MEDICAL SURGICAL (MS) LECTURE

RESPIRATORY SYSTEM: ALTERATION IN OXYGENATION

​
ORGANS AND ASSOCIATED STRUCTURES OF THE RESPIRATORY SYSTEM

FUNCTIONS OF RESPIRATORY SYSTEM

1. Oxygenation process and Ventilation

Note:

− As a human we consume Oxygen (O2) and expel Carbon

dioxide (CO2)

TWO MAIN PARTS

A. Upper Respiratory Tract (URT)

Consist of the following organs:

EXTERNAL PORTIONS

❖ NOSE
− Organ for smelling
− Supported by nasal bones and cartilages that is from our facial structure
− Anterior nares (2 nostrils); external opening which air can enter and leave the nasal cavity
− There are internal hairs that guard the nostrils this prevents entry of large particles carried by the air
INTERNAL PORTIONS

❖ NASAL CAVITY
− Hollow space behind the nose
− Separated by the Nasal Septum which is composed of bone and cartilage
− Which is divided intro (3) passageways by the Nasal Conchae
− Mucus secretions are moved by the action of Cilia
Note

− Nasal Septum is usually straight at birth but it can bend as the result of birth injury, the septum bend one side
or the other one if such deviated septum is severe, it may obstruct the nasal cavity which makes BREATHING
DIFFICULT

CROSS-SECTION OF NASAL CAVITY

TURBINATE BONES

− Also known as Conchae

− Warms the air that we breath
− Humidifies the air
− Assists in filtering air (dust and pollens)
− Nasal Conchae supports the mucus membrane that lines the Nasal cavity
− It also helps increase the mucus membranes surface area
Functions:

− Passageway for air to ass to and from the lung’s impurities

− Humidifies and warms the air
− Olfaction (sense of smell) which diminishes with age (Usually at the age of 70 and above; because the
formation of our mucus membrane decreases; mucus less the production that is why older age has a
decreased in sense of smell; no longer sharp)

Notes:

Air coming from outside, going upward to the NOSE to the inside of our body through the NASOPHARYNX
going to the LUNGS

If there is a difficulty of breathing/ shortness of breath one particular intervention is to give artificial oxygen
(O2)

If it’s a dry air, then there’s a possibility that the mucus membrane of the nose might dry up and that will be
a PROBLEM. THAT IS WHY WE NEED TO HUMIDIFY IT with HUMIDIFIER.

DON’T FORGET TO CHECK FOR THE LEVEL OF FLUID/WATER ON THE HUMIDIFIER; IF ITS EMPTY
THEN YOU’RE GIVING THE CLIENT A DRY AIR

❖ PARANASAL SINUSES
− Four pairs of bony activities
− These paranasal sinuses are AIR FILLED spaces
o Frontal
o Ethmoidal
o Sphenoidal
o Maxillary
− Opens into the nasal cavity it is lined with nasal mucosa and ciliated pseudostratified
columnar epithelium

− Connected by a serious of ducts that drain into the Nasal Cavity

− Paranasal Sinuses helps to reduce the weight of the skull and is also used as resonant chamber
which affects the quality of our voice

❖ PHARYNX (Throat)
− Space behind the oral cavity, nasal
cavity and larynx; tubelike structure
connecting the nasal and oral cavities to
the larynx

− Act as the passageway of the food; from

the oral cavity down to the esophagus;
Also, for the air which passes from the nasal cavity to the larynx

− It also helps produce the sounds of speech

− Divided into three (3) regions
o Nasal
− Posterior to the nose above the soft palate
o Oral
 − Houses the facial or the palatine tonsils
o Laryngeal

− Extends from the hyoid bone to the cricoid cartilage

❖ LARYNX (Voice
box)

− Made of cartilaginous
epithelium lined
structure which
connects the
pharynx to the
trachea

− The Larynx is the

enlargement of
airway at the top of
the Trachea; It conducts air IN and OUT of the trachea

− For vocalization and protects the airway from foreign substances

− Facilitates coughing reflex
− The largest of the cartilage on the Larynx is the Thyroid (Adam’s apple), Cricoid and Epiglottic
cartilage

INSIDE THE LARYNX:

o Epiglottis

− A valve flap of cartilage covering the opening of the larynx during swallowing
o Glottis

− Opening between the vocal cords in the Larynx

o Thyroid Cartilage

− Largest of the cartilage structure, forms part of the Adams Apple

o Cricoid Cartilage

− ONLY complete cartilaginous ring in the larynx

− Usually used this during the process of intubation; called cricoid maneuver

o Arythenoid Cartilage

− Used in vocal cords movement with thyroid cartilages

− During normal breathing; The vocal cords are relaxed and glottis is in a triangular slit
o Vocal Cords

− Ligaments controlled by muscular movements producing sound

Notes:

Although the
major function of
the larynx is
vocalization, it
also protects the
lower airway
from foreign
substances and
facilitates
coughing, it is,
therefore
sometimes
referred to as
the
“WATCHDOG
OF THE
LUNGS”

Changing the
shapes of the pharynx and oral cavity and using the tongue and lips transform the sounds into words
 B. Lower Respiratory Tract (LRT)

❖ TRACHEA (Wind pipe)

− Windpipe (2.5cm in diameter, 12.5cm in length)
− Smooth muscle
− (2O) C-shaped rings of hyaline cartilages at
regular intervals

− These cartilaginous rings prevent the Trachea

from collapsing and blocking the airway

− Passages between the larynx and the bronchi; which primarily air
− Conducts air between the larynx and the bronchi

❖ LUNGS
− Paired elastic structure enclosed in the
thoracic cage

− Ventilation- Breathing mechanism;

Process of Oxygenation

− Air movement
o Inspiration- Inhalation
o Expiration- Exhalation
− ATMOSPHERIC PRESSURE- Provides
the force that moves air into the lungs

ANTERIOR VIEW OF THE LUNGS

− The Visceral and Parietal Pleura are almost entirely in contact with each other; The potential space
between them is called the Pleural cavity it has a thin film of serous fluid that lubricates surfaces; It
won’t produce friction as they move against one another during breathing; this fluid helps hold the
pleural membranes together.

❖ PLEURA
− Lining of the lungs, layers of serous membrane
− Visceral Pleura
 o Covers the lungs
− Parietal Pleura
o Lines the thorax
− Pleural Fluid
o Fluid between the pleura permitting smooth motion of
the lungs

o Too much fluid is dangerous; it might aggravate the

oxygen (presence of fluid)

❖ MEDIASTINUM

- In the middle of the thorax; The division of your thoracic cavity

− Visceral compartment of the thoracic cavity
− Extends from the sternum to the vertebral column
− Contains all the thoracic tissue outside the lungs

❖ LOBES
− Left lung
o Upper
o Lower lobes
− Right lung
o Upper
o Middle
o Lowe lobes
− Each lobe is subdivided into two or five segments separated fissures

❖ BRONCHI AND BRONCHIOLES

− Right and left bronchi begin at the carina
− Functions for air passage
 Right Bronchus
o Wider

o Shorter

o More vertical

Left Bronchus
o Narrower

o Longer

o More horizontal

Notes:

From the Trachea down to the Bronchial tree which branches from the two different airways; Left and Right
th
bronchi which is at the level of the 5 thoracic vertebra; Each bronchus enters in each perspective lung from
there you’ll see the Alveoli where the blood exchange, oxygenation, carbon dioxide is being done or
processed

Once your Diaphragm is damaged there will be a problem in breathing

❖ ALVEOLI
− Acinus (Acini)
o Respiratory unit
− Consist of:
o Respiratory bronchiole
o Alveolar duct
o Alveolar sac
− Functions for Gas exchange
− Oxygen breathing from the air passes from the alveoli into the blood and travels to the tissues
throughout the body

− Types of Alveolar Epithelial Cells

o Type I Pneumocytes
− Most abundant, thin and flat where gas exchange occur
o Type II Pneumocyte (Clara cells)
− Secreted the lung surfactant (liquid that serves to have less friction inside)
o Type III Pneumocytes
− Just a macrophage ingesting foreign material and acts as an important defense
mechanism

SUMMARY
PART DESCRIPTION FUCNTION
NOSE Part of face Nostrils provide entrance
centered above to nasal cavity; Internal
mouth, in and hairs begin to filter
 below space incoming air
between eyes
NASAL Hollow space Conducts air to pharynx;
CAVITY behind nose mucous lining filter
warms, and moistens
incoming air
PARANASAL Hollow spaces in Reduce weight of skull;
SINUSES certain skull bones serve as resonant
chambers
PHARYNX Chamber behind Passageway for air
nasal cavity, oral moving from nasal cavity
cavity, and larynx to larynx and for food
moving from oral cavity
to esophagus
LARYNX Enlargement at top Passageway for air;
of trachea prevents foreign objects
from entering trachea;
houses vocal cords
TRACHEA Flexible tube that Passageway for air;
connects larynx mucous lining continues
with bronchial tree to filter particles from
incoming air
BRONCHIAL Branched tubes Conducts air from
TREE that lead from trachea to alveoli;
trachea to alveoli mucous lining continues
to filter incoming air
LUNGS Soft, cone-shaped Contain air passages,
organs that occupy alveoli, blood vessels,
a large portion of connective tissues,
the thoracic cavity lymphatic vessels, and
nerves

FUNCTIONS OF THE RESPIRATORY SYSTEM

− Gas Exchange (Oxygen and Carbon dioxide)

o Gas exchange through ventilation, external respiration and cellular respiration
o Alveoli- Tiny air sacs that found in the lungs
o Cellular respiration is where cells use the Oxygen to breakdown sugar to obtain energy; Series of
metabolic processes that takes place within a cell

− Breathing- Movement of air

− Sound production
− Olfactory Assistance (Sense of smell)
− Protection- From dust and microbes entering body through mucus production (Cilia), cilia and coughing
PHYSIOLOGY OF RESPIRATION

2 MECHANICS OF BREATHING IN AND BREATHING OUT

o Exhalation and Inhalation

Physiology of Respiration:

− Atmospheric pressure outside of our body usually has an effect

on our breathing; Air outside through your atmospheric pressure
usually manages the ability of the air to enter.

