OVERVIEW By: Sir Ronie

Pathophysiology TERMS

Oxygenation • Cells- basic unit of life

• Tissues-made up of combined cells
Hypoxemia • Organs-made up of combined tissues
( O2 in blood) • Organic Hypoxia- S/sx will occur once there is an organ damage
Hypoxia Functions
( O2 in cells)
Respiratory System
Anoxia ▪ O2 (in) → ABN: O2 input → Hypoxemia → Hypoxia→ Anoxia→ Cellular Death
(Total absence of O2 in cells) ▪ Co2 (out)

Cellular death
Factors that affect the inhalation:

Systems Involved 1. OBSTRUCTIVE DISORDER

-there is an airway obstruction due to:
✓ Respiratory Mucus
✓ Cardiovascular Bronchoconstriction
✓ Hematology Foreign objects
❖ Management:
Vital Organs ✓ Mucus- DOC: mucolytics
Involved
✓ Bronchoconstriction- DOC: bronchodilators
✓ Heart ✓ Foreign objects- Heimlich maneuver
✓ Lungs ✓ LAST RESORT: INTUBATION
✓ Kidneys - is the act of inserting a tube into a bodily orifice to remove or add
fluids or air.
✓ Brain - artificial airways
*These organs reacts/gives Uses:
signal once hypoxia occurs • Endotracheal Tube (ET tube)
- is a flexible plastic tube that is placed through the nose or
*Therefore s/sx of hypoxia mouth into the trachea, or windpipe, to help a patient
are organic or in cellular breathe.
origin • Tracheostomy tube
- is a curved tube that is inserted into a tracheostomy
stoma.
• Ventilation support
VENTILATION (inhalation and exhalation) The exchange
of air between the lungs and the atmosphere so that
oxygen can be exchanged for carbon dioxide in the alveoli
(the tiny air sacs in the lungs).
help keeps oxygen flowing throughout the body by
pushing air into the lungs.
2 TYPES:
1. Manual- Bag Valve Mask (BVM/Ambu Bag)
2. Machine- Mechanical ventilator

2. INFECTIOUS DISORDER
“Viruses are self-limiting -there is an airway infection due to:
(does not replicate)
C/A: Bacteria, Virus, Fungi
therefore it can be
❖ Management:
Once c/a enters

managed by rest and

Bacteria – antibiotics (anti-infectives)
The body
it causes

increase fluid intake” Virus – antivirals (severe); key for viruses is the viral load
Fungi – rare (indicates pt. is immunocompromised); antifungal
*Get rid of the C/A or COI (chain of infection)
“First Tx of choice is to
GET RID OF THE C/A”
Inflammation
❖ Management: (anti-inflammatory)
leads to

NSAIDs-mild to moderate inflammation

Corticosteroids-moderate to severe
Obstruction
❖ Management:
❖ Mucus- DOC: mucolytics
❖ Bronchoconstriction- DOC: bronchodilators
 OVERVIEW
3. TRAUMA
A. Penetration (e.g., chest injury)
• Pain
B. Rib fracture Lung collapse Atelectasis
• bleeding
C. Blunt Trauma (Internal bleeding)

❖ Management
PAIN SCALE
Pain- (Subjective) analgesics 1-3: Mild -distractions (guided imagery), acupressure, deep breathing
- Mild-moderate (NSAIDs) 4-6: Moderate
- Moderate-Severe (Opioids) 7-10: Severe

Bleeding – Thoracostomy + 3-way Bottle System

- Thoracostomy (opening of the thorax at the mid-axillary 4th-5th intercostal area)

BOTTLES & FUNCTIONS

Bottle A: Drainage

Bottle B: Maintain negative pressure

Bottle C: Suction

Tx of Atelectasis
“Dili niya ipagawas tanang hangin inig exhale naa syay
✓ perform intubation
ipabilin para kadtong nabilin nga hangin mao toy matulod
✓ connect pt. to mechanical ventilator
pag inhale ug balik sa mechanical ventilator”
✓ PEEP (Positive End Expiratory Pressure)
-setting of mechanical ventilators done by respiratory therapist in collab with the doctor).
-Function: to reverse atelectasis
 COPD
(Chronic Obstructive Pulmonary Disorder)
Nature of the D/O:
• chronic • progressive • irreversible
- Commonly in geriatric patients-

