RESPIRATORY DISORDERS

Ms. Dinah d.G. Araneta RN,MN

COMMON HEALTH PROBLEMS:
 Clients with Upper Airway Disorders:

 Clients with Ventilation Disorders:

 Clients with Gas Exchange Disorders:

CLIENTS WITH UPPER AIRWAY
DISORDERS:

Upper Respiratory Trauma or Obstruction

Epistaxis

Nasal Trauma or Surgery

Laryngeal Obstruction or Trauma

Obstructive Sleep Apnea

 CLIENTS WITH VENTILATION
DISORDERS:

Intrapulmonary Restrictive Pleural Disorders

Pleuritis
Pleural Effusion
Pneumothorax – spontaneous, traumatic, tension

Trauma of the chest or Lung

Thoracic injury – rib fracture, Flail Chest,
pulmonary contusion
Inhalation injury – smoke inhalation, near drowning
CLIENTS WITH GAS EXCHANGE
DISORDERS:
 Reactive Airway Disorders
Asthma
COPD – Bronchitis, Emphysema
Cystic Fibrosis
Atelectasis
 Interstitial Pulmonary Disorders
Occupational Lung Disease – Asbestosis,
Silicosis, Coal Worker’s Pneumoconiosis,
Hypersensitivity Pneumonitis
Sarcoidosis
 Pulmonary Vascular Disorders
Pulmonary Embolism
Pulmonary Hypertension
Pulmonary Edema
 EPISTAXIS
 Hemorrhage from nose Or Bleeding from inside the nose.
 It can occur in any age group namely children, middle aged
and elderly.
 It is a very common cause of emergency visits.

Common Causes:
 Trauma in the form of finger nail trauma, nose injury,
fractures of middle third of the face or the base of the skull
 Infections like acute sinusitis, viral rhinitis, nasal
diphtheria , atrophic rhinitis, tuberculosis, granulomatous
lesions of the nose like rhinosporidiasis
 Any neglected foreign body in the nose .
 Epistaxis may also occur in atmospheric changes like high
altitude
 Deviated nasal septum -common cause of nose bleeding
 Sites of bleeding
 Most common: anterior septum

 Can be serious problem resulting is

significant blood loss or airway compromise
 HOW DO YOU STOP THE COMMON
NOSEBLEED?
Most people who develop nose bleeding can handle the problem without the
need of a physician if they follow the recommendations below:

 Pinch all the soft parts of the nose together between your thumb and index
finger.

 Press firmly toward the face - compressing the pinched parts of the nose
against the bones of the face.

 Lean forward slightly with the head tilted forward. Leaning back or tilting
the head back allows the blood to run back into your sinuses and throat
and can cause gagging or inhaling the blood.

 Hold the nose for at least five minutes. Repeat as necessary until the nose
has stopped bleeding.

 Sit quietly, keeping the head higher than the level of the heart. Do not lay
flat or put your head between your legs.

 Apply ice (wrapped in a towel) to nose and cheeks

 HOW DO YOU PREVENT THE NOSE FROM BLEEDING AGAIN?
 Go home and rest with head elevated at 30 to 45 degrees.

 Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will
escape out the mouth and not through the nose.

 Do not strain during bowel movements. Use a stool softener (for example, Colace).

 Do not strain or bend down to lift anything heavy.

 Try to keep your head higher than the level of your heart.

 Do not smoke.

 Stay on a soft, cool diet. No hot liquids for at least 24 hours.

 Do not take any medications that will thin the blood [aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or
warfarin (Coumadin)]. If these have been prescribed by your physician, you need to contact them
regarding stopping these medications.

 Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).

 If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can temporarily use a
nasal decongestant spray, such as Afrin or Neo-Synephrine. These types of sprays constrict blood
vessels. (NOTE: If used for many days at a time, these can cause addiction and do not use if you have
high blood pressure.)

 Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the doctor
and/or visit to the emergency room.
 NURSING CARE OF PATIENTS WITH
EPISTAXIS
 Assessment of bleeding
 Monitor airway, breathing

 Vital signs

 Reduce anxiety

 Patient teaching
 Avoid nasal trauma, nose picking, nose blowing
 Air humidification
 Pressure on nose to stop bleeding; if bleeding
does not stop in 15 minutes, seek medical
attention
 TREATMENT OF EPISTAXIS

 Topical vasoconstrictors
 Adrenaline
 Cocaine HCl – local anesthetic to temporarily numb
areas of the mouth, nose, and throat (mucous
membranes).
This medication should be used with caution in
children and elderly because they may be more
sensitive to side effects (e.g., mental/ mood
changes). This medication should be used only when
clearly needed during pregnancy.
 Phenylephrine

 Packing of nasal cavity or balloon catheter

CONTROL OF EPISTAXIS: NASAL PACK
 NASAL TRAUMA OR SURGERY

1. Nasal septum deviation: Failure of the

nasal septum to be in the midline where it is
supposed to be. (The nasal septum is the wall
inside the nose that runs down the middle
dividing it into two sides.)
 Deviation of the nasal septum may be
congenital (present at birth) or occur later from
trauma. The major problem that it tends to
cause is airway obstruction. Correction is by
surgery.
 The "deviation" of the nasal septum is from its
normal position. It is a deviant septum
 NASAL TRAUMA OR SURGERY
2. Septal hematoma is an accumulation of blood within
the nasal septum. It is usually due to trauma.
Treatment is incision (to drain the blood from the
hematoma), packing of the nose (to keep the blood
from reaccumulating) and antibiotics, if infected

3. Perforation of the nasal septum (a hole through it)

can be due to trauma (a blow to the nose, picking the
nose, etc), drug abuse (e.g., cocaine), an abscess.
Symptoms include crusting, bleeding, discharge and,
most dramatically, whistling on inspiration (on
breathing in). Treatment is surgical closure of the
perforation (a procedure that frequently fails) or the
insertion of a specially designed septal button.
NASAL SURGERY:
 Nasal obstruction - caused by:
1. deviated or crocked septum or
2. enlarged tissues (turbinates) within the nose.
Surgical Treatment:
1. Septoplasty - to correct a deformity of the partition (the
septum)
between the two sides of the nose.
2. Turbinectomy - surgical removal of an abnormally enlarged
turbinate
from inside the nose to improve breathing.
The goals of nasal airway surgery include the following:
To improve airflow through the nose,
to control nosebleeds,
to enhance visualization of the inside of the nose,
to relieve nasal headaches associated with swelling of the
inside of the nose, and
to promote drainage of the sinus cavities.
Nasal airway surgery is done through the nostrils without the
need for external incisions.
NASAL OBSTRUCTION : NON-
SURGICAL TXT.
 Nasal corticosteriods – 1-3 mos. (small
polyps)
 Oral corticosteriods – (6day course
Prednisone)
 Antibiotics

 Antihistamines

 Astringent agent – Hypertrophied turbinates

NURSING MANAGEMENT:
 OPD – Explains procedure after doctor’s initial
description
 Post-Op:

-Elevates HOB – promote drainage and

alleviate discomfort from edema
-Freq. Oral hygiene
-Instruct to avoid blowing the nose with force,
signs and symptoms of bleeding and infection
 Discharge

-post-op instructions esp. Emergency situations

LARYNGEAL OBSTRUCTION
 Causes: Edema
DANGERS OF LARYNGEAL
OBSTRUCTION:
Swelling – close off the opening tightly –
HYPOXIA or SUFFOCATION
Freq. In people with severe inflammation of the
throat (Scarlet Fever)
Aspirated foreign bodies – pharynx, larynx or
trachea leads to:
1. Obstruction of Airway – DOB, Asphyxia
2. Drawn farther – sx. Irritation (croupy
cough),
Hemoptysis
Labored breathing
CONFIRMATORY : X-ray and physical signs
 MANIFESTATIONS: / MEDICAL
MANAGEMENT
 Lowered oxygen saturation
 Use of accessory muscles – retractions in the
neck/abdomen during inspiration
 Medical Management:

ensure a patent airway

Finger dislodge : foreign body lodged in pharynx
Subdiaphragmatic abdominal thrust maneuver –
larynx/trachea is obstructed
Tracheostomy
Subcutaneous Epinephrine and Corticosteriod-for
edema due to allergic reaction
Ice application (neck)
ARTERIAL BLOOD GASES

 Arterial blood gas analysis provides

information on the following: 

1] Oxygenation of blood through gas

exchange in the lungs.

2] Carbon dioxide (CO2) elimination through

respiration. 

