College of Applied Medical Sciences –Al Quwayiyah

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Objectives:
At the end of this lecture, the student should be able to:
1. Define key terms.
2. Describe the purpose, nursing responsibilities, and significance
of expected results for common respiratory diagnostic studies.
3.Describe nursing care for clients experiencing infectious or
inflammatory upper respiratory disorders
4. Describe nursing interventions in caring for clients with upper
respiratory tract disorders.
5. Assist in developing a nursing care plan for a client with an
upper respiratory tract disorder.
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 Respiratory System
Nasal Cavity
Throat
Nose (pharynx)
Mouth
Windpipe
(Trachea)
Bronchus
Left lungs
Bronchiole Ribs

Alveolus

Diaphragm
College of Applied Medical Sciences- Al Quwayiyah
Introduction
• Respiration
The process of gas exchange between atmospheric air and the
blood at the alveoli, and between the blood cells and the cells
of the body.
Types of respiration:
A. External respiration is the exchange of gases between the
inhaled air, now in the alveoli, and the blood in the pulmonary
capillaries.
B. Internal respiration is the exchange of gases at the cellular
level between tissue cells and blood in systemic capillaries.
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• Phases of Respiration:
a. Inspiratory b. Expiratory

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Diagnostic test of respiratory system:
Chest X – Rays
• Radiographic visualization of the chest
• Instruct patient to hold his breath and remove metals from the chest
Lung Scan
• Measures blood perfusion through the lungs
• Helps confirm pulmonary embolism or other blood-flow abnormalities
• After radioisotope injection, scans are taken with a camera
• Remain still during the procedure
Lymph Node Biopsy
• Assesses lung cancer malignant
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 Bronchoscopy
• Direct inspection and observation of the trachea and bronchi through
flexible scope
• Diagnostic uses: to collect secretions/specimen, to determine
location of pathologic process
• Therapeutic uses: remove foreign object and excise lesions

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 Sputum Studies
Sputum specimens are examined for pathogenic microorganisms
and cancer cells. Culture and sensitivity tests are done to diagnose
infections and prescribe antibiotics.
Computed Tomography (CT scan)
A CT scan can show cancers, pneumonia, emphysema, and more &
useful for evaluating trauma or blood vessel abnormalities.
Pulse oximetry
Pulse oximetry is a noninvasive method of continuously monitoring the
oxygen saturation of hemoglobin (SaO2).

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College of Applied Medical Sciences- Al Quwayiyah 9
 Magnetic Resonance Imaging (MRI)
• MRI yields a much more detailed diagnostic
image than CT because it visualizes soft tissues.
MRI is used to characterize pulmonary nodules,
to help stage bronchogenic carcinoma
(assessment of chest wall invasion), and to
evaluate inflammatory activity in interstitial lung
disease
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MRI

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Upper respiratory tract disorder

Rhinitis
Pharyngitis

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Rhinitis
• A group of disorders characterized by inflammation and
irritation of the mucous membrane of the nose.

Types:
a. Non-allergic – caused by infection, age, systemic
disease
b. Allergic – due to inhalation of dust, fumes, odors
c. Drug-induced - associated w/ use of
antihypertensive drugs, oral contraceptives and chronic
use of nasal decongestant.
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Viral Rhinitis (Common Cold)

is an acute inflammation of the mucous membrane.

caused by 6 viruses
• rhinovirus
• influenza virus
• parainfluenza virus
• corona virus
• syncytial virus
• adenovirus College of Applied Medical Sciences- Al Quwayiyah 14
Manifestations:

• Rhinorrhea (clear nasal discharge)

• nasal congestion
• sneezing
• Headache
• watery eyes
• scratchy or sore throat
• general malaise
• low grade fever
• Chills,
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The symptoms of viral rhinitis may last from 1 to 2 weeks

Management:
• Medications – antihistamine, decongestant,
corticosteroid, ophthalmic agents, saline nasal
spray, Vit. C
• Avoidance of allergens (dust, pollen, dander,
fumes ) and Rest
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Nursing Management (Teaching Patients Self-Care)

• Hand hygiene which greatly reduces the spread of

infection.
• avoiding close contact with individuals who have
upper respiratory infections or colds are vital in
preventing the spread of infection.
• The client should cover cough to prevent spread
and be encouraged to cough up all secretions and
dispose of them in a tissue
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Pharyngitis
Is an inflammation or infection of the throat

• Viruses and bacteria cause pharyngitis. The most

serious bacteria are the group A streptococcal,
which cause a condition commonly referred to as
strep throat. Strep throat can lead to dangerous
cardiac

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Types:

a. Acute pharyngitis
usually causing symptoms of sore throat caused by group A
beta-Hemolytic Streptococcus (Strep throat).

pharyngitis spreads easily in the droplets of coughs and

sneezes and unclean hands that have been exposed to
the contaminated fluids.

