OXYGENATION : RESPIRATORY

RESPIRATORY DISORDERS (UPPER AIRWAY) ▪ Assist patient on communicating –

provide writing materials
SINUSITIS ▪ Practice swallowing
Nursing Management: ▪ Cover tracheostomy with porous
✓ Positioning material
✓ Analgesic, antipyretics ▪ Avoid powder, spray, aerosol near
✓ Antimicrobials trachea
✓ Nasal decongestants [Sudafed, Dimetapp]
✓ Irrigation of Maxillary Sinus w. warm NSS COPD (Chronic Obstructive Pulmonary Disease)
✓ Caldwell-Luc Surgery [Radical Antrum Surgery] DO that obstruct the pathway of normal alveolar ventilation either by
o Do no chew on affected side spasm of the airways, mucus secretions or changes in the airway and
o Caution with oral care to prevent trauma, or alveoli
Infection
o Do not wear dentures for 10 days EMPHYSEMA CHRONIC BRONCHITIS
o No blowing of nose for 2 weeks Permanent overdistention of Long term inflammation of
o Avoid sneezing for 2 weeks after surgery alveoli with resulting mucus membrane of bronchial
destruction of the alveolar tubes with recurrent cough and
TONSILITIS walls sputum production for 3
Signs and Symptoms: months or more in 2
✓ Sore throat consecutive years
✓ Dysphagia
“PINK BUFFER” “BLUE BLOATER”
✓ Otalgia (ear pain)
✓ Generalized Malaise
✓ Cervical Lymphadenopathy
✓ Fever
✓ Foul Breath

Nursing Management:
✓ Rest and increase fluid intake
✓ Warm saline throat irrigation
✓ Ice collar to relieve discomfort
✓ Analgesic and antipyretics
✓ Antibiotics
✓ Surgery-tonsillectomy
o PreOP Care:
▪ Check for loose tooth
▪ Assess for URTI [ postop bleeding]
▪ Check PT

LARYNGEAL CANCER
Predisposing Factor:
➢ Over use of voice [ ex. Teachers and singers]
➢ Family predisposing to cancer

Signs and Symptoms:

✓ Persistent hoarseness associated with otalgia and
dysphagia
✓ Lump in throat
✓ Pain in the adam’s apple that radiates to the ear
✓ Dyspnea, enlarged cervical nodes and cough

Management:
✓ Subtotal Laryngectomy – retains voice
✓ Total – absolute loss of voice
✓ Tracheostomy – temporary or permanent
o PostOP Care:
▪ Establish patent airway
▪ Head and bead elevated 45 degree
 OXYGENATION : RESPIRATORY

Collaborative Management: ✓ Wheezing

▪ REST: decrease oxygen demand of tissues ✓ Pallor or cyanosis
▪ Increase fluid intake
▪ Good oral care. To remove sputum and prevent infxn
▪ DIET: increase calorie, increase CHON, decrease CHO
▪ Oxygen therapy, 1-3LPM (2lpm safest)
▪ Breathing exercises [pursed-lip breathing]
▪ Avoid cigarette smoking, alcohol pollutants
▪ CPT- percussion, vibration, postural drainage
▪ Bronchial hygiene measures [steam, aerosol, medimist
inhalation]
▪ Pharmacotherapy [Antitussives, Bronchodilators,
antihistamine, steroids, antimictobial]

Signs and Symptoms:

✓ Chronic cough with purulent sputum Complications:
✓ Hemoptysis ✓ STATUS ASTHMATICUS- A life threatening asthmatic attack
✓ Exertional dyspnea in which symptoms of asthma continues and do not
respond to treatment.

Level of consciousness Description

Awake Alert, responds immediately
and full to commands
- May or may not be
fully oriented
Confused The inability to think rapidly
and clearly. There is impaired
judgement and decision making
Disoriented The begging of loss of
consciousness. There is
disorientation in place,
ASTHMA impaired memory, and a loss of
➢ chronic inflammatory disease of the airways characterized recognition of self which is the
by hyper-responsiveness, mucosal edema and mucous last to deteriorate.
production Lethargic Drowsy, sleeps a lot, but is
➢ disorder of the bronchial airways characterized by periods easily aroused with minimal
of reversible bronchospasm stimuli, i.e. voice and then
➢ also known as the “reactive airway disease” responds, but not be oriented
in time, place or person
Obtundation Can be aroused by stimuli (not
Types of Asthma:
in pain), i.e. shaking, and will
❖ immunologic asthma – occurs in childhood
then respond to questions or
❖ non-immunologic asthma- occurs in adulthood and commands. Remains aroused
associated with recurrent respiratory infections as long as stimulation is
❖ mixed, combined immunologic and non-immunologic applied, if not will fall asleep,
questions are answered with
Cause and Risk Factors: minimal response. During the
✓ family history of asthma arousal, patient responds but
✓ Allergens: dust, pollens may be confused.
✓ Secondary smoke inhalation
✓ Air pollution Stuporous There is a condition of deep
✓ Stress sleep or unresponsiveness. The
patient can only be aroused or
caused to make a motor or
Signs and Symptoms:
verbal respond by vigorous and
✓ Tends to sit uo
repeated external stimulation
✓ Restlessness or anxiety (painful). The response initiated
✓ Dyspnea, tachypnea, tachycardia is often withdrawal or grabbing
✓ Flaring of alae nasi, retractions at stimulus
✓ Cough, tightness or pressure on chest Comatose There is no motor response to
✓ Cold clammy skin the external environment or to
 OXYGENATION : RESPIRATORY

