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RESPIRATORY SYSTEM

1.Pulmonary Function Test

Nursing Care

Carefully explain the procedure.

Perform tests before meals.

Withhold medication that may alter respiratory

function unless otherwise ordered.

After procedure assess pulse and provide for rest

period.

2. Sputum Culture and Sensitivity Test

Nursing Care

Explain the procedure to the client.

If the client is unable to cough,

heated aerosol will assist with

obtaining a specimen.

Collect the specimen in a sterile

container that can be capped

afterwards.

Volume need not exceed 1-3 ml.

Deliver specimen to the lab

immediately.

3. Thoracentesis

Nursing care (pre-test)

Informed consent

Instruct the client not to cough or talk

during the procedure.

Position the client appropriately at the

side of the bed. Assess vital signs.

Nursing care (post-test)

Observe for signs and symptoms of

pneumothorax, shock, leakage at the

puncture site.

4. Bronchoscopy

Nursing Care (pre-test)

Informed consent

Explain the procedure, remove

dentures, and provide good oral

hygiene

Keep the client NPO 6-12 hours pre-

test.

Nursing Care (post-test)

Position the client on the side or in

semi-Fowlers position

Keep NPO until the return of gag

reflex.

Assess for and report frank bleeding

Apply ice bags to sore throat for

comfort.

CLASSIFICATION OF PULMONARY

DISORDERS

Restrictive disorders

Chronic obstructive pulmonary disease

Pulmonary vascular disorders

RESTRICTIVE DISORDERS

A. PNEUMONIA

Classification

Community Acquired Pneumonia

occur either in the community or 48

hours before hospitalization

Streptococcus pneumoniae,

H. influenza, Mycoplasma

pneumoniae

Hospital Acquired Pneumonia also

called nosocomial infection, onset of

symptoms more than 48 hours after

hospitalization

P. aeruginosa,

Staphylococcus pneumoniae,

Klebsiella pneumoniae, E.

coli

RESTRICTIVE

DISORDERS

Aspiration Pneumonia pulmonary

consequences resulting from the entry

of endogenous or exogenous substances

into the lower airway.

Streptococcus pneumoniae,

H. influenza, Staphylococcus

pneumoniae, gastric contents

Risk Factors

Conditions that produce mucus or bronchial

obstruction

Smoking

Cancer, COPD

Immunosuppressed patients

Prolonged immobility

Depressed cough reflex

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Alcohol intoxication

Respiratory therapy with improperly cleaned

instruments

Aging

Laboratory Diagnostics

Complete Blood Count

Chest X-Ray

Blood culture

Sputum examination

Arterial Blood Gas (ABG)

Nursing Diagnosis

Ineffective airway clearance related to copious

tracheobronchial secretions.

Impaired gas exchange due to alveolocapillary

membrane changes.

Risk for fluid volume deficit related to fever and

dyspnea.

Altered nutrition: less than body requirements

related to increased metabolic needs

Nursing Interventions

Monitor for increased respiratory distress

Administer oxygen therapy via nasal cannula

Assist patient to cough effectively

Suction airway using sterile technique

Assist with nebulizer therapy

Chest physiotherapy

Antibiotics and bronchodilators as ordered

Adequate fluid intake

Assist with ADL

If comatose, reposition q 2 hours and do passive

ROM q 4 hours

Deep breathing exercises q 2 hours

Small frequent feedings, high CHO and CHON

Monitor for s/s of complications

Influenza vaccine for elderly.


B. PULMONARY TUBERCULOSIS

Caused by Mycobaterium tuberculosis

Spreads via droplet infection (generally particles

1 to 5 micrometers in diameter)

Risk Factors:

close contact with someone with active TB

immunocompromised status

substance abuse

any person without adequate health care

pre-existing medical conditions

living in overcrowded, substandard housing

health care providers

Pathophysiology

Inhalation of mycobacterium

Multiplication of bacteria in lower airways

Transmission of bacteria to other parts

(lymph nodes, kidneys, brain)

Immune system activated

Formation of Primary tubercle

Caseation necrosis

cavitation


Clinical Manifestations:

1. Anorexia

2. weight loss

3. fatigue

4. cough

5. low-grade fever

6. night sweats

7. hemoptysis



Diagnostics:

Chest X-ray

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Sputum smear and culture

Gastric aspirate

Tuberculin skin test

Medical Management:

First line drugs

INH and rifamipicin for 6months

PZA, ethambutol/streptomycin for 2 months

Second line drugs

Kanamycin

Amikacin

Quinolones

Cycloserine

Para-aminosalicylic acid


Nursing Interventions:

Administer medications as ordered.

Client should be in a well-ventilated private

room, with the door kept closed at all times.

All visitors and staff should wear masks when in

contact with patient.

Patient should cover nose and mouth when

coughing, sneezing and laughing.

Handwashing is required after direct contact with

patient.

Offer small, frequent feedings and nutritional

supplements.

Weigh client at least 2x/week.

Discuss client's feelings and assess for boredom,

depression, and anxiety and fatigue.

Advise client regarding necessity of patient's

compliance to medications.

Classification of TB

Class O no exposure, no infection

Class 1 with exposure, no infection

Class 2 infection, no disease (+PPD reaction

but no clinical evidence of active TB)

Class 3 disease, clinically active

Class 4 disease, not clinically active

Class 5 suspected disease, diagnosis pending

Stages of Tuberculosis

1. During the primary stage, the

bacteria reside in tissue in the lungs

and elsewhere in the body. During this

stage, most people have no symptoms.

The body's natural defenses areactivated to produce antibodies to

fight the infection. If the body's

defenses are successful, the bacteria

are walled off within a capsule, and the

infection doesn't progress. The person

is now in latency stage. However, the

bacteria are still alive and can escape

and become active later. This can

happen if the body's immune system

becomes impairedby illness, poor

nutrition, certain drugs, or infection

with AIDS.

2. The secondary stage (active stage

)

begins several months after the primary

stage if the body's defenses were not

successful. Bacteria begin destroying

body tissue, particularly lung tissue.

Symptoms include a slight fever,

weight loss, fatigue, and night sweats.

TB in the lungs causes a chronic cough

that is initially dry but eventually

produces sputum that contains blood

and pus. Symptoms will also appear in

other areas of the body where the

bacteria have spread.

There are three important ways to describe

the stages of TB. They are as follows:

1. Exposure: This occurs when a person has

been in contact, or exposed to, another person

who is thought to have or does have TB. The

exposed person will have a negative TB skin test,

a normal chest x-ray, and no symptoms of the

disease.

2. TB infection: This occurs when a person has

the TB bacteria in his/her body, but does not have

symptoms of the disease. This person would have

a positive skin test, but a normal chest x-ray and

no illness.

3. TB disease: This describes the person that has

symptoms of an active infection. The person

would have a positive skin test, a positive chest

x-ray, and might be ill.

The cause of TB is the bacterium Mycobacterium

tuberculosis (M. tuberculosis). Most people

infected with M. tuberculosis never developactive TB. However, in people with weakened

immune systems, including those with HIV

(human immunodeficiency virus), TB organisms

can overcome the body's defenses, multiply, and

cause an active disease.

Types of Tuberculosis

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1. Primary tuberculosis

the childhood form of tuberculosis. It

often occurs in the lungs, the back of

the throat, or the skin.

Infants are prone to infection. Theyalso are especially open to quick and

bodywide spread of the infection

through their bodies.

In childhood, the disease is often over

quickly. The tuberculin test will show

signs of having tuberculosis for the rest

of one's life.

Post-Primary Tuberculosis

2. Miliary tuberculosis

a form of tuberculosis with spreading

through the bloodstream of the germs

(tubercle bacilli).

In children it is linked to high fever,

night sweats, and, often, swelling of the

membranes covering the brain and

spinal cord (meningitis).

Other symptoms are fluid in the chest

cavity and inflammation of the stomach

and intestinal lining (peritonitis).

A similar illness may occur in adults.

Then there are weeks or months of mild

symptoms, such as weight loss,

weakness, and light fever.

Many small objects looking like millet

seeds may show up on chest x-ray

films.

The liver, spleen, bone marrow, and

membrane covering of the brain

(meninges) are often affected.