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Clinical Manifestations
The signs and symptoms of acute pharyngitis
include:
• fiery red pharyngeal membrane and tonsils
• swollen cervical lymph nodes
• Fever
• malaise
• Hoarseness
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Medical Management
• Nutritional therapy- liquid/soft diet
• Encourage rest
• Warm saline gargles
• Monitor V/S
Pharmacologic therapy:
• analgesics/antipyretics, antitussive, antibiotics
• The antibiotic regimen is 7 to 14 days.

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• Early antibiotic treatment is the best choice for pharyngitis to
treat the infection and help prevent potential complications.

complications
• endocarditis
• rheumatic fever
• renal complications.
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b. Chronic pharyngitis
• persistent inflammation of the pharyngeal. Common in
adults who work and live in dusty surroundings, suffer from
chronic cough
Clinical Manifestations
The signs and symptoms of acute pharyngitis include:
• constant sense of irritation or fullness in the throat
• dysphagia (difficulty swallowing)
• mucus that collects in the throat which is expelled by
coughing

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Medical Management
• Treatment of chronic pharyngitis is based on relieving
symptoms, avoiding exposure to irritants, and correcting any
upper respiratory, pulmonary, gastrointestinal, or cardiac
condition that might be responsible for a chronic cough.

• For adults with chronic pharyngitis, tonsillectomy is an

effective option

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Nursing Management
• avoidance of alcohol, smoke, secondhand smoke, and
exposure to cold or to environmental
• encourages the patient to drink plenty of fluids.
• Gargling with warm saline solution may relieve throat
discomfort.
• The patient may minimize exposure to pollutant by wearing a
disposable facemask.

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lower respiratory tract disorder
Pneumonia
Tuberculosis (T.B )

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 Objectives:
At the end of this lecture, the student should be able to:
1. Define key terms.
2. Describe infectious and inflammatory disorders of the
lower respiratory airway.
3. Discuss the modes of therapy and related nursing
management for patients with pneumonia and TB.
4. Define the cause, treatment, interventions, and clinical
outcomes in tuberculosis
2 College of Applied Medical Sciences- Al Quwayiyah
pneumonia

College of Applied Medical Sciences- Al Quwayiyah

Definition
• is an inflammatory process affecting the
bronchioles and alveoli.
caused by various microorganisms,
including bacteria, mycobacteria, fungi,
and viruses.

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 Incidence &
PATHOPHYSIOLOGY
• Pneumonia can affect anyone, but those at greatest
risk are people less than 2 years of age or over the
age 65.
• In pneumonia some or all of the alveoli, interstitial
tissue, and bronchioles become filled with fluid or
blood as a result of the inflammatory process of
infection or chemical irritants. The warm moist
pulmonary tissue provides an excellent medium for
bacterial growth.
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 Classification of
pneumonia

• Lobar pneumonia; if
one or more lobe is involved
• Broncho-pneumonia;
the pneumonic process has
originated in one or more
bronchi and extends to the
surrounding lung tissue

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Etiology
Inflammatory disease usually caused by an infections agent:
• bacterial
• Viral
• fungal
• inhalation of chemicals
• aspiration of gastric contents.
• Pneumococcal pneumonia. the most common type of bacterial
pneumonia, occurs in winter and spring.
 Risk factors of pneumonia

• Immuno-suppresed patients
• Cigarette smoking
• Difficult swallowing (due to stroke, dementia, or other
neurological conditions)
• Impaired consciousness ( loss of brain function due to
dementia, stroke, or other neurological conditions)

College of Applied Medical Sciences- Al Quwayiyah

Cont,
• Chronic lung disease (COPD)
• Frequent suction
• Other serious illness such as heart disease, liver cirrhosis,
and DM (Diabetes mellitus)
• Recent cold, laryngitis

College of Applied Medical Sciences- Al Quwayiyah

Sings& Symptoms:
Chest pain that increases on inspiration.
• Dyspnea
• Elevated temperature. ( 39.5 to 40.5 degree)
• Increased WBC. ( white blood cells)
• Chills
• Cough with purulent, blood tinged, rusty sputum.
• Tachypnea &tachycardia
• Loss of appetite (anorxia )
• low energy, and fatigue
• Cyanosed lips and nail.
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 Diagnostic tests

