RESPIRATORY SYSTEM 1.

Pulmonary Function Test

Keep NPO until the return of gag reflex. Assess for and report frank bleeding Apply ice bags to sore throat for comfort.

Nursing Care Carefully explain the procedure. Perform tests before meals. Withhold medication that may alter respiratory function unless otherwise ordered. After procedure assess pulse and provide for rest period.

CLASSIFICATION OF PULMONARY DISORDERS Restrictive disorders Chronic obstructive pulmonary disease Pulmonary vascular disorders RESTRICTIVE DISORDERS PNEUMONIA Classification

2. Sputum Culture and Sensitivity Test Nursing Care Explain the procedure to the client. If the client is unable to cough, heated aerosol will assist with obtaining a specimen. Collect the specimen in a sterile container that can be capped afterwards. Volume need not exceed 1-3 ml. Deliver specimen to the lab immediately.

A.

Community Acquired Pneumonia

occur either in the community or 48 hours before hospitalization Streptococcus pneumoniae, H. influenza, Mycoplasma pneumoniae

Hospital Acquired Pneumonia also

called nosocomial infection, onset of symptoms more than 48 hours after hospitalization P. aeruginosa, Staphylococcus pneumoniae, Klebsiella pneumoniae, E. coli RESTRICTIVE DISORDERS

3. Thoracentesis Nursing care (pre-test) Informed consent Instruct the client not to cough or talk during the procedure. Position the client appropriately at the side of the bed. Assess vital signs.

Aspiration Pneumonia pulmonary

Nursing care (post-test) Observe for signs and symptoms of pneumothorax, shock, leakage at the puncture site. consequences resulting from the entry of endogenous or exogenous substances into the lower airway. Streptococcus pneumoniae, H. influenza, Staphylococcus pneumoniae, gastric contents

4.

Bronchoscopy Risk Factors

Nursing Care (pre-test) Informed consent Explain the procedure, remove dentures, and provide good oral hygiene Keep the client NPO 6-12 hours pretest.

Conditions that produce mucus or bronchial obstruction Smoking Cancer, COPD

Immunosuppressed patients Prolonged immobility Depressed cough reflex

Nursing Care (post-test) Position the client on the side or in semi-Fowlers position

Alcohol intoxication Respiratory therapy with improperly cleaned instruments Aging Laboratory Diagnostics Complete Blood Count Chest X-Ray Blood culture Sputum examination

Caused by Mycobaterium tuberculosis

Spreads via droplet infection (generally particles 1 to 5 micrometers in diameter)

Risk Factors: close contact with someone with active TB immunocompromised status substance abuse any person without adequate health care pre-existing medical conditions living in overcrowded, substandard housing health care providers Pathophysiology

Arterial Blood Gas (ABG)

Nursing Diagnosis Ineffective airway clearance related to copious tracheobronchial secretions. Impaired gas exchange due to alveolocapillary membrane changes. Risk for fluid volume deficit related to fever and dyspnea. Altered nutrition: less than body requirements related to increased metabolic needs Nursing Interventions Monitor for increased respiratory distress Administer oxygen therapy via nasal cannula Assist patient to cough effectively Suction airway using sterile technique Assist with nebulizer therapy Chest physiotherapy Antibiotics and bronchodilators as ordered Adequate fluid intake

Inhalation of mycobacterium

Multiplication of bacteria in lower airways

Transmission of bacteria to other parts (lymph nodes, kidneys, brain)

Immune system activated

Formation of Primary tubercle

Caseation necrosis cavitation RESTRICTIVE DISORDERS

Clinical Manifestations: 1. 2. Anorexia weight loss fatigue cough low-grade fever night sweats hemoptysis RESTRICTIVE DISORDERS RESTRICTIVE DISORDERS

Assist with ADL 3. If comatose, reposition q 2 hours and do passive ROM q 4 hours Deep breathing exercises q 2 hours Small frequent feedings, high CHO and CHON Monitor for s/s of complications Influenza vaccine for elderly. RESTRICTIVE DISORDERS 4. 5. 6. 7.

B. PULMONARY TUBERCULOSIS

Diagnostics: Chest X-ray

Sputum smear and culture Gastric aspirate Tuberculin skin test

Stages of Tuberculosis

1. During the primary stage, the

bacteria reside in tissue in the lungs and elsewhere in the body. During this stage, most people have no symptoms. The body's natural defenses are activated to produce antibodies to fight the infection. If the body's defenses are successful, the bacteria are walled off within a capsule, and the infection doesn't progress. The person is now in latency stage. However, the bacteria are still alive and can escape and become active later. This can happen if the body's immune system becomes impaired by illness, poor nutrition, certain drugs, or infection with AIDS.

Medical Management: First line drugs INH and rifamipicin for 6months

PZA, ethambutol/streptomycin for 2 months

Second line drugs Kanamycin Amikacin Quinolones

2. The secondary stage (active stage)

Cycloserine Para-aminosalicylic acid RESTRICTIVE DISORDERS begins several months after the primary stage if the body's defenses were not successful. Bacteria begin destroying body tissue, particularly lung tissue. Symptoms include a slight fever, weight loss, fatigue, and night sweats. TB in the lungs causes a chronic cough that is initially dry but eventually produces sputum that contains blood and pus. Symptoms will also appear in other areas of the body where the bacteria have spread. There are three important ways to describe the stages of TB. They are as follows:

Nursing Interventions: Administer medications as ordered. Client should be in a well-ventilated private room, with the door kept closed at all times. All visitors and staff should wear masks when in contact with patient. Patient should cover nose and mouth when coughing, sneezing and laughing. Handwashing is required after direct contact with patient. Offer small, frequent feedings and nutritional supplements. Weigh client at least 2x/week. Discuss client's feelings and assess for boredom, depression, and anxiety and fatigue. Advise client regarding necessity of patient's compliance to medications. Classification of TB Class O no exposure, no infection Class 1 with exposure, no infection Class 2 infection, no disease (+PPD reaction but no clinical evidence of active TB) Class 3 disease, clinically active Class 4 disease, not clinically active Class 5 suspected disease, diagnosis pending

1. Exposure: This occurs when a person has

been in contact, or exposed to, another person who is thought to have or does have TB. The exposed person will have a negative TB skin test, a normal chest x-ray, and no symptoms of the disease.

2. TB infection: This occurs when a person has

the TB bacteria in his/her body, but does not have symptoms of the disease. This person would have a positive skin test, but a normal chest x-ray and no illness.

3. TB disease: This describes the person that has

symptoms of an active infection. The person would have a positive skin test, a positive chest x-ray, and might be ill. The cause of TB is the bacterium Mycobacterium tuberculosis (M. tuberculosis). Most people infected with M. tuberculosis never develop active TB. However, in people with weakened immune systems, including those with HIV (human immunodeficiency virus), TB organisms can overcome the body's defenses, multiply, and cause an active disease. Types of Tuberculosis

 1. Primary tuberculosis
the childhood form of tuberculosis. It often occurs in the lungs, the back of the throat, or the skin. Infants are prone to infection. They also are especially open to quick and bodywide spread of the infection through their bodies. In childhood, the disease is often over quickly. The tuberculin test will show signs of having tuberculosis for the rest of one's life.

Gastrointestinal
Peritonitis with acute abdominal pain, abdominal distention, vomiting, anorexia, weight loss, night sweats; gastrointestinal bleeding, bowel obstruction

Neurologic Meningitis with headache, vomiting, fever, declining consciousness, and neurologic deficit

Musculoskeletal Joint pain, swelling, tenderness, deformities; limitation of motion

Post-Primary Tuberculosis

2. Miliary tuberculosis
a form of tuberculosis with spreading through the bloodstream of the germs (tubercle bacilli). In children it is linked to high fever, night sweats, and, often, swelling of the membranes covering the brain and spinal cord (meningitis). Other symptoms are fluid in the chest cavity and inflammation of the stomach and intestinal lining (peritonitis). A similar illness may occur in adults. Then there are weeks or months of mild symptoms, such as weight loss, weakness, and light fever. Many small objects looking like millet seeds may show up on chest x-ray films. The liver, spleen, bone marrow, and membrane covering of the brain (meninges) are often affected.

Genitourinary Urgency, frequency, dysuria, hematuria, pyuria; infertility, amenorrhea, vaginal bleeding and discharge; salpingitis with lower abdominal pain

Lymphatics Enlarged lymph nodes

Diagnostic Tests

1. Skin tests (purified protein

derivative/Mantoux) - Positive reaction indicates past infection and presence of antibodies; it is not indicative of active disease

2. Mantoux test - injecting a solution containing

a small amount of bacteria just under the skin on the inside of the forearm. skin reaction consists of a rash, blisters, or swelling around the injection site. An early reaction is not significant. Swelling in 48 to 72 hours may indicate a positive reaction, depending on the size of the swelling. Mantoux Test

Miliary tuberculosis Signs/Symptoms

Pulmonary
Weight loss, fatigue, generalized weakness, anorexia; slight fever with chills and night sweats; nonproductive cough that eventually becomes productive with mucopurulent sputum; tachycardia; dyspnea on exertion; hemoptysis Intradermal Read 48-72 hours after injection (+) Mantoux Test is induration of 10mm or more For HIV positive clients, induration of 5mm is considered positive (+) Mantoux Test signifies exposure to Mycobacterium Tubercle Bacilli If a skin test is positive, further procedures are necessary to determine whether the TB is active.

