NCM112OFI - Care of Clients w Problem in Oxygenation

First semester // prelims // lecture

Trisha Julienne D. Cua BSN3 hall

Module 1: Anaphy and Assessment 6. Lung compliance

I. Respiratory system: Primary functions - the distensibility of the lungs
provides O2 for oxygen metabolism in the tissues - decreased by factors that decrease the elasticity of the lungs,
removes CO2, the waste product of cellular metabolism block the respiratory passageways or interfere with the movement
of the rib cage
Secondary functions:
- facilitates sense of smell II. Assessment
- produces speech A. Interview Assessment
- maintains acid-base balance Cough, Sputum Production, Shortness of Breath, Chest Pain with
- maintains body water balance Breathing, Past History of Respiratory Infection, Smoking History,
- maintains heat balance Environmental Exposure, and Self Care Behaviors

LUNG VOLUME AND CAPACITIES B. Physical Assessment

● Tidal Volume: amount of air breathe during a quiet breathing; Posterior Thorax and Lungs
500 ml a. INSPECTION
● Inspiratory Reserve Volume: amount of extra air inhaled beyond • Color
TV; 2000-3000 ml • Spine and mobility and any structural deformity
● Expiratory Reserve Volume: extra air that can be exhaled after a • Symmetry of the posterior chest and posture and mobility of the
forced breath; 1200 ml thorax on respiration
● Vital Capacity: amount of air moved on deepest inspiration and • Note any bulges or retractions of the costal interspaces on
expiration; 3000-5000 ml respiratory movement
● Inspiratory Capacity: maximum amount of air an individual can • Note the anteroposterior diameter in relation to the lateral
inspire after a normal expiration; 2500-3500 ml diameter of the chest
● Residual Volume: amount of air that cannot be forcefully expired;
b. PALPATION
1000-1200 ml
• Identify any areas of tenderness, masses and inflammation
● Minimal Air: amount of air that remains in the alveoli even if the
• Palpate the ribs for symmetry, mobility and tenderness and the
lung has collapsed maybe because of trauma; 40% of RV
spine for tenderness and vertebral position
● Total Lung Capacity
• Check for symmetric chest expansion
• Check the tactile fremitus
FACTORS AFFECTING VENTILATION AND RESPIRATION
1. Air pressures c. PERCUSSION
- pulmonary ventilation depends on the volume changes within the • Percuss the entire lung fields
thoracic cavity • Assess diaphragmatic excursion
- pressures present in the thoracic cavity
- 2 phases of pulmonary ventilation: inspiration and expiration Tone Description Tone Description
2. O2, CO2 and H ion concentrations Flat soft intensity, high Resonance loud intensity,
respiratory changes in the medulla oblongata and pons of the brain pitch, short duration low pitch, long
and by the chemoreceptors located in the medulla and in the carotid *bones, large pleural duration
and aortic bodies effusion *normal lung
Dull medium intensity, Hyperresonance very loud, low
3. Airway resistance medium pitch and pitch, longer
- friction encountered as gases move along the respiratory duration duration
passageway, by constriction of the passageways, by accumulations *liver, pneumonia, *emphysema,
of mucus or infectious material and by tumors tumor, pleural effusion pneumothorax
- as resistance increases, gas flow decreases
d. Auscultation
4. Lung elasticity • Assess breath sounds
• Assess voice sounds
5. Alveolar surface tension
Anterior Thorax and Lungs 4. Bronchoscopy
a. INSPECTION Visual examination of the larynx, trachea and bronchi with a
• Inspect for symmetry of the thorax, ribs and clavicles bronchoscope
• Inspect skin color, lesions, hair distribution and note width of
costal angle Pre-Procedure
• Note manner of breathing and any signs of respiratory difficulty - informed consent
• Assess the respiratory rate, depth and symmetry - NPO prior
- assess coagulation studies
b. PALPATION - remove dentures/ eyeglasses
• General Palpation - prepare suction
• Symmetrical Chest Expansion - sedatives as ordered
• Assess Tactile Fremitus - have resuscitation equipment available

c. PERCUSSION Post-Procedure
- vital signs
d. AUSCULTATION - high-fowler's position
• Assess Breath Sounds - assess gag reflex
• Assess Voice Sounds - monitor for bloody sputum
- monitor respiratory status
Labs and Dx Tests - monitor for complications: bronchospasm, bronchial perforation,
1. Chest X-ray crepitus, dysrhythmia, fever, hemorrhage, hypoxemia & pneumothorax
Information on the anatomic location and appearance - notify MD if complications occur

Pre-Procedure Nursing Care 5. Pulmonary Angiography

- Remove jewelries and other metal objects
-Assess ability to inhale and hold breath
-Question regarding pregnancy or possibility of pregnancy
2. Sputum Collection
Obtained by expectoration, tracheal suctioning or bronchoscopy
Pre-Procedure Nursing Care
- Determine specific purpose
- Early morning sterile specimen
- Rinse mouth with water prior to collection
- Take several deep breaths and then cough forcefully
- Collect specimen before giving antibiotics
Post-Procedure Nursing Care
- Transport specimen stat
- Mouth care
Insertion of a fluoroscopy via the antecubital or femoral vein into
pulmonary artery Involves iodine or radiopaque or contrast material
Pre-Procedure
- NPO/ Vital Signs
- assess coagulation studies and renal system functioning
- establish an open line/ IV
- administer sedation
- client must lie still during the procedure
- urge to cough, flushing, nausea or a salty taste
- emergency equipment available
Post-Procedure
- vital signs/ no BP taking for 24 hours in the affected extremity
- monitor peripheral neurovascular status
- encourage increase oral fluid intake/ IVF
- assess for bleeding and dye reaction

