RESPIRATORY DISORDERS

I. RESPIRATORY DISORDERS COMMON

AMONG NEONATES
CHOANAL ATRESIA

• Atresia
• Congenital absence or abnormal narrowing of a body opening
• Choana
• A funnel – shaped opening, particularly either of the openings between the nasal cavity and
the pharynx
• Signs and Symptoms
• Respiratory distress at birth
• They are quite for the first time and attempt to breathe through the nose
• Infant struggle and become cyanotic at feedings
• Simultaneously or difficulty feeding
• Danger signs:
• Persistent cry and difficult breathing*
Medical-Surgical management

• Medical management
• oral airway insertion*

• Surgical management
• For bilateral atresia
• - Local piercing of the obstruction membrane
• Surgical removal of the bony growth
INFANT RESPIRATORY DISTRESS SYNDROME (IRDS)
• A hyaline – like membrane lines the terminal bronchioles, alveolar
ducts and alveoli, preventing the exchange of oxygen and carbon
dioxide
• Clinical manifestations
• Nasal flaring
• Expiratory grunting
• Tachypnea or more than 60 bpm
• Sternal and substernal retractions
• Fine crackles and diminished breath sounds
• Respiratory acidocis
• Hypothermia
Diagnostic evaluation
•ABG analysis
•Chest X-rays
Nursing diagnosis
• Impaired gas exchange
• Ineffective tissue perfusion (cardiopulmonary)
• Ineffective infant feeding pattern
• Risk for impaired parent or infant attachment
Nursing care
• Assess cardiovascular, respiratory, and neurologic status
• Monitor continuous electrocardiography and vital signs
• Initiate and maintain ventilator support status
• Administer medications including endoctracheal surfactant, as
prescribed
• Initiate and maintain I.V. therapy
• Provide adequate nutrition through enteral feedings, if possible, or
TPN
• Maintain thermoregulation
• Obtain blood samples as necessary
SIDS/SUDDEN INFANT DEATH/CRIB DEATH

• Possible causes:
• Abnormality in the control of ventilation causing
prolong apneic period with profound hypoxia and
arrhythmias
• Immature respiratory system & respiratory function
• Sleep in prone position
 Clinical manifestation
• Sudden, unexplained death of an infant under 1 year of
age
• Death takes place during sleep without noise or struggle
• Parents or caregivers usually discover that the child has
died in her sleep
• Frothy, blood – tinged fluid fills the infan’ts mouth and
nostrils
• The infant maybe lying in secretions
• The diaper is filled with the urine and stool
Diagnostic evaluation
• Autopsy
• Is the only way to diagnoses SIDS
• Autopsy findings indicate pulmonary edema intra
thoracic
• Petechiae or hemorrhage and other minor changes
suggesting chronic hypoxia
 Nursing management

• Avoid implying wrong doing, abuse, or neglect

• Evaluate family coping and grieving patterns
• Provide anticipatory guidance for typical feelings
• Allow the parents verbalize, listen and validate feelings
• Be non-judgmental about parent’s attempts at resuscitation
Nursing management

• Support parents
• Refer family for counseling, if needed
• Refer to community self – help group
• Monitor infant at risk for apnea
• Teach parent how to minimize the risk of SIDS
II. INFANT AND CHILD
 CROUP
• a general term referring
to a group of disease
involving inflammation of
the larynx, trachea and
major bronchi
CROUP

•Two forms of croup

1. Acute LTB
(laryngotracheobronchitis)
2. Spasmodic croup or laryngitis
Clinical manifestations
• Acute LTB
• Gradual onset*
• Hoarseness
• Inspiratory stridor, retractions
• Low – grade fever (possible)
• Restlessness and irritability
• Pallor/ cyanosis
• Wheezing, rales, ronchi, and localized areas of
diminished breath sounds
CLINICAL MANIFESTATIONS

• Spasmodic croup
• s/s similar to acute LTB, but the child is:
• Afebrile
• onset is sudden
• child is awakened at night with bark like cough,
brassy cough (“seal bark cough”)
DIAGNOSTIC EVALUATION

• Throat cultures
• Laryngoscopy
• Neck X-ray
MEDICAL MANAGEMENT

• Cool humidification during sleep with a cool mist

tent or humidifier
• Inhaled epinephrine and corticosteroids*
• Tracheostomy
• Oxygen administration
• Drug Therapy Options
• Antipyretic*
• Inhaled epinephrine*
• Cortiscosteroid*
NURSING MANAGEMENT

• Assessment
• Assess respiratory and cardiovascular
status
• Note color, respiratory effort evidence of
fatigue
• Monitor vital signs* and pulse oximetry
Nursing diagnoses