Cardiovascular
Pericarditis with precordial chest pain, fever, ascites, edema, and distention of neck veins

 3. Sputum culture - Positive for causative agent

within 2 to 3 weeks of onset of active disease; it is not positive during latency

S-treptomycin
prescribed for a period of time up to six months or more for the medication to be effective. Patients usually begin to improve within a few weeks of the start of treatment. The patient is not usually contagious once treatment begins, provided that treatment is carried through to the end, as prescribed by a physician.

4. Acid-fast sputum smear - Positive for acidfast bacillus

5. Pleural needle biopsy - Positive for causative

agent

6. Tissue biopsy/culture - Positive for causative

agent

2. Surgery
Drainage of pulmonary abscesses; correction of complications such as intestinal obstruction or urethral strictur

7. Chest x-rays - May reveal cavitation,

calcification, parenchymal infiltrate; not diagnostically definitive PPD Test TB Chest X-ray

3. General
Sputum precautions until negative sputums are evident (10 to 14 days after start of drug therapy); management usually on an outpatient basis unless the disease is in an advanced state with complications; instruction about the importance of uninterrupted drug therapy and the need for periodic recultures of sputum throughout drug therapy, which may last a year or longer; skin testing and examination of close contacts at the time of initial diagnosis and again in 2 to 3 months; long-term medical followup to prevent recurrence

Immediate testing:
If the child is thought to have been exposed in the last five years. If the child has an x-ray that indicates possible TB. If the child has any symptoms of TB. A child that is coming from countries where TB is prevalent. Yearly skin testing: Children with HIV. Children that are in jail.

Potential Complications massive destruction of lung tissue, leading to pneumothorax, pleural effusion, pneumonia, and respiratory failure; brain abscess; cardiac tamponade; vertebral collapse and paralysis; liver failure; renal failure; and generalized, massive dissemination of disease that usually is fatal. New drug-resistant strains of tuberculosis are emerging, leading to more frequent progression to complications. Patient Teaching Avoid alcohol while taking isoniazid and rifampin because this can cause serious liver problems. Take both drugs on an empty stomach with a full glass of water. If stomach upset is a problem, take them with a small amount of food. Avoid taking antacids that contain magnesium or aluminum within 1 hour of taking isoniazid, since this can interfere with drug absorption.

Testing every 2 to 3 years:

Children that are exposed to high-risk people.

Consider testing in children from ages 4 to 6

and 11 to 16 if: A child's parent has come from a high-risk country. A child has traveled to high-risk areas. Children who live in densely populated areas. Treatment

1. Anti- Tubercular Agents

R-ifampin I-soniazid P-yrazinamide E-thambutol

Rifampin can make oral contraceptives less effective, so if you are on the pill, use another method of birth control. Rifampin gives a reddish or brownish color to urine, saliva, sputum, stools, sweat, and tears and will discolor soft contact lenses. Other possible side effects are dizziness, stomach upset, diarrhea, or rash. Report to the doctor blurred vision, eye pain, chills, joint pain and swelling, breathing difficulty, fever, weakness, vomiting, or yellowing of the skin or eyes.

1. Suction nose frequently. 2. 3. 4. 5. Promote pain relief. Promote wound drainage. Administer monitor tube feedings as ordered. Observe stoma/structure lines for signs of infection. Enhance communication. Support client during adaptation to altered physical status. Restrictive Disorder Provide client teaching: Tracheostomy/laryngectomy and stoma care Control of dryness and crusting of the tongue. Need for a humidifier at home. Protect stoma while showering. Use electric razors for the first 6 months after the operation. Cover stoma when coughing or sneezing. Necessity of installing smoke detectors. Restrictive Disorder

6. 7.

8.

Client Education: Preventing the spread of TB

TB is not extremely contagious, but you need to protect close contacts. Bacteria is spread by coughing, so cover your nose and mouth and dispose of soiled tissues properly and wash hands thoroughly. Good room ventilation helps to reduce the amount of bacteria in the air. Sometimes household members are required to take antituberculosis drugs for 6 to 9 months (as a precaution).

D. Lung Cancer May be metastatic or primary #1 cause of mortality Associated with smoking Poor prognosis Adenocarcinoma- most prevalent type Small cell carcinoma- poorest prognosis Signs and Symptoms Asymptomatic Cough Hemoptysis Pain on inspiration Dyspnea Pleural effusion Easy fatigability Clubbing of fingers

Client Education Cover nose and mouth when coughing, sneezing and laughing TB is transmitted by droplet infection Wash hands after any contact with body substances, masks or soiled tissues Wear masks when advised Anti-TB drugs must be taken in combination to avoid bacterial resistance Drugs to be taken on empty stomach for maximum absorption Restrictive Disorder

Medical Management: 1. 2. 3. Radiation Chemotherapy Surgery Restrictive Disorder

Nursing Interventions:

Weight loss Diagnostics Chest X-ray Fiberoptic bronchoscopy

Keep all tubing as straight as possible. Keep all connections tight Observe for air bubbles and fluctuations Monitor V/S and breath sounds regularly Never elevate the drainage system at the level of the patients chest.

CT Scan MRI Thoracentesis Pulmonary function tests Medical Management Surgery Radiation Chemotherapy Nursing Management Pneumonectomy Lobectomy Segmentectomy Wedge resection Decortication

1. Atelectasis- an abnormal condition marked by the collapse of lung tissue. This collapse prevents the exchange of carbon dioxide and oxygen by the blood. Symptoms include lessened breath sounds, fever, and difficulty breathing. The condition may be caused by obstruction of the major airways and bronchioles. It may also be caused by pressure on the lung from fluid or air in the area around the lungs (pleural space), or by pressure from a tumor outside the lung. Loss of lung tissue may cause increased heart rate, higher blood pressure, and faster breathing.

Causes, incidence, and risk factors Anesthesia, prolonged bed rest with few changes
in position, shallow breathing, and underlying lung diseases are risk factors for atelectasis. Secretions that plug the airway, foreign objects (common in children) in the airway, and tumors that obstruct the airway may lead to atelectasis. In an adult, small regions of atelectasis are usually not life-threatening, because unaffected parts of the lung compensate for the loss of function in the affected area. Large-scale atelectasis, especially in someone who has another lung disease or illness may be lifethreatening. In a baby or small child, lung collapse due to a mucus obstruction or other causes can be life-threatening. Massive atelectasis may result in the collapse of a lung.

Administer O2 as ordered
Post-op: flat on bed until BP is stable, after which semi-fowlers position

Position on unoperated side, but for

pneumonectomy on operated side Coughing and deep breathing exercises

Assist patient in abdominal

breathing Mist therapy Nursing Management Suctioning as needed Pain medications as ordered Assist patient in performing arm exercises

Symptoms Breathing difficulty Chest pain Cough Signs and tests Chest x-ray

Check dressings periodically Check for presence of subcutaneous emphysema, report to MD if worsening Nursing Management Care of chest tube

Bronchoscopy
Fluoroscope

X Ray penetrating electromagnetic radiation, having a shorter wavelength than light,

and produced by bombarding a target, usually made of tungsten, with highspeed electrons (Cathode Ray; Electromagnetic Radiation; Electron; Light; Radiation). Despite the fact that the tube was encased in a black cardboard box, Roentgen noticed that a bariumplatinocyanide screen, inadvertently lying nearby, emitted fluorescent light whenever the tube was in operation. After conducting further experiments, he determined that the fluorescence was caused by invisible radiation of a more penetrating nature than ultraviolet rays (Luminescence; Ultraviolet Radiation). He named the invisible radiation X ray because of its unknown nature. Subsequently, X rays were known also as Roentgen rays in his honor. more...

Percussion of the chest to loosen

secretions (clapping) Positioning so that secretions drain by gravity where they can be coughed up (postural drainage)

Treatment of tumor or underlying

condition, if present

Expectations (prognosis) The collapsed lung usually re-inflates

gradually once the obstruction has been removed, although some residual scarring or damage may be present.

Complications Pneumonia may develop rapidly after

atelectasis.

Fluoroscope apparatus for examining internal organs, used especially in diagnosis. The essential parts of the fluoroscope are an X-ray tube and a fluorescent screen. The subject to be diagnosed is placed between the X-ray tube and the fluorescent screen. Wherever the X-ray radiations fall on the screen, it glows vividly; where the X rays are reflected or absorbed, shadows are cast on the screen. Bones cast heavy shadows, and fleshy organs such as the heart cast light shadows. In abdominal analysis barium salts are administered either orally or rectally before examination. Because these salts are opaque to X rays, their passage through the alimentary canal can be traced. Fluoroscopy can reveal cancer of the bones or digestive tract; ulcers of the digestive tract; and osteoporosis, a condition in which the bones are reduced in mass. See also X Ray.

Calling your health care provider

Call your health care provider if you develop symptoms of atelectasis.

Prevention
Keep small objects out of the reach of young children. Maintain deep breathing after anesthesia.

Encourage movement and deep

breathing in anyone who is bedridden for long periods. 2. Pleurisy An inflammation of the visceral and parietal pleurae that envelop the lungs.

