Cabucos, Shania Laine BSN 3-D September 15, 2020

NCM 112 CI: Mr. Fervi B. Kwek, RN, MAN

A. Pulmonary Edema
Etiology

 Congestive heart failure

- The most common cause of pulmonary edema is congestive heart failure (CHF). Heart failure
happens when the heart can no longer pump blood properly throughout the body. This creates a
backup of pressure in the small blood vessels of the lungs, which causes the vessels to leak fluid.
- In a healthy body, the lungs will take oxygen from the air you breathe and put it into the
bloodstream. But when fluid fills your lungs, they cannot put oxygen into the bloodstream. This
deprives the rest of the body of oxygen.

Other medical conditions:

Other less common medical conditions that can cause pulmonary edema include:

 heart attack, or other heart diseases

 leaking, narrowed, or damaged heart valves
 sudden high blood pressure
 pneumonia
 kidney failure
 lung damage caused by severe infection
 severe sepsis of the blood, or blood poisoning caused by infection
Signs & symptoms
- In cases of pulmonary edema, your body will struggle to gain oxygen. This is due to the amount
of increasing fluid in the lungs preventing oxygen moving into the bloodstream. Symptoms may
continue to worsen until you get treatment.
- Symptoms depend on the type of pulmonary edema.

 Long-term pulmonary edema

The symptoms for long-term pulmonary edema include:

 shortness of breath when being physically active
 difficulty breathing when lying down
 wheezing
 waking up at night with a breathless feeling that goes away when you sit up
 rapid weight gain, especially in the legs
 swelling in the lower part of the body
 fatigue

 High-altitude pulmonary edema

Pulmonary edema due to altitude sickness, or not getting enough oxygen in the air, will have
symptoms that include:
 headaches
 irregular, rapid heartbeat
 shortness of breath after exertion and during rest
 coughing
 fever
 difficulty walking uphill and on flat surfaces
Diagnostic Procedures
You doctor will look for fluid in your lungs, or symptoms caused by its presence. They will perform a
basic physical examination and listen to your lungs with a stethoscope, looking for:

 an increased heart rate

 rapid breathing
 a crackling sound from your lungs
 any abnormal heart sounds
Your doctor may also look at your neck for fluid buildup, legs and abdomen for swelling, and if you have
pale or blue-colored skin. They will also discuss your symptoms, and ask about your medical history. If
they believe you have fluid in your lungs, they’ll order additional tests.
Examples of tests used in diagnosing pulmonary edema include:

 complete blood count

 echocardiogram, or an ultrasound, to check for abnormal heart activity
 chest X-ray to see fluid
 blood tests to check oxygen levels
 electrocardiogram (ECG) to look for heart rhythm problems or signs of a heart attack

Medical/Surgical Management
Pulmonary edema is a serious condition that requires quick treatment. Oxygen is always the first line of
treatment for this condition. Your healthcare team may prop you up and deliver 100 percent oxygen
through an oxygen mask, nasal cannula, or positive pressure mask.
Your doctor will also diagnose the cause of pulmonary edema and prescribe the appropriate treatment for
the underlying cause.
Depending on your condition and the cause of your pulmonary edema, your doctor may also give:

 Preload reducers. These help decrease pressures from the fluid going into your heart and lungs.
Diuretics also help reduce this pressure by making you urinate, which eliminates fluid.
 Afterload reducers. These medications dilate your blood vessels and take pressure off your heart.
 Heart medications. These will control your pulse, reduce high blood pressure, and relieve
pressure in arteries and veins.
 Morphine. This narcotic is used to relieve anxiety and shortness of breath. But fewer doctors
today use morphine due to the risks.
In severe cases, people with pulmonary edema may need intensive or critical care.
In other cases of pulmonary edema, you may need treatment to help you breathe. A machine will deliver
oxygen under pressure to help get more air into your lungs. Sometimes this can be done with a mask or
cannula, also called Continuous Positive Airway Pressure (CPAP).
Nursing Management
Patient Monitoring

 Continuously monitor oxygenation status with pulse oximetry monitoring.

