Respiratory

Diseases
ANATOMY
Chronic Obstructive
Pulmonary Disease
 What is COPD?
Chronic obstructive pulmonary disease (COPD) is a chronic
inflammatory lung disease that causes obstructed airflow
from the lungs.

Chronic obstructive pulmonary disease (COPD) is a

common lung disease causing restricted airflow and
breathing problems. It is sometimes called emphysema or
chronic bronchitis.
CHRONIC BRONCHITIS EMPHYSEMA

blue bloaters pink puffers

(cyanosis, dyspnea, damage to the
corpulmonale) alveoli ---> gas
cough with sputum trapping (dyspnea
production (from and hyperinflated
bronchial lungs)
inflammation)
Alpha 1 antitrypsin
deficiency
 Signs and Symptoms

Shortness of
breath
Wheeze or chest
tightness

Cough with
sputum
Signs and Symptoms

Fatigue or
tiredness

Reoccuring lung
infections
 Complications

Respiratory
infections
Pulmonary
Hypertension
Heart Problems

Depression

Lung Cancer
 Risk Factors

Exposure to tobacco
smoke
Genetics

People with asthma

Low socioeconomic
status
Occupational exposure
to dusts and chemicals
 Laboratory Diagnosis

Spirometry Test

Alpha-1 Testing
 Laboratory Diagnosis

Chest X-Ray

CT Scan
Laboratory Diagnosis

ABG Test
 Treatment

Vaccination Avoid Triggers

Smoking Pulmonary
Cessation Rehab
Medications

Inhaled
Corticosteroids

Expectorant
Bronchiectasis
Introduction

Bronchiectasis is a chronic, irreversible dilation of the bronchi and

bronchioles that results from destruction of muscles and elastic
connective tissue. The condition may be limited to a single lobe or
lung segment, or it may affect one or both lungs more diffusely.

This condition can affect people of all ages, and can sometimes
begin in childhood. Although the incidence is not accurately known,
it is more common in women and the elderly.
Anatomy
Types of Bronchiectasis
1. Cylindrical bronchiectasis, the mildest form of bronchiectasis shows
the loss of normal airway tapering.
2. Saccular or varicose bronchiectasis shows further distortion of the
airway wall along with more mucous and sputum production by the
individual; some of the bronchi may appear to be in a beaded form.
3. The most severe form of bronchiectasis and the least common form is
cystic bronchiectasis. This form has large air spaces and a
honeycombed appearance in CT scan studies and usually has thicker
walls than the blebs seen with emphysema. Some people have more
than one type in their lungs.
 Signs and Symptoms

Daily production of
Daily cough
mucus (sputum)

Fatigue, feeling run-

SOB
down or tired
 Signs and Symptoms

Wheezing or whistling
Fevers and/or
sound while you
chills
breathe

Chest pain
Hemoptysis
Clubbing
 Risk Factors

Recurrent respiratory
Cystic Fibrosis
infections

Rheumatic and Tuberculosis or

Primary ciliary
other systemic immune deficiency
dysfunction
diseases disorders
 Treatment

Antibiotics Mucus thinning

Airway clearance
Smoking cessation
devices
 Treatment

Nebulized mucolytics Nebulized hypertonic

saline

Bronchodilator Vaccination
 Laboratory Diagnosis

CT Scan/Chest X-ray Sputum Culture

Patient History Lung Function Test

 Nursing responsibilities

Clear pulmonary secretions

Postural drainage and to avoid exposure to people with
upper respiratory or other infections
The patient is educated about the early signs of
respiratory infection and the progression of the disorder
Status Asthmaticus
Acute Severe Asthma Exacerbation
Introduction

It is a respiratory failure that comes with the worst

form of acute severe asthma, or an asthma attack.
The attacks can occur with little or no warning and
can progress rapidly to asphyxiation. It occurs
when asthma symptoms — difficulty breathing,
wheezing, and coughing — fail to improve with
emergency medicine treatment.
Pathophysiology
BRONCHOSPASM Cauae a DECREASED in the
EDEMA AND INFLAMMATION airway diameter and thus
MUCUS PRODUCTION INCREASED airflow resistance