Causes and Incidence

Pleurisy arises from a pleural injury, which may be caused by an underlying lung disease (e.g., pneumonia, asbestosis, or infarction); an infectious agent, neoplastic cells, or irritants that invade the pleural space (e.g., amebic empyema, tuberculosis, pleural effusion, systemic lupus erythematosus, pleural carcinomatosis, rheumatoid disease); or pleural trauma (e.g., rib fracture).

Treatment
The goal of treatment is to remove pulmonary (lung) secretions and re-expand the affected lung tissue. The following treatments may be implemented: Aerosolized respiratory treatments Positioning on the unaffected side to allow re-expansion of lung

Removal of the obstruction, if

present, by bronchoscopy or another procedure Deep breathing exercises (incentive spirometry)

Disease Process
The pleura becomes edematous and congested, cellular infiltration ensues, and fibrinous exudate forms on the pleural surface as plasma proteins leak from damaged vessels.

This causes the visceral and parietal pleural surfaces to rub together rather than sliding over each other during respiration. The pleura becomes increasingly inflamed and stretched, causing pain on each breath.

swollen lung surfaces caused by many things, as a blood clot in the lung, an injury, a tumor, or an infection. Diagnostic tests Thoracentesis

Symptoms
The primary symptom is sudden onset of pain in the chest or abdominal wall that may vary from vague to an intense stabbing sensation. The pain is aggravated by breathing and coughing. Respirations are rapid and shallow, with guarding and decreased motion on the affected side.

Thoracocentesis also called thoracentesis.

Surgery to break into the chest wall and lung membrane space with a needle to remove fluid for diagnostic or therapeutic purposes. It may also be done to remove a specimen for biopsy. The procedure is usually done using local anesthesia. The patient is seated leaning forward over a table that is chest high. Puncture of a cavity of the chest wall may be used to treat pleural effusion, as may occur in cancer of the lung (bronchogenic carcinoma). Fluid samples may be examined for erythrocyte, leukocyte, and differential white cell counts, protein, glucose, and amylase concentrations. They may be cultured for studies of microorganisms that may be present.

Potential Complications
Permanent adhesions that restrict lung expansion may develop.

Diagnostic Tests
Auscultation reveals a friction rub, along with the characteristic presentation of pain. A chest x-ray may reveal pleural effusion. Treatment

Treatments

Surgery (None) Drugs

Narcotic analgesic to relieve pain during deep breathing and coughing exercises; analgesics and antipyretics

The cause is treated, and the fluid may be removed by suction or drained. Other treatment may include giving drugs to get rid of fluids and other drugs giving oxygen using mechanical breathing. Chest tube insertion Chest tube Figure 1 Normal anatomy. The pleural space is the space between the inner and outer lining of the lung. It is normally very thin, and lined only

General
Treatment of underlying disease; positioning and splinting of chest; coughing and deep breathing to prevent atelectasis and infection

Painkillers

3. Pleural effusion an abnormal buildup of fluid in the lungs.

Symptoms are fever, chest pain,

breathing difficulty, and a dry cough. The fluid comes from

with a very small amount of fluid. Figure 2

Recovery from the chest tube insertion and removal is usually complete, with only a small scar. The patient will stay in the hospital until the chest tube is removed. While the chest tube is in place, the nursing staff will carefully check for possible air leaks, breathing difficulties, and need for additional oxygen. Frequent deep breathing and coughing is necessary to help re-expand the lung, assist with drainage, and prevent normal fluids from collecting in the lungs.

Indication
If fluid, such as blood, or air, gets into the pleural space, the lung can collapse, preventing adequate air exchange. Chest tubes are used to treat conditions that can cause the lung to collapse, such as: air leaks from the lung into the chest (pneumothorax) bleeding into the chest (hemothorax) after surgery or trauma in the chest (pneumothorax or hemothorax) lung abscesses or pus in the chest (empyema). 4. Pneumothorax

a collection of air or gas in the chest (pleural space) causing the lung to collapse. Cause/Etiology It may be the result of an open chest wound that permits air to enter the break of an air-filled blister (vesicle) on the lung's surface or a severe bout of coughing.

Figure 3 Procedure Chest tubes are inserted to drain blood, fluid, or air and allow full expansion of the lungs. The tube is placed in the pleural space.

The area where the tube will be inserted is numbed (local anesthesia). The patient may also be sedated. The chest tube is inserted between the ribs into the chest and is connected to a bottle or canister that contains sterile water. Suction is attached to the system to encourage drainage. A stitch (suture) and adhesive tape is used to keep the tube in place. The chest tube usually remains in place until the X-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed, usually without the need for medications to sedate or numb the patient. Medications may be used to prevent or treat infection (antibiotics). Signs/Symptoms

may begin with a sudden, sharp chest pain It is followed by difficult, rapid breathing, normal chest movements stopped on the affected side. There may be rapid heart beat a weak pulse low blood pressure Sweating Fever pale skin dizziness.

Nursing/Medical Intervention patient should stay quiet in bed, in a halfway upright position. Oxygen may be given. The air should be taken from the chest space at once.

Figure 4

10

Thoracostomy tube- cut made into the chest wall to provide an opening for draining. To remove the air, a tube is put in, and not removed until the air is no longer coming out through a water-seal draining system.

Cause: Usually results from blunt or penetrating chest trauma. Hemothorax may result from thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm anticoagulant therapy.

Pain may be controlled with painkillers, but drugs that can cause slowed breathing are not used. Mechanical breathing may be given. The patient must learn how to turn, cough, breathe deeply passive exercises without making the condition worse. For example, stretching, reaching, or sudden movements must be not be done

Symptoms:
Percussion reveals dullness, and auscultation reveals decreased to absent breath sounds over the affected side. Chest pain Tachypnea Mild to severe dyspnea (difficulty breathing) may be present If respiratory failure results, the patient may appear anxious, restless, possibly stuporous, and cyanotic. Marked blood loss produces hypotension and shock. The affected side of the chest expands and stiffens, while the unaffected side rises and falls with the patient's gasping respirations

Treatment of Tension Pneumothorax Insertion of

Drainage Tubes 5. Hemothorax -a buildup of blood and fluid in the usually because of injury. - Hemothorax may also be caused by blood vessels that break as a result of swelling from pneumonia, tumors. -Shock from hemorrhage, pain, and failure follows if emergency available.

chest cavity,

Treatment:
Goal: to stabilize the patient's condition, stop the bleeding, evacuate blood from the pleural space, and reexpand the underlying lung. Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding. In severe hemothorax, thoracentesis may be performed, (not only use as a diagnostic tool, but also as a method of removing fluid from the pleural cavity.) Chest tube Suction may be used to prevent clot blockage Thoracotomy may be done to evacuate blood and clots and to control bleeding.

small tuberculosis, or

breathing care is not

In this disorder, blood from damaged intercostal , pleural , mediastinal, and sometimes lung parenchymal vessels enters the pleural cavity. Depending on the amount of bleeding and the underlying cause, hemothorax may be associated with varying degrees of lung collapse and mediastinal shift. Pneumothorax (air in the pleural cavity) commonly accompanies hemothorax.

Autotransfusion of Pleural Blood Under-WaterSeal Drainage Respiratory Infections Acute tracheobronchitis Pneumonia Shock and respiratory failure

Normal Pleural Space

Anterior Relations of the Heart Hemotho

rax

11

6. Acute tracheobronchitis -swelling of the windpipe and bronchi. -It is a common form of breathing infection.

severe cases, a pale or blue skin. The child's condition often gets better in the morning, but it may get worse at night.

croup , acute
laryngotracheobronchitis, exudative angina /krp/, also called acute laryngotracheobronchitis, angina trachealis, exudative angina, laryngostasis.

TREATMENT:
Treatment is bed rest, drinking a lot of fluids, and relieving airway blockage. Antibiotic treatment depending on the symptoms, sputum purulence and sputum culture Expectorants Suctioning and Bronchoscopy Cool vapor therapy or Steam inhalation Mild analgesics or antipyretics Humidity and oxygen are often given. FOR CHILDREN: Drugs are not given. To prevent chilling, many changes of clothing and bed linen are needed because of the humid air. In most children the condition is mild and runs its course in 3 to 7 days. The infection may spread to other areas of the breathing tract, causing problems, as bronchiolitis, pneumonia, and ear infections

Compare acute epiglottitis.croupous, croupy. A virus infection of the upper and lower breathing tract that occurs mostly in infants and young children aged 3 months to 3 years of age. Cause: Croup occurs after another upper breathing tract infection Parainfluenza viruses

respiratory syncytial viruses (RSV) influenza A and B viruses are the usual causes Inhalation of physical and chemical irritants, gases and other air contaminants Signs/Symptoms: hoarseness fever and chills Night sweats, headache, general malaise a distinct "barking" cough many degrees of breathing distress from blockage of the windpipe. Irritability Pale or blue skin caused by many Sputum culture

7. Pneumonia -is an infection of the lungs that can be different organisms. -The symptoms can vary depending on the cause.

DIAGNOSIS:
Infection is carried by airborne particles or by contact with infected fluids. The acute stage starts rapidly, most often occurs at night, and may be triggered by exposure to cold air. The child becomes irritable, gets a barking cough, and, in

considerably,

Facts about pneumonia:

Pneumonia can occur year round, but is usually seen in the winter and spring. Boys are affected by pneumonia more often than girls.