• History taking
• Physical examination
• Chest x-ray
• Blood test
• Sputum culture

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 Medical Management
• Antibiotics (based on the result of sputum or blood culture &
sensitivity).
• Oxygen therapy usually via nasal cannula. (if patient is
hypoxemic).
• Antipyretic and analgesic.
• Increased of fluid intake
• Pneumococcal vaccination reduces the incidence of pneumonia
• Bed rest is recommended until infection shows signs of clearing.
College of Applied Medical Sciences- Al Quwayiyah
Nursing Care of Client's with Pneumonia
1. Encourage coughing and deep breathing.
2. Collect sputum specimen for culture and sensitivity tests In sterile Container.
3. Increase warm fluid intake.
4. Monitor vital signs.
5. Plan rest periods.
6.Instruct client to cover nose and mouth when coughing.
7.Administer antibiotics as ordered.
Cont,
8.Provide a quiet, calm environment, with frequent rest periods.

9. Monitor the patient’s ABG( Arterial Blood Gases) levels,

especially if he’s hypoxic.

10. Assess the patient’s respiratory status. Auscultate breath

sounds at least every 4 hours.

11. Provide a high calorie, high protein diet of soft foods.

College of Applied Medical Sciences- Al Quwayiyah
 Pulmonary
Tuberculosis(TB)
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Definition
Tuberculosis (TB) is an infection of the lung tissue by
Mycobacterium tuberculosis.

It also may be transmitted to other parts of the body,

including the kidneys, liver, brain & bone.

TB spreads from person to person by airborne

transmission.
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Causes tubercles;
fibrosis and calcification within the lungs
Risk Factors for Tuberculosis(TB);
• alcoholism
• cardiovascular disease
• DM (Diabetes mellitus)
• cirrhosis as well as poor nutrition and crowded
living conditions.
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Sings& Symptoms:
• Easily fatigued.
• low-grade fever
• Night sweats.
• The cough may be nonproductive, or mucopurulent
sputum may be expectorated.
• Hemoptysis. (coughing up of blood.)
• Weight loss.
• Anorexia
Diagnostic testing
Tuberculin skin test ( (PPD) purified protein.1
;derivative
A small amount of tuberculin is injected directly under the
skin, and the size of the induration is evaluated at 48 to 72
hours.
Chest x-ray .2
Acid-fast bacillus (AFB) .3
Sputum culture .4
CT Scan .5
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Tuber culin skin test

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Medical and Surgical Management
1. Program of combined antituberculin drugs such as
streptomycin ,pyrazinamide, rifampin for 6 to 12 months.
2. Bed rest until symptoms abate or therapeutic regimen.
3. Determine whether surgical resection of the involved lobe is
necessary if symptoms such as hemorrhage.
4. Have the client begin a high-carbohydrate, high-protein,
high- vitamin diet with supplemental vitamin B 6

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 Nursing interventions
◆ Weight the patient daily
◆ Practice good hand hygiene techniques to reduce the risk of
spreading the infection
◆ Explain disease transmission to the patient and the need for
prolonged therapy to help increase his compliance with the
treatment plan
◆ Encourage increased fluid intake
◆ Encourage the patient to maintain adequate dietary intake.

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NURSING PROCESS
Subjective Data
• The history includes questions about the presence of signs
and symptoms of TB, such as night sweats, dyspnea on
exertion or at rest in late disease, anorexia and fatigue.
Objective Data
Objective data include weight loss, low-grade fever and
persistent cough. The cough may be nonproductive early
in the disease. Later, the cough is productive and yields
.thick, purulent sputum. Eventually, hemoptysis
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 Evaluation Implementation Planning Nursing Assessment
Diagnoses
Client will effectively Encourage client to drink 3 to 4 The patient will Ineffective airway
clear secretions. L/day. have improved clearance related
Encourage deep breathing and airway clearance to the inability to
coughing every 2 hours remove airway
Place client in semi-Fowler’s secretions
position.

The patient will Observe skin and mucous The patient will Impaired gas
have adequate membranes for cyanosis. experience exchange related
pulmonary tissue Monitor arterial blood gas improved gas to the active
perfusion as values and pulse oximetry as exchange inflammatory
manifested by ordered. process
normal arterial blood  Administer supplemental
gas (ABG) oxygen.

 the patient will  Monitor intake and output Demonstrate Imbalanced

maintain weight (I&O) progressive nutrition, less than
 Encourage and provide for weight gain body
frequent rest periods toward goal with requirements,
 Provide oral care before and normalization of related to
after respiratory treatments laboratory increased caloric
 Encourage small, frequent values and be requirements
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