TOPIC # 1: Care and Management of Clients with Problems in OxygenationInstructor: Mr. Alain Pilar

*irreversible brain damage can occur within 6 mins.

PEDIATRIC1. EPIGLOTTITIS – medical emergency that may result in death if not treated

quicklyEpiglottis – flap of tissue that sits at the base of the tongue

- keeps food from going into the trachea when swallowing- when it gets infected or inflamed, it can obstruct or close off the trachea

which may be fatal unless treated promptly

EPIDEMIOLOGY more common in children than in adults in the past due to the smaller diameter of

children’s epiglottic opening when compared to adults little narrowing of the windpipe can dramatically increase the resistance of an

airway, making breathing more difficult epiglottitis caused by HIB (haemophilus influenza B) has a distribution in that it

typically occurs among children aged 2-7 y.o. and has not been reported among Navajo Indians and Alaskan Eskimos

epiglottitis occurs in different peaks in both children and adultso children 2-4 y.o.o adults 20-40 y.o.

epiglottitis in the very young (younger than 1 y.o.) is unusual and occurs in only about 4% of cases

CLINICAL MANIFESTATIONS sore throat muffling or changing in the voice difficulty in speaking fever difficulty in swallowing fast heart rate – tachycardia DOB

DIAGNOSTICS laryngoscopy – visualize the size of the epiglottis x-ray

NURSING/COLLABORATIVE MANAGEMENT initial treatment may consist of making the person as comfortable as possible,

including placing an ill child in a dimly lit room with the parent holding the child, humidified oxygen, and close monitoring. If there are no signs of respiratory

distress, IV fluids may be helpful. It is important to prevent anxiety because it may lead to an acute airway obstruction especially in children

- if epiglottitis is severe, don’t or only give minimal fluids- calm approach

people with possible signs of airway obstruction require laryngoscopy in the operating room with proper staff and airway intervention equipment. In severe cases, the doctor may need to perform cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe)

IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually obtained with the premise that any organism found growing in the blood can be attributed as the cause of epiglottitis. However, in many cases, if not the actual majority, blood cultures fail to yield this information.

Corticosteroids and epinephrine have been used in the past. However, there is no good proof that these medications are helpful in cases of epiglottitis

2. Laryngotracheobronchitis – inflammation of the mucous membrane of the larynx, trachea and bronchial tree

- often follows infection of the upper respiratory tract

RISK FACTORS: smoking exposure to people with respiratory infections underlying respiratory infections

CLINICAL MANIFESTATIONS (initially) dry, irritating cough with scanty amount of mucoid sputum sternal soreness from coughing fever with chills nigh sweats headaches general malaise(late signs) DOB Noisy inspiration (stridor) and expiration (wheeze) Purulent (pus filled) sputum Blood streaked secretions

DIAGNOSTICS bronchoscopy culture and sensitivity of sputum

COMMON CAUSATIVE ORGANISMS Streptococcus pneumoniae Haemophilus influenza

Mycoplasma pneumoniae Fungal Aspergillus

NURSING/COLLABORATIVE MANAGEMENT encourage bronchial hygiene increase fluid intake effective coughing encourage to sit up frequently – every 2 hours encourage rests – to heal our body mild analgesics antipyretics ABT (complete course) Expectorants Cool vapor therapy Moist heat to chest

NOTE: Antihistamines not prescribed because it causes excessive drying and may make secretions more difficult to expectorate

3. BRONCHITIS – generally refers to an acute inflammation of the air passages within your lungs

- occurs when trachea (windpipe) and large and small bronchi (airways) in your lungs become inflamed because of infection or other causes

ETIOLOGY/CAUSE cigarette smoking heavy air pollution recurrent infection thin mucus lining of those airways can become irritated and swollen the cells that make up this lining may leak fluids in response to the inflammation coughing is a reflex that works to clear secretions from your lungs both adults and children can get bronchitis

CLINICAL MANIFESTATIONS cough sputum production dyspnea elevated temperature tachycardia tachypnea

DIAGNOSTICS chest x-ray pulmonary function test ABG – best indicator for oxygen saturation Culture and sensitivity of sputum

NURSING /COLLABORATIVE respiratory hygiene oxygen ABT (will not work for viral) Expectorants Bronchodilators

4. BRONCHIOLITIS – common illness of the respiratory tract caused by an infection that affects the tiny airways called the bronchioles, which lead to the lungs. As those airways become inflamed, they swell and fill with mucus, making breathing difficult.