12

There is an increased chance of developing pneumonia in a crowded area. Ten to 15 percent of children with a respiratory infection have pneumonia. Types of Pneumonia A. Viral pneumonia Upper respiratory viral infections and influenza sometimes spread to the lungs. In addition to influenza-type symptoms (fever, headache, general aching, and loss of appetite), viral pneumonia is marked by an irritating cough that may produce sputum, shortness of breath, and chest pain. The so-called "walking pneumonia" can cause very mild symptoms. Viral pneumonia is usually treated at home with bed rest, plenty of liquids, and cough medicine that contains an expectorant to clear the lungs of mucus. A humidifier to add moisture to the air also helps loosen the mucus. Antibiotics or other drugs are not effective in treating viral pneumonia. Most otherwise healthy people recover within a week or so. However, viral pneumonia can lead to bacterial infection in certain people. For this reason, doctors may prescribe antibiotics for people with chronic lung diseases or other chronic illnesses to prevent this complication.

Bacterial pneumonia is usually caused

by either Streptococcus, Staphylococcus, or Haemophilus. The infection can start from an upper respiratory infection such as "strep" throat, from inhaling fluid or other foreign substance into the lungs, or from viral pneumonia. The symptoms include fever, shortness of breath, chest pain, coughing, and sputum that is yellowish or greenish and often has a foul odor. It is a serious infection that often requires hospitalization. Treatment consists of antibiotics, bed rest, fluids, humidified air, and an expectorant cough medication. Oxygen and chest physiotherapy may be necessary for hospitalized patients. Legionnaires' disease is a serious type of bacterial pneumonia that occurs in older people and people who smoke or who have chronic diseases such as emphysema, chronic bronchitis, diabetes, renal disease, and cancer. It is treated with erythromycin.

bacterial pneumonia - caused by various

bacteria. The streptococcus pneumoniae is the most common bacterium that causes bacterial pneumonia. Many other bacteria may cause bacterial pneumonia including: Group B streptococcus (most common in newborns) Staphylococcus aureus Group A streptococcus (most common in children over age 5)

viral pneumonia - caused by various viruses,

including the following: respiratory syncytial virus, or RSV (most commonly seen in children under age 5) parainfluenza virus influenza virus adenovirus

Bacterial pneumonia may have a quick onset and the following symptoms may occur: productive cough pain in the chest vomiting or diarrhea decrease in appetite fatigue

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. However, with viral pneumonia, the respiratory involvement happens slowly. Wheezing may occur and the cough may worsen. Viral pneumonias may make a child susceptible to bacterial pneumonia. B. Bacterial pneumonia

c. Other types of pneumonia

Mycoplasma pneumonia is caused by

one of the Mycoplasma bacteria.

13

It most often infects children and young adults, and it is a common cause of "walking pneumonia."

chest or stomach pain decrease in appetite chills breathing fast or hard vomiting headache not feeling well fussiness The symptoms of pneumonia may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Mycoplasma pneumonia is treated with

the antibiotic erythromycin or doxycycline.

mycoplasma pneumonia - presents somewhat

different symptoms and physical signs than other types of pneumonia. It is caused by mycoplasmas, the smallest free-living agents of human disease, which have the characteristics of both bacteria or viruses, but which are not classified as either. They generally cause a mild, widespread pneumonia that affects all age groups. Symptoms usually do not start with a cold, and may include the following: fever and cough are the first to develop cough that is persistent and may last three to four weeks a severe cough that may produce some mucus

How is pneumonia diagnosed?

Diagnosis is usually made based on the season and the extent of the illness. Based on these factors, your physician may diagnose simply on a thorough history and physical examination, but may include the following tests to confirm the diagnosis:

Other less common pneumonias may be caused by the inhaling of food, liquid, gases or dust, or by fungi.

chest x ray - a diagnostic test which

uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Pneumocystis pneumonia is caused by the

protozoa Pneumocystis carinii. This serious infection occurs in patients with AIDS and those whose immune systems are deficient.

blood tests - blood count for evidence

of infection; arterial blood gas to analyze the amount of carbon dioxide and oxygen in the blood.

A chronic fungus infection of the lungs can lead

to pneumonia. Histoplasma, Blastomyces, Cryptococcus, Aspergillus, and Candida are fungi that can establish themselves in the lungs. This type of pneumonia is rare and occurs mainly in patients whose immune systems are deficient.

sputum culture - a diagnostic test

performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.

Lobar pneumonia - affects one or more sections

(lobes) of the lungs.

pulse oximetry - an oximeter is a small

machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot. Specific treatment for pneumonia will be determined by your child's physician based on: your child's age, overall health, and medical history extent of the condition cause of the condition

Bronchial pneumonia (or bronchopneumonia)

- affects patches throughout both lungs. Photomicrograph of Pneumonia Bronchopneumonia Lobar Pneumonia

What are the symptoms of pneumonia?

In addition to the symptoms listed above, all pneumonias share the following symptoms. However, each child may experience symptoms differently. Symptoms may include: fever

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your child's tolerance for specific medications, procedures, or therapies expectations for the course of the condition your opinion or preference Treatment may include antibiotics for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma pneumonia and some special cases. There is no clearly effective treatment for viral pneumonia, which usually resolves on its own. Other treatment may include:

Complication of bacterial pneumonia or caused by aspiration or oral anaerobes Localized necrotic lesion of the lung parenchyma containing purulent material that collapses and forms a cavity Lung Abscess Patients who are at risks Causes of lung abscess Site of abscess Signs and Symptoms Assessment and Diagnostic Findings Prevention Medical Management and Nursing Management Pharmacologic Therapy 12. Empyema a collection of pus in a body cavity, especially the space between the lung and the membrane that surrounds it (pleural space). It is caused by an infection, as pleurisy or tuberculosis. It is a life-threatening condition requiring surgical drainage and prolonged antibiotic treatment. Empyema- Description It is a collection of pus within the pleural cavity The fluid is thin, opaque and foul smelling The most common cause is pulmonary infection and lung abscess caused by thoracic surgery or chest trauma, in which bacteria are introduced directly into the pleural space Treatment focuses on emptying the empyema cavity, re expanding the lung and controlling the infection Empyema - Assessment Recent febrile illness or trauma Chest pain, cough, dyspnea Anorexia and weight loss Malaise Elevated temperature and chills Night sweats Diminished chest wall movement on the affected side

appropriate diet increased fluid intake cool mist humidifier in the child's room acetaminophen (for fever and discomfort) medication for cough

Some children may be treated in the hospital if they are having severe breathing problems. While in the hospital, treatment may include: intravenous (IV) or oral antibiotics

intravenous (IV) fluids, if your child is unable to drink well oxygen therapy frequent suctioning of your child's nose and mouth (to help get rid of thick secretions) breathing treatments, as ordered by your child's physician -

bronchodilator
a drug that relaxes contractions of the bronchioles to improve breathing. Bronchodilators are given for asthma, bronchiectasis, bronchitis, and emphysema. Commonly used bronchodilators include steroids, ephedrine, isoproterenol hydrochloride, theophylline, and many related combinations of these drugs. The steroids beclomethasone dipropionate and triamcinolone can be used in aerosol form.

11. Lung Abscess

15

Pleural exudate on chest x-ray film Empyema Nursing Interventions

veins of the neck, arms, and legs are usually swollen. Severe pulmonary edema is an emergency. Treatment place person in bed in a sitting position give narcotic painkillers to relieve pain, slow breathing, anxiety heart tonic, drug that acts quickly to increase the passing of urine (diuretic), drug to enlarge the breathing tubes may be given. Mechanical breathing help may be ordered by the doctor. Tourniquets placed on one arm or leg at a time and then moved to a different arm or leg after a short time, to pool blood in the arms and legs, reducing the load on the heart. The patient should exercise moderately, rest often, report any symptoms, avoid smoking, and follow the prescribed routines for drugs, diet, and return checkups. 14. Acute Respiratory Failure the inability of the heart and lung systems to keep enough of a transfer of oxygen and carbon dioxide in the lungs.

Monitor breath sounds Position client on a semi fowlers or high fowlers position Encourage coughing and deep breathing Administer antibiotics as prescribed Instruct the client to splint the chest as necessary Assist with chest tube insertion to promote drainage and lung expansion If marked pleural thickening occurs, prepare the client for decortication; if prescribed; this is a surgical procedure that involves removal of the restrictive mass or fibrin and inflammatory cells DECORTICATION Carried out when thickening of the visceral pleura prevents re expansion of the lung as may occur in chronic empyema. Visceral pleura is peeled off the lung, which is then re expanded by positive pressure thru an anesthetic apparatus Surgical removal of cortex or outer covering of an organ such as the lungs 13. Pulmonary Edema fluid in lung tissues Most often occurs as result of abnormal cardiac function Crackles Orthopnea Treat underlying disease Cause

Decreased respiratory drive Dysfunction of the chest wall Dysfunction of lung parenchyma Inadequate ventilation Treat underlying cause Cause lack of oxygen (hypoxemic failure) or a transfer of gases problem (ventilatory failure). A sign of hypoxemic failure is excess breathing (hyperventilation). This occurs in diseases that affect the air sacs (alveoli) or supporting tissues of the lobes of the lungs, as alveolar edema, emphysema, fungus infections, leukemia, pneumonia, lung cancer, or tuberculosis. Ventilatory failure occurs in conditions in which fluids remaining in the lungs cause more airway resistance and lowered lung use, as in bronchitis and emphysema.

congestive heart failure but also occurs as a side effect of drugs, infections, inflammation of the pancreas, or kidney failure. Pulmonary edema also may follow a stroke, skull fracture, near drowning, the breathing in of poisonous gases, the rapid transfusion of whole blood or fluids into the veins. Signs/Symptoms breathes quickly, shallowly, and with difficulty. restless and hoarse and have pale or bluish skin. cough up frothy, pink sputum.