− Air will pass through nasal cavity, air exchange will occur
(composition of oxygen, nitrogen, water, helium and carbon dioxide) muscles on our diaphragm helps the
ability of the respiration process; The muscles contract during inhalation lifting the ribs and pulling them
outward the diaphragm moves downward enlarging the chest cavity reduction air pressure cause air to enter
the lungs and expiration reverse these steps

NURSING ASSESSMENT
CLINICAL HISTORY

− Check for the presence of the following

o Dyspnea
o Orthopnea
o Precipitating factors of DOB
o Frequency of DOB
o Effect on activity
o Pain
 o Cyanosis

o Accumulation of mucus

o Sputum production

o Hemoptysis (Blood in the sputum)

o Cough

o Fatigue

o Clubbing of the fingers

o Weakness

o SOB

Notes:

Monitor the signs of any condition that would suggest that your client has problems with breathing. Ask your
client, know the significance of observation, and history taking. The subjective (what the client states) and
objective (overt or observable) cues

❖ CYANOSIS
− Bluish discoloration of Fingernails
− Lack of Oxygen that circulate in RBCs; this occurs when you don’t have enough Oxygen in the blood making
the skin or membrane turn into purplish blue color

❖ CLUBBING
− Occurs when the soft tissues on the fingertip is
becoming swollen or spongy; this straightens the
natural curvature of the nail bed causing club
appearance

− Symptom of the disease often of the HEART and

LUNGS which cause chronically low blood levels
or oxygen

❖ HEMOPTYSIS
− Couching of (bright red or rust) that may be admixed
with sputum and frothy

❖ HEMATEMESIS
− Vomiting of blood; dark red or brown maybe mixed
with food particles

FAMILY HISTORY

− Pulmonary Tuberculosis (PTB) most common

o Pulmonary I
PAST MEDICAL HISTORY

SOCIAL HISTORY

ENVIRONMENTAL/LIFESTYLE PATTERNS

PHYSICAL EXAMINATION

− Vital signs
o RR - 12-20 bpm
o HR - 60-100 bpm
o BP
o T
 o Pain scale

INSPECTION
o Barrel chest

o Funnel chest

o Pigeon chest

o Lordotic

o Kyphosis

Chest Wall Motion

− Vital component of the respiratory system. position, changes disturbance, joint orientation around the chest
wall, and results in performance modification of the respiratory muscles and movement surrounding the
ribcage and abdomen

CHEST CONFIGURATIONS

a. BARREL CHEST
− Occurs as a result of overinflation of the lungs,
which increases the anteroposterior diameter of the
thorax. It occurs with aging and is a hallmark sign
of emphysema and Chronic Obstructive
Pulmonary Disease (COPD).

− The term barrel chest describes a rounded bulging

chest that resembles the shape of a barrel.

− Barrel chest is not a disease, but it may indicate an

underlying condition. Barrel chest itself cannot be
treated, but once the underlying diseases will be
treated (emphysema, COPD) there will now be formation of the normal chest AGAIN

b. FUNNEL CHEST (Pectus Escavatum)

− Occurs in a depression on the lower portion of the sternum. Depression pushes and compresses the heart and
great vessels to the side. This will result in pushing the heart to the side and also results in murmurs.

− One of the causes of funnel chest is RICKKETS

o Rickkets - condition that affects bone development in children. It causes bone pain, poor growth
and soft weak bones, that usually causes bone deformities.

o In adults, this condition is called Osteomalasia or soft bones (pigeon chest)

c. PIGEON CHEST (Pectus

Carinatum)

− This is caused by the anterior

displacement of the sternum,
which increases the
anteroposterior diameter. This
may also occur in Rickkets, or
in severe kyphoscoliosis in even
morvan syndrome.

− Problems in the bone

development where bones
become brittle (kyphoscoliosis)

d. KYPHOSCOLIOSIS
− Characterized by elevation of the scapula
with corresponding S shaped spine.
This deformity limits lung expansion
within the thorax and occurs with
osteoporosis and other skeletal
disorders;

− A forward rounding of the back which

leads to hunchback or slouching
posture. S shaped both sides may
curve

o Scoliosis is either the left or right side curvature of the spine, either c or s shaped.
 PALPATION

− TACTILE FREMITUS (Tactile Vocal Fremitus)

o nine nine/ tres tres (bronchophony)
o E E (pectoriloquy)
o Check vibrations of the sound waves
NORMAL: Should be felt symmetrically along both sides
of the chest
ABNORMAL: When it is increased or decreased;

− Decreased: fremitus fluid/air outside the lungs

− Increased: fremitus consolidation
PERCUSSION

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

AUSCULTATION
(3) NORMAL BREATH SOUNDS:

a. BS vesicular - rustling/swishing sound, higher pitch on inspiration, fades on expiration

b. Bronchovesicular - equal lung sounds during inspiration to expiration periods
c. Tracheal - I/E are both loud
ABNORMAL BREATH SOUNDS

a. Inspiratory stridor
− High pitched wheezing sound as air enter the trachea and the bronchi
− Usually appears in inspiration which is seen in patients with laryngomalacia, foreign bodies, tumors,
infections.

o This usually happens when there is blockage of air in the oral cavity that is why there is a
high pitched wheezing sound

b. Rales/Rhonchi/Crackles
− Also known as adventitious breath sounds, which most likely means there is an accumulation
of fluid in the lungs

− Discrete non continuous sound resulting from a delayed reopening of a deflated airway
− Indicates underlying inflammation or congestion -usually seen in pneumonia, bronchitis, heart
failure, bronchiectasis, and pulmonary fibrosis

c. Wheezes
− Usually as a result of narrowing of the airway, producing a vibration in the larynx and transmitted
to the chest wall

− Commonly heard in asthma, bronchiectasis and chronic bronchitis

❖ EUPNIA
− Normal, breathing at 14-20 breaths/min

❖ BRADYPNEA
− Slower than normal rate (<10 breaths/min) with normal depth and regular rhythm. associated with
increased intracranial pressure, brain injury, and drug overdose

❖ TACHYPNEA
− Rapid shallow breathing >24 breaths/min. associated with pneumonia, pulmonary edema, metabolic
acidosis, septicemia, severe pain, rib fracture

❖ HYPOVENTILATION
− Shallow irregular breathing
 ❖

HYPERPNEA

− Increase depth of respiration

❖ HYPERVENTILATION/ KUSSMAUL’S RESPIRATION

− Increased rate and depth of breathing those results in decreased PaCO2 level. inspiration and
expiration nearly equal in duration. associated with exertion, anxiety, and metabolic acidosis.

− Called Kussmaul's respiration if associated with

diabetic ketoacidosis or renal origin.

❖ APNEA
− Period of cessation of breathing, time duration varies, apnea may occur briefly during other breathing
disorders, such as with sleep apnea, life threatening if sustained.

❖ CHEYNE- STROKE
− Regular cycle where the rate and depth of breathing
increase, then decrease until apnea (usually about
20 seconds) occurs.

− Duration of apnea may vary and progressively lengthen, therefore it is timed and reported.
Associated with heart failure, and damage to the respiratory center (drug induced, tumor, trauma)

❖ BIOT’S RESPIRATION
Periods of normal breathing (3-4 breaths), followed by varying period of apnea (usually 10-60 seconds).

− Also known as Ataxic breathing, associated with complete irregularity. associated with respiratory
depression resulting from drug overdose and brain injury, normally at the level of the medulla

❖ OBSTRUCTIVE
− Prolonged expiratory phase or respiration. associated with airway narrowing and seen in asthma,
COPD, and bronchitis

LUNG VOLUMES AND CAPACITIES

− Lung Volumes also known as Respiratory Volumes

− The air in our lungs is measured in terms of lung volume and capacities. The volume measures the amount of
air for one function such as during inhalation and exhalation and the capacity in any two or more volumes

− Ex. How much can be inhaled from a maximum exertion

 ❖ PULMONARY FUNCTION TEST (PFT)
− Pulmonary function testing measures how well you are breathing. There are different types of
pulmonary function tests that can be done

− Non-invasive test that shows how out lungs working

− Average human has 6L air in the body
o Spirometry

o Lung volume test (plethysmography)

o Gas diffusion test. (This test measures hoe oxygen

and other gases move from the lungs to the blood
stream)

o Exercise stress test. (This test looks at how exercise

affect lung function)

LUNG VOLUME TABLE

TERM SYM DESCRIPTIO NORMAL SIGNIFICANC
BOL N V E
TIDAL VT/ The volume of 500ml or The tidal
VOLUME TV air inhaled 5- volume may
and exhaled 10mg/kg not vary, even
with each with severe
breath disease
INSPIRATOR IRV The maximum 3000ml
Y RESERVE volume of air
VOLUME that can be
inhaled after a
normal
inhalation
EXPIRATORY ERV The maximum 1100ml Expiratory
RESERVE volume of air reserve
VOLUME that can be volume is
exhaled decreased
forcibly after a with restrictive
normal conditions,
exhalation such as
obesity
ascites,
pregnancy
RESIDUAL RV The volume of 1200ml Residual
VOLUME air remaining volume may
in the lungs be increased
after a with
maximum obstructive
exhalation disease

LUNG CAPACITIES
TERM SYMB DESCRIPT NORMAL SIGNIFICANCE
OL ION VALUE
VITAL VC The A decrease
CAPACITY maximum in vital
volume of capacity
air exhaled may be
from the found in
point of neuromuscu
maximum lar disease,
inspiration: generalized
VC= TV fatigue,
+IRV + atelectasis,
ERV pulmonary
4600ml edema,
COPD, and
obesity
INSPIRATO IC The 3500ml A decrease
RY maximum in
CAPACITY volume of inspiratory
air inhaled capacity
after may
normal indicate
expiration: restrictive
IC- TV + disease. It
IRV may also be
deceased in
obesity
FUNCTIONA FRC The 2300ml Functional
L RESIDUAL volume of residual
CAPACITY air capacity
remaining may be
in the lungs increased
after a with COPD
normal and
expiration: decreased
FRC= ERV in ARDS
 + RV and Obesity
TOTAL TLC The 5800ml Total lung
LUNG volume of capacity
CAPACITY air in the may be
lungs after decreased
a maximum with
inspiration restrictive
TLC- TV + disease
IRV +ERV such as
+ RV atelectasis
and
pneumonia
and
increased in
COPD

Notes:

Different efforts in breathing move different volumes of air in and out of the lungs.

