiratory capacity (VT +IRV)- (respiratory
3600mL emergencies)- fatal
compressive atelectasis
5. Inspiratory Reserve Volume
(IRV) Management of Patients with ➢ restricts normal lung
✓ Volume of air one is able Chest and Lower Respiratory Tract expansion on inspiration:
to inhale in addition to Disorders possible cause, post op-
the VT- 3100mL prolong supine position
6. Residual Volume (RV) ➢ pressure can be
ATELECTASIS
✓ Volume of air that produced by fluid
▪ closure or collapse of accumulation
remains in the lungs alveoli
following forced -pleural space —-pleural effusion
▪ chest x-ray findings - (fluid accumulation)
expiration beyond acute or chronic
normal (ERV)-1200mL -air in the pleural space leads to
Can be developed by: pneumothorax
7. Vital CApacity ▪ postoperative setting
✓ Sum of ERV, VT and IRV- -blood in the pleural space leads
▪ COPD to Hemothorax
4800mL ▪ Lung cancer- -pericardial area pericardial
malignancies effusion
Respiration (Diffusion) ▪ Microatelectasis -certain
area of alveoli.
Clinical Manifestations
 ➢ insidious- develops - It measures volumetric spontaneously
slowly. displacement on the device breathing patient.
➢ increasing dyspnea, 2. Flow-oriented devices ✓ Increases the amount
cough, and sputum - It provides only an indirect of air remaining in the
production. indicator of the patient’s inspired lungs at the end of
➢ lobar atelectasis, one volume expiration.
lobe is affected (worse) ✓ Fewer complications
➢ marked respiratory Management than PEEP.
distress • improve ventilation and ✓ Ordered as 5–10 cm
➢ tachycardia, remove secretions: turn H2O
tachypnea, pleural patient, early
➢ pain, and central ambulation, instruct pt. Acute Tracheobronchitis
cyanosis( not enough deep breathing ▪ acute inflammation of
air)- caused by exercises the mucous membranes
hypoxemia • In patients who do not of the trachea
➢ Orthopnea- difficulty in respond to first-line ▪ bronchial tree
breathing while laying measures or who cannot ▪ airway is affected
(sitting best position to perform deep-breathing
relieve) exercises: PEEP( mech Pathophysiology
➢ chronic atelectasis? – vent) help alveoli ➢ Streptococcus
manifestation: pt, • simple mask pneumoniae
having probs with • one-way valve system ➢ Haemophilus influenzae
ventilation of alveoli, risk provides varying ➢ Mycoplasma
for pulmonary infection amounts of expiratory pneumoniae.
➢ Friction happen- pleurisy resistance, usually 10 to ➢ fungal infection
15 cm H2O (e.g.,Aspergillus)
Assessment and Diagnostic • CPAP ➢ sputum culture sensitivity
Findings ● Positive End-Expiratory Pressure ➢ inhalation of physical-
➢ Chest x-ray- best way to (PEEP): person to person (talk,
diagnose ✓ Increases oxygenation sneeze)
✓ patchy infiltrates or by increasing functional ➢ chemical irritants, gases,
consolidated areas residual capacity (FRC). or other air
✓ pulse oximetry (SpO2) - ✓ Keeps alveoli inflated contaminants
<90% after expiration. ➢ ventilatorassociated
✓ partial pressure of ✓ Can use lower O2 trachea bronchitis-
arterial oxygen (PaO2) concentrations with commonly cause by
✓ Below Normal PEEP;decreases risk of fungal infection
3 hall mark signs: O2 toxicity. Ordered as
• Decrease O2 sat- cause 5–10 cm H2O Clinical Manifestation
by hypoxemia ● Low-flow O2 Therapy • dry, irritating cough
• Marked tachypnea ✓ Simple masks • expectorates a scanty
• Difficulty in breathing ✓ allow for higher FiO2 but amount of mucoid
precise calculation of sputum
Prevention of collapse Alveoli FiO2 is again • sternal soreness
• frequent turning dependent on the • coughing
• early mobilization( patient’s respiratory • fever or chills
specially for patient pattern.