Types of COPD

Obstructive Disorders

1. Chronic Bronchitis
2. Chronic emphysema

Others: (eliminated in the COPD category)

• Bronchiectasis
➔ Eliminated due to early death/mortality caused by: malnutrition, tuberculosis, and poor hospitalization
➔ Lifespan: 37 y.o. (Brunner & Suddarth); 30-40 y.o. (Philippines)
• Asthma
➔ reversible
• Cystic Fibrosis
➔ Eliminated because it is a multisystem d/o
• Acute bronchitis
➔ Reversible and sudden/explosive
• Acute emphysema
➔ Reversible and sudden/explosive

Infectious Disorders
Causative agents
1. Bacteria
➔ Upper respi
Junction: trachea/windpipe
➔ Lower respi

Leading cause of UPPER RESPI INFECTION:

▪ GABHS (Group A Beta Hemolytic Streptococcus)
➢ Can lead to heart disease
➢ Common in pedia
➢ Recurrent sore throat in pedia can lead to heart disease
“Antibiotics- ➢ Can become systemic
usually taken for ➢ Causes inflammation of endocardium (where heart valves located)
7 days” ➢ Results to heart valve damage
➢ Pinnacle of Heart damage is Heart Failure (HF) RANITIDINE (Zantac)
H2 Receptor Blocker → decreases production of
❖ Tx: Penicillin/Pen G (4-6 weeks)
hydrochloric acid

Leading cause of LOWER RESPI INFECTION:

Given with antibiotics to prevent gastric upset.
▪ PNEUMONIA
➢ Bacteria: PTB, Hemophilus, Staphylococcus, Acinetobacter
❖ Tx:
→ PTB – RIPES (RIPE -oral; taken 6 AM before meals for easy absorption;) (S-IM); 6 mos
→ Hemophilus: Betalactams (Cefuroxime), Azithromycin – taken for 3days
→ Staphylococcus: Methicillin, Vancomycin
Abbreviations: → Acinetobacter: if (+) in gram staining
__ -multidrug resistant bacteria; mechanical ventilation assistive pneumonia
pc → post cebum “after meals” -Meropenem, ipanemem
__
ac → ante cebum “before meals”
 2. Virus
▪ Adenovirus: common colds
▪ Coronavirus: C/A: SARS COV 2
❖ Tx:
→acyclovir
→ganciclovir
→atazanavir
→tocilizumab (1 shot is worth 6k to 10k, 3x a day)
Given to COVID pts.
→remdesivir (1 dose is worth 50k to 70k, good for 1 week)

3. Fungi (Fungal Pneumonia)

❖ Tx:
→Amphotericin B

Traumatic Disorders

PENETRATIONS:
Pneumothorax - air in thoracic cavity; Example: Stabbed wound
Hemothorax – blood in thoracic cavity; Example: Rib Fracture (flail chest)
Hydrothorax – water in thoracic cavity; Example: Penetrated under water

There will be a sucking motion because of the negative pressure.

COMPLICATIONS:

• Pleural Effusion
- increase water in pleural
- Not a primary disease
- A secondary condition to trauma, lung cancer and TB
❖ Mgt:
→Thoracentesis
- done at the back depending on the location as seen on X-ray.
- at lower costal margin
Management of COPD:
1. Bronchodilators
➔ Sympathetic drugs (SNS) → Receptors: Beta 1 (heart) and 2(lungs)
o Function of B2: dilation of smooth muscle
o Effect of bronchodilator to B1: HR

CAUTION!!!
Do not give propranolol together with bronchodilator or to patients with COPD
because it reverses the effect of the bronchodilators causing Bronchoconstriction to
B2 (lungs).