3] Acid-base balance or imbalance in extra-

cellular fluid (ECF).
NORMAL BLOOD GASES
 Arterial Venous pH 7.35 - 7.45
Not a gas, but a measurement of acidity or alkalinity, based
on the hydrogen (H+) ions present.
 PaO2 80 to 100 mm Hg.
The partial pressure of oxygen that is dissolved in arterial
blood.
New Born – Acceptable range 40-70 mm Hg. 
Elderly: Subtract 1 mm Hg from the minimal 80 mm Hg
level for every year over 60 years of age:  80 - (age- 60) 
(Note: up to age 90)
 HCO3  22 to 26 mEq/liter
The calculated value of the amount of bicarbonate in the
bloodstream. Not a blood gas but the anion of carbonic acid.
 PaCO2 35-45 mmHg
The amount of carbon dioxide dissolved in arterial blood. 
Measured.  Partial pressure of arterial CO2.  (Note: Large A=
alveolor CO2). 
 Ph 7.35–7.45
 The pH indicates if a patient is

acidotic (pH < 7.35)

alkalemic (pH > 7.45)

 PaO2 80–100 mmHg

A low O2 indicates that the patient is not respiring
properly, and is hypoxemic.
 At a PaO2 of less than 60 mm Hg, supplemental

oxygen should be administered.

 At a PaO2 of less than 26 mm Hg, the patient is at

risk of death and must be oxygenated immediately.

 PaCO2 35–45 mmHg
 The carbon dioxide partial pressure (PaCO2) indicates a
respiratory problem:
for a constant metabolic rate, the PaCO2 is determined
entirely by ventilation.[7]
 A high PaCO2 (respiratory acidosis) indicates
underventilation,
 a low PaCO2 (respiratory alkalosis) hyper- or overventilation.

 PaCO2 levels can also become abnormal when the respiratory

system is working to compensate for a metabolic issue so as
to normalize the blood pH.
 An elevated PaCO2 level is desired in some disorders
associated with respiratory failure; this is known as
permissive hypercapnia (high carbon dioxide in the blood)
 HCO3− 22–26 mEq/L

 The HCO3− ion indicates whether a metabolic

problem is present (such as ketoacidosis).

 A low HCO3− indicates metabolic acidosis,

 A high HCO3− indicates metabolic alkalosis.

 HCO3− levels can also become abnormal when the

kidneys are working to compensate for a
respiratory issue so as to normalize the blood pH.
 
 ACID-BASE IMBALANCES
Primary Abnormality Compensation Clinical Manifestations

RESPIRATORY ACIDOSIS HCO3 RR and shallow – to

pH < 7.35 to raise pH blow off CO2
Hypotension, weak and thready
CO 2 > 45 pulse, tachycardia, warm and
flushed skin, headache, decreased
LOC, drowsiness, coma
RESPIRATORY ALKALOSIS HCO3 myocardial irritability,
pH > 7.45 to lower pH HR, dyspnea, chest tightness,
dizziness, anxiety, panic, seizure
CO2 < 35
METABOLIC ACIDOSIS CO2 Hypotension, cold, clammy
pH < 7.35 to lower pH skin, deep, rapid resp.
(Kussmaul’s),
HCO3 <22
Nausea & vomiting, diarrhea,
abdominal pain
METABOLIC ALKALOSIS CO2 HR, hypotension,
pH > 7.45 to raise pH hypoventilation, resp. Failure,
dizziness, irritability,
HCO3 >26
nervousness, muscle cramps
 ASTHMA
 Chronic inflammatory disease of the
airways

 Obstructive disease of the lower

respiratory tract

 Most common chronic respiratory disease

in children, in younger children affects
twice as many boys as girls; incidence
equal by adolescence.