Spirometry is a test that measures your air volume.

THREE DISTINCT RESPIRATORY VOLUME CAN BE MEASURED USING A SPIROMETRY
o tidal volume

o inspiratory reserve volume

o expiratory reserve volume

How to use the Incentive Spirometer

1. sit on the edge of the bed

2. hold spirometer in an upright position
3. place the mouthpiece in the mouth, be sure it is sealed by the lips tightly
4. breathe in slowly and deeply
5. hold the breath as long as possible, allowing the indicator to fall to the
bottom of the column

6. rest then repeat previous steps 1-5x every hour

AGE RELATED CHANGES IN THE RESPIRATORY SYSTEM

STR FUNCTIONA HX AND PHYSICAL
UCTUR L CHANGES FINDINGS
AL
CHANG
ES
DEFEN ↓ Nu ↓ Protection ↓ Cough reflex and
SE MECH. mber of against mucus
(RESPI Cilia and foreign ↑ Infection rate
AND ↓ Mucus particles History of respiratory
NONRESPI ↓ Co ↓ Protection infections, chronic
) ugh and against obstructive pulmonary
gag aspiration disease (COPD),
 reflex ↓ Antibody pneumonia
Los response to Risk factors: Smoking,
s of a antigens environmental, exposure
uniform ↓ Response to tuberculosis (TB)
or to hypoxia
consiste and
nt hypercapnia
ventilatio (chemorecep
n and/or tors)
blood
flow
LUNG ↓ Si ↑ Airway Unchanged total lung
ze of resistance capacity (TLC)
airway ↑ Pulmonary ↑ Residual volume (RV)
↑ compliance ↓ Inspiratory reserve
Diamete ↓ Expiratory volume (IRV)
r of flow rate ↓ Expiratory reserve
alveolar ↓ Oxygen volume (ERV)
ducts diffusion ↓ Forced vital capacity
↑ capacity (FVC) and Vital capacity
Collagen ↑ Dead (VC)
of space ↑ Functional residual
alveolar Premature capacity (FRC)
walls closure of ↓ PaO2
↑ airways ↑ CO2
Thickne ↑ Air
ss of trapping
alveolar ↓ Expiratory
membra flow rates
nes Ventilation-
↓ El perfusion
asticity mismatch
of ↓ Excessive
alveolar capacity
sacs ↑
Anteroposter
ior (AP)
diameter

CHEST WALL AND Calcification ↑ Rigidity Kyphosis, barrel chest

MUSCLES of and stiffness Skeletal changes
intercostal of thoracic ↑ AP diameter
cartilages cage Shortness of breath
Arthritis of ↓ ↑ Abdominal and
costovertebr Respiratory diaphragmatic breathing
al joints muscle ↓ Maximum expiratory
Osteoporoti strength flow rates
c changes ↑ Work of
↓ Muscle breathing
mass ↓ Capacity
Muscle for exercise
atrophy ↓ Peripheral
chemosensiti
vity
↑ Risk for
inspiratory
muscle
fatigue

BLOOD SPUTUM TEST

− ABG
Arterial Blood Gas

● measurements of blood pH and arterial oxygen and carbon dioxide

➔ PaO2 -arterial oxygen
➔ PaCO2
➔ PH
● assess the lungs to provide adequate oxygen and remove carbon dioxide with the ability of the
kidneys to reabsorb or excrete bicarbonate ions
Nursing Responsibilities
Pre test

○ choose site carefully

○ secure all equipments
- heparinized syringe needle (to prevent from blood to clot immediately), container with ice

○ Allen's Test- standard test to assess arterial blood supply of hand; radial artery harvesting
How to perform:
→ ask client to clench palm
→ occlude ulnar and radial artery (wait for 3-5 minutes)
→ Put finger on radial and ulnar artery
→ observe for flushes (after 5-15 secs, hands turns red = indication of good blood flow = positive test; if hand
is still pale = not good blood flow, not good site collection = negative test = check other hand for site)
Post test

○ apply firm pressure for 5 minutes

○ label specimen
○ place in container with ice
○ documentation
Arterial Blood Gas Analysis- checks level of oxygenation and pH of blood

AFB (Acid fast bacilli)/ Cytology/ Sputum

Sputum Exam

○ Identify pathogenic organism

○ Determine the presence of malignant cells
○ Assess hypersensitivity for any fungal
infection in cases of prolong antibiotic use,
steroids, and PCP (pneumocystis carinii
pneumonia)

○ Collected thru ET tube, by patients cough

mechanism, bronchoscopy,
tracheoesophageal aspiration and gastric
aspiration

○ Should be read within 2 hours of collection

How the test is Performed:

➢ Rinse the mouth with water only

➢ You will be asked to cough deeply and spit
any substance that comes up from your lungs
(sputum) into a special container.

➢ You may be asked to breath in a mist of salty

steam. This makes you cough more deeply
and produce sputum.

➢ If you still do not produce enough sputum, you

might have a procedure called bronchoscopy.

➢ To increase the accuracy, this test is

sometimes done 3 times, often 3 days in a
row. (specifically every morning)

Cultures

● Throat swabs in infections

● Throat cultures
● Nasal swabs
● Test used to diagnose bacterial infection in
 the nose and the throat.

● We could also check the sensitivity and

resistance of the bacteria for specific
antibiotic.

● Chest X ray
● CT scan
● MRI
● Fluoroscopic Studies
● Pulmonary Angiography
● Lung Scans
Nursing Intervention

○ Explain procedure to patients

○ Assess ability to remain still in confined
places

○ Evaluate patients for magnetic implants like

pacemakers, prosthetic valves, metallic clips

○ Consider contraindications like pregnancy,

allergies

○ Stop taking the metformin, days before the

test, pwede magkaroon ng lactic acidosis
specifically from the radio dye na pwedeng
ibigay as a contrast.

CT Pulmonary Angiogram (CTPA)

○ Takes pictures of the blood vessels that

runs from the heart to the lungs to your
pulmonary arteries in order to see those
embolus or emboli which blocks the
circulation on the lungs.

Pulmonary Angiography

Minimally invasive procedure that is

performed most frequently by an
interventional radiologist or interventional
cardiologist.

Endoscopic studies
Bronchoscopy

○ This is an invasive procedure to look

○ directly at the airways in the lungs using
a bronchoscope. Bronchoscope is a
lighted tube connected to a computer. It
is directly put in the mouth, either on the
oral or nasal, and this is move down to
the throat and the windpipe or trachea
and into the airways.

○ Direct inspection and examination of

your larynx, trachea, and bronchi using
your fiber optic scope, your flexible
bronchoscopy.

○ It could examine the tissues and may

collect secretions, biopsy, determine the
location and extent of the pathologic
process, obtain a tissue sample, and it
could determine a tumor that could be
resected surgically, bleeding sites.

○ Therapeutic; it can remove foreign

bodies, secretions, and lesions.

Two types of Bronchoscopy

● Fiberoptic o Thin flexible scope

○ Directed to the segmental bronchi
○ Allow increased visualization of the peripheral airways
 ○ Can be performed at bed side, thru ET and trach tube

● Rigid Bronchoscope
○ Hollow metal tube with light at its end
used for removal of foreign body,
see the source of massive hemoptysis
and perform Endobronchial surgery

○ Performed at the OR
Complications

○ Allergy to anesthesia
○ Infection due to instrumentation
○ Aspiration
○ Bronchospasm
○ Hypoxemia
○ Pneumothorax
○ Bleeding
○ Perforation
Nursing Interventions

Pre-Test/Intra-test

○ Signed consent form is obtained

○ NPO 6 hours prior
○ Explain the procedure to the patient
○ Alleviate anxiety and fear
○ May administer pre op meds as ordered
○ Remove denture and prostheses
Post test

○ NPO after the procedure UNTIL

GAG reflex has returned

○ Semi fowler’s position with head turn to

sides

○ Assess for lethargy and confusion

post op due to large doses of
anesthesia given

○ Observe for hypoxia, hypotension,

tachycardia

○ Hemoptysis and dyspnea

Thoracoscopy
- Direct visualization of your pleural cavity using an endoscope.
- Indicated for evaluation of pleural effusion
- Can be used for certain surgical procedure; video assisted thoracoscopic surgery – a type of surgery used to
diagnose and treat a variety of conditions that involves the chest area or the thorax; it uses a special video
camera called thoracoscope; it is a type of minimally invasive surgery.