3. Pulse Oximetry 6. Thoracentesis

A non-invasive test that registers arterial O2 Saturation (SaO2) Insertion of a hollow needle or similar instrument into the pleural
Normal Values: 95-100% cavity of the chest in order to drain pleural fluid, pus or air
Alert hypoxemia before clinical signs occur
Pre-Procedure
Procedure - informed consent
- a sensor is placed: finger, toe, nose or earlobe - vital signs
- do not select extremity with impediment to blood flow - CXR or UTZ prior to the procedure
- results lower than 91% - immediate treatment - NPO if pX will receive sedation, otherwise local anesthesia is given
- if the SaO2 is below 85% - hypo-oxygenation - assess coagulation studies
- if the SaO2 is below 70% - life threatening situation - upright position
- do not cough, breathe deeply or move during the procedure
Post-Procedure 10. Arterial Blood Gas Analysis (ABG)
- vital signs/ respiratory status Measurement of tissue oxygenation, carbon dioxide removal and
- pressure dressing acid base balance
- assess site for bleeding and crepitus
pH PaO2 PaCO2 HCO3
- monitor for signs of complications
7.35-7.45 80-100 mmHg 35-45 mmHg 22-26 mEq/L
Pressure of
7. Lung Biopsy Partial Carbon Dioxide
Indicated if CXR, CT-Scan or bronchoscopy have failed to identify pressure Pressure of Oxygen When combines Bicarbonate, base
of Hydrogen in itself
the cause of pulmonary lesions with water forms
carbonic acid
Pre-Procedure > 45 mmHg, respi < 22 mEq/L,
- informed consent < 7.35- When low indicates acidosis metabolic acidosis
acidosis, < 35 mmHg, respi > 26
- NPO post NOC hypoxemia
> 7.45- alkalosis mEq/L,metabolic
- CXR and blood studies alkalosis alkalosis
- anesthetic
- pressure during insertion and aspiration Quick Steps in Interpreting ABG Results
- analgesics and sedatives as ordered LABEL THE pH: Look at the pH and determine if it is moving towards
- keep calm and quiet acidosis or alkalosis. In either case, there is a CAUSE! Note that
the pH only follows the direction of either PaCO2 or HCO3
Post-Procedure
- vital signs FIND THE CAUSE: because the pH only follows whether PaCO2 or HCO3,
- pressure dressing the cause is only either of the two. If the PaCO2 is the cause, it
- monitor for bleeding and respiratory distress is RESPIRATORY but if HCO3 is the cause, it is METABOLIC.
- monitor for complications
- CXR DETERMINE THE COMPENSATION: If the cause is respiratory, then the
opposite side, the metabolic system will normally compensate and vice
8. Ventilation Perfusion Scan versa. If the movement of other value is towards the opposite,
Determines the patency of the pulmonary airways there is compensation. If it remains normal, then there is no
compensation
Pre-Procedure
- informed consent ROME: Respiratory Opposite Metabolic Equal
- assess allergies to dye, iodine or seafood
R Alka R Acid M Alka M Acid
- remove jewelries
pH Inc Dec Inc Dec
- review breathing methods
PaCO2 Dec Inc N N
- IV access
- administer sedation HCO3 N N Inc Dec
- emergency resuscitation equipment Examples (ABG):
Post-Procedure a. pH - 7.33 (acid)
- monitor reaction to radionuclide PaCO2 - 50 (acid)
- handle body secretions carefully HCO3 - 23 (normal)
- wash hands carefully with soap and water Respiratory Acidosis, Uncompensated
b. pH - 7.41 (normal)
9. Skin Tests PaCO2 - 50 (acid)
- Determine hypersensitivity HCO3 - 23 (alkaline)
- Should be on the area without excessive body hair and dermatitis Metabolic Alkalosis, Fully Compensated
- Circle, document the date, time and test site If pH is normal = .35 - .40 (acid); 41 - .45 (alkaline)
- Do not scratch nor wash
c. pH - 7.33 (acid)
- Assess for induration, erythema and vesiculation
PaCO2 - 50 (acid)
- Tuberculin test/ PPD
HCO3 - 28 (alkaline)
0-4 mm not significant Respiratory Acidosis, Partially Compensated
5mm or greater significant in patients with HIV and close d. pH - 7.33 (acid)
contacts of someone with active PTB PaCO2 - 50 (acid)
10 mm or greater significant in people who have normal or HCO3 - 20 (acid)
mildly impaired immunity
Combined Respiratory and Metabolic Acidosis anaphylaxis
Obtaining Specimen for ABG by stabilizing the mast
- Do Allen's Test cell membrane, as a
- Use heparinized syringe result, the stimulus for
- No bubbles in the syringe bronchospasm is reduced
- Send specimen on ice and occlude needle to prevent and bronchospasm is
air from coming in the syringe relieved
- Check site for hematoma, bleeding and pain Liquify and loosen thick acetylcysteine
Mucolytics mucus secretions so that ambroxol
11. Pulmonary Function Tests they can be expectorated
- Pulmonary function laboratory Thin mucus so it’s cleared guaifenesin
- Nose clip is applied to unsedated client then breathes into a more easily out of
spirometer or body plethysmograph Expectorants airways; also soothe
- Using measured lung volumes, respiratory capacities are mucous membranes in the
calculated to assess pulmonary status respiratory tract

