LESTER LINTAO,RN,RM,LPT,MAP,MAN,PsyD

PNEUMOTHORAX
 It is the accumulation of air in the pleural space PLEURAL EFFUSION
 Primary Complication: atelectasis (lung collapse)  Refers to an abnormal accumulation of fluid in
o Injury to the affected site. the pleural cavity.
 Results in partial of complete lung collapse  Primary Complication: atelectasis (lung
Types: collapse)
 Tension  May be:
o Unknown cause o Hydrothorax (Transudate) – edema of
 Secondary/ open/ sucking wound (chest surgery the pleural space
complication)  Cause: the cause of edema
o Trauma to the chest wall  Fluid shift
o Most common type o Empyema (Exudates) – pyothorax
 Spontaneous - o Hemothorax (Blood)
o Caused when air-filled blebs (blisters)  Trauma/ surgery complication
rupture o Chylothorax (Chyle) – lymphatic fluid
Predisposing Factor: Smoking  Water with anti-bodies
Pathophysiology:  Hodgkin’s disease – cancer of
Symptoms: the lymph nosed
 Pleuritic pain – pain in inhalation (same pain as Symptoms:
MI)  Dyspnea
 Increase RR  Pleuritic Pain - pain in inhalation (same pain as
 Dyspnea – difficulty of breathing MI)
 Asymmetry of chest wall  Constant discomfort – chest fullness
o Ensure safety (may have rib fractures) Severity:
 Decrease breath sounds  Minimal (300-500cc)
o unilateral o Resolves in 10-14 days
 Trachea deviating to the injury site o No operation needed
 Mediastinal shift (Major complication) o Management: supportive & symptomatic
o Total Atelectasis approach
o Cardiac tamponade leading to  Semi-fowler’s
cardiogenic shock  Codeine sulfate
 Signs of Cardiogenic (due to large  Moderate (500-1000cc)
pneumothorax) o Fills about 1/3 of the pleural cavity lung
Nursing Interventions: compression and signs of hypovolemia
 Monitor V/S for signs of shock (cardiogenic o Management: supportive & symptomatic
shock)  Semi-fowler’s
 Observe respirations  Codeine sulfate
o ↑RR, ↓breath sounds  IVF
 Semi-fowler’s position  Thoracentesis
o To lessen compression due to pressure  Large (1000c or more) severe
o Maximize the strength of the diaphragm o Fills half or more of the chest and
o To prevent femoral congestion requires immediate drainage
 Administer oxygen if necessary o Chest tube thoracostomy
o ↓ flow to prevent further respiratory o Management:
alkalosis  Orthopneic
 Analgesics as ordered  Gauge 14
o Codeine sulfate – only analgesic that  PNSS
does not cause respiratory depression Avoid:
 Chest tube: (to remove air) water seal drainage Leakage→
system Unaffected site
o Maintain Hemorrhage→
 Asepsis Affected
 Patency and integrity
o Evaluate amount of fluid and
effectiveness through breath sounds.
 LESTER LINTAO,RN,RM,LPT,MAP,MAN,PsyD
2. Dislodge
CHRONIC OBSTRUCTIVE PULMONARY DISEASE a.
(COPD) b.
Diagnosis: Impaired Gas Exchange 3. Expel
Asthma Bronchitis Emphysema a.
Other names Reversible Blue Bloaters Pink Puffers b.
Obstructive Airway
Disease c.
Centrilobular Pan lobular
Oxygen Therapy
Reactive Allergic
Terminal Lungs  Maintained at ____
Disorder
Disorder Hypersensitivity Inflammatory Autoimmune  Common methods
Type 1
Reversibility Reversible; Acute - Age: 65↑
o Nasal cannula: mixes oxygen with
reversible – Heredity: white o Venturi Mask
lower men
Allergens respiratory Asthma & Nutrition – small frequent feeding
Intrinsic – anxiety
and stress
bronchitis Coping and _____
Extrinsic – Predisposing High- Fowler’s/ ________ - to maintain maximum air
Ingestants, Factor:
Injectants, Inhalants, smoking, exchange
Contactants goblet - Intermittent Positive Pressure Breathing/ Ventilation
secretions
Pathophyso Allergen ↑goblet cells No Anti elastase (IPPB/IPPV)
logic Basis ↓ ↓ ↓ Avoid Allergens
IgE → skin ↑secretions No deflation
(eosinophils) – ↓ ↓ Lung exercises
rashes Pulmonary Over inhalation a. _____ breathing
↓ congestion of the alveoli
Destroys mast cells ↓ ↓ b. Pursed – lip breathing
(found in lungs) ↓O2 ↑CO2 (↓O2)
↓ Early: ↓
Histamine restlessness Hyper ventilation Inspiration – Expiration Ratio: ____
(bronchoconstriction, Late: cyanosis
vasodilation) Cromolyn Na (Intal)
↑CO2 (↓O2)
↓
Pulmonary
+ Administer medications as ordered
congestion a) Bronchodilators
↓
Pulmonary b) Mast Cells Stabilizers
hypertension c) Antibiotics
(25 mmHg) →
Involvement Ventilation Goblet cells* Alveoli diffusion d) ___
Hallmark Wheezing Productive Barrel chest e) Antihistamine
cough – 3
months a year f) ____
for 2 Remove pulmonary irritants
consecutive
years Encourage rest
Other signs -Non-productive Cyanosis Non-productive
cough Obvious rales & cough
rhonchi Pinkish skin tone
-Chest tightness
Unusual Hyperventilation
-dyspnea irritability Dyspnea
Generalized
edema
High CO2
Exertion
Dyspnea
Distended
Jugular Vein
Management:
Bronchodilators
Beta 2 Adrenergic Xanthine Derivatives
Agonist (10-20mg/dL)
Route Inhaler (best route) Oral
blue cannister – Parenteral – long
bronchodilator (beta2) halflife
Injectable
Oral
Advantage fast acting - short Long half-life
lasting
Examples Salbutamol, Albuterol Theophyline,
Aminophyline
10-20 mg/dL
Respiratory Therapy: Goal:
1. Liquefy/ Loosen
a.
b.
c.