ANATOMY AND PHYSIOLOGY OF THE Turbinate Bones

RESPIRATORY SYSTEM ○ Conchae

○ Warms the air that we breathe
Organs and Associated Structures of the ○ Humidifies the air
Respiratory System ○ Assists the filtering air (dust and
pollens
Organs of the Respiratory System ○ Nasal Conchae supports the
● Nasal Cavity plus Paranasal Sinuses mucous membrane that lines the
● Nostril nasal cavity. It helps increase the
● Oral Cavity mucous membrane area that's why
● Pharynx it is important if the air you breathe
● Larynx is warm or moist.
● Trachea
● Carina of trachea Functions of Nose
● Right main (Primary) bronchus right lung ○ Passageway for air to pass to and
● Left main (Primary) bronchus from the lungs filters impurities.
● Bronchi ○ Humidifies and warms the air
● Alveoli ○ Olfaction (Sense of smell) which
● Right lung diminishes with age.
● Left lung ■ 70 and above smell
● Parietal pleura (and Visceral Pleural covers diminishes this is because of
lung surfaces themselves) the decreased formation of
● Diaphragm mucous membrane.

Oxygenation process and ventilation are the main If there is difficulty of breathing or shortness
functions of the respiratory system. As humans we of breath one particular intervention done in
consume oxygen and expel carbon dioxide the hospital is administration of oxygen, but
before administration you need to humidify
Two Main Parts the air from the oxygen tank as it is dry
oxygen, using a humidifier. Also check for
A. Upper Respiratory Tract the level of fluid or water in the humidifier.

Nose Paranasal Sinuses

- External Portions - Air filled spaces
○ Nasal bones & cartilages - supports - Four pairs of bony cavities
the nose and its facial structure. 1. Frontal
○ Anterior nares (nostrils) - entrance of 2. Ethmoidal
air and exit. Many internal hairs 3. Sphenoidal
guard the entrance of the nostrils 4. Maxillary
that prevent entry of large particles - Lined with nasal mucosa and ciliated,
carried in the air. pseudostratified columnar epithelium.
○ External openings of the nasal - Connected by a series of ducts that drain
cavities. into the nasal cavity
- Internal Portions - Mucous membrane lines the sinuses and
○ Hollow space behind the nose - continues with the lining of the nasal cavity.
NASAL CAVITY - Paranasal sinuses help reduce the weight of
○ Separated by the NASAL SEPTUM the skull and these are also used as a
(composed of bones and cartilage, resonant chamber which affects the quality
straight at birth, but can bend due to of our voice.
birth injury. As the person ages it
bends on one side or the other one, Throat (pharynx, tonsils and adenoids)
if such deviated septum is severe it - Space behind the oral cavity, nasal cavity,
will result to difficulty in breathing) larynx. It is somewhat acts as a
○ Divided into three passageways by passageway for the food moving from the
the NASAL CONCHAE oral cavity down to our esophagus and also
○ Mucus secretions are moved by the for the air which passes between the nasal
action of CILIA cavity and the larynx.
- Tubelike structure connecting the nasa &
Nasal Cavity oral cavities to the larynx
- When air enters from your nose it will go to - Divided into three regions
your nasal cavity, from the nasal cavity it 1. Nasal - posterior to the nose above
will go to the paranasal sinuses then down the soft palate
to your pharynx and larynx. 2. Oral - houses the facial or the
palatine tonsils
3. Laryngeal - extends from the hyoid
bone to the cricoid cartilage
 - The pharynx helps produce the sounds of Lungs
speech - Paired elastic structure enclosed in the
thoracic cage
Voice box (larynx) - Ventilation - breathing mechanism
- It also protects the lower airway from - Air movement
foreign substances and facilitates ● Inspiration - inhalation
coughing, it is, therefore, sometimes ● Expiration - exhalation
referred to as “watchdog of the lungs”
- Cartilaginous epithelium lined structure. Atmospheric pressure - provides the force that
- Connects the pharynx to the trachea. The moves air into the lungs.
larynx is the enlargement of the airway on
top of the trachea anterior and somewhat Visceral and parietal pleura are almost
inferior to the laryngopharynx. It also entirely in contact with each other the
conducts air in and out of the trachea and potential space between them is called
also prevents objects from entering the PLEURAL CAVITY it has a thin film of
trachea. It houses the vocal ports. serous fluid that lubricates the adjacent
- For vocalization and protects the airway surfaces and reduces friction as they move
from foreifn substances against one another during breathing
- Facilitates coughing and sneezing. Helps This fluid also helps hold the pleural
expel those invading microorganisms membranes together as explained in the
- The largest cartilage in the larynx is the ventilation process.
THYROID
Pleura
Consists of the following: - Serous membrane lining of the lungs and
1. Epiglottis - a valve flap of cartilage covering wall of thoracic cavity
the opening of the larynx during - Visceral pleura - covers the lungs
swallowing. - Parietal pleura - lines the thorax
2. Glottis - opening between the vocal cords - Pleural fluid - fluid between the pleura
in the larynx. permitting smooth motion of the lungs. Too
3. Thyroid cartilage - largest of the cartilage much of this fluid can aggravate the
structure, forms part of the Adam's Apple. oxygenation process.
4. Cricoid cartilage - ONLY complete
cartilaginous ring in the larynx. (used in the Mediastinum
procedure of incubation which is called - In the middle of the thorax
cricoid maneuver which nurses usually do - Visceral compartment of the thoracic cavity.
when inserting the laryngoscope into the Contains the heart, thymus gland, portions
mouth) of the esophagus and trachea and other
5. Arytenoid Cartilage - used in vocal cord structures.
movement with thyroid cartilages. - Extends from the sternum to the vertebral
6. Vocal Cords - ligaments controlled by column
muscular movements producing sound. - Contains all the thoracic tissue outside the
lungs
During normal breathing the vocal cords are
relaxed and the glottis is in a triangular slit. 1. Lobes
Changing the shapes of the pharynx and ● Left lung
oral cavity in using the tongue and lips ○ Upper
transforms the sound into words. ○ Lower
● Right lung
B. Lower Respiratory Tract ○ Upper
○ Middle
Trachea (Windpipe) ○ Lower
- 2.5cm in diameter, 12.5 cm in length Each lobe is subdivided into two or five
- Smooth muscle with c-shaped rings of segments separated by fissures
(hyaline) cartilages at regular intervals, one
above the other. 2. Bronchi & Bronchioles
The open ends of this incomplete rings are ● Right and left bronchi begin at the
directed posteriorly in the smooth muscles carina
and connective tissues fill the gaps in the ● Functions for air passage
ends. ● Right Bronchus
This cartilaginous rings prevents the ○ Wider
trachea from collapsing and blocking the ○ Shorter
airway. ○ More vertical
- Passages between the larynx and the ● Left bronchus
bronchi ○ Narrower
- Conducts air between the larynx and the ○ Longer
bronchi ○ More horizontal
 3. Alveoli
from entering
● The blood exchange and
trachea;
oxygenation and carbon dioxide
houses vocal
during the process of breathing in
cords
and out is being done.
● Acinus (acini) Trachea Flexible tube Passageway
○ Respiratory unit that connects for air;
● Consist of larynx with mucous lining
○ Respiratory bronchiole bronchial tree continues to
○ Alveolar sac filter particles
● Function of gas exchange. from incoming
air.
Types of Alveolar Epithelial Cells
1. Type I - Pneumocytes Bronchial Tree Branched Conducts air
a. Most abundant, thin & flat where tubes that lead from trachea
gas exchange occurs. from trachea to alveoli;
2. Type II - Pneumocyte (Clara Cells) to alveoli mucous lining
a. Secreted the lung surfactant this is continues to
the specific liquid which has the filter incoming
same way as the pleural cavity to air.
also lessen the friction. It is
developed during age. Lungs Soft, cone - Contain air
- Premature babies that don't shaped organs passages,
have this surfactant or lacts that occupy a alveoli, blood
the liquid are given. large portion vessels,
3. Type III - Pneumocytes of the thoracic connective
a. Just a macrophage ingesting foreign cavity tissues.
material and acts as an important Lymphatic
defense mechanism. vessels, and
nerves.
Part Description Function

Nose Part of face Nostrils FUNCTIONS OF THE RESPIRATORY SYSTEM

centered provide
above mouth, entrance to General Functions:
in and below nasal cavity; 1. Gas Exchange - oxygen and carbon
space internal hairs dioxide. (Gas exchange through ventilation,
between eyes begin to filter external respiration, and cellular respiration)
incoming air Ventilation - exchange of air between the
lungs and the atmosphere so that oxygen
Nasal cavity Hollow space Conducts air can be exchanged with carbon dioxide
behind nose to pharynx; External respiration - inhalation and
mucous lining exhalation of oxygen and CO2
filters, warms, Cellular respiration - where cells use the
and moistens oxygen to break down sugar and obtain
incoming air. energy; can also be defined as a series of
metabolic processes that take place within
Paranasal Hollow spaces Reduce weight
a cell
SInuses in certain skull of skull; serve
Alveoli - tiny air sac found in the lungs; take
bones as resonant
up oxygen you breathe
chambers.
2. Breathing - movement of air
Pharynx Chamber Passageway 3. Sound Production
behind nasal of air moving 4. Olfactory Assistance - sense of smell
cavity, oral from nasal 5. Protection - from dust and microbes
cavity and cavity to entering the body through mucus
larynx larynx and for production, cilia, and coughing.
food moving
from oral Physiology of Respiration:
cavity to 1. Exhalation
esophagus 2. Inhalation