Miliary tuberculosis

Signs/Symptoms

Pulmonary

Weight loss, fatigue, generalized

weakness, anorexia; slight fever with

chills and night sweats; nonproductive

cough that eventually becomes

productive with mucopurulent sputum;

tachycardia; dyspnea on exertion;hemoptysis

Cardiovascular

Pericarditis with precordial chest pain,

fever, ascites, edema, and distention of

neck veins

Gastrointestinal

Peritonitis with acute abdominal pain,

abdominal distention, vomiting,

anorexia, weight loss, night sweats;

gastrointestinal bleeding, bowel

obstruction

Neurologic

Meningitis with headache, vomiting,

fever, declining consciousness, and

neurologic deficit

Musculoskeletal

Joint pain, swelling, tenderness,

deformities; limitation of motion

Genitourinary

Urgency, frequency, dysuria,

hematuria, pyuria; infertility,

amenorrhea, vaginal bleeding and

discharge; salpingitis with lower

abdominal pain

Lymphatics

Enlarged lymph nodes

Diagnostic Tests

1. Skin tests (purified protein

derivative/Mantoux) - Positive reaction

indicates past infection and presence of

antibodies; it is not indicative of active disease

2. Mantoux test - injecting a solution containing

a small amount of bacteria just under the skin on

the inside of the forearm.

skin reaction consists of a rash, blisters,

or swelling around the injection site.

An early reaction is not significant.Swelling in 48 to 72 hours may indicate

a positive reaction, depending on the

size of the swelling.

Mantoux Test

Intradermal

Read 48-72 hours after injection

(+) Mantoux Test is induration of 10mm or more

For HIV positive clients, induration of 5mm is

considered positive

(+) Mantoux Test signifies exposure to

Mycobacterium Tubercle Bacilli

If a skin test is positive, further

procedures are necessary to determine

whether the TB is active.

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3. Sputum culture - Positive for causative agent

within 2 to 3 weeks of onset of active disease; it

is not positive during latency

4. Acid-fast sputum smear - Positive for acid-

fast bacillus

5. Pleural needle biopsy - Positive for causative

agent

6. Tissue biopsy/culture - Positive for causative

agent

7. Chest x-rays - May reveal cavitation,

calcification, parenchymal infiltrate; not

diagnostically definitive

PPD Test

TB Chest X-ray

Immediate testing:

If the child is thought to have been exposed in the

last five years.

If the child has an x-ray that indicates possible

TB.

If the child has any symptoms of TB.

A child that is coming from countries where TB

is prevalent.

Yearly skin testing:

Children with HIV.

Children that are in jail.

Testing every 2 to 3 years:

Children that are exposed to high-risk people.

Consider testing in children from ages 4 to 6

and 11 to 16 if:

A child's parent has come from a high-risk

country.

A child has traveled to high-risk areas.

Children who live in densely populated areas.

Treatment

1. Anti- Tubercular Agents

R-ifampin

I-soniazid

P-yrazinamide

E-thambutol

S-treptomycin

prescribed for a period of time up to six

months or more for the medication to

be effective. Patients usually begin to

improve within a few weeks of the start

of treatment. The patient is not usuallycontagious once treatment begins,

provided that treatment is carried

through to the end, as prescribed by a

physician.

2. Surgery

Drainage of pulmonary abscesses;

correction of complications such as

intestinal obstruction or urethral strictur

3. General

Sputum precautions until negative

sputums are evident (10 to 14 days

after start of drug therapy);

management usually on an outpatient

basis unless the disease is in an

advanced state with complications;

instruction about the importance of

uninterrupted drug therapy and the

need for periodic recultures of sputum

throughout drug therapy, which may

last a year or longer; skin testing and

examination of close contacts at the

time of initial diagnosis and again in 2

to 3 months; long-term medical follow-

up to prevent recurrence

Potential Complications

massive destruction of lung tissue, leading to

pneumothorax, pleural effusion, pneumonia, and

respiratory failure;

brain abscess; cardiac tamponade; vertebral

collapse and paralysis; liver failure; renal failure;

and generalized, massive dissemination of

disease that usually is fatal.

New drug-resistant strains of tuberculosis are

emerging, leading to more frequent progression

to complications.

Patient Teaching

Avoid alcohol while taking isoniazid

and rifampin because this can cause

serious liver problems.

Take both drugs on an empty stomach

with a full glass of water.

If stomach upset is a problem, take

them with a small amount of food.

Avoid taking antacids that contain

magnesium or aluminum within 1 hour

of taking isoniazid, since this can

interfere with drug absorption.

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Rifampin can make oral contraceptives

less effective, so if you are on the pill,

use another method of birth control.

Rifampin gives a reddish or brownish

color to urine, saliva, sputum, stools,

sweat, and tears and will discolor softcontact lenses.

Other possible side effects are

dizziness, stomach upset, diarrhea, or

rash.

Report to the doctor blurred vision, eye

pain, chills, joint pain and swelling,

breathing difficulty, fever, weakness,

vomiting, or yellowing of the skin or

eyes.

Client Education: Preventing the spread of TB

TB is not extremely contagious, but

you need to protect close contacts.

Bacteria is spread by coughing, so

cover your nose and mouth and dispose

of soiled tissues properly and wash

hands thoroughly.

Good room ventilation helps to reduce

the amount of bacteria in the air.

Sometimes household members are

required to take antituberculosis drugs

for 6 to 9 months (as a precaution).

Client Education

Cover nose and mouth when coughing, sneezing

and laughing

TB is transmitted by droplet infection

Wash hands after any contact with body

substances, masks or soiled tissues

Wear masks when advised

Anti-TB drugs must be taken in combination to

avoid bacterial resistance

Drugs to be taken on empty stomach for

maximum absorption

Restrictive Disorder

Medical Management:

1. Radiation

2. Chemotherapy

3. Surgery



1. Suction nose frequently.

2. Promote pain relief.

3. Promote wound drainage.

4. Administer monitor tube feedings as ordered.

5. Observe stoma/structure lines for signs of

infection.

6. Enhance communication.

7. Support client during adaptation to altered

physical status.


8. Provide client teaching:

Tracheostomy/laryngectomy and stoma care

Control of dryness and crusting of the tongue.

Need for a humidifier at home.

Protect stoma while showering.

Use electric razors for the first 6 months after

the operation.

Cover stoma when coughing or sneezing.

Necessity of installing smoke detectors.


D. Lung Cancer

May be metastatic or primary

#1 cause of mortality

Associated with smoking

Poor prognosis

Adenocarcinoma- most prevalent type

Small cell carcinoma- poorest prognosis

Signs and Symptoms

Asymptomatic

Cough

Hemoptysis

Pain on inspiration

Dyspnea

Pleural effusion

Easy fatigability

Clubbing of fingers

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Weight loss

Diagnostics

Chest X-ray

Fiberoptic bronchoscopy

CT Scan

MRI

Thoracentesis

Pulmonary function tests

Medical Management

Surgery

Pneumonectomy

Lobectomy

Segmentectomy

Wedge resection

Decortication

Radiation

Chemotherapy

Nursing Management

Administer O2 as ordered

Post-op: flat on bed until BP is stable, after

which semi-fowlers position

Position on unoperated side, but for

pneumonectomy on operated side

Coughing and deep breathing exercises

Assist patient in abdominalbreathing

Mist therapy

Nursing Management

Suctioning as needed

Pain medications as ordered

Assist patient in performing arm exercises

Check dressings periodically

Check for presence of subcutaneous emphysema,

report to MD if worsening

Nursing Management

Care of chest tube

Keep all tubing as straight as possible.

Keep all connections tight

Observe for air bubbles and

fluctuations

Monitor V/S and breath sounds

regularly

Never elevate the drainage system at

the level of the patients chest.

1. Atelectasis- an abnormal condition marked by the

collapse of lung tissue. This collapse prevents the exchange

of carbon dioxide and oxygen by the blood. Symptoms

include lessened breath sounds, fever, and difficulty

breathing. The condition may be caused by obstruction of

the major airways and bronchioles. It may also be caused

by pressure on the lung from fluid or air in the area around

the lungs (pleural space), or by pressure from a tumor

outside the lung. Loss of lung tissue may cause increased

heart rate, higher blood pressure, and faster breathing.

Causes, incidence, and risk factors

Anesthesia, prolonged bed rest with few changes

in position, shallow breathing, and underlying

lung diseases are risk factors for atelectasis.

Secretions that plug the airway, foreign objects

(common in children) in the airway, andtumors

that obstruct the airway may lead to atelectasis.

In an adult, small regions of atelectasis are

usually not life-threatening, because unaffected

parts of the lung compensate for the loss of

function in the affected area. Large-scale

atelectasis, especially in someone who has

another lung disease or illness may be life-

threatening. In a baby or small child, lung

collapse due to a mucus obstruction or other

causes can be life-threatening.