TLC: total volume of lungs at their maximum inflation; TV, IRV, ERV IV. Special Procedure and Device
and RV are used to calculate TLC
Chest Tube Thoracostomy
VC: IRV, TV and ERV
- a flexible plastic tube is inserted through the side of the chest
IC: TV and IRV
into the pleural space
Functional Residual Capacity: volume of air left in the lungs after
a normal exhalation; ERV and RV Indications:
Forced Expiratory Volume: amount of air that can be exhaled in 1 sec - pneumothorax
Forced Vital Capacity: amount of air that can be exhaled forcefully - pleural effusion
and rapidly after maximum air intake - empyema
Minute Volume: total amount of air breathe in 1 minute
Nursing Considerations:
III. Drugs - ensure that drainage tubing does not kink, loop or interfere with
DRUGS MOA EXAMPLES the patient's movement
decrease nasopharyngeal diphenhydramine - encourage patient to assume a comfortable position with good body
secretions by blocking the loratadine alignment
Antihistamines - make sure that there is fluctuation or "tidaling" of the fluid in
H1 receptors citirizine
the water seal chamber in wet systems or check the air leak
Act on the cough-control dextromethorphan indicator for leaks in dry systems with one-way valve
Antitussives center in the medulla to codeine - observe for air leaks in the drainage system - they are indicated
suppress the cough reflex benzonatate by constant bubbling in the water seal chamber or by air leak
Relaxes the smooth theophylline indicator in dry systems with a one-way valve*
muscles of the bronchi, - observe and immediately report rapid and shallow breathing,
bronchioles and pulmonary cyanosis, pressure in the chest, subcutaneous emphysema, symptoms
blood vessels by inhibiting of hemorrhage or significant changes in the vital signs
Methylxantines the enzyme - the chest tube is removed as directed when the lung has
phosphodiesterase, reexpanded
resulting in an increase
cAMP, which promotes Mechanical Ventilator
bronchodilation - a positive or negative-pressure breathing device that supports
Stimulates beta 2 pirbutetol ventilation and oxygenation for a prolonged period of time
receptors to cause albuterol Indications:
Beta 2 agonist
smooth muscles of the - continuous decrease in oxygenation (PaO2)
bronchi to relax - increase in arterial CO2 levels
Prevents the release of cromolyn sodium - persistent acidosis (decreased pH)
Mast cell histamine and slow- - conditions* that lead to respiratory failure
stabilizer reacting substances of - apnea that is not readily reversible
 RESPIRATORY THERAPIES
1.Oxygen therapy
- provide adequate transport of oxygen in the blood while decreasing
the work of breathing and reducing stress on the myocardium
2. Incentive Spirometry
- is a method of deep breathing that provides visual feedback to
encourage the patient to inhale slowly and deeply to maximize lung
inflation and prevent or reduce atelectasis
Indications: used after surgery, especially thoracic and abdominal
surgery, to promote the expansion of the alveoli and to prevent or
treat atelectasis
3. Small- Volume Nebulizer (Mini- Nebulizer) Therapy
- a handheld apparatus that disperses a moisturizing agent or
medication such as a bronchodilator or mucolytic agent, into
microscopic particles and delivers it to the lungs as the patient
inhales. rather than air driven
V. Emergency Management of Upper Airway Obstruction
Causes:
a. food particles
b. vomitus
c. blood clots
d. or anything that obstructs the larynx or trachea.
e. enlargement of tissue in the wall of the airway
f. Epiglottitis
g. obstructive sleep apnea
h. laryngeal edema
i. laryngeal carcinoma
j. peritonsillar abscess
k. . thick secretions
l. patient with an altered level of consciousness from any cause
m. Due to loss of the protective reflexes (cough and swallowing) and
loss of the tone ofthe pharyngeal muscles, which causes the tongue
to fall back and block the airway
1. Endotracheal Intubation
- involves passing an endotracheal tube through the nose or mouth
into the trachea
Complications:
• can occur from pressure exerted by the cuff on the tracheal wall.
• Cuff pressures should be maintained between 20 and 25 mm Hg (24
to 30 cm H2O)
• high cuff pressure can cause: tracheal bleeding, ischemia, and
pressure necrosis,
• low cuff pressure can increase the risk of aspiration pneumonia.
2. Tracheostomy
- is a surgical procedure in which an opening is made into the
trachea.
- The indwelling tube inserted into the trachea is called a
tracheostomy tube
Complications:
- dislodgement, accidental decannulation, bleeding,pneumothorax, air
embolism, aspiration, subcutaneous mediastinal emphysema, recurrent
laryngeal nerve damage, posterior tracheal wall penetration.
Long-term complications:
- airway obstruction from accumulation of secretions
- protrusion of the cuff over the opening of the tube
- infection,
- dysphagia
- tracheal dilation
- tracheal ischemia, and necrosis. Tracheal stenosis may develop
after the tube is removed
Mechanical Ventilator
- a positive or negativepressure breathing device that supports
ventilation and oxygenation for a prolonged period of time
Types of Mechanical Ventilator
1. Positive-Pressure Ventilators
- inflate the lungs by exerting positive pressure on the airway,
pushing air in, similar to a bellows mechanism, and forcing the alveoli
to expand during inspiration
2. Noninvasive Positive-Pressure Ventilation (NIPPV)
a.CPAP – Continuous Positive Airway Pressure
b.BiPAP – Bilevel Positive Airway Pressure
- a method of positive-pressure ventilation that can be given via
facemasks that cover the nose and mouth, nasal masks, or other
oral or nasal devices such as the nasal pillow (a small nasal cannula
that seals around the nares to maintain the prescribed pressure)
- it eliminates the need for endotracheal intubation or tracheostomy
and decreases the risk of nosocomial infections such as pneumonia
Indication:
- acute or chronic respiratory failure
- acute pulmonary edema
- COPD
- chronic heart failure
- sleep-related breathing disorder
e.g. OSA
Ventilator Modes:
- refers to how breaths are delivered to the patient
1.A/C mode – Assist- control mode
- Provides full ventilator support by delivering a preset tidal
volume and respiratory rate
2. SIMV – synchronized intermittent mandatory ventilation
- delivers a preset tidal volume and number of breaths per minute
- Between ventilator-delivered breaths, the patient can breathe
spontaneously with no assistance from the ventilator on those extra
breaths
- Because the ventilator senses patient breathing efforts and does VI. Disorders
not initiate a breath in opposition to the patient’s efforts fighting UPPER RESPIRATORY TRACT INFECTION (URTI)
the ventilator is reduced
Rhinitis
3. Pressure support ventilation – is an inflammation and irritation of
- applies a pressure plateau to the airway throughout the patient the mucous membranes of the nose
triggered inspiration – may be acute or chronic, and allergic
or nonallergic
Ventilators setting:
Factors:
1.tidal volume (6-10ml/kg or 4-8ml/kg for patients with ARDS)
○ changes in temperature or humidity
2.Mode
○ Odors
3.FIO2
○ Infection
4.Rate
○ Age
5.PEEP if applicable
○ systemic disease
6.Peak inspiratory pressure (PIP) – (Normal – 15-20cmH2O)
○ use of over-the-counter (OTC) and prescribed nasal
Increased = increased airway resistance or decrease
decongestants
compliance
○ presence of a foreign body.
Complications: Allergic rhinitis may occur with:
1. Trauma- Barotrauma (damage to the lungs by positive pressure) a. exposure to allergens such as Foods
can occur due to a pneumothorax, subcutaneous emphysema or b.medications
pneumomediastinum. Volutrauma (damage to the lungs by volume c. particles in the indoor and outdoor
delivered from one lung to the other).
2. Fluid retention - can be due to decreased CO, activation of RAAS Rhinosinusitis
3. Oxygen toxicity - can result from high concentrations of oxygen – inflammation and congestion, with thickened mucous secretions
(typically greater than 50%), long durations of oxygen therapy filling the sinus cavities and occluding the openings
(typically more than 24 to 48 hr), and/or the client’s degree of lung
disease. Signs and symptoms:
4. Hemodynamic compromise - can increase thoracic pressure 1. Rhinorrhea (excessive nasal drainage, runny nose)
(positive pressure), which can result in decreased venous return. 2. Nasal congestion (purulent with bacterial rhinitis)
3. Sneezing
5. Aspiration - Keep the head of the bed elevated 30° at all times
4. Pruritus of the nose, roof of the mouth, throat, eyes and ears
to decrease the risk of aspiration.
5. Headache – if rhinosinusitis is also present
6. Gastrointestinal ulceration (stress ulcer) - ulcers can be
evident in clients receiving mechanical ventilation. Medical Management:
1.Antihistamines – most common treatment
NURSING INTERVENTIONS 2.Oral decongestants – for nasal obstruction
2 Important General Nursing Interventions: 3.Saline nasal spray
1. pulmonary auscultation 4.Intranasal corticosteroids – severe congestion
2. interpretation of ABG measurements
- Enhance Gas Exchange Patient education:
- Promote Effective Airway Clearance ○ Avoid or reduce exposure to control allergens and irritants
- Prevent Trauma and Infection ○ Instruct the importance of controlling the environment at home
- Promote Optimal Level of Mobility and at work
- Promote Optimal Communication ○ Review hand hygiene techniques in case of infection
- Promote Coping Ability ○ Review the importance of influenza vaccination each year - older
- Monitor and Manage Potential Complications adults and high risk populations