• night sweats, headache
after surgery) ✓ Flow rates administered
• General malaise
• teach strategies to via simple masks range
• short of breath- late
expand the lungs (deep from 8 to 12 LPM.
signs
breathing exercises) ● Non-rebreather masks
• noisy inspiration and
- at least every 2 hours - manage -dependent on patients
expiration (inspiratory
secretions : directed cough breathing, effort
stridor and expiratory
• Suctioning ✓ have valves over the
wheeze)
• aerosol nebulizer ports that allow exhaled
• produce purulent (pus-
treatments/ MDI air to escape but
filled) sputum
• chest physiotherapy: prevent room air from
• blood-streaked
postural drainage and being inhaled.
✓ This mask is capable of secretion
chest percussion
• incentive spirometry; delivering up to 100%
O2. Medical Management
bronchoscopy- use to ❖ Antibiotics
check for collapse of ● Continuous Positive Airway
Pressure (CPAP): ❖ Antihistamines- not
alveoli usually given because
✓ Maintains positive
pressure throughout the secretions may become
Incentive Spirometry dry
1. Volume –oriented devices respiratory cycle of a
❖ Suctioning and
bronchoscopy
 ❖ endotracheal marcescens,Pseudomon
intubation- last resort as aeruginosa, Risk Factors??
❖ acute respiratory failure methicillin-sensitive or Clinical Manifestations
methicillin-resistant • sudden onset of chills,
Nursing Management Staphylococcus aureus rapidly rising fever
➢ increased fluid intake (MRSA), and S. • pleuritic chest pain that
➢ directed coughing to pneumoniae is aggravated by deep
remove secretions 4. Ventilator-associated breathing and coughing
➢ Rest and activity pneumonia (VAP) • streptococcal
balance ➢ A type of HAP that (pneumococcal)
develops ≥48 hours after pneumonia
Pneumonia endotracheal tube • headache, low-grade
▪ inflammation of the lung intubation fever, pleuritic pain,
parenchyma myalgia, rash, and
▪ Pneumonitis Pneumonia in the pharyngitis
▪ Restrict lung Immunocompromised Host - • mucoid or
Classification Pneumocystis pneumonia (PCP) mucopurulent sputum
1. Community-Acquired ➢ Pneumocystis jiroveci • cheeks are flushed and
Pneumonia (CAP) ➢ fungal pneumonias the lips and nail beds
✓ Acquired in community ➢ Mycobacterium • demonstrate central
setting or within the first tuberculosis cyanosis
48 hours after Aspiration Pneumonia • late sign of poor
hospitalization or ➢ pulmonary oxygenation
institutionalization consequences resulting [hypoxemia]
✓ Causative agents? from entry of • Orthopnea (orthopneic
endogenous or position, inclined
2. Health care–associated exogenous substances position)
pneumonia (HCAP) into the lower airway. • Poor appetite,
✓ Pneumonia occurring in diaphoretic and tires
a non hospitalized Pathophysiology easily
patient with extensive ❖ normal flora present in • Rusty, blood-tinged
health care contact patients whose sputum
with one or more of the resistance has been • streptococcal
following: altered (pneumococcal),
✓ Hospitalization for ≥2 ❖ Oropharynx staphylococcal, and
days in an acute care ❖ often have an acute or Klebsiella pneumonia
facility within 90 days of chronic underlying • Crackles- fluid
infection disease that impairs host accumulation in kung
✓ Residence in a nursing defenses tissue
home or long-term care ❖ bloodborne organisms • consolidation of lung
facility ❖ affects both ventilation tissue- xray result (white
✓ Antibiotic therapy, and diffusion- churva)
chemotherapy, or oxygenation is affected • tactile fremitus
wound care within 30 ❖ Exudate- excess mucous • vocal vibration
days of current infection production detected on palpation,
H ❖ oxygen and carbon
• percussion dullness,
✓ Hemodialysis treatment dioxide- O2 down