 Often caused by an allergic reaction to

environmental allergen, may be seasonal
or by year-end
 immunologic/allergic reaction results
in histamine release, which produces
three airway responses
(immunologic response)
 Edema of mucus membrane
 Spasm of smooth muscle of bronchi and
bronchioles
 Status asthmatic occurs when there
is a little response to treatment and
symptoms persist
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Asthma ALLERGY (Extrinsic)
INFLAMMATION (Intrinsic)

Histamine,
Bronchospasm
Bradykinin,
Mucosal edema
PG, Serotonin,
Hypersecretion of mucus
Leukotrienes…
Respiratory Narrowing of AWs,
Exhaustion effort ↑ work of breathing

Hypoventilation Air trapping

res
pi
Hypoxia & Respiratory Acidosis diso
rder
s
 CAUSE
 Physical/Chemical irritants

 Allergic reaction with obstruction

 A delayed bronchial response

MEDICAL MANAGEMENT
 Drug therapy: Bronchodilators
 Beta-adrenergic agonist

 metered dose inhaler (MDI)- most children

need spacers

 nebulizer- infants and toddlers

 rescue drugs for acute attack

 RESCUE MEDICATIONS
Short acting B2 antagonists
Anticholinergics
Systemic corticosteroids
 CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Asthma Management
Clinical  Pharmacotherapy
Beta agonists [Epinephrine,
Manifestations Terbutaline]
Orthopnea Methylxanthines [Aminophylline]
Restlessness Corticosteroids
Dyspnea, tachypnea Anticholinergics [Atropine]
Tachycardia Mast cell inhibitors [Cromolyn]
Nasal flaring  Oxygen via nasal cannula
Retractions  Fluids to 3L/day
 Breathing exercises
Cough  Metered dose inhaler
Chest tightness
Cold clammy skin
Wheezing res
pi
Cyanosis diso
rder
s
 PREVENTIVE
 Corticosteroids
 Antiallergic

 NSAIDs

 Long acting B2 antagonists

 Leukotreine modifiers (prevents

brochospasms and antiinflammatory)
NEBULIZER
TREATMENT
 Mixed with sailine

 Pre: breathing exercises

 Post: oral care

 NEBULIZATION
 CORTICOSTEROIDS
 inhaled by MDI or nebulizer
 oral for persistent wheezing
 IV in hospital
 NON-STEROID ANTI-INFLAMMATORY AGENTS
 Cromolyn sodium
 nedocromil
 leukotriene inhibitors and preceptors-antagonist
 used for maintenance
 XANTHINE-DERIVATIVES
 theophylline (oral)
 Aminophylline (IV)

 used for status asthmaticus

 ASSESSMENT FINDINGS
 Coughing in the absence of respiratory
infection especially at night
 Family history of allergies
 Client history of eczema
 Respiratory distress: shortness of breath,
expiratory wheeze, prolonged expiratory
phase, air trapping (barrel chest if chronic),
use of accessory muscles, irritability (from
hypoxia), diaphoresis, change in sensorium if
severe attack.

 Diagnostic test: ABGs indicates respiratory

acidosis
 NURSING INTERVENTIONS
 Place client in high-fowler’s
position.
 Administer oxygen as ordered.
 Administer medications ass ordered.
 Provide humidification/hydration to
loosen secretions.
 Provide chest percussion and
postural drainage when
bronchodilation improves.
 Monitor for respiratory distress.
 NURSING INTERVENTIONS

 Provide client teaching and

discharge planning concerning
 Modification of environment
 ensure room is well ventilate
 Stay indoors during grass cutting or
when pollen count is high.
 Use dump dusting.
 Avoid rugs, draperies or curtains,
stuffed animals.
 Avoid natural fibers (wools and
feathers).
 NURSING INTERVENTIONS
 Importance of moderate
exercise (swimming is excellent)
 Purpose of breathing exercise
(to increase the end expiratory
pressure of each respiration).
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Bronchitis

Emphysema
Causes
Congenital weakness
Respiratory irritants: smoke, polluted air,
chemical irritants
Respiratory tract infections
Genetic predisposition res
pi
diso
rder
s
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Chronic
Smoking, RTI, Pollutants
Bronchitis
Inflammation
Excessive
bronchial Bradykinin, Histamine, PGs
mucus  Capillary permeability
production
Fluid/Cellular Exudation
Chronic or Mucosal edema
recurrent
productive Hypersecretion of mucus
cough Persistent Cough
res
pi
diso
rder
s
 CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Smoking, heredity, Emphysema

nionoveno@yc
aging process
Destruction of elastin

Disequilibrium between
elastase & antielastase
Loss of elastic recoil
44
alters alveolar walls
& narrows airways