Larynx Enlargement Passageway The atmospheric pressure outside our bodies

at top of for air; affects our breathing; the air outside/the
trachea prevents atmospheric pressure usually manages the ability
foreign objects of the air to enter our lungs through our nose. The
air will then pass through the nasal cavity and
through other organs such as the pharynx, larynx, pulmonary tuberculosis; this is highly
trachea, bronchi, and alveoli. Then air exchange communicable)
will occur; that would be the composition of ● Past Medical History
oxygen, nitrogen, water vapor, helium, and carbon ● Social History
dioxide. The muscles on our diaphragm help with ● Environmental/Lifestyle Patterns
the respiration process. The muscles contract
during inhalation, lifting the ribs and pulling them Physical Examinations:
outwards. The diaphragm moves downward ● Vital Signs
enlarging the chest cavity, reduction in air pressure ○ RR: 12-20cpm
causes the air to enter the lungs and expiration ○ HR: 60-100bpm
reverse these steps. ○ BP
○ T
NURSING ASSESSMENT ○ Pain
● Clinical History: Inspection
Check for the presence of the following: ● Barrel chest
- Dyspnea ● Funnel chest (pectus excavatum)
- Orthopnea ● Pigeon chest (pectus carinatum)
- Precipitating factors ● Lordotic
- Frequency of DOB ● Kyphosis
- Effect on activity
- Pain Significance: chest wall motion is a vital
- Cyanosis component of the respiratory system. Body
- Accumulation of mucus position, changes disturbed, joint
- Sputum production orientation around the chest wall results in
- Hemoptysis performance modification of your
- Cough respiratory muscles and movement
- Fatigue surrounding the rib cage and abdomen.
- Clubbing of fingers
- SOB Barrel Chest
- Occurs as a result of overinflation of the
Subjective cues - what the client tells you lungs, which increases the anteroposterior
Objective cues - overt signs/observable diameter of the thorax. It occurs with aging
symptoms that is congruent to what your and is a hallmark sign of emphysema and
patients says COPD.
- The term barrel chest describes a rounded
If there would be signs of bluish bulging chest that resembles the shape of a
discoloration on the fingernails, these are barrel.
caused primarily by low levels/lack of - It is not a disease but it may indicate an
oxygen that circulates in your RBCs. underlying condition.
Cyanosis occurs when there is not enough - Generally, the barrel chest itself isn’t treated
oxygen in the blood, making the skin or but when the cause is severe, emphysema
membrane below the skin turn a purplish or the underlying disease condition is
blue color. treated, the chest will return to its normal
state.
Clubbed fingers occur when soft tissues at
the fingertips become swollen or spongy. Funnel Chest (Pectus Excavatum)
This straightens the natural curvature of the - Depression in sternum, Depression pushes
nail bed causing a clubbed appearance. heart to the side
This is a symptom often associated with - There is a depression on the lower sternum.
heart and lung diseases which cause If there’s a depression on the sternum, this
chronically low blood levels of oxygen. may compress the heart and the great
vessels that would push the heart to the
This is the presence of blood that is side. This would then result in murmurs.
generally bright red or rust, mixed with - One cause of funnel chest is rickets.
sputum, and is usually frothy. Another is Rickets is a condition that affects bone
hematemesis which is the vomiting of development in children. It causes bone
blood. Usually the blood in hematemesis is pain, poor growth, and soft weak bones
dark red or brown, and is mixed with food that usually cause bone deformities. In
particles. Coughing out of blood is adults, a similar condition is called
hemoptysis, while vomiting with blood is osteomalacia or soft bones. Children:
hematemesis. Rickets, Adults: Osteomalacia

● Family History - family history of any Pigeon Chest (Pectus Carinatum)

medical condition that have the affection of - Occurs as a result of the anterior
the respiratory system (common is displacement of the sternum which also
increases the anteroposterior diameter. This
 may also occur with rickets or even in ○ Discrete non continuous sound
severe kyphoscoliosis and marfan resulting from a delayed reopening
syndrome. There is a problem with bone of a deflated airway
development (marupok). For Rickets, it’s ○ Indicates underlying inflammation or
either carinatum or excavatum; either congestion
protrude or compress/decompress. ○ Usually seen in pneumonia,
bronchitis, heart failure,
Kyphoscoliosis bronchiectasis, and pulmonary
- Kyphoscoliosis is characterized by the fibrosis
elevation of the scapula and corresponding ● Wheezes
S-shaped spine. ○ Usually as a result of narrowing of
- This deformity limits lung expansion within the airway, producing a vibration in
the thorax and occurs with osteoporosis the larynx and transmitted to the
and other skeletal disorders that affect the chest wall
thorax. Similar to this (they aren’t the same) ○ Commonly heard in asthma,
is scoliosis, which is the sideway curvature bronchiectasis, and chronic
of the spine (only one side;either right or left bronchitis
lateral side way of the spine. Can also
occur on both sides, taking the shape letter If adventitious breath sounds are present,
S or C). While Kyphoscoliosis is more of a most likely there is an accumulation of fluid
forward rounding of the back which leads in the lungs of the patient.
to hunchback or slouching posture.
Breathing Patterns (rates and depths of
Palpation respiration):
Tactile fremitus/ Vocal fremitus - Eupnea - normal breathing
- also known as tactile vocal fremitus. Refers - Bradypnea - slow
to the vibration of the chest wall that results - Tachypnea - rapid, shallow
from the sounds created by speech or - Hypoventilation - shallow, irregular
vocal sounds. In normal individuals, tactile - Hyperventilation/Kussmaul’s respiration - *
fremitus should be felt symmetrically along see pic below*
both sides of the chest. It is abnormal when - Apnea - period of cessation of breathing
it is increased or decreased. - Cheyne-Stokes - *see pic below*
- nine nine/tres tres (patient will voice - Biot’s respiration - also called ataxic
out nine nine or tres breathing
tres) - Obstructive - prolonged expiratory phase of
- vibrations of the sound waves respiration
- decreased fremitus (fluid/air outside
the lungs)
- increased fremitus (consolidation)

Percussion
- Tapping the body with the fingertips to
evaluate the size, borders, and consistency
of some of the internal organs.

Auscultation
Normal Breath Sounds
- Vesicular - rustling/swishing sound, higher
pitch on inspiration, fades on expiration
- Bronchovesicular - equal lung sounds
during inspiration to expiration periods
- Tracheal - I/E are both loud

Abnormal Breath Sounds (adventitious)

● Inspiratory Stridor
○ High pitched wheezing sound as air
enters the trachea and the bronchi
○ Usually appear in inspiration
○ Seen in patients with
laryngomalacia, foreign bodies,
tumors, infections.
○ This is because of blocking of air
through the mouth/oral cavities.
● Rales/Rhonchi/Crackles
LUNG VOLUMES AND CAPACITIES How to use the Incentive Spirometer:
- This volume measures the amount of air for - sit on the edge if the bed
one function such as during inhalation and - hold spirometer in an upright position
exhalation, and capacity in any two or more - place the mouthpiece in the mouth, be sure
volumes. For example: How much can be it is sealed by the lips tightly
inhaled from the end of a maximal - breathe in slowly and deeply
exhalation? - hold the breath as long as possible,
- Also known as Respiratory volumes; this is allowing the indicator to fall to the bottom
primarily the volume of gas in the lungs at a of the column
given time during the respiratory cycle. - rest then repeat previous steps 1-5x every
- The average total lung capacity in adults is hour
about 6 liters of air.

Pulmonary Function Test (PFT)