Atelectasis Air Trapping

Decreased
Ventilation
Hypoxemia

Respiratory Failure BIG 3 WORSEN

 Signs and Symptoms

PROLONGED
ACUTE EXHALATION
BREATHLESSNESS

CAN'T SPEAK
WHEEZING IN FULL
SENTENCES
 Signs and Symptoms

FEEL AGITATED,
CHEST FEELS CONFUSED, OR
CAN'T
TIGHT CONCENTRATE

BLUISH HUNCHED SHOULDERS,

TINT OF STRAINED MUSCLE IN
STOMACH AND NECK
LIPS
 RISK FACTORS

SOCIAL MEDICAL

✓ Inner city residence ✓ Respiratory failure

✓ Non-white race ✓ Rapid sudden deterioration
✓ Poor outpatient compliance ✓ Past ICU admission
✓ Denial of disease severity ✓ Intubation
 Treatment

IV ACCESS
VENTILATION
BLOOD GAS
MONITORING

CONTINUOUS
CONTINUOUS
CARDIORESPIRATORY
MONITORING PULSE
OXIMETRY
 Laboratory Diagnosis

ARTERIAL BLOOD ELECTROLYTE

GAS LEVELS
Results:
Result: ✓
✓
Hypokalemia
Hypoxemia ✓ Hypomagnesemia

✓ Respiratory Acidosis ✓
✓
Hyponatremia or Hypernatremia
Hypophosphatemia

COMPLETE BLOOD SERUM BIOMARKERS

COUNT Results:
Results: ✓ Elevated C-reactive Protein
✓
✓
Elevated level of Eosinophils
✓ Elevated Procalcitonin Level
✓
✓
Increased WBC
Normal Elevated Neutrophil Count
Increased Hematocrit and
✓ Elevated Serum IgE Level
Hemoglobin Levels
 Laboratory Diagnosis

PEAK EXPIRATORY CHEST X-RAY

FLOW Results:
✓ Lung Hyperinflated
✓ Peribronchial Thickening
✓ Pneumothorax
 Medications
CORTICOSTEROIDS
✓Methylprednisolone
✓Dexamethasone
✓Hydrocortisone IV AND SUBCUTANEOUS
B AGONIST
✓Terbutaline ✓ Ephedrine
✓Epinephrine ✓Isopresterenol

INHALED B AGONIST
✓ Salbutamol
✓ Levalbuterol
 Medications

METHYLXANTINES
(THEOPHYLLINE)
COMBINING THERAPIES
✓ Theophylline + Inhaled or
IV B Agonist + Inhaled
Ipratropium Bromide and
Steroids

ANTICOLINERGICS
✓Ipratropium Bromide
 Medications

MAGNESIUM SULFATE

ANTIBIOTICS

HELIUM-OXYGEN
Medications

MEDICATIONS FOR
INTUBATION
✓ Induced Agents
✓ Neuromuscular Blocking
Agents
 Nursing Responsibility

✓ Continuous monitoring of vital signs (RR, PR, BP, O2 Saturation and,

Temperature)
✓ History taking
• Usual and recent
treatment
• Previous acute episodes
and severity
• Best peak expiratory flow
scale
• Have they been
admitted to ICU before
✓ Assess severity of attack
• Peak Expiratory Flow • Ability to speak
• Respiratory rate • Pulse rate • Oxygen Saturation
 Nursing Responsibility

SEVERE ATTACK LIFE THREATENING

✓ Unable to complete ✓ Exhaustion,

sentences in one breath confusion, coma
✓ Respiratory rate is ✓ Feeble respiratory
greater than or equal to
effort, silent chest (no
25/min
✓ Pulse rate is greater
wheezes)
✓ Arythmia or
than or equal to 110
beats/min hypotension
✓ Peak Expiratory Flow ✓ PEF is lesser than
(PEF) 33-50% 33%
 Nursing Responsibility

✓ Administering prescribed medications

✓ Positioning the patient comfortably
✓ Providing emotional support and reassurance to the
patient and their family members
✓ Educating the patient and family members about asthma
management
✓ Ensuring a calm and quiet environment
✓ Documenting assessment, interventions, and patient
response
✓ Continuously re-evaluating the patient's condition
 Complications

✓ Respiratory Failure
✓ Pneumothorax
✓ Atelectasis
✓ Secondary Infection
✓ Systemic Inflammatory Response
Syndrome (SIRS)
✓ Death
Emphysema
Pink Puffers
Introduction

Emphysema is a lung condition that causes shortness of breath.