• bronchial breath sounds,
at a hospital or clinic CarbD, increases- leads
- egophony, when
✓ Home infusion therapy to respi acidosis
auscultated, the spoken
or home wound care ❖ White blood cells –
“E” becomes a loud,
✓ Family member with neutrophils
nasal-sounding “A”
infection due to ❖ Decreased ventilation-
• whispered pectoriloquy
multidrug-resistant decrease O2 entering
• whispered sounds are
bacteria alveoli
easily auscultated
❖ Decreased alveolar O2
through the chest wall -
3. Hospital-acquired pneumonia tension
consolidation
(HAP) ❖ Bronchospasm-
✓ Pneumonia occurring narrowing of bronchi
Assessment and Diagnostic
≥48 hours after hospital ❖ Hypoventilation- affect
Findings
admission that did not ventilation perfusion
✓ history (particularly of a
appear to be ❖ V/Q mismatch - Venous
recent respiratory tract
incubating at the time blood (ventilation and
infection)
of admission perfusion no longer
✓ physical examination
➢ Enterobacter species, sustaining the need of
✓ chest x-ray
Escherichia coli, H. the body)
✓ blood culture
influenzae, Klebsiella ❖ Poorly oxygenated -
(bloodstream
species, Proteus, Serratia hypoxemia
 invasion[bacteremia] ❖ talking, coughing, • sputum culture for acid-
occurs frequently) sneezing, laughing, or fast bacilli
✓ sputum examination? singing. • complete history
✓ rinse the mouth with ❖ Larger droplets settle • physical examination
water to minimize ❖ smaller droplets remain • tuberculin skin test
contamination by suspended in the air and • chest x-ray
normal oral flora, are inhaled by a • Assessment
✓ breathe deeply several susceptible person • Physical examination
times, cough deeply, • Chest X-ray
and (4) expectorate the Pathophysiology • Multinodular infiltrates
raised sputum into a • Mycobacterium with calcification in
sterile container • Alveoli upper lobes
• Lymph system and • Sputum cultures
Pharmacologic Therapy - blood stream • Acid-fast smear
Antibiotic • Kidneys, bones, cerebral • Negative after 3 months
➢ culture and sensitivity. cortex - Inflammatory of treatment - Mantoux
➢ ceftriaxone (Rocephin), reaction test
➢ ampicillin/sulbactam • Phagocytes (neutrophils • Reliable test
(Unasyn), and macrophages • Positive reaction?
➢ levofloxacin (Levaquin), • TB-specific lymphocytes • Active disease
➢ ertapenem (Invanz) lyse - Exudate • Previous exposure—
➢ cephalosporin or • Alveoli inactive
ceftazidime (Fortaz) • bronchopneumonia • Assessment - PPD test
➢ antipseudomonal • 2 to 10 weeks • Positive
carbapenem
• 10mm or more--- 48 to
➢ piperacillin/tazobactam Risk factors 72 hours after injection
(Zosyn) plus • Close contact For pts. With HIV 5 mm
antipseudomonal • Immunocompromised or greater – Positive
fluoroquinolone status • QuantiFERON-TB Gold
➢ aminoglycoside plus • Substance abuse test
linezolid (Zyvox) or • Poverty • A blood analysis test by
vancomycin (Vancocin) • Preexisting Medical an enzyme-linked
condition Travel to immunosorbent assay
NURSING PROCESS countries with high TB • A sensitive and rapid
1. Assessment cases test (results can be
2. Diagnosis • Institutionalization available in 24 hours)
3. Planning • Living condition that assists in diagnosing
4. Nursing Interventions • Health Worker the client
a. Improving airway
b. Promoting rest and conserving Prevention? (CDC) Pharmacologic Management
energy ❖ Early identification and - Rifamipicin (Rifampin
c. Fluid intake treatment of persons - Isoniazid (INH)
d. Nutrition with active TB - Pyrazinamide (PZA)
e. Education ❖ Prevention of spread of - Ethambutol
f. Monitoring of complications infectious droplet nuclei - Streptomycin
delirium- older patient by source control
methods and by Nursing Management