- is a non-invasive test that shows how well
the lungs are working.
- Pulmonary function testing measures how
well you are breathing. There are different
types of pulmonary tests that can be done.
○ Spirometry - usual method used to check
lung/ air volume, measures (1) tidal volume
(2) inspiratory reserve volume (3) expiratory
reserve volume
○ Lung Volume Test - also known as body
plethysmography - used to measure
residual volume
○ Gas diffusion test - this test measures how Blood/Sputum Test
oxygen and other gases move from the ● ABG
lungs to the bloodstream ● AFB/Cytology/ Sputum Analysis
○ Exercise stress test - this test looks at how
exercise affects lung function Arterial Blood Gas
○ ABG (Arterial Blood Gas) - measures the ● Measurements of blood pH and arterial
acidity (pH) and the levels of oxygen and oxygen and carbon dioxide.
carbon dioxide in the blood from an artery. a. PaO2 - arterial oxygen
This test is used to find out how well your b. PaCO2
lungs are able to move oxygen into the c. PH
blood and remove carbon dioxide from the - Measures the acidity and levels of oxygen
blood. and carbon dioxide in the blood from the
○ Allen’s test - checks ulnar & radial artery if artery.
blood on the hands are normal. Pinch ulnar ● Assess the lungs to provide adequate
and radial for a minute or two and then oxygen and remove carbon dioxide with the
remove pinch on ulnar, look for flush as well ability of the kidneys to reabsorb or excrete
as return of blood on the hand should be bicarbonate ions.
5-15 sec. - Leads to assessment of adequacy of
○ Sputum Examination - definitive test for TB, ventilation and oxygenation.
TB bacilli, pulmonary tuberculosis, acid fast Nursing Responsibility
bacilli (AFB) ● Pre test
○ Nose and Throat Swab (NTS) - throat ● Intra Test
culture can determine the specific bacteria ● Post Test
present - We took the specific blood sample
○ Mantoux Test - skin test detects if individual
is exposed to someone with TB Pre Test
● Choose site carefully
● Secure all equipments
a. Heparinized syringe needle,
container with ice
● Perform ALLEN’s test
- The Allen test is a first-line standard test
used to assess the arterial blood supply of
the hand. This test is performed whenever
intravascular access to the radial artery is
planned or for selecting patients for radial
artery harvesting, such as for coronary
artery bypass grafting or for forearm flap
elevation.
 - We have the blood supply from ulnar artery ● To increase the accuracy, this test is
and radial artery sometimes done 3 times, often 3 days in a
row.
How to perform Allen’s Test - Done every morning.
1. Instruct the client to clinch his/her palm - Sputum cup container
2. Then afterwards, occlude the ulnar and - If saliva is produced, specific sputum might
radial artery. not be seen for the particular test.
3. After 3 to 5 minutes, pick up our hands or
fingers in the ulnar artery. Cultures
4. Observe for flushes. ● Throat swabs in infections
5. If the hands flushes within 5-15 seconds, ● Throat cultures
the color will become color red again which ● Nasal swabs
indicates radial artery has a good blood - Throat swabs and cultures are used to
flow. (normal flushing = positive test) diagnose bacterial infection in the nose and
6. If it shows paleness after 5-15 seconds, it throat.
means one artery is not enough to supply - These infections can include many types of
blood to the hand. infection, streptococcus, pneumonia,
7. The particular side will not be able to be tonsillitis, etc.
used for site of selection. (Negative) - Once you get the sample, the cultured
- Importance of having a good flow. sample is able to determine any presence
of bacteria.
Post Test - Culture takes a couple of days.
● Apply firm pressure for 5 minutes - Could also check the sensitivity and
● Label specimen correctly resistance of the bacteria of a specific
● Place in the container with ice antibiotic.
● Document
- Right the name, birthdate, etc. + RIPES: TB can be treated effectively by
- ABG Analyser Machine to check the level of using first line drugs (FLD) isoniazid
oxygenation and pH of the blood. (INH), rifampin (RIF), pyrazinamide (PZA),
ethambutol (EMB) and streptomycin
ABG Normal Values (SM).
● PaO2: 80 - 100 mmHg
● PaCO2: 35 - 45 mmHg Imaging Studies
● pH: 7.35 - 7.45 ● CXRay
● HCO3: 22 - 26 mEq/L ● CT Scan
● O2 Sat: 90 - 100% ● MRI or magnetic resonance imaging
● Fluoroscopic Studies
Sputum Exam ● Pulmonary Angiography
● Identify pathogenic organisms ● Lung scans
● Determine the presence of malignant cells
● Assess hypersensitivity states Nursing Interventions
● Assess patients for any fungal infection in ● Explain procedure to patients
cases of prolonged antibiotic use, steroids ● Assess ability to remain still in confined
and PCP places
● Collected through ET tube, by patients ● Evaluate patients for magnetic implants like
cough mechanism, bronchoscopy, pacemakers, prosthetic valves, metallic
tracheoesophageal aspiration and gastric clips.
aspiration ● Consider contraindications like pregnancy,
● Should be read within 2 hours of collection allergies.
- PCP is the most common opportunistic - Usually during MRI or CT scan, some
infection of the patients patients are claustrophobic so you ask
- Patients with AIDS them to remain still
- We instruct the client to cough to retain - All metals must be removed during the MRI
freshness of samples or scans.
- Check any problems with creatinine
How the Test is Performed problems: contrast with MRI and CT scan.
● Rinse the mouth with water only. - If creatinine levels are high, patient cannot
● You will be asked to cough deeply and spit undergo test.
any substance that comes up from your - During the MRI or CT scan, follow the rules
lungs (sputum) into a special container. i.e. stop the medications days before the
● You may be asked to breathe in a mist of test.
salty steam. This makes you cough more - During a computerized tomography (CT)
deeply and produce sputum scan, a thin X-ray beam rotates around an
● If you still do not produce enough sputum, area of the body, generating a 3-D image of
you might have a procedure called the internal structures.
bronchoscopy.
CT Pulmonary Angiogram (CTPA) Nursing Interventions
- CT scan of your pulmonary angiogram ● Pre Test/Intra Test
- Non invasive, safest a. Signed consent form is obtained
- Looks primarily for blood clot b. NPO 6 hours prior
- Patients with pulmonary embolism c. Explain the procedure to the patient
- Take pictures of the blood vessels that d. Alleviate anxiety and fear
come from the heart to the lungs to your e. May administer pre op meds as
pulmonary arteries in order to see the ordered
embolies. f. Remove dentures and prostheses
● Post Test
Pulmonary Angiography a. NPO after the procedure UNTIL
- This is a minimally invasive procedure GAG reflex has returned
- Performed by interventional radiologist or b. Semi-fowler’s position with head
interventional cardiologist. turn to sides
- Adequate of probability to create certain c. Assess for lethargy and confusion
conditions. post op due to large doses of
- A fiber optic is inserted to visualize the anesthesia given
problem in the emboli. d. Observe for hypoxia, hypotension,
tachycardia
ENDOSCOPIC STUDIES e. Hemoptysis and dyspnea
Bronchoscopy
- Invasive procedure to look directly to the Thoracoscopy
lungs using a bronchoscope. - Done on the side
- Bronchoscope directly put in the nose or - This is a direct visualization of the pleural
mouth. It is moved down the throat and cavity.
windpipe (trachea), and into the airways. - Indicated for evaluation of pleural effusion.
- Bronchoscopy is the direct inspection and - Could also be used for certain surgical
examination of larynx, trachea, and bronchi procedures.
using your fibre optic scope. - Video assisted thoracoscopy or VATs.
- Purpose of this could be a diagnostic one. - Used to diagnose and treat a variety of
- Can examine the tissues and may collect conditions that involve the chest area or
secretions thorax.
- Can be used in biopsy - Rigid instruments for medical
- Determine the locations and extend of thoracoscopy: a) trocar and cannula with
pathologic process valve; b) single-incision thoracoscope
- Obtaining a tissue sample (9-mm diameter); c) biopsy forceps with
- Could be receptive surgically straight optics; d) magnification of optics
- Can be used as therapeutic type of and forceps in the thoracoscope shaft
intervention ready for biopsy.
- Can be used to remove foreign body
- Can destroy lesions Nursing Interventions
● Follow up the patients at health care facility
2 types of Bronchoscopy or at home
1. Fibre optic ● Minor activity restrictions
● Thin flexible scope ● Monitor for any shortness of breath
● Directed to the segmental bronchi ● Monitor chest drainage if with CTT
● Allow increased visualization of the
peripheral airways. Thoracentesis
● Can be performed at bedside, thru ET and ● Aspirations of pleural fluid in the pleural
trach tube. cavity
2. Rigid Bronchoscope ● Fine needle
● Hollow metal tube with light at its end ● Specimen should be subjected to different
● Used for removal of foreign body, see the exams like wet smear, culture and
source of massive hemoptysis and perform sensitivity, gram’s stain, AFB, difft count,
● Endobronchial surgery ph, spec grav, total protein determination
● Performed at the OR ● Used for:
a. Removal or fluid and air from the
Complications pleural cavity
● Allergy to anesthesia b. Aspiration of pleural fluid for
● Infection due to instrumentation analysis
● Aspiration c. Biopsy
● Bronchospasm d. Instillation of mediation
● Hypoxemia
● Pneumothorax Nursing Interventions
● Bleeding ● Check if CXR had been done to locate
● Perforation lesion
 ● Assess any allergy history - Observe the color, consistency and amount
● Inform patient of the nature of procedure of drainage.
● Position the patient comfortable - Proper documentation
a. Sit on the edge of the bed, feet
supported and arm and head on a Thoracotomy
padded over the bed table or may - surgical procedure in which a cut is made
lie on the unaffected side with hand between the ribs to see and reach the lungs
elevated 30 degrees or other organs in the chest or thorax.
b. Reassure patient - Typically, a thoracotomy is performed on
the right or left side of the chest.
Biopsy
● Pleural biopsy INHALATIONAL THERAPY
● Lung biopsy Nebulization
● Lymph node biopsy - Nebulization is a process by which
- After getting the samples, we need to wait medications are added to inspired air and
for days to check if the sample is benign. converted into a mist that is then inhaled by
the patient into their respiratory system
Pulse Oximetry - With the help of nebulizer
● Non invasive method of monitoring O2 - Normally done to patients with asthma.
saturation of hemoglobin
● Sensor probe is attached to the fingertip or Oxygen Therapy
earlobe or forehead - Used if there is DOB and decreased O2
- Normal value: 95 to 100% saturation
- There are lots of types of oxygen therapy
PPD/Mantoux Test
● Screening test for tuberculosis Nasal Cannula
● A.K.A > tuberculin sensitivity test, purified - A nasal cannula is generally used wherever
protein derivative test small amounts of supplemental oxygen are
- 40 to 72 hours after result of screen test for required, without rigid control of respiration,
TB such as in oxygen therapy.
- Positive result of PPD - the reaction should - Most cannulae can only provide oxygen at
be measured by the induration and not the low flow rates— 1 to 2 litres per minute
redness. (L/min)—delivering an oxygen concentration
- Induration of 15 mm or more is considered of 28–44%.
positive. - Humidified oxygen must be used.
- But once you get positive with PPD, it
doesn’t mean you have TB. Partial Rebreather Mask
- To diagnose TB, sputum tests can be used. - a face mask that delivers moderate to high
concentrations of oxygen.
SURGICAL INTERVENTION - Frequent inspection of the reservoir bag is
Tracheostomy required to ensure that it remains inflated; if
- Incision through the neck into the tracheal it is deflated, exhaled air collects in it, which
- Done to open airway results in the patient rebreathing exhaled
- Done during emergency carbon dioxide.
- Can be done at bedside or OR - Side port openings on the mask vent
- Use of anesthesia exhaled air on expiration and allowed room
- Tracheostomy tube will be placed. air to enter on inspiration.
● It is usually done for one of three reasons: - The delivered oxygen can be as high as
a. To bypass an obstructed upper 60%, but percentage varies, depending on
airway the rate and depth of the patient's
b. To clean and remove secretions breathing.
from the airway
c. To more easily and safely deliver Face tent
oxygen to the lungs - A face tent is a shield-like device that fits
under the patient’s chin and encircles the
Chest Tube Drainage face.
- Chest tube thoracostomy involves placing a - It is used primarily for humidification and for
hollow plastic tube between the ribs and oxygen only when the patient cannot or will
into the chest to drain fluid or air from not tolerate a tight-fitting mask. Because
around the lungs. the tent is so close to the patient's face, the
- The tube is often hooked up to a suction concentration of oxygen delivered to the
machine to help with drainage. patient cannot be estimated.
- Observe the fluid being drained
- During the first 2 hours, we have to check
the fluid every 15 minutes.
Venturi Mask Nursing Interventions
- A Venturi mask is a cone-shaped device ● Know the medical diagnosis, lung or lobes
with entrainment ports of various sizes at its involve
base. ● Advice patient to perform drainage 2-4x
- The entrainment ports adjust to deliver daily
various oxygen concentrations. ● Done before meals and at bedtime
- The mask is useful because it delivers a ● Evaluate skin color and pulse prior to
more precise concentration of oxygen. procedure

Metered Dose Inhaler (MDI)

● Pressurized canister
● Handheld device
● Use of propellants to deliver dose
medications on the lungs of the patients
- Used especially by those people who have
asthma