Massive atelectasis may result in the collapse of a

lung.

Symptoms

Breathing difficulty

Chest pain

Cough

Signs and tests

Chest x-ray

Bronchoscopy

Fluoroscope

X Ray-

penetrating electromagnetic radiation,

having a shorter wavelength than light,

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and produced by bombarding a target,

usually made of tungsten, with high-

speed electrons (Cathode Ray;

Electromagnetic Radiation; Electron;

Light; Radiation).

Despite the fact that the tube was

encased in a black cardboard box,

Roentgen noticed that a barium-

platinocyanide screen, inadvertently

lying nearby, emitted fluorescent light

whenever the tube was in operation.

After conducting further experiments,

he determined that the fluorescence

was caused by invisible radiation of a

more penetrating nature than ultraviolet

rays (Luminescence; Ultraviolet

Radiation). He named the invisible

radiation X ray because of its

unknown nature. Subsequently, X rayswere known also as Roentgen rays in

his honor. more...

Fluoroscope-

apparatus for examining internal organs, used

especially in diagnosis. The essential parts of the

fluoroscope are an X-ray tube and a fluorescent

screen. The subject to be diagnosed is placed

between the X-ray tube and the fluorescent

screen. Wherever the X-ray radiations fall on the

screen, it glows vividly; where the X rays are

reflected or absorbed, shadows are cast on thescreen. Bones cast heavy shadows, and fleshy

organs such as the heart cast light shadows. In

abdominal analysis barium salts are administered

either orally or rectally before examination.

Because these salts are opaque to X rays, their

passage through the alimentary canal can be

traced.

Fluoroscopy can reveal cancer of the bones or

digestive tract; ulcers of the digestive tract; and

osteoporosis, a condition in which the bones are

reduced in mass. See also X Ray.

Treatment

The goal of treatment is to remove pulmonary

(lung) secretions and re-expand the affected lung

tissue.

The following treatments may be implemented:

Aerosolized respiratory treatments

Positioning on the unaffected side to

allow re-expansion of lung

Removal of the obstruction, if

present, by bronchoscopy or another

procedure

Deep breathing exercises (incentive

spirometry)

Percussion of the chest to loosen

secretions (clapping)

Positioning so that secretions drain

by gravity where they can be

coughed up (postural drainage)

Treatment oftumor or underlying

condition, if present

Expectations (prognosis)

The collapsed lung usually re-inflates

gradually once the obstruction has been

removed, although some residual

scarring or damage may be present.

Complications

Pneumonia may develop rapidly after

atelectasis.

Calling your health care provider

Call your health care provider if you

develop symptoms of atelectasis.

Prevention

Keep small objects out of the reach

of young children.

Maintain deep breathing after

anesthesia.

Encourage movement and deep

breathing in anyone who is

bedridden for long periods.

2. Pleurisy

An inflammation of the visceral and

parietal pleurae that envelop the lungs.

Causes and Incidence

Pleurisy arises from a pleural injury,

which may be caused by an underlying

lung disease (e.g., pneumonia,

asbestosis, or infarction); an infectious

agent, neoplastic cells, or irritants that

invade the pleural space (e.g., amebic

empyema, tuberculosis, pleural

effusion, systemic lupus erythematosus,

pleural carcinomatosis, rheumatoid

disease); or pleural trauma (e.g., rib

fracture).

Disease Process

The pleura becomes edematous and

congested, cellular infiltration ensues,

and fibrinous exudate forms on the

pleural surface as plasma proteins leak

from damaged vessels.

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This causes the visceral and parietal

pleural surfaces to rub together rather

than sliding over each other during

respiration.

The pleura becomes increasingly

inflamed and stretched, causing pain oneach breath.

Symptoms

The primary symptom is sudden onset

of pain in the chest or abdominal wall

that may vary from vague to an intense

stabbing sensation.

The pain is aggravated by breathing

and coughing.

Respirations are rapid and shallow,with guarding and decreased motion on

the affected side.


Permanent adhesions that restrict lung

expansion may develop.

Diagnostic Tests

Auscultation reveals a friction rub,

along with the characteristic

presentation of pain. A chest x-ray mayreveal pleural effusion.

Treatments

Surgery (None)

Drugs

Narcotic analgesic to relieve

pain during deep breathing

and coughing exercises;

analgesics and antipyretics

General

Treatment of underlying

disease; positioning and

splinting of chest; coughing

and deep breathing to prevent

atelectasis and infection

Painkillers

3. Pleural effusion

an abnormal buildup of fluid in thelungs.

Symptoms

are fever, chest pain,

breathing difficulty, and a dry

cough. The fluid comes from

swollen lung surfaces caused

by many things, as a blood

clot in the lung, an injury, a

tumor, or an infection.

Diagnostic tests

Thoracentesis

Thoracocentesis

also called thoracentesis.

Surgery to break into the chest wall and

lung membrane space with a needle to

remove fluid for diagnostic or

therapeutic purposes. It may also be

done to remove a specimen for biopsy.

The procedure is usually done usinglocal anesthesia. The patient is seated

leaning forward over a table that is

chest high.

Puncture of a cavity of the chest wall

may be used to treat pleural effusion, as

may occur in cancer of the lung

(bronchogenic carcinoma).

Fluid samples may be examined for

erythrocyte, leukocyte, and differential

white cell counts, protein, glucose, and

amylase concentrations. They may becultured for studies of microorganisms

that may be present.

Treatment

The cause is

treated, and the

fluid may be

removed by suction

or drained.

Other treatment

may include givingdrugs to get rid of

fluids and other

drugs

giving oxygen

using mechanical

breathing.

Chest tube insertion

Chest tube

Figure 1

Normal anatomy.

The pleural space is

the space between

the inner and outer

lining of the lung.

It is normally very

thin, and lined only

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with a very small

amount of fluid.

Figure 2

Indication

If fluid, such as blood, or air, gets into the pleural

space, the lung can collapse, preventing adequate

air exchange.

Chest tubes are used to treat conditions

that can cause the lung to collapse, such

as:

air leaks from the lung into the chest

(pneumothorax)

bleeding into the chest (hemothorax)

after surgery or trauma in the chest

(pneumothorax or hemothorax)

lung abscesses or pus in the chest

(empyema).

Figure 3

Procedure

Chest tubes are inserted to drain blood, fluid, or

air and allow full expansion of the lungs.

The tube is placed in the pleural space.

The area where the tube will be

inserted is numbed (local anesthesia).

The patient may also be sedated.

The chest tube is inserted between the

ribs into the chest and is connected to a

bottle or canister that contains sterile

water.

Suction is attached to the system to

encourage drainage.

A stitch (suture) and adhesive tape is

used to keep the tube in place.

The chest tube usually remains in place

until the X-rays show that all the blood,

fluid, or air has drained from the chest

and the lung has fully re-expanded.

When the chest tube is no longer

needed, it can be easily removed,

usually without the need for

medications to sedate or numb thepatient.

Medications may be used to prevent or

treat infection (antibiotics).

Figure 4

Recovery from the chest tube insertion and

removal is usually complete, with only a small

scar.

The patient will stay in the hospital

until the chest tube is removed.

While the chest tube is in place, the

nursing staff will carefully check for

possible air leaks, breathing difficulties,

and need for additional oxygen.

Frequent deep breathing and coughing

is necessary to help re-expand the lung,

assist with drainage, and prevent

normal fluids from collecting in the

lungs.

4. Pneumothorax

a collection of air or gas in the chest

(pleural space) causing the lung to

collapse.

Cause/Etiology

It may be the result of an

open chest wound that

permits air to enter

the break of an air-filled

blister (vesicle) on the lung's

surface

or a severe bout of coughing.

Signs/Symptoms

may begin with a sudden, sharp chest

pain

It is followed by difficult, rapid

breathing,

normal chest movements stopped on

the affected side.

There may be rapid heart beat

a weak pulse

low blood pressure

Sweating

Fever

pale skin

dizziness.

Nursing/Medical Intervention

patient should stay quiet in bed, in a

halfway upright position.

Oxygen may be given. The air should

be taken from the chest space at once.

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Thoracostomy tube- cut made into the

chest wall to provide an opening for

draining.

To remove the air, a tube is

put in, and not removed until

the air is no longer comingout through a water-seal

draining system.

Pain may be controlled with painkillers,

but drugs that can cause slowed

breathing are not used.

Mechanical breathing may be given.

The patient must learn how to turn,

cough, breathe deeply

passive exercises without making the

condition worse.