 Monitor ECG for dysrhythmia development that may be related to hypoxemia, acid-base
imbalance, or ventricular irritability.
 Calculate arterial-alveolar oxygen tension ratio as an index of gas exchange efficiency.
 Document hourly the input and output to monitor fluid status. Obtain daily weights.
Patient Assessment

 Measure HR, RR, and BP every 15 minutes to evaluate the patient’s response to therapy and to
detect cardiopulmonary deterioration.
 Assess the patient for changes that may indicate respiratory compromise, necessitating intubation
and mechanical ventilation.
Diagnostic Assessment

 Review ABGs for hypoxemia (Pao2 < 60 mm Hg) and acidosis (pH < 7.35), which may further
compromise tissue perfusion and to indicate need for mechanical ventilation.
 Review serial chest radiographs for worsening or resolving pulmonary congestion.
 Review lactate levels as an indicator of anaerobic metabolism.
Patient Management

 Provide supplemental oxygen via mask as indicated.

 Administer diuretic agents or nesiritide to reduce circulating volume, which will improve gas
exchange.
 Monitor urine output and electrolytes.
 Administer vasodilating agents to redistribute fluid volumes, which will facilitate gas exchange.
 Morphine sulfate maybe ordered to promote preload and afterload reduction and to decrease
anxiety.
B. Acute Respiratory Failure
Etiology
 Obstruction
- When something lodges in your throat, you may have trouble getting enough oxygen into your
lungs. Obstruction can also occur in people with chronic obstructive pulmonary disease
(COPD) or asthma when an exacerbation causes the airways to become narrow.
 Injury
- An injury that impairs or compromises your respiratory system can adversely affect the amount
of oxygen in your blood. For instance, an injury to the spinal cord or brain can immediately affect
your breathing. The brain tells the lungs to breathe. If the brain can’t relay messages due to injury
or damage, the lungs can’t continue to function properly.
- An injury to the ribs or chest can also hamper the breathing process. These injuries can impair
your ability to inhale enough oxygen into your lungs.

 Chronic bronchitis and emphysema (COPD)

 Pneumonia
 Pulmonary edema
 Pulmonary fibrosis
 Asthma
 Pneumothorax
 Pulmonary embolism
 Pulmonary arterial hypertension
 Pneumoconiosis
 Granulomatous lung diseases
 Cyanotic congenital heart disease
 Bronchiectasis
 Adult respiratory distress syndrome
 Fat embolism syndrome
 Kyphoscoliosis
 Obesity

Signs & symptoms

The symptoms of acute respiratory failure depend on its underlying cause and the levels of carbon dioxide
and oxygen in your blood.
People with a high carbon dioxide level may experience:

 rapid breathing
 confusion
  People with low oxygen levels may experience:
 an inability to breathe
 bluish coloration in the skin, fingertips, or lips
People with acute failure of the lungs and low oxygen levels may experience:

 restlessness
 anxiety
 sleepiness
 loss of consciousness
 rapid and shallow breathing
 racing heart
 irregular heartbeats (arrhythmias)
 profuse sweating

Diagnostic Procedures

Acute respiratory failure requires immediate medical attention. You may receive oxygen to help you
breathe and to prevent tissue death in your organs and brain.

After your doctor stabilizes you, he or she will take certain steps to diagnose your condition, such as:
 perform a physical exam
 ask you questions about your family or personal health history
 check your body’s oxygen and carbon dioxide levels level with a pulse oximetry device and an
arterial blood gas test
 order a chest X-ray to look for abnormalities in your lungs

Medical/Surgical management
Treatment usually addresses any underlying conditions you may have. Your doctor will then treat your
respiratory failure with a variety of options.

 Your doctor may prescribe pain medications or other medicines to help you breathe better.
 If you can breathe adequately on your own and your hypoxemia is mild, you may receive
oxygen from an oxygen tank to help you breathe better. Portable air tanks are available if your
condition requires one.
 If you can’t breathe adequately on your own, your doctor may insert a breathing tube into your
mouth or nose, and connect the tube to a ventilator to help you breathe.
 If you require prolonged ventilator support, an operation that creates an artificial airway in the
windpipe called a tracheostomy may be necessary.
 You may receive oxygen via an oxygen tank or ventilator to help you breathe better.
 Correct hypoxemia: non-invasive positive pressure ventilation (NPPV)
 Reduce preload: upright position, diuretics, nitroglycerin, and treating the underlying cause.
 Reduce after load: Antihypertensive such as nitroprusside and Morphine
 Support perfusion: The left ventricle is supported by using isotropic medication such as
dobutamine, monitor --urine output and an intra-aortic balloon pump (IABP)