In people with emphysema, the air sacs in the lungs (alveoli) are
damaged. Over time, the inner walls of the air sacs weaken and
rupture — creating larger air spaces instead of many small ones.
This reduces the surface area of the lungs and, in turn, the
amount of oxygen that reaches your bloodstream.
Bernoulli Principle
 Signs and Symptoms

Shortness of
Breath Hyperventilization

Weight loss Barrel Chest

 Risk factors

Smoking
Age

Exposure
to Air
Pollutants Second hand Smoke
 Treatment

There is no cure for

emphysema

1 stop smoking immediately and

completely
2 avoiding other air pollutants

oxygen treatment, in advanced gentle, regular exercise to

3 cases 4 improve overall fitness
 Laboratory Diagnosis
Imaging Tests Lab Test
Computerized tomography (CT) scans Blood taken from an artery in
combine X-ray images taken from many
different directions to create cross-
your wrist can be tested to
sectional views of internal organs. determine how well your lungs
transfer oxygen into, and remove
CT scans can be useful for detecting and
diagnosing emphysema. You may also have a carbon dioxide from, your
CT scan if you're a candidate for lung bloodstream.
surgery.

Lung function tests

These noninvasive tests measure how
much air your lungs can hold and how
well the air flows in and out of your
lungs. They can also measure how well
your lungs deliver oxygen to your
bloodstream. One of the most common
tests uses a simple instrument called a
spirometer, which you blow into.
 Medications

Bronchodilators
These drugs can help relieve
coughing, shortness of breath and
breathing problems by relaxing
constricted airways.

Inhaled steroid
Corticosteroid drugs inhaled as
aerosol sprays reduce inflammation
and may help relieve shortness of
breath.
 Nursing Management
Breathing Techniques Oxygen Therapy
Administer supplemental oxygen
Teach patients breathing as prescribed and monitor its
exercises, such as pursed-lip effectiveness.
breathing, to help improve
lung function and reduce Educate the patient on the proper
shortness of breath. use of oxygen equipment and
safety measures.

Health Education
Provide comprehensive education
about emphysema, its causes,
symptoms, and progression. Teach
patients about the importance of
smoking cessation, avoiding air
pollution, and proper inhaler
technique.
Blunt Trauma
Introduction
Blunt trauma, also known as non-penetrating
trauma or blunt force trauma, refers to injury of the
body by forceful impact, falls, or physical attack
with a dull object.

On the other hand, Penetrating trauma involves an

object or surface piercing the skin, causing an open
wound.
 Anatomy

The sternum, or breastbone, is a long, flat, bony

plate that forms the most anterior section of the rib
cage. The primary function of the sternum is the
protection of the heart, lungs, and blood vessels
from physical damage. The sternum is made of the
manubrium, the gladiolus, and the xiphoid process.
Anatomy

The ribs are the bony framework of the thoracic

cavity. The ribs form the main structure of the
thoracic cage protecting the thoracic organs,
however their main function is to aid respiration.
Anatomy

Thoracic vertebrae: The twelve vertebrae in the

upper back, providing support and attachment
points for the ribs.
 Anatomy

Intercostal muscles: These muscles sit between the

ribs, responsible for expanding and contracting the
chest cavity during breathing.
Anatomy

The diaphragm is a muscle that helps you inhale

and exhale (breathe in and out). This thin, dome-
shaped muscle sits below your lungs and heart. It's
attached to your sternum (a bone in the middle of
your chest), the bottom of your rib cage and your
spine.
 Anatomy

The lungs and respiratory system allow us to

breathe. They bring oxygen into our bodies (called
inspiration, or inhalation) and send carbon dioxide
out (called expiration, or exhalation). This exchange
of oxygen and carbon dioxide is called respiration.
Pathophysiology
 CAUSES

VEHICULAR ACCIDENTS

FALLS

SPORTS INJURIES
 CAUSES

CRUSH
INJURIES

ASSAULTS
 CAUSES

BLAST
INJURIES

MEDICAL
PROCEDURES
 RISK FACTORS

Children and older adults: Both

AGE children and older adults have
weaker bones and tissues, making
them more susceptible to fractures
and other injuries from blunt force
trauma to the chest.