Laryngitis
– an inflammation of the larynx,
often occurs as a result of
voice abuse or exposure to dust,
chemicals, smoke, and other
pollutants or as part of a URI
Causes: - Liquid or soft diet
1. isolated infection involving only the vocal cords
2. gastroesophageal reflux (referred to as reflux laryngitis) Medical management:
1. Viral pharyngitis – supportive measures
Clinical Manifestations: 2. Bacterial pharyngitis – penicillin (treatment of choice),
- hoarseness or aphonia (loss of voice) cephalosporins and macrolides
- severe cough
Medical Management: Tonsilitis and Adenoiditis
1. resting the voice - Tonsils frequently serve as the site of acute infection (tonsillitis)
2. avoiding irritants (including smoking) Caused by: GABHS (bacterial) Epstein–Barr virus (viral)
3. resting and inhaling cool steam or an aerosol. Clinical Manifestations:
- sore throat
Acute Pharyngitis (sore throat) - Fever
– is a sudden painful inflammation - Snoring
of the pharynx, the back portion of - difficulty swallowing
the throat that includes the - Enlarged adenoids may cause: mouth breathing, earache, draining
posterior third of the tongue, soft ears, frequent colds, bronchitis, foulsmelling breath, voice
palate, and tonsils. impairment, and noisy respiration
Causes:
Diagnostics:
1. Group A beta-hemolytic streptococcus (GABHS)/ group A
- Primarily clinical
streptococcus (GAS) or streptococcal pharyngitis.
- Throat swab culture
2. groups B and G streptococci, Neisseria gonorrhoeae, Mycoplasma
pneumoniae, Arcanobacteriumhaemolyticum, and HIV (Randel, 2013). Medical Management
1.Supportive measures – increase fluid intake, analgesics, salt-
Pathophysiology
water gargles, rest
- Viral infection causes most cases of acute pharyngitis
2. Penicillins (first line therapy) or cephalosporins
Responsible viruses include: 3. Tonsillectomy – treatment of choice for Chronic tonsillitis
1. adenovirus, influenza virus
2. Epstein–Barr virus Nursing Management
3. herpes simplex virus. 1. Provide post operative care
- Bacterial infection accounts for the remainder of cases - Continuous nursing observation is required in the immediate
postoperative and recovery periods because of the risk of
Bacterial invasion hemorrhage
↓ - Place patient on prone position with head turned to one side – to
Inflammatory response - pain, fever,
allow drainage from mouth and pharynx
vasodilation, edema, tissue damage
(redness, and swelling in the tonsillar - Apply ice collar to the neck
pillars, uvula and soft palate.)
2. Educating Patients About Self-Care
Clinical Manifestations: - The patient and family must understand the signs and symptoms of
1. fiery-red pharyngeal membrane and tonsils hemorrhage( Bleeding may occur up to 8 days after surgery).
2. lymphoid follicles that are swollen and flecked with white-purple - The nurse instructs the patient about the use of liquid
exudate acetaminophen with or without codeine for pain control
3. enlarged and tender cervical lymph nodes, and no cough
4. Fever (higher than 38.3°C [101°F]) Obstructive Sleep Apnes (OSA)
3. Malaise – a disorder characterized by
4. sore throat recurrent episodes of upper airway
obstruction and a reduction in
Diagnostics: ventilation
1. Rapid antigen detection testing (RADT) – It is defined as cessation of
- uses swabs that collect specimen from posterior pharynx and tonsil breathing (apnea) during sleep usually
- 90-95% sensitive caused by repetitive upper airway
2. Throat culture obstruction
Nutritional therapy
Risk factors: 4. Maxillomandibular surgery - may be performed to advance the
1. Obesity – major risk factor maxilla and mandible forward in order to enlarge the posterior
- a larger neck circumference and increased amounts of pharyngeal region
peripharyngeal fat narrow and compress the upper airway 5. Tracheostomy - relieves upper airway obstruction but has
2. male gender numerous adverse effects, including speech difficulties and
3. postmenopausal status increased risk of infections
4. advanced age
Pharmacologic Therapy
Pathophysiology 1. Modafinil - to reduce daytime sleepiness (Downey, 2015)
- pharynx is a collapsible tube that can be compressed by the soft 2. Protriptyline (Triptil) - given at bedtime may increase the
tissues and structures surrounding it respiratory drive and improve upper airway muscle tone
3. Medroxyprogesterone acetate (Provera) and acetazolamide (Diamox)
During sleep
used for sleep apnea associated with chronic alveolar hypoventilation
↓
The tone of the muscles of the upper airway is reduced Nursing Management
↓
Reduced diameter of the upper airway explain the disorder in terms that are understandable to the patient
Dynamic changes during sleep = Obstruction and relates symptoms (daytime sleepiness) to the underlying
These sleep-related changes may predispose to disorder
↓ 1. Instruct the patient and family about treatments, including the
Upper Airway collapse
↓ correct and safe use of CPAP, BiPAP, MAD, and oxygen therapy
Apnea
↓ Epistaxis (Nosebleed)
Repetitive Apneic events
↓
– a hemorrhage from the nose
Hypoxia and hypercapnia – caused by the rupture of tiny, distended vessels in the mucous
membrane of any area of the nose
Classic Signs and Symptoms (“3S”)
1. snoring - loud Risk factors:
2. sleepiness • Local infections (vestibulitis, rhinitis, rhinosinusitis)
3. significant-other report of sleep apnea episodes • Systemic infections (scarlet fever, malaria)
• Drying of nasal mucous membranes
Symptoms typically progress with increase in weight and aging • Trauma (digital trauma, blunt trauma, fracture, forceful nose
1. Excessive daytime sleepiness blowing)
2. Frequent nocturnal awakening • Arteriosclerosis
3. Morning headaches • Hypertension
• Tumor (sinus or nasopharynx)
Diagnostics: • Thrombocytopenia
1. Clinical features • Use of aspirin
2. Polysomnographic finding
Medical Management
Medical management: - Depends on the cause and location
- Weight loss, - Apply direct pressure
- avoidance of alcohol - Nasal decongestants (phenylephrine) - vasoconstrictors
- positional therapy (using devices that prevent patients from Nursing management
sleeping on their backs) - monitors the patient’s vital signs
- oral appliances – e.g. mandibular advancement devices (MADs) - assists in the control of bleeding
- provides tissues and an emesis basin to allow the patient to
SURGICAL MANAGEMENT expectorate any excess blood
1. Simple tonsillectomy - patients with larger tonsils - assess the patient’s airway and breathing
2. Uvulopalatopharyngoplasty - resection of pharyngeal soft tissue
and removal of approximately 15 mm of the free edge of the soft Educating Patients About Self-Care
palate and uvula - avoid vigorous exercise for several days
3. Nasal septoplasty - may be performed for gross anatomic nasal - avoid hot or spicy foods and tobacco (causes vasodilation and
septal deformities increase the risk of rebleeding)
- avoid forceful nose blowing, straining, high altitudes, and nasal 2. inhalation of physical and chemical irritants
trauma (including nose picking = gases, or other air contaminants
- Applying direct pressure to the nose for 15 minutes ↓
cause acute bronchial irritation
Laryngeal Obstruction
- Obstruction of the larynx because of edema Clinical Manifestations
- is a serious condition that may be fatal without swift, decisive 1. Dry, irritating cough and expectorates a scanty amount of mucoid
intervention sputum
- It is an occasional cause of death in severe anaphylaxis 2. Report of sternal soreness from coughing
(angioedema). 3. fever or chills
4. night sweats
CAUSES OF LARYNGEAL OBSTRUCTION 5. headache
6. General malaise
PRECIPITATING EVENT MECHANISM OF OBSTRUCTION
7. shortness of breath
History of allergies; exposure to anaphylaxis
8. noisy inspiration and expiration (inspiratory stridor and
medications, latex, foods, bee
expiratory wheeze)
stings
9. purulent (pus-filled) sputum
Foreign body inhalation / ingestion of meat or
10. blood-streaked secretions - due to mucosal airways irritation
other food items, coin, chewing
gum, balloon fragments
Medical Management
Heavy alcohol consumption; heavy Obstruction from tumor
1. Antibiotic treatment may be indicated depending on the symptoms,
tobacco use
sputum purulence, and results of the sputum culture and sensitivity.
Use of ACE inhibitor Increased risk of Angioedema of 2.Antihistamines usually are not prescribed, because they can cause
the mucous membranes excessive drying and make secretions more difficult to expectorate.
History of surgery or previous Possible subglottic stenosis 3.Increase Fluid intake
tracheostomy
Clinical Manifestations Nursing Management
- lowered oxygen saturation - is usually treated in the home setting
- use of accessory muscles 1. encourage bronchial hygiene
- increased fluid intake
Assessment and Diagnostic Findings - directed coughing to remove secretions
1.thorough history - can be very useful - encourage and assist patient to sit up frequently to cough