For example, stretching,

reaching, or sudden

movements must be not be

done

Treatment of Tension Pneumothorax Insertion of

Drainage Tubes

5. Hemothorax

-a buildup of blood and fluid in the

chest cavity, usually because of injury.

- Hemothorax may also be caused by

small blood vessels that break as a result of

swelling from pneumonia,

tuberculosis, or tumors.

-Shock from hemorrhage, pain, and

breathing failure follows if emergency

care is not available.

In this disorder, blood from damagedintercostal , pleural , mediastinal, and

sometimes lung parenchymal vessels

enters the pleural cavity.

Depending on the amount of bleeding

and the underlying cause, hemothorax

may be associated with varying

degrees of lung collapse and

mediastinal shift.

Pneumothorax (air in the pleural

cavity) commonly accompanies

hemothorax.

Normal Pleural Space

Anterior Relations of the Heart

Hemotho

rax

Cause:

Usually results from blunt or

penetrating chest trauma.

Hemothorax may result from thoracic

surgery, pulmonary infarction,

neoplasm, dissecting thoracic aneurysm

anticoagulant therapy.

Symptoms:

Percussion reveals dullness, and

auscultation reveals decreased to absent

breath sounds over the affected side.

Chest pain

Tachypnea

Mild to severe dyspnea (difficultybreathing) may be present

If respiratory failure results, the patient

may appear anxious, restless, possibly

stuporous, and cyanotic.

Marked blood loss produces

hypotension and shock.

The affected side of the chest expands

and stiffens, while the unaffected side

rises and falls with the patient's gasping

respirations

Treatment:

Goal: to stabilize the patient's

condition, stop the bleeding, evacuate

blood from the pleural space, and

reexpand the underlying lung.

Mild hemothorax usually clears in 10 to

14 days, requiring only observation for

further bleeding.

In severe hemothorax, thoracentesis

may be performed, (not only use as a

diagnostic tool, but also as a method of

removing fluid from the pleural cavity.)

Chest tube

Suction may be used to prevent clot

blockage

Thoracotomy may be done to evacuate

blood and clots and to control bleeding.

Autotransfusion of Pleural Blood Under-Water-

Seal Drainage

Respiratory Infections

Acute tracheobronchitis

Pneumonia

Shock and respiratory failure

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6. Acute tracheobronchitis

-swelling of the windpipe and bronchi.

-It is a common form of breathing infection.

croup, acute

laryngotracheobronchitis, exudative

angina /krp/, also called acute

laryngotracheobronchitis, angina

trachealis, exudative angina,

laryngostasis.

Compare acute epiglottitis.-

croupous, croupy. A virus infection of

the upper and lower breathing tract that

occurs mostly in infants and young

children aged 3 months to 3 years of

age.

Cause:

Croup occurs after another upper

breathing tract infection

Parainfluenza viruses

respiratory syncytial viruses (RSV)

influenza A and B viruses are the usual

causes

Inhalation of physical and chemical

irritants, gases and other air

contaminants

Signs/Symptoms:

hoarseness

fever and chills

Night sweats, headache,

general malaise

a distinct "barking" cough

many degrees of breathing

distress from blockage of the

windpipe.

Irritability

Pale or blue skin

DIAGNOSIS:

Infection is carried by

airborne particles or by

contact with infected fluids.

The acute stage starts rapidly,

most often occurs at night,

and may be triggered by

exposure to cold air.

The child becomes irritable,

gets a barking cough, and, in

severe cases, a pale or blue

skin.

The child's condition often

gets better in the morning,

but it may get worse at night.

TREATMENT:

Treatment is bed rest,

drinking a lot of fluids, and

relieving airway blockage.

Antibiotic treatment

depending on the symptoms,

sputum purulence and

sputum culture

Expectorants

Suctioning and

Bronchoscopy

Cool vapor therapy or Steam

inhalation

Mild analgesics or

antipyretics

Humidity and oxygen are

often given.

FOR CHILDREN:

Drugs are not given. To

prevent chilling, many

changes of clothing and bed

linen are needed because of

the humid air.

In most children the

condition is mild and runs its

course in 3 to 7 days.

The infection may spread to

other areas of the breathing

tract, causing problems, as

bronchiolitis, pneumonia, and

ear infections

Sputum culture

7. Pneumonia

-is an infection of the lungs that can be

caused by many different organisms.

-The symptoms can vary

considerably, depending on the cause.

Facts about pneumonia:

Pneumonia can occur year round, but is usually

seen in the winter and spring.

Boys are affected by pneumonia more often than

girls.

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There is an increased chance of developing

pneumonia in a crowded area.

Ten to 15 percent of children with a respiratory

infection have pneumonia.

Types of Pneumonia

A. Viral pneumonia

Upper respiratory viral infections and

influenza sometimes spread to the

lungs.

In addition to influenza-type symptoms

(fever, headache, general aching, and

loss of appetite), viral pneumonia is

marked by an irritating cough that may

produce sputum, shortness of breath,

and chest pain.

The so-called "walking pneumonia"

can cause very mild symptoms.

Viral pneumonia is usually treated at

home with bed rest, plenty of liquids,

and cough medicine that contains an

expectorant to clear the lungs of mucus.

A humidifier to add moisture to the air

also helps loosen the mucus.

Antibiotics or other drugs are not

effective in treating viral pneumonia.

Most otherwise healthy people recover

within a week or so.

However, viral pneumonia can lead to

bacterial infection in certain people.

For this reason, doctors may prescribe

antibiotics for people with chronic lung

diseases or other chronic illnesses to

prevent this complication.

viral pneumonia - caused by various viruses,

including the following:

respiratory syncytial virus, or RSV

(most commonly seen in children under

age 5)

parainfluenza virus

influenza virus

adenovirus

Early symptoms of viral pneumonia are the same

as those of bacterial pneumonia. However, withviral pneumonia, the respiratory involvement

happens slowly. Wheezing may occur and the

cough may worsen.

Viral pneumonias may make a child susceptible

to bacterial pneumonia.

B. Bacterial pneumonia

Bacterial pneumonia is usually caused

by eitherStreptococcus,

Staphylococcus, orHaemophilus.

The infection can start from an upper

respiratory infection such as "strep"

throat, from inhaling fluid or otherforeign substance into the lungs, or

from viral pneumonia.

The symptoms include fever, shortness

of breath, chest pain, coughing, and

sputum that is yellowish or greenish

and often has a foul odor.

It is a serious infection that often

requires hospitalization.

Treatment consists of antibiotics, bed

rest, fluids, humidified air, and anexpectorant cough medication.

Oxygen and chest physiotherapy may

be necessary for hospitalized patients.

Legionnaires' disease is a serious type

of bacterial pneumonia that occurs in

older people and people who smoke or

who have chronic diseases such as

emphysema, chronic bronchitis,

diabetes, renal disease, and cancer.

It is treated with erythromycin.

bacterial pneumonia - caused by various

bacteria. The streptococcus pneumoniae is the

most common bacterium that causes bacterial

pneumonia.

Many other bacteria may cause bacterial

pneumonia including:

Group B streptococcus (most common

in newborns)

Staphylococcus aureus

Group A streptococcus (most common

in children over age 5)

Bacterial pneumonia may have a quick onset and

the following symptoms may occur:

productive cough

pain in the chest

vomiting or diarrhea

decrease in appetite

fatigue

c. Other types of pneumonia

Mycoplasma pneumonia is caused by

one of the Mycoplasma bacteria.

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It most often infects children and young

adults, and it is a common cause of

"walking pneumonia."

Mycoplasmapneumonia is treated with

the antibiotic erythromycin or

doxycycline.

mycoplasma pneumonia - presents somewhat

different symptoms and physical signs than other

types of pneumonia. It is caused by

mycoplasmas, the smallest free-living agents of

human disease, which have the characteristics of

both bacteria or viruses, but which are not

classified as either. They generally cause a mild,

widespread pneumonia that affects all age

groups.

Symptoms usually do not start with a cold, and

may include the following:

fever and cough are the first to develop

cough that is persistent and may last

three to four weeks

a severe cough that may produce some

mucus

Other less common pneumonias may be caused

by the inhaling of food, liquid, gases or dust, or

by fungi.

Pneumocystis pneumonia is caused by the

protozoaPneumocystis carinii. This serious

infection occurs in patients with AIDS and those

whose immune systems are deficient.

A chronic fungus infection of the lungs can lead

to pneumonia.Histoplasma, Blastomyces,

Cryptococcus, Aspergillus, andCandida are

fungi that can establish themselves in the lungs.