This condition weakens

OSTEOPOROSIS bones, increasing the risk
of fractures in the ribs
and spine.
 RISK FACTORS

Conditions like chronic obstructive

pulmonary disease (COPD) can make
PRE-EXISTING it more difficult to breathe after a
chest injury.
LUNG DISEASE

Existing heart problems

can worsen after a chest
CARDIOVASCULAR
injury due to the
DISEASE increased stress on the
heart.
 RISK FACTORS

People who work in construction,

JOBS WITH HIGH transportation, or other industries
with a high risk of falls or collisions
RISK FOR FALLS are more likely to experience blunt

AND COLLISIONS chest trauma.

Alcohol and drug intoxication

can impair judgment and
SUBSTANCE ABUSE coordination, increasing the
risk of accidents and injuries.
 RISK FACTORS

Athletes who participate in contact

CONTACT SPORTS sports like football, rugby, and
hockey are at higher risk of chest
trauma.

People who experience

domestic violence are more
DOMESTIC likely to sustain blunt chest
VIOLENCE trauma due to physical
assaults.
 Signs and Symptoms

This is the most common symptom

CHEST PAIN of blunt chest trauma and can
range from a dull ache to a sharp,
stabbing pain. The pain may
worsen with breathing, coughing,
or movement.

This can occur if the lungs

Shortness of breath are injured or if there is
bleeding in the chest
cavity.
 Signs and Symptoms

a sign that the body

RAPID BREATHING is trying to
compensate for a lack
of oxygen.

HEMOPTYSIS Coughing up blood

(bleeding in the
lungs or airways)
 Signs and Symptoms

DEFORMITY OF THE This can occur if there

CHEST WALL are broken ribs.

DYSPHAGIA
This can occur if there is
damage to the esophagus
 Signs and Symptoms

This can occur if there

CONFUSION OR is head injury or if the
DIZZINESS brain is not receiving
enough oxygen.

BRUISING OR This can occur if there

SWELLING is damage to the skin,
muscles, or blood
AROUND THE
vessels.
CHEST
 Treatment for minor injuries

REST In most cases, minor blunt chest

trauma like soft tissue contusions or
rib fractures with minimal
displacement can heal with rest

PAIN RELIEVERS Helps manage

(OTC: ibuprofen, discomforts
acetaminophen)
 Treatment for minor injuries

For rib fractures, a sling or

compression wrap can provide
IMMOBILIZATION support and reduce pain during
breathing and movement.

Applying ice packs to

ICE PACKS the affected area can
help reduce swelling and
inflammation.
 Treatment for moderate injuries

Stronger pain medications like

prescription opioids might be
PAIN MANAGEMENT needed for moderate pain.

if the injury affects lung

function, supplemental
SUPPLEMENTAL O2 oxygen therapy can help
improve oxygen levels in
the blood.
 Treatment for moderate injuries

CHEST TUBE In cases of pneumothorax

(collapsed lung) or hemothorax ,
INSERTION a chest tube might be inserted
to drain air or fluid buildup.
(Thoracentesis)

Patients with moderate

injuries are typically
CLOSE monitored closely in the
OBSERVATION hospital to ensure their
condition doesn't worsen.
 Treatment for SEVERE injuries

For life-threatening injuries like

cardiac tamponade or major
EMERGENCY blood vessel damage, immediate
SURGERY surgery might be necessary.