Be careful in giving to patient with HR:

FACTORS THAT COULD HR

▪ Hx of ANXIETY (mild, moderate, severe, panic)
-because it can cause palpitation
▪
CYSTIC FIBROSIS
Babies are obligatory nose breather
- Altered anion (chloride) transport -SIDS (sudden infant death syndrome)
-Genetic: Autosomal recessive -Sternocleidomastoid & trapezius muscle for
-Defect in chromosome #7 (“syetec fibrosis”) neck movement
-Sticky semen: Exocrine glands -11th cranial nerve (spinal or accessory)
-head sag phenomena (first month)

1.LUNGS
mucus plugging → prepare suction
promote breast feeding: r/f infection → PNEUMONIA Altered anion
-Found at the right side of the periodic table
2. SKIN (sweat glands) -Negatively charge
Major extracellular anion
Two types: eccrine (panit), apocrine (oily) CHLORIDE → Normal: 95-105 meq/L
sticky sweat and odorous
12 yo greatest fear in acne and body odor (hygienic prob) Major intracellular anion
SODIUM → Normal: 135-145 meq/L
3.PANCREAS (endo-exocrine gland)
secretes (Amylase-Lipase-Trypsin enzymes)
K+: 3.5-5.5 meq/L (major intracellular cation
Once fat is not absorbed: Na+: 135-145 meq/L (major intracellular anion)
• failure to thrive Extracellular (2 compartments)
• STEATORRHEA (FAT IN STOOLS) -blood
• Vitamin deficiency (water-soluble taken OD) -3rd space
Fat soluble:

• A-ABN: xeropthalmia (nigh blindness)

• D-for Ca+ absorption. ABN: bone deformities (rickets)
• E-
• K-blood coagulation

4.LIVER +GALLBLADDER
5.MALE REPRODUCTIVE GLANDS- impotence, infertility 1tsp (5 mL)

Genetic: cause of altered transport

Autosomal Recessive- 25 % sa anak
Gregor Mendel – father of modern genetics

23RD PAIR or 45th and 46th chromosome- there is problem in sex (reproductive issue)
If there is prob in 22 pairs: autosomes daghan ng prob (physical ug sulod)

Autodigestion phenomena
-inflammation of pancreas (acute pancreatitis) gi digest sa pancreas iyang cells ky dili kagawas ang ALT
-bile mo stock up sa gall bladder→cholelithiasis
-RUQ pain sharp and colicky pain radiating to the right nipple, shoulder or scapula (Kehr’s Sign)

Whipple resection (pancreaticoduodenectomy)

-surgical removal of the head of the pancreas.
-if gallstones motapot sa sphincter of oddii

Major cause of death to patient with pancreatitis is Hemorhagic shock because of bleeding
Hallmark sign of pancreatitis-
severe, excruciating pain, unrelieved by vomiting (increase pH→ Metabolic alkalosis: will end up to COMA), food, and
antacids. Located in the Epigastric area.
Bluish discoloration of the umbilicus because of bleeding (Cullen’s sign)
Bluish discoloration of the Flank area/retroperitoneal area (Grey-Turner Sign)

Management:
1.Bronchodilators
2.Mucolytics
3.Antitussives
4.O2-High flow 10-15 LPM during exacerbation non-rebreather mask (It has the highest accommodation of o2)
5.VIOKASE (Pancrealipase) artificial pancreatic enzyme. Effective when there is relief in steatorrhea. Becoz the fat in stool is already
absorbed using the pancrealipase.
6.IVTT- ADEK

Promising Mgt.
1.Pneumonectomy-removal of the entire lung
2.lobectomy-removal of a certain lobe of the lung
-needs chest tube for drainage.

POST-OP Positioning: LU-PA

Lobectomy-unaffected (side lying)
Pneumonectomy-Affected (side lying)
To allow lung expansion

Diagnostic Tests:
Sweat chloride test-To determine if there is chloride in the sweat
Chest X-ray- if there is fluid in lungs
Serum Lipase- will increase if there is presence of pancreatitis (to rule out presence of pancreatitis)
-normal: 0-160 u/L
UTZ- to diagnose gallstones

O2
Nasal prongs-1-3 LPM
Face mask- 4-8 LPM
Venturi mask- it has its own gauge COPD for
client’s safety below 10 LPM
Partial rebreather – 8-10 LPM
Non-rebreather- 10-15 LPM

LAST RESORT: INTUBATION

Bronchiectasis
(Chronic dilatation of the bronchioles)

Unknown cause→ multifactorial

Infectious
Environment
genetics

-Damaged cilia

Hallmark Sign: Layering of Sputum (different colors and character)