This type of pneumonia is rare and occurs mainly

in patients whose immune systems are deficient.

Lobar pneumonia - affects one or more sections

(lobes) of the lungs.

Bronchial pneumonia (or bronchopneumonia)

- affects patches throughout both lungs.

Photomicrograph of Pneumonia

Bronchopneumonia

Lobar Pneumonia

What are the symptoms of pneumonia?

In addition to the symptoms listed above, all

pneumonias share the following symptoms.

However, each child may experience symptoms

differently. Symptoms may include:

fever

chest or stomach pain

decrease in appetite

chills

breathing fast or hard

vomiting

headache

not feeling well

fussiness

The symptoms of pneumonia may resemble other

problems or medical conditions. Always consult

your child's physician for a diagnosis.

How is pneumonia diagnosed?

Diagnosis is usually made based on the

season and the extent of the illness.

Based on these factors, your physician

may diagnose simply on a thorough

history and physical examination, but

may include the following tests to

confirm the diagnosis:

chest x ray - a diagnostic test which

uses invisible electromagnetic energy

beams to produce images of internaltissues, bones, and organs onto film.

blood tests - blood count for evidence

of infection; arterial blood gas to

analyze the amount of carbon dioxide

and oxygen in the blood.

sputum culture - a diagnostic test

performed on the material that is

coughed up from the lungs and into the

mouth. A sputum culture is often

performed to determine if an infection

is present.

pulse oximetry - an oximeter is a small

machine that measures the amount of

oxygen in the blood. To obtain this

measurement, a small sensor (like a

Band-Aid) is taped onto a finger or toe.

When the machine is on, a small red

light can be seen in the sensor. The

sensor is painless and the red light does

not get hot.

Specific treatment for pneumonia will be

determined by your child's physician based

on:

your child's age, overall health, and medical

history

extent of the condition

cause of the condition

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your child's tolerance for specific medications,

procedures, or therapies

expectations for the course of the condition

your opinion or preference

Treatment may include antibiotics for bacterial

pneumonia.

Antibiotics may also speed recovery from

mycoplasma pneumonia and some special cases.

There is no clearly effective treatment for viral

pneumonia, which usually resolves on its own.

Other treatment may include:

appropriate diet

increased fluid intake

cool mist humidifier in the child's room

acetaminophen (for fever and

discomfort)

medication for cough

Some children may be treated in the hospital if

they are having severe breathing problems.

While in the hospital, treatment may include:

intravenous (IV) or oral antibiotics

intravenous (IV) fluids, if your child is

unable to drink well

oxygen therapy

frequent suctioning of your child's nose

and mouth (to help get rid of thick

secretions)

breathing treatments, as ordered by

your child's physician

bronchodilator

a drug that relaxes contractions of the

bronchioles to improve breathing.

Bronchodilators are given for asthma,

bronchiectasis, bronchitis, and

emphysema.

Commonly used bronchodilators

include steroids, ephedrine,

isoproterenol hydrochloride,

theophylline, and many relatedcombinations of these drugs.

The steroids beclomethasone

dipropionate and triamcinolone can be

used in aerosol form.

11. Lung Abscess

Complication of bacterial pneumonia or caused

by aspiration or oral anaerobes

Localized necrotic lesion of the lung parenchyma

containing purulent material that collapses and

forms a cavity

Lung Abscess

Patients who are at risks

Causes of lung abscess

Site of abscess

Signs and Symptoms

Assessment and Diagnostic Findings

Prevention

Medical Management and Nursing Management

Pharmacologic Therapy

12. Empyema

a collection of pus in a body cavity, especially the

space between the lung and the membrane that

surrounds it (pleural space).

It is caused by an infection, as pleurisy or

tuberculosis.

It is a life-threatening condition requiring surgical

drainage and prolonged antibiotic treatment.

Empyema- Description

- It is a collection of pus within the pleural cavity

- The fluid is thin, opaque and foul smelling

- The most common cause is pulmonary infection

and lung abscess caused by thoracic surgery or

chest trauma, in which bacteria are introduced

directly into the pleural space

- Treatment focuses on emptying the empyema

cavity, re expanding the lung and controlling the

infection

Empyema - Assessment

Recent febrile illness or trauma

Chest pain, cough, dyspnea

Anorexia and weight loss

Malaise

Elevated temperature and chills

Night sweats

Diminished chest wall movement on the affected

side

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Pleural exudate on chest x-ray film

Empyema Nursing Interventions

Monitor breath sounds

Position client on a semi fowlers or high fowlers

position

Encourage coughing and deep breathing

Administer antibiotics as prescribed

Instruct the client to splint the chest as necessary

Assist with chest tube insertion to promote

drainage and lung expansion

If marked pleural thickening occurs, prepare the

client for decortication; if prescribed; this is a

surgical procedure that involves removal of the

restrictive mass or fibrin and inflammatory cells

DECORTICATION

Carried out when thickening of the visceral

pleura prevents re expansion of the lung as

may occur in chronic empyema. Visceral

pleura is peeled off the lung, which is then re

expanded by positive pressure thru an

anesthetic apparatus

Surgical removal of cortex or outer covering

of an organ such as the lungs

13. Pulmonary Edema

fluid in lung tissues

Most often occurs as result of abnormal cardiac

function

Crackles

Orthopnea

Treat underlying disease

Cause

congestive heart failure but also occurs as a side

effect of drugs, infections, inflammation of the

pancreas, or kidney failure.

Pulmonary edema also may follow a stroke, skull

fracture, near drowning, the breathing in of

poisonous gases, the rapid transfusion of whole

blood or fluids into the veins.

Signs/Symptoms

breathes quickly, shallowly, and with difficulty.

restless and hoarse and have pale or bluish skin.

cough up frothy, pink sputum.

veins of the neck, arms, and legs are usually

swollen.

Severe pulmonary edema is an emergency.

Treatment

place person in bed in a sitting position

give narcotic painkillers to relieve pain, slow

breathing, anxiety

heart tonic, drug that acts quickly to increase the

passing of urine (diuretic),

drug to enlarge the breathing tubes may be given.

Mechanical breathing help may be ordered by the

doctor.

Tourniquets placed on one arm or leg at a time

and then moved to a different arm or leg after a

short time, to pool blood in the arms and legs,

reducing the load on the heart.

The patient should exercise moderately, rest

often, report any symptoms, avoid smoking, and

follow the prescribed routines for drugs, diet, and

return checkups.

14. Acute Respiratory Failure

the inability of the heart and lung

systems to keep enough of a transfer ofoxygen and carbon dioxide in the

lungs.

Decreased respiratory drive

Dysfunction of the chest wall

Dysfunction of lung parenchyma

Inadequate ventilation

Treat underlying cause

Cause

lack of oxygen (hypoxemic failure) or a

transfer of gases problem (ventilatory

failure).

A sign of hypoxemic failure is excess

breathing (hyperventilation).

This occurs in diseases that affect the

air sacs (alveoli) or supporting tissues

of the lobes of the lungs, as alveolar

edema, emphysema, fungus infections,leukemia, pneumonia, lung cancer, or

tuberculosis.

Ventilatory failure occurs in conditions

in which fluids remaining in the lungs

cause more airway resistance and

lowered lung use, as in bronchitis and

emphysema.

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lowered if the breathing center is slowed by

barbiturates or opiates

Other factors slowing breathing are oxygen

problems, brain diseases, injury, or tumors of the

nerve and muscle system or the chest

long-term caused by added stress, as heart failure,

surgery, anesthesia, or upper breathing tract

infections.

Treatment

clearing the airways by suction

giving lung drugs (bronchodilators)

making an airway (tracheostomy)

antibiotics for infections

drugs that stop blood clotting to avoid

clots in the lungs

electrolyte replacements for fluid

imbalance.

Oxygen may be given in some cases

15. Acute/Adult Respiratory Distress Syndrome

An emergency

Sudden and progressive pulmonary edema,increasing bilateral infiltrates, hypoxemia

refractory to oxygen supplementation and

reduced lung compliance

Result of inflammatory trigger

Treat underlying condition

Ventilator considerations

Cause

failure of the lungs to work.

This may follow heart and lung bypass surgery

severe infection

blood transfusions

too much oxygen

trauma, pneumonia, or other lung infections.

It may also occur in Guillain-Barre syndrome,

muscular dystrophy, myasthenia gravis,

emphysema, asthma, or polio.