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lowered if the breathing center is slowed by barbiturates or opiates Other factors slowing breathing are oxygen problems, brain diseases, injury, or tumors of the nerve and muscle system or the chest long-term caused by added stress, as heart failure, surgery, anesthesia, or upper breathing tract infections. Treatment clearing the airways by suction giving lung drugs (bronchodilators) making an airway (tracheostomy)

Confusion skin getting red, and changes in actions may be caused by too much carbon dioxide Oxygen levels that are too high can cause the heart to race and the blood pressure to rise Breathing failure brings falling blood pressure and a blue tinge to the skin cyanosis DIAGNOSIS Blood Tests show low amounts of oxygen and more carbon dioxide in the blood The changes that occur within the lungs may include damage to the very small blood vessels, bleeding, and swelling TREATMENT mechanical assistance with breathing Oxygen Mist respiratory therapy PATIENT CARE constant and careful care Confusion The patient is weighed often x-ray films of the chest are taken and secretions are checked. 16. Pulmonary Hypertension a condition of abnormally high pressure within the arteries and veins of the lungs. Systolic pulmonary artery pressure > 30 mm Hg. or mean pulmonary artery pressure >25 mm Hg. Primary is idiopathic Secondary results from existing cardiac or pulmonary disease Manage underlying disease 17. Pulmonary Heart Disease (Cor Pulmonale) swelling of the right lower chamber (ventricle) of the heart. This results from high blood pressure (hypertension) of the lung circulation Right ventricle enlarges with or without rightsided heart failure

antibiotics for infections drugs that stop blood clotting to avoid clots in the lungs electrolyte replacements for fluid imbalance. Oxygen may be given in some cases 15. Acute/Adult Respiratory Distress Syndrome An emergency Sudden and progressive pulmonary edema, increasing bilateral infiltrates, hypoxemia refractory to oxygen supplementation and reduced lung compliance Result of inflammatory trigger Treat underlying condition Ventilator considerations Cause failure of the lungs to work. This may follow heart and lung bypass surgery severe infection blood transfusions too much oxygen trauma, pneumonia, or other lung infections. It may also occur in Guillain-Barre syndrome, muscular dystrophy, myasthenia gravis, emphysema, asthma, or polio. Signs/Symptoms shortness of breath quick breathing

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 Caused by severe COPD

Improve ventilation with supplemental oxygen, chest physical therapy, and bronchial hygiene Signs/Symptoms constant cough difficulty breathing fatigue, and weakness As the disease grows worse, breathing difficulty may become more severe water retention swollen neck veins rapid heart beat A weak pulse and low blood pressure may result from decreased heart function. awake or drowsy TREATMENT increase oxygen increase exercise tolerance correct the defect if possible bed rest digitalis Oxygen drugs to fight lung infection low-salt diet a small amount of fluids Diuretics anticlotting drugs. PATIENT CARE careful diet of many small meals The amount of fluids drunk daily must be limited Digitalis poisoning is often a danger The patient must be alert to the symptoms. These include appetite loss, nausea, vomiting, and seeing yellow halos around images. The cor pulmonale patient must avoid mixing with crowds and taking drugs that can harm breathing, as sedatives Chronic Cor

18. Pulmonary Embolism Obstruction of pulmonary artery or one of its branches by a thrombus or embolus Dyspnea,tachypnea, and chest pain occur suddenly Prevention of deep vein thrombosis Emergency management Anticoagulation therapy Thrombolytic therapy

Description

Occurs when a thrombus that forms in the deep

vein detaches and travels to the right side of the heart and then lodges in a branch of the pulmonary artery Clients prone to pulmonary embolism are those at risk for deep vein thrombosis, including those with prolonged immobilization,surgery, obesity, pregnancy, congestive heart failure, advanced age, or history of thromboembolism Fat emboli can occur as a complication following a fracture of a flat long bone Treatment is aimed at preventing venous status and includes ROM exercises and early ambulation following surgery, the use of antiembolism stockings and preventing pressure under the popliteal space Causes and Incidence thrombus, which typically forms in the leg or pelvic vein but may be seen in other locations Fat, amniotic fluid Air, gas, thrombophlebitis major surgery pregnancy and childbirth fractures myocardial infarction congestive heart failure venous insufficiency polycythemia vera prolonged immobility chronic illness. It is estimated that up to 5% of hospital deaths are attributable to pulmonary emboli.

Cor Pulmonale
Pulmonale

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Pathophysiology Emboli travel through bloodstream, lodge in pulmonary arteries affected artery becomes underperfused but is still ventilated. results in physiologic dead space or wasted ventilation and contributes to hyperventilation Histamine release from embolus produces reflex bronchoconstriction, leading to further hyperventilation Depletion of alveolar surfactant results in diminished lung volume and compliance. If the clot is large enough and interferes greatly with pulmonary perfusion, it may result in pulmonary hypertension. Symptoms nonspecific and vary in degree and intensity, depending on the size of the embolus the extent of occlusion, the amount of collateral circulation, and preexisting cardiopulmonary function Small emboli may be asymptomatic. The chief manifestation is breathlessness anxiety, restlessness, tachypnea, sweating, cough, hemoptysis, chest pain, fever, and rales. Cyanosis may be present with a massive embolus. Assessment Findings: Blood tinged sputum Chest pain, cough, cyanosis Distended neck veins Dyspnea accompanied by anginal and pleuritic pain, exacerbation by inspiration Hypotension Wheezes on auscultation

4. Blood gases - Arterial hypoxemia (decreased

PaO2 and PaCO2)

5. Electrocardiography - To rule out myocardial

infarction; PE is characterized by tall, peaked P waves, depressed ST segments, T-wave inversions, and supraventricular tachyarrhythmias

6. Chest x-ray - Unilateral elevation of the

diaphragm, enlarged pulmonary artery, and pleural effusion 2 hours or longer after the event

Treatments
Surgery Embolectomy for large emboli unresponsive to treatment; umbrella filter in inferior vena cava to trap multiple emboli before they reach the lung; interruption of blood flow through the inferior vena cava by ligation for multiple emboli

Drugs
Anticoagulants to halt clot propagation (heparin is used in the acute phase and is replaced by coumadin, which may be administered for 6 months to life; medications should overlap for 5 to 7 days to achieve effective blood levels of coumadin); fibrinolytic enzymes may be used in place of anticoagulants for clot lysis, particularly of large clots; analgesics for pain; vasopressors, dopamine to treat hypotension

General
Oxygen therapy bed rest in acute phase, followed by progressive mobilization hemodynamic and cardiac monitoring; facilitation of breathing intake and output measurements to monitor renal function observation for bleeding as a side effect of anticoagulants safety measures to prevent bleeding information about long-term anticoagulant therapy antiembolism hose and instruction in preventing pooled blood in the lower extremities

Shallow respirations, tachypnea and tachycardia Diagnostic Tests

1. Pulmonary angiogram - Visualization of

intraarterial filling defects

2. Lung perfusion scan - To detect perfusion

defects

3. Ventilation scan - To detect altered ventilation

patterns

Potential Complications

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Cardiac arrhythmias, cor pulmonale, atelectasis, shock, hepatic congestion, and necrosis are complications Pulmonary infarction is an uncommon complication of PE that results in hemorrhagic consolidation and tissue necrosis distal to the occlusion Death following a PE usually occurs within 1 to 2 hours of the initial event Those with underlying cardiovascular or pulmonary disease and those with a large embolus are at greater risk of dying Untreated individuals risk recurrent emboli and about a 50% chance of death. Nursing Interventions: Administer O2 as prescribed Position client in high fowlers position Monitor lung sounds and maintain bed rest with active/ passive ROM Encourage use of incentive spirometry

It may appear in organs of the body, such as the lungs, spleen, liver, skin, mucous membranes, and tear and salivary glands, usually along with the lymph glands The sores usually go away after a period of some months or years, but lead to widespread grainy swelling and fibrosis. Signs and Symptoms: Sarcoidosis Night sweats, fever Weight loss, cough Skin nodules, polyarthritis KVEIM TEST- sarcoid node antigen is injected intradermally and causes a local nodular lesion in about one month Nursing Interventions: Administer corticosteroids to control symptoms Monitor temperature Increase fluid intake Provide frequent periods of rest Encourage small, nutritious meals Sarcoidosis Eruption affecting the nose Sarcoidosis affecting the spleen 20. Occupational Lung Diseases: Pneumoconioses any of a group of unusual problems in the lungs caused by breathing dusts, fumes, gases, or vapors in a place where a patient works A. Silicosis B. Asbestosis C. Coal Workers Pneumoconiosis

Monitor pulse oximetry Prepare for intubation or mechanical ventilation for severe hypoxemia Administer anticoagulation therapy intravenously with Heparin sodium (bolus), followed by continuous infusion during the acute phase Administer Warfarin (Coumadin) orally, as prescribed, when infusion is discontinued Monitor prothrombin time and ptt Prepare the client for embolectomy, vein ligation or insertion of an umbrella filter as prescribed Pulmonary Embolism

19. Sarcoidosis

A. Silicosis

Boeck's sarcoid, also called sarcoid of Boeck

Multisystem granulomatous disease of unknown etiology Involves lungs, lymph nodes, liver, spleen, CNS, skin, eyes, fingers, and parotid glands Hypersensitivity response Corticosteroid therapy or other cytotoxic and immunosuppressive agents may be used CAUSE A long-term disease of unknown origin marked by small, round bumps in tissue

grinder's disease, quartz silicosis also called

grinder's disease, quartz silicosis

inhaling silicon dioxide continuously over a long

period of time.