Mechanical Ventilation
● Used in patient who are in acute RDS in an
intensive care set up
● MAY be a final attempt to continue
breathing
● Use will have to depend on benefit against
possible risk.
- The machine makes sure that the body Position 1: upper lobes, apical segments
receives adequate oxygen and that carbon Position 2: upper lobes, posterior segments
dioxide is removed. Position 3: upper lobes, anterior segments
- Mechanical ventilation works by applying a Position 4: Lingula
positive pressure breath and is dependent Position 5: Middle lobe
on the compliance and resistance of the Position 6: lower lobes, anterior basal segments
airway system, which is affected by how Position 7: lower lobes, posterior basal segments
much pressure must be generated by the Position 8 and 9: lower lobes, lateral basal
ventilator to provide a given tidal volume segments
(TV). Position 10: lower lobes, superior segments
- The TV is the volume of air entering the lung
during inhalation. Chest Percussion and Vibration
● Help to dislodge mucus adhering to the
Continuous Positive Airway Pressure (CPAP) bronchioles and bronchi
● Used primarily in the treatment of SLEEP ● Performed 3-5 minutes for each position
APNEA ● Vibration is when you apply manual
● Used with O2 therapy to reverse or prevent compression and tremor to the chest wall
microatelectasis during the exhalation phase
● Allow patients to breathe spontaneously
while applying pressure in the respiratory Nursing Interventions
cycle to keep alveoli open. ● Make sure the patient is comfortable,
wearing loose clothing
Chest Physiotherapy ● Uppermost areas of the lungs are treated
- Group of physical techniques that improve first
lung function and help you breathe better. ● STOP treatment if:
- Chest PT, or CPT expands the lungs, a. There is pain, increased SOB,
strengthens breathing muscles, and weakness, lightheadedness or
loosens and improves drainage of thick hemoptysis.
lung secretions.
- Deep breathing exercises involve inhaling Pharmacology
deeply through the nose and breathing out Commonly Used Agents in Respiratory Illnesses
very slowly through pursed lips. ● Antihistamines
- Vibration involves placing the hands against ● Steroids
the patient's chest. The hands create ● Bronchodilators
vibrations by quickly contracting and ● Adrenergic Drugs
relaxing. ● Expectorants/Mucolytics
- Postural drainage involves taking positions ● Antimicrobials
that allow gravity to help drain secretions. ● Antitussives
Postural drainage is often useful with chest ● Mast cell stabilizers
percussion and coughing techniques. ● Leukotriene modifiers
Antihistamines Bronchodilators
● H1 Blockers or H1 antagonist ● Bronchodilators and smooth muscle
● Compete with histamine receptor sites relaxants
preventing histamine release ● Methylxanthine derivatives:
● Decreases mucus secretions by blocking ○ Aminophylline
the H1 receptors ○ Theophylline
● Blocks histamine effects that occurs in an ● Bronchial Smooth Muscle Relaxants
immediate hypersensitivity reaction ○ Terbutaline Sulfate
● Used to treat acute exacerbation of asthma
H1-receptor antagonists produce their effects by: ● Increase bronchodilation, increasing vital
● Blocking the action of histamine on small capacity
blood vessels ● Side effects include tachycardia and easy
● Decreasing arteriole dilation and tissue fatigability
engorgement
● Reducing leakage of plasma proteins and Beta2-Adrenergic Agonist Drugs
fluids out of the capillaries ● Used for the treatment of symptoms
● Inhibiting most smooth muscle responses associated with asthma and chronic
to histamine in particular, blocking the obstructive pulmonary disease (COPD).
constriction of bronchial, GI, and vascular Agents in this class can be divided into two
smooth muscle categories:
● Relieving symptoms by acting on the ○ Slow-acting
terminal nerve endings in the skin that flare ○ Long-acting
the itch when stimulated by histamine ● Relaxes the smooth muscle in the airways
● Suppressing adrenal medulla stimulation, which allow increased airflow to the lungs
autonomic gandia stimulation, and exocrine ● Short-acting beta2-adrenergic agonists
gland secretion, such as lacrimal and include:
salivary secretion ○ Albuterol (systematic, inhalation)
○ Bitolterol (systemic)
Adverse Reaction ○ Levalbuterol (inhalation)
● The most common adverse reaction of ○ Metaproterenol (inhalation)
antihistamines (with the exception of ○ Pirbuterol (inhalation)
fexofenadine, loratadine, and desloratadine) ○ Terbutaline (systemic)
is CNS depression. Other CNS reactions ● Long-acting beta2-adrenergic agonists
include: include:
○ Dizziness ○ Albuterol (oral, systemic)
○ Fatigue ○ Formoterol (inhalation)
○ Disturbed coordination ○ Salmeterol (inhalation)
○ Muscle weakness
● Primarily used to treat signs and symptoms Adverse Reaction
of hypersensitivity reaction such as allergic ● Adverse reaction to short-acting
rhinitis, vasomotor rhinitis, allergic beta2-adrenergic agonists include
conjunctivitis, urticaria (hives), and paradoxical bronchospasm, tachycardia,
submucosal swelling palpitations, tremors, and dry mouth
● Adverse reaction to long-acting
Steroids beta2-adrenergic agonists include
● Acts as an antiinflammatory agent in cases bronchospasm, tachycardia, palpitations,
of severe anaphylaxis, allergic reaction hypertension, and tremors
where there is bronchoconstriction
● Used to treat hematologic conditions such Expectorants/ Mucolytics
as rheumatoid arthritis, lupus, inflammation ● Loosens bronchial secretions hence
of the blood vessels eliminated by coughing
● Used as adjuvant therapy in cases of ● Facilitates removal of viscous mucus
premature birth ○ Carbocisteine
○ Given 24 hours prior to expected ○ Guaifenesin - reduces thickness and
delivery of preterm infant adhesiveness, and surface tension
○ Antenatal betamethasone is of mucus for easier clearing up of
administered to accelerate an airways. Provides a soothing effect
infant's lung maturation/ to mucus membranes of the
development. Stimulates synthesis respiratory tract resulting in a more
and release of surfactant. productive cough. Take with a full
○ Can be given up to 34 weeks AOG glass of water to liquify secretions.
○ Premature newborns are given ● Adverse reaction to Guaifenesin include:
hydrocortisone or dexamethasone ○ Vomiting (if taken in large doses)
to help maintain normal blood ○ Diarrhea
pressure ○ Drowsiness
○ Nausea
 ○ Abdominal pain and basophils, immune response, can
○ Headache result in smooth muscle contraction of the
○ Hives or skin rash airways and increase and activates
secretion of other inflammatory mediators
Antimicrobials ● These are two types:
● Interferes with the biosynthesis of the ○ Leukotriene receptor antagonists
bacterial cell wall include Zafirlukast and Montelukast
● May also inhibit bacterial enzymes and - inhibit leukotriene from interacting
cellular metabolism with its receptor so there is a
● May also inhibit protein synthesis blocking action
● Culture and sensitivity to determine specific ○ Leukotriene formation inhibitors
pathogen include Zileuton - inhibits production
● Avoid antibiotic resistance by having a of lipoxygenase, an enzyme that
prescription and adhering to treatment produces leukotrienes which
completion contributes to swelling,
○ Quinolones, Penicillin, Macrolides bronchoconstriction and mucus
○ Aminoglycosides, Cephalosporins, secretion
Tetracyclines ● Adverse reaction to leukotriene modifier
include:
Antitussives ○ Headache
● Antitussive drugs suppress or inhibit ○ Dizziness
coughing. Typically used to treat dry, ○ Nausea and vomiting
nonproductive coughs. The major ○ Myalgia
antitussive include: ○ Cough
○ Benzonatate - anesthetizes stretch ● Zileuton is contraindicated in patients with
receptors throughout the bronchi active liver disease
and alveoli which stops the
coughing. Administered orally - Decongestants
swallow whole, avoid chewing as it ● Decongestants are medicines that relieve
may cause a local anesthetic effect congestion by reducing swelling,
in your mouth inflammation and mucus formation within
○ Codeine, Dextromethorphan the nasal passages or the eye.
hydrobromide - suppresses cough ● Used to help reduce the symptoms of a
reflex by direct action on the cough blocked or stuffy nose
center in the medulla of the brain ● Classified as: systemic or topical,
thus lowering the cough threshold depending on how they are administered.
○ Hydrocodone bitrate ○ Systemic - stimulates SNS to
reduce swelling of respiratory tract
Mast Cell Stabilizers ○ Topical - provides immediate relief
● Used for treatment of allergies from nasal congestion
● Can be used for prevention of asthma ● Most adverse reactions of decongestants
especially for pediatrics result from CNS stimulation and include:
● Drug of choice for individuals with ○ Restlessness and insomnia
exercise-induced asthma ○ Nausea
● The mechanism of action of mast cell ○ Palpitations and tachycardia
stabilizers is poorly understood, but these ○ Difficulty urination
agents seem to inhibit the release of ○ Elevated blood pressure
inflammatory mediators by stabilizing the
mast cell membrane, possibly through the Alternative Therapies
inhibition of chloride channels. Echinacea
● Adverse reactions to inhaled mast cell ● Genus Asteraceae
stabilizers may include: ● Common name: Purple Coneflowers
○ Pharyngeal and tracheal irritation ● Immunostimulator warding off infections
○ Cough ● Can reduce symptoms of infections and
○ Wheezing other illnesses, including the common cold
○ Bronchospasm ● Essential trace element
○ Headache ● Usually taken from food supplements and
● Medications fruits
○ Nedocromil, cromolyn sodium ● Used for treatment and prevention of zinc
deficiency
Leukotriene Modifiers ○ Boost immune system
● Leukotriene modifiers are used for the ○ Treats common colds
prevention and long-term control of mild ○ Treats recurrent ear infections
asthma. ○ Prevent lower respiratory tract
● Leukotriene are substances which are infection
released from the mast cells. Eosinophils
 ○ Serves as antimalarial and
antiparasitic

Inflammatory Disorders of the Respiratory

System/ Common Disorders of the Respiratory
Tract

DYSPNEA
- Common signs and symptoms of
respiratory ailments 2. O2 usually via nasal cannula
- Breathing difficulty - Oxygen therapy can be administered via
- Associated with many conditions such as nasal cannula or it depends. Administer
muscular dystrophy, airway obstruction, oxygen to the client as needed (PRN)
etc. usually about 1-2 Liters but if the patient
- Sometimes it is difficult to treat and needs more it can be increased, it depends
diagnose dyspnea as there are several also on the doctor’s order.
causes of this.
- Dyspnea can happen as a result of over 3. Provide comfort and distractions
exertion or spending time at a higher
altitude. COUGH AND SPUTUM PRODUCTION
- Atmospheric pressure increases when - Cough is a protective reflex
altitude increases. So if your dyspnea - Sputum production has many stimuli
occurs suddenly or if symptoms are very - Thick, yellow, green or rust-colored
severe, this is a serious sign of a medical bacterial pneumonia
condition. - Profuse, pink, frothy pulmonary edema
- Scant, pink-tinged, mucoid lung tumor
General Nursing Interventions
Hypoxia or hypoxemia are associated with This is a part of our immune system/ it is
dyspnea which indicates that there is low blood our body’s normal response to a specific invasion
oxygen level. So sometimes dyspnea, because of dust or pollen especially when we inhale
oxygen levels are low, could lead to decreased something that is not common/ our bodies don’t
level of consciousness or other severe symptoms. need and we want to expel/ get rid of. Coughing
If dyspnea is severe or continuous for some time, reflex is a defensive reflex that enhances the
there is a risk for temporary or permanent cognitive clearance of secretions and particulates from the
impairment. Our tissues need oxygen to survive, if airway and protects us from foreign materials that
there’s no oxygen in the brain problems in CNS will may occur as a consequence of aspiration or
occur, it could lead to irreversible brain damage. inhalation.
Sputum production has many stimuli. It
1. Fowler’s position to promote maximum lung occurs when the respiratory tract secretions are
expansion and promote comfort. An beyond the ability of the mucus ciliary mechanisms
alternative position is the ORTHOPNEIC of the body. Our sputum is produced when a
position. person’s lungs are diseased or damaged. The
- We have to increase the head of the bed for saliva is different from sputum. Sputum is much
example. There are different forms of more thick and is sometimes called phlegm.
Fowler’s position, it may be low, semi, or The color of the sputum varies. It depends
high position. It depends on the degree. on the type of microorganisms present in the
Usually if it’s High fowler’s position that’s lungs. Sometimes when there is an infection in the
above 45 degrees. If it’s Semi fowler, that's lungs, an excess of mucus is produced. Our body
about 20-30 degrees upward. And if it’s usually gets rid of that by coughing. There's also
Low fowler’s that’s 10-15 degrees. It an increase in sputum production. Yellow -
depends on the patient’s needs and also if bacterial, green - viral.
the patient can tolerate the position.
- An alternative one is the Orthopneic General Nursing Intervention
position or the Tripod position. When we 1. Provide adequate hydration
say orthopneic position, this is a sitting - For us to be able to liquify those secretions.
position that promotes lung expansion for When we increase the fluid intake of the
gaseous exchange. Same with fowler’s, this patient we need to look out for fluid
promotes lung expansion especially to overload. Administration of fluids must be
those patients who have difficulty breathing tolerated by the heart/ within the
and those people that cannot lie flat in bed. cardiovascular ability only.
If they cannot tolerate lying down in bed,
and they feel as if they’re drowning when 2. Administer aerosolized solutions
lying down and have difficulty breathing, we - Normal saline solution, usually with water
use the orthopneic position. We can just and salt, helps to loosen up those viscous
place a resting pillow on the overhead table mucus.
 3. Advise smoking cessation HEMOPTYSIS
- This affects the respiratory system of the - Expectoration of blood from the respiratory
individual because of its chemicals. Second tract/ spitting of blood that is from the lungs
hand smokers are much affected. Advise or the bronchial tubes.
patients to gradually stop smoking - Common causes: Pulmonary infection,
Lung CA, Bronchiectasis, Pulmo emboli
4. Oral hygiene - Bleeding from stomach acidic pH, coffee
- Proper oral hygiene should be practiced. ground material
Hygiene in the oral cavity must be - Classified into 2 (Non-massive and
maintained to avoid accumulation of germs, Massive). This is based on the volume of
bacteria, or any microorganisms. blood loss. Hemoptysis is considered as
Non-massive if blood loss is less than
CYANOSIS 200ml/day. It is massive if blood loss is
- Bluish discoloration of the skin more than 200mL/day.
- a LATE indicator of hypoxia
- Appears when the unoxygenated Nursing Interventions
hemoglobin is more than 5 g/dL - Keep patent airway - because hemoptysis
- Central cyanosis observe color on the might lead to hematemesis and blockage
undersurface of tongue and lips may occur which leads to aspiration of the
- Peripheral cyanosis - observe the nail beds, blood being excreted
earlobes - Determine the cause
- RBCs provide oxygen to bloody tissues. - Suction and oxygen therapy
Most of the time, nearly all your RBCs in - Administer Fibrin stabilizers like
the arteries carry a full supply of oxygen. aminocaproic acid and tranexamic acid
The blood cells are bright red and the skin - 3 folds is important
is pinkish or red, so the blood that has lost 1) Bleeding cessation - to stop this
its oxygen is dark bluish red. People who fibrin stabilizers may be
have low levels of oxygen tend to have a administered.
bluish color to their skin, that is cyanosis. 2) Aspiration precaution - that is why
Those with dark skin like Africans, cyanosis we need to maintain a patent airway
may be observed on the mucous and do suctioning.
membrane, such as on the lips, gums, 3) Treat the underlying cause - that’s
around the eyes, and nails. why we have to determine causation