Nursing management

 Monitoring patient responses and arterial blood gases

 Monitoring vital signs
  Turning, mouth care, skin care, and range of motion
 Teaching about the underlying disorders
 Assists intubations procedures

C. Acute Respiratory Distress Syndrome

Etiology
ARDS is primarily caused by damage to the tiny blood vessels in your lungs. Fluid from these vessels
leaks into the air sacs of the lungs. These air sacs are where oxygen enters and carbon dioxide is removed
from your blood. When these air sacs fill with fluid, less oxygen gets to your blood.
Some common things that may lead to this type of lung damage include:

 inhaling toxic substances, such as salt water, chemicals, smoke, and vomit
 developing a severe blood infection
 developing a severe infection of the lungs, such as pneumonia
 receiving an injury to the chest or head, such as during a car wreck or contact sports
 overdosing on sedatives or tricyclic antidepressants
Signs & Symptoms
The symptoms of ARDS typically appear between one to three days after the injury or trauma.
Common symptoms and signs of ARDS include:

 labored and rapid breathing

 muscle fatigue and general weakness
 low blood pressure
 discolored skin or nails
 a dry, hacking cough
 a fever
 headaches
 a fast pulse rate
 mental confusion
Diagnostic Procedures
- If you suspect that someone you know has ARDS, you should call 911 or take them to the
emergency room. ARDS is a medical emergency, and an early diagnosis may help them survive
the condition.
- A doctor can diagnose ARDS in several different ways. There’s no one definitive test for
diagnosing this condition. The doctor may take a blood pressure reading, perform a physical
exam, and recommend any of the following tests:
 a blood test
 a chest X-ray
 a CT scan
 throat and nose swabs
 an electrocardiogram
 an echocardiogram
 an airway examination
- Low blood pressure and low blood oxygen can be signs of ARDS. The doctor may rely on an
electrocardiogram and echocardiogram to rule out a heart condition. If a chest X-ray or CT scan
then reveals fluid-filled air sacs in the lungs, a diagnosis for ARDS is confirmed.
- A lung biopsy can also be conducted to rule out other lung diseases. However, this is rarely done.
Medical/Surgical Management

 Oxygen - The primary goal of ARDS treatment is to ensure a person has enough oxygen to
prevent organ failure. A doctor may administer oxygen by mask. A mechanical ventilation
machine can also be used to force air into the lungs and reduce fluid in the air sacs.
 Management of fluids - Management of fluid intake is another ARDS treatment strategy. This
can help ensure an adequate fluid balance. Too much fluid in the body can lead to fluid buildup in
the lungs. However, too little fluid can cause the organs and heart to become strained.
 Medication - People with ARDS are often given medication to deal with side effects. These
include the following types of medications:
 pain medication to relieve discomfort
 antibiotics to treat an infection
 blood thinners to keep clots from forming in the lungs or legs
 Pulmonary rehabilitation - People recovering from ARDS may need pulmonary rehabilitation.
This is a way to strengthen the respiratory system and increase lung capacity. Such programs can
include exercise training, lifestyle classes, and support teams to aid in recovery from ARDS.
Nursing Management

 Identify and treat cause of the Acute respiratory distress syndrome

 Administer oxygen as prescribed.
 Position client in high fowler’s position.
 Restrict fluid intake as prescribed.
 Provide respiratory treatment as prescribed.
 Administer diuretics, anticoagulants or corticosteroids as prescribed.
 Prepare the client for intubation and mechanical ventilation using PEEP.
D. Pulmonary Hypertension
Etiology