2.emergency measures to secure the patient’s airway should not be effectively
delayed 2. emphasize full course of antibiotics
Medical Management 3. rest
- Medical management is based on the initial evaluation of the
patient and the need to ensure a patent airway ADULT RESPIRATORY DISORDERS
- allergic reaction = subcutaneous epinephrine and a corticosteroid
Bronchial Asthma
- Ice may be applied to the neck =reduce edema.
Chronic inflammatory disease of the airways that causes airway
- Continuous pulse oximetry
hyperresponsiveness, mucosal edema and mucus production
Acute Tracheobronchitis Etiology
- an acute inflammation of the mucous membranes of the trachea and - environmental factors interact with inherited factors to produce
the bronchial tree, often follows infection of the upper respiratory the disease
tract
Asthma Triggers
Pathophysiology - seasonal allergens: grass, tree, weed, pollens
Caused by: - perennial allergens: mold, dust, roaches, animal dander
1. Streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma - airway irritants: air pollutants, cold, heat, weather changes,
pneumoniae,or a fungal infection (e.g., Aspergillus) strong odors or perfumes, smoke
↓
- exercise, stress, emotional upset
Inflammation of bronchial mucosa
↓ - sinusitis with postnasal drip
produces mucopurulent sputum - medications: aspirin, penicillin, beta blockers
- viral respiratory tract infections ○ recognize early symptoms
- hyper allergenic food ○ instruct patient in administration of medications as treatment
○ adequate rest, sleep and a well-balanced diet
Assessment ○ adequate fluid intake
- cough: non-productive to productive ○ exercise as tolerated
- dyspnea
- wheezing COPD (Chronic Obstructive Pulmonary Disorder)
- diaphoresis - aka Chronic Airflow Limitation
- mild apprehension and restlessness - group of diseases including chronic bronchitis and emphysema or a
- tachycardia and palpitation combination of these disorders characterized by progressive airflow
- cyanosis and hypoxia limitations into and out of the lungs, elevated airway resistance,
- hyperventilation irreversible lung distention and ABG imbalance
Diagnostic Tests Risk Factors:
- ABG: respiratory alkalosis to respiratory acidosis; hypoxemia - exposure to tobacco smoke
- blood tests: eosinophilia, elevated IgE - passive smoking
- occupational exposure
Complications - ambient air pollution
○ status asthmaticus - efficiency of alpha1 antitrypsin
○ respiratory failure
○ pneumonia Chronic Bronchitis
○ atelectasis – Inflammation of the bronchi leading to increasedmucus production,
○ dehydration chronic cough and eventualscarring of the bronchial lining
↓
Medical Management Presence of productive cough for at least 3 months in each of two
1) Quick-relief medications consecutive years
a. Short acting beta adrenergic agonists: albuterol (Proventil,
Ventolin), metaproterenol sulfate (Alupent), terbutaline sulfate Assessment
(Bricanyl) - productive cough
b. anticholinergics: ipatropium bromide (Atrovent) - dyspnea on exertion
c. systemic corticosteroids: prednisone - hypercapnia
- cyanosis
2) Long-acting control medications - anorexia and generalized body malaise
a. corticosteroids: prednisolone, prednisone - pulmonary hypertension
b. mast cell stabilizers: cromolyn sodium, nedocromil - polycythemia
c. long acting beta 2 adrenergic agonists: salmeterol (Serevent) - recurrent RTI
d. leukotriene modifiers/ antileukotrienes: act by interfering with
leukotriene synthesis or prevents its binding to receptor sites; Emphysema
montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo) – abnormal and permanent distention of the air spacesbeyond the
e. methylxanthines: theophylline (Theo-Dur, Slo-bid) terminal bronchioles, with destruction ofthe overdistended walls of
the alveoli
Interventions for an Acute Asthma Attack ↓
 assess airway patency the end stage of a process that has progressed slowly for many
 administer humidified oxygen years
 administer rescue meds
 monitor respiratory status, pulse oximeter and color Types of Emphysema:
 initiate IV line 1. Centriacinar/ Centrilobular
 prepare for CXR - the most common type; occurs most commonly in smoker
 prepare to obtain ABG and serum electrolytes - destruction in the bronchioles, usually in the upper lung regions
- spreads peripherally but the alveolar sac remains intact
Nursing Management
2. Panacinar/ Panlobular
○ chest physiotherapy
- destruction of the entire alveolus and most commonly involves the
○ allergen control
lower portions of the lungs
○ avoid extremes of temperature
- seen in individuals with AAT deficiencies
○ avoid exposure to viral respiratory infection
Assessment b) anticholinergics: block the cholinergic receptors located in the
○ dyspnea on exertion larger airways resulting in bronchodilation; ipratropium bromide
○ productive cough (Atrovent)
○ barrel chest c) methylxanthines: enhance mucociliary clearance, stimulate the
○ hyperresonant sound central respiratory drive and improve lung function during sleep;
○ circumoral cyanosis aminophylline (Phyllocontin), theophylline (Slobid, Theo-Dur)
○ digital clubbing
○ wheezing 2) Corticosteroid
○ weight loss - shorten recovery time, improve lung function and decrease
○ orthopnea hypoxemia
○ use of accessory muscles - ex. beclomethasone (Beclo-vent, Vanceril); budesonide (Turbuhaler,
○ neck vein distention Pulmicort)
○ pitting peripheral edema 3) Antimicrobial Agents
○ cor pulmonale 4) Mucolytics/ Expectorants/ Antitussives
Diagnostics
B. Oxygen Therapy
- ABG: decreased PO2, increased PCO2 ( Respiratory acidosis,
- improve survival and quality of life in hypoxemic clients
hypoxemia)
- patients with chronic hyprecapnia may be O2 sensitive, their PaCO2
- CXR: reveals consolidation and hyperinflation
levels may rise when given with supplemental oxygen, leading to:
- PFTs: FEV1/FVC ratio of less than 70%
*CO2 Narcosis: suppression of the CNS and significant lethargy*
Complications
- pneumothorax Nursing Management
- respiratory failure 1. Monitor VS
- pneumonia- chronic atelectasis 2. Administer decreased Oxygenconcentration
- cor pulmonale 3. Monitor pulse oximetry
4. Provide respiratory treatments and chest physiotherapy
Risk Reduction 5. Teach pursed-lip breathing techniques
- smoking cessation 6. Record the color, amount and consistency of sputum
Effects of Smoking 7. Suction if necessary
- nicotine constricts terminal bronchioles which decreases airflow in 8. Monitor weight
and out of the lungs 9. Provide small, frequent feedings, high in calorie and protein with
- CO is smoke binds with hemoglobin and reduces its O2-carrying supplements
capacity 10. Force fluids unless contraindicated
- irritants in smoke cause increased mucus secretion by the mucosa 11. High fowler's position, leaning forward
of the bronchial tree and swelling of the mucosal lining, impairing 12. Adhere to activity limitations
airflow 13. Prevent infections
- irritants in smoke inhibit ciliary action & subsequently destroy it
- with time, smoking leads to the destruction of elastic fibers in Bronchiectasis
the lungs - Chronic irreversible dilation of the bronchi and bronchioles
- loss of elastic fibers causes collapse of small bronchioles and air - Develops when bronchial walls are weakened by chronic inflammatory
trapping in the aveoli at the end of expiration changes in the bronchial mucosa and occurs most often after
recurrent inflammatory conditions
Medical Management
A. Pharmacologic Interventions Predisposing Factors
1) Bronchodilators: - airway obstruction
- relieve bronchospasm and reduce airway obstruction by allowing - diffuse airway injury- pulmonary infections or complications of such
increased O2 distribution throughout the lungs and improving alveolar - genetic disorders (CF)
ventilation
- administered via MDI, USN, Oral Assessment
a) beta 2 adrenergic agonists: act on the the beta 2 adrenoceptors - chronic cough with purulent sputum
in the smooth muscles of the airways and cause bronchodilation; - fever
enhance mucus clearance and improve the endurance of respiratory - hemoptysis
muscles; albuterol (Proventil, Ventolin), metaproterenol sulfate - fatigue and weakness
(Alupent) - clubbing of fingers
Management B2. Staphylococcal PN: occurs thru inhalation of the organism or via
- promotion of bronchial drainage blood; caused by misuse or overuse of antimicrobial agents; CA -
- antimicrobial therapy Staphylococcus Aureus
- bronchodilators B3. Klebsiella PN: occurs in alcoholics, elderly, those with DM and
- management of fatigue and malnutrition chronic lung diseases; CA - Klebsiella Pneumoniae
- prevention of infection
C. Pneumonia in Immunocompromised Host
Pneumonia - occurs with the use of corticosteroids, chemotherapy, nutritional
- inflammation of lung parenchyma leading to pulmonary consolidation depletion, use of broad- spectrum antibiotics, AIDS, genetic immune
as alveoli are filled with exudates disorders and long term advanced life-support therapy

