PNEUMOTHORAX - ABG Test: hypoxemia, possibly w/respiratory

• Simple/ Spontaneous Pneumothorax acidosis & hypercapnia

- air enters through a breach of either parietal or - Pulse Oximetry: hypoxemia
visceral pleura due to rupture of air-filled bleb,
blister on the surface of the lung TREATMENT
Primary - idiopathic or unknown - Needle Aspiration
Secondary - related to a specific disease - Oxygen Administration
• Traumatic Pneumothorax
- air escapes through a laceration in the lung or SURGERY
from a wound in the chest wall and enters the - Thoracotomy and Pleurectomy
pleural space, caused by blunt trauma and - Thoracostomy /Chest tube insertion
penetrating injury
Open Pneumothorax - sucking chest wound, NURSING INTERVENTION
air from outside enter pleural space - Promote bed rest
Closed Pneumothorax - air from the lungs - BP Monitoring
enter pleural space - Respiratory and Pulse rate monitoring
• Tension Pneumothorax
- air in the pleural space is under higher pressure Prognosis
than in the lung.
- one-way valve or ball valve mechanism occurs HEMOTHORAX
where air enters the pleural space but cannot PATHOPHYSIOLOGY
escape.

PATHOPHYSIOLOGY PNEUMONIA
- inflammation of lung parenchyma (pneumonitis)
Open & Closed Trauma • Community-acquired pneumonia / CAP - occurs
| in the community or within 48 hrs of
Accumulation of air in the pleural cavity (build up hospitalization
of positive pressure) • Hospital-aquired pneimonia / HAP - nosocomial
| pneumonia, more than 48 hrs after hospitalization
Lung compression and collapse • Health care-associated pneumonia / HCAP -
| nonhospitalized patient with extensive health care
Decreased lung compliance: reduced total lung contact in outpatient clinics
capacity & vital capacity • Ventilator-associated pneumonia / VAP - ≥ 48
Mediastinal Shift hrs after intubation
|
Ventilation-Perfusion problems • Bronchopnuemonia - pneumonia that is
| distributed in a patchy fashion, involves distal
Hypoxia airways and alveoli
• Lobar pneumonia - involves part of a lobe or an
SYMPTOMS entire lobe
- Pleuritic pain (breathing, coughing)
- Asymmetrical chest wall movement • Primary Pneumonia - caused by aspiration of
- Dyspnea pathogens
- Cyanosis • Secondary Pneumonia - caused by noxious
- Respiratory distress chemicals, irritants such as smoking, aspiration of
- Tachycardia gastric contents

DIANOSTIC TEST & RESULTS PATHOPHYSIOLOGY

- Chest X-ray: air in the pleural space & possibly Exposure to Streptococcus pneumoniae or other
mediastinal shift pathogens
|
 Pathogens reaches the lower respiratory tract - Increase hydration
(lungs) by inhalation, aspiration or vascular
dissemination COPD
| - slowly progressive respiratory disease of airflow
Pathogen multiplies & replicates obstruction involving the airways, pulmonary
| parenchyma, or both
Inflammatory response occur in the alveoli and • Chronic Bronchitis - presence of cough and
Immune response starts: neutrophils migrate to sputum production for at least 3 months in each of
the alveoli 2 consecutive years
| - inflammation of the bronchi, a productive cough,
Increased mucosal secretion and mucosal edema and excessive mucus production
results • Emphysema - abnormal distention of the
| airspaces beyond the terminal bronchioles and
partial occlusion of the bronchi or alveoli destruction of the walls of the alveoli.
| - destruction of the alveolar walls, leading to large,
Impaired gas exchange permanently inflated alveoli.
| Panlobular (panacinar) Emphysema -
Hypoxemia destruction of the respiratory bronchiole, alveolar
duct, and alveolus
SYMPTOMS Centrilobular (centroacinar) Emphysema -
- Cough pathologic changes take place mainly in the
- Sputum production center of the secondary lobule
- Tachypnea
- Dyspnea PATHOPHYSIOLOGY
- Pleuritic pain • Chronic Bronchitis
- Shaking chills Smoking & other Pollutants
- Fever |
- Fatigue Irritates Airways
|
DIANOSTIC TEST & RESULTS Inflammatory Response
- Chest X-ray: shows infiltrates |
- Sputum culture & sensitivity Mucous gland hyperplasia, edema, excessive
- CBC: leukocytosis mucus production, bronchoconstriction, and
- Blood culture: bacteremia cough
- ABG |
- Bronchoscopy or transtracheal aspiration Reduced ciliary function, Damaged and fibrosed
- Pulse oxymetry: hypoxemia alveoli: altered function of alveolar macrophages
|
MEDICATION Increased susceptibility to respiratory infections
- Oxygen therapy
- Antibiotic • Emphysema
- Antipyretic Inhalation of Irritants
- Bronchodilators |
- Corticosteroids Inflammatory response
- Mucolytics |
- Antitussives Immune cells release proteases
- Analgesic for chest pain |
- Mechanical ventilation for respiratory failure Proteases-antiproteases imbalance
|
NURSING INTERVENTION Structural changes in the lung due to cell death
- Chest physiotherapy |
- Promote bed rest
 Alveolar wall destruction - alveoli fails to recoil,
small bronchioles collapse - air trapping MEDICATION
| - Oxygen therapy
Increased deadspace - results to hypoxemia & - Bronchodilators
hypercapnia - leading to respiratory acidosis - Mucolytics
| - Corticosteroids
As the alveolar walls continue to break down, the - Antibiotics
pulmonary capillary bed is reduced in size
| SURGERY
Increased resistance to pulmonary blood flow - Lung reduction
| - Lung transplant
Increased workload in the right ventricle and - Bullectomy
pulmonary hypertension
| NURSING INTERVENTION
Cor pulmonale: RSHF - resulting to Peripheral - Smoking Cessation Education
Edema - Breathing exercises
- Instruct patient to cough
- Promote hydration
- Postural changes
- Chest physiotherapy