Nursing Interventions As with any potential serious condition, evaluation

- Check the airway patency - check for of your ABC is important, that is always the initial
blockage step (Airway, Breathing, Circulation).
- Oxygen therapy
- Positioning - if DOB/Cyanotic, can be EPISTAXIS
positioned in fowler’s or semi-fowler’s or - (Nosebleed/ Balingoyngoy)
orthopneic position - Bleeding from the nose caused by rupture
- Suctioning - if there’s viscous/increased of tiny, distended vessels in the mucous
mucus production; In suctioning, the membrane
important thing we have to do/observe is - Most common site - Anterior Septum (it
check first the patient’s oxygen level could be 1 nasal septum only or both, but
because if it’s too low do not perform usually 1 septum only either left or right)
suctioning. Because when suctioning is - Causes:
done, not only the secretions are being 1) Trauma (ex. facial trauma, foreign
suctioned, oxygen is included. Oxygen bodies)
levels will further decrease if suctioning is 2) Infection (ex. nasal or sinus
done, so administer first infection, etc.)
oxygen/supplemental oxygen if it’s too low. 3) Hypertension (increases blood
Hyperoxygenate the patient first then pressure & blood went out the nose)
suction. Suctioning is only done in a matter 4) Blood dyscrasias, nasal tumor,
of seconds “1, 2, 3, 4, 5 tanggal agad” cardiac diseases
because again, oxygen will also be
suctioned. Nursing Interventions
- Chest physiotherapy - also used to get rid - Position patient: Upright, leaning forward,
of viscous mucus secretions tilted prevents swallowing and aspiration
- Check for gas poisoning - Apply direct pressure: Pinch nose against
- Measures to increase hemoglobin - such as the middle septum about 5-10 minutes
diet, vitamins, iron rich foods, increase the - If unrelieved, administer topical
folic intake of clients, maximize the iron vasoconstrictors, silver nitrate, gel foams
absorption by food rich in vitamin C and A, - Assist in electrocautery (to remove arterial
and also take iron supplements ligation or embolization, and for clotting to
 occur) and nasal packing for posterior Upper Airway Infections - Laboratory test
bleeding ● CBC - To be able to take note, what is the
cause of the virus or caused by your
CONDITIONS OF THE UPPER AIRWAY bacteria
● Culture
From the suffix “-itis” which indicates inflammation.
Upper airway infections are all contagious Upper Airway Infections: Nursing Interventions
infections of the upper respiratory tract. Common 1. Maintain Patent airway
colds are the most well-known upper airway a. Increase fluid intake to loosen
infection. secretions
b. Utilize room vaporizers or steam
Upper Airway Infections: inhalation.
1. Rhinitis - allergic, non-allergic, and c. Administer medications to relieve
infectious nasal congestion.
2. Sinusitis - acute and chronic i. Nasal decongestant
3. Pharyngitis - acute and chronic 2. Promote comfort
a. Administer prescribed analgesics
RHINITIS b. Administer topical analgesics
- inflammation of the nose c. Warm gargles for the relief of sore
Assessment findings: throat
- also known as Rhinorrhea d. Provide oral hygiene
- Nasal congestion 3. Promote communication
- Nasal itchiness a. Instruct patient to refrain from
- Sneezing speaking as much as possible
- Headache b. Provide writing materials
- Once you are having a viral allergic 4. Administer prescribed antibiotics
rhinitis/hay fever the nose becomes a. Monitor for possible complications
inflamed and swollen so nasal congestion like meningitis, otitis media, abscess
occurs, itchiness, sneezing, headache. formation.
5. Assist in surgical intervention
SINUSITIS
- inflammation of the lining inside the sinuses TONSILLITIS
Assessment findings: - Infection and inflammation of the tonsils
- Facial pain - Most common organism - Group A -
- Tenderness over the paranasal sinuses beta-hemolytic streptococcus (GABS)
- Purulent nasal discharges
- Ear pain, headache, dental pain 3 types of Tonsillitis
- Decreased sense of smell (olfactory) 1. Acute
- This is usually caused by colds or allergies. 2. Chronic
It’s an infection that could result from 3. Recurrent
blockage in the sinuses.
- Inflammatory response: rubor, calor, dolor If tonsillitis is left untreated a complication can
(pain, heat production, and redness) develop that is called peritonsillar abscess

PHARYNGITIS ASSESSMENT FINDINGS

- inflammation of the pharynx ● Sore throat and mouth breathing
Assessment findings: ● Fever
- Fiery-red pharyngeal membrane ● Difficulty swallowing
- White-purple flecked exudates ● Enlarged, reddish tonsils
- Enlarged and tender cervical lymph nodes ● Foul-smelling breath - d/t bacteria
- Fever malaise, sore throat
- Difficulty swallowing (dysphagia because Symptoms last up to 10 days or less (if less than
there’s inflammation in the pharynx, or 10 days it is acute, and if longer than 10 days,
tonsils are also inflamed) chronic)
- Cough may be absent But if tonsillitis comes back multiple times within
- Sometimes pharyngitis occurs together the year it is recurrent. Standard treatment for
with tonsillitis. These 2 infections cause the recurrent is tonsillectomy
infection of your tonsillitis together with
your pharynx. If it’s only the throat that’s LABORATORY TEST
pharyngitis. If it’s both that’s called ● CBC
pharyngotonsillitis. ● Throat Culture - for bacteria to be identified

