CHRISTIE V.

MONTANO BSN – 3
NCM 112
MYKA ALLENE CATOTO, RN

Lower Respiratory Management and

Tract Infection Causes Risk factors Clinical Significance of
Manifestations Preventive Health Care

1. PNEUMONIA MEDICAL
an Respiratory Advance age Systemic – high MANAGEMENT
inflammation of viruses fever and chills
the lung Alcohol Antibiotic therapy
parenchyma Streptococcus intoxication Central –
caused by pneumoniae headache a. Streptococcus p.
various Supine Loss of apetite Penicillin sensitive
microorganisms Mycoplasma position Mood swings
, including pneumoniae  Amoxicillin
bacteria, NPO status, Skin –  Ceftriaxone
mycobacteria, Haemophilus placement of Clammy  Cefotaxime
fungi, and influenza tube Cyanotic
viruses. Penicillin Resistant
Pneumonitis is Legionella Depressed Vascular –
a more general cough reflex Low pressure  Levofloxacin
term that Staphylococcus  Vancomycin
describes an aureus Prolonged Heart –  Linezolid
inflammatory immobility Increased heart
process in the rate b. Haemophilus
lung tissue that Smoking influenza
may predispose Gastric –
or place the Immune – Nausea  Doxycycline
patient at risk supressed Vomiting  2nd to 3rd gen
for microbial patients cephalosporins (
invasion. Joints – cefuroxime,
Condition Pain cefoxitin,
that produce ceftriaxone,
CLASSIFICATION mucus or Lungs – Ceftazidime
bronchial Cough with
a. Community – obstruction purulent c. Legionnaires
Acquired and interfere sputum or disease
Pneumonia with lung phlegm
(CAP) drainage
 - occurs either in Shortness of  Azithromycin
the community breath  Moxifloxacin
setting or within
the first 48 hours Pleuritic chest d. Mycoplasma p.
after pain  Unasyn
hospitalization or  Doxycycline
institutionalizati Hemoptysis Supplemental oxygen
on
Muscular – NURSING
MANAGEMENT
b. B. Hospital – Fatigue
Acquired Aches 1. Improving
Pneumonia (HAP) airway patency
c. a. Removing
Develops 48 hours secretions
or more after
admission and Significance of
does not appear Preventive
to be incubating at Care
the time of It is important because
admission. retained secretions
interfere with gas
d. C. Health Care – exchange and may slow
Associated recovery
Pneumonia b. Adequate
(HCAP) hydration
Significance of
An important Preventive
distinction of HCAP Care
is that the causative Adequate hydration
pathogens are often thins and loosens
MDR. pulmonary secretions

c. Lung
e. D. Ventilator – expansion
Acquired manuevers
Pneumonia (VAP) like deep
breathing
A type of HAP that exercises,
develops ≥48 hours Significance of
after endotracheal Preventive
tube intubation Care
It can induce cough and
does expectoration of
mucus or phlegm.
d. Chest
physiotherap
y
Significance of
Preventive
Care
It is important in
loosening and mobilizing
secretions as well as
monitoring cough and
sputum production.

2. Promote rest
and conserve
energy
Significance of
Preventive
Care
The nurse encourages
the debilitated patient to
rest and avoid
overexertion and
possible exacerbation of
symptoms
3. Promote fluid
intake, unless
contraindicated
Significance of
Preventive
Care
To replenish the lost
body fluids, electrolytes
and to prevent
dehydration.

4. Maintain
nutrition.
Significance of
Preventive
Care
Small nutritious meal
 can replenish the lost
nutrients and to gain
energy.

2. PULMONARY
TUBERCULOSIS
Close contact Low grade fever MEDICAL
- Tuberculosis (TB) Mycobacterium with infected MANAGEMENT
is an infectious tuberculosis person Non –
disease that productive Anti - tuberculosis agent:
primarily affects Immuno - cough 6 to 12 months
the lung compromised
parenchyma. It status Night sweats 1. Isoniazid (INH)
also may be Daily dose: 5mg/kg
transmitted to Substance Fatigue (max. of 300mg)
other parts of abuse Side effects:
the body, Weight loss Peripheral neuritis
including the Pre – existing (Pyridoxine)
meninges, medical Hemoptysis Hepatic enzyme
kidneys, bones, condition or elevation
and lymph nodes special Hepatitis
treatment Hypersensitivity
2. Rifampin
Immigration (Rifadin)
to countries Daily dose: 10mg/kg
with high (max. 600 mg)
incidence of
TB Side effects:
Hepatitis
Living in Febrile reaction
crowded Nausea
places Vomiting
Purpura
Healthcare Orange urine and body
workers secretions