If the injuries significantly

compromise breathing,
MECHANICAL patients might require
VENTILATION mechanical ventilation
support.
 Treatment for SEVERE injuries

In cases of severe blood loss,

blood transfusions are essential
BLOOD to replace lost blood volume
TRANSFUSION and maintain vital organ
function.
 Laboratory Diagnosis

Arterial blood gas

Chest x-ray
analysis

ECG CT SCAN
 Laboratory Diagnosis

COMPLETE BLOOD
COUNT
 Medications

Analgesics Antibiotics

Anti-inflammatory
drugs
Nursing responsibilities

AIRWAY MANAGEMENT
Ensure a clear and open airway,
potentially using airway adjuncts like
oxygen masks or endotracheal tubes.
Nursing responsibilities

BREATHING ASSESSMENT
Monitor respiratory rate, depth, effort,
and oxygen saturation. Administer
supplemental oxygen as needed.
Nursing responsibilities

CIRCULATION ASSESSMENT
Monitor vital signs, skin perfusion, and
signs of shock. Administer intravenous
fluids or blood products as prescribed.
Nursing responsibilities

PAIN MANAGEMENT
Utilize various pain management strategies like
oral analgesics, intravenous medications, regional
nerve blocks, or epidural analgesia according to
patient needs and physician orders.
Nursing responsibilities

NEUROLOGICAL ASSESSMENT
Monitor mental status and level of
consciousness for potential head
injuries.
Nursing responsibilities

WOUND CARE
Dress and manage any wounds or
injuries according to physician
instructions.
Nursing responsibilities

DEEP BREATHING EXERCISE

promotes better ventilation and
gas exchange. non-pharmacological
way of dealing with pain
Flail Chest
Introduction

Flail chest is defined as 3 or more

contiguous ribs that are fractured in 2 or
more different locations, resulting in a
freely moving segment of the
chest wall that is discontinuous from the
rest of the thoracic cage
Anatomy
Anatomy
Anatomy
Anatomy
Pathology
Pathology
Pathology
 Causes

Blunt Trauma fall (elderly)

Motor vehicle accidents

 Risk Factors

Intoxication Advanced Age

Contact Sports
 Signs and Symptoms

Severe chest pain SOB

Paradoxical chest wall Respiratory distress

movement
 Signs and Symptoms

Tachypnea Hypoxemia

diminished breath sounds

during chest wall deformity
auscultation
 Diagnosis
CT SCAN

Client’s History and

Physical Assessment

Chest X-ray
 Medical Management

• Providing ventilatory support, clearing secretions from the lungs, and

controlling pain.

• If only a small segment of the chest is involved, the objectives are to clear
the airway through positioning, coughing, deep breathing, and suctioning to
aid in the expansion of the lung, and to relieve pain by intercostal nerve
blocks, high thoracic epidural blocks, or cautious use of IV opioids.

• For mild-to-moderate flail chest injuries, the underlying pulmonary

contusion is treated by monitoring fluid intake and appropriate fluid
replacement while relieving chest pain.
 Medical Management

• For severe flail chest injuries, ET intubation and mechanical

ventilation are required to provide internal pneumatic stabilization of
the flail chest and to correct abnormalities in gas exchange.

• Monitor patient by serial chest x-rays , arterial blood gas analysis,

pulse oximetry and bedside pulmonary function monitoring

• Pain Management
Sternal and Rib
Fracture
Introduction
Sternal fracture-is a fracture of the Rib fractures occur when a significant enough
sternum (the breastbone), located in the force directed at the rib causes a break.
center of the chest.
Anatomy
Sternum- a flat bone that lies
in the middle front part of
the rib cage.

Physiology
*It protects the organs in the
thoracic cage.
*It provides attachment for
various muscles.
Anatomy

Rib-form the main structure

of the thoracic cage
protecting the thoracic
organs; however, their main
function is to aid respiration.
 Causes:

Sternal and Rib Fracture

direct trauma to the chest

(caused by falls, child abuse, and
car crashes)
repetitive chest trauma (due to
recurrent cough or engagement
in certain sports)
 Risk Factors

Sternal and Rib Fracture

modifiable ones, such as

osteoporosis, engagement in
contact sports, and malignant
bone tumors involving the ribs.
non-modifiable ones, such as
advanced age
 Clinical Manifestations:

Sternal Fracture

Anterior chest pain

Overlying tenderness
Ecchymosis
Crepitus
Swelling
Possible chest wall deformity
 Clinical Manifestations:

Rib Fracture
Severe pain
*Location of pain points to possible further underlying injury:
1st rib: possible trauma of lung apices, subclavian vessels
2nd rib: possible ascending aorta, superior vena cava trauma
10th rib: possible diaphragmatic, liver, splenic injury
11th rib: possible diaphragmatic, liver, splenic injury
12th rib: possible renal injury
Swelling
Bruises
Muscle spasm over the area of fracture
 Assessment and Diagnostic Findings

Lateral
chest CT scan
radiograph
Assessment and Diagnostic Findings

A crackling, grating sound in the

thorax (subcutaneous crepitus)
may be detected with
auscultation.
 Complications

Liver injuries, splenic

injuries, renal injuries
Pneumothorax
Hemothorax
Myocardial contusion
pulmonary contusion
 Medical Management:

Goal of Treatment of Rib Fracture:

Sedation is used to relieve pain
-to relieve pain Deep breathing and
and to allow deep breathing and
-to detect and treat injury Incentive spirometry
coughing

Alternative strategies to relieve A chest binder may be used as

pain include an intercostal nerve supportive treatment to
Surgical Fixation
block provide stability to the chest
wall and may decrease pain
 Nursing Management:

Assist the client into a comfortable position, and help them

promote lung expansion by encouraging them to take deep
breaths, cough, and use their incentive spirometer while
splinting the fracture area with their hands, arms, or a pillow.
Assess your client’s respiratory status, including respiratory
rate, depth, effort, breathing pattern, breath sounds, and
oxygen saturation.
Perform a pain assessment, noting the onset, quality, severity,
location, aggravating or relieving factors, and how frequently
your client experiences pain.
 Medications

Nonsteroidal anti-
inflammatory drugs Analgesics
(NSAIDs)

Muscle relaxants
Cough Suppressants
Pulmonary Contusion
Introduction

Pulmonary contusion is when, as a

result of chest trauma, there is
direct or indirect damage of the
parenchyma of the lung that leads
to edema or alveolar hematoma
and loss of physiological structure
and function of the lung.
Pathophysiology

Abnormal accumulation of fluid in the interstitial

and intra-alveolar spaces. It is thought that injury to
the lung parenchyma and its capillary network
results in a leakage of serum protein and plasma.
The leaking serum protein exerts an osmotic
pressure that enhances loss of fluid from the
capillaries. Blood, edema, and cellular debris (from
cellular response to injury) enter the lung and
accumulate in the bronchioles and alveoli, where
they interfere with gas exchange. An increase in
pulmonary vascular resistance and pulmonary
artery pressure occurs. The patient has hypoxemia
and carbon dioxide retention.
 Causes

The main cause of

pulmonary contusion is
blunt trauma to the chest.

Risk Factors
Car crashes
Falls from heights
Child abuse
Sport injuries
Blast injuries
Signs and Symptoms
Shortness of breath
Cough
Hemoptysis
Chest pain
Respiratory distress

Complications

Acute Respiratory Distress

Syndrome (ARDS)
Pneumonia
 Diagnosis
Client’s history
Physical assessment
Pulse oximetry
Chest X-ray

Normal Pulmonary Contusion

 Medications

Analgesics

Treatment

For mild injuries, clients can If needed: In severe cases:

be treated Positive pressure Alternative mechanical
Supplemental oxygen ventilation with ventilation modes can be
Encouraging coughing continuous positive used such as
and deep breathing airway pressure or CPAP extracorporeal
exercises Bi-level positive airway membrane oxygenation,
Using an incentive pressure or BiPAP or ECMO
spirometer Mechanical ventilation
Chest physiotherapy with positive end-
expiratory pressure or
PEEP
 Nursing Responsibility/Management

Position your client in a semi-Fowler or side-lying position with the

healthy lung down.
Institute pulse oximetry and provide supplemental oxygen to keep the
SpO2 at 94% or above, as ordered, and maintain a normothermic body
temperature to decrease oxygen consumption.
Assess the client’s level of consciousness, vital signs, and administer the
ordered analgesics.
Perform a focused respiratory assessment, including rate, depth, use of
accessory muscles, breathing pattern, breath sounds, and oxygen
saturation.
 Nursing Responsibility/Management