- most often affects infants and young children because their small airways can become blocked more easily

- peak occurrence: 3-6 months of age- typically occurs during the first 2 years- more common in males, children who have not been breastfed, and those

who live in crowded areas

CLINICAL MANIFESTATIONS stuffiness runny nose mild cough mild fever(late signs of severe condition) rapid, shallow breathing rapid heartbeat drawing in of the neck and chest with each breath, known as retractions flaring of nostrils irritability with difficulty sleeping and signs of fatigue or lethargy

NURSING/COLLABORATIVE MANAGEMENT fortunately, most cases of bronchiolitis are mild and require no specific

professional treatment antibiotics aren’t useful because bronchiolitis is caused by a viral infection, and

antibiotics are only effective against bacterial infections medications may sometimes be given to help open a child’s airways infants who have trouble breathing, are dehydrated or appear fatigued should

always be evaluated by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely and given fluids and humidified oxygen. Rarely, in very severe cases, some babies are placed on respirators to help them breathed until they start to get better

5. PNEUMONIA – inflammation of the lung parenchyma caused by various microorganisms including bacteria, mycobacteria, chlamydiae, mycoplasma, fungi, parasites and viruses

- “pneumonitis” is a more general term that describes an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion

TYPES Community Acquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP)/ Nosocomial Pneumonia in Immunocompressed Host

o Pneumocystis pneumonia – Pneumocystis jirovelio Fungal pneumonia – Aspergillus fumigatus

Aspiration Pneumonia

RISK FACTORS COPD Cancer Prolonged bed immobility Shallow breathing Cigarette smoking Depressed cough reflex

CLINICAL MANIFESTATIONS sudden onset of chills rapid rising of fever (38.5 – 40 C) pleuritic chest pain tachypnea – lungs is now compensating for extra oxygen rapid and bounding pulse mucoid, purulent sputum – rusty color orthopnea – difficulty breathing while lying down poor appetite generalized weakness

DIAGNOSTICS CXR Blood culture Sputum culture Fiber optic bronchoscopy

NURSING/COLLABORATIVE MANAGEMENT improving airway clearance – pulmonary toileting or respiratory hygiene promoting rest/conserving energy – to recuperate from your illness promoting fluid intake – makes secretions less viscous maintaining nutrition ABT USN Chest physiotherapy

6. ASTHMA – chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema and mucous production

RISK FACTORS allergens respiratory infections exercise and hyperventilation weather changes

CLINICAL MANIFESTATIONS cough dyspnea wheezing(late signs) – STATUS ASTHMATICUS diaphoresis tachypnea widening pulse pressure

DIAGNOSTICS pulmonary function test – spirometer pulse oximetry – peak flow meter ABG CXR Sputum analysis

NURSING/COLLABORATIVE MANAGEMENT calm approach patient education breathing exercise especially for pediatric patients nutritional therapy reduce bronchial secretions – DBE, coughing, USN improving sleep pattern increasing activity tolerance controlling infection

PHARMACOLOGICAL AGENTS quick relief (quicker fast acting medicines)

o short acting bronchodilators(2-4 puffs)

o nebulizers – up to 3 treatments at 20-minute intervalso IV bronchodilators

Long termo Prenisone, Salmetrol, Montelukast, Theophylline

Kinds of puff: DPI – dry powder inhaler

MDI – metered dose inhaler

7. CYSTIC FIBROSIS – most common fatal autosomal recessive disease among the Caucasian population

- person must inherit a copy of the CF gene (one from each parent) in order to have CF

- multisystemic genetic disease, respiratory systems are frequently major manifestations

EPIDEMIOLOGY 1:3 americans have CF less frequent among Asians, Hispanic and African Americans 37% of those affected are 18 y.o. and above

CLINICAL MANIFESTATIONS productive cough wheezing hyperinflation of the lung non-pulmonary: GI (pancreatic insufficiency, vitamin insufficiency, biliary

cirrhosis, recurrent pancreatitis, recurrent abdominal pain, weight loss, CF r/t diabetes

