Responses to Alterations in
rhinitis
oxygenation and ventilation
RISK FACTORS FOR RESPIRATORY
DISEASE
➢ Smoking
➢ Use of chewing tobacco
➢ Allergies
➢ Frequent respiratory
illnesses
➢ Chest injury
➢ Surgery
➢ Exposure to chemicals &
environmental pollutants
➢ Family history of
infectious disease
➢ Geographic residence
& travel to foreign
countries
Management of Patients with
URTD
Upper Airway Infections/ URI
➢ Most common cause of
illness
➢ Acute or chronic?
➢ Common cold (viral
rhinitis) - CA: viruses
➢ Affect : •nasal cavity
•sinuses
Incidence rate: 2 to 4 times per
year
Rhinitis
▪ inflammation and
irritation of the mucous
membrane of the nose
▪ Acute or chronic?
▪ Allergic or nonallergic?
▪ Seasonal or perennial?
Risk factors:
▪ Change in temperature
and humidity
▪ Odors
▪ Infection; age; systemic
disease; use of OTC
Allergens:
Indoor
- dust mite feces
- Dog dander
- Cat dander
- Cockroach droppings
- Molds
Outdoor
- trees
- Weeds
- Grasses
-Molds
Signs/Symptoms:
❖ rhinorrhea
❖ nasal congestion
❖ Nasal discharge
❖ Purulent with bacterial
weeks), and
❖ Sneezing
❖ Pruritus of the nose roof
of the mouth, throat,
eyes and ears
❖ Headache
❖ rhinosinusitis
Medical Management:
- depends on the cause
- Hx and Physical Examination -
Pharmacologic management:
- allergic and nonallergic
— antihistamines and
corticosteroids nasal sprays
- Dimetapp
Viral Rhinitis/ Common Cold
▪ most common and self-
limited
▪ Rhinoviruses- most
common
▪ Coronavirus, adenovirus,
RSV,
▪ influenza, parainfluenza
▪ Location varies -
S/Sx:
❖ low-grade fever,
❖ nasal congestion,
rhinorrhea and nasal
discharge,
❖ halitosis, sneezing,
❖ tearing watery eyes,
“scratchy” or sore
throat,
❖ general malaise,
❖ chills, and often
headache and muscle
aches.
❖ Cough
❖ the virus exacerbates
herpes simplex,
❖ cold sore
Medical Management
-symptomatic therapy
-adequate fluid intake, rest,
prevention
of chilling
-use of expectorants as needed
-Warm salt-water gargles soothe
the sore throat,
- nonsteroidal antiinflammatory
drugs (NSAIDs), such as aspirin or
ibuprofen,relieve aches and
pains.
- Antihistamines
Rhinosinusitis
▪ sinusitis
▪ inflammation of the
paranasal
▪ sinuses and nasal cavity
▪ acute (less than 4
weeks),
▪ subacute (4 to 12
▪ chronic (more than 12
weeks
▪ ABRS
▪ AVRS
▪ Follows viral URI, or
unresolved viral or
bacterial infection
▪ Drainage obstruction
▪ Deviated septum,
hypertrophied
turbinates, spurs or nasal
polyps, tumors or sinus
infection
▪ Suppurative process
▪ Purulent discharge
Assessment and Diagnostic
Findings
-history and physical examination
- head and neck, nose, ears,
teeth, sinuses, pharynx, and chest
- Tenderness of the sinuses
- Transillumination
Medical Management
✓ Antibiotics- to shrink the
nasal mucosa, relieve
pain, and treat infection
Nursing Management
- Educating Patients About Self-
Care
- Report symptoms of
complications
- periorbital edema
- severe pain on palpation
- methods to promote drainage
of the
sinuses
- avoid swimming, diving, and air
travel
during the acute infection
- fever, severe headache, and
nuchal
rigidity—-potential complications
Acute Pharyngitis
▪ sudden painful
inflammation of the
pharynx
▪ adenovirus, influenza
virus,
▪ Epstein–Barr virus, and
herpes
▪ simplex virus - Bacterial
infection
▪ GABHS
S/Sx:
• fiery-red pharyngeal
membrane and tonsils,
 • Swollen lymphoid
follicles flecked with
white-purple exudate
• enlarged and tender
cervical lymph nodes,
and no cough.