Encourage them to cough, deep breathe, and to use the incentive

spirometer every hour while awake.
Report concerning assessment findings, like a respiratory rate below 12
or above 20 breaths per minute, an oxygen saturation below 94%,
confusion, or respiratory acidosis
Be prepared to assist with noninvasive positive end-respiratory
pressure, such as CPAP.
Penetrating Trauma
Introduction
Any organ or structure within the chest is
potentially susceptible to traumatic
penetration. These organs include the chest
wall, lung and pleura, tracheobronchial system,
esophagus, diaphragm, and major thoracic
blood vessels, as well as heart and other
mediastinal structures.
Projectile that enters chest causing small or
large hole.
 Anatomy
Skin and soft tissue:
The skin and soft tissues form the outer covering of
the body and include various structures such as the
epidermis, dermis, subcutaneous tissue, muscles,
tendons, ligaments, fascia, nerves, blood vessels, and
adipose tissue. They play crucial roles in protection,
movement, sensation, and maintaining overall bodily
function.
Muscles:
Muscles are contractile tissues that enable
movement, provide support, and generate force
within the body.
Fascia:
Fascia is a connective tissue that surrounds and
separates muscles, organs, and other structures
within the body.
 Anatomy
blood Vessel
Blood vessels are part of the circulatory system and
are responsible for transporting blood throughout
the body
organ:
Organs are specialized structures composed of tissues
that perform specific functions necessary for the
survival and well-being of an organism. They are
organized into organ systems that work together to
maintain homeostasis and carry out essential
physiological processes in the human body.
bones
Bones protect vital organs from injury and damage
Cavities
refers to a hollow space or compartment within the
body that contains organs, tissues, or fluids.
 Pathophysiology
Penetrating traumas can be caused by violence and
may be caused by violence and may result from
fragments of a broken bone and may often cause
damage to internal organs resulting in shock and
infection.
Severity depends on the body organs involved, the
characteristics of the object, and the amount of
energy transmitted
As the object enters the body, it creates a pressure
wave forcing tissue out of the way, creating a cavity.
The tissues move back into place, eliminating the
cavity, but the cavitation has already done
considerable damage.
Characteristics of the damaged tissue determine the
severity of the injury: the denser the tissue, the
greater the amount of energy transmitted to it.
 Signs and Symptoms

RESPIRATORY DISTRESS IMPALED FOREIGN

decreased breath BODY
sounds,

skin discoloration
SHOCK CYANOSIS
 Risk Factors

Occupational Participation in
Hazzard Risky behavior Access to firearms

Domestic
Mental Health Accidental
issues
Violence injuries
 COMPLICATIONS

PNEUMOTHORAX

HEMOTHORAX

HEMOPNEUMOTHORAX
 COMPLICATIONS

HEMOPERICARDIUM
 Laboratory Test

CHEST X-RAY CT SCAN

 Laboratory Test

CHEST X-RAY CT SCAN

 TREATMENT AND MANAGEMENT
Immediate management: to restore and maintain
cardiopulmonary function.
After an adequate airway is ensured and ventilation is
established, examination for shock and intrathoracic and intra-
abdominal injuries is necessary. The patient is undressed
completely so that additional injuries are not missed.
After the status of the peripheral pulses is assessed, a large-
bore IV line is inserted.
An indwelling catheter is inserted to monitor urinary output.
A nasogastric tube is inserted and connected to low suction to
prevent aspiration.
 TREATMENT AND MANAGEMENT
Minimize leakage of abdominal contents and decompress the
gastrointestinal tract.
Hemorrhagic shock is treated simultaneously with colloid solutions,
crystalloids, or blood, as indicated by the patient’s condition.
Diagnostic procedures are carried out as dictated by the needs of the
patient (e.g., CT scans of chest or abdomen, flat plate x-ray of the
abdomen).
A chest tube is inserted into the pleural space in most patients with
penetrating wounds of the chest to achieve rapid and continuing re-
expansion of the lungs.
If the patient has a penetrating wound of the heart or great vessels,
the esophagus, or the tracheobronchial tree, surgical intervention is
required.
 NURSING RESPONSIBILITIES

Restore and maintain cardiopulmonary functions.