Nursing Interventions
 • Follow up the patients at a health care facility or at home
• Minor activity restrictions
• Monitor for any shortness of breath
• Monitor chest drainage if with CTT
Thoracentesis

• Aspiration of pleural fluid in the pleural cavity

• Fine needle
• Specimen should be subjected to different exams like wet smear, culture and sensitivity, gram’s stain, AFB,
Diff count, pH, spec grav, total protein, determination
• Used for: o Removal of fluid and air from the pleural cavity
o Aspiration of pleural for analysis
o Biopsy
o Instillation of medication
Nursing Interventions:

• Check if CXR had been done to locate lesion

• Assess any allergy history
• Inform patient of the nature of the procedure
• Position the patient comfortable
o Sit on the edge of the bed, feat supported and arm and head on a padded over the bed table or may
lie on the unaffected side with HOD elevated 30 degrees
o Reassure patient
Biopsy

​• ​Pleural Biopsy
- Need to remove a sample of the pleura
- The biopsy is done to check the pleura for any disease or infection
• Lung Biopsy
• Lymph node Biopsy
Pulse Oximeter

• Non-invasive method of monitoring O2 saturation of hemoglobin

• Sensor probe is attached to the fingertip or earlobe or forehead
PPD/ Mantoux test

- Screening test for tuberculosis

- Also known as tuberculin sensitivity test,
Purified Protein Derivative Test
- Primarily used for screening for tuberculosis; should be read after 14-72 hours.
- The reaction should be measured by the in duration that is by millimeter
- 15 millimeter or more is positive
- Check for the sputum examination
(important test for TB to determine of there is AFB-tubercle bacilli)
*PPD positive doesn’t mean na may TB na rin. Only check the exposure. If PPD is positive need parin
icheck for sputum culture
Tracheostomy

- Opening or incision to the neck into the trachea

- Opens the airway and aids in breathing
- Done during emergency, especially if the patient has a problem with the normal opening (mouth and nose) when
it comes
to oxygenation
- It is usually done for one of three reasons: a. To bypass an obstructed upper airway
b. To clean and remove secretions from the airway
c. To more easily and safely deliver oxygen
to the lungs

Chest Tube Drainage

- Involves placing a hollow plastic tube between the ribs and into the chest to drain fluid or air around the
lungs.
- Directly inserted into the pleural space to drain the fluid or air
- Observe the fluid every 15 minutes
- Observe the color, consistency, and the amount of drainage
- Proper documentation should include amount, color, and the presence of any clots in the drainage
Thoracotomy

- ​
A surgical procedure in which a cut is made between the ribs to see and reach the lungs or other
organs in the chest or thorax.
Inhalational therapy
Nebulization

- Process of giving medication directly by inhalation.

 - The machine converts the medication into mist which is then given to the patient either with the help of a
breathing mask.
Oxygen therapy
Nasal Cannula

- This can only provide 4-6 liters per minute of supplemental oxygen.
- A type of low-flow oxygen device
- Nasal prongs may be a good alternative for toddlers
- Allows oxygen in variable concentration of oxygen to be delivered directly to the nasal cavity.
- Provides about 24-45% of oxygen with the appropriate oxygen flow rate of about 1-2 liters per minute (most
safest).
Partial Rebreather Mask

- This delivers about moderate to high concentration of oxygen. It has a reservoir bag which is required to
ensure that it remains inflated; if it is deflated exhaled air collects in it, which results that the patient will
rebreathe exhaled carbon dioxide
- The delivered oxygen can be as high as 60% but percentage varies depends on the rate and depth of the
patients breathing.
Face tent

- This device fits under the patient’s chin and encircles the faces. It is used primarily for humidification and for
oxygen only if the patient will not tolerate a tight-fitting mask.
- Check for the auto saturation (if it is effective)
Venturi mask

- the mask is useful because it delivers a more precise concentration of oxygen

- you can control kung ilang percentage yung ibibigay mo sa patient.
Metered Dose Inhaler (MDI)

- pressured canister
- handheld device
- use of propellants to deliver dose on the lungs of the patient.
- Usually used for those patients who has asthma.
Mechanical Ventilation

- Used in patient who are in acute RDS in an intensive care set up

- May be a final attempt to continue breathing
- Use will have to depend on benefit against possible risk
- Works by applying a positive pressure breath and is dependent on the compliance and resistance of the airway
system, which is affected by how much pressure must be generated by the ventilator to provide a given tidal
volume
- Tidal volume- volume of air entering the lungs during inhalation.

Continuous Positive Airway Pressure (CPAP)

- Used primarily in the treatment of SLEEP

APNEA
- Used with O2 therapy to reverse or prevent micro atelectasis
- Allow patient to breath spontaneously while applying pressure in the respiratory cycle to keep alveoli open
Chest Physiotherapy

- ​Group of physical techniques that improve lung function and will help clients to breath better
• Principles ​
• o Chest Percussion
• o Chest Vibration
• When done manually, the person’s performing the vibration places his or her hands
against the patient chest and creates vibrations by quickly contracting and relaxing arm
and shoulder muscles while the patient exhales.
o Postural Drainage
▪ Helps to expand the lungs and strengthens the breathing muscles and loosens and
improves drainage of thick lung secretions
▪ Perform as the patient breathes deeply
• Goal of CPT o Remove bronchial secretions o Improve ventilation o Increase the
efficiency of the respiratory muscle
Postural Drainage

• Use of specific positions that allow the force of gravity to assist in the removal of bronchial secretions
• Nursing Intervention o Know the medical diagnosis, lung or lobes involve o Advice patient to perform
drainage 2-4x daily o Done before meals and at bed time o Evaluate skin color and pulse prior to
procedure
Chest percussion and vibration

• Help to dislodge mucus adhering to the bronchioles and bronchi

• Performed 3-5 min for each position
• Vibration is when you apply manual compression and tremor to the chest wall during the exhalation phase.
Chest percussion and Postural drainage is contraindicated when:
• When client has hemoptysis
Nursing Interventions

• Make sure the patient is comfortable, wearing loose clothing

• Uppermost areas of the lungs are treated first
• STOP treatment if:
 o There is pain, increased SOB, weakness, lightheadedness or hemoptysis

Pharmacology
Commonly used agents in Respiratory

• Antihistamines
• Steroids
• Bronchodilators
• Adrenergic Drugs
• Expectorant/Mucolytics
• Antimicrobials
• Antitussives
• Mast cell stabilizers
• Leukotriene modifiers
Antihistamines

• H 1 Blockers or H 1 antagonists
• Competes with histamine receptor sites preventing histamine release
• Decreases mucus secretions by blocking H 1 receptors
• Absorb well after oral or parenteral administration, some can also be given rectally, with the exception of
loratadine.
• Distributed widely throughout the body and your central nervous system
• Primarily used to treat signs and symptoms of hypersensitivity reaction such as allergic rhinitis, vasomotor
rhinitis, allergic conjunctivitis, urticaria such as,
hives, and angioedema or submucosal swelling in the hands, face, and feet.
H 1 – receptor antagonists produce their effects by:

• Blocking the action of histamine on small blood vessels

• Decreasing arteriole dilation and tissue engorgement
• Reducing leakage of plasma proteins and fluids out of the capillaries
• Inhibiting most smooth-muscle responses to histamine (in particular, blocking the constriction of bronchial, GI,
and vascular smooth muscle)
• Relieving symptoms by acting on terminal nerve endings in the skin that flare and itch when stimulated by
histamine
• Suppressing adrenal medulla stimulation, autonomic ganglia stimulation, and exocrine gland secretion, such
as lacrimal and salivary secretion.
Adverse Reactions

• The most common adverse reaction to antihistamine (with the exception of fexofenadine, loratadine, and
desloratadine) is CNS depression.
Other CNS reactions include:

• Dizziness
• Fatigue
• Disturbed coordination
• Muscle weakness
Steroids

• Acts as an inflammatory agent in cases of severe anaphylaxis, allergic reaction where there is
bronchoconstriction
• Typically used to treat hematologic diseases such rheumatoid arthritis, lupus, vasculitis, inflammation of
the blood vessels.
• Specific corticosteroids include cortisone and prednisone.
• Used as an adjuvant therapy in cases of premature birth
o Given 24 hours to the expected delivery of a preterm infant
o Can be given up to 34 weeks AOG o Antenatal betamethasone is

- primarily used to speed up lung development in preterm fetuses. It stimulates the synthesis and
release of surfactant. o Given to preterm mothers o Hydrocortisone and

- dexamethasone are given to premature newborns after birth to help with maintaining a normal blood
pressure.
Bronchodilators

• Bronchodilators and smooth muscle relaxants

• Often used to treat long term conditions where the airways may become narrow and inflamed such as for
patients with asthma.
• Methylxanthine derivatives:
o Aminophylline
o Theophylline
• Bronchial smooth muscle relaxants
o Terbutaline sulfate
• Used to treat acute exacerbation of asthma
• Increase bronchodilation, increasing vital capacity
• Side effects include tachycardia and easy fatigability
• Corticosteroids lowers swelling in the breathing passage in the lungs while bronchodilators opens up the air
passages of the lungs to make it easier for air to get in and out of the lungs.
Beta2-Adrenergic Agonist Drugs

• Used for the treatment of symptoms associated with asthma and chronic obstructive pulmonary disease (COPD)
Agents in this class can be divided into two categories:
o Short acting
 o Long acting
• Relaxes the smooth muscle in the airways which allow increased airflow to the lungs
Short-acting beta2-adrenergic agonist include:

• Albuterol (systemic, inhalation)

• Bitolterol (system)
• Levalbuterol (inhalation)
• Metaproterenol (inhalation)
• Pirbuterol (inhalation)
• Terbutaline (systemic)
Long-acting beta2-adrenergic agonists include:

• Albuterol (oral, systemic)

• Formoterol (inhalation)
• Salmeterol (inhalation)
More appropriately used with antiinflammatory agents, specifically, inhaled corticosteroids.
Adverse Reaction

• Adverse reactions to short-acting beta2 adrenergic agonists include paradoxical bronchospasm, tachycardia,
palpitation, tremors, and dry mouth.
• Adverse reactions to long-acting beta2 adrenergic agonists include bronchospasm, tachycardia, palpitations,
hypertension, and tremors.
Expectorants/Mucolytics

• Loosens bronchial secretions hence eliminated by coughing

• Facilitates removal of viscous mucus
• Examples:
o Carbocistein, Guaifenesin (reduces the thickness, adhesiveness, and surface tension of the mucus
making it easier to clear it from the airways) (result is productive cough)
o Diphenhydramine
Adverse reactions to guaifenesin include:

• Vomiting (if taken in large doses)

• Diarrhea
• Drowsiness
• Nausea
• Abdominal pain
• Headache
• Hives or skin rash

​
Antimicrobials

• Interferes with the biosynthesis of the bacterial cell wall

• Can be grouped according to the microorganism that they act primarily against, for example, antibiotics are
used against bacteria, and antifungals are used against fungal.
• May also inhibit bacterial enzymes and cellular metabolism
• May also inhibit protein synthesis
• Examples:
o Quinolones, Penicillin, Macrolides
o Aminoglycosides, Cephalosporins, Tetracyclines
Antitussives

• Antitussive drug suppresses or inhibit coughing. They're typically used to treat dry, non-productive coughs.
The major antitussive include:

o Benzonatate – acts by anesthetizing stretch receptors throughout the bronchi, alveoli, and pleura.
Primary anesthetic agent

▪ Pag oral type, you need to swallow it as a whole – bawal ichew and icrush
o Codeine

o Dextromethorphan hydrobromide (most common)

o Hydrocodone bitartrate

▪ Suppresses the cough reflex by direct action on the cough center in the medulla of the brain,
thus lowering the cough threshold
Mast cell stabilizers

• Used for treatment for allergies

• Could also be used for the prevention and long-term control of asthma, especially, in pediatric patients and
patients with mild diseases

• The mechanism of action of mast cell stabilizers is poorly understood, but these agents seem to inhibit the
release of inflammatory mediators by stabilizing the mast cell membrane, possibly through the inhibition of
chloride channels
 • Exercised induced asthma
Adverse reactions to inhaled mast cell stabilizers may include:

o Pharyngeal and tracheal irritation

o Cough

o Wheezing

o Broncho spasm

o Headache

• Medications
o Nedocromil, cromolyn sodium

Leukotriene formation inhibitors include Zileuton

• Inhibits the production of your lipoxygenase, an enzyme that inhibits the formation of leukotriene which are
known to contribute to swelling, bronchoconstriction, and mucus secretions, which is seen on patient with

asthma. ​
• Adverse reactions to leukotriene modifiers include:
o Headache
o Dizziness
o Nausea and vomiting
o Myalgia
o Cough
• Zileuton is contraindicated in patients with active liver disease.
Decongestants

• Prevent lower respiratory infection

• Serves as antimalarial and anti- Decongestants are medicines that relieve
o parasitic congestion by reducing swelling

o inflammation by reducing swelling,

o inflammation and mucus formation within the nasal passages or the eye.

• Used to help reduce the symptoms of a blocked or stuffy nose

• Classified as systemic or topical, depending on how they’re administered.
• Most adverse reactions to decongestants result from CNS stimulation and include:
o Nervousness

o Restlessness and insomnia

o Nausea

o Palpitations and tachycardia

o Difficulty urinating

o Elevated blood pressure

Systemic decongestants

• Stimulates the sympathetic nervous system to reduce swelling of the respiratory tract vascular network
• Phenylephrine, ephedrine
Topical decongestants

• These are also powerful vasoconstrictors when applied directly to swollen mucus membranes of the nose,
they will provide immediate relief from nasal congestion.

• Ephedrine, phenylephrine, naphazoline, tetrahydrozoline

Alternative Therapies
Echinacea

• Genus Asteraceae
• Common name: Purple cornflowers
• Immunostimulatory symptoms warding off infections
• Can reduce symptoms of infections and other illnesses, including the common cold
• Essential trace element
• Usually taken from food supplements and fruits
• Used for treatment and prevention of zinc deficiency
o Boost immune system

o Treats common colds

o Treats recurrent ear infections

​
​
MS LEC
COMMON DISORDERS OF THE RESPIRATORY TRACT

Common Signs and Symptoms of

Respiratory Ailments
Dyspnea
• Difficulty of breathing, shortness of breath, air hunger.
• Can range from mild, temporary, serious and long lasting
• Associated with many conditions
o Muscular dystrophy, airway obstruction, etc…
o Associated with muscular
o dystrophy, airway obstruction
o Difficult to diagnose and treat because it has many different causes(over exertion, high altitude =
high atmospheric pressure)
o If suddenly and severe = serious sign of medical condition

o Hypoxia, low blood oxygen level lead to decrease level of consciousness, risk for temporary or
permanent cognitive impairment

General nursing interventions:

• Fowler's position to promote maximum lung expansion and promote comfort. An alternative position is
the ORTHOPNEIC position
 Fowler's position:
High: 45 - 60
Semi-fowler’s: 30-45
Low: 15 - 30

Alternative position:
ORTHOPNEIC/TRIAD

o sitting position permit lung expansion

o px who cannot lay in bed

• O2 usually via nasal cannula PRN (As needed usually 1-2 L/m also depend on doctors order)
• Provide comfort and distractions
• Check for vs and inspect
Cough and sputum production
• Cough is a protective reflex, normal defense response to foreign bodies.
• Sputum production has many stimuli: occurs when respiratory tract secretions are beyond the ability of the
mucous ciliary mechanism of our body.
• Sputum production are produced when lung is deceased or damaged
• Sputum are much more thick, also called phlegm.
• Infection in the lung produces excess sputum production.

Bacterial pneumonia
• Thick, yellow, green or rust-colored(pneumonia)
Pulmonary edema
• Profuse, Pink, frothy
Lung tumor
• Scant, pink-tinged, mucoid
General nursing Intervention:
• Provide adequate hydration
o to liquify secretions (check for fluid overload)
• Administer aerosolized solutions
o normal saline solution (water with salt loosen viscous mucous)
• advice smoking cessation
• oral hygiene
o to remain it clean and free of microorganism/bacteria
Cyanosis
 • Bluish discoloration of the skin
• A LATE indicator of hypoxia
• Appears when the unoxygenated hemoglobin is more than 5 grams/dL
• Rbc provide oxygen to body tissue, carry full supply of oxygen,
• RBC bright red=pinkish/red in skin, blood that losses oxygen=dark bluish red - For dark skin cyanosis is
observed in mucous membrane(lips, eyes, gums, nails)

Central cyanosis
• observe color on the undersurface of tongue and lips
Peripheral cyanosis
• observe the nail beds, earlobes
Interventions:
• Check for airway patency (blocking of airway)
• Oxygen therapy
• Positioning (semi-fowler’s/orthopneic)
• Suctioning (for viscous secretions)
o check for oxygen level since nasasama ang oxygen sa pag suction, give oxygen
first/hyperoxygenate the px first
• Chest physiotherapy
• Check for gas poisoning
• Measures to increased hemoglobin
o Diet: iron-riched food
o Supplemental vitamins C, iron supplements
o Increase folic intake
Hemoptysis
• Expectoration of blood from the respiratory tract
• Common causes
o Pulmo infection
o Lung CA
o Bronchiectasis
o Pulmo embolism
• Bleeding from stomach acidic pH, coffee ground material
• Classified as Non-massive and massive depending on the volume of blood loss.
o Non-massive if blood loss is less than 200ml per day
o Massive if blood loss is more than 200ml
Interventions:
• Keep patent airway (nagkakaroon ng blocking and baka ma aspirate niya yung nilalabas na blood)
• Determine the cause
• Suction and oxygen therapy
• Administer Fibrin stabilizers like aminocaproic acid and tranexamic acid
3 FOLDS:
• Bleed cessation (fibrin stabilizers)
• Aspiration precaution (suction)
• Treat underlying cause
o Always check for the ABC: airway, breathing, circulation
Epistaxis
• Bleeding from the nose caused by rupture of tiny, distended vessels in the mucus membrane. (nose bleeding)
• Most common site - anterior septum
Causes:
• Trauma (facial trauma, foreighn bodies)
• Infection (nasal and sinus infection)
• Hypertension
 • blood dyscrasias, nasal tumor, cardio diseases
Nursing Interventions:
• Position patient
o Upright, leaning forward, tilted prevents swallowing and aspiration
• Apply direct pressure.
o Pinch nose against the middle septum x 5-10 minutes
• If unrelieved, administer topical vasoconstrictors, silver nitrate, gel foams
• Assist in electrocautery and nasal packing for posterior bleeding. (if may need na tanggalin Electrocautery
gagawin it uses heat to destroy abnormal tissue)

CONDITIONS OF THE UPPER AIRWAY

• Upper airway infections: itis=inflammation
• Common cold is the most well known upper airway infection (contagoius)
• Rhinitis- allergic, non-allergic and infectious
• Sinusitis- acute and chronic
• Pharyngitis- acute and chronic

Rhinitis
Assessment findings
• inflammation of the nose produces mucus normally thin/clear and prevents dust, pollens, bacteria and viruses.
o Rhinorrhea
o Nasal congestion
o Nasal itchiness
o Sneezing
o Headache
ig nagkaroon ng viral rhinitis/hay fever it becomes inflamed and swollen causing nasal ingestion, itchiness and non-
stop sneezing may also lead to headache.