DIAGNOSTICS elevated sweat chloride concentration (>60 meq/L) (quantitative pilocarpine

iontophoresis sweat test)pilocarpine – induce sweating

NURSING/COLLABORATIVE MANAGEMENT chest physiotherapy (postural drainage, chest percussion, vibration, breathing

exercise) education (avoid exposure to crowd/people with infection) adequate fluid and dietary intake ABT for acute exacerbations (oral, IV or aerosolized) Bronchodilators Inhaled mucolytics (mucomyst) Anti-inflammatory agents (corticosteroids/ibuprofen) Gene therapy Double lung transplantation8. SIDS (SUDDEN INFANT DEATH SYNDROME) – syndrome marked by the

symptoms of sudden and unexplained death of an apparently healthy infant aged one month to one year

- the term cot death is often used in the United Kingdom, Australia and New Zealand, while crib death is used in North America

RISK FACTORSPrenatal

inadequate prenatal care inadequate prenatal nutrition tobacco smoking use of heroin subsequent births less than one year apart alcohol abuse being overweight smoking and taking other drugs while pregnant

Post-natal LBW (especially less than 1.5 kg – 3.3 lbs) Exposure to tobacco smoke Laying an infant to sleep on his or her stomach Failure to breastfeed Excess clothing and overheating Excess bedding, soft sleep surface and stuffed animals Gender (61 % of SIDS cases occurs in males) Age (incidence rises from zero at birth, is highest from two to four months and

declines towards zero at one year) Premature birth (increase risk of SIDS death by 50 times)

ADULTI. Chest Injuries

1. Pneumothorax – parietal or visceral pleura is breached- pleural space is exposed to the positive atmospheric pressure, normally the

pressure in the pleural space is negative or sub atmospheric. This negative pressure is required to maintain lung expansion, when either pleura is breached, air enters the pleural space and the lung or a portion of it collapses

TYPES simple – rupture of a bleb or a bronchopleural fistula, may enter through a breach

of either parietal or visceral pleura- may be associated with diffuse intestinal lung disease and sever

emphysema traumatic – occurs when air escapes from a laceration in the lung itself and enters

the pleural space (unusually accompanied by hemothorax) open pneumothorax – when wound in the chest wall is large

enough to allow air to pass freely in and out of the thoracic cavity (sucking chest wound)

tension pneumothorax – small wound in the chest, air is trapped (like a one way valve) with subsequent pressure build-up

RISK FACTORS

smoking trauma underlying respiratory disease

CLINICAL MANIFESTATIONS sudden pleuritic pain tachypnea dyspnea anxiety cyanosis hypotension tachycardia

SIMPLE TENSIONTrachea midline shifted away from the

affected side

Chest Expansion decreased decreased or fixed in a hyper expansion state

Breath Sounds diminished diminished or absent

Percussion normal sound/ affected side is hyper resonant

hyper resonant

DIAGNOSTICS CXR ABG Pulse oximetry

NURSING/COLLABORATIVE MANAGEMENT main goal: evacuate the air or blood from the pleural space small chest tube (28 french) inserted into the 2nd intercostals space for removal of

air large chest tube (32 French) inserted into the 4 th or 5th intercostals space – drain

blood emergency – anything large enough to fill the chest wall may be used ABT High concentration oxygen for severe hypoxia

2. FLAIL CHEST – complication of blunt chest trauma

- usually occurs when 3 or more adjacent ribs are fractured at 2 or more sites resulting in a free floating segment, as a result, the chest wall loses stability causing respiratory impairment

CLINICAL MANIFESTATIONS hypoxemia respiratory acidosis

DIAGNOSTICS serial CXR ABG Pulse oximetry

NURSING/COLLABORATIVE MANAGEMENT clearing secretions from the lungs (small segment) positioning, coughing, deep breathing coughing, deep breathing

suctioning (mild to moderate flail chest) monitor fluid intake, appropriate fluid replacement,

pulmonary physiotherapy (severe flail chest) intubation and mechanical ventilator pain management:

o patient controlled analgesiao intercostals nerve blockso epidural analgesiao intrapleural administration of opioids