Predisposing Factors Types:

- age C1. Pneumocystis PN (PCP): observed in immunocompetent hosts and is
- smoking often an initial AIDS-defining symptom; CA - Pneumocystis Jiroveci
- air pollution C2. Fungal PN: greatest incidence in immunocompromised and
- prolonged immobility neutropenic patients; CA - Aspergillus Fumigatus
- immunosuppression
D. Aspiration Pneumonia
- chronic disease states
- refers to the pulmonary consequences resulting from entry of
- URTI
endogenous or exogenous substances into the lower airway
Mode of Transmission - most common form is bacterial infection from aspiration of
- respiratory droplets through person-to-person bacteria that normally reside in the upper airways
contact - most common pathogens: S. Pneumoniae, H. Influenzae and S. Aureus

CLASSIFICATIONS OF PNEUMONIA 2. According to Lung Involvement

1. According to Nature of Acquisition
A. Community Acquired Pneumonia
- occurs in the community setting or within the first 48 hours after
hospitalization
Types:
A1. Streptococcal/ Pneumococcal Pneumonia: most common; greatest
incidence in the elderly and COPD patients; CA - Streptococcus
Pneumoniae
A2. Haemophilus Influenzae: affects the elderly and patients in long
term care facilities
A3. Legionnaire's Disease: greatest incidence in smokers and
immunosuppressed; CA - Legionella Pneumophilia
A4. Mycoplasma Pneumonia: occurs most often in older children and
young adults; CA - MycoplasmaPneumoniae
A5. Viral Pneumonia: caused by influenza virus types A, B,
parainfluenza, cytomegalovirus and coronavirus
B. Hospital Acquired Pneumonia
- aka Nosocomial Pneumonia
- the onset of pneumonia symptoms more than 48 hours after
admission in patients with no evidence of infection at the time of
admission
Types:
B1. Pseudomonal PN: occurs in debilitated patients, on prolonged
intubation or with tracheostomy; CA - Pseudomonas Aeruginosa
A. Segmental Pneumonia - one or more segments of the lungs are
affected
B. Lobar Pneumonia - one or more entire lobes are affected
C. Bilateral Pneumonia - lobes in both lungs are affected
3. According to Location and Radiologic Appearance
A. Bronchopneumonia (Bronchial PN) - involves the terminal bronchioles
and alveoli
B. Interstitial (Reticular) Pneumonia - involves inflammatory
responses within lung tissue surrounding the air spaces and vascular
structures rather than the air passages themselves
C. Alveolar (Acinar) Pneumonia - there is fluid accumulation in the
lung's distal air spaces
D. Necrotizing Pneumonia - causes death of a portion of lung tissue
surrounded by viable tissue
Assessment
- productive cough: *pathognomonic sign - greenish to rusty sputum
- dyspnea
- tachypnea
- orthopnea
- fever, chills, anorexia, generalized body malaise
- anorexia and weight loss
- pleuritic friction rub and crackles
- cyanosis
Diagnostics
- CXR: consolidation
- Sputum GS, C & S: determines causative agent and drugs that are
effective
- CBC: increased WBC and ESR Diagnostics
- ABG: decreased PO2 - CXR: reveals pleural exudates
- CBC: elevated WBC
Complications - Chest CT/ Thoracentesis under UTZ guidance
- shock and respiratory failure
- atelectasis Medical Management
- pleural effusion - drain pleural cavity and achieve complete lung reexpansion - needle
- superinfection aspiration, CTT, open chest drainage via thoracotomy
- administration of antibiotics
Management - Decortication
- macrolides: azithromycin (Zithromax), clarithromycin
- fluoroquinolones: levofloxacin (Levaquin) Nursing Management
- cephalosporins: cefuroxime (Zinacef) - monitor breath sounds
- beta lactamase inhibitors: co-amoxiclav (Augmentin) - semi-fowler's/ high- fowler's
- antipyretics - encourage coughing and DBE
- mucolytics/ expectorants - assist with promotion of lung drainage and lung reexpansion
- O2 therapy
Acute Respiratory Distress Syndrome (ARDS)
Nursing Management - aka Adult Respiratory Distress Syndrome
- enforce CBR - a form of acute respiratory failure that occurs as a complication
- force fluids (2-3 L/day) of some other conditions, caused by a diffuse lung injury and leads
- institute pulmonary toilet: DBE, coughing exercises, chest to extravascular lung fluid the major site of injury is the alveolar
physiotherapy, turning and repositioning, postural drainage capillary membrane the interstitial edema causes compression and
- diet: increase CHO or calories, CHON and Vitamin C obliteration of the terminal airways and leads to reduced lung volume
- position: semi-fowlers and compliance.