Silicon dioxide is found in sands, quartzes,

flints, and many other stones. Silicosis is marked by the development of small fiberlike growths in the lungs.

In advanced cases, severe shortness of breath

may develop.

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 incidence of silicosis is highest among

industrial workers exposed to silica powder in manufacturing processes, in those who work with ceramics, sand, or stone, and in those who mine silica Assessment: Silicosis Uncomplicated or simple: asymptomatic with evidence of fibrosis on chest x-ray film Chronic complicated: malaise, anorexia, weight loss, severe dyspnea on exertion, evidence of massive fibrosis on chest x-ray film Nursing Interventions: Silicosis Administer antitussive for cough Adminster medication for tuberculosis as prescribed (Tuberculosis is a complication) Eliminate toxic substances Administer Oxygen as prescribed Encourage cough and deep breathing Silicosis B. Asbestosis A diffuse, interstitial pulmonary fibrosis resulting from inhalation of asbestos Causes and Incidence

Symptoms exertional dyspnea decreased exercise toleranc as the disease progresses, dyspnea is chronic even at rest and a dry cough may develop.

Diagnostic Tests 1. Clinical examination - History of long-term

exposure to asbestos

2. Radiology - Interstitial markings in lower

lung, thickening, plaques, calcification

3. Pulmonary function - Early: normal; later:

reduced lung capacity and compliance

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

decreased PO2, increased PCO2

Treatments
Surgery - None Drugs - None General Eliminate exposure chest physiotherapy increased fluids steam inhalation to loosen secretions oxygen therapy

prolonged exposure to airborne asbestos

particles Susceptibility increases with increasing length and intensity of exposure. The incidence is greatly increased by chronic occupational exposure Families of workers also at risk from fibers carried home on clothing. The general public is at risk from long-term exposure to asbestos dust in old buildings in which asbestos was used as insulation, or from asbestos in shingling or building material. Pathophysiology Asbestos particles are deposited on bronchiole or alveolar walls and are ingested by cells leading to an edematous process in the wall that results in nonnodular alveolar and interstitial fibrosis reduced lung volume and compliance and impaired gas transfer. Asbestosis-lung biopsy specimen

Potential Complications Asbestos is a cocarcinogen with tobacco asbestos workers who smoke are 90 times more likely to develop lung cancer than smokers who are not exposed to asbestos. C. Coal Workers Pneumoconiosis

anthracosis, black lung, coal worker's

pneumoconiosis, miner's pneumoconiosis, also called black lung, coalworker's pneumoconiosis, miner's pneumoconiosis

A long-term lung disease of coal miners

caused by coal dust in the lungs It forms black bumps on the bronchioles that result in emphysema. The condition is made worse by cigarette smoking. There is no real treatment. The progress of the disease may be halted by staying away from coal dust Anthracosis

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21. Chest Trauma A. Blunt trauma B. Flail chest C. Penetrating trauma D. Pneumothorax A. Blunt trauma having a dull edge or point; not sharp

The skin may be pale, gray, or blue.

2. Subcutaneous Emphysema- Air entering the

tissue planes and passing under skin

Also called aerodermectasia Cause - The air or gas may come from the
bursting of an airway or small pocket in the lung and move through the chest between the lungs (mediastinum) up into the neck

Signs/Symptoms - face, neck, and chest appear

B. Flail chest a chest in which many broken ribs cause the chest wall to be unstable The lung under the injured area contracts on breathing in and bulges on breathing out The condition, if uncorrected, leads to air hunger Flail chest is marked by sharp pain; uneven chest expansion; shallow, rapid breathing; and reduced breath sounds Problems are collapsed lung, shock, and the stopping of breathing The treatment is to stabilize the inside of the chest wall with a mechanical lung Chest tubes may be needed to remove air or fluid stopping the affected lung from expanding, and a tube may be used to provide food and fluids through the nose Traction may be applied by attaching a steel wire to the ribs or breastbone and connecting the wire to a rope, pulley, and weight. C. Penetrating trauma Entering, piercing, boring, going through, puncturing sticking into, permeating, infiltrating, forcing passing through, punching into, edged, pointed 22. Cardiac Tamponade and Subcutaneous Emphysema swollen. Skin tissues can be painful and may produce a "crackling" sound as air moves under them. (dyspnea) (cyanosis) if the air leak is severe.

Treatment - may require a cut to release the

trapped air. 23. Smoker's Lung Tissue

lungs made up of approximately 350 million tiny

sacs called alveoli, where carbon dioxide from the body is exchanged for oxygen from the air Various diseases that affect the lungs either destroy the alveoli directly, as does emphysema, or impair the alveolis ability to exchange gases.

caused - smoking on lung Symptoms - difficulty in breathing, chest pain,

coughing, and wheezing. Lung cancer, most commonly caused by smoking tobacco, is the deadliest lung disease, and each year it kills more Americans than any other kind of cancer. 24. Severe Acute Respiratory Syndrome (SARS) is a rapidly spreading, potentially fatal infectious viral disease. Cause - A virus known as SARS-associated coronavirus (SARS-CoV) causes the illness. When viewed under a microscope, coronaviruses are a group of viruses that look like they have crowns or halos. Coronaviruses commonly cause mild to moderate upper-respiratory illness in humans, but can cause respiratory, gastrointestinal, liver, and neurologic diseases in animals. Symptoms SARS can be difficult to recognize because it mimics other respiratory diseases, such as influenza. It generally begins with a fever higher than 100.4 F (38 C) and one or more of the following symptoms: headache

1. Cardiac Tamponade - Compression of heart

as result of fluid within the pericardial sac

Cause - when a blood vessel in the heart breaks

or by a wound to the heart

Signs/Symptoms - neck veins that stand out, low

blood pressure, decreased heart sounds, fast breathing, and weak or absent pulses The patient can be anxious and restless, tending to sit upright or lean forward.

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overall feeling of discomfort body aches and chills sore throat cough

Currently, there is no vaccine available to prevent SARS. The CDC recommends taking the following steps toward prevention of SARS: Wash your hands regularly with warm water and soap. Avoid touching your eyes, nose, and mouth. Use a disposable tissue instead of your hands to cover your mouth when you cough, and throw it away immediately after use. Follow public health recommendations if you are in the area of an epidemic. Carbon Monoxide Poisoning Description: carbon monoxide is a colorless, odorless and tasteless gas that has an affinity for hemoglobin 200 times greater than that of oxygen Oxygen molecules are displaced, and carbon monoxide reversibly binds to hemoglobin to form carboxyhemoglobin; tissue hypoxia occurs Carbon Monoxide Poisoning: Assessment 1% - 10% 11% - 20% 21% - 30% detrexity 31% - 40% syncope 41% - 50% Impaired visual acuity Flushing headache Nausea and impaired

difficulty breathing shortness of breath hypoxia (insufficient oxygen in the blood) diarrhea (for 10 percent to 20 percent of patients) Transmission/Spread SARS-CoV spreads from one person to another mainly through close contact with a SARS patient When a person with SARS coughs or sneezes without covering his or her mouth, respiratory droplets containing living virus can spray up to 3 feet and invade the mucous membranes of another person. Individuals in close contact with someone with SARS are most at risk, which means they live or work with someone with SARS or have direct contact with the person through kissing, hugging, or sharing eating utensils. The virus also can spread when an individual touches an object with infectious droplets on it and then touches his or her mouth, nose, or eyes. It is not known whether SARS can spread more broadly through the air. Symptoms fever or cough They are most infectious during their second week of illness As a precaution, the CDC recommends that SARS patients stay in isolation at home or in the hospital to keep others from getting sick They should stay home from work or school for 10 days after their symptoms have gone away. Treatment Research is currently underway to develop an effective antiviral drug for SARS-CoV. Until then, SARS patients may receive the same treatment that any patient with severe atypical pneumonia might receive. This treatment is mainly supportive therapy, with oxygen and fluids to help ease symptoms, and antibiotics to help prevent or treat secondary infections. Preventing SARS

Vomiting, Dizziness and

Tachypnea and tachycardia

Greater than 50% COMA Nursing Interventions: Remove victim from exposure Administer oxygen Assess need for basic life support Monitor vital signs Monitor carbon monoxide levels