3. PULMONARY CONTUSION – thoracic injury and is frequently associated with flail chest

Contusion – no break in the skin but there is a bruise- damage to the tissues resulting in hemorrhage and localized edema- may not be evident initially on examination but develops in the post

traumatic period- it may involve a small portion of one long, a massive section o f a lung,

one entire lung, or both lungs- dependent on the impact

CLINICAL MANIFESTATIONS decreased breath sounds – not known initially

- thickening of lung tissues (gabungol ang sound) tachypnea – lungs compensate tachycardia – compensatory mechanism chest pain hypoxemia – lung’s vital capacity is decreased because it is now swollen blood tinged secretions – when coughing

- not to be confused as having pulmonary tuberculosis- only due to injury

changes in sensorium/eratic mood – baseline: px. is cooperative/friendly- brain is affected because of decreased oxygenation

agitation, combative irrational behavior

DIAGNOSTICS pulse oximetry ABG CXR (changes usually shows 1-2 days post injury) – due to delayed lung

contusion

NURSING MANAGEMENT pulmonary toileting – secretions/drainage due to “hubag” supplemental oxygen

non-rebreather oxygenation – to hyperoxygenate pain control – due to rubbing and friction between pleural walls intubation and mechanical ventilation/respirator – depending on the degree

4. RESPIRATORY FAILURE – sudden life threatening deterioration of the gas exchange function of the lung

- it exists when the exchange of oxygen for carbon dioxide in the lungs cannot keep up with the rate of oxygen consumption and carbon dioxide production by the cells of the body

- can be caused by excessive energy expenditure

TYPES:

ARF (acute respiratory failure)- decreased PAO2 <50 mm hg (hypoxemia)- increased PACO2 >50 mm hg (hypercapnia)

CRF (chronic respi failure) – deterioration in the gas exchange function of the lungs that has developed insidiously or has persisted for along period after an episode of ARF

CLINICAL MANIFESTATIONS Restlessness – because you have that feeling of impending doom Fatigue – “waras” ‘coz you need more energy headache dyspnea – difficulty of breathing air hunger tachypnea increased BP(late signs) confusion lethargy central cyanosis – palanggit-om diaphoresis - palamugnaw respiratory arrest

DIAGNOSTICS ABG Pulse Oximetry CXR

NURSING/COLLABORATIVE MANAGEMENT assisting in intubation/mechanical ventilation monitor level of responsiveness – if patient is a respi patient, make rounds as

often as possible turning (to sides every 2 hours to prevent complication), mouth care, skin care

(prevent decubitus ulcer) , ROM (always allow them to move at their maximum potentials)

medical management objective is to correct the underlying cause and to restore adequate gas exchange in the lung (intubation and mechanical ventilation)

RSI – rapid sequence intubation- done with the aid of tranquilizers

5. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) – previously called adult respiratory distress syndrome

- severe form of acute lung injury- characterized by a sudden and progressive pulmonary edema, increasing

bilateral infiltrates on chest x-ray, hypoxemia refractory to oxygen

supplementation, and reduced lung compliance. These signs occur in the absence of left sided heart failure.

3 HALLMARK FEATURES: bilateral patchy infiltrates on CXR no signs of heart failure no improvement in PaO2 despite increasing O2 delivery

RISK FACTORS aspiration drug ingestion and overdose hematologic disorders – blood dyscrasias, leukemia, sickle cell anemia prolonged inhalation of high concentration oxygen, smoke or corrosive substances localized infection – there are pus inside the lungs metabolic disorders – extreme cases of hypo/hyperglycemia shock – any type of shock (e.g. hypovolemic shock, neurogenic shock) trauma – due to blood loss or extreme pain major surgery fat or air embolism systemic sepsis – septicemia disseminated vascular coagulation massive blood transfusion – BT is supposed to have a time interval so as not to

have massive blood transfusion burns pancreatitis near drowning

CLINICAL MANIFESTATIONSStage 1

dyspnea upon exertion respiratory rate are normal or increased cardiac rate are normal or increased diminished breath sounds

Stage 2 increased respiratory rate usage of accessory muscle restless, apprehensive, mentally sluggish or agitated present dry cough or frothy sputum increased cardiac rate cool, clammy skin crackles – a type of adventitious breath sound

Stage 3 (intubation is ordered) severe tachypnea decreased mental acuity tachycardia with arrhythmias (irregularities) labile blood pressure

skin is pale and cyanotic diminished breath sounds crackles ronchi

Stage 4 decreased respi rate decreased cardiac rate loss of consciousness skin is cool and cyanotic breath sounds are severely diminished or absent