• Impaired gas exchange

• Ineffective breathing pattern
• Ineffective airway clearance
• Risk for imbalanced fluid volume
• Anxiety
Implementation
• Assess airway obstruction by evaluating respiratory status
• Keep emergency equipment*
• Administer oxygen therapy and maintain the child in cool mist
tent, if needed
• Administer medications as ordered, and note effectiveness to
maintain or improve child’s condition
• Promote desired fluid’s intake
• Provide emotional support for the parents to decrease anxiety
 Implementation
• Provide age – appropriate act for the child confine to mist tent to
ease anxiety
• Monitor for rebound obstruction when administering racemic
epinephrine
• Provide child & family teaching
• When the child’s awakens with a bark like cough, tell them to place the
child in the bathroom and run hot water
• Instruct the parent’s to stay in the bathroom with the child to prevent
accidental injury
• change the clothing frequently and bedding
BRONCHIOLITIS
•An infection of the
lower respiratory
tract (bronchioles),
produces
inflammation
obstruction by thick
mucus and edema.
CLINICAL MANIFESTATION
• Atelectasis
• Tachypnea*
• Dyspnea
• Sternal retractions, wheezing, crackles, rhonchi on auscultations, thick mucus
• Signs of a mild upper respiratory infection, such as nasal drainage or pharyngitis
• Lower grade fever- 101F- 102F (38.3C – 38.93C)
• Sneezing, dry and persistent cough
• Air hunger, cyanosis, anorexia
• Signs of otitis media
• Apprehensive, irritable and restless
• Dehydration
DIAGNOSTIC EVALUATION

• Clinical findings
• Bronchial mucus culture
-Shows RSV
MEDICAL MANAGEMENT

• Provide cool mist tent humidification

• Administer humidified oxygen therapy
• Administer and maintain I.V. therapy
• Drug therapy options
• Bronchodilator *
• RSV immune globulin (I.V.)
NURSING MANAGEMENT
• Monitor vital signs and pulse oximetry
• Assess respiratory and cardiovascular status
• Early signs of respiratory distress, Anxiety, dyspnea, restlessness, tachypnea
• Use gloves, gowns aseptic hand washing as secretion precautions
• Administer physiotherapy after edema has abated

• Nursing diagnoses
• Impaired gas exchange
• Ineffective breathing pattern r/t mucus accumulation and respiratory tract
edema
• Ineffective airway clearance r/t increase tracheobronchial secretions
TONSILITIS/ADENOIDITIS
• is the term commonly use to refer to infection
and inflammation of the palatine tonsils
• CLINICAL MANIFESTATIONS
• Mouth breathing/ difficulty breathing
• Frequent sore throat
• Anorexia, decrease growth velocity
• Low – grade fever
• Obstruction to swallowing
• Nasal or muffled voice
• Night cough
• Offensive or foul odor
DIAGNOSTIC EVALUATION

• Ears, nose and throat exam & appropriate

cultures
• Pre – operative blood studies
• CBC
Medical management
• Bacterial tonsillitis
• Appropriate antibiotics is given
• Penicillin/azithromycin*
• Viral tonsillitis
• No therapy other than comfort or fever
reduction strategies
Surgical management

• Tonsillectomy
• Adenoidectomy
Nursing intervention

• Reducing fear
• Relieving parental anxiety
• Maintaining adequate food volume
• Promoting effective airway clearance
CYSTIC FIBROSIS
• Is a generalized dysfunction of the exocrine
glands that affects multiple organ system
• Is a generalized multisystem disorder affecting
the exocrine glands so the substances the secrete
are abdominally viscous, affecting primarily
pulmonary and G. I. function
CLINICAL MANIFESTATIONS
• Bulky, greasy foul – smelling stool that contain undigested food
• Distended abdomen and thin arms and legs from steatorrhea or partial or
complete intestinal obstruction
• Thick intestinal secretions
• Meconium ileum in the new born (earliest sign)
• Salty taste on the child’s skin
• Sweat that contains 2-5 times the normal levels of sodium and chloride
• Voracious/increase appetite
• Obstruction of pancreatic ducts
• Rectal prolapse
DIAGNOSTIC EVALUATION
• Chest X-ray
• Sweat chloride test
• Stool specimen analysis
• Pulmonary function studies ( after 4 y.o.)
• Prenatal diagnostic tests
Medical management
• CPT
• Postural drainage
• Coughing and DBE
• Broncho-pulmonary lavage
• Administer pancreatic enzymes with meals and snacks
• Provide zinc and iron supplements and water – soluble and fat
soluble vitamins
• Provide high calorie, high protein foods with added food salt and
salt intake
Drug Therapy
• Mucolytic (domase alfa) [pulmozymel]
• Bronchodilator
• Antibiotic nebulizer inhalation
• I.V. antibiotics
• Oral pancreatic enzymes replacement with
pancrealipase (pancrease)
Surgical management
• Lobectomy
• Resection of sympatomatic lobar
bronchiectasis to retard progression of
lesion to total lung capacity
Nursing care
• Assess respiratory and cardiovascular status
• Monitor vital signs and I&O
• Monitor pulse oximetry
• Encourage physical activity
• Teach parent to have a thorough
understanding of dietary regimen and
special needs for calories, fat and vitamins
RESPIRATORY DISORDERS
COMMON AMONG ADOLESCENT &
YOUNG ADULTS
 FRACTURE OF THE NOSE/ NASAL FRACTURE
• Septal dislocation/fracture due to minor trauma the most
common facial fracture and third common fracture of the
skeleton overall.
• CLINICAL MANIFESTATION
• Nose pain
• Swelling of the nose.
• A crooked or bent appearance.
• Bruising around the nose or eyes.
• A runny nose or nosebleed.
• A grating sound or feeling when the nose is touched or rubbed.
• Blocked nasal passages.
Diagnostic Evaluation