• Fever (higher than
38.3°C
• malaise, and sore throat
Assessment and Diagnostic
Findings
▪ Rapid antigen detection
testing
▪ (RADT)
▪ swabs that collect
specimens
▪ from the posterior
pharynx and tonsil
▪ Negative results should
be confirmed- culture
Medical Management
▪ Viral pharyngitis-
supportive measures
▪ Bacterial pharyngitis-
antimicrobial agents-
Penicillin V potassium
▪ Nutritional Therapy-liquid
or soft diet
Nursing Management
✓ supportive measures
✓ Watch out!!- dyspnea,
drooling, inability to
swallow, and inability to
fully open the mouth
Chronic Pharyngitis
• persistent inflammation
of the pharynx
Risk factors
• dusty surroundings,
• use their voice to excess,
• suffer from chronic
cough, habitually use
alcohol- tobacco
There are three types of chronic
pharyngitis:
Hypertrophic—char. by general
thickening and congestion of the
pharyngeal mucous membrane
Atrophic—probably a late stage
of the first type (the membrane is
thin, whitish, glistening, and at
times wrinkled)
Chronic granular—char. by
numerous swollen lymph follicles
on the pharyngeal wall
S/Sx.
• constant sense of
irritation
• fullness in the throat
• mucus that collects in
the throat and can be
expelled by coughing,
• difficulty swallowing.
• intermittent postnasal
drip
*A sore throat that is worse with
swallowing in the absence of
pharyngitis- thyroiditis
Medical Management
❖ relieving symptoms
❖ avoiding exposure to
irritants
❖ correcting any upper
respiratory, pulmonary,
gastrointestinal, or
cardiac condition—---
chronic cough.
Tonsillitis and Adenoiditis
• bacterial pathogens
include GABHS
S/Sx:
➢ sore throat, fever,
snoring, and difficulty
swallowing
➢ Enlarged adenoids
➢ mouth breathing,
earache,
➢ draining ears, ,
bronchitis, foul-smelling
breath, voice
impairment, and noisy
respiration
Assessment and Diagnostic
Findings? Medical Management?
Nursing Management?
Postoperative Care
risk of hemorrhage
Position?
ice collar to the neck -
Complications?
- fever, throat pain, ear pain, and
bleeding
Peritonsillar Abscess
▪ Quinsy- pus filled
▪ common major
suppurative
▪ complication of sore
throat
▪ 20 to 40 years
▪ collection of purulent
exudate
▪ tonsillar capsule and the
surrounding tissues,
▪ soft palate
▪ acute tonsillar infection
▪ local cellulitis and
abscess
S/Sx.
• severe sore throat
• fever, t
• Trismus- inability to open
the mouth
• Drooling
• Intense pain
• Rancid breath
• raspy voice
• odynophagia- pain in
swallowing
• dysphagia- discomfort in
swallowing
• otalgia-ear pain
Assessment and Diagnostic
Findings
• aspiration
• Intraoral ultrasound
• transcutaneous cervical
ultrasound
Medical Management
• Antimicrobial agents
• penicillin
• corticosteroid therapy
Surgical Management
• Needle aspiration
• Incision and drainage
• Tonsillectomy
Nursing Management
✓ patient requires
intubation
✓ Cricothyroidotomy
✓ Tracheotomy
✓ Gentle gargling after the
procedure with a cool
normal saline gargle
✓ The patient must be
upright and
✓ clearly expectorate
forward.
✓ patient requires
intubation
✓ Cricothyroidotomy
✓ Tracheotomy
✓ Gentle gargling after the
procedure with a cool
normal saline gargle
✓ 1 or 2 hours for 24 to 36
hours
✓ The patient must be
upright and clearly
expectorate forward
✓ Adequate fluid intake
Laryngitis
Risk
▪ voice abuse or exposure
to dust, chemicals,
smoke, and other
pollutants or as part of a
URI
 ▪ gastroesophageal reflux
▪ Reflux laryngitis
▪ Pathogens? –
S/sx:
➢ hoarseness or aphonia
and severe cough
Medical Management
resting the voice,
avoiding irritants (including
smoking), resting,
inhaling cool steam or an aerosol.
Nursing Management
rest the voice and to maintain a
well humidified environment
NURSING PROCESS????
1. Assessment — enumerate!!
2. Diagnosis? Based on priority
3. Planning
4. Nursing Intervention
a. MAINTAINING A PATENT
AIRWAY
b. PROMOTING COMFORT
c. PROMOTING
COMMUNICATION
d. ENCOURAGING FLUID INTAKE
e. MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
Pulmonary Volumes and
Capacities
1. Total Lung Capacity (TLC)
✓ Max vol the lungs can
hold- 6000 mL
2. Tidal Volume (VT)
✓ Volume of one
inhalation/exhalation
cycle - 500 mL
3. Functional residual volume
(FRC)
✓ Vol remaining in the
lungs after a normal
exhalation- 2400mL
4. Inspiratory capacity (VT +IRV)-
3600mL
5. Inspiratory Reserve Volume
(IRV)
✓ Volume of air one is able
to inhale in addition to
the VT- 3100mL
6. Residual Volume (RV)
✓ Volume of air that
remains in the lungs
following forced
expiration beyond
normal (ERV)-1200mL
7. Vital CApacity
✓ Sum of ERV, VT and IRV-
4800mL
Respiration (Diffusion)
Ventilation-Perfusion
Relationships
● Gas exchange relies on
adequate perfusion of the alveoli.