Rusty: damaged bronchial wall

White: sputum
Foamy
Yellow green: Infection

Dx: bronchial CT scan

Mgt:
• CPT
• Mucolytics + Bronchodilators (given first before CPT)
• Antibiotic Prophylaxis

LUNG RESECTION
1.wedge resection-pie
2.segmentectomy -half/segment of a lobe
3.lobectomy
4.pneumonectomy

Before surgery:
✓ Informed consent
✓ CP clearance
✓ Withhold→ blood thinner, anticoagulants

After surgery:
✓ Positioning
✓ A-B-C
A
• Ascertain/check if the ET tube is in place using X-ray.
• Co2 detector
• Auscultate breath sound
• Suction at bedside
Principle of suctioning:
✓ hyperoxygenate before and after suctioning
2 minutes hyperventilate using mechanical ventilator
✓ suction- during withdrawal only
-circular motion
-intermittent
-10-15 secs
✓ PNSS use to clean the suction
B
• Connect to mechanical ventilator
• Connect to BVM
C
• Check capillary refill
• Check distal pulse
• Check temp of the extremities (cold-poikilothermia)
• Check color of the extremities
• Check urine output- N: 30 mL/hr
• Check vital signs : hypo,tachy,tachy
Asthma
-reversible hyperresponsiveness and acute inflammation of the airways
-inflammation of the airways

Factors:
• Anaphylaxis/allergy (foods, meds, dust, dander, bee stings, weather)
• Hereditary
• Exercise induced
• Petrichor-induced asthma (singaw sa kalsada)

Inflammation
- mucus production
- bronchoconstriction

S/sx:
✓ cough (with or without secretions)
✓ air hunger
✓ dyspnea, S.O.B.
✓ decrease LOC
✓ wheezing
✓ Cyanosis
▪ Central-late
▪ Peripheral- early

Status Asthmaticus
-severe form of asthma with frequent episodes

Dx test:
• CBC
→ WBC→ eosinophil: ELEVATED (eosinophilia)
Eosinophil→ 1%-2%
WBC: 4,000-11,000
Histamine mediator/anti-histamine

5 WBC:
NEBML-neutrophils,eosinophil,basophil,monocyte,Lymphocytes
• X-ray
• PFM (Peak Flow Meter): measures the force of expiration

Green Yellow red

- Green-normal
- Yellow-mild to moderate asthma
- Red-severe

Incentive Spirometry-promotes deep breathing

DOC-bronchodilator
Histamine-primary chemical mediator
Leukotriene-secondary chemical mediator; 3x most potent than histamine
Severe:
- Epinephrine (long acting) -theophylline (+)toxicity (palpitation, chest pain)
- aminohylline
- Quick acting (albuterol)
Mild-moderate:
- Ipratropium
- Corticosteroids-hydrocortisone
- Theophylline
- Montelukast, Zafirlukast (Leukotriene Modifiers)- given 9 pm-extreme drowsiness
Hora Somni-hours of sleep
- Antihistamine
Sedating: hangover effect (cetirizine)
Non-sedating: Loratadine (Alerta)
 Infectious Disorders
PTB(Pulmonary Tuberculosis Bacteria)
C/A: Tubercle Bacilli (Mycobacterium Tubercle)
MOT: Airborne Droplet
Form of Pneumonia: bronchopneumonia → IP: 2-10 weeks
Complication: Pulmonary Fibrosis
Pleural Effusion

Process with (COI-Chain of Infection):

1. Infected Host
-full blown
-Active disease
2. Portal of Exit
-cough
-sneeze
3. C/A
4. Susceptible Host
-inhale: PO entry
-IP: 2-10 weeks
-Bronchopneumonia (cough, fever (low grade), fatigue, may not have hemoptysis
5. WBC activation
▪ Neutrophils
▪ Antibodies Phagocytosis
▪ macrophages

6. Granuloma Formation (scarring) Normal disappears in 6 months

7. In the middle of scar there is Ghon tubercle
8. dormant phase
9. active phase (makagawas ang infection)
-reinfection
-immunosuppression (WOF: WBC)
10. ulceration of the granuloma
11. pulmonary fibrosis (hardening of the lungs)
12. TB transmitted to bloodstream: Miliary TB (Extrapulmonary TB)