Pulmonary Tuberculosis reduction of microbial ✓ Promoting Airway
▪ infectious disease that contamination of indoor Clearance
primarily affects the lung air ✓ Promoting Adherence
parenchyma ❖ Initiate AFB isolation to Treatment Regimen
▪ meninges, kidneys, precautions - ✓ Promoting Activity and
bones, and lymph nodes Surveillance for TB Adequate Nutrition
▪ M. tuberculosis -is an transmission ✓ Preventing Transmission
acid-fast aerobic rod of Tuberculosis Infection
that grows slowly and is Clinical Manifestations
sensitive to heat and ❖ low-grade fever,
cough, night sweats, Lung Abscess
ultraviolet light
fatigue, and weight loss ▪ lung abscess is a
Transmission and Risk Factors ❖ Hemoptysis localized collection of
❖ spreads from person to pus caused by microbial
person by airborne infection
transmission ▪ caused by anaerobic
❖ An infected person Assessment and Diagnostic bacteria (doesn’t need
releases droplet nuclei Findings any oxygen to stay)
(usually particles 1 to 5 • positive skin test enters lung by aspiration
mcm in diameter) • blood test
 ▪ chest x-ray ▪ grating or creaking
demonstrates a cavity sound Pleurisy
of atleast 2 cm in lungs ▪ Crackles - chest x-ray • inflammation of both
(hole, pus, exudates) wtf ▪ infiltrate with an air–fluid layers of the pleurae
level - sputum culture • Complication of;
Risk Factors: ▪ fiberoptic bronchoscopy pneumonia or an upper
• impaired cough reflexes ▪ computed tomography respiratory tract
• swallowing difficulties (CT) scan infection, TB, or collagen
• CNS disorders disease; after trauma to
• drug addiction Bronchoscopy the chest, pulmonary
• Alcoholism ❖ direct inspection and infarction, or PE
• esophageal disease examination of the • primary or metastatic
• compromised immune larynx, trachea, and cancer; and after
function bronchi through either a thoracotomy
• patients without teeth flexible fiberoptic
• nasogastric tube bronchoscope or a rigid Clinical Manifestations
feedings bronchoscope • pleuritic pain
• altered state of • severe, sharp, knifelike
consciousness 1. to visualize tissues and pain
determine the nature, location, • Intensifies during
Pathophysiology and extent of the pathologic inspiration
• complication of process • deep breath, coughing,
bacterial pneumonia 2. to collect secretions for analysis or sneezing
• aspiration of oral and to obtain
anaerobes into the lung. a tissue sample for diagnosis Assessment and Diagnostic
• The site of the lung 3. to determine whether a tumor Findings
abscess is related to can be resected • pleural friction rub
gravity surgically • chest x-rays, sputum
• Initially the cavity in the 4. to diagnose sources of analysis,
lung may or may not hemoptysis. • thoracentesis
extend directly into a • pleural fluid for
bronchus Medical Management examination
• the abscess becomes ❖ postural drainage and Medical Management
surrounded, or chest • discover the underlying
encapsulated, by a wall ❖ physiotherapy condition
of fibrous tissue ❖ percutaneous chest
• causing the pleurisy
• extend until it reaches catheter
• to relieve the pain
the lumen of a bronchus ❖ long-term drainage of
• monitored for signs and
or the pleural space the abscess. - Surgical
symptoms of pleural
• respiratory tract, the intervention is rare
effusion
pleural cavity, or both o but pulmonary
• shortness of breath,
• If bronchus? resection
pain,
• purulent contents are (lobectomy)
• Prescribed analgesic
expectorated o massive
agents and topical
continuously in the form hemoptysis
applications of heat or
of sputum o if there is little
cold
• if Pleura- empyema or no response
• NSAIDs
• If Both—-- to medical
bronchopleural fistula management.