Sinusitis
Assessment findings
• inflammation of the lining inside the sinus,
o fluid in sinuses = blockage, usually caused by colds, allergies and infection
• Facial pain
• Tenderness over the paranasal sinuses
• Purulent nasal discharges
• Ear pain, headache, dental pain
• Decreased sense of smell
Pharyngitis
Assessment findings
• inflammation of the pharynx
o could also associate tonsillitis (pharyngotonsillitis)
• Fiery-red pharyngeal membrane
• White-purple flecked exudates
o Contagious
• Enlarged and tender cervical lymph nodes - namamaga
• Fever malaise, sore throat
• Difficulty swallowing
• Cough may be absent

Upper airway infections- Laboratory tests

 1. CBC
2. Culture

Upper airway infections: Nursing Interventions

• Maintain Patent Airway
o Increase fluid intake to loosen secretions
o Utilize room vaporizers or steam inhalation (lossen viscous mucus)
o Administer medications to relieve nasal congestion
• Promote comfort
o Administer prescribed analgesics (pain)
o Administer topical analgesics
o Warm gargles for the relief of sore throat
o Provide oral hygiene
• Promote communication
o Instruct patient to refrain from speaking as much as possible
o Provide writing materials
• Administer prescribed antibiotics
o Monitor for possible complications like meningitis, otitis media, abscess formation
o Medication depends on what kind of bacteria
• Assist in surgical intervention
Upper airway infection:

Tonsillitis
• Infection and inflammation of the tonsils
• Most common organism - Group A beta hemolytic streptococcus (GABS)
• Acute, chronic, recurrent tonsillitis
• If left untreated complication can occur peritonsillar abscess
ASSESSMENT FINDINGS
• Sore throat and mouth breathing
• Fever
• Difficulty swallowing
• Enlarged, reddish tonsils
• Foul-smelling breath(bacteria)
• If the symptoms last around or less than 10 days - acute
• Last more than 10 days - chronic
• Comes back multiple times - recurrent (not common, tonsillectomy is advised removal of tonsils)
Laboratory test
1. CBC
2. throat culture

MEDICAL management
• Antibiotics
o penicillin
• Tonsillectomy for chronic cases and abscess formation (complication of hemorrhage)
NURSING INTERVENTION:
• Pre-operative care
o Consent
o Routine pre-op surgical care
• POST-operative care
o Position: Most comfortable is PRONE, with head turned to side
o Maintain oral airway, until gag reflex returns
 o Tonsillectomy can cause hemorrhage

▪ Check for bleeding in mouth or nose and frequent swallowing = sign of bleeding and vomiting
of bright red/dark brown blood.
o Apply ICE collar to the neck to reduce edema

▪ relieve possible bleeding, vasoconstriction decrease bleeding

• Advise patient to refrain from talking and coughing
• Ice chips are given when there is no bleeding and gag reflex returns
• Notify physician if:
o Patient swallows frequently
o vomiting of large amount of bright red or dark blood
o PR increased, restless and Temp is increased

Infectious Disorders of the Lungs

• inflammation of the lung parenchyma caused by a bacterial/ viral or fungal, parasitic, mycoplasma agent
• Number 1 leading cause of death in children under the age of 5
• Can be classified or categorized into various groups
Pneumonia
Categorized into:
• Origin
• Location
• Type

Microorganisms:
• Streptococcus pneumonia
• Mycoplasma pneumonia
• Haemophilus influenzae pneumonia
• Legionella pneumophila
• Chlamydial pneumonia
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Pneumocystis carinii pneumonia
• Aspergillus fumigatus
• Mycobacterium tuberculosis

Acquired Pneumonia
Community Acquired Pneumonia (CAP)
• occurs in a community setting or within 48hours of hospitalization
• Most common type of pneumonia
• Usually caused by pneumococci infection.
• Streptococcus Pneumonia
Hospital Acquired Pneumonia (HAP)
Nosocomial Pneumonia

• onset of pneumonia symptoms starts at least 48 hours upon admission to the hospital, or within three
months of a hospital stay
• Often connected w/ staphylococci infections
• Leading cause of death at least 22% in all hospitals acquired infection. (HAI)
4 TYPES HAI:
• HAP
• Clabsi infection (bloodstream)
• CAUTI infection
o catheter associated urinary tract infection
• VAP
o Ventilator associated pneumonia
o most acquired infection in ICU setup and most fatal. Mortality rate of 45% (caused by pathogens in
ET Tube
o Use of contaminated equipment, poor nursing care)

Bacterial Pneumonia
• Walking Pneumonia
o less severe form of bacterial pneumonia, symptoms are mild (atypical pneumonia)
• Caused by bacteria
• Occur in any parts of the lungs
• Trigger alveolar inflammation and edema
• Cause low ventilation with normal perfusion
• Atelectasis
• In severe bacterial pneumonia the lungs look heavy and liver like (ARDS)

Viral Pneumonia
• 2nd most common cause of Pneumonia
• Viruses that bring on colds and flu
• Coronavirus, COVID-19
• First attack bronchioles epithelial cells causing inflammation and desquamate.
• Resembles ARDS

Fungal Pneumonia
• Less common cause (opurtunistic fungi)
• Higher chance of catching if your immune system is weakened such as
o An organ transplant
o Chemotherapy for cancer
o Drugs to treat autoimmune diseases.
o HIV (Pneumocytis Carinii Pneumonia)
• 3 most common fungal pneumonia:
o Streptococcus
o Pneumocystis
o Aspergillus
Aspiration Pneumonia
• It is a complication of pulmonary aspiration.
• caused by inhaling toxic and/or irritant substances, usually gastric contents, into the lungs
• Gastric contents obstruct the airway and damage alveoli
• More likely to occur on elderly, debilitated px, those receiving NGT feeding, impaired gag reflex, poor oral
hygiene, and decreased level of consciousness.
Risk Factors:
• depressed immune system
• Smoking
o Almost 3000 deaths per year
• prolonged immobility
o (hindi mailalabas ang secretions may lead to atelectasis = hypostatic pneumonia)
• shallow breathing patterns
• conditions with copious mucus production
• depressed cough reflex
• Instrumentations
• alcohol intoxication
• advance age - degenerate immune system
Clinical Manifestations:
● increased sputum production
● Wheezing
● Dyspnea
● Rales
● chest pain and retraction
● pleural effusion
● Dullness
● Orthopnea
● Bacterial - fever

Diagnostics:
• Chest X-ray
• Sputum Examination (gram staining)
• Sputum Culture & Sensitivity Test
• WBC count is important
o Leukocytosis = bacterial pneumonia, pag viral pneumonia normal-low
• Pulse oximetry/O2 saturation below normal
• ABG, bronchoscopy
General Management:
• Antimicrobial therapy depending on the microorganism px have
• Rest
• Oxygen therapy
• Increased fluid intake (within cardiac tolerance)
• Bronchial hygiene
• Postural drainage
• Splint chest when coughing
• Monitor: sputum, chest x ray, temperature
• Proper antibiotics (bronchodilators, antitussives)
• High caloric diet

Nursing Management
• Maintain patent airway and adequate oxygenation
• Teach patient how to cough and do deep breathing exercises
• Maintain adequate nutrition
• Proper disposal of sputum
• Control temperature by cooling measures
• Monitor vital signs closely,
o watch for danger signs like:
 ▪ Marked dyspnea Irregular
▪ thready pulse
▪ Delirium with extreme restlessness
▪ Cold, moist skin
▪ Cyanosis and exhaustion
Prevention and Control
• Vaccination - Pneumococcal Vaccine (PCV)
• Immunization against anti-haemophilus influenzae (Hib), pneumococcus, measles and whooping cough
(pertussis) is the most effective way to prevent pneumonia.
• Adequate nutrition
• Environmental sanitation

PULMONARY TUBERCULOSIS

• Chronic lung infection that leads to consumption of alveolar tissues

• Other Names Koch's Disease - Robert Koch pathologist who discovered TB bacilli Consumption Phthisis
• Poorman's Disease
• Mode of Transmission: Airborne Transmission
Classification:
• Pulmonary Tuberculosis
o affects the lung, can be easily spread kasi sa lungs lang siya nakikita unlike pag tb sa bone, brain,
blood.
• Extra pulmonary tuberculosis
o affects the lung and other organs in the body such as:
▪ TB meningitis - brain
▪ Pott's disease - bone
▪ Miliary tuberculosis – sepsis to the blood
Quantitative Classification of TB
• Minimal with slight lesion without demonstrable excavation
• Moderately advance
• One or both lungs maybe involved
• Diameter of the cavity should not exceed 4 cm 3.Far advance - lesions are more extensive than moderate, more
than 4cm
Causative Agent : acid-fast bacilli/airborne
• Mycobacterium Tuberculosis
• Mycobacterium Africanum
• Mycobacterium Bovis/Bovine
 o an infectious disease of cattle, drinking contaminated milk.

o Milk is pasteurized to prevent this

Risk factors:
• Poor living condition
• Close contact with infected person
o coughing , sneezing
• Overcrowding
• Poor nutritional intake
• Inadequate treatment of primary infection (primary complex - non communicable)

