● Antihistamine (First and Second

UPPER RESPIRATORY TRACT DISORDERS Generation)

Upper respiratory tract disorders: are those that (In severe cases corticosteroids)
involve the nose, paranasal sinuses, pharynx,
larynx, trachea, or bronchi. Nasal Corticosteroid Sprays
Oral Corticosteroids (Prednisone)
Upper Airway Infections: often defined as an
infection of the mucous membrane of the nose, Nursing Management
sinuses, pharynx, upper trachea, or larynx.
● The nurse instructs the patient with allergic
rhinitis to avoid or reduce exposure to
RHINITIS allergens and irritants, such as dusts,
molds, animals, fumes, odors, powders,
Rhinitis: is a group of disorders characterized by
inflammation and irritation of the mucus sprays, and tobacco smoke.
membranes of the nose. ● The nurse instructs the patient about the
importance of controlling the environment
Cause by various Factors at home and at work.
● Changes in temperature or humidity ● The nurse instructs the patient in correct
● Odors administration of nasal medications.
● Infection ● In the case of infectious rhinitis, the nurse
● Age reviews hand hygiene techniques with the
● Systemic disease patient.
● Use of over-the-counter (OTC)
● In older adults and other high-risk
● Prescribed nasal decongestants
● The presence of a foreign body populations, the nurse reviews the
Foods: peanuts, walnuts, brazil nuts, wheat, importance of receiving an influenza
shellfish, soy, cow’s milk, eggs vaccination each year to achieve immunity
before the beginning of the flu season.
Medications: penicillin, sulfa medications, aspirin

Common Indoor Allergens: dust mite, feces, dog PHARYNGITIS

dander, cat dander, cockroach droppings, molds
Pharyngitis: is a sudden painful inflammation of
Common Outdoor Allergens: trees, weeds, the pharynx, the back portion of the throat that
grasses, molds, pollen includes the posterior third of the tongue, soft
palate, and tonsils. It is commonly referred to as a
sore throat.
Rhinosinusitis: is the sixth most common chronic Types of Pharyngitis
disease among older adults. With anticipated
future growth in the older adult population. ● Acute Pharyngitis
● Chronic Pharyngitis
Clinical Manifestations Acute Pharyngitis: is a sudden painful
inflammation of the pharynx, the back portion of
● Rhinorrhea (excessive nasal drainage,
the throat that includes the posterior third of the
runny nose)
● Nasal congestion tongue, soft palate, and tonsils.
● Nasal discharge Chronic Pharyngitis: is most often caused by
● Sneezing
persistent viral or bacterial infection of the sinuses
● Pruritus of the nose, roof of the mouth,
and tonsils.
throat, eyes,and ears

Medical Management
TONSILLITIS AND ADENOIDITIS;
● Allergen Avoidance
PERITONSILLAR ABSCESS; LARYNGITIS
● Decongestants agents:
○ Pseudoephedrine Tonsillitis
○ Phenylephrine
 ● Location: Inflammation of the tonsils at The signs and symptoms of acute pharyngitis
the back of the throat. includes:
● Symptoms: Sore throat, difficulty
● fiery red pharyngeal membrane and tonsils
swallowing, swollen tonsils with white or
● lymphoid follicles that are swollen and
yellow patches.
flecked with white purple exudate
● Causes: Viral or bacterial infections.
● enlarged and tender cervical lymph nodes
Adenoiditis
● no cough
● Location: Inflammation of the adenoids, ● Fever (higher than 38.3)
located higher up in the throat, behind the ● malaise also may be present
nose. ● patients with GAS pharyngitis exhibit
● Symptoms: Nasal congestion, difficulty vomiting, anorexia and scarlet fever
breathing through the nose, earaches. ● people with streptococcal pharyngitis
● Causes: Often associated with chronic develop a painful sore throat 1 to 5 days
infections and allergic reactions. after being exposed to bacteria
Peritonsillar Abscess ● headache
● myalgia
● Location: Abscess formation around the
● The roof of the mouth is often
tonsils.
erythematous and may demonstrate
● Symptoms: Severe throat pain, difficulty
petechiae.
swallowing, a visibly swollen and
● bad breath is common
displaced uvula.
Medical Management
● Causes: Usually a complication of
untreated or severe tonsillitis. Pharyngitis(sore throat) : TWO TYPES
Laryngitis
● Viral pharyngitis - treated with supportive
● Location: Inflammation of the larynx measures. Antibiotics have no effects for
(voice box).
causal organisms.
● Symptoms: Hoarseness, sore throat,
cough, difficulty speaking. ● Bacterial pharyngitis - treated with a
● Causes: Viral infections, overuse of the variety antimicrobial agents
voice, or irritants. Pharmacologic Therapy
Pathophysiology
● Penicillin - (Penicillin V Potassium)
● Most cases of acute pharyngitis are
- a type of antibiotic to treat infections
caused by viral infection.
● When group A beta-hemolytic caused by bacteria.
streptococcus, the most common bacterial
● Given orally, for 10 days.
organism,causes acute pharyngitis,the
condition is known as strep throat. ● Patients who are allergic in Penicillin: may
● The body responds by triggering an use [CEPHALOSPORINS or
inflammatory response in the pharynx. MACROLIDES]
● This results in pain,fever,vasodilation, (clarithromycin/azithromycin)
edema, and swelling in the tonsillar
● Patients with Severe sore throat may give:
pillars,and soft palate.
[Analgesics]

Clinical Manifestations (Aspirins/Acetaminophen)

