Evolve.

Adapt.
Overcome.
CEFI is now ready.

PATHOPHYSIOLOGIC BASIS

OXYGENATION - VENTILATION

KENNETH P. VELUYA
College Name
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

RESPIRATORY
TRACT INFECTIONS
Study Home
UPPER RESPIRATORY TRACT INFECTION
Disorders of the upper respiratory tract include problems occurring in the nose, sinuses,
pharynx, larynx, and trachea
VIRAL RHINITIS (COMMON COLD)
The term “common cold” often is used when referring to an upper respiratory tract infection
that is self-limited and caused by a virus (viral rhinitis).
The release of histamine and other substances causes vasodilation and edema, which result in
symptoms.
S/Sx: Nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Medical Mgt. URTI Nursing Mgt.

• No specific treatment, symptomatic • Teach patient how to break
treatment
chain of infection
• Adequate rest, Increase oral fluid
intake • Proper Hand Hygiene
• Increase Vitamin C intake • Cough etiquette
• Expectorants as needed
• Warm salt-water gargle for sore
throat
• Antihistamines - to relieve sneezing,
rhinorrhea, and nasal congestion
• Topical (nasal) decongestant agent
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

An acute inflammatory
PNEUMONIA process involving the lung
parenchyma

TYPES OF PNEUMONIA:
• Community acquired pneumonia (cap)
• Hospital acquired pneumonia (hap)
• Opportunistic pneumonia
• Aspiration pneumonia
• Hypostatic pneumonia

Study Home
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

PNEUMONIA
Predisposing
Factors Diagnostic
Procedures
• Streptococcus • Smoking
pneumoniae • Air pollution
• Hemophylus • Productive cough
• Immunocompro- • Dyspnea • Sputum GS CS
influenzae mised • Chest x-ray
• Diplococcus • Fever, chills,
• Related to anorexia and general • ABG analysis
pneumoniae prolonged • CBC
• Klebsiella body malaise
immobility • Weight loss
pneumoniae • Aspiration
• Escherechia • Rales/ crackles
Etiologic
Agent pneumoniae • Bronchial wheezing
• Pseudomonas • Cyanosis
• Pleuritic friction rub
• Chest pain
Signs and
• Abdominal
Symptoms distention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

PNEUMONIA
Nursing Mgt.
• Enforce CBR
• Administer O2 inhalation low inflow
• Administer medication as ordered
• Force fluid
• Place on semi-fowler’s position
• Institute pulmonary toilet
• Nebulize and suction as needed
• Assist in postural drainage
• Provide increase carbohydrates,
calories, protein and Vit. C
• Health teaching and discharge
planning
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Is an infectious disease caused by

bacteria (Mycobacterium
TUBERCULOSIS tuberculosis) that are usually
spread from person to person
through the air.

MODE OF TRANSMISSION:
• airborne
• droplet; coughing , sneezing, talking

Study Home
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

TUBERCULOSIS
Precipitating
Factors Diagnostic
Procedures
• Mycobacterium • Malnutrition
tuberculosis/ • No symptoms at first
• Overcrowded
Tubercle bacilli (primary infection)
places • Mantoux test, PPD
Koch’s bacilli • Low grade afternoon
• Alcoholism (Tuberculin Skin
fever, night sweats
• Over fatigue test)
• Productive cough
• Ingestion of • Sputum Exam
(yellowish sputum)
infected cattle • Chest X-ray
• Anorexia,
with • CBC
generalized body
Etiologic mycobacterium
Agent malaise
bovis
• Weight loss
• Virulence of
• Dyspnea
microorganism
• Chest pain
Signs and• Hemoptysis
Symptoms (chronic)
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

TUBERCULOSIS
Nursing Mgt.
• Enforce CBR
• Institute strict respiratory isolation
• Administer O2 inhalation
• Force fluids
• Place client on semi-fowler’s position
• Encourage deep breathing and coughing exercise
• Nebulize and suction when needed
• Comfortable and humid environment
• Institute short course chemotherapy
• Provide increase carbohydrates, protein, vitamin
C and calories
• Provide client health teaching and discharge
planning
• Avoidance of precipitating factors
• Prevent complications
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Medical Mgt. Preventive Measures