✓ Normally, the volume in
the conducting airways,
such as the trachea and
bronchioles, do not
participate in gas
exchange.
● anatomical dead space
✓ because these
structures are not
designed for gas
exchange
● Alveolar dead space unit
✓ when an alveolus is not
perfused
(obstructed/collapsed),
air did not arrive in
alveolus.
✓ because no gas
exchange is occurring
✓ ventilation exceeds
perfusion
■ pulmonary embolism- has dead
space
■ pulmonary infarct.
● shunt unit
✓ when an alveolus is
inadequately ventilated
in the presence of
perfusion (there’s a
supply of blood, but
alveolus is not
✓ perfusion exceeds
ventilation
■ pneumonia
■ atelectasis.
● Silent unit
✓ when ventilation and
perfusion are impaired
✓ severe ARDS or
pneumothorax
(respiratory
emergencies)- fatal
Management of Patients with
Chest and Lower Respiratory Tract
Disorders
ATELECTASIS
▪ closure or collapse of
alveoli
▪ chest x-ray findings -
acute or chronic
Can be developed by:
▪ postoperative setting
▪ COPD
▪ Lung cancer-
malignancies
▪ Microatelectasis -certain
area of alveoli.
▪ Macroatelectasis- affect
segment of a lung loss of
segmental, lobar or
overall lung volume
(visible on xray)
Pathophysiology
➢ nonobstructive
atelectasis-caused by
post op complications-
reduced ventilation
➢ obstructive atelectasis-
obstruction in the
passage of air going to
alveoli : blockage that
obstructs passage of air
to and from the alveoli -
most common type.
➢ reabsorption of gas
➢ no additional air can
enter into the alveoli
➢ affected portion of the
lung becomes airless
➢ alveoli collapse:
obstructive
Causes;
❖ foreign body, tumor
❖ altered breathing
patterns
❖ retained secretions,
pain,
❖ alterations in small
airway function,
❖ prolonged supine
positioning,
❖ increased abdominal
pressure,
❖ reduced lung volumes
caused by:
Musculoskeletal,
neurologic disorders,
restrictive defects
❖ specific surgical
procedures (e.g., upper
abdominal, thoracic, or
open heart surgery
compressive atelectasis
➢ restricts normal lung
expansion on inspiration:
possible cause, post op-
prolong supine position
➢ pressure can be
produced by fluid
accumulation
-pleural space —-pleural effusion
(fluid accumulation)
-air in the pleural space leads to
pneumothorax
-blood in the pleural space leads
to Hemothorax
-pericardial area pericardial
effusion
Clinical Manifestations
 ➢ insidious- develops
slowly.
➢ increasing dyspnea,
cough, and sputum
production.
➢ lobar atelectasis, one
lobe is affected (worse)
➢ marked respiratory
distress
➢ tachycardia,
tachypnea, pleural
➢ pain, and central
cyanosis( not enough
air)- caused by
hypoxemia
➢ Orthopnea- difficulty in
breathing while laying
(sitting best position to
relieve)
➢ chronic atelectasis? –
manifestation: pt,
having probs with
ventilation of alveoli, risk
for pulmonary infection
➢ Friction happen- pleurisy
Assessment and Diagnostic
Findings
➢ Chest x-ray- best way to
diagnose
✓ patchy infiltrates or
consolidated areas
✓ pulse oximetry (SpO2) -
<90%
✓ partial pressure of
arterial oxygen (PaO2)
✓ Below Normal
3 hall mark signs:
• Decrease O2 sat- cause
by hypoxemia
• Marked tachypnea
• Difficulty in breathing
Prevention of collapse Alveoli
• frequent turning
• early mobilization(
specially for patient
after surgery)
• teach strategies to
expand the lungs (deep
breathing exercises)
- at least every 2 hours - manage
secretions : directed cough
• Suctioning
• aerosol nebulizer
treatments/ MDI
• chest physiotherapy:
postural drainage and
chest percussion
• incentive spirometry;
bronchoscopy- use to
check for collapse of
alveoli
Incentive Spirometry
1. Volume –oriented devices
- It measures volumetric
displacement on the device
2. Flow-oriented devices
- It provides only an indirect
indicator of the patient’s inspired
volume
Management
• improve ventilation and
remove secretions: turn
patient, early
ambulation, instruct pt. Acute Tracheobronchitis
deep breathing
exercises
• In patients who do not
respond to first-line
measures or who cannot
perform deep-breathing
exercises: PEEP( mech Pathophysiology
vent) help alveoli
• simple mask
• one-way valve system
provides varying
amounts of expiratory
resistance, usually 10 to
15 cm H2O
• CPAP
● Positive End-Expiratory Pressure
(PEEP):
✓ Increases oxygenation
by increasing functional
residual capacity (FRC).