● Sore Throat ● Patients with Severe Cases

● Malaise,headache,anorexia -gargles with benzocaine
● Fever,chills
● Pain on swallowing Nutritional Therapy
● Nausea
● Enlarged congested tonsils
 ● Acute Stage: may advice for Liquids or ● Cotton tampon
Soft diet ● Suction
● Cool beverages/Warm liquids are also ● Gauze impregnated with petroleum jelly or
antibiotic ointment; topical anesthetic
recommended.
spray and decongestant agent before
● For patients with severe situations gauze packing is inserted or a balloon-
- IV fluid therapy is highly recommended inflated catheter
● Nasal sponge
EPISTAXIS Nursing Management
Epistaxis: Is a hemorrhage from the nose, caused ● The nurse monitors the patient’s vital
by the rupture of tiny, distended vessels in the signs, assists in the control of bleeding, &
mucous membrane of any area of the nose. Most provide tissues and emesis basin
● Assuring the patient is calm, efficient
commonly, the site is the anterior septum, here
manner that bleeding will can be controlled
three major blood vessels enter the nasal cavity: to help reduce anxiety
the anterior ethmoidal artery on the forward part of ● The nurse continuously assess the pt’s
the roof(kiesselbach’s plexus), the sphenopalatine airway & breathing as well as vital signs
artery in the posterosuperior region, and the Educating Patient about self-care
internal maxillary branches (the plexus of veins ● The nurse instructs the patient to avoid
located at the back of the lateral wall under the vigorous exercise for several days &
inferior turbinate) avoid hot & spicy foods, tobacco use or
ENDS use.
Risk Factors ● Discharge education includes reviewing
ways to prevent epistaxis: avoiding
● Local infections (vestibulitis, rhinitis,
forceful nose blowing, straining, high
rhinosinusitis)
altitudes, & nasal trauma (nose picking)
● Systemic infections (scarlet fever, malaria)
● The nurse explains how to apply direct
● Drying of nasal mucous membranes
pressure to the nose with thumb and the
● Nasal inhalation of corticosteroids ( e.g.
index finger for 15 mins in the case of
beclomethasone) or illicit drugs (e.g.
recurrent nosebleed
cocaine)
● Seek additional medical attention if
● Trauma (digital trauma, blunt trauma,
recurrent bleeding cannot be stopped
fracture , forceful nose blowing)
● Arteriosclerosis
● Hypertension Nasal Obstruction
● tumor(sinus or nasopharynx)
The passage of air through the nostrils is
● Thrombocytopenia
frequently obstructed by deviation of the nasal
● Use of aspirin
speculum, hypertrophy of the turbinate bones, or
● Liver disease the pressure of nasal polyps.
● Rendu-osler-weber syndrome (hereditary
hemorrhagic telangiectasia) Medical Management
Medical Management- depends on its cause &
● Removal of obstruction, followed by
location of the bleeding site.
measures to treat whatever chronic
● A nasal speculum, penlight, or head light infection exists
may be used to identify the site of bleeding ● Underlying allergy also require treatment
in the nasal cavity. ● Measure to reduce or alleviate nasal
● Applying direct pressure obstruction include nonsurgical as well as
● The patient sits upright with the head tilted surgical technique
forward to prevent swallowing and ● Common medications include oral
aspiration of blood and is directed. leukotriene inhibitors, such as
● Application of nasal decongestants montelukast.
 ● Treatment with nasal corticosteroids 2 ● Deformity of the nose
months is usually successful for the ● Skin laceration
treatment of small polyps & may even ● Asymmetric appearance
reduce the need for surgical intervention Assessment and Diagnostic Findings
● A short course of oral corticosteroids (6-
The nose is examined internally to rule out
day course of prednisone) may be
the possibility that the injury may be complicated
beneficial in treatment of nasal obstruction
by a fracture of the nasal septum and a
due to polyps (Papadakis et al., 2018). submucosal septal hematoma. Intranasal
● Additional medication include antibiotic or examination is performed in all cases to rule out
antihistamines septal hematoma. An x-ray may reveal
● Hypertrophied turbinates may be treated displacement of the fractured bones and may help
by applying an astringent agent to shrink rule out extension of the fracture into the skull.
them
● A more aggressive approach involves Medical management
surgical reduction of hypertrophy ● Cold compress
● Functional rhinoplasty ● Ensure a patent airway
Nursing Management ● Antibiotics
● The nurse explains the procedure to the ● Analgesic agents
patient. ● Decongestant Nasal Spray
● The nurse elevates the head of the bed to ● Septorhinoplasty
promote drainage and to alleviate Nursing management
discomfort from edema. ● The nurse applies Ice and encourages the
● Frequent oral hygiene is encouraged to patient to keep the head elevated.
overcome dryness caused by breathing ● The nurse instructs the patient to apply ice
through the mouth. packs to the nose to decrease swelling.
● Before discharge from the outpatient or ● The nurse gives comfort when the patient
same-day surgical unit, the patient is feels frightened, anxious, and needs
instructed to avoid blowing the nose with reassurance.
force during the postoperative recovery ● Taking analgesic agents such as
period. acetaminophen or NSAIDs is encouraged.
● The patient is also instructed about the ● The nurse carefully inspects the mucosa
signs and symptoms of bleeding and for lacerations or a septal hematoma when
infection and when to contact the primary removing the cotton pledgets.
provider. ● The nurse instructs the patient to avoid
● The patient is provided with written sports activities for 6 weeks.
postoperative instructions, including
emergency phone numbers.
Laryngeal Obstruction

Fractures of the Nose Obstruction of the larynx because of edema is a

serious condition that may be fatal without swift,
Nasal Fracture is the most common facial fracture decisive intervention.
and the most common fracture in the body
because of its location that makes it susceptible to Causes of Laryngeal Obstruction
injury. Participating Event:
Clinical manifestations Mechanism of Obstruction:
● History of allergies; exposure to
● Pain
medications, - Anaphylaxis
● Epistaxis latex, foods (peanuts, tree nuts [e.g.,
● Swelling of the soft tissues adjacent to the walnuts,
nose
● Periorbital Ecchymosis pecans]), bee stings
● Nasal obstruction ● Foreign body
 - Inhalation/ingestion of  The lower respiratory system, also known as
meat or items, coin, chewing gum, balloon the lower respiratory tract, is comprised of the
fragments, drug packets (ingested to avoid
criminal arrest) trachea, bronchi, bronchioles, and the lungs'
● Heavy alcohol consumption; heavy alveoli.
tobacco use  A lower respiratory tract infection (LRTI) is an
- Obstruction from tumor
infection that affects the respiratory system's
● Family history of airway problems lower parts, including the trachea, bronchi,
- Suggests angioedema (type I
bronchioles, and lungs.
hypersensitivity reaction)
● Use of angiotensin-converting enzyme  Common examples of lower respiratory tract
inhibitor infections include pneumonia, bronchitis, and
- Increased risk of angioedema of
bronchiolitis.
the mucous membranes
● Recent throat pain or recent fever  These infections are often caused by viruses
- Infectious process or bacteria and can result in symptoms such
● History of surgery or previous
tracheostomy - Possible as coughing, difficulty breathing, chest
subglottic stenosis discomfort, and fever.
Clinical manifestations  Severe cases may lead to complications and
● The patient’s clinical presentation and x- can be particularly concerning for vulnerable
ray findings confirm the diagnosis of populations, such as the elderly, child or
laryngeal obstruction. individuals with compromised immune
● The patient may demonstrate lower
systems.
oxygen saturation; however ,normal
oxygen saturation should not be
interpreted as a sign that the obstruction is
not significant. What is Pneumonia?
● The use of accessory muscles to
maximize airflow may occur and is often Pneumonia is a common and potentially serious
manifested by retractions in the neck or respiratory infection that affects the lungs. It can
abdomen during inspirations. be caused by a variety of microorganisms,
● Patients who demonstrate these
including bacteria, viruses, fungi, and even certain
symptoms are at an immediate risk of
chemicals or irritants. When someone has
collapse, and respiratory support
Assessment and Diagnostic Findings pneumonia, the air sacs(alveoli) in their lungs
become filled with pus and other inflammatory
A thorough history can be very useful in
diagnosing and treating the patient with a laryngeal fluids, which can make it difficult to breathe.
obstruction. However ,emergency measures to
Types of Pneumonia
secure the patient's airway should not be delayed
to obtain a history or perform tests.
BRONCHOPNEUMONIA
Medical management
- is a type of pneumonia characterized by
● Ensure a patent airway inflammation and infection of the bronchi (the
● Advance cardiopulmonary resuscitation
larger air passages in the lungs) and the
● Administration of subcutaneous
epinephrine and a corticosteroid surrounding lung tissue. It is often considered a
● Applied ice more diffuse and patchy form of pneumonia.
● Continuous pulse oximetry
LOBAR PNEUMONIA

- is a specific type of pneumonia

PNEUMONIA
characterized by the inflammation and infection an
LOWER RESPIRATORY TRACT
entire lobe of one lung. The term "lobar" refers to Pneumonia in the Immunocompromised Host
the lung lobes, and this type of pneumonia
- refers to a specific category or
typically involves one or more entire lobes.
classification of pneumonia that occurs in
INTERSTITIAL PNEUMONIA individuals with compromised immune systems.
Immunocompromised individuals have a
- is a group of lung disorders characterized
weakened ability to fight off infections, making
by inflammation and scarring (fibrosis) of the
them more susceptible to various pathogens,
interstitium—the tissue that supports the alveoli
including bacteria, viruses, fungi, and other
(air sacs) in the lungs. The interstitium is the space
microorganisms.
between the air sacs, and it includes the walls of
the air sacs and the surrounding connective tissue. Walking pneumonia

Classification of Pneumonia - is colloquial term used to describe a mild

form of pneumonia that allows individuals to
Community-Acquired Pneumonia
remain relatively active and continue with their
- is a type of pneumonia that develops in daily activities, as opposed to more severe cases
individuals who have not recently been that may require bed rest. The medical term for
hospitalized or residing in a long-term care facility. walking pneumonia is often referred to as atypical
As the name suggests, it is acquired in the pneumonia.
community setting, such as at home, work, or
CAUSATIVE AGENT
school.
BACTERIAL PNEUMONIA:
Hospital-acquired pneumonia.
Streptococcus pneumoniae (pneumococcus)
- also known as nosocomial pneumonia, is
a type of pneumonia that develops during a - his bacterium is a common cause of community-
hospital stay or within 48 hours of discharge from acquired pneumonia. Pneumococcal pneumonia
the hospital. It is characterized by an infection of can be severe, especially in certain populations
the lungs that was not present or in the incubation like the elderly and those with weakened immune
stage at the time of admission to the hospital. systems.