Overdistention of alveoli
Enlargement
of air spaces distal
CO2 retention
to terminal bronchioles
Hypoxia leads to coalesced alveoli
Respiratory acidosis & air trapping res
pi
diso
rder
s
 Chronic
Emphysema
Bronchitis

eno@yc
No cyanosis (Pink) Cyanosis (Blue)
Thin appearance Edematous
Exertional dyspnea Exertional dyspnea

45
Ineffective cough Recurrent cough w/
Barrel chest Sputum production
Pursed-lip breathing Digital clubbing
Prolonged expiration ↑Respiratory rate
Use of accessory muscles Use of accessory muscles

R-sided Heart Failure R-sided Heart Failure

Pulmonary HPN Cor pulmonale
Spontaneous pneumothorax res
pi
diso
rder
s
 CHRONIC OBSTRUCTIVE
PULMONARY DISEASE

nionoveno@yc
Management
 Rest:  O2 demand of tissues
  Fluid intake: 3 L/day

46
 Diet:  calorie,  CHON,  CHO,  vit. C
 Low-flow O2 therapy: 1-3 LPM
 Breathing exercises [pursed-lip]
 Avoid cigarette smoking, alcohol, pollutants
 CPT: postural drainage  percussion 
vibration
 Bronchial hygiene measures: steam, aerosol,
medimist inhalation res
pi
 Pharmacotherapy: Antitussives, bronchodilators,
diso
antihistamine, steroids, antimicrobials rder
s
 CHRONIC OBSTRUCTIVE PULMONARY
DISEASE

Bronchiectasis
Destruction of bronchial
mucosa with fibrous scar
tissue formation

Loss of resilience
& airway dilation causes
pooling of secretions

Obstruction of airflow res
pi
diso
rder
s
 CYSTIC FIBROSIS
 Cystic fibrosis (CF) is an inherited disease of the
mucus and sweat glands.

 It affects mostly your lungs, pancreas, liver,

intestines, sinuses and sex organs.

 CF causes your mucus to be thick and sticky. The

mucus clogs the lungs, causing breathing
problems and making it easy for bacteria to grow.

 This can lead to problems such as repeated lung

infections and lung damage.

NIH: National Heart, Lung, and Blood Institute

 CYSTIC FIBROSIS
 The symptoms and severity of CF vary
widely. Some people have serious problems
from birth. Others have a milder version of
the disease that doesn't show up until they
are teens or young adults.
 Although there is no cure for CF, treatments
have improved greatly in recent years. Until
the 1980s, most deaths from CF occurred in
children and teenagers. Today, with improved
treatments, people with CF live, on average,
to be more than 35 years old.
  In cystic fibrosis,
the lungs fill
with thick
mucus — a
                                                                                                                       
perfect breeding
ground for
bacteria and
viruses. Most
people with
cystic fibrosis
have almost
constant
infections in
their lungs and
sinuses
Symptoms
 Cystic fibrosis signs and symptoms can vary from child
to child, depending on the severity of the disease. Even
in the same child, symptoms may worsen or improve as
time passes. In some children, symptoms begin during
infancy. Other people may not begin experiencing
symptoms until adolescence or adulthood.
 One of the first signs of cystic fibrosis is an excessively
salty taste to the skin. They tend to have higher than
normal amounts of salt in their sweat. Parents often can
taste the salt when they kiss their child.
 Most of the other signs and symptoms of cystic fibrosis
affect the respiratory system or the digestive system.
 Respiratory signs and symptoms
The thick and sticky mucus associated with cystic fibrosis
clogs the tubes that carry air in and out of your lungs. This
can cause:
Persistent cough
Wheezing
Repeated lung infections
Repeated sinus infections
 Digestive signs and symptoms
The thick mucus can also block tubes that carry digestive
enzymes from your pancreas to your small intestine.
Without these digestive enzymes, your intestines can't fully
absorb the nutrients in the food you eat. This can cause:
Foul-smelling, greasy stools
Poor weight gain and growth
Distended abdomen from constipation
Intestinal blockage, particularly in newborns
 Risk factors
 Family history. Because cystic fibrosis is an
inherited disorder, it tends to run in families.
 Race. Although cystic fibrosis occurs in all
races, it is most common in white people of
northern European ancestry.
 Complications