• Physical exam
• Axial and Coronal CT scan
SURGICAL MANAGEMENT

• Rhinoplasty*
• Closed reduction
• Open reduction
DEVIATED SEPTUM*
• Is an abnormal configuration of the cartilage
that divides the sides of nasal cavity, which
may cause problem with proper with
breathing or nasal discharge.
CLINICAL MANIFESTATION

• Nosebleeds
• Sinus infections or sinusitis
• Postnasal drip*
• Loud breathing in children
• Nasal congestion
• Pain in the face
Surgical management

• Septoplasty
• surgery to correct a deviated nasal septum*
 NASAL POLYPS

• The end product of the ongoing inflammation that may result from viral or
bacterial infections, from allergies or from an immune system response to
fungus.

• CLINICAL MANIFESTATIONS
• Difficulty breathing/mouth breathing
• Runny nose
• Persistent stuffiness
• Chronic sinus infections
• Loss or diminishment of your sense of smell
• Dull headaches
• Snoring
MEDICAL MANAGEMENT
• DRUG THERAPY
• Oral corticosteroids or corticosteroid nasal spray
• Fluticasone ( Flonase)
• Triancinolone ( Nasacort)
• Budisonide (rhinocort)
• Medications to control allergies or infections
• Antifungal medications

• SURGICAL MANAGEMENT
• Polypectomy
• Endoscopic sinus surgery
RHINITIS/RHINOSINUSITIS

• Is an inflammation of nasal mucusa

• TYPES
• Acute rhinitis/common colds/coryza
• Allergic rhinitis
• Non-allergic rhinitis
• Drug induce rhinitis
• Vasomotor rhinitis
• Rhinitis of pregnancy
CLINICAL MANIFESTATION

• Hypersecretion or increase nasal drainage

• Nasal obstruction symptoms – nasal
congestion stuffiness or paroxysmal sneezing
• Headache
MEDICAL MANAGEMENT

• 1. Treatment of underline cause

• Allergy – anti – histamines
• Infection or acute rhinitis
• supportive care for viral
• antibiotics for bacterial
• 2. Topical decongestants (for short – term use)
• 3. Intranasal corticosteroids
NURSING INTERVENTIONS

• Avoid irritating inhalants

• Do not overused topical nasal sprays or drops
• Don’t blow nose to frequently or too hard
• Blow through both nostrils at the same time
• Side effect of systemic decongestant is stimulation of SNS
• Intranasal corticosteroids do not cause significant systemic
absorption
PHARYNGITIS/SORE THROAT

• Is an inflammation of the pharynx including

palate, tonsils and posterior wall of the pharynx.

• 3 FORMS
• Acute bacterial pharyngitis
• Viral pharyngitis
• Chronic pharyngitis
CLINICAL MANIFESTATION

• Throat soreness and dryness

• Pain on swallowing*
• Fever
• Cough
• Mild to severe redness of the throat*
• Nasal discharge
• Lymph node enlargement in the neck
MEDICAL MANAGEMENT

• For streptococcal pharyngitis, penicillin V 25 mg

qid orally, for penicillin G benzatine (Bicillin) in a
single intramuscular dose of 2.4 million units
• Erythromycin for patient who is allergic to
penicillin
• Other penicillin, macrolides, and cephalosporin
are also used
NURSING INTERVENTIONS & PATIENT EDUCATION

• Advise patient to have any sore throat with fever

evaluated & encouraged compliance with full course of
antibiotic therapy
• Lukewarm saline gargles and use of
antipyretic/analgesics as directed
• Encourage bed rest with increased fluid intake during
fever
• Inform the patient of good hand washing
LARYNGITIS
• Is an inflammation of the mucus membranes lining the
larynx and may/ may not include edema of the vocal
cords

• CLINICAL MANIFESTATIONS
• Hoarseness of voice
• Dry cough
• Difficulty in swallowing
• Complete but temporary voice loss* may occur
DIAGNOSTIC EVALUATION

• Laryngeal mirror
• X-ray
• Computed tomography
• Fiber trophic laryngoscopic exam
MEDICAL MANAGEMENT

• Antibiotic is prescribed if a bacterial

infection is suspected
• In severe cases, systemic steroids (methyl
prednisolone[Medrol])
• Supplemental humidification
• Mucolytic agents may also prescribed
 NURSING MANAGEMENT*

• 1. Treatment consist of voice rest, steam inhalations, increase

fluid, throat lozenges
• 2. Inform the client and the family about the relief measures,
infection prevention, in avoidance of tobacco and alcohol and
pollutants
• 3. Preventive therapy is aimed toward increasing the client’s and
family’s awareness of the hazards of tobacco and alcohol use.
• 4. Long term voice retraining may be necessary if improper use or
overuse of the voice is the main cause
SINUSITIS
• Inflammation of the sinuses.*

• CLINICAL MANIFESTATION
• Acute sinusitis
• Pain*
• Nasal congestion and discharges
• Anosmia*
• Red and edematous nasal mucosa
• Fever
•Chronic sinusitis
• Persistent nasal obstruction, chronic nasal
discharge, clear or purulent discharge
• Cough*
• Feelings of facial fullness/pressure
• Headache
• Fatigue
DIAGNOSTIC EVALUATION