Extrapulmonary TB once it gets to the:

• Brain-encephalitis
• CNS covering- meningitis
• Bones- Pott’s Disease (causes degeneration and demineralization)
-diet high in calcium (e.g., dairy, seaweed)
• Liver-liver failure (EARLIEST SIGN: Jaundice)
• Kidneys- renal failure
• Adrenal cortex- Addison’s Disease
• Testicles –
• Lymphnodes-lymphadenopathy

HIV/AIDS
• <200 cells/mm³ (WBC count)
• Target CD4 (helper cells)
• Common to sodomy (“luvey”) because blood is the fastest way of transport.

Leading cause of Mortality:

United States: PCP
• Pneumocystic
• Carinii
• Pneumonia
Philippines
• PTB
S/sx:
C-cough; 3 weeks; productive
H-hemoptysis; blood-tinged sputum; sudden onset
A-afternoon fever (low grade fever: 37.6-37.9)
N-night sweats
A-anorexia leading to weight loss (unintentional)
K-kapoy (Fatigue secondary to hypoxia)

Diagnostic tests:
Confirmatory exams:
1.X-ray -detects presence of granuloma
2 Sputum exam- use to confirm active PTB
• AFB (Acid Fast Bacilli)
• GeneXpert test: AFB + Detects Drug Resistance

Rifampicin-daghan ng na immune ani

Nursing Consideration:
• 2 sputums exams
-Collected at 6AM & 7AM consecutively
-Container: must be sterile
Instruct patient to:
➔ Gargle with water (salt water, warm water) to minimize the contamination of the sample normal flora of
the mouth.
➔ Do not use mouthwash because it contains antiseptics (chlorhexidine).
➔ do not spit the surface saliva
➔ deep breath 3x and cough forcefully
-once obtained ihatod ang sample sa lab.
-2 hours life span

Brain threshold sa hypoxia- lethargy

Earliest s/sx- restlessness, confusion

Wernicke’s korsakoff’s psychosis

Huntington’s

Management of PTB
1.Mgt. Program: NTCP (National Tuberculosis Control Program)
2. Therapy: DOTS (Directly-Observed Treatment Shortcourse) or “Tutok Gamutan”
• given for 6 mos :
✓ 2 mos: intensive phase (R-I-P-E) + S [IM—MDR TB]
✓ 4 mos: Maintenance Phase (R-I-P/R-I)

S-only given if pt is already MDR TB

R-rifampicin (R) → S/E (expected): Red orange urine discoloration

→ A/E (report): abdominal pain, jaundice, oliguria → this indicates hepatorenal failure

hepatorenal failure (liver & kidney affected):

• Kidney Function test (indicates if the kidney is functioning well) → blood specimen
✓ Blood Urea Nitrogen (BUN) from protein→ n: 10-20 mg/dL
✓ Creatinine – most specific indicator → n: 0.6-1.2 mg/dL

Caloric Intake:
Carbs: 1gm x 4
Protein: 1gm x 4
Fats: 1 gm x 9

Duodenum-pepsin
 Amino acid→ nutrient→waste: ammonia (NH4)→ liver→urea→ kidney→urine
• Liver function Test:
Glutamic Acid (waste):
✓ SGPT/ALT :7-56 u/L
✓ SGOT/AST: 10-40 u/L
Hepatic encephalopathy-complication of liver failure
Can lead to coma
Azotemia/uremia- complication of kidney failure

HRZE old name sa RIPE sa health center ( H or INH, R for Rifampicin, Z for pyrazeenamide

I-isoniazid (H) – other name INH →S/E: numbness (Temporary) → A/E: Painful digits + paresthesia (peripheral neuritis)

Neuropathy-loss of sensation (DM)

INH-Neuritis (inflammed neurons)—mgt: give B6 (pyridoxine) or any B complex

P-pyrazenamide (Z)→ A/E: Hyperuricemia ( uric acid > 6mg/dl)

WOF: Uricosoric Drug:
✓ joints: Gouty→ tophi Zyloprim (Allopurinol),
✓ kidneys: stones (nephrolithiasis Probenecid, ulasimang
bato
Uric acid- by product of Purine -ipa-ihi ang uric acid

E-Ethambutol (E)→ A/E: Optic Neuritis (WOF: blurring vision, eye pain)→mgt: Vit. A, B complex (B1, B6, B12)

6 yo- 20/20 vision fully developed.