Empyema Risk Factors

- An accumulation of thick, purulentbfluid within the pleural space • sepsis, fluid overload, shock, trauma, neurological injuries, burns,
drug ingestion, inhalation of toxic substances
Causes
✓ bacterial PN or lung abscess Phases
✓ penetrating chest trauma One: injury reduces normal blood flow to the lungs; platelets
✓ hematogenous infection of the pleural space aggregate and release histamines, serotonins and bradykinins
✓ nonbacterial infections✓ iatrogenic causes (post-thoracic surgery, Two: released substances inflame and damage the alveolar capillary
thoracentesis) membrane increasing capillary permeability; fluids then shift into the
interstitial space
Assessment Three: capillary permeability increases and proteins and fluids
• fever leakout,increasing interstitial osmotic pressure thus causing
• night sweats pulmonary edema
• pleural pain Fourth: decreased blood flow and fluids in the alveoli damage
• Cough surfactant and impair the cell's ability to produce more; the alveoli
• Dyspnea then collapse, hence impairing gas exchange
• weight loss Fifth: oxygenation is impaired but CO2 easily crosses the alveolar
• dullness on percussion capillary membrane and is expired; blood O2 and CO2 are low;pulmonary
• decreased fremitus edema worsens and inflammation leads to fibrosis; gas exchange is
• decreased/absent breath sound further impeded
• anorexia
Assessment
Nursing Management - tachypnea
- monitor breath sounds - dyspnea
- semi-fowler's/ high- fowler's - decreased breath sounds
- encourage coughing and DBE - hypoxemia
- assist with promotion of lung drainage and lung re-expansion - sudden and progressive pulmonary edema
Diagnostics Nursing Management
ABG: respiratory acidosis with hypoxemia or respiratory alkalosis due - administer O2
to hyperventilation followed by metabolic acidosis - administer antiemetics, antihistamines, antipyretics and
CXR: shows diffuse, bilateral and rapid progressing interstitial or corticosteroids as prescribed
alveolar infiltrates - encourage coughing and DBE
- semi-fowler's position
Interventions
- force fluids
- identify and treat the underlying cause
- CBR
- high fowler's/ prone
- instruct client to spray area with water before sweeping barn and
- prepare for intubation or mechanical ventilation using PEEP
chicken coops
- administer diuretics, anticoagulants or corticosteroids as
- spray breeding places
prescribed