• Simultaneous administration of 3 or more
TB • BCG IMMUNIZATION
• IMPROVED SOCIAL CONDITIONS
drugs ( increases the therapeutic effects of
medication and decreases the DRUG SIDE EFFECTS
development of resistant bacteria ISONIAZID (INH) Bactericidal PERIPHERAL NEURITIS
• Course of treatment: average 6 – 12 mos. RIFAMPIN Bactericidal Body secretions may turn to
• DOTS (DIRECTLY OBSERVED TREATMENT orange (urine, tears,
SHORT COURSE) perspiration,)
• Is the name for a comprehensive strategy ETHAMBUTOL Bacteriostatic OPTIC NEURITIS (decreased
red-green color discrimination,
which primary health care services around
decreased visual acuity)
the world are using to detect and cure TB. PYRAZINAMIDE Bactericidal Hyperuricemia, Hepatotoxicity
STREPTOMYCIN Bactericidal OTOTOXICTY, NEPHROTOXICITY
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Influenza, commonly referred to

INFLUENZA as the flu, is a viral infection of
the respiratory tract.

MODE OF TRANSMISSION:
• via droplets from coughs and sneezes of infected individuals,
direct contact

The INCUBATION PERIOD from time of exposure to onset of

symptoms is 1 to 3 days.
Study Home
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

INFLUENZA
Precipitating
Factors Diagnostic
Procedures
• AH1N1 • Immunocompro-
• MERS-COV • Nonproductive
missed
• BIRD FLU/AVIAN FLU cough
• Comorbidity • viral culture,
• SARS • Fever over 101F ,
• History of serology,
• NCOV/COVID Chills and sweats
exposure • rapid antigen
• Fatigue and malaise
• Virulence of testing,
• Headache
microorganism • reverse transcription
• Muscle aches
polymerase chain
(myalgia)
Etiologic reaction (RT-PCR)
Agent • Watery, nasal
discharge
• Sore throat

Signs and
Symptoms
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Medical Mgt. FLU Nursing Mgt.

• Treatment is primarily symptomatic.
• Acetaminophen is given for fever, headache, • Administer medications as
and myalgia. Aspirin is avoided in children ordered.
because it increases the risk for Reye’s • Administer fluids and
syndrome.
electrolytes as ordered.
• Rest and fluids.
• Antibiotics are used only if a secondary • Monitor respiratory status for
bacterial infection is present. rate, effort, use of accessory
• Antiviral drugs such as amantadine muscles, skin color, and breath
(Symmetrel), zanamivir (Relenza) and sounds.
oseltamivir (Tamiflu) may be helpful for
high-risk patients if given within 48 hours of
exposure
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

PNEUMOTHORAX/ Partial or complete collapse of

the lungs due to accumulation
HEMOTHORAX/ of air or fluid in the pleural
HYDROTHORAX space.

ASSESSMENT FINDINGS:
• sudden sharp pain in the chest, dyspnea, diminished or absent
breath sounds on affected side, hyperresonance on percussion,
decreased vocal fremitus, tracheal deviation to opposite side
(tension pneumothorax with mediastinal shift)
• weak, rapid pulse, anxiety, diaphoresis
Study Home
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Medical Mgt. Pneumothorax

/Hydrothorax/
Nursing Mgt.
• Oxygen therapy. Hemothorax
• Chest tube placement: removes air or blood from • Bed rest to decrease need for
the pleural space so the lung can re-expand.
• Possible surgery: thoracotomy oxygen.
• Pain medications: monitor respirations • Monitor vital signs.
• If chest trauma, the doctor may place an epidural • Elevate the head of the bed:
catheter to manage pain. promotes maximum lung
• Administer anxiolytics and teach relaxation
techniques expansion, decreases work of
• If client has a tension pneumothorax, the initial breathing.
treatment of choice is to insert a large-bore
needle into the second intercostal space
midclavicular line to relieve pressure. Next, a
chest tube system is placed
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Collapse of lung tissue at any

ATELECTASIS structural level

TYPES:
PRIMARY – due to decreases surfactant factor

SECONDARY – due to airway obstruction and lung compression

RISK – post surgery, elderly, obese, bedridden, history of smoking

CAUSES – reduction in lung distention forces (pneumothorax, pleural effusion, ascites, obesity)
Localized airway obstruction (FBAO, mucus plug)
Insufficient pulmonary surfactant (RDS, inhalation anesthesia, Aspiration of Gastric contents)
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Signs and Symptoms ATELECTASIS Management

• Initially detected on CXR
• Some are asymptomatic • Treatment is directed toward
• IF significant hypoxemia occurs = the cause
dyspnea, tachypnea, tachycardia, and • Change position frequently
cyanosis • Early ambulation
• Diminished breath sounds and crackles • Deep breathing and coughing
over involved area exercise
• Fever: less than 101F (common) • Chest physiotherapy
• Oxygen therapy if with hypoxia
• Check VS and breath sounds
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Chronic Obstructive Pulmonary

COPD Disorders

TYPES:

• CHRONIC BRONCHITIS
• ASTHMA
• BRONCHIECTASIS
• EMPHYSEMA
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Inflammation of bronchus
resulting to hypertrophy or
CHRONIC hyperplasia of goblet mucous
BRONCHITIS producing cells leading to
narrowing of smaller airways.