MEDICAL MANAGEMENT
1. Antibiotics - penicillin
2. Tonsillectomy for chronic cases and
abscess formation
NURSING INTERVENTION - In general the lower respiratory tract can be
For tonsillectomy exposed to different pathogens; inhalation,
1. Pre-operative care aspiration, vascular dissemination, direct
a. Consent contact with contaminated equipment
b. Routine pre-op surgical care (suction catheter); after pathogen gets
2. Post-operative care inside they usually colonize and infection
a. Position: Most comfortable is develops. Affects alveoli and gas exchange.
PRONE with the head turned to the - Alveoli with pneumonia - fluid and pus filled
side. air spaces
b. Maintain oral airway, until gag reflex - Lobar Pneumonia - lower left lung lobe; has
returns. solidification, has fluid or pus
c. Apply ICE collar to the neck to
reduce edema Microorganisms
i. Ice could promote ● Streptococcus pneumonia
vasoconstriction and ● Mycoplasma pneumonia
decrease the risk of ● Haemophilus influenzae pneumonia
bleeding. ● Legionella pneumophila
d. Advise patient to refrain from talking ● Chlamydial pneumonia
and coughing. ● Pseudomonas aeruginosa
e. Ice chips are given when there is no ● Klebsiella pneumoniae
bleeding and gag reflex returns. ● Pneumocystis carinii pneumonia (common
f. Notify the physician if: in HIV/AIDS; opportunistic)
i. Patient swallows frequently ● Aspergillus fumigatus
ii. Vomiting of large amount of ● Mycobacterium tuberculosis
bright red or dark blood
iii. PR increased, restless and Acquired Pneumonia
Temperature increased
a. Community Acquired Pneumonia (CAP)
MOST COMMON complication for tonsillectomy: - Occurs in a community setting or within 48
Hemorrhage hours of hospitalization
- Check for any bleeding sites on the mouth - Usually caused by pneumococci infection
or nose. - Streptococcus Pneumonia
- Observe frequent swallowing of the patient. - Most common type
- Vomiting of bright red, dark brown blood.
b. Hospital Acquired Pneumonia (HAP)/
Infectious Disorders of the Lungs Nosocomial Pneumonia
- Onset of pneumonia symptoms stats at
Pneumonia least 48 hours upon admission to the
Inflammation of the lung parenchyma caused by a hospital or within three months of a hospital
bacterial/viral/fungal/parasitic/mycoplasma stay
(protozoan) agent. - Often connected w/ staphylococci
- Acute inflammation of lung parenchyma infections
- Impaires gas exchange - Hospital Acquired Infections (HAI)
- Occurs in both sexes and all ages - HAP is the leading cause of death in
- US 4 million cases annually HAI - 22%
- Leading cause of death from an infectious - Viral, bacterial, fungal pathogens
disease according to statistics - 4 types HAI
- According to WHO, it is the leading cause - HAP
of death in children. 18% of death under - Bloodstream
age of 5 - Clabsi, Cauti, Surgical site
- Preventable: infection
- Immunization
- Adequate pre and postnatal care c. Ventilator-Associated Pneumonia
- Sufficient nutrition - Develops 48 hours or longer after
- Provision of clean water mechanical ventilator is given by means of
- Prognosis is good on those who have endotracheal tube (ET) or tracheostomy
normal lungs and adequate immune - Results from the invasion of the lower
system; however bacterial pneumonia is the respiratory tract and lung parenchyma by
leading cause of death in those who have microorganism
debilitated immune systems. - Most commonly acquired especially in an
- Can be classified or categorized into ICU setup; secondary only to cauti
various groups. - Most fatal in HAI; 45% mortality rate
- Categorized into: - Primary risk factor is ET itself; improper
1. Origin - where it is originated from placement/ not clean; direct passageway to
2. Location lungs; can be reservoir for pathogens
3. Type
 - Patients cannot cough; no natural defense - Triggers inflammatory changes and also will
to remove secretions; can cause aspiration inactivate surfactant over a large area
as well. - Decrease surfactant can lead to alveolar
- Must prevent: collapse
1) Aspiration - Acidic/ gastric contents can cause damage
2) Colonization to airway and alveoli; may obstruct and
3) Use of contaminated equipment reduce airflow
- Commonly happens to elderly or debilitated
Causes patients; those with NGT feeding, impaired
Bacterial Pneumonia gag reflex, poor oral hygiene and decreased
- Most common cause LOC
- Walking Pneumonia: (Atypical Pneumonia, - If NGT, make sure that it is inside the
mild case) less severe form of bacterial stomach and not the in the lungs***
pneumonia, symptoms are mild
- Mycoplasma bacteria Risk Factors
- Bedrest and hospitalization are not ● Depressed immune system
usually needed ● Smoking - causes mortality approximately
- Symptoms are mild enough that you 3,000 deaths per year; increases the risk for
can continue your daily activities lung diseases and lower tract infection
- Can happen in any part of the lungs and ● Prolonged immobility - increase respiratory
triggers alveolar inflammation or edema secretion since no movement of secretion;
- Low ventilation with normal perfusion leads to atelectasis; hypostatic pneumonia
- Capillaries will engorge in blood and cause ● Shallow breathing patterns - Disrupts the
stasis balance of oxygen and carbon dioxide
- Breakdown of alveoli and cause atelectasis ● Conditions with copious mucus production
- Severe: Lungs will look heavy and liver like; ● Depressed cough reflex
reminiscent of Acute Respiratory Distress ● Instrumentations - bypasses normal
Syndrome (ARDS) barriers and can lead to infection/
pneumonia
Viral Pneumonia ● Alcohol intoxication - alters body’s flora and
- Second most common cause of pneumonia impair bodies defense mechanism; can
- Viruses that bring on colds and flu further lead to breakdown of local
- Coronavirus, Covid-19 protective barriers in the respiratory tract
- First attacks bronchiolar epithelial cells; ● Advanced age
causing inflammation that then leads to
desquamation Manifestations
- Also invades bronchial mucus glands and - Increased sputum production
goblet cell and spreads to the alveoli; fills - Wheezing
with blood and fluid - Dyspnea - common symptoms
- Advance infection hyaline membrane may - Rales
form like a bacterial infection - Chest pain
- Clinically resembles ARDS - Pleural effusion - water in pleural space
- Dullness
Fungal Pneumonia - Orthopnea
- Less common cause - Fever - bacterial
- Higher chance of catching if your immune
system is weakened such as: Diagnostics
- Organ transplant - Chest x-ray - non invasive, confirm infiltrate
- Chemotherapy for cancer in lungs
- Drugs to treat autoimmune diseases - Sputum examination - gram’s staining
- HIV (PCP) - Sputum culture and sensitivity test - to
- Infection process wherein the lungs are differentiate the type of infection
caused by endemic or opportunistic fungi - WBC count
- Occurs following inhalation of spores; after - Leukocytosis is bacterial
inhalation there will be activation of latent pneumonia, normal-low levels is
infection viral
- 3 common cause: - Pulse oximetry/ O2 saturation
1) Pneumocystis - Below normal
2) Cryptococcus - ABG, bronchoscopy
3) Aspergillus
General management
Aspiration Pneumonia - Antimicrobial therapy - depends on the
- It is a complication of pulmonary aspiration. microorganism
- Caused by inhaling toxic and/or irritant - Rest - comfort measure should be done to
substances, usually gastric contents, into decrease the hunger for oxygen, with DOB
the lungs. - decrease oxygen consumption
 - O2 therapy - humidify oxygen or oxygen 2. Moderately advance
therapy especially for those with hypoxia ● One or both lungs maybe involved
who need supplemental oxygen ● Diameter of the cavity should not
- Increased fluid intake - within the cardiac exceed 4cm
ability/ tolerance to prevent pulmonary 3. Far advanced - lesions are more extensive
congestion than moderate, more than 4cm
- Bronchial hygiene - spit out to get read the
sputum such as 3 types of causative agent
● Postural drainage - Mycobacterium tuberculosis
● Splint chest when coughing - Mycobacterium africanum
- Monitor sputum, CXR, temperature - to - Mycobacterium bovis/ bovine
check if the procedure is effective or not - infectious disease of cattle,
the antibiotic or the antimicrobial therapy drinking contaminated milk
- Proper antibiotics - can also administer
bronchodilators to dilate the bronchial Risk factors
muscles, antitussives to help stop coughing - Poor living conditions (environmental)
- Maintain patent airway and adequate - Close contact with infected person -
oxygenation droplet transmission
- Teach patient how to cough and do deep - Overcrowding
breathing exercises - Poor nutritional intake
- Maintain adequate nutrition - high caloric - Inadequate treatment of primary infection
diet - Primary complex - non
- Proper disposal of sputum - highly communicable
communicable
- Control temperature by cooling measures (if Signs and Symptoms
fever, administer analgesics - Afternoon fever
- Monitor V/s closely watch for danger sign - Night sweating
like: - Productive cough
● Marked dyspnea - Weight loss
● Irregular Thready pulse (pulse rate) - Pathognomonic sign or specific
● Delirium with extreme restlessness symptoms: hemoptysis
● Cold moist skin
● Cyanosis and exhaustion Lab Test and Diagnostic Test
- CXR - determine extent of the disease
Preventive and Control - Sputum culture - sputum AFB 3x
- Vaccination - pneumococcal vaccine (PCV) - Mantoux test - PPD testing 48- 72 hours to
- Immunization against anti-haemophilus be check exposure TB bacilli
influenzae (HIB) pneumococcus, measles - ABG - evaluate lung perfusion and
and whooping cough (pertussis) is the most compensatory mechanism
effective way to prevent Pneumonia - Liver function test - SGOT SGPT, check
- Adequate nutrition kidney damage while in anti-TB drugs
- Environmental sanitation - CBC
- Pulmonary function test - determine extent
Pulmonary Tuberculosis pulmonary function
- Chronic lung infection that leads to - Electrocardiogram - cardiovascular
consumption of alveolar tissues function, check the electrical rhythm of the
- Koch’s disease, Consumption (alveolar heart
tissues), Phthisis, Poor man’s disease
- Mode of transmission: Airborne General Management
- Drug therapy (antibiotics, anti-TB) - may
Classification cause liver and kidney damage,
1. Pulmonary Tuberculosis - affects the lungs, hepatotoxicity/ nephrotoxicity. Liver enzyme
spreads easily as it is situated in the lungs test is done before anti-TB therapy. First 4
2. Extra pulmonary Tuberculosis - affects doses are administered orally.
lungs and other organs of the body such ● Rifampin - red/ orange color urine
as: ● Isoniazid - causes peripheral
a. TB meningitis - meninges of brain neuritis, numbness, pain, tingling,
b. Pott’s disease - bone particularly in swelling of the muscles
the spine, noncommunicable ○ Vitamin B6/ pyridoxine given
c. Miliary TB - sepsis to the blood and to client as a prophylaxis
spread to other organs ● Pyrazinamide - hepatotoxicity and
nephrotoxicity
Quantitative Classification of TB ● Ethambutol - optic neuritis, visual
1. Minimal - with slight lesion without acuity, color blindness
demonstrable excavation, enters the lungs ○ given orally in the morning
leads to excavation without any food intake
 ● Streptomycin - given intramuscularly Nursing management
for 60 days - 2 months, cranial nerve - Diet - increase CHON, calorie intake
8 autotoxicity - hearing impairment - Chest physiotherapy (CPT) - to mobilize
● All can cause kidney damage and secretions
hepatomegaly and nephrotoxicity - Maintain respiratory isolation and PPES -
- Bronchodilators - dilate the airway passage highly communicable disease so N95
- Mucolytics - liquefy tenacious secretions should be worn
- Expectorants - evacuate secretions - Administer medications as ordered
- Administer oxygen as needed
Directly Observed Treatment Short Course (TB - Always check sputum for purulent or
DOTS) bloody expectorations
DOTS for TB consist of: - Maintain semi fowlers position - to facilitate
a) diagnosing cases easy breathing
b) treating patients for 6-8 months with drugs - Frequent positioning - every 30 minutes to
c) promoting adherence to the relatively mobilize secretions
difficult treatment regimen - Adequate hydration - IVF
Track record: When strictly followed the - Encourage deep breathing and coughing
treatment regimen cures TB and prevents exercise and proper expectoration
death - Proper nutrition
- Comfort measure
Elements of DOTS - Teach patient everything about TB to be
1. Sustained political commitment - increased more compliant with the treatment regimen
financial and human resources - Prevent complications
2. Access to quality-assured TB sputum
microscopy Prevention and Control
● Case detection of persons - Massive BCG immunization
presenting symptoms Of TB - Avoid overcrowding
● Screening of individuals - Good personal hygiene and environmental
● Health education about quality- sanitation
assured sputum microscopy - Improved nutritional status
3. Standard short-course chemotherapy to all
cases of TB Obstructive Disorders of the Airways
● Direct observation of treatment
4. Uninterrupted supply of quality assured Chronic Obstructive Pulmonary Disease (COPD)
drugs - A collective term for a number of lung
● Sustain supply of anti-TB drugs diseases that prevent proper breathing,
● Establish a reliable system of regular airflow blockage.
distribution of anti-TB drugs - Three most common types of COPD are
● Anti-TB drugs should be available emphysema, chronic bronchitis, and
free for all TB patients asthma.
● Reduce non-adherence to treatment - Cigarette smoking is the most significant
and prevent the development of risk factor for COPD.
MDR - Impairs ciliary action and
5. Recording and reporting system macrophage function
● Monitors treatment and progress - Causes inflammation in airway and
outcome of individual patients increase mucus production, alveolar
● Evaluate overall program destruction, and peribronchiolar
performance fibrosis
- Especially passive smokers
Vitamins supplements - There is no cure for COPD, but disease
● Vitamin A - promotes good eyesight management can slow disease progression,
● Vitamin B1, B6, B12 - prevents hepatic relieve symptoms and keep you out of the
anomalies hospital.
● Vitamin C - boost/ increase immune system - Damage in the airways does not
● Vitamin D - promotes strong bones regenerate
● Vitamin E - promotes a healthy heart - Treatment aims to prevent further damage,
reduce risk of complications and ease
Antipyretic some symptoms.
Analgesic - Treatment options include pulmonary
rehabilitation, medicines and oxygen
Surgical management therapy.
- Bronchoscopy
- Thoracentesis Asthma
- Pneumonectomy - Chronic inflammatory airway disorder
- Lobectomy (lobe) - Episodic airway obstruction
- Chest tube thoracotomy (CTT) - Hyper responsiveness
 - Bronchospasms week, nighttime symptoms occur
- From acute reactions with increase less than twice per month
mucus production and mucosal - In mild persistent, symptoms occurs
edema 3-6 times per week, nighttime
- Reversible symptoms occur 3-4 times per
- Can occur at any age but this is the most month
common chronic disease of childhood - Moderate persistent asthma
- ⅓ of patients develop this between - Has normal or below normal air
ages 10-30, both sexes, familial exchange
- Allergy is the most predisposing factor - Signs and symptoms include cough,
- Bronchial linings overreact to wheezing, chest tightness, DOB
various triggers which cause - Nighttime symptoms occur five or
smooth muscle spasms constricting more times per month
airway - Severe persistent asthma: Status
- Mucosal edema and thickened Asthmaticus
secretions that further block airway - Has below normal air exchange
- Overreaction is primarily attributed - Experiences cough, wheezing, chest
to genetics and environment tightness, DOB, marked respiratory
distress, absent breath sounds,
Pathophysiology chest wall contraction will be seen
- immunologic/ allergic reaction results in - Activity level is greatly affected
histamine release, which produces three - Nighttime symptoms occur
main airway responses frequently
a. Edema of mucous membranes - Does not respond to conventional
b. Spasm of the smooth muscle of treatments
bronchi and bronchioles
- Narrowing of air passage Status Asthmaticus is respiratory failure that
interrupting normal flow of air into comes with the worst form of acute severe asthma,
and out of the lungs or an asthma attack.
c. Accumulation of tenacious
secretions Diagnostic Examination
- Airflow is further interrupted by an - Pulmonary Function Test
increase in mucous secretions - Reveals signs of obstructive airway
forming mucus plugs and swelling diseases
of bronchial tubes - There is decreased vital capacity,
increase in total lung capacity and
Triggers/ Precipitating Factors residual capacity
a. Inhaled allergens - genetically induced - Serum Immunoglobulin E - Increased IgE
asthma, sensitivity to specific external during allergic reaction
allergens, begins at childhood - CBC - Reveals increased eosinophil count
- Dust mites - CXR - Used to monitor asthma progress
- Pollens and may show hyperinflation with areas of
- Food allergens atelectasis
b. Non allergenic - environmentally induced - ABG - Detects hypoxemia and guides
asthma, a reaction to internal non allergic treatment plan of client
reactions - ST and Bronchial Challenge Test
- Viral respiratory infection - ST identifies specific allergens.
- Weather changes Read 1-2 days to detect early
- Fumes, strong odors reaction and again 3-4 day for
- Smoking delayed reaction
- Exercise - BCT evaluates clinical significance
- Drugs: aspirin, NSAIDs of allergens identified by ST