Do not give ethambutol to pt <6yo.--> becoz dili mabantayan ang early sign of optic neuritis or blurring of vision ky dili
sab ka verbalize ang mga bata.

B1-thiamine
B2-riboflavin
B6-pyridoxine
B12-cyanocobalamine

DOTS- oral (Red-orange tablet)→ FixCom4 (RIPE/HRZE), Quadtab → 6 AM → after 2-3 weeks of taking DOTS continuous
pt. is not contagious anymore.

Isoniazid-prophylactic medication 4-6 months

If TB is MDR diri na ang IM injections or the Streptomycin/vancomycin/ (Amino glycosides) A/E: damages organs in bean-
shaped organs which are the:
• Kidneys: WOF: urine output, KFT ( BUN, crea)
• Ears: hearing loss, tinnitus (ototoxic)
TYPES OF PNEUMONIA BASES ON LOCATION:
Pneumonia -inflammation of lung parenchyma
• Bronchi, bronchioles – broncho pneumonia
• Alveoli- alveolar pneumonia
• Pleura-pleural pneumonia
Causes of Pneumonia:
• Bacteria – staphylococcus, strep, acinetobacter, pseudomonas
• Viral-
• Fungal- immunocompromised pts.

Diagnotic Exams:
• Chest X-ray
• Sputum exam → GSCS (for bacteria only)
✓ Gram Staining- to determine tx;
✓ Culture & Sensitivity- to determine C/A and resistance of a certain bacteria
• ELISA- Enzyme-Linked immunosorbent assay → SCREENING TEST
✓ Antibodies
• PCR- polymerase chain reaction → CONFIMATORY FOR VIRAL PNEUMONIA
• For covid RTPCR (Reverse Transcriptase Polemerase Chain Reaction) – CONFIRMATORY TEST FOR COVID
• Western Blot – CONFIRMATORY TEST FOR HIV
• Bronchoscopy
• CBC
✓ Neutrophils: Bacterial
✓ T Lymphocytes: Viral
✓ Monocytes: fungal infection

Bronchopneumonia
1. If the cough sputum is:
• Rusty: Bacterial
• Greenish: streptococcus, staph
• Yellowish: acinitobacter, pseudomonas

o If the sputum is pink frothy sputum (hallmark sign): pulmonary edema (Manifest in Heart and respiratory
Failure)
o If the sputum is red (hemoptysis): PTB
o If the sputum is whitish, sticky (dry cough)→ virus
o If the sputum is greenish: fungal
o If the cough (sputum) is mucoid: allergy, itchy

2. Low-grade fever
3. Night sweats
4. Mild chest tightness
5. Adventitious Sounds:
• crackles (popping sound during inspiration – ky ang hangin mo bangga sa sputum)
✓ Course crackles- early inspiration
6. Rhonhi

Alveolar Pneumonia
1. Cough
2. High-grade fever
3. Chest pain after coughing
4. Adventitious Sounds (Fine crackles- late inspiration)
5. Rhonchi
6. Chest retractions
7. See-saw-respiration (chest indrawing) → happens when there is retractions

Pleural Pneumonia
1. Cough
2. High-grade fever
 3. Sharp chest pain: worsen during inspiration
4. Pleurisy- if this is presence there will be:
✓ Friction: friction rub→ harsh grating sound like rubbing your hair together (High pitch). Auscultate
using diagphram.