✓ Keeps alveoli inflated
after expiration.
✓ Can use lower O2
concentrations with
PEEP;decreases risk of
O2 toxicity. Ordered as
5–10 cm H2O Clinical Manifestation
● Low-flow O2 Therapy
✓ Simple masks
✓ allow for higher FiO2 but
precise calculation of
FiO2 is again
dependent on the
patient’s respiratory
pattern.
✓ Flow rates administered
via simple masks range
from 8 to 12 LPM.
● Non-rebreather masks
-dependent on patients
breathing, effort
✓ have valves over the
ports that allow exhaled
air to escape but
prevent room air from
being inhaled.
✓ This mask is capable of
delivering up to 100%
O2. Medical Management
● Continuous Positive Airway
Pressure (CPAP):
✓ Maintains positive
pressure throughout the
respiratory cycle of a
spontaneously
breathing patient.
✓ Increases the amount
of air remaining in the
lungs at the end of
expiration.
✓ Fewer complications
than PEEP.
✓ Ordered as 5–10 cm
H2O
▪ acute inflammation of
the mucous membranes
of the trachea
▪ bronchial tree
▪ airway is affected
➢ Streptococcus
pneumoniae
➢ Haemophilus influenzae
➢ Mycoplasma
pneumoniae.
➢ fungal infection
(e.g.,Aspergillus)
➢ sputum culture sensitivity
➢ inhalation of physical-
person to person (talk,
sneeze)
➢ chemical irritants, gases,
or other air
contaminants
➢ ventilatorassociated
trachea bronchitis-
commonly cause by
fungal infection
• dry, irritating cough
• expectorates a scanty
amount of mucoid
sputum
• sternal soreness
• coughing
• fever or chills
• night sweats, headache
• General malaise
• short of breath- late
signs
• noisy inspiration and
expiration (inspiratory
stridor and expiratory
wheeze)
• produce purulent (pus-
filled) sputum
• blood-streaked
secretion
❖ Antibiotics
❖ Antihistamines- not
usually given because
secretions may become
dry
❖ Suctioning and
bronchoscopy
 ❖ endotracheal
intubation- last resort
❖ acute respiratory failure
Nursing Management
➢ increased fluid intake
➢ directed coughing to
remove secretions
➢ Rest and activity
balance
Pneumonia
▪ inflammation of the lung
parenchyma
▪ Pneumonitis
▪ Restrict lung
Classification
1. Community-Acquired
Pneumonia (CAP)
✓ Acquired in community
setting or within the first
48 hours after
hospitalization or
institutionalization
✓ Causative agents?
2. Health care–associated
pneumonia (HCAP)
✓ Pneumonia occurring in
a non hospitalized
patient with extensive
health care contact
with one or more of the
following:
✓ Hospitalization for ≥2
days in an acute care
facility within 90 days of
infection
✓ Residence in a nursing
home or long-term care
facility
✓ Antibiotic therapy,
chemotherapy, or
wound care within 30
days of current infection
H ❖ oxygen and carbon
✓ Hemodialysis treatment
at a hospital or clinic
✓ Home infusion therapy
or home wound care
✓ Family member with
infection due to
multidrug-resistant
bacteria
3. Hospital-acquired pneumonia
(HAP)
✓ Pneumonia occurring
≥48 hours after hospital
admission that did not
appear to be
incubating at the time
of admission
➢ Enterobacter species,
Escherichia coli, H.
influenzae, Klebsiella
species, Proteus, Serratia
marcescens,Pseudomon
as aeruginosa, Risk Factors??
methicillin-sensitive or Clinical Manifestations
methicillin-resistant
Staphylococcus aureus
(MRSA), and S.
pneumoniae
4. Ventilator-associated
pneumonia (VAP)
➢ A type of HAP that
develops ≥48 hours after
endotracheal tube
intubation
Pneumonia in the
Immunocompromised Host -
Pneumocystis pneumonia (PCP)
➢ Pneumocystis jiroveci
➢ fungal pneumonias
➢ Mycobacterium
tuberculosis
Aspiration Pneumonia
➢ pulmonary
consequences resulting
from entry of
endogenous or
exogenous substances
into the lower airway.