 Diseases that affect flow out of the heart to the rest of the body result in backflow of
blood (stacking of blood) that raises pulmonary venous pressures leading to pulmonary
hypertension.
 Hypoxic pulmonary vasoconstriction is the process in which the lung vessels narrow in attempt to
divert blood from poorly functioning segments of the lung. For instance,
when pneumonia develops, a portion of lung becomes inflamed and works poorly in performing
the functions of the lung (to add oxygen and remove carbon dioxide from the blood). This process
diverts blood from these poorly working areas and sends it to better functioning lung tissue.
However, a problem develops when all the blood has a low oxygen level (hypoxia). This causes
constriction of the vessels on the pulmonary arterial side and hence raises the pressure.
 Remodeling of blood vessels also occurs in some diseases whereby the inner lining (lumen) of the
vessel becomes narrowed due to inappropriate growth of the tissue within and around the vessel.
Masses and scarring from other diseases can compress and narrow vessels causing increased
resistance to flow resulting in elevation of pressures.
 In a fairly common parasitic infection in the Middle East (schistosomiasis), the blood vessels in
the lung become blocked by the parasites causing pulmonary artery hypertension.
 Some substances cause constriction of the blood vessels. Pulmonary hypertension has been rarely
reported with the use of anti-obesity drugs, such as dexfenfluramine (Redux) and Fen/Phen.
These medications have seen been removed from the market. Some street drugs, such
as cocaine and methamphetamines, can cause severe pulmonary hypertension.
 Some diseases raise pulmonary pressures to cause pulmonary artery hypertension for unclear
reasons. Perhaps an unknown toxin or chemical effects the blood vessels by causing constriction
or inappropriate growth of the tissue within or around the vessel. For example, there is a
condition known as portopulmonary hypertension that is a result of liver failure. When these
individuals receive a liver transplant, the pulmonary hypertension disappears suggesting that the
failing liver is unable to clear some biochemical that leads to pulmonary artery hypertension.
Signs & Symptoms

 Shortness of breath that worsens with activity

 Other common complaints are cough, fatigue, dizziness, and lethargy.
 With the advancement of the condition and ensuing right heart failure, shortness of breath may
become worse and retention of fluid in the body may increase (due to failure of the heart to pump
blood forward) resulting in swelling in the legs.
 People may also complain of chest pain and angina.
 Depending on the underlying associated disease, pulmonary artery hypertension can have other
manifestations. For example, characteristic skin changes seen in scleroderma, or the signs of liver
disease seen in portopulmonary hypertension.
Signs of pulmonary hypertension may include:

 Rapid breathing, hypoxia (low oxygen level in the blood), and swelling in the legs.
 In severe pulmonary hypertension, the health care professional may hear louder than normal
components of heart sounds when he or she listens to the heart with a stethoscope (auscultation).
 The doctor may also feel elevation of the chest wall when the heart pumps and this may indicate
enlargement of the right side of the heart suggestive of pulmonary hypertension (right ventricular
heave).
Diagnostic Procedures
- Pulmonary hypertension is diagnosed by measuring the pulmonary pressures by either ultrasound
of the heart (echocardiogram) or right heart catheterization.
Medical/Surgical Management
- The treatment for pulmonary hypertension can include oxygen, diuretics, blood thinners,
medications that open the pulmonary arteries, and treatments for any underlying disease.
- Echocardiogram, Doppler, heart catheterization - Many tests, such as echocardiogram, may be
performed that may give clues to the possibility of pulmonary hypertension. It is important that a
Doppler study be performed with the echocardiogram, which enables the doctor to approximate
the pulmonary artery pressures. These values are calculated based on the sound quality of the
wave approaching and leaving the echocardiogram machine sensor/probe. This is based on the
principle that explains why the sound of an approaching and then passing train varies.
Nursing Management

 Review clients at risk as noted in Related Factors as well as individuals with conditions that stress
the heart
 Check laboratory data (cardiac markers, complete blood cell count, electrolytes, ABGs, blood
urea nitrogen and creatinine, cardiac enzymes, and cultures, such as blood, wound or secretions).
 Monitor and record BP. Measure in both arms and thighs three times, 3–5 min apart while patient
is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate
technique
 Note presence, quality of central and peripheral pulses.
 Auscultate heart tones and breath sounds
 Observe skin color, moisture, temperature, and capillary refill time.
 Note dependent and general edema.
 Evaluate client reports or evidence of extreme fatigue, intolerance for activity, sudden or
progressive weight gain, swelling of extremities, and progressive shortness of breath.
Therapeutic Interventions