Pericardial friction rub-heart

Pleural friction rub- lungs

According to Acquisition:
CAP (Community Acquired Pneumonia)

HAP (Hospital Acquired Pneumonia) or Nosocomial pneumonia

✓ occurs after 48-72 hours of hospitalization
✓ ventilator-assisted pneumonia
✓ there should be no respi sx upon admission

Tx of pneumonia:
1.Antibacterials- Penicillins/Pen G, Methicillin→ Class: Cephalosphorins S/E: tinnitus (sensorineural)
-Class: Fluroquinolones – best for pts w/ cardiac problems ; ciprofloxacin, ofloxacin
-Betalactams (IVTT): Cefuroxime, cefixime
-Aminoglycosides: “mycin”→ gentamycin, azithromycin
-First-Line of Drugs in the Community: amoxicillin, cotrimoxazole

Staphylococcus- DOC: Cephalosporins (methicillin, penicillin)

-once evolve becomes:
• MRSA (methicillin-resistant staphylococcus aureus)
❖ DOC: Aminoglycoside: Vancomycin
• VRSA (vancomycin resistant staphylococcus aureus)
❖ Trimethoprim-sulfamethoxazole (TMP-SMZ)/ Cotrimoxazole
Antibacterial + If IVTT (give H2 Blocker)
✓ Ranitidine- common S/E drowsiness
✓ Cimetidine : most cheapest but have lots of S/E
✓ Famotidine : S/E, D-D interaction

BID-8am-6pm
TID-8am-1pm-6pm

4. Antivirals
5. Antifungals
6. Mucolytics
7. Antitussives
8. Bronchodilator
9. Hydrocortisone (steroids)

Pneumothorax
✓ presence of air in the thoracic cavity pleural cavity-outside
✓ enclosed- negative pressure visceral cavity- inside
✓ once there is an opening there will be a vacuum/sucking effect
Dx test: X-ray

A. Open pneumothorax
-puncture injuries, penetration (sucking-chest wound)
-it will result to an air in the thoracic cavity.
-S/sx: dyspnea, air hunger, feeling of impending doom, restlessness, shortness of breath
-Mgt. cover using anything (community), vaselinized gauze (gauze soaked in PNSS) -hospital

B. Close pneumothorax
-it will result to an air in the thoracic cavity, which could pressure on the thoracic cavity, and tension on
the thoracic cavity called TENSION PNEUMOTHORAX (mediastinal shift- organs will be pushed to the unaffected
side)
TENSION PNEUMOTHORAX:
✓ Mediastinal Shift:
✓ lung collapse
 ✓ D.O.B, air hunger
✓ PMI/Apex→ Left 5th ICS MCL
Change in position
✓ tracheal deviation
✓ absence of breath sound
✓ percussion: hyperresonance to tympany (there is amount of air in the lungs) same as chronic emphysema,
pneumothorax
✓
-caused by:
• Rupture of bleb
• Central line insertion-subclavian vein
• Thoracentesis-(tripod/orthopneic) presence of lung puncture
-Mgt: giving antitussive and instruct not to cough forcefully
• Flail chest- rib fracture

MGT:
Thoracostomy- surgical opening of thoracic cavity
3-way bottle system:

Bottle A: Drainage Bottle/Drainage chamber

• n: 100 mL/hr for the first 2 hrs & gradually decreasing in
amount
• bright red:24 hours
• active bleeding > 24 hours bright red bleeding
Bottle B: Water Seal Bottle/ Chamber
• 20 ml water
• Fxn: to maintain the negative pressure of the thoracic cavity
• N: bubbling/ oscillations (rise and fall of water) during inhalation; intermittent
• If continuous: air leak
• If absence of bubbling:
1. Obstruction- due to kinks (unkink) or clots (refer to doctor: milk the clot towards the bottle
2.lung re-expansion – naulian na and pt; (+) breath sounds; to CONFIRM: X-ray

Bottle C: Suction Bottle

• Low and continuous suctioning → 20mmHg

Things at Bedside:
1.Vaselinized Gauze (if natangtang sa patient nga part)
2. clamps (If natangtang sa bottle)
✓ RULE: do not clamp for more than 30 minutes: becoz PROLONG clamping can lead to tension pneumothorax
✓ Extra bottle w/ NSS

Procedure if nabuak: clamp, transfer to extra bottle, document

MED MGT:
1. Pain medication-to prevent respiratory acidosis
2. If severe injury: provide artificial airway and connect to mechanical ventilator

REMOVAL of CHEST TUBE:

-Instruct to take a deep breath and slowly exhale while the doctor removes the tube
-palpate site for HALLMARK: crepitus (crackling sensation) – presence of air inside the skin (Subcutaneous Emphysema)
assure pt that it will resolved in days to weeks.