Ventilator Associated Pneumonia Haemophilus influenzae

- Is a type of hospital-acquired pneumonia - This bacterium can cause pneumonia,

that occurs in individuals who are on mechanical particularly in individuals with underlying
ventilation (breathing support provided by a respiratory conditions.
machine) in intensive care units (ICUs) or other
Mycoplasma pneumonia
healthcare settings. VAP typically develops 48
hours or more after the patient has been intubated - Often referred to as atypical pneumonia,
and placed on a ventilator. Mycoplasma pneumoniae infections are usually
milder and can be more common in young adults.
Aspiration pneumonia

- is a type of lung infection that occurs when

foreign material, such as food, liquid, saliva, or Legionella pneumophila
vomit, is breathed into the lungs instead of being
- Legionella bacteria can cause Legionnaires'
swallowed into the stomach. This can lead to
disease, a severe form of pneumonia. It is
inflammation and infection in the lungs.
associated with contaminated water sources, such • Children younger than 5 years old.
as air conditioning systems and hot tubs.
• People who have ongoing medical conditions
Staphylococcus aureus
• People who smoke cigarettes
- Staphylococcal pneumonia can be caused by
• Being in the hospital
Staphylococcus aureus, including methicillin-
resistant Staphylococcus aureus (MRSA). It is • Having a chronic disease
often associated with healthcare settings.
• Having a suppressed immune system
VIRUSES:
• Exposure to animals, chemicals, or
Influenza virus: Influenza (flu) environmental toxins

- Influenza, or flu, is a common viral cause of CLINICAL MANIFESTATION

pneumonia, especially during flu seasons.
• Fever
Respiratory syncytial virus (RSV)
• Headache
- is a significant cause of respiratory infections,
• Chills and sweating
particularly in young children and older adults.
• Productive cough
Adenoviruses
• Shortness of breath
-denoviral infections can cause a range of
respiratory illnesses, including pneumonia. • Pleuritic chest pain

Rhinoviruses • Hypoxemia

-While rhinoviruses are commonly associated with • Fatigue

the common cold, they can also contribute to
• Tachypnea
pneumonia, especially in people with weakened
immune systems. • Hemoptysis

FUNGI: • Dyspnea

Pneumocystis jirovecii • Dullness on percussion on affected area

- This fungus is a common cause of pneumonia in • Decrease in breath sounds

individuals with weakened immune systems, such
• CXR
as those with HIV/AIDS.
• Pleural effusion

• Unequal chest expansion

Histoplasma, Coccidioides, and Blastomyces
species DIAGNOSTIC TESTS AND PROCEDURES

- These fungi can cause fungal pneumonia,  Physical Examination

particularly in specific geographic regions where  Chest X-ray
the fungi are endemic.  Blood tests
 Sputum Test
RISK FACTORS
 ABG (Arterial Blood Gas) Test
• Adults 65 years old older.  PCR (Polymerase Chain Reaction) Test
 Bronchoscopy E - Empyema

MEDICAL MANAGEMENT AND R - Respiratory failure /renal failure

PHARMACOLOGY
CONSIDERATIONS
Medical management of patients with pneumonia
Gerontologic
includes prescribing appropriate antibiotics for
bacterial pneumonias; assisting the patient to get Pneumonia in older adults can occur as a primary
adequate rest and hydration; and managing diagnosis or as a complication of a chronic
complications if they occur. In some patients, disease. It is often challenging to treat in this
supplemental oxygenation may be prescribed population and has a higher mortality rate
compared to younger individuals. The onset of
Blood culture
pneumonia in older adults may be signaled by
Blood culture is performed for identification of the general deterioration, weakness, abdominal
causal pathogen and prompt administration of symptoms, anorexia, confusion, tachycardia, and
antibiotics in patients in whom CAP is strongly tachypnea. However, the classic symptoms of
suspected. cough, chest pain, sputum production, and fever
may be absent or masked. Abnormal breath
Administration of macrolides
sounds may be caused by decreased mobility,
Macrolides are recommended for people with lung volume, or other respiratory function changes.
drug-resistant S. pneumoniae.
COVID 19

SARS-CoV-2 is a coronavirus that primarily affects

Administration of antipyretics. the respiratory system and is transmitted through
direct person-to-person contact via respiratory
Antipyretics are used to treat fever and headache.
droplets. There is also a possibility of transmission
Administration of antitussives and antibiotic through inanimate surfaces that carry the virus
(fomite transmission). The virus enters host cells
Antitussives are used for treatment of the
by binding to ACE2 cellular surface receptors,
associated cough.
which are abundant in type II alveolar and vascular
Oxygen administration endothelial cells within the pulmonary vascular
circuit. This allows the virus to replicate and cause
Oxygen can be given if hypoxemia develops.
infection.
Bed rest
NURSING INTERVENTION
Complete rest is prescribed until signs of infection
 Improving Patency Of Airway
are diminished.
 Promoting Rest And Co0nserving Energy
COMPLICATIONS  Promoting Fluid
 Maintaining Nutrition
S - Septicaemia
 Promoting Patient Knowledge
L - Lung abcess  Monitoring And Managing Potential
Complication
A - ARDS

P - Para-pneumonic effusions

H - Hypotension
PLEURAL DISORDERS - involves the and applies it against your chest wall to take
membranes covering the lungs (visceral pleura) samples of the pleura. The needle is removed
and the inner surface of the chest wall (parietal at the end.
pleura) or disorders affecting the pleural space.  Afterwards, you don’t need absolutely to be
hospitalized but you should stay in observation
PLEURISY also known as “pleuritis” that refers to
during 4 hours and perform a chest X-ray
inflammation of both layers of pleurae (parietal and
before leaving hospital to be sure that
visceral).
everything went right.

• During a thoracoscopy: it is an invasive

procedure performed under general anesthesia by
a thoracic surgeon. You need to be hospitalized for
CLINICAL MANIFESTATIONS:
a few days after. This procedure is not described in
 chest pain that worsens when you breath or this factsheet.
sneeze
MEDICAL MANAGEMENT
 shortness of breath
 cough  A prescribed analgesics agents and topical
 fever and chills applications of heat or cold provide
 breathing issues asymptomatic relief.
 unexplained weight loss  A nonsteroidal anti-inflammatory drug may
 sore throat provide pain relief while allowing the patient to
 collapse lungs take deep breaths and cough more effectively.
 complications from the underlying diseases
NURSING MANAGEMENT
ASSESSMENT AND DIAGNOSTIC FINDINGS
 Administer analgesics
Diagnostic tests include:  Teach patient to support ribcage while
coughing
 chest x-rays
 Help reposition to alleviate pain, such as lying
 sputum analysis
on the affected side
 pleural biopsy
 thoracentesis - to obtain a specimen of pleural PLEURAL EFFUSION
fluid for examination
 Is a collection of fluid in the pleural space, is
What is a pleural biopsy? rarely a primary disease process but is usually
a secondary to other diseases.
- A pleural biopsy is an invasive procedure
 The pleural space normally contains only
which allows your doctor to take a sample of the
about 10 – 20 ml of serous fluid.
pleura, a membrane surrounding your lungs.
PATHOPHYSIOLOGY
There are two ways to perform a pleural biopsy:
In certain disorders, fluid may accumulate in the
• During a thoracentesis:
pleural space to a point at which it becomes
 It is a mini-invasive procedure performed clinically evident. This almost always has
under local anesthesia by your respiratory pathologic significance. The effusion can be
physician. relatively clear, or it can be bloody or purulent. An
 Your doctor introduces a biopsy-needle effusion or clear fluid may be a transudate or an
through the same way than the thoracentesis exudate.
CLINICAL MANIFESTATIONS NURSING MANAGEMENT