 Many different types of complications can

occur with cystic fibrosis. The most common
complications affect the respiratory,
digestive and reproductive systems.
RESPIRATORY SYSTEM
COMPLICATIONS
 Bronchiectasis. Cystic fibrosis is one of the leading causes of
bronchiectasis, a condition in which damaged airways widen and
become flabby and scarred.
 Chronic infections. Thick mucus in the lungs and sinuses provide
an excellent breeding ground for bacteria. Most people with cystic
fibrosis have almost constant infections in their lungs and sinuses.
 Collapsed lung. Repeated lung infections damage the lungs,
making it more likely for the lung to collapse.
 Nasal polyps. Because the lining inside the nose is inflamed and
swollen, it's more likely to develop large or multiple polyps — soft,
fleshy growths inside your nose.
 Respiratory failure. Over time, cystic fibrosis can damage lung
tissue so badly that it won't work anymore. Lung function typically
worsens gradually, and it eventually can become life-threatening
DIGESTIVE SYSTEM
COMPLICATIONS
 Nutritional deficiencies. Thick mucus blocks the tubes
that carry digestive enzymes from your pancreas to your
intestines. Without these enzymes, your body can't absorb
protein, fats or the fat-soluble vitamins — A, D, E and K.
 Diabetes. The pancreas also produces insulin, which your
body needs to use sugar. Cystic fibrosis increases your risk
of developing diabetes.
 Blocked bile duct. The tube that carries bile from your
liver and gallbladder to your small intestine may become
blocked and inflamed, leading to liver problems, such as
cirrhosis, and sometimes gallstones.
 Rectal prolapse. Frequent coughing or straining during
constipation can cause internal rectal tissue to protrude
outside the anus, particularly in infants.
 Intussusception. Children with cystic fibrosis are at higher
risk of intussusception, a condition in which a section of the
intestines folds in on itself like an accordion. This results in
bowel obstruction, an emergency condition.
 Reproductive system complications
Many men with cystic fibrosis are infertile because the tube that
connects the testes and prostate gland (vas deferens) is either
blocked with mucus or missing entirely. Certain fertility
treatments and surgical procedures sometimes make it possible
for men with cystic fibrosis to become fathers.
 Although women with cystic fibrosis may be less fertile than
other women, it's possible for them to conceive and to have
successful pregnancies. Still, pregnancy can worsen the signs
and symptoms of cystic fibrosis, so be sure to discuss the
possible risks with your doctor.
 Other complications
 Osteoporosis. People with cystic fibrosis are at higher risk of
developing osteoporosis, a dangerous thinning of bones. This
may be linked to the body's inability to absorb vitamin D, which
helps build strong bones.
 Electrolyte imbalances. Because people with cystic fibrosis
have saltier sweat, this can upset the balance of minerals in
their blood. Symptoms include increased heart rate, fatigue,
weakness and low blood pressure.
TESTS AND DIAGNOSIS
LABORATORY TESTS
 Newborn screening test. Within the past decade, most states have
begun to routinely screen newborns for cystic fibrosis. This test checks a
blood sample for a particular component that is commonly elevated in
babies who have cystic fibrosis. Other tests are needed to confirm the
diagnosis.
 Sweat test. This test is necessary to confirm a diagnosis of cystic fibrosis.
A sweat-producing chemical is applied to a small area of skin, which is then
stimulated with a very weak and painless electric current. The collected
sweat is then tested to see if it's saltier than most people's sweat.
 Genetic testing. If the sweat test results aren't clear-cut, DNA samples
from blood or saliva can be checked for specific mutations on the gene
responsible for cystic fibrosis.
 Sputum tests. If it appears that you have a lung infection, your doctor
may ask you to cough up a sample of the mucus (sputum) so it can be
tested to see what types of germs are in it. Your doctor can then choose an
antibiotic that works especially well for that specific variety of germ.
 Organ function tests. During the course of cystic fibrosis treatment, your
doctor may order blood tests that help measure the health of your
pancreas and liver.
Imaging tests
Damage to your lungs or intestines can be
monitored with:
 X-rays. This painless test can reveal
overinflation of the lungs and clogged bronchial
tubes or sinuses.
 Computerized tomography (CT). CT scans
combine X-ray views taken from many different
directions to produce more detailed images of
internal structures.
 Magnetic resonance imaging (MRI). MRI
machines use radio waves and a strong
magnetic field to produce very detailed images
of internal organs.
Lung function tests
These tests measure:
 The size of your lungs