MONITOR
Serum glutamic pyruvic
transaminase (SGPT)

Serum glutamic
oxaloacetic
transanimase (SGOT)
 3. Streptomycin
Daily dose: 15 mg/kg
(max of 1g)

Side effects:
8th cranial nerve
damage (deafness)
Nephrotoxicity (elderly)

MONITOR:
Vestibular function
Audiograms
Blood, Urea Nitrogen
Creatinine

4. Pyrazinamide
Daily dose: 15 to
30mg/kg (max. of
2.0mg)
Side effects:

Hyperuricemia
Hepatotoxicity
Skin rashes
GI stress

MONITOR

Serum Uric Acid (SUA)

Serum glutamic pyruvic

transaminase (SGPT)

Serum glutamic
oxaloacetic
transanimase (SGOT)

5. Ethambutol
Daily dose : 15 to
25mg/kg
Side effects:
Optic neuritis (blindness)
Skin rashes

MONITOR

Visual acuity
Color discrimination

NURSING
MANAGEMENT

1. Promoting
airway clearance.
Significance of
Preventive
Care
To prevent copious
secretions obstruct the
airways in many patients
and interfere with
adequate gas exchange.
Also, through increasing
the fluid intake
promotes systemic
hydration and serves as
an effective expectorant.

2. Advocating
adherence to
treatment
regimen.
Significance of
Preventive
Care
The nurse educates the
patient that TB is a
communicable disease
and that taking
medications is the most
effective means of
preventing transmission
while avoidance from
antibiotic resistance.

3. Promoting
activity and
adequate
nutrition.
Significance of
Preventive
Care
Patients with TB are
often debilitated from
prolonged chronic illness
and impaired nutritional
status. Thus, to replenish
the body nutrients loss,
small nutritious meals
should be introduced
while early ambulation
should be done slowly.
4. Monitoring and
managing
potential
complications.
Significance of
Preventive
Care
To address the
developing
complications and
prevent further severe
complications.

5. Promoting home
and community –
based care.
Significance of
Preventive
Care

This is to prevent
transmission, early
detection and health
education should be
conducted by the nurses
 in the community.

3. ATELECTASIS - Loss of Adults Increasing NURSING

refers to segmental, dyspnea, MANAGEMENT
closure or lobar, or overall Post- cough, and
collapse of lung volume operative sputum 1. Frequent turning,
alveoli and caused by patients production early ambulation,
often is excess lung volume
described in secretions or Patient with Tachycardia expansion
relation to mucus plug lung cancer maneuvers (e.g.,
chest x-ray Tachypnea, deep-breathing
findings and/or Prolonged exercises and
clinical signs supine Pleural pain incentive
and symptoms. positioning spirometry), and
Atelectasis may Central cyanosis coughing.
occur in adults Increased Significance of
as a result of abdominal Mild-to- preventive care
reduced pressure moderate 2. Positive
ventilation (non hypoxemia endexpiratory
- obstructive Reduced lung pressure (PEEP; a
atelectasis) or volumes due simple mask and
any blockage to one-way valve
that obstructs musculoskele system.
passage of air tal or 3. Bronchoscopy
to and from the neurologic 4. Change patient’s
alveoli disorders position
(obstructive frequently,
atelectasis), Restrictive especially from
thus reducing defects supine to upright
alveolar position
ventilation Specific Significance of
surgical preventive care
procedures To promote ventilation
and prevent secretions
from accumulating.
5. Encourage early
mobilization
from bed to chair
followed by early
ambulation.
6. Encourage
 appropriate deep
breathing and
coughing.
Significance of
preventive care
To mobilize secretions
and prevent them from
accumulating.
7. Educate/reinforc
e appropriate
technique for
incentive
spirometry.
8. Administer
prescribed
opioids and
sedatives
judiciously.
Significance of
preventive care
To prevent respiratory
depression.
9. Perform postural
drainage and
chest percussion,
if indicated.
10. Institute
suctioning.
Significance of
preventive care
To remove
tracheobronchial
secretions, if indicated.