Nursing Management
❖ enhance comfort- such
Clinical Manifestations Medical Management
as turning frequently
❖ fever • IV antimicrobial therapy
onto the affected side—
❖ productive cough with • clindamycin (Cleocin),
To splint the chest wall
moderate to copious ampicillin-sulbactam
and reduce the
amounts of foul-smelling (Unasyn) or
stretching of the
❖ bloody sputum carbapenem
pleurae.
❖ Leukocytosis -use the hands or a
❖ Pleurisy Nursing Management
pillow
❖ Dyspnea • administers antibiotics
-splint the rib cage while
❖ Weakness • Chest physiotherapy
coughing
❖ anorexia, and weight • Health education
loss • deep-breathing and
Pleural Effusion
coughing exercises
Assessment and Diagnostic • proper nutritional intake ▪ collection of fluid in the
Findings • high in protein and pleural space
▪ Physical Examination calories ▪ secondary to other
▪ pleural friction rub • emotional support, diseases.
 ▪ pleural space fluid? 5 to ▪ abnormal accumulation
15 ml Chest Drainage Systems of fluid in the lung tissue,
▪ Complication of; ➢ suction source- create the alveolar space, or
-heart failure, TB, negative pressure and both
pneumonia, pulmonary promote drainage of ▪ severe, life-threatening
infections, nephrotic fluid and removal of air. condition
syndrome, connective -20 cm H2O ▪ damage of the
tissue disease, PE and -bubbling appears in the pulmonary capillary
neoplastic tumors suction chamber lining
➢ collection chamber for
Pathophysiology pleural drainage -
❖ accumulate in the reservoir for fluid Risk Factors
pleural space draining • direct injury
•clear fluid ➢ water seal chamber • chest trauma, aspiration,
•Bloody -mechanism to prevent and smoke inhalation
•Purulent air from reentering the • hematogenous injury
Transudate- filtrate of plasma that chest with inhalation • sepsis, pancreatitis,
moves across intact capillarywalls multiple transfusions,
❖ heart failure. and cardiopulmonary
Empyema
Exudate- extravasation of fluid bypass
into tissues or a cavity ▪ accumulation of thick,
•bacterial products or tumors purulent fluid within the
pleural space
Chronic Obstructive Pulmonary
Clinical Manifestations ▪ complications of
bacterial pneumonia or Disease
❖ fever, chills, and pleuritic
chest pain lung abscess. ➢ preventable and
❖ a malignant effusion ▪ penetrating chest treatable slowly
❖ dyspnea, difficulty lying trauma progressive respiratory
flat, and coughing - ▪ hematogenous infection disease of airflow
of the pleural space, obstruction
Assessment and Diagnostic ▪ nonbacterial infections ➢ airflow limitation or
Findings ▪ iatrogenic causes (after obstruction in COPD is
• Physical examination thoracic surgery or not fully reversible
thoracentesis) ➢ emphysema and
• decreased or absent
breath sounds chronic bronchitis
Clinical Manifestations Risk Factors:
• decreased fremitus
• acute respiratory • cigarette smoking-
• dull, flat sound on
infection or pneumonia destroys the ability of
percussion
• fever, night sweats, lung to clean up respi
• Tracheal deviation
pleural pain, cough, tract)
• chest x-ray
dyspnea, anorexia, • Passive smoking
-lies on the affected side
weight loss • Tobacco
chest CT, and
thoracentesis • Age
Assessment and Diagnostic • Occupational exposure
Findings • Genetic abnormalities—
Thoracentesis ▪ Physical Assessment alpha1-antitrypsin
