Improve breathing pattern
– diaphragmatic breathing sheet of patient, be sure that the patient is
(feeling of rise and fall of the
abdomen with a pillow)
– Pursed-lip breathing (inhale
with a nose then exhale with the
mouth)
Improving Activity tolerance
– Pacing activities throughout the
day or using supportive devices
to decrease energy expenditure.
(ask her time schedule and have
rest)
– using of cane ,wheelchair, with an
portable oxygen tank
• Avoid temperature extremes
• Avoid very hot and very cold
weather
ASTHMA
- Is a chronic inflammatory disease of
airways that causes
- Airway hyper responsiveness (could be
heard thru auscultation: wheezing)
- Mucosal edema and
- Mucus production
Predisposing Factors
- Females: is most common because of
hormonal changes
- Exposure to allergens
- Occupational sensitizers (factories)
- Respiratory Infections
- Air pollutions
- Diet
- Exercise and hyperventilation
- Medications
- Exposure to sulfur Dioxide
- respond to the standard treatment of
What is the best textile for a patient with
asthma: COTTON: does not attract further
dust
Reminder: if you will be changing the bed
wearing mask
 Usually associated with allergy
 Chest tightness
 Cough
 Wheezing: expiration more strenuous &
prolonged than inspiration
 Use of accessory muscles of respiration
 Hypoxia with cyanosis, weak pulse,
diaphoresis
 PFT: decreased FEV, increased RV,
increased TLC
 CXR: flattened diaphragm, increased AP
diameter
 ABG: increased PCO2, decreased PO2;
Monitor the oxygen of the patient.
Prevention
• Identify the substances that precipitate
the symptoms.
– Possible causes are dust, dust
mites, roaches, and certain types
of cloth, pets, horses, detergents,
soaps, certain foods, molds, and
pollens.
– Special Doctor: Allergologist
(doctor for Allergies
• If the attacks are seasonal, pollens can
be strongly suspected.
• The patient is instructed to avoid the
causative agents whenever possible.
– Desensitization- gradual
exposure to the allergic
components
Complications
• status asthmaticus - acute
exacerbation of asthma that doesn’t not
bronchodilators
• Respiratory failure
• Pneumonia
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 • Atelectasis- Collapse of Lungs
Medical Mgt
• Corticosteroid (IV, and then Oral)
• Anticholinergics (eg, ipratropium
bromide [Atrovent]) – to decrease
secreation
• Peak flow monitoring to measure
asthma severity
Nsg Mgt
• Assess patient’s respiratory status by
monitoring the severity of symptoms,
breath sounds, peak flow, pulse
oximetry, and vital signs.
• Obtain a history of allergic reactions to
medications before administering
medications and identifies the patient’s
current use of medications.
• Administer medications as prescribed
and monitor the patient’s responses to
those medication
• Fluids may be administered if the patient
is dehydrated, and antibiotic agents may
be prescribed if the patient has an
underlying respiratory infection
(Antibiotic: Amoxiclav: 2nd generation )
RESTRICTIVE PULMONARY DISEASE
- (also known as interstitial lung diseases)
are a category of respiratory disease
characterized by a loss of lung
compliance causing incomplete lung
expansion and increased lung stiffness
(example: Infant Respiratory Distress
Syndrome IRDS)
o Lung compliance
o Measure of the lung ability to
stretch and respond to treatment.
Pneumothorax
- Air in the pleural space
- Occurs when the parietal or visceral
pleura is breached and the pleural
space is exposed to positive
atmospheric pressure (the pleural space
should be maintained in negative
atmospheric pressure )
- As a complication of severe chest
trauma injury
- Normal amount of pleural/Parietal fluid:
10-20 ml : to prevent friction of the
pleural spaces
Types of pneumothorax
• Simple or Spontaneous - occurs when
the air enters the pleural space through
a breach of either a parietal or visceral
pleura.
SPONTANEOUS = SUDDEN
• Traumatic or Open – occurs when air
escape from a laceration in the lung
itself and enters the pleural space or air
enters the pleural space through a
wound in the chest wall.
Ex. Gunshot wounds
• Tension Pneumothorax – is a serious
valvular type, in which air enters the
pleural space with each inspiration,
becomes trapped and is not expelled
during expiration.
• Occurs more with patients who
uses mechanical ventilator
`Clinical Manifestations
• Sudden chest pain
• Close fracture – there’s a fracture
but can’t see the opening
• Open fracture – you can see the
bones
• Minimal respiratory distress
• tachypnea
• Acute respiratory distress occurs when
lung totally collapse
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 • Anxious
• dyspnea and air hunger
• Uses accessory muscles