• Sinus X-rays and CT scan

• Antral puncture and lavage
• Nasal sinus endoscopy
MEDICAL MANAGEMENT
• Topical decongestant spray or drops/systemic decongestant
• Topical nasal corticosteroids
• Antibiotic:
• Trimethoprim – sulfamethoxazole (Bactrim)
• Penicillinase – resistant penicillins
• Cephalosporins or macrolide antibiotics
• Analgesics
• Warm compresses, cool vapor humidity for comfort
SURGICAL MANAGEMENT

• Functional endoscopic sinus surgery (FESS)

• Caldwell LUC procedure (radical antrum surgery)
• External sphenoethmoidectomy
NURSING MANAGEMENT

• Maintaining a patent airway

• Promoting comfort
• Promoting communication
• Encouraging fluid intake
 ACUTE BRONCHITIS
• Is an infection of the lower respiratory tract
that is generally an acute sequel to an URTI

•Chronic bronchitis*
• a productive cough lasting at least 3 months
and occurring for 2 consecutive years
CLINICAL MANIFESTATION

• Dyspnea, fever, tachypnea

• Productive cough, clear to purulent sputum
• Pleuritic chest pain, occasionally
• Diffuse rhonchi and crackles heard on auscultation
DIAGNOSTIC EVALUATION

• Chest X-ray
• No evidence of infiltrates or consolidation
• Sputum culture
• Bronchoscopy
MEDICAL MANAGEMENT

• Antibiotic therapy for 7-10 days

• Hydration and humidification
• Secretion clearance interventions*
• Bronchodilators*
NURSING INTERVENTION

• Establishing effective airway clearance

• Administer or teach self – administration of antibiotics as
ordered
• Encourage mobilizations of secretions, though hydration
• Educate patient that beverages with caffeine or alcohol
should be avoided
• Teach self – administration of inhaled bronchodilators
LEGIONAIRE’S DISEASE
• Is an acute bronchopneumonia, an inflammation of the lungs, that
begins in the terminal bronchioles*
• CLINICAL MANIFESTATION
• Cough that’s initially non productive but that can eventually be productive
• Grayish, nonpurulent, blood – streaked sputum
• High fever, recurrent chills
• Malaise, generalized weakness
• Headache, diffuse myalgias
• Anorexia, diarrhea
• Chest pain, tachypnea
• Respiratory distress
DIAGNOSTIC EVALUATION

• Blood tests
• Chest X-ray
• Direct immunoflourescence of L. pneumophilia
and indirect fluorescent serum antibody testing
• Sputum test
MEDICAL MANAGEMENT
• Oxygen therapy*
• Drug therapy options
• Antibiotic
• Erythromycin (erythrocin)
• Rifampin (rifadin)
• Tetracycline ( achromycin)
• Antipyretic
• Acetamenophin (Tylenol)
• Aspirin
• Inotropic agent
• Dopamine ( intropin)
NURSING MANAGEMENT
• Closely monitor the client’s respiratory status
continually, v/s, pulse oximetry or ABG values, LOC, and
dryness and color of the lips and mucus membranes
watch for signs of shock
• Keep the client comfortable*
• Provide mouth care frequently
• Replace fluids and electrolytes as needed
• Provide mechanical ventilation and other respiratory
therapy
• Give antibiotics as necessary
PULMONARY EMBOLISM INFARCTION

• Refer to obstruction of one or more pulmonary

arteries by thrombus
• necrosis of lung tissue that can result from
interference with blood supply

•ETIOLOGY
• THROMBUS
CLINICAL MANIFESTATIONS
• Dyspnea, pleuritic pain, tachypnea, apprehension
• chest pain with apprehension & a sense of impending
doomed occurs when most of the pulmonary artery is
obstructed
• Cyanosis, tachyarrhythmias, syncope, circulatory collapse,
and possibly deaths encountered in patients with massive
pulmonary embolism subtle deterioration in patients
conditions with no explainable cause pleural friction rub
DIAGNOSTIC EVALUATION

• ABG’s
• Chest X-ray
• Ventilation – perfusion lung scan
 MEDICAL MANAGEMENT
• Oxygen*
• An infusion is started to open an I.V. route for drugs/fluids
• Vassopressors, inotropic agents such dopamine (intropin) &
or antidysrhythmic agents
• ECG is monitored continuously for right ventricular failure,
may have a rapid onset
• Small doses of I.V. morphine*
MEDICAL MANAGEMENT

• Pulmonary angiography, hemodynamic measurements,

ABG determinations, and other studies are carried out
• Subsequent management – anticoagulation and
thrombolysis:
• I.V. heparin
• Oral anticoagulation with warfarin (Coumadin)
• Thrombolytic agents- streptokinase (streptase)
• Newer clot specific thrombolytics
SURGICAL MANAGEMENT

• Interruption of vena cava

• Embolectomy
•*
NURSING INTERVENTIONS:

• Correcting breathing pattern

• Improving tissue perfusion
• Relieving pain
• Reducing anxiety
CHEST TRAUMA/INJURIES
 1. PNEUMOTHORAX
• Air in the pleural space occurring spontaneously after a
trauma
• Result of laceration to the lung parenchyma
tracheobronchial tree, or esophagus