4. ACUTE Streptococcus Patients with dry, irritating MEDICAL

TRACHEO – pneumoniae viral cough MANAGEMENT
BRONCHITIS infections
- an acute Haemophilus scanty amount 1. Antibiotic
inflammation of influenzae Untreated of mucoid treatment – to
the mucous upper sputum treat the
membranes of Mycoplasma respiratory causative agents
the trachea and pneumonia infection sternal soreness of the infection.
the bronchial 2. Cold vapour
tree, often Aspergillus Exposure and fever or chills therapy – to
follows infection inhalation of relieve laryngeal
of the upper physical and night sweats irritation
respiratory tract chemical 3. Endotracheal
.The inflamed irritants, headache intubation – for
mucosa of the gases, or severe infection
bronchi other air general malaise 4. Mild analgesics –
produces contami - for pain
mucopurulent nants Severe case: management
sputum, often in
response to purulent (pus- NURSING
infection. filled) sputum MANAGEMENT
blood-streaked
secretions 1. Encourage
bronchial
hygiene such as
increased fluid
intake and
directed
coughing.
Significance of
preventive care
To remove secretions.

2. Advise the
patient to take
enough rest.
Significance of
preventive care
To prevent exacerbation
that could cause
overexertion and
fatigue.
3. Emphasize full
course of
antibiotic
therapy.

Significance of
preventive care
To prevent antibiotic
resistance
 5. PLEURAL
CONDITONS -
Pleural conditions
are disorders that
involve the
membranes
covering the
lungs (visceral
pleura) and the
surface of the chest
wall (parietal
pleura) or disorders
affecting the pleural
space.

a. PLEURISY –
is a Rubbing of Patients with Pleuritic pain MEDICAL
condition in inflamed pneumonia that radiates the MANAGEMENT
which the pleural or an upper shoulder and
pleura – two membrane respiratory the abdomen 1. Patient must be
large, thin tract monitored for
layers of infection, TB, signs and
tissue that or collagen symptoms of
separate the disease pleural effusion,
lungs from such as shortness
the chest of breath, pain.
wall 2. Assumption of a
becomes after a position that
inflamed trauma to decreases pain,
(pleuritis) the chest, and decreased
chest wall
pulmonary excursion
infarction, or 3. Prescribed
PE analgesics
4. Topical
after application
thoracotomy 5. NSAID’s drugs -
pain relief
6. Intercostal nerve
block – for
severe pain
 NURSING
MANAGEMENT

1. Provide comfort
like frequently
turning.
Significance of
preventive care
To splint the chest wall
and reduce the
stretching of the pleurae
2. Educate the
patient to use
the hands or a
pillow while
coughing.
Significance of
preventive care
To splint the ribcage to
help lung expansion and
inspiration.

MEDICAL
b. PLEURAL MANAGEMENT
Patients with
EFFUSION Fluid Fever
heart failure,
Pleural accumulation in 1. Treatment of the
TB,
effusion, a the pleural Chills underlying
pneumonia,
collection of space causes.
pulmonary
fluid in the pleuritic chest 2. Thoracentesis
infections
pleural pain 3. Pleurodesis
(particularly
space, is 4. Surgical
viral
rarely a For malignant pleurectomy
infections),
primary effusion:
nephrotic
disease NURSING
syndrome,
process; it is dyspnea MANAGEMENT
connective
usually
tissue
secondary difficulty lying 1. Support the
disease, PE
to other flat medical regimen.
and
diseases. Significance of
neoplastic
preventive care
tumors.
coughing To guide to patient and
to prevent antibiotic
resistance
2. Prepare and
position the
patient for
thoracentesis
and offers
support
throughout the
procedure.
Significance of
preventive care
To put the patient at
ease and to gain
cooperation.

3. Monitor the
system’s function
and recording
the amount of
drainage at
prescribed
intervals.
Significance of
preventive care
To check any
abnormalities that could
be a cause of another
compications.

4. Assist the patient

in pain
management.
Significance of
preventive care
To relieve anxiety and
pain of the patient.

5. Educate the
family about
management and
care of the
catheter and
drainage system.
 Significance of
preventive care

In order for the family to

know how to manage
catheter independently
and for them to find out
if there’s an
abnormalities with the
drainage that will tend
them to report to the
health care provider.

c. EMPYEMA Accumulation Patient with Fever MEDICAL

is an of thick, pneumonia MANAGEMENT
accumulation of purulent fluid or lung night sweats
thick, purulent within the abscess 1. Antibiotic
fluid within the pleural space as pleural pain regimen to treat
pleural space, such the underlying
often with fibrin complications cough dyspnea condition
development of bacterial 2. Needle aspiration
and loculated pneumonia or anorexia (thoracentesis)
(walled-off) lung (weight loss) 3. Tube
area where Abscess thoracostomy
infection is 4. Open chest
located drainage via
thoracotomy.