Signs/Symptoms

shortness of breath

quick breathing

Confusion

skin getting red, and changes in actions may be

caused by too much carbon dioxide

Oxygen levels that are too high can cause the

heart to race and the blood pressure to rise

Breathing failure brings falling blood pressure

and a blue tinge to the skin

cyanosis

DIAGNOSIS

Blood Tests show low amounts of oxygen and

more carbon dioxide in the blood

The changes that occur within the lungs may

include damage to the very small blood vessels,

bleeding, and swelling

TREATMENT

mechanical assistance with breathing

Oxygen

Mist

respiratory therapy

PATIENT CARE

constant and careful care

Confusion

The patient is weighed often

x-ray films of the chest are taken

and secretions are checked.

16. Pulmonary Hypertension

a condition of abnormally high pressure within

the arteries and veins of the lungs.

Systolic pulmonary artery pressure > 30 mm Hg.

or mean pulmonary artery pressure >25 mm Hg.

Primary is idiopathic

Secondary results from existing cardiac or

pulmonary disease

Manage underlying disease

17. Pulmonary Heart Disease

(Cor Pulmonale)

swelling of the right lower chamber (ventricle) of

the heart. This results from high blood pressure

(hypertension) of the lung circulation

Right ventricle enlarges with or without right-

sided heart failure

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Caused by severe COPD

Improve ventilation with supplemental oxygen,

chest physical therapy, and bronchial hygiene

Signs/Symptoms

constant cough

difficulty breathing

fatigue, and weakness

As the disease grows worse, breathing difficulty

may become more severe

water retention

swollen neck veins

rapid heart beat

A weak pulse and low blood pressure may result

from decreased heart function. awake or drowsy

TREATMENT

increase oxygen

increase exercise tolerance

correct the defect if possible

bed rest

digitalis

Oxygen

drugs to fight lung infection

low-salt diet

a small amount of fluids

Diuretics

anticlotting drugs.

PATIENT CARE

careful diet of many small meals

The amount of fluids drunk daily must be limited

Digitalis poisoning is often a danger

The patient must be alert to the symptoms. These

include appetite loss, nausea, vomiting, and

seeing yellow halos around images.

The cor pulmonale patient must avoid mixing

with crowds and taking drugs that can harm

breathing, as sedatives

Cor Pulmonale Chronic Cor

Pulmonale

18. Pulmonary Embolism

Obstruction of pulmonary artery or one of its

branches by a thrombus or embolus

Dyspnea,tachypnea, and chest pain occur

suddenly

Prevention of deep vein thrombosis

Emergency management

Anticoagulation therapy

Thrombolytic therapy

Description

Occurs when a thrombus that forms in the deep

vein detaches and travels to the right side of the

heart and then lodges in a branch of the

pulmonary artery

Clients prone to pulmonary embolism are those at

risk for deep vein thrombosis, including those

with prolonged immobilization,surgery, obesity,

pregnancy, congestive heart failure, advanced

age, or history of thromboembolism

Fat emboli can occur as a complication following

a fracture of a flat long bone

Treatment is aimed at preventing venous status

and includes ROM exercises and early

ambulation following surgery, the use of

antiembolism stockings and preventing pressure

under the popliteal space


thrombus, which typically forms in the leg or

pelvic vein but may be seen in other locations

Fat, amniotic fluid

Air, gas, thrombophlebitis

major surgery

pregnancy and childbirth

fractures

myocardial infarction

congestive heart failure

venous insufficiency

polycythemia vera

prolonged immobility

chronic illness.

It is estimated that up to 5% of hospital deaths are

attributable to pulmonary emboli.

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Pathophysiology

Emboli travel through bloodstream, lodge in

pulmonary arteries

affected artery becomes underperfused but is still

ventilated.

results in physiologic dead space or wasted

ventilation and contributes to hyperventilation

Histamine release from embolus produces reflex

bronchoconstriction, leading to further

hyperventilation

Depletion of alveolar surfactant results in

diminished lung volume and compliance.

If the clot is large enough and interferes greatly

with pulmonary perfusion, it may result in

pulmonary hypertension.

Symptoms

nonspecific and vary in degree and intensity,

depending on the size of the embolus

the extent of occlusion, the amount of collateral

circulation, and preexisting cardiopulmonary

function

Small emboli may be asymptomatic.

The chief manifestation is breathlessness

anxiety, restlessness, tachypnea, sweating, cough,

hemoptysis, chest pain, fever, and rales. Cyanosis

may be present with a massive embolus.

Assessment Findings:

Blood tinged sputum

Chest pain, cough, cyanosis

Distended neck veins

Dyspnea accompanied by anginal and pleuritic

pain, exacerbation by inspiration

Hypotension

Wheezes on auscultation

Shallow respirations, tachypnea and tachycardia

Diagnostic Tests

1. Pulmonary angiogram - Visualization of

intraarterial filling defects

2. Lung perfusion scan - To detect perfusion

defects

3. Ventilation scan - To detect altered ventilation

patterns

4. Blood gases - Arterial hypoxemia (decreased

PaO2 and PaCO2)

5. Electrocardiography - To rule out myocardial

infarction; PE is characterized by tall, peaked P

waves, depressed ST segments, T-wave

inversions, and supraventricular tachyarrhythmias

6. Chest x-ray - Unilateral elevation of the

diaphragm, enlarged pulmonary artery, and

pleural effusion 2 hours or longer after the event

Treatments

Surgery

Embolectomy for large emboli

unresponsive to treatment; umbrella

filter in inferior vena cava to trap

multiple emboli before they reach the

lung; interruption of blood flow

through the inferior vena cava by

ligation for multiple emboli

Drugs

Anticoagulants to halt clot propagation

(heparin is used in the acute phase and

is replaced by coumadin, which may be

administered for 6 months to life;

medications should overlap for 5 to 7

days to achieve effective blood levels

of coumadin); fibrinolytic enzymes

may be used in place of anticoagulants

for clot lysis, particularly of large clots;

analgesics for pain; vasopressors,

dopamine to treat hypotension

General

Oxygen therapy

bed rest in acute phase, followed by

progressive mobilization

hemodynamic and cardiac monitoring;

facilitation of breathing

intake and output measurements to

monitor renal function

observation for bleeding as a side effect

of anticoagulants

safety measures to prevent bleeding

information about long-term

anticoagulant therapy

antiembolism hose and instruction in

preventing pooled blood in the lower

extremities


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Cardiac arrhythmias, cor pulmonale, atelectasis,

shock, hepatic congestion, and necrosis are

complications

Pulmonary infarction is an uncommon

complication of PE that results in hemorrhagic

consolidation and tissue necrosis distal to theocclusion

Death following a PE usually occurs within 1 to 2

hours of the initial event

Those with underlying cardiovascular or

pulmonary disease and those with a large

embolus are at greater risk of dying

Untreated individuals risk recurrent emboli and

about a 50% chance of death.


Administer O2 as prescribed

Position client in high fowlers position

Monitor lung sounds and maintain bed rest with

active/ passive ROM

Encourage use of incentive spirometry

Monitor pulse oximetry

Prepare for intubation or mechanical ventilation

for severe hypoxemia

Administer anticoagulation therapy intravenously

with Heparin sodium (bolus), followed by

continuous infusion during the acute phase

Administer Warfarin (Coumadin) orally, as

prescribed, when infusion is discontinued

Monitor prothrombin time and ptt

Prepare the client for embolectomy, vein ligation

or insertion of an umbrella filter as prescribed

Pulmonary Embolism

19. Sarcoidosis

Boeck's sarcoid, also called sarcoid of Boeck

Multisystem granulomatous disease of unknown

etiology

Involves lungs, lymph nodes, liver, spleen, CNS,

skin, eyes, fingers, and parotid glands

Hypersensitivity response

Corticosteroid therapy or other cytotoxic and

immunosuppressive agents may be used

CAUSE

A long-term disease of unknown origin marked

by small, round bumps in tissue

It may appear in organs of the body, such as the

lungs, spleen, liver, skin, mucous membranes,

and tear and salivary glands, usually along with

the lymph glands

The sores usually go away after a period of some

months or years, but lead to widespread grainyswelling and fibrosis.

Signs and Symptoms: Sarcoidosis

Night sweats, fever

Weight loss, cough

Skin nodules, polyarthritis

KVEIM TEST- sarcoid node antigen is injected

intradermally and causes a local nodular lesion in

about one month


Administer corticosteroids to control symptoms

Monitor temperature

Increase fluid intake

Provide frequent periods of rest

Encourage small, nutritious meals

Sarcoidosis Eruption affecting the nose

Sarcoidosis affecting the spleen

20. Occupational Lung Diseases:

Pneumoconioses

any of a group of unusual problems in the lungs

caused by breathing dusts, fumes, gases, or

vapors in a place where a patient works

A. Silicosis

B. Asbestosis

C. Coal Workers Pneumoconiosis

A. Silicosis

grinder's disease, quartz silicosis also called

grinder's disease, quartz silicosis

inhaling silicon dioxide continuously over a long

period of time.