Signs and Symptoms:

• Afternoon fever
• Night sweats
• Cough
• Weight loss
• hemoptysis - pathognomonic sign

Laboratory Test/ Diagnostic Test

• Chest X-ray determine extent of the disease
• Sputum Culture
o Sputum AFB 3x
• Mantoux Test
o PPD Testing, 48-72 hours
• Arterial Blood Gas (ABG)
o to evaluate lung perfusion and compensatory mechanism
• Liver Function Test (LFT)
o SGOT, SGPT OCBC
o RBC, WBC
o needed if px is taking anti tb drugs
• Pulmonary Function Test
o extent of pulmonary function
• Electrocardiogram
o Cardiovascular Function
o problem in the hearts
General Management
Drug Therapy
• Antibiotics
o Anti-TB Meds, can cause liver and kidney damage, hepatotoxicity/nephrotoxicity
• Before px take TB drugs they undergo liver enzyme test (first 4 med given orally)
o Rifampicin
▪ red/orange color urine
o Isoniazid
▪ INH can cause peripheral neuritis
▪ feeling of numbness, tingling, swelling in the muscle. Given Vitamin B6 supplements.
o Pyrazinamide
▪ hepatotoxicity, nephrotoxicity
o Ethambutol
▪ causes optic neuritis, visual problem, color blindness.
o Streptomycin
▪ given intramuscular, cause problem in cranial nerve, hearing (autotoxicity) everyday
injection for 60 days.
 • Bronchodilator
o to dilate the airway passage
• Mucolytics
o to liquefy tenacious secretions
• Expectorants
o to evacuate secretions
Directly Observed Treatment, Short-course
(DOTS, also known as TB-DOTS)
• DOTS for TB consists of
o diagnosing cases,
o treating patients for 6-8 months with drugs, and
o promoting adherence to the relatively difficult treatment regimen. Track record: When strictly
followed, the treatment regimen cures TB and prevents death.

Elements of DOTS:
• Sustained political commitment
o increase financial and human resources
• Access to quality-assured TB sputum microscopy
o Case detection of persons presenting symptoms of TB
o Screening of individuals
o Health education about quality-assured sputum microscopy
• Standard short-course chemotherapy to all cases of TB
o Direct observe of treatment
• Uninterrupted supply of quality-assured drugs
o Sustained supply of anti-TB drugs
o Establish a reliable system of regular distribution of anti-TB drugs
o Anti-TB drugs should be available FREE to all TB patients
o Reduce non-adherence to treatment and prevent the development of MDR-multi drug resistance,
resistant to the first 2 medication
• Recording and reporting system
o Monitors treatment and progress outcome of individual patient
o Evaluate overall program performance

Vitamin Supplements:
• Vitamin A - promotes good eyesight
• Vitamin B 1-6-12- prevents hepatic anomalies
• Vitamin C - boost/ increases immune system
• Vitamin D - promotes strong bones
• Vitamin E - promotes a healthy heart
• Antipyretic
• Analgesic
MANAGEMENT:
• Diet
o increase CHON-carbohydrates, increase Calorie

• O₂ Support
• Chest Physiotherapy (CPT)
o to mobilize secretions
• Hydration
o IVF
 • Surgical Management
o Bronchoscopy
o Thoracentesis
o Pneumonectomy
o Lobectomy
o Chest Tube, Thoracotomy (CTT)
o
Nursing Management:
• Maintain respiratory isolation and PPE's
• Administer medications as ordered
• Administer O₂ as needed
• Always check sputum for purulent or bloody expectorations
• Maintain semi-fowler's position
o to facilitate easy breathing
• Frequent positioning (every 30 mins)
o to mobilize secretions
• Adequate hydration
• Encourage deep breathing and coughing exercises and proper expectoration
• Proper nutrition
• Comfort measure
• Teach patient everything about TB
o to be more compliant with the treatment regimen
• Prevent complications
Prevention and Control
• Massive BCG immunization
• Avoid overcrowding
• Good personal hygiene and environmental sanitation
• Improved nutritional status

CHRONIC OBSTRUCTIVE PULMONARY DISEASES

• Asthma
• Bronchitis
• Emphysema
Chronic Obstructive Pulmonary Disease (COPD)
• Chronic obstructive pulmonary disease (COPD) is the collective term for a number of lung diseases that
prevent proper breathing. NO CURE
o damage in airways does not degenerate

• Three of the most common types of COPD are emphysema, chronic bronchitis, and asthma.
• Diseases that causes airflow blockage, breathing related problems
• Cigarette smoking is the most significant risk factor for COPD. impairs ciliary action, macrophage function,
inflammation of airway, increased mucus production, alveolar destruction, peribronchiolar fibrosis.
• There is no cure for COPD, but disease management can slow disease progression, relieve symptoms and
keep you out of hospital.
• Treatment aims to prevent further damage, reduce the risk of complications and ease some of the symptoms.
• Treatment options include pulmonary rehabilitation, medicines and oxygen therapy.

Asthma
• Chronic inflammatory airway disorder
• Common in children, ages 10-30
• Episodic airway obstruction
• Hyper responsiveness
 • Bronchospasm
• Reversible
• Can occur at any age but this is the most common chronic disease of childhood
• Allergy is the most common predisposing factor
Pathophysiology
• Immunologic/allergic reaction results in histamine release, which produces three main airway responses
o Edema of mucous membranes
▪ causes narrowing of airway passage
o Spasm of the smooth muscle of bronchi and bronchioles
o Accumulation of tenacious secretions

Triggers/Precipitating Factors
• Inhaled allergens
o Dust mites
o Pollens
o Food allergens
• Non allergenic
o Viral respiratory infection
o Weather changes
o Fumes, strong odors
o Smoking
o Exercise
o Drugs- aspirin, NSAIDS

Manifestations:
• Mild persistent asthma
o adequate air exchange
o asymptomatic between attacks
• Mild intermittent
o Cough
o Wheezing
o chest tightness
o DOB less than twice per week
o night time symptoms occurs less than twice per month
• Mild persistent
o Cough
o Wheezing
o chest tightness
 o DOB occurs about 3 to 6 times per week

o night time symptoms 3 to 4 times per month.

• Moderate persistent asthma

o normal to below normal air exchange cough
o wheezing
o chest tightness
o DOB
o night symptoms 5 or more per month
• Severe persistent asthma
o Status Asthmaticus
o below normal air exchange
o continuous symptoms of cough
o wheezing
o chest tightness
o DOB
o Night symptoms occur frequently
o Doesn’t respond to conventional treatment.
• Status asthmaticus is respiratory failure that comes with the worst form of acute severe asthma, or an asthma
attack.

Diagnostic Examination:
• Pulmonary Function Test
o lung volume capacity
• Serum Immunoglobulin E
o increased during allergic reaction
• CBC
o eosinophil is increased due to allergic reaction
• CXR
o monitor asthma progress, show hyperinflation of atelectasis
• ABG
o detect hypoxemia, guide treatment type for client
• ST and Bronchial Challenge Testing
o identify allergen
o read 1-2 days detect early reaction
o 4-5 days for late allergic reaction.
o Bronchial challenge testing evaluates the clinical significance of your allergens identify by skin
testing.

General Management
• ABC
• Long Acting medications/Long Term asthma control medications
o to achieve and maintain control of persistent asthma
• Bronchodilators
• Quick relief medications (rescue medications)
• Anti-inflammatory agents
• MDI Spacer device

Long Acting Medications:

• Corticosteroids
o inhaled form should use a Space dose inhaler
o rinse the mouth after administration to prevent thrust
 o Long term used for asthma

• Mast Cell Stabilizers

o Cromolyn sodium/ nedocromil
o prevents exercise induced asthma
o Given prophylactically which blocks the acute obstructive effect of your antigen exposure

• Long Acting Beta adrenergic agonist (LABAS)

o Levecort/Symbicort
o not indicated for immediate relief of asthma (long acting)
Quick Relief Medications:
• Short acting beta adrenergic drugs (SABA)
o rapid onset of action
o Salbutamol
o Albuterol
Nursing Interventions
• approach the patient calmly
• take the history and any allergic reactions, history of allergy
• Early treatment and education of the patient
• administer medications as prescribed
• keep patient well hydrated
• health education, use of patient follow up care
COPD

• Caused by Smoking
o Bronchitis
▪ inflammation of bronchi
o Emphysema
▪ destruction of the structure of bronchi.
Pink puffer Emphysema dominant:
• Thin body
• Rapid breathing
• Shortness of breath
• Pursed-lip breathing
• Pinkish colored skin
o face turns red/pink because of gasping of air
Blue bloater Bronchitis dominant:
• Overweight
• Shortness of breath
• Chronic cough
• Bluish colored skin
• Take deeper breaths but they can’t take in the right amount of oxygen

Bronchitis
• acute inflammation of the mucus membranes of the trachea and the bronchial tree
• a clinical history of productive cough for 3 months of the year for 2 consecutive years.
• Presence of dyspnea and airway obstruction
• Leads to mucosal thickening obstructing airways

Chronic Obstructive Bronchitis "Blue Bloater"

• Clients with COB appear bloated, have large barrel chest and peripheral edema, cyanotic nail beds and
circumoral cyanosis.
• Occurs when irritants are inhaled for a prolonged period of time. Resulting in a resistance to small airways and
severe imbalance that would decrease arterial oxygenation.