 How much air you can breathe in and out

 How fast you can breathe in and out

 How well your lungs deliver oxygen to your

blood
Treatments and drugs
 There is no cure for cystic fibrosis, but treatments can
ease symptoms and reduce complications.
Medications
 Antibiotics. These drugs are used to treat and
prevent lung infections. They may be swallowed in pill
form, inhaled in a mist or delivered intravenously.
 Mucus-thinning drugs. Drugs that reduce the
stickiness of your mucus make it easier to cough up
the mucus, which improves lung function.
 Bronchodilators. Medications such as albuterol —
delivered by an inhaler or a nebulizer — help keep
your airways open by relaxing the muscles around
your bronchial tubes
Therapy
People with cystic fibrosis need a way to physically
remove thick mucus from their lungs. This is often
done by manually clapping with cupped hands on the
front and back of the chest — a procedure that's best
performed with the person's head over the edge of the
bed so that gravity helps clear the secretions.
 There also are mechanical devices that help loosen
lung mucus. They include:
 Chest clapper. This hand-held device can mimic the
effect of cupped hands clapping over the ribs.
 Inflatable vest. This device vibrates at high
frequency to loosen chest mucus.
 Breathing devices. Performing specific breathing
exercises while exhaling through the device's tube or a
mask may also be helpful.
 Oral enzymes and better nutrition
Cystic fibrosis can cause you to become malnourished
because the pancreatic enzymes needed for digestion
don't reach your small intestine, preventing food from
being absorbed. Consider adding:
 Supplemental high-calorie nutrition. Special fat-
soluble vitamins. Oral pancreatic enzymes
 Drink lots of fluids
Increasing fluid intake can help thin the mucus in your
lungs, which makes it easier to cough it out of your
lungs.
 Keep immunizations up to date
In addition to other usual childhood vaccines, this
includes the pneumococcal and annual influenza
vaccines. Cystic fibrosis doesn't affect the immune
system, but children with cystic fibrosis are more likely
to develop complications when they become sick.
 Exercise
Regular exercise helps loosen mucus in your airways and
strengthens your heart and lungs. And for many people with
cystic fibrosis, participating in sports can improve confidence
and self-esteem. It isn't necessary to take part in an organized
sport or take classes at a gym. Anything that gets you moving,
including walking and biking, can help.
 Eliminate smoke
Don't smoke in your home or car, and don't allow other people
to smoke around your child. Secondhand smoke is harmful for
everyone, but especially for people with cystic fibrosis.
 Encourage hand washing
Teach all the members of your family to wash their hands
thoroughly before eating, after using the bathroom, when
coming home from work or school, and after being around a
person who is sick. Hand washing is the best way to protect
against infection.
NURSING INTERVENTIONS:

 Monitor weight at least weekly to assess

effectiveness of nutritional interventions.
 Monitor respiratory status and sputum
production, to evaluate response to
respiratory care measures.
 To promote airway clearance, employ
intermittent aerosol therapy three to four
times per day when the child is symptomatic.
 Perform chest physical therapy three to four
times per day after aerosol therapy.
 Help the child to relax to cough more easily
after postural drainage.
NURSING INTERVENTIONS:
 Suction the infant or young child when necessary, if
not able to cough.
 Teach the child breathing exercises using pursed lips
to increase duration of exhalation.
 Provide good skin care and position changes to
prevent skin breakdown in malnourished child.
 Provide frequent mouth care to reduce chances of
infection because mucus is present.
 Restrict contact with people with respiratory
infection.
 Encourage diet composed of foods high in calories
and protein and moderate to high in fat because
absorption of food is incomplete.
NURSING INTERVENTIONS:

 Administer fat-soluble vitamins, as

prescribed, to counteract malabsorption.
 Increase salt intake during hot weather,
fever, or excessive exercise to prevent
sodium depletion and cardiovascular
compromise.
 To prevent vomiting, allow ample time for
feeding because of irritability if not feeling
well and coughing.
 Encourage regular exercise and activity to
foster sense of accomplishments and
independence and improve pulmonary
function.
NURSING INTERVENTIONS:

 Provide opportunities for parents to learn all

aspects of care for the child.
 Teach the parents about dietary regimen and
special need for calories, fat, and vitamins.
 Discuss need for salt replacement, especially
on hot summer days or when fever, vomiting,
and diarrhea occur.
ATELECTASIS
Collapse of the part of the
lung due to bronchial
obstruction
Causes: 1. obstruction

airless alveoli
collapse of part of lung
2. W/o surfactant

surface tension
Collapse of part of lung
OCCUPATIONAL LUNG DIS
Exposure to occupational / environmental dust