Usually the clinical manifestations are those  Assist with thoracentesis if indicated
caused by the underlying disease and severity of  Maintain chest drainage as needed
effusion  Provide care after pleurodesis
 Monitor for excessive pain from the sclerosing
 Fever, chills and pleuritic chest pain
agent, which may cause hypoventilation.
 Malignant effusion may result in dyspnea and
 Administer prescribed analgesic
coughing
 Administer oxygen as indicated by dyspnea
 Dullness or flatness to percussion
and hypoxemia
 Decrease or absent breath sounds  Observe patients breathing pattern and
ASSESSMENT AND DIAGNOSTIC FINDINGS oxygen saturation.

Assessment of the area of the pleural effusion EMPYEMA An accumulation of thick, purulent fluid
reveals decreased or absent breath sound; within the pleural space, often with fibrin
decreased fremitus; and a dull, flat sound on a development and a loculated area where infection
percussion. is located.

 Physical examinations, Chest X-ray, Chest CT PATHOPHYSIOLOGY

and Thoracentesis confirms the presence of Most empyemas occur as complications of

fluid bacterial pneumonia or lung abscess. They also
 Pleural fluid is analyzed by bacterial culture, result from penetrating chest trauma,
gram stain, AFB stain (for TB), red and white hematogenous infection of the pleural space, non-
blood cell counts bacterial infections, and iatrogenic causes (after
 Pleural biopsy may be performed as a thoracic surgery or thoracentesis)
diagnostic tool
CLINICAL MANIFESTATION
MEDICAL MANAGEMENT
 Acutely ill
The objective of treatment are to discover the  Signs and symptoms similar to acute
underlying cause to prevent the re-accumulation of respiratory failure or pneumonia.
fluid and to relieve discomfort, dyspnea and  Fever
respiratory compromise.  Night sweats
 Pleural pain
General
 Cough
•Treatment is aimed at underlying cause (heart  Dyspnea
disease, infection)  Anorexia
 Weight loss
•Thoracentesis is done to remove fluid, collect a
specimen, and relieve dyspnea ASSESSMENT AND DIAGNOSTIC FINDINGS

• Chest auscultation demonstrates decreased or

absent breath sounds over the affected area.
For malignant effusions
• Chest percussion, there is a dullness as well as
•Chest tube drainage, radiation chemotherapy,
decreased fremitus.
surgical pleurectomy, pleuroperitoneal shunt, or
pleurodesis Diagnostic tests include:
  Chest CT scan infection, and how and when to contact the primary
 Chest X-ray provider.
 Thoracentesis
 Ultrasound
ACUTE RESPIRATORY FAILURE
MEDICAL MANAGEMENT
- Is a sudden and life-threatening deterioration of
- Objectice is to drain the pleural cavity and to the gas exchange function of the lungs and
achieve complete expansion of the lung. indicates their failure to provide adequate
- Fluid drain and appropriate antibiotics in large oxygenation or ventilation for the blood.
doses - Defined as hypoxemia and hypercapnia with
- Sterilization of the empyema cavity requires 4 to acidosis.
6 weeks of antibiotic PATHOPHYSIOLOGY
Drainage of the pleural fluid depends on the stage Impaired Gas Exchange
of the disease:
• Depends on proper function of the alveolar –
• Thoracentesis with a thin percutaneous catheter capillary membrane.
• Tube thoracostomy with thrombolytic agents • Mechanisms
instilled
 Collapse of alveoli
• Open chest drainage via thoracotomy, including  Collection of fluid in alveoli
potential rib resection.  Direct membrane damage
 Collection of fluid in insterstitial space.

• Abnormalities leading to Impaired Gas Exchange:

Surgical Procedure - Pneumothorax/pleural effusion

1. Decortication - Pneumonia

- Treatment Duration: weeks to months - Atelectasis

- Monitored by serial chest x-ray - Inhalation of toxic gases/gastric contents

- Instructed to monitor fluid drainage at home. - Pulmonary edema

NURSING MANAGEMENT Impaired Ventialtion (Hypoventilation)

• Helps the patients cope with the condition • Abnormalities Leading to Hypoventilation:

• Instructs the patient in lung-expanding breathing - Neurological Depression:

exercise to restore normal respiratory function - Medications, drug overdose
• Provides care specific to the method of drainage - Anesthesia, head injuries, strokes
of the pleural fluid
- Nerve impairment
• Instructs the patient and family on care of the
drainage system and drain site, measurement and  Spinal cord injury
observation of drainage, signs and symptoms of  Nerve damage
  Inflammation and diseases  Tachycardia
 Increased blood pressure
Airway Obstruction
More obvious signs as the hypoxemia progresses:
• There is an obstruction of airflow through the
airways, preventing the flow into the lungs, leading  Confusion
to hypoventilation of the alveoli.  Lethargy

• Some abnormalities that can lead to airway  Tachycardia

obstruction:  Tachypnea
 Central cyanosis
 Thickening of airways: Edema, Fibrosis
 Diaphoresis
 Constriction: Asthma, COPD
 Respiratory arrest
 Blockage: Foreign body, fluid, secretions
 Compression: Tumors, enlarged lymph nodes, DIAGNOSTIC TESTS
interstitial edema
 Pulse oximetry
Ventilation – Perfusion Mismatch (V/Q)  Arterial Blood Gas Test

• There is an obstruction of airflow through the  Lung Function Tests

airways, preventing the flow into the lungs, leading  Imaging

to hypoventilation of the alveoli.  Electrocardiogram (EKG)

• Some abnormalities that can lead to airway MEDICAL MANAGEMENT

obstruction:
• Tracheostomy
 Thickening of airways: Edema, Fibrosis
- Performed in the operating room under
 Constriction: Asthma, COPD
general anesthesia, where the patient’s
 Blockage: Foreign body, fluid, secretion
ventilation can be well controlled and
 Compression: Tumors, enlarged lymph nodes,
optimal aseptic technique can be
interstitial edema
maintained
Musculoskeletal Dysfunction
• Endotracheal tube intubation
• Some abnormalities that can lead to airway
- Provides an airway for patients who
obstruction:
cannot maintain an adequate airway on
- Chest Trauma their own

- Kyphoscoliosis • Mechanical Ventilation

- Malnutrition  Maintains an adequate alveolar ventilation

and arterial blood oxygen content,
CLINICAL MANIFESTATIONS
preventing respiratory acidosis and
Early Signs hypoxia.