Microorganisms
• Commonly isolated agents:
o Streptococcus pneumoniae,
o Staphylococcus aureus
o H Influenza
o Mycoplasma pneumoniae
Manifestations
Cough with sputum production
• Wheezing
• Inspiratory and expiratory rhonchi
• Tachycardia
o exacerbation of bronchitis
• Pulmonary hypertension
Diagnostics
• Imaging - Chest X-Ray
• Pulmonary Function Tests
• Arterial Blood Gas
• Polycythemia
Pulmonary vascular disorders

Pulmonary embolism

- Refers to obstruction of the pulmonary artery or one of its branches by a blood clot (thrombus) that originates
somewhere in the venous system or in the right side of the heart

- Most commonly,b pulmonary embolism is due to a clot or thrombus from the deep veins of the lower legs.
Causes:

● Fat embolism, Air embolism (comes from lower extremities)

● Multiple trauma
● Abdominal surgery
● Immobility (prolonged bed rest)
● Hypercoagulability
Pathophysiology

- The thrombus travels from any part of the venous system obstructs either completely or partially. The lungs will
have an inadequate blood supply, with a resultant increase in dead space in the lungs

- Gas exchange will be impaired or absent

In the involved area

- The regional pulmonary vasculature will constrict causing increased resistance, increased pulmonary arterial
pressure, and then increase the workload of the right side of the heart.

Manifestations

● Tachycardia
● Air hunger
● Feeling od impending doom
● Productive cough (sputum may be blood-tinge)
● Low-grade fever
● pleural effusion
Less common signs include

● Massive hemoptysis
● Splinting of the chest
● Leg edema
● Cyanosis, syncope, and distended neck veins(with large embolism)
Diagnostic exam

● Ventilation-perfusion scan
● Pulmonary arteriography
 ● CXR
● ECG
● ABG
Treatment of pulmonary embolism is designed to:

- Maintain adequate cardiovascular and pulmonary function during resolution of the obstruction

- Prevent embolism recurrence

Note: most emboli can be resolved 10 -14 days,
treatment: Pharmacological
o2 therapy prn
-Anticoagulant with heparin,
-Heparin therapy. Monitor coagulating test.

treatment: Non-pharmacological
-Compression stockings
-Fibrinolytic therapy (streptokinase)

General management

● O2 therapy
● Early ambulation postop
● Monitor obese patient
● Don’t massage legs
● Relieve pain using analgesics
● Head of bed should be elevated
● Heparin (2weeks)
● Coumadin (3-6 months)
Note blood studies, bleeding time, clotting time upon giving anticoagulant

Nursing interventions

● Active leg exercises tp avoid stasis

● Early ambulation
● Use elastic compression stockings
● Avoidance of leg crossing and sitting for prolonged periods
● Drink a lot of fluids
Traumatic injuries to the lungs
Flail chest

​A complication of the chest trauma occurring when 3 or more adjacent ribs are fractured at two or more sites,
resulting in free-floating rib segments
Note: Due to severe blunt trauma, accidents, serious fall causes fractured on ribs = ribs to float

​Result to free-floating rib segment, and the chest wall loses its stability

Pathophysiology

​
​
During inspiration as the chest expands the detached part of the rib segment flail segment moves in a
paradoxical manner

​The chest is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs.
 ​
The chest bulges outward during expiration because the intrathoracic pressure exceeds atmospheric
pressure. The patient has impaired exhalation.

This paradoxical action will lead to

● Increased dead space

● Reduced alveolar ventilation
● Decreased lung compliance
● Hypoxemia and respiratory acidosis
● Hypotension, inadequate tissue perfusion can also follow.
Manifestations
Severe dyspnea: rapid, shallow grunty breathing; paradoxical chest motion.
The chest will move inwards on inhalation and outwards on exhalation.

​Cyanosis, possible neck vein distention, tachycardia, hypotension

Diagnostic Exam
ABG result

● PO2 decreased (hypoxia)

● pCO2 elevated (hypercapnia)
● pH deacreased (respi acidosis)
General management
Supportive

● Internal stabilization with a volume cycled ventilator, ventilatory support

● Drug therapy (narcotic, sedatives)
● Pain control
● Clearing secretions from the lungs
Nursing interventions

● Maintain open airway: suction secretions, blood from the nose, throat, mouth, via endotracheal tubes;
Note changes in the amount, color, and characteristics

● Monitor mechanical ventilation

● Encourage turning, coughing and deep breathing
● Monitor for signs of shock HYPOTENSION AND TACHYCARDIA

Pneumothorax

- Partial or complete collapsed of the lungs due to an accumulation of air or fluid in pleural space

- Occurs when the parietal or visceral pleura is breached and the pleural space is exposed to a positive
atmospheric pressure

Note: Amount of air increased increased also tension tension in plural cavity = lung collapse

Types:
Traumatic

​Open- Sucking chest wound

​
Closed- Blunt or pentrating trauma
Simple/spontaneous

​Primary- idiopathic
​Secondary- Related to a specific disease
​
Simple/spontaneous pneumothorax
 ​
The most common type of closed pneumothorax; air accumulates within the pleural space without an obvious
cause.
Rapture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.

​It can occur on a healthy individual

Traumatic/open pneumothorax

- Air enetrs the pleural space through an opening in the chest wall; usually caused by stubbing or gunshot wound
- May occur with taruma or procedures
- Often accompanied by hemothorax
- AKA sucking wounds
Tension pneumothorax

- Air enters the pleural space with each inspiration but cannot escape; causes increased intrathoracic pressure
and shifting of the mediastinal content to the unaffected side (mediastinal shift)

- Occurs when air si drawn into the pleural space from a lacerated lung.
Manifestations

● Sudden pain, tachypnea

● Chest discomfort
● Air hunger
● Increased tympahy in chest wall
● Decreased breath sounds on auscultation
● Mediastinal shift

Diagnostic exams

● Chest x-ray reveals area and degree of pneumothorax

● pCO2 elevated
● pH decreased (acidosis)
General management
Goal of treatment

- To evacuate the air or blood from the pleural space

- Treatment of pneumothorax depends on its type.
Spontaneous

- Treatment is usually conservative for spontaneous pneumothorax when there’s

● No sign of increased pleural pressure
● Lung collapse less than 30%
● No dyspnea or indication of physiologic compromise
Traumatic

- Traumatic pneumothorax requires thoracostomy tube insertion and chest drainage and may also require surgica
repair.

Tension

- Medical emergency. If the tension in the pleural space isn’t relieved, the patient will die ffrom inadequate cardiac
or hypoxemia. A large bore needle is inserted into the pleural space through the second intercostal. If large
amounts of air escape through the needle after insertion, the needle is left in place until a thoracostomy tube
is inserted.

Nursing interventions

- ET tubes: suction secretions, vomitus, blood from nose, mouth, throat, or via ET tube; monitor mechanical
ventilator.

- Restore/promote adequate respiratory function

- Assist with thoracentesis and provide appropriate nursing care.
- Assist with insertion of chest tube to water-seal drainage and provide appropriate nursing care.
 - Continuously evaluate respiratory changes patterns and report any changes
- Provide relief/control of pain
-Administer narcotics/sedatives/sedatives as ordered and monitor effects
-Position client in high fowler’s position

Complication:
Cardiac tamponade

- compression of the heart as a result of fluid within the pericardial sac.

Acute Respiratory failure

- Sudden and life threatening deterioration of the gas exchange function of the lungs
- Occurs when the lungs no longer meet the body’s metabolic needs
Defined clinically as:

● PaO2 of less than 50mmHg

● PaCo2 of greater than 50mmHg
● Arterial pGH of less than 7.35
Causes:

● CNS depression- head trauma, sedatives

● CVS diseases- MI, CHF, Pulmonary emboli
● Airway irritants- smoke, fumes
● Endocrine and metabolic disorders myxedema, metabolic alkalosis
● Thoracic abnormalities- chest trauma, pneumothorax
Pathophysiology

- Decreased respiratory drive

- Brain injury, sedatives, metabolic disorders,-impair the normal response of the brain to normal respiratory
stimulation

- Dysfunction of the chest wall

- Dysfunction of lung parenchyma
Manifestations

● Restlessness
● Dyspnea
● Cyanosis
● Altered respiration
● Altered mentation
● Tachycardia
● Cardiac arrhythmias
● Respiratory arrest

Diagnostic exams

● Pulmonary function test- pH below 7.35

● CXR pulmonary infiltrates
● ECG arrhythmias
General Management

​Therapy for acute respiratory failure ARF focuses on correcting hypoxemia and preventing resapiratory
acidosis.

Oxygenation
 - Deep breathing with pursed lips, if the patient isn’t intubated and mechanically ventilated, to help keep airway
patent.

- Incentive spirometry increases lung volume oxygen therapy to promote oxygenation and raise partial pressure
of arterial oxygen

- Mechanical ventilation with an endotracheal or tracheostomy tube, if needed to provide adequate oxygenation
and reverse acidosis\

- High-Frequency ventilation, if the patient doesn’t respond to treatment, to force the airways open, promoting
oxygenation and preventing alveoli collapse
Drugs

- Antibiotics to treat infections:

- Bronchodilators to mainatain airway patent
- Corticosteroids to decrease inflammation
- Positive inotroic agents to increase cardiac output
- Vasopressors to maintain BP
- Diuretics to reduce edema or fluid overload
- Opioids such as morphine to reduce respiratory rate and promoted comfort by relieving anxiety
- Anxiolytics such as lorazepam to reduce anxiety
- Sedatives such as propofol, if the patient requires mechanical ventilation and is having difficulty tolerating it.
Nursing interventions

- Maintain patent airway

- Administer o2 ro maintain Pao2 at more than 50mmhg
- Suction airways as requires
- Monitor serum electrolyte levels
- Administer care of patient on mechanical ventilation