DIAGNOSTICS ABG CXR Pulmonary Artery Catheterization – measurement of pulmonary artery

- used for cardiac functions- check effectivity of medications to the heart- used to rule out cardiac cause of difficulty of breathing- results indicates COPD, emphysema, and other respiratory illnesses- measures difference blood pressure once inside the left ventricle of the

blood- Central line catheter or Swan-ganz catheter

NURSING/COLLABORATIVE MANAGEMENT assess the patient’s respiratory status every 2 hours, more often f indicated (note

rate, rhythm and depth) auscultate lungs bilaterally for adventitious or diminished breath sounds monitor VS and institute cardiac monitoring monitor level of consciousness ABT(suspect involvement of infectious process) and steroids (great anti-

inflammatories) Diuretics may be needed Respiratory support (humidified air, ET intubation and mechanical ventilation,

PEEP – positive end expiratory pressure, suctioning) Place patient in prone position

6. COPD (Chronic Obstructive Pulmonary Disease)- disease characterized by airflow limitation that is not fully reversible- includes emphysema and chronic bronchitis - (CF, bronchiectasis, and asthma are now classified as chronic pulmonary

disorders)

7. PLEURAL EFFUSION- presence of excessive fluid in the pleural space

TYPES transudative effusion (watery fluid) exudative effusion (less watery, contains high concentration WBC and

plasma protein) empyema – presence of pus in the pleural space hemothorax – presence of blood chylothorax – presence of chyle (a milky fluid containing lymph

fat droplets and digestive enzymes)

CLINICAL MANIFESTATIONS fever with chills pleuritic chest pain dyspnea orthopnea cough

DIAGNOSTICS CXR Chest CT Thoracentesis – invasive procedure done to release fluid

- a.k.a pleural fluid effusion/aspiration- done to relieve discomfort caused by pain and other symptoms of

respi problems- px. may feel pressure like pain upon insertion

Pleural fluid culture Pleural biopsy

Blood tinged drainage – malignant pleural effusion

NURSING/COLLABORATIVE MANAGEMENT pulmonary toileting assisting in thoracentesis – a minor surgery pain control

EMPYEMA - an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and loculated (walled-off) area where infection is locatedCLINICAL MANIFESTATIONS

fever night sweats pleural pain cough dyspnea anorexia weight loss(symptoms are similar to that of pneumonia)

DIAGNOSTICS chest CT ultrasound guided diagnostic thoracentesis C & S of pleural fluid

NURSING/COLLABORATIE MANAGEMENT lung expanding breathing exercise pleural drainage pulmonary toileting thoracentesis tube thoracostomy open chest drainage via thoracotomy (rib resection)

PLEURISY – inflammation of the pleura

CLINICAL MANIFESTATION pleuritic pain, or pleuritic (movement related, once breath is held pain is

absent) dry cough – because pleura is just inflamed fever assymetrical chest expansion – depending on the location of pleurisy tachypnea diminished breath

DIAGNOSTICS CXR

NURSING/COLLABORATIVE MANAGEMENT assess respiratory status, percuss and auscultate lung sound v/s, noting fever and respiratory rate encourage bed rest instruct to splint chest wall when coughing ABT Antitussive at night time NSAIDS

PULMONARY EMBOLISM (PE) – refers to the obstruction of the pulmonary artery or one of its braches by a thrombus (or thrombi) that

RISK FACTORS trauma surgery pregnancy heart failure age older than 50 hypercoagulable states prolonged immobility

CLINICAL MANIFESTATIONS dyspnea – sudden blockage of the lungs tachycardia – compensation from dyspnea chest pain (pleuritc, may mimic angina pectoris or MI) anxiety, apprehension – because of the sudden feeling of impending doom fever cough diaphoresis hemoptysis syncope