Problem with the airway characterized by excessive mucus production,

impaired ciliary function which decreases mucus clearance.
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Predisposing Factors CHRONIC

BRONCHITIS
Signs and Symptoms
• Smoking
• Air pollution • Productive cough
• Dyspnea on exertion
• Prolonged expiratory grunt
• Anorexia and generalized body
malaise
• Scattered rales/ronchi
• Cyanosis
• Pulmonary hypertension
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

CHRONIC BRONCHITIS
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Reversible inflammatory lung

BRONCHIAL condition due to
hypersensitivity to allergens
ASTHMA leading to narrowing of smaller
airways.

Chronic inflammatory process that produces mucosal edema, mucus secretion

and airway inflammation.
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

BRONCHIAL ASTHMA
Predisposing
Factors Diagnostic
Procedures
1. Extrinsic Asthma 2. Intrinsic Asthma
(Atopic / Allergic) • Cough that is non-
(Non-Atopic / Non- productive
• Pollen Allergic) • Pulmonary Function
• Dust • Dyspnea
• Hereditary • Wheezing on
Test - Incentive
• Fumes • Drugs spirometer reveals
• Smoke expiration
• Foods • Cyanosis
decrease lung
• Gases • Food additives capacity
• Danders • Mild stress/
• Sudden change in • ABG analysis - PO2
apprehension
Predisposing • Furs temperature, air decrease
Factors • Lints • Tachycardia,
pressure and palpitations
humidity • Diaphoresis
• Physical and
emotional stress
Signs and
Symptoms
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

BRONCHIAL ASTHMA

Nursing Mgt.
• Enforce CBR
• O2 inhalation with low inflow
• Administer medication as ordered
• Force fluids
• Semi-fowler’s position
• Nebulize and suction when needed
• Provide client health teachings and
discharge planning
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Abnormal permanent dilation of

BRONCHIECTASIS bronchus leading to destruction
of muscular and elastic tissues
of alveoli.

PREDISPOSING FACTORS:
• Recurrent lower respiratory tract infections
• Chest trauma
• Congenital defects
• Related to presence of tumor
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

BRONCHIECTASIS

Signs and Symptoms

Treatment
• Productive cough Dx Procedure
• Dyspnea • Surgery
• ABG – PO2
• Cyanosis • Segmental
decrease
• Anorexia and generalized body wedge
• Bronchoscopy
malaise lobectomy
• Hemoptysis (only COPD with sign)
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Problem with the alveoli that is

characterized by a loss of alveolar
EMPHYSEMA elasticity, overdistention and
destruction;with severe gas exchange
impairment

IRREVERSIBLE TERMINAL STAGE OF COPD CHARACTERIZED BY:

• Inelasticity of alveoli
• Air trapping
• Maldistribution of gases
• Over distention of thoracic cavity
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

EMPHYSEMA
 COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

EMPHYSEMA
Nursing
Management Diagnostic
Procedures
1. Smoking
• Productive cough
2. Air pollution • Enforce CBR
• Dyspnea at rest
3. Allergy • Administer O2 via low-flow
• Administer medication as
• Prolong expiratory grunt • Pulmonary Function
4. High risk: elderly • Anorexia and generalized
ordered
body malaise
Test
5. Hereditary • High fowler’s position • ABG analysis
• Resonance to
• Force fluids
hyperresonance
• Institute pulmonary toilet
• Decrease tactile fremitus
• Nebulize and suction when
• Decrease or diminished
needed
breath sounds
Predisposing • Provide comfortable and
• Rales or ronchi
Factors humid environment
• Bronchial wheezing
• Provide high carbohydrates,
• Barrel chest
protein, calories, vitamins
• Flaring alai nares
and minerals
• Purse lip breathing
• Health teachings and
discharge planning
Signs and
Symptoms
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

Questions???