 Provide calm, restful surroundings, minimize environmental activity and noise. Limit the number
of visitors and length of stay.
 Maintain activity restrictions (bedrest or chair rest); schedule periods of uninterrupted rest; assist
patient with self-care activities as needed
 Provide comfort measures (back and neck massage, elevation of head).
 Instruct in relaxation techniques, guided imagery, distractions.
E. Pulmonary Heart Disease
Etiology
- Two causes are vascular changes as a result of tissue damage (e.g. disease, hypoxic injury), and
chronic hypoxic pulmonary vasoconstriction. If left untreated, then death may result. The heart
and lungs are intricately related; whenever the heart is affected by a disease, the lungs risk
following and vice versa.
 Acute respiratory distress syndrome (ARDS)
 COPD
 Primary pulmonary hypertension
 Blood clots in lungs
 Kyphoscoliosis
 Interstitial lung disease
 Cystic fibrosis
 Sarcoidosis
 Obstructive sleep apnea (untreated)
 Sickle cell anemia
 Bronchopulmonary dysplasia (in infants)

Signs & Symptoms

The predominant symptoms of compensated cor pulmonale are related to the pulmonary disorder and
include chronic productive cough, exertional dyspnea, wheezing respirations, easy fatigability, and
weakness. When the pulmonary disease causes RV failure, these symptoms may be intensified.
Dependent edema and right upper quadrant pain may also appear. The signs of cor pulmonale include
cyanosis, clubbing, distended neck veins and tricuspid regurgitation, an RV heave or gallop (or both),
prominent lower sternal or epigastric pulsations, an enlarged and tender liver, dependent edema, and
ascites. Severe lung disease can be a cause of low cardiac output by reducing LV filling and subsequently
LV preload and stroke volume. RV volume and function differ depending on the degree of emphysema
present in patients with COPD; those with greater degrees of emphysema have smaller RV volumes and
mass and a lower RVEF as assessed by cardiac MRI than those with less emphysema.
Diagnostic Procedures

 Chest x-ray – right ventricular hypertrophy, right atrial dilatation, prominent pulmonary artery
 ECG – right ventricular hypertrophy, dysrhythmia, P pulmonale (characteristic peaked P wave)
 Thrombophilia screen- to detect chronic venous thromboembolism (proteins C and
S, antithrombin III, homocysteine levels
Medical/Surgical Management
The treatment for cor pulmonale can include the following:
-  antibiotics, expectorants, oxygen therapy, diuretics, digitalis, vasodilators, and anticoagulants.
Some studies have indicated that Shenmai injection with conventional treatment is safe and
effective for cor pulmonale (chronic)
- Treatment requires diuretics (to decrease strain on the heart).Oxygen is often required to resolve
the shortness of breath. Additionally, oxygen to the lungs also helps relax the blood vessels and
eases right heart failure. When wheezing is present, the majority of individuals require
a bronchodilator. A variety of medications have been developed to relax the blood vessels in the
lung, calcium channel blockers are used but only work in few cases and according to NICE are
not recommended for use at all.
- Anticoagulants are used when venous thromboembolism is present. Venesection is used in severe
secondary polycythemia (because of hypoxia), which improves symptoms though survival rate
has not been proven to increase. Finally, transplantation of single/double lung in extreme cases of
cor pulmonale is also an option.
Nursing Management

 Monitor ventilators
 Monitor heart and lungs
- O2
- Na Restriction diet
- Diuretics
- Stop smoking
F. Pulmonary Embolism
Etiology

 Trauma. Trauma anywhere in the body could cause PE especially if a clot is released from the
venous system.
 Surgery. Certain surgical procedures such as orthopedic, major abdominal, pelvic, and
gynecologic surgeries could cause PE.
 Hypercoagulable states. A patient with hypercoagulability disorders would most likely develop a
clot that could result in PE.
 Prolonged immobility. Being unable to move for a prolonged time predisposes a person to PE.