CATARACT
- lens opacity or cloudiness resulting in hazy vision
• Senile Cataract - develop in elderly people,
probably because of changes in the chemical state
of lens proteins.
• Congenital Cataract - occur in neonates as a
result of genetic defects or maternal rubella during
the first trimester
• Traumatic Cataract - develop after a foreign
body injures the lens with sufficient force to allow
SYMPTOMS aqueous or vitreous humor to enter the lens
- Productive cough capsule.
- Dyspnea
- Hypoxemia Four Stages of Cataract Development
- Hypercapnia • Immature - partially opaque lens
- Cyanosis • Mature - completely opaque lens; significant
- polycythemia vision loss
- Pulmonary hypertension • Tumescent - water-filled lens, which may lead to
- Edema glaucoma
- Wheezing - • Hypermature - deteriorating lens proteins and
- Barrel chest peptides that leak through the lens capsule, which
- Diminished breath sounds may develop into glaucoma if intraocular outflow is
- Use of Accessory Muscles for breathing obstructed.

DIANOSTIC TEST & RESULTS PATHOPHYSIOLOGY

- ABG Study: Hypoxemia, Hypercapnia Denaturation of the Crystalline protein of the Lens
- Chest X-ray: Hyperinflation of lung |
- Pulmonary Function Test: increased residual Accumulation of Crystalline Protein and Lipids
volume, decreased vital capacity, forced |
expiratory flow Opacification of the Lens
- ECG: Hypertrophy of right ventricle, arrhythmia |
 Cataract Formation |
Direct Mechanical Damage and Ischemia of Optic
SYMPTOMS Nerve
- painless, blurring of vision |
- whitened pupil Optic Nerve Atrophy
- halos around light/ astigmatism
- double vision/ diplopia SYMPTOMS
- better vision in dim light than in bright sun light - Pain around eyes
- Halos around light
DIANOSTIC TEST & RESULTS - Tunnel Vision
- Visual Acuity test: poor vision - Blurred vision
- Opthalmoscopy: revealing a dark area in the - Headache
normally homogeneous red reflex - Nausea and Vomiting

SURGERY DIANOSTIC TEST & RESULTS

- Phacoemulsification - a method of extracapsular - Tonometry: IOP greater than 22 mmhg
cataract surgery where a portion of the anterior - Perimetry: Tunnel Vision
capsule is removed, allowing extraction of the lens - Opthalmoscopy: Cupping of optic disc
nucleus and cortex while the posterior capsule and - Visual Acuity test: poor acuity
zonular support are left intact - Gonioscopy: differentiates open and closed angle
- Lens Replacement - The lens, which focuses light glaucoma
on the retina, must be replaced for the patient to
see clearly MEDICATION
- Miotic
GLAUCOMA - Beta blockers
- characterized by high IOP that damages the optic - Alpha-adrenergic agonist
nerve - Carbonic anhydrase inhibitors
PRIMARY GLAUCOMA - Prostaglandin analogues
• Open-Angle (Chronic) Glaucoma - outflow
obstruction of aqueous humor at the trabecular SURGERY
meshwork - Trabeculectomy
• Angle-closure (acute) glaucoma - there is - Trabeculoplasty
displacement of the iris toward the cornea - Iridotomy
obstructing the outflow of aqueous humor from
the anterior chamber DIABETES MELLITUS
• Congenital glaucoma - congenital malformations - characterized by hyperglycemia resulting from
and other genetic anomalies present at birth which defects in insulin production, insulin action, or both
results in an abnormal development of outflow • Type 1 DM - insulin dependent, absolute insulin
channels of the eye. deficiency, usually occurs before age 30; the
SECONDARY GLAUCOMA - Open-angle or closed- patient is usually thin and requires exogenous
angle obstruction that may result from the use of insulin and dietary management.
certain medications, eye diseases, systemic • Type 2 DM - non-insulin dependent, commonly
diseases, and trauma occurs in obese adults after age 40; it’s usually
treated with exercise, meal planning, and
PATHOPHYSIOLOGY antidiabetic drugs.
Outflow Obstruction of Aqueous Humor
| PATHOPHYSIOLOGY
Aqueous Humor Accumulation • Type 1 DM
| Autoimmune attack on Beta Cells
Increased IOP |
| Reduction of Beta Cells Mass
Compression of Optic Nerve |
 Insulin Production Deficiency
|
Increased Glucose Serum levels
• Type 2 DM
Insulin Resistance
|
beta-cells compensate to increase insulin
secretion - to normalize blood glucose
|
Worsening of insulin resistance and beta cells tire
out - hyperglycemia results
|
Beta cells deterioration and stops insulin
production
|
Insulin Production Deficiency

SYMPTOMS
- Polyuria
- Polydipsia
- Polyphagia
- Weight loss
- Fatigue

DIANOSTIC TEST & RESULTS

- Capillary Blood Glucose Test:
- Random Blood Sugar of 200 mg/Dl &
above
- Fasting Blood Sugar above 126 mg/Dl
- Glucose Tolerance Test: pt will ingest 75 g of
sugar drink and monitored after 2 & 3 hrs, blood
sugar takes longer or does not return to normal
- Glycosylated Hemoglobin (HbA1c)
Determination: shows avrg blood glucose during
the past 3 months, normal level shoul be 2.5-6%
- Urinalysis: glucosuria

MEDICATION
Type 1 DM - Insulin Replacement
Type 2 DM - Oral antidiabetic drug, insulin as
needed

SURGERY
-