• CLASSIFICATION
• Spontaneous pneumothorax
• Open pneumothorax
• Tension pneumothorax
CLINICAL MANIFESTATION
• Hyperesonance, diminished breath sounds
• Reduced mobility of affected half of thorax
• Tracheal deviation away from effected side in tension
pneumothorax
• Clinical picture of open or tension pneumothorax
• Air hunger, agitation, hypotension, cyanosis
• Mild to moderate dyspnea and discomfort may be present
with spontaneous pneumothorax
DIAGNOSTIC EVALUATION
•Chest X-ray
MEDICAL MANAGEMENT

• 1. Spontaneous pneumothorax:
• Non – operative if non extensive
• Observe and allow for spontaneous resolution
• Needle aspiration or chest tube drainage
• 2. Tension pneumothorax
• Close the chest wound immediately
• Chest tube is inserted and water – seal drainage set up
SUGICAL MANAGEMENT
• Pleurodesis
• Thoracotomy

• COMPLICATIONS
• Acute respiratory failure
• Cardiovascular collapse
NURSING INTERVENTIONS
• 1. Achieving effective breathing pattern
• Provide emergency care as indicated
• Apply petroleum gauze to sucking chest wound
• Assist with emergency thoracentesis or thoracotomy
• Be prepared to performed CPR or administered
medication if cardiovascular collapse occur
• Maintain patent airway, suction needed
• Position upright if condition permits
• Maintain patency of chest tubes
• Assist patient to splint chest while turning or
coughing and administer pain medication as needed
NURSING INTERVENTIONS

• 2. Resolving impaired gas exchange

• Encourage patient in the used of inspiratory
spirometer
• Monitor oximetry and ABG’s to determine oxygenation
• Provide oxygen as needed
 2. Rib fracture
• Most common chest injury
• May interfere with ventilation and may lacerate underlying
lung

• CLINICAL MANIFESTATION
• Pain fracture site
• Painful, shallow respirations
• Localized tenderness and crepitus (crackling) over fracture site
3. Hemothorax
• Blood in the pleural space as result of penetrating
or blunt chest trauma*

• CLINICAL MANIFESTATION
• Dyspneic, apprehensive, or in shock
4. Flail chest
• Loss of stability of chest wall as a result of multiple rib
fractures, or combined rib & sternum fractures
• one portion of the chest has lost its bony connection to the
rest of the rib cage
• During respiration, the detached part of the chest will be
pulled in on inspiration and blown out on expiration
(paradoxical movement).
• CLINICAL MANIFESTATION
• Dyspnea and cyanosis
• Lung effusion, lung laceration
 5. Pulmonary contusion
• Bruise of the lung parenchyma that results in leakage of
blood, edema & fluid into the alveolar and interstitial
spaces of the lung*
• CLINICAL MANIFESTATION
• Tachypnea, tachycardia
• Crackles on auscultation
• Pleuritic chest pain
• Copious secretions
• Cough – constant, loose, rattling
6. Cardiac Tamponade
• Compression of the heart as a result of accumulation of fluid within
the pericardial space
• Caused by penetrating injuries

• CLINICAL MANIFESTATIONFalling BP
• Distented neck veins, elevated CVP
• Muffled heart sounds
• Pulsus paradoxus*
• Dyspnea, cyanosis, shock
MEDICAL & SURGICAL MANAGEMENT for
Chest Trauma

• The goal is to restore normal cardio –

respiratory function as quickly as possible.
MEDICAL & SURGICAL MANAGEMENT for
Chest Trauma

• Rib fracture
• Give analgesics
• Encourage deep breathing
• Assess with intercostal nerve block
• For multiple rib fractures, epidural anesthesia may be
used
MEDICAL & SURGICAL MANAGEMENT for
Chest Trauma

• Hemothorax
• Assist with thoracentesis
• Assist with test tube insertion and set up drainage
system
• Auscultate lungs and monitor for relief of dyspnea
• Monitor amount of blood loss in drainage
• Replace volume with I.V. fluids or blood products
MEDICAL & SURGICAL MANAGEMENT for
Chest Trauma

• Flail chest
• Stabilize the flail portion of the chest with hands
• Thoracic epidural analgesics may be used
• If respiratory failure is present, prepare for
immediate endotracheal intubations and mechanic
ventilation
• Prepare for operative stabilization of chest wall in
select patients
MEDICAL & SURGICAL MANAGEMENT for
Chest Trauma