• Central cyanosis from severe
hypoxemia
• Hemoglobin level: pt w/ central
cyanosis
Mgt
• Management depends on its cause and
severity
• The goal of treatment is to evacuate the
air or blood from the pleural space.
• Thoracentesis (to remove excess
pleural fluid)/ CTT
• Can be done in the pt. room
• Needs a consent
• Pt is placed in a sitting position
with pt over bed table
• Local anesthesia
• Pt should lie in the affected site:
to apply pressure and drain
exacerbation
• CTT: if the bottle is broken, pump
the tube manually
• Is should monitored, it’s a part of
the output
• You should have 3 sterile bottle
PLEURAL EFFUSION
- Abnormal accumulation of fluid in the
pleural space
- It is rarely a primary disease but is
usually secondary to other diseases
- More than 20 ml of parietal fluid
- Usually secondary to major diseases
o PTB
o Lung Cancer
Use of Consent:
1. Will serve as legal document
2. The protection of the nurses
Etiology
• Complication of:
1. Disseminated cancer (particularly lung
and breast); lymphoma
2. Infection: tuberculosis, bacterial
pneumonia, pulmonary infection
3. Congestive Heart Failure
4. Cirrhosis: Scarring of liver
5. Kidney disease
6. Others: sarcoidosis (abnormal
collection of inflammatory cells that form
as nodules in many body organs),
systemic lupus erythematosus (an
autoimmune disorder which cause
multiple organ failure
pathognomonic sign: Butterfly rash in
the face, Photophobia ) , peritoneal
dialysis, etc.
Clinical Manifestations
• Increasing dyspnea
• Dullness or flatness to percussion
(over areas of fluid) with minimal or
absent breath sounds
• Normal percussion sound of the lungs:
Resonance
Dx Evaluation
• Chest x-ray
• Thoracentesis – biochemical, and
cytologic studies of pleural fluid
• Pallative and Diagnostic
• Physical examination
• Pleuroscopy (visual exploration of
pleural space through a thoracoscope
inserted into the pleural space); pleural
biopsy (aspiration of lung tissues#
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Tx
• Thoracentesis
• Tube drainage (chest catheter)
• Radiation of the chest wall
• Surgical procedures to control malignant
effusions – parietal pleurectomy; pleural
abrasion. Or lobectomy depending on
the doctors order
ATELECTASIS
- Closure or collapse of Alveoli
- is the collapse of the lung tissue at any
structural level (segmental, basilar or lobar)
-may be acute or chronic and may cover a
broad range of pathophysiology changes, from
micro to macro atelectasis
S/s
• Cough
• Sputum production
• Low grade fever
• respiratory distress
• Dyspnea
• Tachycardia
• Tachypnea
• Pleural pain- pt will be complaining of
chest pain
• Central cyanosis
Mgt
• Frequent turning: STS
• Early ambulation: if not ambulated there
will be collapsed of lung
• Deep breathing exercise to promote
lung expansion
• Use of incentive spirometry
• Coughing exercise
• Suctioning secretions (3)
• Nebulization as prescribed (1)
• Postural drainage (2)
Occupational Lung Diseases
Pneumoconioses
- Are group of diseases caused by
inhalation of certain inorganic and
organic dusts
1. Asbestosis
- Is a chronic inflammatory medical
condition affecting the parenchymal
tissue of the lungs
- It occurs after long term, heavy
exposure to asbestos e.g. in mining
S/s
• Shortness of breath
• Coughing
• Respiratory failure
Tx
• There is no curative treatment
• Oxygen therapy
• Supportive treatment of symptoms
includes resp physiotherapy by postural
drainage, chest percussion, and
vibration
• Nebulized medications
2. Silicosis
- Also known as:
- Grinder’s disease
- Potter’s Rot
-Is a form of occupational lung disease
caused by inhalation of crystalline silica dust
4 of 5
 -Is marked by inflammation and • Oxygen administration
scarring in form of nodular lesions in the upper • Bronchodilators.
lobes of the lungs • Lung transplantation

S/s
• Dyspnea exacerbated by exertion
• Dry or severe cough, often persistent
and accompanied by hoarseness of the
throat
• Fatigue
• Tachypnea
• Loss of appetite
• Chest pain
• Fever
• Gradual dark shallow rifts in nails
eventually leading to cracks as protein
fibers within nail beds are destroyed.
In advanced cases, the following may
also occur:
• Cyanosis
• Cor pulmonale –inflammation of the
right ventricle
• Respiratory insufficiency

At risk occupations:
-construction
-Mining
-Sandblasting
-masonry
-demolition
-manufacturing of class and metal products
-plumbing
- Painting

Tx
• Stopping further exposure to silica and
other lung irritants, including tobacco
smoking
• Cough suppressants
• Antibiotics and antitubercular agents to
prevent tuberculosis.
• Chest physiotherapy

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