Review:

1.Atelectasis - Closure or collapse of alveoli 2. Pleurisy 3. Pleural effusion 4. Pneumothorax 5. Hemothorax 6. Acute tracheobronchitis 7. Pneumonia

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8. Asthma 9. Respiratory Failure 10. ARDS 11. Pulmonary Tuberculosis 12. Lung Abcess 13. Empyema 14. Pulmonary Edema 16. Pulmonary Hypertension 17. Pulmonary Heart Disease (Cor Pulmonale 18. Pulmonary Embolism 19. Sarcoidosis 20. Occupational Lung Diseases: Pneumoconioses 21. Chest Trauma

Diaphoresis Hypotension Tachycardia Mediastinal shift Unequal chest movement Absence of breath sounds on affected side Diminished heart sounds Restrictive Disorder

Clinical Manifestations: 1. Supraglottic Localized throat pain Burning when drinking hot liquids or orange juice Lump in the neck Dysphagia Dyspnea Glottic Hoarseness dyspnea Medical Management Occlusion of open wound Chest tube insertion Pleurodesis Nursing Management Monitor V/S frequently. Report to MD if dyspnea worsens Semi-Fowlers position Occlude wound with non-porous covering Care of chest tubes Chronic Obstructive Pulmonary Disease Includes diseases that cause airflow obstruction Chronic Bronchitis Emphysema Risk Factors include environmental exposures and host factors Primary symptoms are cough, sputum production and dyspnea

22. Cardiac Tamponade and Subcutaneous Emphysema 23. SARS Restrictive Disorder 2. E. Pneumothorax - A condition where there is air in the pleural space between the lung and the chest wall. TYPES: 1. Closed pneumothorax Injury to the lungs from mechanical ventilation Perforation of the esophagus Injury to the lungs from the broken ribs Ruptured blebs or bullae in patients with COPD

2. Open pneumothorax Gunshot wounds Stab wounds Surgical thoracotomies

3. Tension pneumothorax True medical emergency

Clinical Manifestations Sharp pain on inspiration Increasing dyspnea

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1. Asthma 2. Chronic Bronchitis 3. Bronchiectasis 4. Emphysema

Drugs that open the airways (bronchodilators) are given to prevent the condition from getting worse. Heart failure is managed by restricting salt in the diet, diuretics, and sometimes digitalis. Patients with chronic bronchitis should be vaccinated against influenza and lung infections. Low-flow oxygen is often used in the home. Exercise, especially walking, and therapy are often given. Medical Management Risk reduction- smoking cessation Bronchodilators Corticosteroids Influenza and pneumococcal vaccination Oxygen therapy Surgical Management Bullectomy Lung Volume Reduction Surgery Lung Transplantation Nursing Management Patient education Breathing exercises Inspiratory muscle training Activity pacing Self-care activities Physical conditioning Oxygen and nutritional therapy Coping measures Bronchiectasis Chronic, irreversible dilation of bronchi and bronchioles Chronic cough and purulent sputum production Postural drainage promotes clearing of secretions Antibiotics may be prescribed Asthma Chronic inflammatory disease of airways causing airway hyperresponsiveness, mucosal edema, and mucus production

1. Asthma Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a child is exposed to certain triggers: The lining of the airways become swollen and inflamed. The muscles that surround the airways tighten. The production of mucus in increased, leading to mucus plugs. 2. Chronic Bronchitis a very common respiratory disease that causes severe weakness. The glands of the windpipe (trachea) and the large airways of the lungs (bronchi) produce too much mucus. This results in a cough that produces mucus (expectoration). The condition has a strong link to smoking and air pollutants. The disease was formerly seen almost only in men. It is becoming more common in women who smoke. A deep cough, often with wheezing, is always found. This is followed by breathing difficulty with exercise. The disease is noted for frequent pus-forming infections of the lungs. Difficult breathing results from narrow airways and often brings lung failure. Heart failure is a common result. Some patients develop too many red blood cells caused by lack of oxygen. Sharp attacks of breathing distress with rapid, labored breathing, long exhaling, intense cough, and bluish skin can result. Patients who suffer from these symptoms are called "blue bloaters." It is usual to give antibiotics during the acute attack of symptoms.

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Reversible, either spontaneously or with treatment Allergy is strongest predisposing factor

Mucolytic expectorants Oxygen therapy Digitalis Diuretics Nursing Management Teach patient on how to do diaphragmatic breathing Coughing exercises Chest physiotherapy Nebulize patient Adequate hydration Smoking cessation and avoidance of irritant factors Avoid contact with sick people Low flow oxygen therapy Relaxation training Bronchial Asthma Characterized by airway obstruction, inflammation and increased responsiveness to a variety of stimuli Status asthmaticus is a severe life-threatening complication that is refractory to treatment.

Asthma (contd)

Long-Acting Control Medications:

corticosteroids and long-acting beta2-adrenergic agonists, methylzanthines, and leukotriene modifiers Quick-Relief Medications: short-acting betaadrenergic agonists Cystic Fibrosis Autosomal recessive disease Airflow obstruction is key feature Medical Management: antibiotics, bronchodilators, inhaled mucolytic agents Nursing Management: chest physiotherapy, fluid and dietary intake, reduce risk for infection Chronic Obstructive Pulmonary Disease Emphysema Chronic Bronchitis Bronchial Asthma

DIAGNOSTICS: Chest X-ray Pulmonary function tests Sputum specimen ABG ECG Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Medical Management Antibiotics Influenza vaccination Bronchodilator therapy B adrenergic agonists Anticholinergic agents (Ipratropium bromide) Theophylline Corticosteroids

TRIGGER FACTORS Allergens Respiratory infections Exercise Drugs and food additives Emotional stress Clinical Manifestations Wheezing Cough Dyspnea Chest tightness Severely diminished breath sounds Pulsus paradoxus Use of accessory muscles Tachycardia

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Ventricular dysrythmias Classification of Asthma Diagnostics Pulmonary function test ABG Sputum specimen

Tracheitis Epiglottitis, epiglottiditis Dust mites Child with sinusitis Allergic Rhinitis as seen in Fiberoptic Rhinoscope Herpes Simplex blisters around mouth regionOne strain of the herpes simplex virus causes cold sores (also known as fever blisters) in and around the mouth, lips, pharynx, nose, face, and ears. The causative agent remains in the cell bodies of facial nerves, causing repeated attacks of the blisters. No established therapy, beyond topical lotions for pain relief, has been developed. Chronic Pharyngitis-The pharynx is subject to infections that enter through both the mouth and the nose. The symptoms of a sore throat generally involve inflammation or infection of the pharynx called pharyngitis. Causes of pharyngitis include viral infections such as the common cold, influenza, German measles (rubella), herpes, and infectious mononucleosis. In addition, diphtherial, chlamydial, streptococcal, and staphylococcal bacteria may rapidly multiply in the pharynx and cause soreness in the throat. /, a swelling or infection of the throat (pharynx), usually causing symptoms of a sore throat. Treatment depends on the cause, as in finding out whether the cause of the infection is a virus or a bacterium. Symptoms may be relieved by painkillers, drinking warm or cold liquids, or salt-water gargles

Medical Management B-adrenergic drugs metaproterenol, albuterol, isoproterenol, epinephrine

Corticosteroids hydrocortisone, beclamethasone,

prednisone, methylprednisolone, triamcinolone Mast cell stabilizer cromolyn sodium, nedocromil

Anticholinergics ipratropium bromide, atropine

Nursing Management Administer medications and monitor closely High fowlers position; slow rhythmic breathing Adequate fluid intake Provide extra humidity

If with respiratory acidosis- O2 as prescribed

Calm, quiet environment Instruct patient to recognize trigger factors

Tonsillitis- , an infection or inflammation of a

tonsil. Sudden tonsillitis is often caused by a streptococcus infection. It is marked by severe sore throat, fever, headache, malaise, difficulty in swallowing, earache, and large, tender lymph nodes in the neck. Sudden tonsillitis may go along with scarlet fever. Treatment includes systemic antibiotics, painkillers, and warm irrigations of the throat. Soft foods and enough fluids are given. Tonsillectomy is sometimes done for returning tonsillitis or tonsillar abscess. See also peritonsillar abscess, scarlet fever, strep throat.

Teach importance of hydration, adequate

nutrition and exercise Upper Airway Infections Rhinitis vs. Viral Rhinitis Acute Sinusitis vs. Chronic Sinusitis Chronic Pharyngitis Tonsillitis Adenoiditis Peritonsillar AbscessLaryngitis

tonsillectomy, the surgical removal of

the palatine tonsils. It is done to prevent returning swelling of the tonsil (streptococcal tonsillitis). Tonsillitis Adenoiditis-lymphoid tissue at the back of the throat, which usually shrinks and disappears by adolescence. Enlargement of this tissue, however, is fairly common in children and may interfere

27

with breathing. Symptoms of enlarged adenoids include a nasal voice, persistent breathing through the mouth, snoring, and restless sleep. Formerly these tissues were routinely removed in children, because it was thought that inflamed adenoids led to recurrent infections and colds. More recently, medical science has recognized this condition as usually benign, and the number of adenoidectomies has consequently declined.