• Cardiac tamponade
• For penetrating injuries
• Assist with pericardiocentesis
• Prepare thoracotomy to control bleeding and to repair
cardiac injury
NURSING RESPONSIBLITIES FOR CHEST
TRUAMA
• Suction as indicated through nose or mouth or endotracheal tube
• Prepare for tracheostomy
• Secure one or more I.V. lines for fluid replacement, and obtain
blood for baselines studies
• Monitor CVP readings. ABG/SpO2
• Obtain urinary output hourly
• Continue to monitor thoracic drainage to provide information about
rate of blood loss. Whether bleeding has stopped, whether surgical
Chest Tube Thoracostomy (CTT)
CHRONIC OBSTRUCTIVE
PULMONARY DISEASEs
(COPD’S)
 A. Emphysema
• Enlargement and destruction
of the alveolar, bronchial and
bronchiolar tissue
• Caused by smoking,
infection, inhaled irritants,
heredity, allergic factors,
aging, deficiency of alpha 1 –
antitrypsin
 Signs and symptoms:
• Anorexia, fatigue, weight loss
• Feeling of breathless, cough, sputum production, flaring of
the nostrils, use of accessory muscles for breathing,
increased rate & depth of breathing, dyspnea, barrel chest
• Decreased respiratory excursion, resonance to
hyperresonance, decreased breath sounds with prolonged
expiration, normal -decreased tactile fremitus, pursed-lip
breathing
• pCO2 elevated or normal, pO2 normal or slightly decreased
 B. Chronic bronchitis
• Excessive production of
mucus in the bronchi with
accompanying persistent
cough
• Caused by cigarette
smoking, infection, inhaled
irritants, hereditary, allergic
factors, aging
 Signs and symptoms

• Productive (copious) cough, dyspnea on exertion, use of

accessory muscles for respiration, wheezing and rhonchi
• Feeling of epigastric fullness, slight cyanosis, distended
neck veins, ankle edema
• Increased pCO2, decreased pO2
• Finger clubbing later in the disease, weight gain, edema,
jugular venous distention
 C. Bronchiectasis
• Chronic abnormal dilation of
the bronchi with destruction of
muscular elastic structure of
the bronchial wall
• Caused by bacterial infection,
congenital defects, tenacious
secretions, obstruction of
bronchi, foreign bodies
 Signs and Symptoms
• Chronic cough that produces copious, foul – smelling, mucopurulent
secretions, possibly totaling several capfuls daily
• Coarse crackles during inspiration over involved lobes or segments
• Dyspnea
• Occasional wheezes
• Sinusitis
• Weight loss
• Finger clubbing
• Recurrent fever and bouts of pulmonary infection
COPD Complications
• Respiratory failure
• Pneumonia, overwhelming respiratory infection
• Right heart failure, dysrhythmias
• Depression
• Skeletal muscle dysfunction
Diagnostic evaluation
• Chronic Bronchitis and Emphysema
• PFT demonstrate airflow obstruction
• ABG’s – decreased PaO2, pH and increased CO2
• Chest X-ray – in late stages, hyperinflation, flattened
diaphragm, increased retrosternal space, decreased
vascular markings
• Alpha 1 – antritypsin assay useful in identifying
genetically determined deficiency in emphysema
Diagnostic evaluation
• Bronchiectasis
• Bronchoscopy
• Chest X-ray
• CBC
• PFT
• Sputum culture and Gram stain
NURSING CARE FOR COPD
• Low concentration of oxygen (2-3 L/min)
• Monitor pulse oximetry
• Provide respiratory treatments and chest physiotherapy
• Diaphragmatic or abdominal and pursed – lip breathing
technique
• Record the color, amount and consistency of sputum
• Suction the client
• Monitor weight
 NURSING CARE FOR COPD
• Encourage small, frequent meals
• High calorie, high protein diet with supplements
• Encourage fluids up to 3000 ml/day
• High - Fowler’s and lean forward
• Allow activity as tolerated
• Administer bronchodilators, corticosteroids, and
antibiotic, mucolytic as prescribed
 PULMONARY HEART DISEASE (COR
PULMONALE)

• An alteration in the structure or function of the

right ventricle resulting from disease affecting
lung structure or function or its vasculature
heart disease caused by lung disease
Signs and symptoms:
• Increasing dyspnea and fatigue
• Distended neck veins, peripheral edema,
hepatomegaly
• Bibasilar crackles and split second heart sound
• Carbon dioxide narcosis – headache, confusion,
somnolence, coma
• Decreased pO2 and pH, Increased pCO2
Diagnostics examination
• ABG’s decreased PaO2 and pH, increased PaCO2
• PFT’s may show airway obstruction
• Blood test show HCT greater than 50%
• Electrocardiogram changes are consistent with
right ventricle hypertrophy
• Chest X-ray shows right heart enlargement
• Echocardiogram shows right heart enlargement
NURSING INTERVENTIONS
• Improving gas exchange
• Monitor ABG
• Use continuous low –flow oxygen
• Avoid central nervous system depressants
• Monitor for signs of respiratory
NURSING INTERVENTIONS
• Attaining fluid balance
• Watch alterations in electrolyte levels
• Employ ECG monitoring
• Limit physical activity
• Restrict sodium intake
• Stopping cigarette smoking
• Recognize and treat infectious immediately
• Treat hypoxemia with supplemental oxygen
• Chronic lung disease – continuous low – flow oxygen therapy
at home
 Pleurisy
• Inflammation of the visceral &
parietal membranes
•Assessment findings
• Knife – like pain that is aggravated
on deep breathing and coughing
• Dyspnea
• Pleural friction rub heard on
auscultation
• Apprehension
Diagnostic evaluation:
• Chest X-ray
• Sputum exam
• Thoracentesis
• Pleural biopsy
NURSING INTERVENTIONS