 Restlessness NURSING MANAGEMENT

 Fatigue
 Assisting with intubation and maintaining
 Headache mechanical ventilation
 Dyspnea
 Air hunger
 Assess patient’s respiratory status by • Airway obstruction from accumulation of
monitoring the level of responsiveness, ABG, secretions or protrusion of the cuff over the
pulse oximetry, and vital signs. opening of the tube
 Assess the patient’s understanding of the
• Infection
management
 Assess the patient’s knowledge of the • Rupture of the innominate artery
underlying disorder and provide education as
• Dysphagia
appropriate.
• Tracheoesophageal fistula
TRACHEOSTOMY
• Tracheal dilation
 Is a surgical procedure in which an
opening is made into the trachea. The • Tracheal ischemia
indwelling tube inserted into the trachea is
• Necrosis
called a TRACHEOSTOMY TUBE.
Preventing complications associated with
TRACHEOSTOMY PROCEDURE
Endotracheal and Tracheostomy Tubes
- Is usually performed in the operating room
• Administer adequate warmed humidity
under general anesthesia, where the patient’s
ventilation can be well controlled and optimal • Maintain cuff pressure at appropriate level
aseptic technique can be maintained.
• Suction as needed per assessment
COMPLICATIONS findings

Early Complications • Maintain skin integrity. Change tape and

dressing as needed or per protocol
• Tube dislodgement
• Auscultate lung sounds
• Accidental decannulation
• Monitor for signs and symptoms of
• Bleeding
infection, including temperature and white blood ell
• pneumothorax count

• Air embolism • Administer prescribed oxygen and monitor

oxygen saturation
• Aspiration
• Monitor for cyanosis
• Subcutaneous or mediastinal emphysema
• Maintain adequate hydration of the patient
• Recurrent laryngeal nerve damage
• Use sterile technique when suctioning and
• Posterior tracheal wall penetration
performing tracheostomy care

Suctioning the Tracheostomy or Endotracheal

Tube

Long-term complications - Tracheal suctioning is performed when

adventitious breath sounds are detected or
whenever secretions are obviously present.
Managing the Cuff  Respiratory distress with confusion
 Circulatory shock
- The cuff on a ET or tracheostomy tube
 Increased work of breathing not relived by
should be inflated if the patient requires
other interventions
mechanical ventilation or is at high risk for
aspiration.  Controlled hyperventilation (e.g. patient
with a severe head injury)
Promoting Home, Community – Based and
Transitional Care

• Educating Patients about self – care ACUTE RESPIRATORY DISTRESS SYNDROME

- Is an inflammatory lung injury that

• Continuing and transitional care
happens when fluids build up in small air
sacs (called alveoli) in the lungs. ARDS
ENDOTRACHEAL INTUBATION
prevents the lungs from filling up with air
and causes dangerously low oxygen levels
- Is a medical procedure in which tube is
in the blood (hypoxemia)
placed into the windpipe (trachea) through the - This condition prevents other organs such
mouth or nose. as brain, heart, kidneys and stomach from
getting the oxygen they need to function.
- This is often done in emergency situations, ARDS is dangerous and can lead to a
in the operating room, or when a person is unable number of serious and life-threatening
problems.
to breathe on their own.
- ARDS typically happens in hospital
Purposes of Endotracheal Intubation settings while the patient is being treated
for infection or trauma. It tends to develop
• To open up the airway to help a person breathe within few hours to few days of the event
that caused it, and can worsen rapidly.
• To deliver high levels of oxygen to the lungs ARDS patients may have to be put in an
intensive care unit (ICU) and on a
• To prepare a person for certain types of surgery ventilator to help them breathe.

RISK FACTORS
• To protect the lungs in certain situations, such as
during a surgery or if the person is unable to - Sepsis
protect their own airway. - History of chronic alcoholism
- Heavy alcohol use
- Smoking tobacco
- Aspiration
- Covid-19 Pneumonia
- Fat or Air Embolism
MECHANICAL VENTILATION - Hematologic Disorder
- Localized Infection
- Is a technique that may be required to manage
- Major Surgery
acute respiratory failure. - Metabolic Disorder
- Prolonged inhalation of high concentration
- A mechanical ventilator is a positive or negative oxygen, smoke or corrosive substances
pressure breathing device that can maintain - Shock
ventilation and oxygen delivery for a prolonged - Trauma
period. CLINICAL MANIFESTATION
GENERAL INDICATIONS - Fine crackles
- Rapid onset of severe dyspnea
 Apnea or bradypnea - Arterial hypoxemia
 Confusion with need for airway protection
 Classification of ARDS according to the  Manage nutrition
severity of hypoxemia  Treating underlying cause or injury
 Mild ARDS with arterial oxygen  Improve oxygenation with mechanical
tension (PaO2) /fraction of ventilation
inspired oxygen (FIO2) > 200  Suction oral cavity
mmHG but ≤ 300 mmHg  Give antibiotics
 Moderate ARDS with arterial  Stress ulcer prophylaxis.
oxygen tension (PaO2) /fraction of  Observe for barotrauma.
inspired oxygen (FIO2) > 100  Monitor blood chemistry and fluid levels
mmHG but ≤ 200 mmHg
 Severe ARDS arterial oxygen PULMONARY EDEMA - abnormal accumulation of
tension (PaO2) /fraction of fluid in the lung tissue, the alveolar space, or both.
inspired oxygen (FIO2) ≤ 100 It’s also known as lung congestion, lung water, and
mmHg pulmonary congestion. When pulmonary edema
- Tachypnea occurs, the body struggles to get enough oxygen,
- Tachycardia and you may experience shortness of breath or
- Mental status changes wheezing.
- Cyanosi
CAUSES
DIAGNOSTIC FINDINGS
 Cardiogenic (Congestive Heart Failure)
 Echocardiograph  Noncardiogenic
 Imaging tests (Chest X-ray and CT Scan) - Fluid Overload (Renal Failure)
 Blood tests - ARDS (Permeability edema with
diffuse alveolar damage
COMPLICATIONS
FLUID MECHANISM
 Multiple organ failure
 Blood clots forming during treatment  Hydrocostatic Pressure
Atelectasis  Capillary Permeability
 Pulmonary fibrosis  Oncotic pressure
 Ventilator-associated pneumonia
STAGING
MEDICAL MANAGEMENT
- Stage 1: Pulmonary Vascular Congestion
 Supplemental Oxygen - Stage 2: Interstitial Pulmonary Edema
 ET intubation and Mechanical Ventilation - Stage 3: Alvelor Edema
Ventilatory PEEP
CLINICAL MANEFISTATION
 Adequate Fluid Volume
 Nutritional Support  The patient’s anxiety and restlessness
 Prone positioning increase; the patient becomes confused,
 Extracorporeal Membrane Oxygenation then stuporous
(ECMO)  Sudden onset of breathlessness that
worsens when lying down
PHARMACOLOGIC MANAGEMENT
 Pulse is weak and rapid, and the neck
 Improve patient-ventilatorsynchronization veins are distended.
and help to decrease severe hypoxemia:  Cough that produces frothy sputum that
- Neuromuscular blocking agents may have blood in it
- Sedatives ASSESSMENT
- Analgesics
 Inhaled nitric oxide (an endogenous  Abnormal heart sounds
vasodilator) may help to reduce V./Q.  Crackles and wheezing sound in the lungs
(Ventilation/Perfusion) mismatch and  Heart rate
improve oxygenation.  Rapid breathing
 Diuretics
DIAGNOSTIC FINDINGS
NURSING INTERVENTION/MANAGEMENT
  Chest x-ray who never smoke may also develop
 Chest Computerized Tomography (CT) COPD.
scan Pulse Oximetry - This is not curable but preventable and
 Arterial Blood Gas test can be treated.
 Echocardiogram (ultrasound of the heart)
CLINICAL MANIFESTATIONS
Electrocardiogram (ECG)
 Chronic Cough
MEDICAL MANAGEMENT
 Sputum Production
Oxygenation  Dyspnea
 Weight Loss
- Oxygen in concentrations adequate to
 Barrel Chest
relieve hypoxia and dyspnea
- Endotracheal intubation and mechanical RISK FACTORS
ventilation, if respiratory failure occurs
- Positive end-expiratory pressure (PEEP) -  Smoking Tobacco Exposure to
Monitoring of pulse oximetry and ABGS Occupational Dusts and Chemicals
 Air pollution
PHARMACOLOGIC THERAPY  Alpha-1 Antitrypsin Deficiency
- Morphine ASSESMENT & DIAGNOSTIC FINDINGS
- Naloxone hydrochloride (Narcan)
- Inotropes  Physical Examination - Breathing Pattern,
- Diuretics (eg, furosemide) Chest Shape, Percussion and Auscultation
 Lung (pulmonary) function tests –
NURSING MANAGEMENT Spirometry
 Chest X-ray or CT scan
- Help the patient relax to promote
 6-Minute Walk - This tests your exercise
oxygenation
capacity by measuring how far you can
- Position the patient into high fowlers walk on a flat surface over the course of 6
position minutes. It helps determine how your
- Assess and Monitor the patient’s lungs are functioning and whether you can
condition and vital signs every 15 -30 perform daily activities
minutes or more often as indicated  Arterial blood gas analysis
- Review all prescribed medications
with the patient and carefully record COMPLICATIONS
the time morphine is given and the
amount administered  Respiratory infections (colds, flu, and
- Encourage the patient to comply with pneumonia)
the prescribed medication regimen  Collapsed Lungs
- Explain the procedure to the patient  Lung Cancer Heart problems; cardiac
and his family, and emphasize arrhythmias, and congestive
reporting the early signs of fluid  heart failure
overload  Pulmonary Hypertension
- Watch for treatment complication  Anxiety and Depression