CO Poisoning Sarcoidosis
- a multisystem, granulomatous disease of unknown etiology
- CO is a colorless, odorless and tasteless gas that has an affinity
for hgb 200 x greater than O2 Assessment
Assessment - night sweats, fever, weight loss, cough, skin nodules, polyarthritis
- 1-10%: impaired visual acuity Diagnostics
- 11-20%: flushing, headache - Kveim test: sarcoid node antigen in injected intradermally and
- 21-30%: nausea and impaired dexterity causes a local nodular lesion in about 1 month
- 31-40%: vomiting, dizziness and syncope - CXR/ CT Scan: hilar adenopathy and disseminated miliary and
- 41-50%: tachypnea and tachycardia nodular lesions in the lungs
- greater than 50%: coma and death - Transbronchial/ Open Biopsy: shows noncaseating granulomas
Interventions Management
- remove victim from exposure - administer corticosteroids to control symptoms
- administer O2 - monitor temperature
- monitor VS and CO level - force fluids
- assess the need for basic life support - provide adequate rest periods
Histoplasmosis - encourage small, nutritious meals
- a pulmonary fungal infection caused by Histoplasma capsulatum
. Occupational Lung Diseases: Pneumoconioses
which lives in the moist soil of appropriate composition such as:
- refers to nonneoplastic alteration of the lung resulting from
a. mushroom cellars
inhalation of mineral or inorganic dust leading to its deposition in
b. floors of chicken houses and bat caves in bird droppings
the lungs
(starlings, pigeons and
- progresses to pulmonary fibrosis and parenchymal changes
c. blackbirds)
- maybe asymptomatic but advanced disease is often accompanied by
- transmission occurs by inhalation of the spores
disability and premature death
- endemic to the Central America, India and Cyprus
Assessment the effects of inhaling these materials depend on:
- dyspnea, fever and chills, chest and joint pains, productive cough, - composition of the substance
fatigue, anorexia and weight loss - its concentration and ability to initiate an immune response
- its irritating properties
Diagnostics - the duration of exposure
- histoplasmin skin test (+) - the individual's response or susceptibility to the irritant
- ABG: PO2
- CXR: pulmonary infiltrates Types
- CBC: increased WBC 1. Silicosis
- caused by inhalation of silica dust in mining,quarrying, tunneling
Medical Management operations, glass manufacturing, stone- cutting, pottery, soap,
- antifungal agents: itraconazole amphotericin B (Fungizone): polish and filSigns and Symptoms
nephrotoxicity and hypokalemia
- corticosteroids
- mucolytic/ expectorants
Signs and Symptoms: Management
- acute: dyspnea, fever, cough, weight loss ○ observe respiratory status and maintain airway patency
- chronic: hypoxemia, severe airflow obstruction and right sided ○ assess temperature vial axillary not the oral route
heart failureter manufacturing ○ no attempts should be made to visualize the posterior pharynx to
obtain a throat culture
2. Asbestosis
○ maintain on NPO status
- characterized by diffuse pulmonary fibrosis from the
○ do not leave the child unattended
inhalation of asbestos dust during asbestos mining and
○ do not force the child to lie down nor restrain him/her
manufacturing, shipbuilding, demolition and roofing
○ provide cool-mist tent oxygen therapy
Signs and Symptoms
○ antibiotics, analgesics and antipyretics as prescribed
- progressive dyspnea, persistent dry cough, mild to
○ provide high humidification to cool the airway and decrease
moderate chest pain, anorexia, weight loss, malaise,
swelling
crackles, clubbing of fingers
○ have resuscitation equipment ready, prepare for intubation or
3. Coal Worker's Pneumoconiosis tracheotomy for severe respiratory distress
- aka "Black Lung Disease" ○ up-to-date immunization schedule including Hib conjugate vaccine
- includes a variety of lung diseases found in coal workers who have
. Acute Laryngotracheobronchitis
inhaled coal dust (mixture of coal, kaolin, mica and silica)
- inflammation of the larynx, trachea and bronchi that affects
Signs and Symptoms children below 5 years old
- chronic cough and sputum production, dyspnea, coughing up of - most common type of croup; maybe viral or bacterial
sputum with varying amounts of black fluid (melanoptysis). - has a gradual onset that maybe preceeded by an URTI
Complications Assessment
- pulmonary tuberculosis - barking cough, low grade to high fever, hoarseness of voice,
- cor pulmonale irritability and restlessness, pallor or cyanosis, inspiratory stridor,
- respiratory failure suprasternal retractions, crackles and wheezing, anorexia, n/v,
- lung cancer respiratory distress
Management Management
- eliminate toxic substances ○ observe closely for signs of airway obstruction
- supportive therapy since symptoms are already irreversible ○ elevate HOB and provide bed rest
- control infection ○ provide humidified O2 via cool-mist tent
○ when child awakens with a bark-like cough, place child in a
PEDIATRIC RESPIRATORY DISORDERS bathroom and run hot water to produce steam to provide relief
Differences of Children to Adults in Respiratory Responses ○ have child breathe in the cool night air or air from an open
4. Poor tolerance of nasal congestion freezer or take the child to a cool basement or garage to
5. Increased susceptibility to ear infection relieve laryngeal spasm if without cool-air vaporizer or humidifier
6. Increased severity of respiratory symptoms ○ force fluids; administer IVF
7. A total body response to respiratory infection ○ administers antipyretics, analgesics, bronchodilators and
Epiglottitis mucolytics as prescribed
- an acute and severe inflammation of the epiglottis. ○ epinephrine for severe attacks, stridor at rest, retractions and
- an emergency situation occurring in children ages 2-5 years old dyspnea
○ corticosteroids for inflammation and antibiotics for bacterial
Causative Agent: causes
Haemophilus Influenzae Type b or Streptococcus Pneumoniae
Bronchiolitis
Assessment - inflammation of the bronchioles that causes a thick production of
- high fever mucus that occludes bronchiole tubes and small bronchi
- drooling CA: Respiratory Syncitial Virus
- absence of spontaneous cough mode of transmission: direct person-to- person contact
- inspiratory stridor
- difficulty in swallowing Assessment
- red, inflamed throat with large, cherry-red and edematous - rhinorrhea, low-grade fever, lethargy, poor feeding and irritability,
epiglottis tachypnea, increased dyspnea, nasal flaring and retractions,wheezing
- tripod position and grunting, diminished breath sounds
Management Pathophysiology
- maintain a patent airway ○ CFTR not functioning properly
- position the child at a 30-40 degree angle with the neck slightly ○ CFTR resembles other transmembrane transport proteins but lack
extended to maintain an open airway and decrease pressure on the phenylalanine
diaphragm ○ interferes with cAMP-regulated chloride transport and that of
- provide cool, humidified O2 other ions
- encourage fluids, administer IV ○ mutation affects volume-absorbing epithelia, salt- absorbing
- assess for signs of dehydration epithelia and volume-secreting epithelia
- maintain child on respiratory isolation ○ dehydration, increased viscosity of mucous gland secretions
- administer antiviral meds: ribavirin (Virazole) leading to obstruction of glandular ducts
- administer Respiratory Syncytial Virus Immune Globulin (RSV-IGIV)
Diagnostics
1) Quantitative Sweat Chloride Test
Cystic Fibrosis - sweat production is stimulated with pilocarpine iontophoresis, then
- a chronic, multi- system disorder of the exocrine glands it is collected and the sweat electrolytes are measured
characterized by abnormally thick pulmonary secretions - minimum of 50 mg of sweat is needed
- an autosomal recessive trait disorder affecting the whites the
mucus produced by the exocrine glands is abnormally thick, causing Results:
obstruction of the small passageways of the affected organs - normal: less than 40 mEq/L
- (+) pancreatic enzyme deficiency caused by duct blockage, - positive result: greater than 60 mEq/L
progressive lung disease associated with infection and sweat gland - highly suggestive of CF: 40-60 mEq/L*
dysfunction resulting in increased sodium and chloride sweat 2) CXR: atelectasis and obstructive emphysema
concentrations 3) PFTs: provide evidence of abnormal small airway function
Assessment 4) Stool/fat and/or enzyme analysis: a 72 hour- stool sample is
1) Respiratory System collected to check the fat and/or enzyme (trypsin) content
a. stagnation of the mucus in the airway Management
b. emphysema and atelectasis
1. Respiratory System
c. chronic hypoxemia a) preventing pulmonary infectionb) antimicrobial medications
d. pneumothorax c) chest physiotherapy
e. wheezing and dry non-productive cough d) bronchodilators
f. dyspnea and cyanosis e) avoid cough suppressants
g. clubbing of fingers and toes f) encourage coughing and DBE
h. repeated episodes of bronchitis and pneumonia g) recombinant human deoxyribonuclease (DNase)/ dornase alfa
2) Gastrointestinal System (Pulmozyme): decreases mucus viscosity
a. meconium ileus in the neonate h) administer O2
b. intestinal obstruction: pain, abdominal distention, n/v i) monitor for hemoptysis*
c. steatorrhea j) lung transplantation
d. deficiency of A,D,E and K
2. GIT System
e. malnutrition and failure to thrive
a) replacement of pancreatic enzymes administered with meals and
f. hypoalbuminemia
snacks (or within 30 minutes of food intake) to ensure mixing of the
g. rectal prolapse
enzymes with food in the duodenum
h. lack of supportive fat pads around the rectum
b) encourage a well-balanced diet, high CHON, high calorie, intake of
multivitamins and vitamins ADEK
3) Integumentary System
c) monitor for weight and failure to thrive
a. increased Na and Cl in sweat
d)monitor for constipation and intestinal obstruction
b. dehydration and electrolyte imbalances during hyper thermic
e)supplement salt during extremely hot weather or during fever;
conditions
institute electrolyte replacements
4) Reproductive System
a. delayed puberty in females  the unexpected death of an apparently healthy infant under age
b. infertility (highly viscous cervical secretions) 1 year for which a thorough autopsy fails to demonstrate an
c. sterility (blockage of vas deferens) adequate cause of death
 etiology is unknown but maybe related to a brainstem abnormality
in the neurological regulation of cardiorespiratory control
 time of year: most frequently during winter months
 time of death: usually during sleep
 age: most frequently from 2-4 months of life
 sex and race: incidence higher in males, in Native Americans,
African Americans and Hispanics

Maternal Risk Factors

- maternal smoking
- substance abuse
- younger mothers

Birth Risk Factors

- prematurity
- low birth-weight infants
- multiple births
- infants with CNS problems

Sleep Risk Habits

- prone position
- use of soft beddings
- overheating (thermal stress)
- possibly sleeping with an adult

Appearance when found

- child is apneic, blue and lifeless
- frothy, blood-tinged fluid is in the nose and mouth
- child is typically found in a disheveled bed with blankets over the
head and huddled in a corner
- child maybe clutching bedding
- diaper maybe wet and full of stool

Prevention
- infants should be placed in supine position for sleep
- soft, moldable mattresses and bedding such as pillows or quilts,
should not be used under the infant for bedding
- stuffed animals should be removed from the crib while the infant
is sleeping
- discourage bed sharing (sleeping with an adult)
- avoid overheating during sleep