• Identify and treat cause

• Monitor lung sounds
• Administer analgesics, NSAID Indomethacin as prescribed
• Apply hot or cold application as prescribed
• Encourage coughing and deep breathing
• Instruct the client to lie unaffected side to splint chest
Pneumoconiosis
• Non neoplastic alteration of the lung resulting from inhalation of
mineral or inorganic dust (dusty lung)
• Most common pneumoconiosis are silicosis, asbestosis and coal
worker’s pneumoconiosis

• CLINICAL MANIFESTATION
• Chronic cough and sputum production
• Dyspnea
• Melanoptysis
NURSING INTERVENTIONS
• Promote measures to reduce the exposure of workers to
industrial products
• Dust control
• Ventilation
• Spraying an area with ether
• Floor cleaning
• Toxic substances should be enclosed and placed in restricted areas
NURSING INTERVENTIONS

• Workers must wear protective devices

• Ongoing educational programs
• Stop smoking
• Receive an influenza vaccination
• Responsibility for their own health
 Epistaxis (Nosebleed)
• Hemorrhage from the nose, caused by the rupture of tiny,
distended vessels in the mucous membrane of any area of the
nose.*
• Causes:
• Trauma 6. Nasal tumors
• Infection 7. Low humidity
• Drugs (anticoagulants) 8. Foreign body in nose
• Cardiovasculaur disease (atherosclerosis, HPN)
• Blood dyscrasias 9. Deviated nasal septum
Medical Management:
• Pinch the anterior portion of the nose for a minimum of 5-10
minutes.
• Ice compress application*
• Cauterization of the bleeding vessel with application of Silver
Nitrate.
• Nasal packing (Posterior and Anterior) – antibacterial ointment is
applied to half- inch gauze which is then gently but firmly inserted
into the anterior nasal cavity.
• Nasal Balloon – substitute of nasal packing
• Should remain in place for a minimum of 48-72 hours.
• Diet – liquid to soft diet.
Surgical Management:
• 1. Artery ligation (internal maxillary & ethmoidal
artery).
Nursing Management:
• Monitor for hypoxia
• Monitor BP
• Comfort measure to alleviate discomforts
• Monitor closely for any manifestation of airway
obstruction & bleeding from anterior and posterior nares.
• Inspect oral cavity for presence of blood and soft palate
necrosis and proper placement of posterior plug.
 Nursing Management:
• Prophylactic antibiotics – are used to prevent toxic shock
syndrome and sinusitis.
• Instruct client to minimize activity for approximately 10
days.*
• Oral hygiene (half strength Hydrogen peroxide mixed
with water or saline)
• Use of humidifier or vaporizer – adds supplemental moisture to
prevent dryness and crusting secretion.
Bronchogenic Cancer/Lung CA
• -31% deaths in men than in woman 25%
•Etiology:
• Tobacco smokers (active or passive)
• Environment and occupational Exposure
• Genetics
• Dietary factors
Types:
• 1. Small Cell Lung Cancer (SCLC)- about 10-15%of lung
cancers*
• a. Oat cell cancer
• 2. Non-small cell lung cancer (NSCLC) –most common lung
cancer accounting for about 85% of all cases.
Types:
a. Squamous cell cancer
b. Adenocarcinoma
c. Undifferentiated cancer
Clinical Manifestation
• Any change in respiration pattern
• Persistent cough
• Sputum streaked with blood
• Frank hemoptysis
• Rust colored or purulent sputum’
• Chest, shoulder, arm pain
• Recurring episodes of pleural effusion, pneumonia,
bronchitis, dyspnea, unexplained or out of proportion
Diagnostic Evaluation
• Chest X-ray
• CT Scan
• Sputum cytology
• Fiberoptic bronchoscopy
Medical and Surgical Mgt.
• Chemotherapy
• Radiation therapy
• Surgery
• Pneumonectomy
• Lobectomy
• Segmentectomy
• Decortication/Pleurectomy
• Thoracoplasty
• Wedge resection*
 Asthma
• form of chronic obstructive airway disease in which
the bronchial linings overreact to various stimuli,
causing episodic spasms and inflammation that
severely restricts airway.
•Classification:
• Extrinsic asthma* -Aspirin induced asthma
• Intrinsic asthma* -Exercise-induced asthma
• Mixed asthma - Occupational asthma
Precipitating factors:
• Exercise
• Emotional stress
• Endocrine changes
• Atmospheric changes
• Inhalation of irritant
• Family history
According to severity:
•Mild intermittent – symptoms < 2 times a
week
•Mild persistent – symptoms > 2 times a
week but < 1time a day
•Moderate persistent – daily symptoms
•Severe Persistent – continual symptoms
Clinical Manifestation:
• Non-productive cough
• Dyspnea
• Wheezing
• Peak flow variability
• Chest tightness
Triad of asthma
•a. severe dyspnea
•b. excessive mucus secretion
•c. expiratory wheezes
Diagnostics Evaluation:
• ABG’s in acute severe asthma
• Blood test
• Chest X-ray
• PFT during attacks
• Skin test
Nursing Interventions:
• 1. Administer Low-flow humidified Oxygen
• 2. Administer medications as prescribed
• 3. Express feelings about fear of suffocation
• 4. Allow activity as tolerated with rest periods
• 5. Turning, coughing, deep breathing, & breathing retraining
• 6. High Fowlers position
• 7. Provide chest physiotherapy, postural drainage, incentive
spirometry and suction
• 8. small frequent feedings, encourage fluids
 INFLUENZA
• acute viral infection of the respiratory tract (both
upper and lower respiratory tract)*
• People who are most at risk:
• very young children
• older adults
• people who are living in institutional setting
• people with chronic diseases
• health care personnel
Causative Agent:
• Type A virus- is the most prevalent and is associated
with the most serious epidemics
• Type B virus – outbreaks also can reach epidemic
level but disease is generally milder than type A
• Type C virus – never been connected with large
epidemics
• Mode of Entry:
• direct contact through droplet spread
• airborne spread following coughing or sneezing by an
infected person
• Incubation Period : 1 to 3 days
• Period of Communicability : about 3 to seven days
from onset of symptoms.
Clinical Manifestations:
•onset of sudden chilly sensation
•fever
•myalgias*
•cough
•headache
Complications:
•viral bronchitis
•pneumonia
•bacterial pneumonia
•superinfections
 Management:
• 1. Usually symptomatic*
• 2. Antiviral drugs*
• Zanamivir (Relenza)- *adults and children > 7 years old who
have been symptomatic for < 2days*
• Nsg. Respon.=monitor for bronchospasm and decline in lung
function
• Oseltamivir phosphate (Tamiflu) –used for influenza virus A or
B in adults and in children > 1year old who have been
symptomatic for < 2 days*
• Nsg. Respon.= Must be taken with meals to decrease GI Effects
Both should be administered within 24 hour of onset.
 Management:
• Rimantidine (flumadine) – prophylaxis and treatment of
illness caused by type A virus in adults but no effect in type
B.*
• Nsg. Respon.=use cautiously in patient with renal and
hepatic impairment and in patients with history of
seizures.
• Amantadine HCl (Symmetrel)
• 3. Immunization
• 4. Prevention of spread of infection:
 Pneumonia
• -is an inflammatory process in lung
parenchyma usually associated with a
mark increased in interstitial and
alveolar fluid.
•Classification:
• Community acquired pneumonia (CAP)
• Hospital acquired pneumonia (HAP)
• Pneumonia in Immunocompromised Host
• Aspiration pneumonia
Diagnostics:
• Sputum culture analysis and sensitivity
testing
• Skin test
• Blood and urine culture
• ABG measurements
• Chest X-ray
 Management
• 1. Antibiotic therapy
• 2. Respiratory support
• - O2 therapy
• -Bronchodilators
• -Tracheal suctioning
• 3. Nutritional support
• 4. Fluid and electrolyte management
 Complications
• 1. Pleural effusion
• 2. Sustained hypotension and shock especially in gram-
negative bacteria disease, particularly in the elderly
• 3. Superinfection: pericarditis, bacteremia & meningitis
• 4. Delirium
• 5. Atelectasis
• 6. Delayed resolution
Nursing Diagnosis and intervention:

• 1. Ineffective airway clearance related to

excessive secretion and weak cough
• -Increase fluid
• -Effective coughing & DBE
• -frequent turning sides
• -Chest physiotherapy, suctioning & artificial airways
• -Collaborative: Brochodilators administration
• 2. Ineffective Breathing pattern r/t tachypnea
• -Positioning for comfort
• -Teach client on splinting of chest wall with pillow
during coughing and the use of incentive spirometry
• -Cough supressants and analgesics if prescribed
• -Auscultate chest and record findings
• -Monitor ABGs – observe for hypoxemia, hypercapnia,
and acid-base imbalance)
• 3. Activity intolerance related to decrease
oxygen levels
• -assess client’s baseline level and response to activity
• -Schedule activity after treatment or medication
• -Oxygen as needed
• -Gradual increase in activity on basis of tolerance
• -Teach client to avoid conditions that increases oxygen
demand
• -Instruct on pursed lip and diagphragmatic breathing
• -psychological support and quite environment
Atelectasis
• -collapse of lung tissue at any level (segmental,
basilar, lobar or microscopic)
• Risk Factors:
• 1. Reduction in lung distention forces (lung
compression)
• 2. Localized airway obstruction
• 3. Insufficient pulmonary surfactant
• 4. Increased elastic recoil
Diagnostic Examination:
•-may be diagnose through PE
•-chest radiograph
Assessment findings:
• 1. low level of oxygen in the blood
• 2. dyspnea
• 3. tachypnea, tachycardia, increase temperature
• 4. cyanosis
• 5. bronchial or diminished breath sounds and crackles
over involved area
 Nursing Interventions:*
• 1. Frequent positioning
• 2. Early ambulation
• 3. Deep–breathing and effective coughing*
• 4. Oxygen administration
• 5. Postural drainage, chest physiotherapy
Nursing Interventions:*
• 6. Tracheal suctioning
• 7. Drug therapy
• 8. Encourage the patient to stop smoking, lose weight or
both as needed.
• 9. Humidify inspired air and encourage adequate fluid
intake
• 10. Provide reassurance and emotional support
• 11. Relaxation technique
The end….