NURSING
MANAGEMENT

1. Help the patient

cope with the
condition and
instructs the
patient in lung-
expanding and
breathing
exercises.
 2. Instruct the
patient and
family on care of
the drainage
system and drain
site,
measurement
and observation
of drainage, signs
and symptoms of
infection

MEDICAL
d. PULMONARY Accumulation Increasing MANAGEMENT
EDEMA – of fluid in the respiratory
abnormal lung tissue distress 1. Correct the
accumulatio underlying cause
n of fluid in Dyspnea
the lung Cardiac in origin ---
tissue, Air hunger Vasodilators
alveolar Inotropic medications
space, or Central cyanosis Contractility medications
both Anxious
Agitated Fluid overload ----
Diuretics
Presence of
foamy or frothy 2. Oxygen
blood tinged administration –
secretions to correct
hypoxemia

NURSING
MANAGEMENT

1. Assist the patient

in oxygen
 administration to
correct
hypoxemia.
2. Administer
medications to
guide the patient
the proper
medication and
antibiotic
therapy stressing
to complete the
whole course to
prevent
antibiotic
resistance.

ACUTE CO2 Patient with Dyspnea MEDICAL

RESPIRATORY elimination abnormality MANAGEMENT
FAILURE (ARF) – inability of the lungs Headache
occurs when the or chest wall 1. Identify and treat
client can’t Restlessness the cause of
eliminate CO2 from Has defect in respiratory
the alveoli and the Confusion failure to address
when 02 reaches respiratory to accurate
Tachycardia
the alveoli but can’t control condition of the
be absorbed or center in the patient
Cyanosis
used properly brain 2. Administer
Dysrhytmnias oxygen to
Impairment maintain the
in the Decreased level PaO2 level 60 –
function of of conscious-ness 70 mmHg to
respiratory prevent
muscles hypoxemia.
Alterations in 3. Position in High
respirations and
Fowler’s position
breath sounds
to enhance lungs
expansion
4. Encourage deep
breathing
5. Administer
bronchodilator as
prescribed to
help for
 ventilation.
6. Prepare the
client for
mechanical
ventilator if
supplement 02
cannot maintain
acceptable Pa01
levels

ACUTE Diffuse lung Patient who Tachypnea NURSING

RESPIRATORY injury resulting experiences MANAGEMENT
DISTRESS to extra Dyspnea
SYNDROME (ARDS) vascular lung Sepsis 1. Identify and treat
– occurs as a fluid Decreased the cause of
complication of Fluid breath sound ARDS for
some other overload accurate
condition caused by Deteriora – ting diagnosis and
a diffuse lung injury Shock blood gas level treatment of the
that leads to extra condition
vascular lung fluid. Neurological Hypoxemia 2. Administer
injuries despite of high oxygen as
02 prescribed to
Burns prevent
Decreased hypoxemia.
DIC pulmonary 3. Position client in
compliance high Fowler’s
Drug position for
ingestion Pulmonary maximum lungs
infiltrates expansion
Inhalation of 4. Restrict fluid
toxic intake as
substances prescribed
5. Administer
diuretics,
anticoagulants,
or corticosteroids
as prescribed.
6. Prepare the
client for
intubation and
mechanical
ventilation using
PEEP
 PULMONARY thrombus and Patient with Depends on the MEDICAL
EMBOLISM emboli trauma, size and area MANAGEMENT
- PE refers to the formation in surgery
obstruction of the deep veins (orthopedic, Dyspnea 1. Oxygen
the pulmonary major administration to
artery or one of abdominal, Chest pain prevent
its branches by a pelvic, hypoxemia
thrombus (or gynecologic), Anxiety 2. Anticoagulant
thrombi) that pregnancy therapy –
originate Fever Coumadin to
somewhere in heart failure avoid clumping
the venous Tachycardia and coagulating
system or in the age older of thrombus or
right side of the than 50 years Cough emboli.
heart. 3. Thrombolytic
Diaphoresis therapy -
hypercoagula streptokinase to
ble states, Hemoptysis dissolve blood
clots that have
Syncope
prolonged formed in the
immobility. blood vessels

NURSING
MANAGEMENT

1. Minimize the risk

of pulmonary
embolism to
prevent the
development of
embolism
2. Monitor
thrombolytic
therapy to
identify clotting
and clumping
3. Assess potential
for pulmonary
 embolism to
identify clumping
and accumulating
of emboli that
blocks the
vessels.
4. Manage pain to
reduce anxiety
and stress on the
patient.
5. Manage oxygen
therapy to
regulate and
treat hypoxemia.
6. Relieve anxiety of
the patient to
put the patient at
ease and less
stressful dealing
with the
condition.