Silicon dioxide is found in sands, quartzes,

flints, and many otherstones.

Silicosis is marked by the development of small

fiberlike growths in the lungs.

In advanced cases, severe shortness of breath

may develop.

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incidence of silicosis is highest among

industrial workers exposed to silica powder in

manufacturing processes, in those who work with

ceramics, sand, or stone, and in those who mine

silica

Assessment: Silicosis

Uncomplicated or simple: asymptomatic with

evidence of fibrosis on chest x-ray film

Chronic complicated: malaise, anorexia, weight

loss, severe dyspnea on exertion, evidence of

massive fibrosis on chest x-ray film

Nursing Interventions: Silicosis

Administer antitussive for cough

Adminster medication for tuberculosis as

prescribed (Tuberculosis is a complication)

Eliminate toxic substances

Administer Oxygen as prescribed

Encourage cough and deep breathing

Silicosis

B. Asbestosis

A diffuse, interstitial pulmonary fibrosis resulting

from inhalation of asbestos


prolonged exposure to airborne asbestos

particles

Susceptibility increases with increasing length

and intensity of exposure.

The incidence is greatly increased by chronic

occupational exposure

Families of workers also at risk from fibers

carried home on clothing.

The general public is at risk from long-term

exposure to asbestos dust in old buildings in

which asbestos was used as insulation, or from

asbestos in shingling or building material.

Pathophysiology

Asbestos particles are deposited on bronchiole or

alveolar walls and are ingested by cells

leading to an edematous process in the wall thatresults in nonnodular alveolar and interstitial

fibrosis

reduced lung volume and compliance

and impaired gas transfer.

Asbestosis-lung biopsy specimen

Symptoms

exertional dyspnea

decreased exercise toleranc

as the disease progresses, dyspnea is chronic even

at rest and a dry cough may develop.

Diagnostic Tests

1. Clinical examination - History of long-term

exposure to asbestos

2. Radiology - Interstitial markings in lower

lung, thickening, plaques, calcification

3. Pulmonary function -Early: normal; later:

reduced lung capacity and compliance

4. Arterial blood gases -Early: normal; later:

decreased PO2, increased PCO2

Treatments

Surgery - None

Drugs - None

General

Eliminate exposure

chest physiotherapy

increased fluids

steam inhalation to loosen secretions

oxygen therapy


Asbestos is a cocarcinogen with tobacco

asbestos workers who smoke are 90 times morelikely to develop lung cancer than smokers who

are not exposed to asbestos.

C. Coal Workers Pneumoconiosis

anthracosis, black lung, coal worker's

pneumoconiosis, miner's pneumoconiosis, also

called black lung, coalworker's

pneumoconiosis, miner's pneumoconiosis

A long-term lung disease of coal miners

caused by coal dust in the lungs

It forms black bumps on the bronchioles that

result in emphysema. The condition is made

worse by cigarette smoking. There is no real

treatment. The progress of the disease may be

halted by staying away from coal dust

Anthracosis

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21. Chest Trauma

A. Blunt trauma

B. Flail chest

C. Penetrating trauma

D. Pneumothorax

A. Blunt trauma

having a dull edge or point; not sharp

B. Flail chest

a chest in which many broken ribs cause the chest

wall to be unstable

The lung under the injured area contracts on

breathing in and bulges on breathing out

The condition, if uncorrected, leads to air hunger

Flail chest is marked by sharp pain; uneven chest

expansion; shallow, rapid breathing; and reduced

breath sounds

Problems are collapsed lung, shock, and the

stopping of breathing

The treatment is to stabilize the inside of the

chest wall with a mechanical lung

Chest tubes may be needed to remove air or fluid

stopping the affected lung from expanding, and a

tube may be used to provide food and fluids

through the nose

Traction may be applied by attaching a steel wire

to the ribs or breastbone and connecting the wire

to a rope, pulley, and weight.

C. Penetrating trauma

Entering, piercing, boring, going through,

puncturing

sticking into, permeating, infiltrating, forcing

passing through, punching into, edged, pointed

22. Cardiac Tamponade and Subcutaneous

Emphysema

1. Cardiac Tamponade - Compression of heart

as result of fluid within the pericardial sac

Cause - when a blood vessel in the heart breaks

or by a wound to the heart

Signs/Symptoms - neck veins that stand out, low

blood pressure, decreased heart sounds, fast

breathing, and weak or absent pulses

The patient can be anxious and restless, tending

to sit upright or lean forward.

The skin may be pale, gray, or blue.

2. Subcutaneous Emphysema- Air entering the

tissue planes and passing under skin

Also called aerodermectasia

Cause - The air or gas may come from the

bursting of an airway or small pocket in the lung

and move through the chest between the lungs

(mediastinum) up into the neck

Signs/Symptoms - face, neck, and chest appear

swollen. Skin tissues can be painful and may

produce a "crackling" sound as air moves under

them. (dyspnea) (cyanosis) if the air leak is

severe.

Treatment - may require a cut to release the

trapped air.

23. Smoker's Lung Tissue

lungs made up of approximately 350 million tiny

sacs called alveoli, where carbon dioxide from

the body is exchanged for oxygen from the air

Various diseases that affect the lungs either

destroy the alveoli directly, as does emphysema,

or impair the alveolis ability to exchange gases.

caused - smoking on lung

Symptoms - difficulty in breathing, chest pain,

coughing, and wheezing. Lung cancer, most

commonly caused by smoking tobacco, is the

deadliest lung disease, and each year it kills more

Americans than any other kind of cancer.

24. Severe Acute Respiratory Syndrome (SARS)

is a rapidly spreading, potentially fatal infectious

viral disease.

Cause - A virus known as SARS-associatedcoronavirus (SARS-CoV) causes the illness.

When viewed under a microscope, coronaviruses

are a group of viruses that look like they have

crowns or halos. Coronaviruses commonly cause

mild to moderate upper-respiratory illness in

humans, but can cause respiratory,

gastrointestinal, liver, and neurologic diseases in

animals.

Symptoms

SARS can be difficult to recognize because it

mimics other respiratory diseases, such asinfluenza.

It generally begins with a fever higher than

100.4 F (38 C) and one or more of the

following symptoms:

headache

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overall feeling of discomfort

body aches and chills

sore throat

cough

difficulty breathing

shortness of breath

hypoxia (insufficient oxygen in the blood)

diarrhea (for 10 percent to 20 percent of patients)

Transmission/Spread

SARS-CoV spreads from one person to another

mainly through close contact with a SARS

patient

When a person with SARS coughs or sneezes

without covering his or her mouth, respiratory

droplets containing living virus can spray up to 3

feet and invade the mucous membranes of

another person.

Individuals in close contact with someone with

SARS are most at risk, which means they live or

work with someone with SARS or have direct

contact with the person through kissing, hugging,

or sharing eating utensils.

The virus also can spread when an individual

touches an object with infectious droplets on it

and then touches his or her mouth, nose, or eyes.

It is not known whether SARS can spread more

broadly through the air.

Symptoms

fever or cough

They are most infectious during their second

week of illness

As a precaution, the CDC recommends that

SARS patients stay in isolation at home or in the

hospital to keep others from getting sick

They should stay home from work or school for

10 days after their symptoms have gone away.

Treatment

Research is currently underway to develop an

effective antiviral drug for SARS-CoV. Until

then, SARS patients may receive the same

treatment that any patient with severe atypicalpneumonia might receive.

This treatment is mainly supportive therapy, with

oxygen and fluids to help ease symptoms, and

antibiotics to help prevent or treat secondary

infections.

Preventing SARS

Currently, there is no vaccine available to prevent

SARS. The CDC recommends taking the

following steps toward prevention of SARS:

Wash your hands regularly with warm water and

soap.

Avoid touching your eyes, nose, and mouth.

Use a disposable tissue instead of your hands to

cover your mouth when you cough, and throw it

away immediately after use.

Follow public health recommendations if you are

in the area of an epidemic.