MRI Pharynx Nursing Management Maintain a patent airway Promote comfort Promote communication Encourage fluid intake Teaching self-care Obstruction and Trauma of the Upper Respiratory Airway Obstruction during sleep Epistaxis Nasal obstruction Fractures Laryngeal obstruction Restrictive Disorder

adenoidectomy, removal of the

adenoids. Surgery is done because the adenoids are large, cause blockage, or are infected.

Peritonsillar Abscess-, quinsy, also called

quinsy. An infection of tissue between the tonsil and throat, most often after an attack of tonsillitis. The symptoms include swallowing difficulty (dysphagia), pain moving to the ear, and fever. The tonsil and soft palate are red and swollen. Treatment includes penicillin, warm salt-water gargles, surgery, and drainage if needed. Compare retropharyngeal abscess.

Laryngitis-, inflammation of the mucous

membrane lining the voicebox (larynx), accompanied by swelling of the vocal cords with hoarseness or loss of voice. It may be caused by a cold, irritating fumes, or sudden temperature changes. Chronic laryngitis may result from excessive use of the voice or heavy smoking. In acute laryngitis, there may be a cough, and the throat usually feels scratchy and painful. The patient should remain in an environment with an even temperature, avoid talking, exposure to tobacco smoke, and inhale steam containing menthol, oil of pine, or similar aromatic vapors. Acute laryngitis may cause serious breathing problems in children under 5 years of age. The child may develop a hoarse, barking cough, noisy breathing, become restless, and gasp for air. Treatment includes providing large amounts of vaporized cool mist. Chronic laryngitis may be treated by removing irritants, avoiding smoking, voice rest, correcting faulty voice habits, cough medication, steam inhalations, and spraying the throat with medications recommended by the physician. Also know n as laryngismus.

C. Laryngeal Carcinoma Types: 1. 2. Glottic Supraglottic

Risk Factors: 1. 2. 3. 4. 5. Cancer of Larynx Cigarette smoking Chronic laryngitis Vocal abuse Alcohol abuse Familial tendency to laryngeal cancer

Laryngopharyngitis, inflammation of both the

voicebox (larynx) and throat (pharynx).

Hoarseness of more than 2 weeks duration Cough and/or sore throat Pain and/or burning Laryngectomy Cancer of Larynx- a malignant tumor arising from the lining of the voicebox (larynx). Laryngeal tumors are almost 20 times more common in men than in women and occur most frequently between 50 and 70 years of age. Chronic alcoholism and heavy use of tobacco increase the risk of developing the cancer.

Tracheitis, any swelling condition of the

windpipe. It may be sudden or long-term. It may result from infection, allergy, or physical irritation.

Epiglottitis, epiglottiditis, also called

epiglottiditis. Inflammation of the structure that prevents food from entering the windpipe while swallowing (epiglottis). Acute epiglottitis is a severe form of the condition, affecting mostly children. The symptoms are fever, sore throat, harsh breathing sounds, croupy cough, and a red swollen epiglottis.

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Persistent hoarseness is usually the first sign. Advanced lesions may cause a sore throat, breathing and swallowing difficulties, and swelling of the lymph glands in the neck. Treatment for small lesions is usually radiation. Surgical removal (laryngectomy), often combined with radiation, is indicated for extensive lesions. Following the operation, many persons with laryngectomies learn esophageal speech, some use an electric voicebox, and a few undergo surgical reconstruction.

remedies may worsen the problem, so don't use them unless your doctor tells you it's okay.) Call your doctor immediately if any of these signs occur: - Increased coughing, wheezing, or trouble breathing, fever - Mucus changes in any of these ways: the mucus is thicker; the amount is either more or less than usual; it has a foul odor; or the color is green, yellow, brown, pink, or red - Stuffy nose, sneezing, or sore throat - Increased fatigue or weakness - Weight gain or loss of more than 5 pounds within a week - Swollen ankles or feet - Confusion, memory loss, or persistent drowsiness PULMONARY VASCULAR DISORDERS

Preventing Respiratory Infections

Respiratory infections can be a serious complication for anyone with a chronic lung disease. Unfortunately, people with chronic lung diseases are more susceptible to respiratory infections; even an ordinary cold that causes only sniffles in someone else can turn into pneumonia. Because of this, you must make every effort to prevent infection. You must also learn the early danger signs and see your doctor at once when any symptoms appear. Preventing infection Follow your doctor's orders. Take your medications exactly as ordered. Perform chest physiotherapy as directed. If oxygen therapy is prescribed, take it as ordered. Take care of yourself every day. Drink at least six glasses of water daily (unless your doctor tells you differently). Eat a nutritious, well-balanced diet. Sleep 7 or 8 hours every night. Take several short rests during the day. Learn to conserve your energy and avoid getting too tired. Stay away from people who have colds and flu, if at all possible. If this can't be avoided, wear a disposable mask (available at medical supply companies and many grocery stores) when around people with colds or flu. Avoid air pollution, including tobacco smoke, wood or oil smoke, car exhaust, and industrial pollution. Take special precautions with your personal hygiene. Wash your hands before taking your medication or handling your oxygen equipment. Wash your hands after handling soiled tissues and before and after using the bathroom. Always rinse your oral inhaler after each use. Ask your doctor about flu vaccines. Detecting infections

PULMONARY EMBOLISM - lodging of a clot usually from DVT or other foreign matter in a pulmonary arterial vessel. PREDISPOSING FACTORS:

Thrombophlebitis Immobility Recent surgery Obesity Recent fracture Estrogen therapy Medical Management Anticoagulant therapy Thrombolytic therapy Plication Therapy Pulmonary embolectomy Nursing Management Provide anti-embolism stockings Hourly active foot dorsiflexion Elevate lower extremities Perform ROM exercises Assess legs for adequate pulses and leg size Anticoagulants as ordered

Symptoms of respiratory infections can appear

suddenly and worsen quickly. When an infection develops, it's important to start treatment right away. Your doctor may decide to prescribe antibiotics or other drugs to get the infection under control before it becomes serious. (Don't try to treat yourself. Over-the-counter cold

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Nursing Management Monitor PT and PTT Coughing and deep breathing

disseminated intravascular coagulation renal failure Acute Respiratory Distress Syndrome

O2 therapy as ordered
Teach patient on preventive measures Do not wear constrictive clothing Avoid sitting or standing for prolonged periods of time Stop smoking

Diagnostics: ABG Chest X-ray Acute Respiratory Distress Syndrome

Principles of Therapeutic Management of ARDS 1. 2. Identify underlying condition Maintenance of adequate oxygenation Establish airway (volume-cycled ventilator or PEEP) Administer blood transfusion and monitor for side-effects. Do chest physiotherapy Suction as needed Position patient appropriately. Provide oximetry and ABGs. Withhold sedative drugs that may further depress respiration. Nebulize patient as needed.

Acute Respiratory Distress Syndrome

Sudden progressive disorder consisting of pulmonary edema of noncardiac origin severe dyspnea refractory hypoxemia reduced lung compliance diffuse pulmonary infiltrates

Stages of ARDS Injury or Exudative Phase Reparative and Proliferative Phase Fibrotic Phase Acute Respiratory Distress Syndrome 3.

Acute Respiratory Distress Syndrome

Clinical Manifestations: Tachypnea Noisy respirations Intercostals retractions Crackles and ronchi Decreased sensorium Tachycardia Diaphoresis Refractory hypoxemia Pleural effusions

Maintenance of cardiac output and blood pressure Administer medications as ordered. Monitor VS and intake and output.

4.

Maintenance of Fluid balance Monitor intake and output. Administer diuretics as ordered and monitor for side-effects Monitor fluid and electrolyte status

Future Trends in Pharmacology: Monoclonal antibodies PGE1 Nitric Oxide Surfactant administration steroids

Complications: nosocomial pneumonia barotraumas stress ulcers

IV. Mechanical Ventilation

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Modes of Mechanical Ventilation Mechanical Ventilation

Always make sure that alarm is on. Pause alarms but do not turn off when suctioning. Provide patient with a bell. Respond immediately to alarms. When connecting ventilator circuit to artificial airway, twist connection rather than just pushing it together. Check cuff for leaks. Monitor ventilator tubing for condensed water and drain as needed.

Complications of Mechanical Ventilation: 1. Decreased Cardiac output Monitor BP every 1-2 hrs. Make sure patient is adequately hydrated.

2.

Barotrauma Monitor for signs of respiratory distress. Monitor for presence of subcutaneous emphysema, pneumothorax and pneumomediastinum

By: Marvie C. Cadacio R.N.

Mechanical Ventilation

Complications of Mechanical Ventilation: 3. Pulmonary infection Maintain strict aseptic technique when suction patient. Change ventilator tubing every 24-48 hrs. Drain condensed water from corrugated tubing. Perform chest physiotherapy Reposition patient every 2 hrs.

4.

Increased cerebral edema Place patient in a semi-Fowlers position. Monitor for decreased LOC

5.

Mechanical Ventilation Stress ulcers and ileus Assess for abdominal distention and measure abdominal girth Test stools and gastric drainage for occult blood Administer medications as ordered. Obtain order and place NGT. If abdominal distention is present, elevate head of bed.

6.

Machine malfunction

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