Chronic obstructive Obstructive pulmonary MEDICAL AND SURGICAL MANAGEMENT

disease(COPD)
 Bullectomy
- is a slowly progressive respiratory disease  Lung Volume Reduction Surgery (LVRS)
of airflow obstruction involving the airways,  Endobronchial Valve Volume Reduction
lung parenchyma, or both (Global Initiative  Lung Transplantation
for Chronic Obstructive Lung Disease
[GOLD], 2015). NURSING MANAGEMENT
- It sometimes called emphysema or chronic  measuring your oxygen saturation
bronchitis. it is often referred to as a
 listening to your lung sounds
“smoker’s disease” - most common cause
 asking about your cough and any mucus
of COPD is cigarette smoking but people
that comes up
  asking what kinds of exercise or activities  Achieving airway clearance
you can tolerate  Improve breathing patterns
 Checking your legs for swelling  Improve Activity intolerance
 Checking the size and shape of your chest  Monitor and Managing potential
 drawing blood for testing complications
 asking about your medication compliance
MEDICAL MANAGEMENT
Emphysema - is a pathologic term that describes
an abnormal distention of the airspaces beyond  Smoking cessation
the terminal bronchioles and destruction of the  Physical therapy to conserve and increase
walls of the alveoli (GOLD, 2015). This end-stage pulmonary ventilation
process progresses slowly for many years.  Maintenance of proper environmental
conditions to facilitate breathing
2 MAIN TYPES OF EMPHYSEMA PHARMACOLOGIC:
- Bronchodilators
 panlobular type of emphysema, there is
- Corticosteroids
destruction of the respiratory bronchiole,
- Other medications
alveolar duct, and alveolus. All airspaces
within the lobule are essentially enlarged,
but there is little inflammatory disease
 centrilobular type, pathologic changes
take place mainly in the center of the
Management for Exacerbations:
secondary lobule, preserving the
peripheral portions of the acinus. - First-line therapy for respiratory
conditions focuses on optimizing
CLINICAL MANIFESTATIONS
bronchodilator medications.
 Chronic Cough - Hospitalization. Patients with acute
 Sputum Production exacerbation of emphysema may require
 Dyspnea hospitalization if they experience
 Chest Tightening respiratory failure.
- Oxygen therapy. Upon arrival of the
patient in the emergency room,
supplemental oxygen therapy is
RISK FACTORS administered and rapid assessment is
performed to determine if the exacerbation
 Smoking is life-threatening.
 Occupational Exposure - Antibiotics have been shown to be of
 Genetics some benefit to patients with increased
 Age dyspnea, increased sputum production,
and increased sputum purulence.
COMPLICATIONS
Surgical Management
 Collapsed Lung
 Chest Infections  Bullectomy
 Heart Problems  Lung Volume Reduction Surgery.
 Large Holes in the Lungs  Lung Transplantation
ASSESSMENT & DIAGNOSTIC PROCEDURES ASTHMA- is a condition in which your airways
narrow and swell and may produce extra mucus.
 History Taking This can make breathing difficult and trigger
 Physical Examination coughing, a whistling sound (wheezing) when you
 Pulmonary Function Tests (PFTs) breathe out and shortness of breath.
 Imaging studies
 Blood Tests RISK FACTORS
 Arterial Blood Gas (ABG) Analysis
 Family History
 Electrocardiogram (ECG)
 Environmental Factors
NURSING MANAGEMENT  Occupational Exposures
  Comorbid Conditions MEDICAL MANAGEMENT