Respiratory disorder

Pneumoconiosis – related to inhalation of dust

Byssinosis – textile workers
Toxic pneumonitis – irritant gases ammonia
Silicosis – crystalline silica dust, fumes
C. Asthma - mining
 SARCOIDOSIS
 Results from a specific type of inflammation of tissues of the
body.
 It can appear in almost any body organ, but it starts most
often in the lungs or lymph nodes.
 The cause of sarcoidosis is unknown.
 The disease can appear suddenly and disappear. Or it can
develop gradually and go on to produce symptoms that
come and go, sometimes for a lifetime.
 As sarcoidosis progresses, microscopic lumps of a specific
form of inflammation, called granulomas, appear in the
affected tissues. In the majority of cases, these granulomas
clear up, either with or without treatment. In the few cases
where the granulomas do not heal and disappear, the
tissues tend to remain inflamed and become scarred
(fibrotic).
SARCOIDOSIS
Hypersensitivity response to agents

Chronic disorder of alveolar structure

Growth of granulomas

T-lymphocytes recruit add’l immune cells

chronic inflammation
Fibrosis leads to dec elasticity & dec gas exchange
 Shortness of breath (dyspnea) and a cough that
won't go away can be among the first
symptoms of sarcoidosis.
 But sarcoidosis can also show up suddenly with
the appearance of skin rashes. Red bumps (
erythema nodosum) on the face, arms, or Shins
and inflammation of the eyes are also common
symptoms.
 It is not unusual, however, for sarcoidosis
symptoms to be more general.
 Weight loss, fatigue, night sweats, fever, or just
an overall feeling of ill health can also be clues
to the disease.
 How is sarcoidosis diagnosed?
 Preliminary diagnosis of sarcoidosis is based on the
patient's medical history, routine tests, a physical
examination, and a chest x- ray.
 The doctor confirms the diagnosis of sarcoidosis by
eliminating other diseases with similar features.
These include such granulomatous diseases as
berylliosis (a disease resulting from exposure to
beryllium metal),
tuberculosis, farmer's lung disease (
hypersensitivity pneumonitis),
fungal infections,
rheumatoid arthritis,
rheumatic fever,
and cancer of the lymph nodes (lymphoma).
 HOW IS SARCOIDOSIS TREATED?
Require no treatment. Symptoms are usually not disabling and
disappears spontaneously.
 When therapy is recommended;

Main GOAL is to keep the lungs and other affected body

organs working and to relieve symptoms.
The disease is considered inactive once the symptoms fade.
corticosteroid drugs remain the primary treatment for
inflammation and granuloma formation.
Prednisone is probably the corticosteroid most often prescribed
today.
There is no treatment at present to reverse the lung scarring
(fibrosis) that might be present in advanced sarcoidosis. More
than one test is needed to diagnose sarcoidosis.
 PULMONARY EMBOLISM

nionoveno@yc
Undissolved substance in pulmonary vasculature
obstructs blood flow

75
Types: Fat, Air, Thrombus

Causes
Flat or long bone fractures
Thrombophlebitis
Venous stasis
res
pi
diso
rder
s
 PULMONARY EMBOLISM

nionoveno@yc
Clinical Manifestations
Dyspnea, tachypnea, crackles

76
Diagnostics
ABGs
Respiratory alkalosis, hypoxemia
Lung Scan
 Pulmonary circulation & blood flow obstruction
Angiography
Location of embolus
Filling defect of pulmonary artery res
pi
diso
rder
s
 PULMONARY EMBOLISM

nionoveno@yc
Management

Intubation & mechanical ventilation

77
Anticoagulants
Thrombolytics

Assess for (+) Homan’s sign

Monitor PT & PTT
WATCH OUT FOR S/S of excessive anticoagulation
res
pi
diso
rder
s
To assess Homan’s
sign, the patient’s
knee is in an
extended position
and the examiner
forcefully
dorsiflexes the
patient’s ankle (1).
A positive sign is
indicated when
pain in the
popliteal region
and the calf is
elicited as the foot
is dorsiflexed.