Pathophysiology
❖ normal flora present in
patients whose
resistance has been
altered
❖ Oropharynx
❖ often have an acute or
chronic underlying
disease that impairs host
defenses
❖ bloodborne organisms
❖ affects both ventilation
and diffusion-
oxygenation is affected
❖ Exudate- excess mucous
production
dioxide- O2 down
CarbD, increases- leads
to respi acidosis
❖ White blood cells –
neutrophils
❖ Decreased ventilation-
decrease O2 entering
alveoli
❖ Decreased alveolar O2
tension
❖ Bronchospasm-
narrowing of bronchi
Assessment and Diagnostic
❖ Hypoventilation- affect
Findings
ventilation perfusion
✓ history (particularly of a
❖ V/Q mismatch - Venous
blood (ventilation and
perfusion no longer
✓ physical examination
sustaining the need of
✓ chest x-ray
the body)
✓ blood culture
❖ Poorly oxygenated -
hypoxemia
• sudden onset of chills,
rapidly rising fever
• pleuritic chest pain that
is aggravated by deep
breathing and coughing
• streptococcal
(pneumococcal)
pneumonia
• headache, low-grade
fever, pleuritic pain,
myalgia, rash, and
pharyngitis
• mucoid or
mucopurulent sputum
• cheeks are flushed and
the lips and nail beds
• demonstrate central
cyanosis
• late sign of poor
oxygenation
[hypoxemia]
• Orthopnea (orthopneic
position, inclined
position)
• Poor appetite,
diaphoretic and tires
easily
• Rusty, blood-tinged
sputum
• streptococcal
(pneumococcal),
staphylococcal, and
Klebsiella pneumonia
• Crackles- fluid
accumulation in kung
tissue
• consolidation of lung
tissue- xray result (white
churva)
• tactile fremitus
• vocal vibration
detected on palpation,
• percussion dullness,
• bronchial breath sounds,
- egophony, when
auscultated, the spoken
“E” becomes a loud,
nasal-sounding “A”
• whispered pectoriloquy
• whispered sounds are
easily auscultated
through the chest wall -
consolidation
recent respiratory tract
infection)
(bloodstream
 invasion[bacteremia]
occurs frequently)
✓ sputum examination?
✓ rinse the mouth with
water to minimize
contamination by
normal oral flora,
✓ breathe deeply several
times, cough deeply,
and (4) expectorate the
raised sputum into a
sterile container
Pharmacologic Therapy -
Antibiotic
➢ culture and sensitivity.
➢ ceftriaxone (Rocephin),
➢ ampicillin/sulbactam
(Unasyn),
➢ levofloxacin (Levaquin),
➢ ertapenem (Invanz)
➢ cephalosporin or
ceftazidime (Fortaz)
➢ antipseudomonal
carbapenem
➢ piperacillin/tazobactam
(Zosyn) plus
antipseudomonal
fluoroquinolone
➢ aminoglycoside plus
linezolid (Zyvox) or
vancomycin (Vancocin)
NURSING PROCESS
1. Assessment
2. Diagnosis
3. Planning
4. Nursing Interventions
a. Improving airway
b. Promoting rest and conserving
energy
c. Fluid intake
d. Nutrition
e. Education
f. Monitoring of complications
delirium- older patient
Pulmonary Tuberculosis
▪ infectious disease that
primarily affects the lung
parenchyma
▪ meninges, kidneys,
bones, and lymph nodes
▪ M. tuberculosis -is an
acid-fast aerobic rod
that grows slowly and is
sensitive to heat and
ultraviolet light
Transmission and Risk Factors
❖ spreads from person to
person by airborne
transmission
❖ An infected person
releases droplet nuclei
(usually particles 1 to 5
mcm in diameter)
❖ talking, coughing,
sneezing, laughing, or
singing.