CLINICAL MANIFESTATION  INHALERS

- RELIEVER INHALER
 Common Symptoms: Cough, dyspnea, - PREVENTER INHALER
and wheezing are typical symptoms.
- COMBINATION INHALER
 Nocturnal Occurrence: Asthma attacks
 TABLET
often occur at night or early morning,
- LEUKOTRIENE RECEPTOR
possibly due to circadian variations.
ANTAGONIS-T (LTRAs)
 Exacerbation: Symptoms may worsen
- THEOPHYLLINE
over a few days, with cough, wheezing,
- STEROID TABLETS
chest tightness, and dyspnea.
 INJECTIONS
 Exercise-Induced Asthma: Maximal
symptoms during exercise, absence of  SURGERY
nocturnal symptoms, and sometimes a  COMPLEMENTARY THERAPIES
"choking" sensation. NURSING MANAGEMENT
Assessment & Diagnostic Findings:
 OBTAIN MEDICATION ALLERGY
 Episodic Symptoms: The clinician must HISTORY
establish the presence of episodic  IDENTIFYING CURRENT MEDICATION
symptoms of airflow obstruction.  ADMINISTER PRESCRIBED
 Reversibility: Airflow obstruction should MEDICATION
be at least partially reversible.  MONITOR RESPONSE
 Exclusion of Other Causes: Other
ASSIST WITH INTUBATION AND MECHANICAL
potential causes of symptoms must be
VENTILATION (ACUTE RESPIRATORY FAILURE
ruled out.
 Environmental Factors: Consideration of
seasonal changes, allergens, and
occupational exposures. SODIUM IMBALANCES
 Specific Questions: Evaluation of asthma HYPONATREMIA
control, impact on daily activities, and the Hypo- low
need for medication or emergency care. Natr- Prefix for sodium
 Laboratory Tests: During acute episodes, Emia- Blood
eosinophilia in sputum and blood, elevated low sodium in the blood
IgE levels if allergy is present, and arterial Normal Na level – 135 to 145 mEq/l
blood gas analysis showing hypoxemia.
 Pulmonary Function Tests: Marked The role of sodium is to help regulate h2o or water
decrease in FEV1 and FVC during inside and outside the cell. Intracellularly and
exacerbations, reversible with extracellularly
bronchodilator administration
DIFFERENT TYPES OF HYPONATREMIA
PREVENTION
Acute Hyponatremia- commonly results from fluid
 Identifying Triggers overload in a surgical patient. This is a dilutional
 Avoidance hyponatremia because the excess water dilutes
 Knowledge the sodium in the blood stream
 Occupational Asthma
Chronic hyponatremia- seen more frequently in
COMPLICATIONS pt outside the hospital settings, has a longer
duration and has less serious neurologic sequelae
- can cause severe sleep deprivations over
time as the majority of symptoms strikes at Exercised associated hyponatremia – most
night which can result to difficulty to frequently found in women and those of smaller
perform well at work or any activities stature
- Adults and children experience similar
It can occur during extreme temperature, because
asthma symptoms and signs,
of excessive fluid intake before excessive or
complications may vary based on age
prolonged excerise that results in excess loss of MNEMONICS
sodium through perspiration or sweating.
S - TUPOR/COMA
Hypovolemic hyponatremia- decrease in both
A- NOREXIA
sodium and water often due to conditions like
excessive sweating, vomiting or diarrhea (the pt L - ETHARGY
becomes dehydrated)
T - ENDON REFLEXES
Euvolemic hyponatremia - water in the body
L - IMP MUSCLES
increases but sodium stays the same frequently
seen in conditions like syndrome of inappropriate O - RTHOSTATIC HYPOTENSION
antidiuretic hormone secretions (SIADH)
S - EIZURES
Hypervolemic hyponatremia- characterized by
excess water retention and sodium typically S - TOMACH CRAMPING
caused by heart failure, cirrhosis or kidney ASSESSMENT AND DIAGNOSTIC FINDINGS
disease.
Targeted assessment includes the history and
PATHOPHYSIOLOGY physical examination with a focused neurologic
examination; evaluation of signs and symptoms as
Hyponatremia primarily occurs due to an
well as laboratory test results; identification of
imbalance of water rather than sodium. Checking
current IV fluids, if applicable; and a review of all
the urine sodium value can assist in differentiating
medications the patient is taking.
renal from nonrenal causes of hyponatremia. Low
sodium in the urine occurs as the nephrons of the Lab tests that can confirm and help diagnose low
kidney retain sodium to compensate for nonrenal sodium include:
fluid loss (i.e., vomiting, diarrhea, sweating). High
sodium concentration in the urine is associated  Comprehensive metabolic panel (includes
with renal salt wasting that occurs in renal blood sodium, normal range is 135 to 145
dysfunction or diuretic use. In dilutional mEq/L, or 135 to 145 mmol/L)
hyponatremia, the ECF volume has excess water  Blood osmolality
but there is no edema, and the excess water  Urine osmolality
dilutes the sodium (Sterns, 2017e).  Urine sodium (normal level is 20 mEq/L in a
random urine sample, and 40 to 220 mEq per
A deficiency of aldosterone, as occurs in day for a 24-hour urine test)
adrenal insufficiency, also predisposes to sodium
deficiency. Lack of aldosterone causes lack of MEDICAL MANAGEMENT
sodium and water reabsorption into the
 Sodium Replacement
bloodstream at the nephrons. In addition, the use
of certain medications, such as anticonvulsants  The most common treatment for hyponatremia
is careful
(e.g., carbamazepine, oxcarbazepine,
levetiracetam), SSRIs (e.g., fluoxetine, sertraline,  administration of sodium by mouth,
nasogastric tube, or a parenteral route.
paroxetine), or desmopressin acetate, have side
 For patients who can eat and drink, sodium is
effects that increase the risk of hyponatremia
easily replaced, because sodium is consumed
(Liamis, Megapanou, Elisaf, et al., 2019). abundantly in a normal diet.
CLINICAL MANIFESTATIONS  For those who cannot consume sodium,
lactated Ringer’s solution or isotonic saline
Neurological symptoms (0.9% sodium chloride) solution may be
prescribed.
- Lethargy, headache, confusion, apprehension,  Also, take note that Serum sodium must not
seizures and coma. be increased by more than 12 mEq/L in 24
hours to avoid neurologic damage due to
Muscle symptoms demyelination (Jain, Phadke, Chauhan, et al.,
- Cramps, weakness, fatigue. 2018). This condition may occur when the
serum sodium concentration is overcorrected
Gastrointestinal symptoms (exceeding 140 mEq/L) too rapidly or in the
presence of hypoxia or anoxia.
- Nausea, vomiting, abdominal cramps, and
diarrhea.
Water Restriction very old, very young, or cognitively impaired.
Administration of hypertonic enteral feedings
 In patients with normal or excess fluid volume, without adequate water supplements leads to
hyponatremia is usually treated effectively by
hypernatremia, as does watery diarrhea and
restricting fluid.
greatly increased insensible water loss through the
 However, if neurologic symptoms are severe lungs or skin (e.g., hyperventilation, burns). In
(e.g., seizures, delirium, coma), or in patients addition, diabetes insipidus, which is a lack of ADH
with traumatic brain injury, it may be due to posterior pituitary dysfunction, can lead to
necessary to administer small volumes of a lack of adequate reabsorption of water into the
hypertonic sodium solution with the goal of bloodstream at the level of the nephron. This leads
alleviating cerebral edema. to inadequate water volume in the bloodstream
 But we should take note that incorrect use of which leads to hypernatremia if the patient does
these fluids is extremely dangerous, because not respond to thirst, or if fluids are excessively
1 L of 3% sodium chloride solution contains restricted (Sterns, 2017c).
513 mEq (milliequivalent) of sodium and 1 L of
5% sodium chloride solution contains 855 mEq Less common causes of hypernatremia
(milliequivalent) of sodium. are heatstroke, nonfatal drowning in seawater
 The recommendation for hypertonic saline (which contains a sodium concentration of
administration in patients with craniocerebral approximately 500 mEq/L), and malfunction of
trauma is 3% saline between 0.10 and 1.0 hemodialysis or peritoneal dialysis systems. IV 790
mL/kg of body weight per hour (Sterns, administration of hypertonic saline or excessive
2017d). use of sodium bicarbonate also causes
hypernatremia. Exertional dysnatremia can occur
PHARMACOLOGIC THERAPY
in performance athletes (Apostu, 2014) (Chart 10-
AVP receptor antagonists (also called
1).
ADH receptor antagonists) are pharmacologic
agents that treat hyponatremia by blocking the CLINICAL MANIFESTATIONS
effect of ADH at the nephron, which in turn allows
diuresis to occur and leads to water excretion. • Dehydration
Use of IV conivaptan HCl, an AVP receptor • Confusion
antagonist, is limited to the treatment of • Behavioral Changes
hospitalized patients. • Excessive thirst
• Irritability
Also, Tolvaptan is an oral medication indicated for • Restlessness
clinically significant hypervolemic and euvolemic • Doughy skin
hyponatremia that must be initiated and monitored
in the hospital setting. ASSESSMENT

1. Assess skin turgor, color, temperature,

HYPERNATREMIA and mucous membrane moisture.
Hyper- High 2. Monitor intake and output
Natr- Prefix for sodium 3. Monitor the level of consciousness
Emia- Blood and muscular strength, tone, and
Normal Na Value= 135-145 mEq/L movement.
Hypernatremia refers to a serum sodium level that 4. Monitor blood pressure.
is greater than 145 mEq/L (145 mmol/L) 5. Monitor respiratory rate and depth.
TYPES OF HYPERNATREMIA MEDICAL MANAGEMENT
• Hypovolemic Hypernatremia The cornerstone of the management is to reduce
• Euvolemic Hypernatremia the total body sodium and volume repletion.
• Hypervolemic Hypernatremia
- Administration of fluids.
- Pharmacological management (Diuretics: such
PATHOPHYSIOLOGY as Furosemide and Thiazide)