Many, especially children, have both of these General Management

triggering factors Best treatment for asthma is prevention by
identifying and avoiding precipitating factors such
Manifestations as environmental allergens
- Mild persistent asthma - ABC - Airway, Breathing clearance,
- There is an adequate air exchange Circulation
and asymptomatic between attacks - Long acting medications/ long term asthma
- Classified as mild intermittent or control medications to achieve and
mild persistent maintain control of persistent asthma
- In mild intermittent, patient - Long acting bronchodilators that
experiences cough, wheezing, chest decrease bronchoconstriction and
tightness, DOB less than twice per reduce bronchial airway edema and
increase pulmonary ventilation
 - Quick relief medications (rescue Chronic Bronchitis and Emphysema
medications)
- Salbutamol, Albuterol Chronic Bronchitis
- Immediate response for relief of - Inflammation of bronchi caused by irritants
symptoms or infection. Distinguishing characteristic is
- Anti Inflammatory agents the obstruction of airflow caused by mucus.
- MDI - to puff for quick relief - Acute inflammation of the mucus
- Spacer device - for quick relief membranes of the trachea and the
bronchial tree
Long Acting Medications - A clinical history of productive cough for 3
- Corticosteroids months of the year for 2 consecutive years
- Inhaled form should use a space - Presence of dyspnea and airway
dose inhaler obstruction
- Rinse the mouth after administration - Inflammation in the larger airways that
to prevent thrust leads to mucosal thickening and mucus
- Has effects of bronchodilation and hypersecretion which contributes to
anti inflammation productive cough
- Used in long term control of asthma - Extension of the inflammatory changes into
- Mast Cell Stabilizers smaller bronchioles that also leads to
- Cromolyn sodium/ nedocromil airflow obstruction
- Prevents exercise induced asthma - Blue bloater bronchitis dominant - blue and
- Given prophylactically which blocks overweight. SOB and chronic cough. Takes
acute obstructive effects of antigen deeper breaths but cannot take in right
exposure amounts of oxygen (alveoli destruction)
- Long Acting Beta Adrenergic Agonist - Clients with COB appears bloated, have
(LABAs) large barrel chest and peripheral edema,
- Levecort/ Sembicort cyanotic nail beds and circumoral cyanosis
- Not indicated for immediate relief of - Occurs when irritants are inhaled for a
asthma prolonged period of time
- Results to resistance in small airways and
Quick Relief Medications imbalance decreasing arterial oxygenation
- Short acting beta adrenergic drugs (SABA)
- Rapid onset of action Microorganisms
- Salbutamol - Commonly isolated agents:
- Albuterol - Streptococcus pneumoniae,
- For acute asthma attacks Staphylococcus aureus
- H Influenza and Mycoplasma
Nursing Interventions pneumoniae
Maintenance of ABC is always important so
supplemental oxygenation is given to client Manifestations
- Approach the patient calmly - Cough with sputum production
- Take the history and any allergic reactions - Wheezing - persistent airway narrowing and
- History of allergy mucus obstruction causes diffuse/ localized
- Early treatment and education of the patient wheezing sound
- Administer medications as prescribed - Inspiratory and expiratory rhonchi - d/t
- Keep patient well hydrated increased mucus production with defective
- Health education, use of patient follow up mucociliary escalator function
care - Tachycardia - common with exacerbation of
bronchitis
- Hypoxemia is significant and chronic
- Pulmonary hypertension can also occur
- Peripheral edema and increased in jugular
vein pressure

Diagnostics
- Imaging/ CXR - findings include increased
lung volume with relatively depressed
diaphragm
- Pulmonary Function Test - decreased in
volume and capacities of the lungs.
measurements of lung volume may reveal
increase in RV and FRC.
- FRC reflects air that is trapped in
the lungs as a result of tissue airway
obstruction and airway closure
 - ABG - hypoxemia, hypercapnia with - Enlarged air spaces
increasing obstruction of airway, decreased - With barrel chest, dyspnea, and weight loss
PCO2 and respiratory acidosis with c. Centrilobular emphysema
compensatory metabolic alkalosis - Also called as “centriacinar emphysema”
- Polycythemia - chronic hypoxemia with a - Seen at the center of secondary lobule, no
variable erythropoietin mediator that will changes in the acini level
increase hematocrit level - Affects the upper lobes of the lungs
damages respiratory passage
General Management - There is an imbalance between the
- Broad spectrum antibiotics ventilation-perfusion ratio
- Expectorants - to move viscous secretions - Chronic hypoxemia, polycythemia and
- Increased fluid intake - to liquify secretions RSFH (Right-sided Heart Failure)
- Rest - to conserve oxygenation - Presented as central cyanosis, edema,
- Moisture therapy - for coughing reflex respiratory failure
- Encourage bronchial hygiene
- Postural drainage Causes of Emphysema
- CPT a. Tobacco smoking - causing airflow
trapping, making the alveoli distended
Emphysema diminishing lung capacity. Does not only
- Presence of overdistended, non functional destroy lung tissue but also irritates airways
alveoli which may rupture resulting in loss causing inflammation and damage to
of aerating surfaces. Loss of recoil tension different organs, especially our respiratory
that is necessary to support the airway tract
during expiration. b. Environmental exposure - exposure to dust,
- Condition marked by irreversible occupational pollutants
enlargement of the airspaces distal to the c. Genetic defect of Alpha 1 Antitrypsin
terminal bronchioles, accompanied by deficiency
destruction of their walls, most often - Alpha 1 Antitrypsin allows
without obvious fibrosis. breakdown of protein (proteolytic
- Abnormal, permanent enlargement of acini enzymes), attacking various tissue
accompanied by the destruction of alveolar of the body
walls. Acini is the respiratory unit found in - An attack results in destructive
alveolar walls. Irreversible. Destruction and changes in the lungs and may also
obstruction of the alveolar wall result from affect liver and the skin
tissue changes rather than mucus - Destruction leads to emphysema
production (bronchitis). d. Passive smoking
- Pink puffer emphysema dominant - thin,
breathing fast, pink in color. SOB and Manifestations
pursed-lip breathing. Difficulty catching - Dyspnea
breath, face reddens while gasping for air - Ongoing fatigue
- Wheezing
- Sputum production - long term mucus
production
- SOB, especially during light exercise or
climbing steps
- Clubbing of fingers
- Assume upright position, leaning forward
(tripod position)
- Long-term cough or “smoker’s cough”
- Barrel chest