❖ Larger droplets settle
❖ smaller droplets remain
suspended in the air and
are inhaled by a
susceptible person
Pathophysiology
• Mycobacterium
• Alveoli
• Lymph system and
blood stream
• Kidneys, bones, cerebral
cortex - Inflammatory
reaction
• Phagocytes (neutrophils
and macrophages
• TB-specific lymphocytes
lyse - Exudate
• Alveoli
• bronchopneumonia
• 2 to 10 weeks
Risk factors
• Close contact
• Immunocompromised
status
• Substance abuse
• Poverty
• Preexisting Medical
condition Travel to
countries with high TB
cases
• Institutionalization
• Living condition
• Health Worker
Prevention? (CDC)
❖ Early identification and
treatment of persons
with active TB
❖ Prevention of spread of
infectious droplet nuclei
by source control
methods and by
reduction of microbial
contamination of indoor
air
❖ Initiate AFB isolation
precautions -
Surveillance for TB
transmission
Clinical Manifestations
❖ low-grade fever,
cough, night sweats,
fatigue, and weight loss
❖ Hemoptysis
Assessment and Diagnostic
Findings
• positive skin test
• blood test
• sputum culture for acid-
fast bacilli
• complete history
• physical examination
• tuberculin skin test
• chest x-ray
• Assessment
• Physical examination
• Chest X-ray
• Multinodular infiltrates
with calcification in
upper lobes
• Sputum cultures
• Acid-fast smear
• Negative after 3 months
of treatment - Mantoux
test
• Reliable test
• Positive reaction?
• Active disease
• Previous exposure—
inactive
• Assessment - PPD test
• Positive
• 10mm or more--- 48 to
72 hours after injection
For pts. With HIV 5 mm
or greater – Positive
• QuantiFERON-TB Gold
test
• A blood analysis test by
an enzyme-linked
immunosorbent assay
• A sensitive and rapid
test (results can be
available in 24 hours)
that assists in diagnosing
the client
Pharmacologic Management
- Rifamipicin (Rifampin
- Isoniazid (INH)
- Pyrazinamide (PZA)
- Ethambutol
- Streptomycin
Nursing Management
✓ Promoting Airway
Clearance
✓ Promoting Adherence
to Treatment Regimen
✓ Promoting Activity and
Adequate Nutrition
✓ Preventing Transmission
of Tuberculosis Infection
Lung Abscess
▪ lung abscess is a
localized collection of
pus caused by microbial
infection
▪ caused by anaerobic
bacteria (doesn’t need
any oxygen to stay)
enters lung by aspiration
 ▪ chest x-ray
demonstrates a cavity
of atleast 2 cm in lungs
(hole, pus, exudates) wtf
Risk Factors:
• impaired cough reflexes
• swallowing difficulties
• CNS disorders
• drug addiction
• Alcoholism
• esophageal disease
• compromised immune
function
• patients without teeth
• nasogastric tube
feedings
• altered state of
consciousness
Pathophysiology
• complication of
bacterial pneumonia
• aspiration of oral
anaerobes into the lung.
• The site of the lung
abscess is related to
gravity
• Initially the cavity in the
lung may or may not
extend directly into a
bronchus
• the abscess becomes
surrounded, or
encapsulated, by a wall
of fibrous tissue
• extend until it reaches
the lumen of a bronchus
or the pleural space
• respiratory tract, the
pleural cavity, or both
• If bronchus?
• purulent contents are
expectorated
continuously in the form
of sputum
• if Pleura- empyema
• If Both—--
bronchopleural fistula
Clinical Manifestations
❖ fever
❖ productive cough with
moderate to copious
amounts of foul-smelling
❖ bloody sputum
❖ Leukocytosis
❖ Pleurisy
❖ Dyspnea
❖ Weakness
❖ anorexia, and weight
loss
Assessment and Diagnostic
Findings
▪ Physical Examination
▪ pleural friction rub
▪ grating or creaking
sound
▪ Crackles - chest x-ray
▪ infiltrate with an air–fluid
level - sputum culture
▪ fiberoptic bronchoscopy
▪ computed tomography
(CT) scan
Bronchoscopy
❖ direct inspection and
examination of the
larynx, trachea, and
bronchi through either a
flexible fiberoptic
bronchoscope or a rigid
bronchoscope
1. to visualize tissues and
determine the nature, location,
and extent of the pathologic
process
2. to collect secretions for analysis
and to obtain
a tissue sample for diagnosis
3. to determine whether a tumor
can be resected
surgically
4. to diagnose sources of
hemoptysis.
Medical Management
❖ postural drainage and
chest
❖ physiotherapy
❖ percutaneous chest
catheter
❖ long-term drainage of
the abscess. - Surgical
intervention is rare
o but pulmonary
resection
(lobectomy)
o massive
hemoptysis
o if there is little
or no response
to medical
management.