DIET
A common cause of hypernatremia is fluid
deprivation in patients who do not respond to - Fluid losses and gains are carefully monitored
thirst. Most often affected are patients who are in patient who are at risk for hypernatremia.
- Encourage to increased oral and IV fluid - helps our bodies digest foods
intake.
- Obtains a medication history, because some In hypokalemia, the serum potassium drops below
prescription medications have a high sodium 3.5 mEq/L. In moderate hypokalemia, the serum
content. potassium level ranges from 2.5 to 3 mEq/L. In
- Provide frequent oral care. Avoid the use of severe hypokalemia, it's less than 2.5 mEq/L.
mouthwash containing alcohol. PATHOPHYSIOLOGY
- The patient is monitored closely for changes in
behavior. The body can’t conserve potassium. Inadequate
intake and excessive output of potassium can
DIAGNOSTIC PROCEDURES
cause moderate drop in its level, upsetting the
1. Blood Test balance and causing a potassium deficiency.
2. Urine Test Conditions such as prolonged intestinal suction,
recent ileostomy, and villous adenoma can cause
NURSING INTERVENTION a decrease in the body's overall potassium level.
In certain situations, potassium shifts from
1. Fluid losses and gains are carefully
monitored in patients who are at risk for extracellular space to the intracellular space and
hypernatremia. hides in the cell (Alkalosis). Because the cells
2. Encourage increased oral and IV fluid contain more potassium than usual, less can be
intake. measured in the blood.
3. Obtains a medication history, because Certain causes of hypokalemia may include:
some prescription medications have a high
sodium content. 1. Low Intake
4. Provide frequent oral care. Avoid the use 2. Excess loss
of mouthwash containing alcohol. A. Renal Loss from medications
5. The patient is monitored closely for
changes in behavior. - Diuretics (especially thiazides and furosemide)

POTASSIUM IMBALANCES - Insulin - Insulin promotes the entry of

potassium into cells from the bloodstream;
HYPOKALEMIA therefore, patients with persistent insulin
Hypo - low hypersecretion may experience hypokalemia
Kal - Potassium - Corticosteroids, aspirin, certain antibiotics
Emia - blood (Gentamicin, carbenicillin, and amphotericin B)
Low Potassium in the Blood - Laxative Abuse
Normal Value: 3.5 to 5.2 mEq/L 3. Gastrointestinal loss

- Severe GI fluid loss from suction lavage,

prolonged vomiting, diarrhea, fistulas, and severe
OVERVIEW
diaphoresis.
Potassium
4. Transient Shift (Alkalosis)
- major cation in intracellular fluid
5. Damaging Diseases
- plays a metabolic role in many metabolic
function - Hepatic disease, acute alcoholism, heart
- 98 % of Potassium is found in intracellular fluid failure, malabsorption syndrome, nephritis,
and 2 % is found in extracellular fluid. This bartter syndrome, and acute leukemias.
significant difference affects nerve impulse - Hyperaldosteronism - Aldosterone from the
transmission. adrenal gland acts on the nephron to increase
sodium and water reabsorption into the
FUNTIONS OF POTASSIUM
bloodstream. It simultaneously secretes
- helps our cell uptake nutrients and water potassium into the renal tubules which in turn
- helps our muscles contract is excreted in the urine. In hyperaldosteronism,
- helps our nerve carry messages between the potassium is constantly secreted into the
brain and the body nephron tubule fluid which leads to loss of
- balances our bodies fluid and regulates blood potassium into the urine.
pressure
CLINICAL MANIFESTATIONS
 - Fatigue -Generally used only in patients with
- Anorexia normal renal function who are prone to
- Nausea and Vomiting significant hypokalemia.
- Muscle weakness - Increases diuresis (urination) without the
- Polyuria loss of potassium.
- Decreased Bowel Motility - These agents may be used in conjunction
- Ventricular Asystole or Fibrillation with thiazide or loop diuretics.
- Paresthesias - There is risk of hyperkalemia if they are
- Leg cramps used with other agents that also retain
- BP potassium such as ACE inhibitors.
- Ileus 5. ACE INHIBITORS
- Abdominal Distention - Inhibits renal potassium excretion.
- Hypoactive Reflexes - Can ameliorate some of the hypokalemia
- ECG: flattened T waves, prominent U that thiazide & loop diuretics can cause.
waves, ST depression, prolonged PR - Can lead to lethal hyperkalemia in patients
interval with renal insufficiency who are taking
potassium supplements or potassium-
ASSESSMENT AND DIAGNOSTIC sparing diuretics.
FINDINGS - Inhibit the production of aldosterone &
- Serum potassium concentration is less decreases renal potassium losses.
than the lower limit of normal, which is 3.5 NURSING INTERVENTION
mEq/L.
- Increased 24-hour urine level. 1. Assess patient for clinical evidence of
- Electrocardiographic (ECG) changes can hypokalemia, especially patients who are
include flat T waves or inverted T waves or receiving a diuretic or digoxin.
both, suggesting ischemia, and depressed 2. Monitor I & O and vital signs.
ST segments. An elevated U wave is 3. Insert & maintain patent IV access as
specific to hypokalemia. ordered.
4. Administer IV K replacement as
MEDICAL MANAGEMENT prescribed.
The treatment for hypokalemia has 4 Facets: 5. Never give K by IV push or as bolus.
Reduction of potassium losses, Replenishment of 6. Administer oral K supplement after meals.
Potassium, Evaluation of Potential Toxicities, & 7. Provide a safe environment for patient
Determination of the cause to prevent future who is weak from hypokalemia.
8. Check signs of constipation (e.g
episodes.
abdominal distention & decreased BM).
1. ORAL POTASSIUM SUPPLEMENT 9. Encourage to have a good, healthy high
- Oral potassium chloride (KCI) is potassium diet.
administered when potassium levels need
to be replenished.
HYPERKALEMIA
- Aside from KCI, potassium acetate &
- an abnormal physiological state resulting
potassium phosphate are also prescribed.
from high extracellular concentrations of
2. IV POTASSIUM REPLACEMENT THERAPY
potassium
- used to treat patients with severe
- a serum potassium concentration higher
hypokalemia.
than 5.2 mEq/L
- Treatment option when oral administration
- it result of decrease renal excretion,
of potassium is not feasible.
excessive intake or shift of potassium from
3. POTASSIUM DIET
inside the cell to extracellular space
- High potassium diet is advised to clients at
risk for hypokalemia. Normal K+ Level: 3.5 - 5.2 mEq/L
- 50- 100 mEq/ day is the average intake of
potassium for adults. Threshold for Hyperkalemia:
- Source of potassium: most fruits &
1) Mild - 5.5 - 6.5 mEq/L
vegetables, legumes, whole grains, milk, &
2) Moderate - 6.5 mEq/L
meat.
3) Severe - >7.5 mEq/L
4. POTASSIUM- SPARING DIURETICS
CAUSES ECG

1) Decreased renal excretion of potassium - an electrocardiogram shows changes in

your heart rhythm. Tall (peaked) T waves
2) Rapid administration of potassium are the earliest sign of hyperkalemia in an
Other causes: ECG. T waves show your heart at rest or
recovering after breathing.
● Diseases
● Medication (Ace Inhibitors and Beta MEDICAL MANAGEMENT
blockers)
● Injuries - cause of excessive bleeding ● ECG should be obtained immediately.
● Excessive intake of potassium ● Monitor blood potassium level.
● Restrict dietary potassium.
RISK FACTORS ● Administer sodium polystyrene sulfonate.
● Administer Patiromer Sorbitex Calcium.
● Premature infants (premature renal
function) EMERGENCY PHARMACOLOGY THERAPHY
● Elderly (60 and older)
● IV calcium gluconate
● IV administration of sodium bicarbonate
● IV administration of regular insulin and a
hypertonic dextrose solution
● Loop Diuretic
● Beta-2 Agonist

NURSING INTERVENTION

- Include or limit in the diet.

- The Administrator prescribed potassium
with caution.
CLINICAL MANIFESTATIONS - Monitor strictly the input and output.
- Treat underlying conditions.
● Muscle Spasms
● Diarrhea
● Flaccid paralysis
● Paresthesias
● Respiratory Depression and Failure
● Tachycardia
● Bradycardia
● Arrythmia
● ECG changes

ASSESSMENT
● Monitor blood potassium level
● Monitor cardiac output
● Physical Examination

DIAGNOSTIC FINDINGS

Blood Test

- a serum potassium test is a type of blood

test that measures your potassium level.

ABG Analysis

- an arterial blood gas test that measures

the amounts of arterial gases such as
oxygen and carbon dioxide.