➢ aspiration of fluid and air ▪ decreased or absent (kulang ng alpha-1,
from the pleural space breath sounds which this is important in
diagnostic or therapeutic?? ▪ dullness on chest respi tract to fight
percussion foreign bodies-
Medical Management ▪ decreased fremitus deficient=magkaka
❖ to discover the ▪ thoracentesis COPD)
underlying cause
❖ to prevent Medical Management Pathophysiology
reaccumulation of fluid ❖ Needle aspiration ▪ symptomatic during the
❖ to relieve discomfort, (thoracentesis) middle adult years
dyspnea, and ❖ Tube thoracostomy ▪ airflow limitation is both
respiratorycompromise progressive and
Nursing Management associated with the
Nursing Management ✓ instructs the patient in lungs’ abnormal
✓ supporting the medical lung-expanding inflammatory response
regimen ✓ breathing exercises to to noxious particles or
✓ prepares and positions restore normal gases (exposur)
the patient for respiratory function ▪ body’s attempts to
thoracentesis repair changes and
✓ chest tube Pulmonary Edema narrowing can occur in
management the airways (instead of
(Noncardiogenic)
✓ Pain management -
 patent, obstructive can the acinus (sa tubing ✓ Monitoring and
happen -2 mm lang) (hyperextended Managing Potential
▪ goblet cells (will ang lobular) Complications
enlarged) and enlarged ▪ chronic hypoxemia,
submucosal glands hypercapnia, Bronchiectasis
(enlarged= additional polycythemia ▪ Chronic but irreversible
mucous plug, mas mag ▪ right-sided heart failure dilation of the bronchi
babara) and bronchiole
▪ hypersecretion of mucus Complication ▪ destruction of muscles
(chronic air limitation) Cor pulmonale- increase pressure and elastic connective
in pulmonary artery. tissue
Chronic Bronchitis (COPD) ▪ right-sided heart failure ▪ dilation of the bronchi
• presence of cough and brought on by long-term and bronchus
sputum production for high blood pressure in (reproduction of
at least 3 months in the pulmonary arteries mucous)
each of 2 consecutive (accumulation of fluid)
years ▪ dependent edema Risk factors
• smoke or other ▪ distended neck veins ➢ respiratory infections
environmental pollutants ▪ pain in the region of the (pneumonia, TB)
• hypersecretion of mucus liver (because of fluid ➢ CF (cystic fibrosis)| own
• Bronchial walls accumulation) immune system tries to
thickened |hypertension in the liver destroy connective
• narrowing the bronchial can occur if last longer,, tissue that leads to
lumen chariz| rebound effect dilation of bronchi and
can also occur bronchus. (also produce
Emphysema (COPD) mucous, excess)
Assessment and Diagnostic ➢ rheumatic and other
• impaired oxygen and
Findings systemic diseases
carbon dioxide
-PFT ➢ primary ciliary
exchange
- Spirometry dysfunction
• results from destruction
- FEV1 to forced vital capacity ➢ Tuberculosis
of the walls of
(FVC) (affected, bumababa- and ➢ mmunodeficiency
overdistended alveoli (in
patient can have an air flow disorders
the alveoli)
limitation=obstructive airway)
• pathologic term that
Pathophysiology
describes an abnormal
Medical Management - damages the bronchial wall
distention of the
- promoting smoking cessation - loss of its supporting structure -
airspaces – Alveoli
prescribing medications: thick sputum obstructs the
• bronchodilators bronchi.