Carbon Monoxide Poisoning

Description: carbon monoxide is a colorless,

odorless and tasteless gas that has an affinity for

hemoglobin 200 times greater than that of oxygen

Oxygen molecules are displaced, and carbon

monoxide reversibly binds to hemoglobin to form

carboxyhemoglobin; tissue hypoxia occurs

Carbon Monoxide Poisoning: Assessment

1% - 10% Impaired visual acuity

11% - 20% Flushing headache

21% - 30% Nausea and impaired

detrexity

31% - 40% Vomiting, Dizziness and

syncope

41% - 50% Tachypnea and tachycardia

Greater than 50% COMA


Remove victim from exposure

Administer oxygen

Assess need for basic life support

Monitor vital signs

Monitor carbon monoxide levels

Review:

1.Atelectasis - Closure or collapse of alveoli

2. Pleurisy

3. Pleural effusion

4. Pneumothorax

5. Hemothorax

6. Acute tracheobronchitis

7. Pneumonia

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8. Asthma

9. Respiratory Failure

10. ARDS

11. Pulmonary Tuberculosis

12. Lung Abcess

13. Empyema

14. Pulmonary Edema

16. Pulmonary Hypertension

17. Pulmonary Heart Disease

(Cor Pulmonale

18. Pulmonary Embolism

19. Sarcoidosis

20. Occupational Lung Diseases: Pneumoconioses

21. Chest Trauma

22. Cardiac Tamponade and Subcutaneous Emphysema

23. SARS


E. Pneumothorax

- A condition where there is air in the pleural

space between the lung and the chest wall.

TYPES:

1. Closed pneumothorax

Injury to the lungs from mechanical

ventilation

Perforation of the esophagus

Injury to the lungs from the broken ribs

Ruptured blebs or bullae in patients

with COPD

2. Open pneumothorax

Gunshot wounds

Stab wounds

Surgical thoracotomies

3. Tension pneumothorax

True medical emergency

Clinical Manifestations

Sharp pain on inspiration

Increasing dyspnea

Diaphoresis

Hypotension

Tachycardia

Mediastinal shift

Unequal chest movement

Absence of breath sounds on affected side

Diminished heart sounds


Clinical Manifestations:

1. Supraglottic

Localized throat pain

Burning when drinking hot liquids or orange

juice

Lump in the neck

Dysphagia

Dyspnea

2. Glottic

Hoarseness

dyspnea

Medical Management

Occlusion of open wound

Chest tube insertion

Pleurodesis

Nursing Management

Monitor V/S frequently. Report to MD if dyspneaworsens

Semi-Fowlers position

Occlude wound with non-porous covering

Care of chest tubes

Chronic Obstructive Pulmonary Disease

Includes diseases that cause airflow obstruction

Chronic Bronchitis

Emphysema

Risk Factors include environmental exposures

and host factors

Primary symptoms are cough, sputum production

and dyspnea

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1. Asthma

2. Chronic Bronchitis

3. Bronchiectasis

4. Emphysema

1. Asthma

Asthma is a chronic, inflammatory disease in

which the airways become sensitive to allergens

(any substance that triggers an allergic reaction).

Several things happen to the airways when a

child is exposed to certain triggers:

The lining of the airways become swollen and

inflamed.

The muscles that surround the airways tighten.

The production of mucus in increased, leading to

mucus plugs.

2. Chronic Bronchitis

a very common respiratory disease that causes

severe weakness.

The glands of the windpipe (trachea) and the

large airways of the lungs (bronchi) produce too

much mucus.

This results in a cough that produces mucus(expectoration).

The condition has a strong link to smoking and

air pollutants. The disease was formerly seen

almost only in men.

It is becoming more common in women who

smoke. A deep cough, often with wheezing, is

always found.

This is followed by breathing difficulty with

exercise.

The disease is noted for frequent pus-forming

infections of the lungs.

Difficult breathing results from narrow airways

and often brings lung failure.

Heart failure is a common result.

Some patients develop too many red blood cells

caused by lack of oxygen. Sharp attacks of

breathing distress with rapid, labored breathing,

long exhaling, intense cough, and bluish skin can

result.

Patients who suffer from these symptoms are

called "blue bloaters."

It is usual to give antibiotics during the acute

attack of symptoms.

Drugs that open the airways (bronchodilators) are

given to prevent the condition from getting

worse.

Heart failure is managed by restricting salt in the

diet, diuretics, and sometimes digitalis.

Patients with chronic bronchitis should be

vaccinated against influenza and lung infections.

Low-flow oxygen is often used in the home.

Exercise, especially walking, and therapy are

often given.

Medical Management

Risk reduction- smoking cessation

Bronchodilators

Corticosteroids

Influenza and pneumococcal vaccination

Oxygen therapy

Surgical Management

Bullectomy

Lung Volume Reduction Surgery

Lung Transplantation

Nursing Management

Patient education

Breathing exercises

Inspiratory muscle training

Activity pacing

Self-care activities

Physical conditioning

Oxygen and nutritional therapy

Coping measures

Bronchiectasis

Chronic, irreversible dilation of bronchi and

bronchioles

Chronic cough and purulent sputum production

Postural drainage promotes clearing of secretions

Antibiotics may be prescribed

Asthma

Chronic inflammatory disease of airways causing

airway hyperresponsiveness, mucosal edema, and

mucus production

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Reversible, either spontaneously or with

treatment

Allergy is strongest predisposing factor

Asthma (contd)

Long-Acting Control Medications:

corticosteroids and long-acting beta2-adrenergic

agonists, methylzanthines, and leukotriene

modifiers

Quick-Relief Medications: short-acting beta-

adrenergic agonists

Cystic Fibrosis

Autosomal recessive disease

Airflow obstruction is key feature

Medical Management: antibiotics,

bronchodilators, inhaled mucolytic agents

Nursing Management: chest physiotherapy, fluid

and dietary intake, reduce risk for infection


Emphysema

Chronic Bronchitis

Bronchial Asthma

DIAGNOSTICS:

Chest X-ray

Pulmonary function tests

Sputum specimen

ABG

ECG



Medical Management

Antibiotics

Influenza vaccination

Bronchodilator therapy

B adrenergic agonists

Anticholinergic agents (Ipratropium

bromide)

Theophylline

Corticosteroids

Mucolytic expectorants

Oxygen therapy

Digitalis

Diuretics

Nursing Management

Teach patient on how to do diaphragmatic

breathing

Coughing exercises

Chest physiotherapy

Nebulize patient

Adequate hydration

Smoking cessation and avoidance of irritant

factors

Avoid contact with sick people

Low flow oxygen therapy

Relaxation training

Bronchial Asthma

- Characterized by airway obstruction,

inflammation and increased responsiveness toa variety of stimuli

- Status asthmaticus is a severe life-threateningcomplication that is refractory to treatment.

TRIGGER FACTORS

Allergens

Respiratory infections

Exercise

Drugs and food additives

Emotional stress

Clinical Manifestations

Wheezing

Cough

Dyspnea

Chest tightness

Severely diminished breath sounds

Pulsus paradoxus

Use of accessory muscles

Tachycardia

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Ventricular dysrythmias

Classification of Asthma

Diagnostics

Pulmonary function test

ABG

Sputum specimen

Medical Management

B-adrenergic drugs

metaproterenol, albuterol,

isoproterenol, epinephrine

Corticosteroids

hydrocortisone, beclamethasone,

prednisone, methylprednisolone, triamcinolone

Mast cell stabilizer

cromolyn sodium, nedocromil

Anticholinergics

ipratropium bromide, atropine

Nursing Management

Administer medications and monitor closely

High fowlers position; slow rhythmic breathing

Adequate fluid intake

Provide extra humidity

If with respiratory acidosis- O2 as prescribed

Calm, quiet environment

Instruct patient to recognize trigger factors

Teach importance of hydration, adequate

nutrition and exercise

Upper Airway Infections

Rhinitis vs. Viral Rhinitis

Acute Sinusitis vs. Chronic Sinusitis

Chronic Pharyngitis

Tonsillitis

Adenoiditis

Peritonsillar Abscess-

Laryngitis

Tracheitis

Epiglottitis, epiglottiditis

Dust mites

Child with sinusitis

Allergic Rhinitis as seen in Fiberoptic

Rhinoscope

Herpes Simplex blisters around mouth region-

One strain of the herpes simplex virus causes

cold sores (also known as fever blisters) in and

around the mouth, lips, pharynx, nose, face, and

ears. The causative agent remains in the cell

bodies of facial nerves, causing repeated attacks

of the blisters. No established therapy, beyond

topical lotions for pain relief, has been

developed.

Chronic Pharyngitis-The pharynx is su

ms respiratory

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