Diagnostics
- Imaging - CXR
- Hyperinflation
- Pulmonary Function Tests
Types - Lung parenchymal destruction and
a. Paraseptal emphysema - involves the loss of lung elastic recoil
distal part of the secondary lobule and is - Increase dynamic compression of
therefore most obvious in subpleural airways, especially during forced
regions. Paraseptal emphysema may be expiration
seen in isolation or in combination with - ABGs
coentilobolar emphysema. - Loss of alveolar capillaries
b. Panlobular emphysema - May maintain PO2 and PCO2
- Destruction of the respiratory bronchiole, - Loss of capillary perfusion
alveolar duct and alveoli
- Minimal inflammation
 - Hypercapnia - excess of CO2, forms a plug occluding the lumen and
respiratory acidosis and obstructing perfusion.
compensatory metabolic alkalosis MOST COMMON P.E - Pulmonary
- Polycythemia thromboembolism (Occurs when there is venous
- Elevated hematocrit because of thrombi shiftly from the low extremity)
hypoxemia
CAUSES:
Pink Puffers ● Fat embolism/ Air embolism
- Presence of pinkish skin color, reddish ○ Comes from the lower part of the
complexion, and less hypoxemia extremities.
- Usually seen in COPD or emphysema ○ The lungs basically possess both
patients excess functional capacity and a
redundant vascular supply that
Complications allows them to filter a significant
- Respiratory insufficiency number of thrombi and platelet
- Coth conditions reduce body’s aggregates with minimal impact on
ability to perform gas exchange lung function or hemodynamics.
- Respiratory failure However, this large
- Either hypercapnic or hypoxemic embolism/thrombo emboli is large
enough accumulation of smaller
General Management ones can cause substantial
- Risk reduction impairment of your cardiac and
- Stop smoking respiratory function and will lead
- Medications: now to death.
a. Bronchodilators - relieves ● Multiple Trauma
bronchospasms and reduce airway ● Abdominal Surgery
obstruction ○ It causes embolism because in
b. MDI surgery the patient is lying down
c. Corticosteroids - as a and has a higher risk of pulmonary
bronchodilator embolism. Some operations are
- Immunizations - pneumococcal vaccine for particularly risky, however, this
65 years above and children would include your pelvic, hip or
- Oxygen therapy - 2-3 L/min so as not to knee surgery.
depress the respiratory drive ○ The risk is the extended time in bed
and the position necessary for the
Nursing Interventions surgery may also increase your
- Patient education pulmonary embolism and deep vein
- Realistic smoking cessation thrombosis are the most common
- Breathing exercises cause.
- Self-care activities ● Immobility
- Physical conditions ○ Prolonged bed rest
- Nutritional therapy ○ Basically, when you don’t walk or
- Assist in ADL move for a long period of time, the
- Coping mechanism blood does not circulate.
- Managing potential complications like ○ This blood pools or collects on the
infections and respiratory failure veins and blood clots now form.
● Hypercoagulability
Traumatic Chest Injury, Acute Respiratory ○ If there would be an increase in
Failure coagulation, there is an increased
risk of the formation of emboli.
Pulmonary Vascular Disorders
PATHOPHYSIOLOGY
Pulmonary Embolism - The thrombus that travels from any part of
- This refers to the obstruction of the the venous system obstructs either
pulmonary artery or one of its branches by completely or partially. Then the lungs will
a blood clot (thrombus) that originates have inadequate blood supply, with
somewhere in the venous system or in the resultant increase in dead space in the
right side of the heart. lungs.
- Most commonly, pulmonary embolism is - The gas exchange will be impaired or
due to a clot or thrombus from the deep absent in the involved area.
veins of the lower legs. - The regional pulmonary vasculature will
- A pulmonary embolus consist of materials constrict causing increased resistance,
that usually gain access to the venous increased pulmonary arterial pressure and
system then to the pulmonary circulation. then increase workload of the right side of
Eventually when it reaches the vessel’s the heart.
caliber that is too small or pre-passage
MANIFESTATIONS ○ One of the factors that are high risk
- Tachycardia of P.E
- “Air hunger” ● Do not message legs
- Feeling of impending doom ○ If the area that has thrombus
- Productive cough (sputum may be formation gets massaged it can now
blood-tinged) form a thrombi and would now go to
- Low-grade fever the circulation.
- Pleural effusion ● Relieve pain-analgesics
Less common signs included: ● HOB elevated
- Massive hemoptysis ● Heparin (2 weeks) then coumadin (3-6
- Splinting of the chest months)
- Leg edema ○ Clients need to have blood studies
- Cyanosis, syncope, and distended neck such as bleeding time, clotting time.
veins (with a large embolus) If ever you need to stop the
medication you will have a specific
DYSPNEA - first symptom of pulmonary embolism, sign.
which may be accompanied with anginal or
pleuritic chest pain. Surgery can be done and the procedures are:
- Vena cava ligation or insertion of a device
DIAGNOSTIC EXAM to filter the blood returning to the heart and
● Ventilation - perfusion scan lungs and that the formed emboli would be
● Pulmonary arteriography removed.
○ DEFINITIVE TEST for the patient
○ See’s where the pulmonary NURSING INTERVENTIONS
embolism is located ● Active leg exercises to avoid venous stasis.
● CTPA - detects the presence of pulmonary ● Early ambulation
embolism ● Use of elastic compression stockings
● CXR ● Avoid of leg - crossing and sitting for
● ECG prolonged periods
○ Helps distinguish your pulmonary ● Drink fluids.
embolism especially when it comes
in relation to myocardial infarction. Traumatic Injuries to the Lungs
● ABG
○ Shows decrease in your partial Flail Chest
oxygen and partial carbon dioxide ● Complication of chest trauma occurring
when 3 or more adjacent ribs are fractured
Treatment of Pulmonary Embolism is designed to: at two or more sites, resulting in
● Maintain adequate cardiovascular and free-floating rib segments.
pulmonary function during the resolution of ➔ Free-floating rib segments cause the chest
the obstruction. wall to lose its stability.
● Prevent embolus recurrence. ➔ Flail chest is described as a situation in
which a portion of the rib cage is separated
➔ Heparin and non-pharmacologic therapies from the rest of the chest wall usually this is
for your patient. due to a severe blood trauma.
➔ Small emboli can be resolved within 10-14 ◆ Examples: car accidents, fall
days. accidents basta an injury directly to
➔ To have adequate cardiopulmonary function the chest wall.
is of course the oxygen therapy as needed ➔ Considered as an emergency, there could
and-anticoagulation with heparin. be a severe associated lung injury and its
➔ While doing the therapy ensure to have imperative that treatment should be
coagulating test this is to monitor if you are immediate.
administering too much medication and for
the patient’s safety as it could lead to PATHOPHYSIOLOGY
bleeding. ● During inspiration, as the chest expands,
➔ Non-pharmacologic therapies may include the detached part of the rib segment (flail
pneumatic compression devices that are segment) moves in a “paradoxical” manner.
the compression stocking as it decreases ● The chest is pulled INWARD during
having deep vein thrombosis. inspiration, reducing the amount of air that
➔ Fibrinolytic therapy using streptokinase to can be drawn into the lungs.
enhance fibrinolysis. ● The chest bulges OUTWARD when
pressure exceeds atmospheric pressure.
GENERAL MANAGEMENT The patient has impaired exhalation.
● Oxygen therapy STAT
● Early ambulation post op This paradoxical action will lead to:
○ Avoid formation of emboli ● Increased dead space
● Monitor obese patient ● Reduced alveolar ventilation
 ● Decreased lung compliance ● Simple / spontaneous
● Hypoxemia and respiratory acidosis ○ Primary - idiopathic
● Hypotension, inadequate tissue perfusion ○ Secondary - related to a specific
can also follow disease
○ The most common type of closed
MANIFESTATIONS pneumothorax; air accumulates
● Severe dyspnea; rapid, shallow, grunty within the pleural space without an
breathing; paradoxical chest motion. The obvious cause. Rupture of a small
chest will move INWARDS on inhalation and bleb on the visceral pleura most
OUTWARDS on exhalation. frequently produces this type of
● Cyanosis, possible neck vein distension, pneumothorax.
tachycardia, hypotension. ○ It may occur on a healthy individual
○ Decrease oxygenation that will
cause difficulty of breathing. ● Tension Pneumothorax
○ this can develop from either simple
DIAGNOSTIC EXAM or traumatic Pneumothorax
ABG result ○ Air enters the pleural space w each
● PO2 decreased inspiration but cannot escape;
● PCO2 elevated causes increased intrathoracic
● pH decreased pressure and shifting of the
○ Sign of respiratory acidosis mediastinal contents to the
unaffected side (mediastinal shift)
GENERAL MANAGEMENT ○ Occurs when air is drawn into the
● Supportive pleural space from a lacerated lung
○ Internal stabilization with a volume
cycled ventilator, ventilatory Manifestation:
support. ● Sudden pain, tachypnea
○ Drug therapy (narcotics, sedatives) ● Chest discomfort
○ Control of Pain ● Air hunger
○ Clearing secretions from the lungs. ● Increased tympany on the chest wall
● Maintain an open airway: suction ● Decreased breath sounds on auscultation
secretions, blood from nose, throat, mouth, ● Mediastinal shift
and via endotracheal tube; note changes in
amount, color, and characteristics. Diagnostic Exams:
● Monitor mechanical ventilation a. Chest x-ray reveals area and degree of
● Encourage turning, coughing, and deep Pneumothorax
breathing. b. pCO2 elevated
○ If the patient is able to move c. pH decreased (a sign of acidosis)
because usual movements can
aggravate. General management
● Monitor for signs of shock: HYPOTENSION, ● Goal of treatment
TACHYCARDIA ○ To evacuate the air or blood from
the pleural space
Pneumothorax ● Treatment of Pneumothorax depends on its
● Partial or complete collapse of the lung due type.
to an accumulation or air or fluid in the
pleural space. Treatments:
● Occurs when the parietal or visceral pleural For spontaneous/simple
is breached and the pleural space is ● Treatment is usually conservative for
exposed to a positive atmospheric spontaneous pneumothorax when there’s:
pressure. ○ No sign of increased pleural
pressure
Types of Pneumothorax ○ Lung collapse less than 30%
● Traumatic ○ No dyspnea or indication of
○ Open - “sucking chest wound” physiologic compromise
○ Closed - “blunt or penetrating
trauma For Traumatic
○ Air enters the pleural space through ● Traumatic pneumothorax requires
an opening in the chest wall; usually thoracostomy tube insertion and chest
caused by stabbing or gunshot drainage and may also require surgical
wounds. repair.
○ May occur with trauma or
procedures For Tension
○ Often accompanied by hemothorax ● Tension pneumothorax is a medical
emergency. If the tension in the pleural
space isn’t relieved, the patient will die from
 inadequate cardiac output or hypoxemia. A Manifestation
large-bore needle is inserted into the pleural ● Restlessness
space through the second intercostal ● Dyspnea
space. If large amounts of air escape ● Cyanosis
through the needle after insertion, the ● Altered respiration
needle is left in place until a thoracostomy ● Altered mentation
tube can be inserted. ● Tachycardia
● cardiac arrhythmias
NURSING INTERVENTIONS: ● Respiratory arrest
● Provide nursing care for the client with an
endotracheal tube: suction secretions, Diagnostic exams
vomitus, blood from nose, mouth, throat, or ● Pulmonary function test - pH below 7.35
via endotracheal tube; monitor mechanical ● CXR - pulmonary infiltrates
ventilation. ● ECG - arrhythmias
● Restore/promote adequate respiratory
function. General management
● Assist with thoracentesis and provide - Therapy for acute respiratory failure (ARF)
appropriate nursing care. focuses on correcting hypoxemia and
● Assist with insertion of a chest tube to preventing respiratory acidosis.
water-seal drainage and provide Oxygenation
appropriate nursing care. ● Deep breathing with pursed lips, if the
● Continuously evaluate respiratory patterns patient isn’t intubated and mechanically
and report any changes. ventilated, to help keep airway patent.
Provide relief/control of pain. ● Incentive spirometry to increase lung
A. administer narcotics/analgesics/sedatives volume oxygen therapy to promote
as ordered and monitor effects oxygenation and raise partial pressure of
B. Position client in high-fowler’s position arterial oxygen
● Mechanical ventilation with an endotracheal
Complication or tracheostomy tube, if needed, to provide
● Cardiac tamponade adequate oxygenation and reverse
○ Compression of the heart as a result acidosis.
of fluid within the pericardial sac ● High-frequency ventilation, if the patient
● Acute respiratory failure doesn’t respond to treatment, to force the
○ Sudden and life-threatening airways open, promoting oxygen and
deterioration of the gas-exchange preventing alveoli collapse.
function of the lungs. Drugs
○ Occurs when the lungs no longer ● Antibiotics to treat infection
meet the body’s metabolic needs. ● Bronchodilators to maintain airway patency
Defined clinically as: ● Corticosteroids to decrease inflammation
1. PaCO2 of less than 50mmHG ● Positive inotropic agents to increase
2. PaCO2 of greater than 50 mmHg cardiac output
3. Arterial pH of less that 7.45 ● Vasopressors to maintain blood pressure
● Diuretics to reduce edema and fluid
Causes overload
● CNS depression - head trauma, sedatives ● Opioids such as morphine to reduce
● CVS diseases - MI, CHF, pulmonary emboli respiratory rate and promote comfort by
● Airway irritants - smoke, fumes relieving anxiety
● Endocrine and metabolic disorders - ● Anxiolytics such as lorazepam to reduce
myxedema, metabolic alkalosis anxiety
● Thoracic abnormalities - chest trauma, ● Sedatives, such as propofol, if the patient
pneumothorax requires mechanical ventilation and is
having difficulty tolerating it
Pathophysiology
● Decreased respiratory drive NURSING INTERVENTION
● Brain injury, sedatives, metabolic disorders ● Maintain patent airway
- impair the normal response of the brain to ● Administer O2 to maintain PaCO2 at more
normal respiratory stimulation than 50 mmHg
● Dysfunction of the chest wall ● Suction airways as required
● Dystrophy, MS disorders, peripheral nerve ● Monitor serum electrolytes levels
disorders - disrupt the impulse transmission ● Administer care of patient on mechanical
from the nerve to the diaphragm - abnormal ventilation
ventilation
● Dysfunction of the lung parenchyma
● Pleural effusion, hemothorax,
pneumothorax, obstruction - interfere
ventilation - prevent lung expansion