any stimuli, even deep pain or ✓ Central cyanosis

suctioning. There is no arousal ✓ Crackles upon auscultation
to any stimulus. Reflexes may ✓ Decreased breath sound on the affected side.
be present abnormal
movement, (posturing) to pain
may be present

Nursing Management:
Diagnostic Test: ✓ Prevention of atelectasis in hospitalized patient is an
✓ Pulmonary functional Test (VC, FVC) important nursing responsibility
✓ Turn and reposition every patient ever 1-2 hours while
Management: bedridden or obtunded
✓ Pharmacoteraphy ✓ Encourage early mobility if permitted
o Beta antagonist [epinephrine, terbutaline] ✓ Promote liquification and removal of secretions
o Methylxanthines [aminophylline] ✓ Avoid administration or large doses of sedatives and opiates
o Corticosteroids that depresses respiratory and cough reflexes
o Anticholinergics [atropine] ✓ Prevent abdominal distention
o Mast cell inhibitors [cromolyn Na] ✓ Administer prophylactic antibiotics to prevent respiratory
✓ Oxygen via vasal cannula infection.
✓ Fluids to 3L/day
✓ Breathing exercises RESPIRATORY DISORDERS (INFECTIOUS)
✓ Metered dose inhaler
PNEUMONIA
ATELECTASIS ➢ Acute inflammatory process of the alveolar spaces -> lung
▪ Collapsed of part or the entire lung due to bronchial consolidation -> exudate [alveoli]
obstruction ➢ An inflammatory process of lung parenchyma associated
▪ Closure or collapsed of alveoli with marked increase in alveolar and interstitial fluid
▪ Acute or chronic in nature Types:
▪ Maybe due to: ✓ Bacterial Pneumonias
o Intrabronchial obstruction (secretions, tumors, o Lobar [strep] – constantly dry, hacking cough,
bronchospasm, foreign bodies) pleuritic pain, watery rust- colored sputum
o Extrabronchial compression (tumors, enlarger o Bronchopneumonia [strep/staph]- due to
lymph node) aspiration, productive cough with yellow or green
o Intrabronchial disease (carcinoma, inflamed sputum
structures) ✓ Alveolar pneumonia [viral]- scanty sputum
✓ Atypical pneumonia [rickettsial]- “walking”, non-productive
cough

ETIOLOGY
➢ Bacterial/viral
o Streptococcus pneumoniae,
o Pseudomonas aeruginosa,
o Influenza
➢ Secondary to respiratory tract infection
Signs and Symptoms: ➢ Incidence decreases with ages
✓ Cough o The higher the age, the higher or stronger the
✓ Sputum production resistance
✓ Low grade fever
✓ Dyspnea
✓ Tachycardia
✓ Pleural pain
 OXYGENATION : RESPIRATORY

Risk Factors:
➢ Age
o Too young and elderly are most prone to develop
o Smoking, air pollution
o URTI
o Altered consciousness
o Tracheal intubation
o Prolonged immobility
▪ Post-operative
▪ Bed ridden patients

Clinical Manifestation
1. Chest pain, irritability, apprehensiveness, restlessness,
nausea, anorexia
2. Productive cough, rusty/yellowish/ greenish sputum,
splinting affected side, chest retraction
3. High fever
4. Fine rales and wheezing upon auscultation

Diagnostic Exams:
1. Chest X-ray
2. Sputum culture
3. Blood culture
4. Increased WBC
5. Elevated sedimentation rate

Nursing Management:
✓ Promote adequate ventilation – positioning, chest
physiotherapy
✓ Provide rest and comfort
✓ Prevent potential complications
✓ Health teaching
o Skin care
o Hygiene
✓ Drug therapy
✓ Rest and adequate activity
✓ Proper nutrition