Medical Management
• IV antimicrobial therapy
• clindamycin (Cleocin),
ampicillin-sulbactam
(Unasyn) or
carbapenem
Nursing Management
• administers antibiotics
• Chest physiotherapy
• Health education
• deep-breathing and
coughing exercises
• proper nutritional intake
• high in protein and
calories
• emotional support,
Pleurisy
• inflammation of both
layers of the pleurae
• Complication of;
pneumonia or an upper
respiratory tract
infection, TB, or collagen
disease; after trauma to
the chest, pulmonary
infarction, or PE
• primary or metastatic
cancer; and after
thoracotomy
Clinical Manifestations
• pleuritic pain
• severe, sharp, knifelike
pain
• Intensifies during
inspiration
• deep breath, coughing,
or sneezing
Assessment and Diagnostic
Findings
• pleural friction rub
• chest x-rays, sputum
analysis,
• thoracentesis
• pleural fluid for
examination
Medical Management
• discover the underlying
condition
• causing the pleurisy
• to relieve the pain
• monitored for signs and
symptoms of pleural
effusion
• shortness of breath,
pain,
• Prescribed analgesic
agents and topical
applications of heat or
cold
• NSAIDs
Nursing Management
❖ enhance comfort- such
as turning frequently
onto the affected side—
To splint the chest wall
and reduce the
stretching of the
pleurae.
-use the hands or a
pillow
-splint the rib cage while
coughing
Pleural Effusion
▪ collection of fluid in the
pleural space
▪ secondary to other
diseases.
 ▪ pleural space fluid? 5 to
15 ml
▪ Complication of;
-heart failure, TB,
pneumonia, pulmonary
infections, nephrotic
syndrome, connective
tissue disease, PE and
neoplastic tumors
Pathophysiology
❖ accumulate in the
pleural space
•clear fluid
•Bloody
•Purulent
Transudate- filtrate of plasma that
moves across intact capillarywalls
❖ heart failure.
Exudate- extravasation of fluid
into tissues or a cavity
•bacterial products or tumors
Clinical Manifestations
❖ fever, chills, and pleuritic
chest pain
❖ a malignant effusion
❖ dyspnea, difficulty lying
flat, and coughing -
Assessment and Diagnostic
Findings
• Physical examination
• decreased or absent
breath sounds
• decreased fremitus
• dull, flat sound on
percussion
• Tracheal deviation
• chest x-ray
-lies on the affected side
chest CT, and
thoracentesis
Thoracentesis
➢ aspiration of fluid and air
from the pleural space
diagnostic or therapeutic??
Medical Management
❖ to discover the
underlying cause
❖ to prevent
reaccumulation of fluid
❖ to relieve discomfort,
dyspnea, and
respiratorycompromise
Nursing Management
✓ supporting the medical
regimen
✓ prepares and positions
the patient for
thoracentesis
✓ chest tube
management
✓ Pain management -
Chest Drainage Systems
➢ suction source- create
negative pressure and
promote drainage of
fluid and removal of air.
-20 cm H2O
-bubbling appears in the
suction chamber
➢ collection chamber for
pleural drainage -
reservoir for fluid
draining
➢ water seal chamber
-mechanism to prevent
air from reentering the
chest with inhalation
Empyema
▪ accumulation of thick,
purulent fluid within the
pleural space
▪ complications of
bacterial pneumonia or
lung abscess.
▪ penetrating chest
trauma
▪ hematogenous infection
of the pleural space,
▪ nonbacterial infections
▪ iatrogenic causes (after
thoracic surgery or
thoracentesis)
Clinical Manifestations
• acute respiratory
infection or pneumonia
• fever, night sweats,
pleural pain, cough,
dyspnea, anorexia,
weight loss
Assessment and Diagnostic
Findings
▪ Physical Assessment
▪ decreased or absent
breath sounds
▪ dullness on chest
percussion
▪ decreased fremitus
▪ thoracentesis
Medical Management
❖ Needle aspiration
(thoracentesis)
❖ Tube thoracostomy
Nursing Management
✓ instructs the patient in
lung-expanding
✓ breathing exercises to
restore normal
respiratory function
Pulmonary Edema
(Noncardiogenic)
▪ abnormal accumulation
of fluid in the lung tissue,
the alveolar space, or
both
▪ severe, life-threatening
condition
▪ damage of the
pulmonary capillary
lining
Risk Factors
• direct injury
• chest trauma, aspiration,
and smoke inhalation
• hematogenous injury
• sepsis, pancreatitis,
multiple transfusions,
and cardiopulmonary
bypass
Chronic Obstructive Pulmonary
Disease
➢ preventable and
treatable slowly
progressive respiratory
disease of airflow
obstruction
➢ airflow limitation or
obstruction in COPD is
not fully reversible
➢ emphysema and
chronic bronchitis
Risk Factors:
• cigarette smoking-