Signs & Symptoms

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the
size of the clots, and whether you have underlying lung or heart disease.
Common signs and symptoms include:

 Shortness of breath. This symptom typically appears suddenly and always gets worse with
exertion.
 Chest pain. You may feel like you're having a heart attack. The pain is often sharp and felt when
you breathe in deeply, often stopping you from being able to take a deep breath. It can also be felt
when you cough, bend or stoop.
 Cough. The cough may produce bloody or blood-streaked sputum.
Other signs and symptoms that can occur with pulmonary embolism include:

 Rapid or irregular heartbeat

 Lightheadedness or dizziness
 Excessive sweating
 Fever
 Leg pain or swelling, or both, usually in the calf caused by a deep vein thrombosis
 Clammy or discolored skin (cyanosis)
Diagnostic Procedures
If your doctor suspects a pulmonary embolism, you’ll have a number of tests,  such as a chest X-ray or
an ultrasound scan to see if you have a blood clot in your leg, and tests to check how well your lungs are
working.
Based on your doctor’s assessment, you may also have specialised tests such as:

 A blood test to look for a protein called D-dimer. High levels of D-dimer in your blood suggest
that pieces of blood clot are loose in your bloodstream.
 A computerised tomography pulmonary angiography (CTPA) to see the blood vessels in your
lungs. You are injected with a dye that helps to show your blood vessels and a scanner uses X-
rays to build a detailed picture of the blood flow in your lungs.
 A ventilation-perfusion scan, also called a V/Q scan or isotope lung scanning, to examine the
flow of air and blood in your lungs. If the scan shows parts of your lungs have air in them but no
blood supply, this may be the result of a pulmonary embolism. You will be asked to inhale a
slightly radioactive gas and given an injection of slightly radioactive material. The radioactivity
 in this test is harmless to adults. But women who are, or might be, pregnant should tell the
radiographer.
 Leg vein ultrasound to confirm you have a clot in the leg. This is not necessary if you’ve been
diagnosed with clots by one of the other methods.
Medical/Surgical Management
Medications

Medications include different types of blood thinners and clot dissolvers.

 Blood thinners (anticoagulants). These drugs prevent existing clots from enlarging and new
clots from forming while your body works to break up the clots. Heparin is a frequently used
anticoagulant that can be given through the vein or injected under the skin. It acts quickly and is
often overlapped for several days with an oral anticoagulant, such as warfarin, until it becomes
effective, which can take days.

Newer oral anticoagulants work more quickly and have fewer interactions with other medications.
Some have the advantage of being given by mouth, without the need for overlap with heparin.
However, all anticoagulants have side effects, and bleeding is the most common.

 Clot dissolvers (thrombolytics). While clots usually dissolve on their own, sometimes

thrombolytics given through the vein can dissolve clots quickly. Because these clot-busting drugs
can cause sudden and severe bleeding, they usually are reserved for life-threatening situations.
Surgical and other procedures

 Clot removal. If you have a very large, life-threatening clot in your lung, your doctor may
suggest removing it via a thin, flexible tube (catheter) threaded through your blood vessels.

 Vein filter. A catheter can also be used to position a filter in the body's main vein (inferior vena
cava) that leads from your legs to the right side of your heart. This filter can help keep clots from
going to your lungs. This procedure is typically reserved for people who can't take anticoagulant
drugs or when they have had recurrent clots despite use of anticoagulants. Some filters can be
removed when no longer needed.
Ongoing care

Because you may be at risk of another deep vein thrombosis or pulmonary embolism, it's important to
continue treatment, such as remaining on blood thinners, and be monitored as often as suggested by your
doctor. Also, keep regular doctor visits to prevent or treat complications.

Nursing Management

 Prevent venous stasis. Encourage ambulation and active and passive leg exercises to prevent
venous stasis.
 Monitor thrombolytic therapy. Monitoring thrombolytic and anticoagulant therapy through INR
or PTT.
 Manage pain. Turn patient frequently and reposition to improve ventilation-perfusion ratio.
 Manage oxygen therapy. Assess for signs of hypoxemia and monitor the pulse oximetry values.
 Relieve anxiety. Encourage the patient to talk about any fears or concerns related to this
frightening episode.
G. Sarcoidosis
Etiology

The exact cause of sarcoidosis is unknown. However, gender, race, and genetics can increase the risk of
developing the condition:

 Sarcoidosis is more common in women than in men.