Manifestation: Barrel chest
• Corticosteroid-
• Hypoxemia can
formoterol/budesonide
increase pulmonary
(Symbicort) Clinical Manifestations
artery pressures leads to
salmeterol/fluticasone - chronic cough
pulmonary hypertension
(Advair) - production of purulent sputum in
• Hypercapnia- excessive copious amounts
• managing
carbon dioxide in the - hemoptysis (blood in sputum)
exacerbations
lungs that results to
• Providing supplemental
respiratory acidosis Assessment and Diagnostic
oxygen therapy as
indicated. Findings
panlobular (panacinar) - prolonged history of productive,
▪ destruction of the Management chronic cough, with sputum
respiratory bronchiole, ✓ Breathing Exercises consistently negative for tubercle
alveolar duct, and ✓ Activity Pacing Bacilli
alveolus ✓ Self-Care Activities
▪ hyperinflated ✓ Physical Conditioning Medical Management
(hyperexpanded) chest ✓ Oxygen Therapy • promote bronchial
▪ marked dyspnea on ✓ Nutritional Therapy drainage (chest
exertion percussion, chest
▪ weight loss Nursing Management physiotherapy- improve
▪ expiration becomes ✓ Achieving Airway removal of secretion)
active Clearance (orthopnic • clear excessive
position) secretions from the
centrilobular (centroacinar) ✓ Improving Breathing affected portion of the
▪ in the center of the Patterns lungs
secondary lobule, ✓ Improving Activity • prevent or control
preserving the Tolerance infection
peripheral portions of
 • Bronchoscopy Chest • atelectasis well as needed changes
physiotherapy in ventilator or oxygen
Assessment and Diagnostic settings.
Findings
Asthma (distinct condition) ❖ determine that episodic Normal Values
➢ heterogeneous disease, symptoms of airflow
usually characterized by obstruction
chronic airway ❖ positive family history
inflammation (cause by ❖ environmental factors
triggering factors: ❖ seasonal changes, high
allergens, food, pollen counts, mold, pet
environmental dander, climate
pollutants, genetic changes
predisposition) ❖ occupation-related
➢ airway chemicals
hyperresponsiveness, ❖ Eosinophilia
mucosal edema, and ❖ IgE
mucus production ❖ allergy
(appears because of
triggering factors) Medical Management
Pharmacologic Therapy
Pathophysiology 1. quickrelief medications
➢ When allergen triggers a. immediate treatment of
inflammatory process, it asthma symptoms
will now react to 3: b. Short-acting beta2-adrenergic
increase airway agonists
reaction, airway i. Albuterol, Proventil, Ventolin c.
limitation (because it ipratropium [Atrovent])
triggers mucosal edema
and mucus production, 2. exacerbations and long-acting
narrowed airway= medications
wheezing sounds, a. To achieve and maintain
coughing, dyspnea, control of persistent asthma
chest tightness b. Corticosteroids
c. Long-acting beta2-agonists
Clinical Manifestations (LABA)
▪ Coughing i. Theophylline ii. Salmeterol
▪ Chest tightness iii. formoterol
▪ Diaphoresis (sweating)
▪ Tachycardia Nursing Management
▪ Hypoxemia (low O2) 1. assesses the patient’s
▪ Restless respiratory status
▪ Irritation a. breath sounds, peak flow, pulse
▪ Anxiety oximetry, and vital signs.
▪ Hyperventilation – CO2 2. Obtains a history of allergic
decreases reactions to medications before
▪ Wheezing sound administering medications.
Note: asthma attack happens 3. Identifies medications the
night or early in the morning (it is patient is taking.
because of the change of 4. Administers medications as
temperature| lumalamig) prescribed and
monitors the patient’s responses
Initial Manifestation: to those medications.
Hypocapnia- decrease in 5. Administers fluids if the patient is
alveolar and blood carbon dehydrated
dioxide level below normal range.
Respiratory Alkalosis-( Arterial Blood Gases (ABG)
hyperventilation) ❖ An ABG directly
measures the pH of the
blood, along with the
Complications: partial pressure of O2,
• can be progressive and CO2, bicarbonate ion,
recurrent leads to status and saturation of Hgb.
asthmaticus, life ❖ When these values are
threatening. abnormal, they can be
• Respiratory failure significant clues to
• Pneumonia respiratory problems as