DIAGNOSTICS CXR ECG – for differential diagnosis Peripheral vascular studies – ultrasound (UTZ) ABG Ventilation–perfusion scan (V/Q) scan – a scan of the lungs- differentiate ventilatory problem or vascular abnormalities of the lungs- two different tests done synchronously- gamma camera visualize image made by the radioactive material- ventilation scan – reflects patency of pulmonary airway- ventilation scan – wash in and wash is normal- pulmonary embolism – normal ventilation and abnormal perfusion ; there

is low O2 saturation- medical imaging to evaluate circulation of air and blood in the lungs- perfusion evaluates how well blood circulates within the lungs- abnormal result due to airway obstruction, COPD, pneumonia, embolus- requires injection of radioactive material- test pulmonary emboli, evaluate pulmonary function

(# of sticks/cigarette /day) x (# years smoking)------------------------------------------------------- = pack years 20NURSING/COLLABORATIVE MANAGEMENTMain goal: to dissolve (lyse) the existing emboli and prevent new ones from forming – use thrombolytics

general measures to improve respiratory and vascular status anticoagulant therapy thrombolytic therapy – to prevent new clots from forming or prevent clots

from getting bigger and bigger surgical intervention – only indicated if indi na madala sa thrombolytic

CARBON MONOXIDE POISONING – occurs after the inhalation of carbon monoxide gas

- following poisoning, long term sequelae often occur

Carbon monoxide (CO) – product of combustion of organic matter under conditions of restricted oxygen supply, which prevents complete oxidation to carbon dioxide (CO2)

- colorless, odorless, tasteless, and non-irritating, making it difficult for people to detect

- significantly toxic gas with poisoning being the most common type of fatal poisoning in many countries symptoms of mild poisoning include headaches and flu-like effects

- larger exposures can lead to significant toxicity of the central nervous system and heart

- can also have severe effects on the fetus of a pregnant woman

CLINICAL MANIFESTATIONS flu-like symptoms depression chronic fatigue syndrome migraine headache tachycardia headache dizziness confusion convulsion

DIAGNOSTICS carboxyhemoglobin – carbon monoxide has 200x affinity to the blood

NURSING/COLLABORATIVE MANAGEMENT (first aid) remove victim from exposure immediately without endangering

oneself 100% oxygen by tight fitting oxygen mask

HISTOPLASMOSIS – a.k.a. Darling’s disease- caused by the fungus Histoplasma capsulatum- symptoms very greatly- primarily affects the lungs

- if other organs are affected – this form of the disease is called disseminated histoplasmosis, and it can be fatal if untreated

CLINICAL MANIFESTATIONSSymptoms will manifest 2 to 27 days after exposure

cough flu like may resemble tuberculosis

DIAGNOSTICS chest x-ray C & S of sputum

NURSING/COLLABORATIVE MANAGEMENT Antifungal medications are used to treat severe cases of acute

histoplasmosis and all cases of chronic and disseminated disease. Typical treatment of severe disease first involves treatment with

amphotrecin B, followed by oral itroconazole. In many milder cases, simply itraconazole is sufficient.

Asymptomatic disease is typically not treated. Past infection results in partial protection against ill effects if reinfected. Educate to avoid areas that may harbor fungus (bird and bat droppings) for

prevention.

Cranberry juice – drink to make your urine acidic

SARCOIDOSIS – multisystem, granulomatous disease of unknown etiology- may involve any organ or tissue but most commonly involves the lungs

CLINICAL MANIFESTATIONSHallmark of sarcoidosis are it its insidious onset and lack of prominent clinical

signs or symptoms dyspnea cough hemoptysis congestion anorexia fatigue weight loss

DIAGNOSTICS CXR CT Scan Transbronchial biopsy Open lung biopsy

NURSING/COLLABORATIVE MANAGEMENT corticosteroids pulmonary support and toileting assisting in diagnostics

SILICOSIS – a chronic fibrotic pulmonary disease caused by inhalation of silica dust

(Pneumoltramicroscopicsilicovolcanoconeosis)

RISK FACTORS miners quarrying tunneling operations glass manufacturing stone cutting

CLINICLA MANIFESTATIONS dyspnea fever cough weight loss(late signs in progression of the disease) hypoxemia severe air flow obstruction right sided heart failure edema

DIAGNOSTICS CXR Biopsy

NURSING/COLLABORATIVE MANAGEMENT There is no specific treatment for silicosis, because the fibrotic process in

the lung is irreversible. Supportive therapy is directed at managing complications and preventing infections.

Oxygen therapy Inhaled beta-adrenergic agonist Anticholinergics Bronchodilators Education about protective materials (e.g. mask)