Adequate airway ventilation.
Examination for shock and injuries
After peripheral pulse status assessed a large bore I.V line is inserted
Nasogastric tube is inserted and connected to low suction to prevent
aspiration.
Shock is treated simultaneously with colloid solutions, crystalloids or blood
as indicated by patients condition.
A chest tube is inserted into pleural space in most patients with penetrating
wound of chest to achieve continuing re-expansion of lungs.
The insertion of chest tube frequently results in complete evacuation of
blood and air
Pneumothorax
Introduction

Pneumothorax is defined as the presence of air or

gas in the pleural cavity (ie, the potential space
between the visceral and parietal pleura of the
lung), which can impair oxygenation and/or
ventilation.
Anatomy

Lungs: Two spongy organs responsible for gas

exchange in the body. They are encased in a thin,
two-layered membrane called the pleura.

Pleura: This double-layered membrane acts as a

lubricant, allowing the lungs to glide smoothly
against the chest wall during breathing. The space
between these layers is called the pleural cavity,
normally containing a minimal amount of air.
Pathophysiology
Types of Pneumothorax

Spontaneous Pneumothorax

Primary spontaneous pneumothorax

-When no underlying health condition or disease causes
the collapsed lung.

·Secondary spontaneous pneumothorax

-Certain lung diseases can lead to a collapsed lung. This
can happen when your lung is blocked, causing bulging
areas (bullae) that can burst.
Types of Pneumothorax

Traumatic Pneumothorax

-Traumatic pneumothorax, also known as a collapsed

lung caused by trauma, arises when air leaks into the
space between your lung and chest wall due to an
external injury. This air buildup causes the lung to
partially or completely collapse, hindering its ability to
function properly and leading to breathing difficulties.

A traumatic pneumothorax resulting from major injury to

the chest is often accompanied by hemothorax.
·collection of blood in the pleural space resulting from
torn intercostal muscles, lacerations of the great vessels,
or lacerations of the lungs
Types of Pneumothorax

Tension Pneumothorax

-It occurs when air accumulates in the pleural space (the

space between the lung and chest wall) and becomes
trapped due to a one-way valve mechanism. This trapped
air creates increasing pressure, further collapsing the lung
and impeding its ability to expand and contract for proper
breathing. Additionally, the pressure buildup displaces vital
organs like the heart and mediastinum, compromising
blood flow and overall circulation.
 Signs and Symptoms

Sudden, sharp chest pain

Shortness of breath
Rapid breathing
Chest tightness
Cough

Other symptoms: In severe cases, rapid heart rate, cyanosis

(bluish skin color), and anxiety can occur.
 Risk Factors

Age and Certain Medical

Gender Smoking Conditions

Injuries
Underlying lung Mechanical
conditions
Ventilator
Treatment Laboratory Diagnosis

Observation
Chest X-ray
Chest tube insertion
Blood tests
Surgery
 Medications

Medication is not typically used for the

treatment of pneumothorax itself. However,
depending on the cause and accompanying
symptoms, pain relievers, cough suppressants,
or oxygen therapy might be used for symptom
management.
 Nursing Management

Immediate Assessment and Monitoring:

Airway Assessment
Physical Examination
Vital Signs Monitoring Supportive Care and Monitoring
Review medical History Oxygen Therapy
Ambulation and Mobilization
Chest Tube Management Nutritional Support
Insertion Assistance Psychological Support
Monitoring Drainage
Pain Management
Patient Education
Subcutaneous
Emphysema
Introduction
Air that infiltrated the subcutaneous layer of the skin
It can travel in the body
development of subcutaneous emphysema may indicate
that air has occupied or occupying deeper areas of the
body not visible to the unadaid eye
Signs and Symptoms

Crepitus
Distention or Bloating
swelling or pain in the neck
Treatment
Laboratory Diagnosis
Medications
Thank you
from: GROUP 2