 People of African-American descent are more likely to develop the condition.
 People with a family history of sarcoidosis have a significantly higher risk of getting the disease.
Sarcoidosis rarely occurs in children. Symptoms usually appear in people between the ages of 20 and 40.
Signs & Symptoms
Some people with sarcoidosis don’t have any symptoms. However, general symptoms may include:

 Fatigue
 Fever
 weight loss
 joint pain
 dry mouth
 nosebleeds
 abdominal swelling

Symptoms vary depending on the part of your body that’s affected by the disease. Sarcoidosis can
occur in any organ, but it most commonly affects the lungs. Lung symptoms can include:

 a dry cough
 shortness of breath
 wheezing
 chest pain around your breastbone

Skin symptoms can include:

 skin rashes
 skin sores
 hair loss
 raised scars

Nervous system symptoms can include:

 seizures
 hearing loss
 headaches

Eye symptoms can include:

 dry eyes
 itchy eyes
 eye pain
 vision loss
 a burning sensation in your eyes
 a discharge from your eyes

Diagnostic Procedures
Can be difficult to diagnose sarcoidosis. Symptoms can be similar to those of other diseases, such
as arthritis or cancer. Your doctor will run a variety of tests to make a diagnosis.
Your doctor will first perform a physical examination to:

 check for skin bumps or a rash

 look for swollen lymph nodes
  listen to your heart and lungs
 check for an enlarged liver or spleen
 Based on the findings, your doctor may order additional diagnostic tests:
 A chest X-ray can be used to check for granulomas and swollen lymph nodes.
 A chest CT scan is an imaging test that takes cross-sectional pictures of your chest.
 A lung function test can help determine whether your lung capacity has become affected.
 A biopsy involves taking a sample of tissue that can be checked for granulomas.
Your doctor may also order blood tests to check your kidney and liver function.
Medical/Surgical Management
There’s no cure for sarcoidosis. However, symptoms often improve without treatment. Your doctor may
prescribe medications if your inflammation is severe. These can include corticosteroids or
immunosuppressive medications (medications that suppress your immune system), which can both help
reduce inflammation.
Treatment is also more likely if the disease affects your:

 eyes
 lungs
 heart
 nervous system
The length of any treatment will vary. Some people take medication for one to two years. Other people
may need to be on medication for much longer.
Nursing Management
H. Pneumoconiosis
Etiology
- is caused by workplace exposure to dusts in the air that are breathed into the lungs
(inhaled). Asbestos, silica, and coal dust are the most common causes
of pneumoconiosis. Pneumoconiosis can be prevented with appropriate protection.
Signs & Symptoms
 difficulty breathing, or shortness of breath.
 a cough, which may produce phlegm.
 tightness in the chest.

Diagnostic Procedures
 Personal history of work exposure.
 Physical examination.
 Chest X-ray or CT scan to look for lung nodules, masses and interstitial disease.
 CT scan of the chest.
 Pulmonary function studies, including blood gasses.
 Biopsy.

Medical/ Surgical Management

There isn't any treatment that can remove the specks of mineral dust in your lungs. Instead, most
treatments try to keep your lungs working.
You may need to stop doing the work that led to your pneumoconiosis. If you're a smoker, your doctor
will recommend you quit to improve your lung health.
Your doctor may prescribe an inhaled medication such as a bronchodilator or corticosteroid.
Bronchodilators open up your airways if you have trouble breathing, while corticosteroids can curb
airway inflammation.
If your tests show low levels of oxygen in your blood, your doctor may suggest you get
"supplemental oxygen therapy." In this treatment, you breathe in extra oxygen through a mask or prongs
in your nose. The oxygen you get this way is stored in a tank or some other kind of device. Some people
use this treatment throughout the day, while others may need it only at night.
Nursing Management

 Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory
muscles.
 Assess cough effectiveness and productivity
 Auscultate lung fields, noting areas of decreased or absent airflow and adventitious
breath sounds: crackles, wheezes.
 Observe the sputum color, viscosity, and odor. Report changes.
 Assess the patient’s hydration status.
Therapeutic Interventions

 Elevate head of bed, change position frequently.

 Teach and assist patient with proper deep-breathing exercises. Demonstrate proper
splinting of chest and effective coughing while in upright position. Encourage him to do
so often.
 Suction as indicated: frequent coughing, adventitious breath sounds, desaturation related
to airway secretions.
 Maintain adequate hydration by forcing fluids to at least 3000 mL/day unless
contraindicated (e.g., heart failure). Offer warm, rather than cold, fluids
 Assist and monitor effects of nebulizer treatment and other respiratory physiotherapy:
incentive spirometer, IPPB, percussion, postural drainage.
 Perform treatments between meals and limit fluids when appropriate.
 Encourage ambulation.
I. chest Trauma