destroys the ability of
lung to clean up respi
tract)
• Passive smoking
• Tobacco
• Age
• Occupational exposure
• Genetic abnormalities—
alpha1-antitrypsin
(kulang ng alpha-1,
which this is important in
respi tract to fight
foreign bodies-
deficient=magkaka
COPD)
Pathophysiology
▪ symptomatic during the
middle adult years
▪ airflow limitation is both
progressive and
associated with the
lungs’ abnormal
inflammatory response
to noxious particles or
gases (exposur)
▪ body’s attempts to
repair changes and
narrowing can occur in
the airways (instead of
 patent, obstructive can
happen -2 mm
▪ goblet cells (will
enlarged) and enlarged
submucosal glands
(enlarged= additional
mucous plug, mas mag
babara)
▪ hypersecretion of mucus
(chronic air limitation)
Chronic Bronchitis (COPD)
• presence of cough and
sputum production for
at least 3 months in
each of 2 consecutive
years
• smoke or other
environmental pollutants
• hypersecretion of mucus
• Bronchial walls
thickened
• narrowing the bronchial
lumen
Emphysema (COPD)
• impaired oxygen and
carbon dioxide
exchange
• results from destruction
of the walls of
overdistended alveoli (in
the alveoli)
• pathologic term that
describes an abnormal
distention of the
airspaces – Alveoli
Manifestation: Barrel chest
• Hypoxemia can
increase pulmonary
artery pressures leads to
pulmonary hypertension
• Hypercapnia- excessive
carbon dioxide in the
lungs that results to
respiratory acidosis
panlobular (panacinar)
▪ destruction of the
respiratory bronchiole,
alveolar duct, and
alveolus
▪ hyperinflated
(hyperexpanded) chest
▪ marked dyspnea on
exertion
▪ weight loss
▪ expiration becomes
active
centrilobular (centroacinar)
▪ in the center of the
secondary lobule,
preserving the
peripheral portions of
the acinus (sa tubing
lang) (hyperextended
ang lobular)
▪ chronic hypoxemia,
hypercapnia,
polycythemia
▪ right-sided heart failure
Complication
Cor pulmonale- increase pressure
in pulmonary artery.
▪ right-sided heart failure
brought on by long-term
high blood pressure in
the pulmonary arteries
(accumulation of fluid)
▪ dependent edema
▪ distended neck veins
▪ pain in the region of the
liver (because of fluid
accumulation)
|hypertension in the liver
can occur if last longer,,
chariz| rebound effect
can also occur
Assessment and Diagnostic
Findings
-PFT
- Spirometry
- FEV1 to forced vital capacity
(FVC) (affected, bumababa- and
patient can have an air flow
limitation=obstructive airway)
Medical Management
- promoting smoking cessation
prescribing medications:
• bronchodilators
• Corticosteroid-
formoterol/budesonide
(Symbicort)
salmeterol/fluticasone
(Advair)
• managing
exacerbations
• Providing supplemental
oxygen therapy as
indicated.
Management
✓ Breathing Exercises
✓ Activity Pacing
✓ Self-Care Activities
✓ Physical Conditioning
✓ Oxygen Therapy
✓ Nutritional Therapy
Nursing Management
✓ Achieving Airway
Clearance (orthopnic
position)
✓ Improving Breathing
Patterns
✓ Improving Activity
Tolerance
✓ Monitoring and
Managing Potential
Complications
Bronchiectasis
▪ Chronic but irreversible
dilation of the bronchi
and bronchiole
▪ destruction of muscles
and elastic connective
tissue
▪ dilation of the bronchi
and bronchus
(reproduction of
mucous)
Risk factors
➢ respiratory infections
(pneumonia, TB)
➢ CF (cystic fibrosis)| own
immune system tries to
destroy connective
tissue that leads to
dilation of bronchi and
bronchus. (also produce
mucous, excess)
➢ rheumatic and other
systemic diseases
➢ primary ciliary
dysfunction
➢ Tuberculosis
➢ mmunodeficiency
disorders
Pathophysiology
- damages the bronchial wall
- loss of its supporting structure -
thick sputum obstructs the
bronchi.
Clinical Manifestations
- chronic cough
- production of purulent sputum in
copious amounts
- hemoptysis (blood in sputum)
Assessment and Diagnostic
Findings
- prolonged history of productive,
chronic cough, with sputum
consistently negative for tubercle
Bacilli
Medical Management
• promote bronchial
drainage (chest
percussion, chest
physiotherapy- improve
removal of secretion)
• clear excessive
secretions from the
affected portion of the
lungs
• prevent or control
infection
 • Bronchoscopy Chest
physiotherapy
Asthma (distinct condition)
➢ heterogeneous disease,
usually characterized by
chronic airway
inflammation (cause by
triggering factors:
allergens, food,
environmental
pollutants, genetic
predisposition)
➢ airway
hyperresponsiveness,
mucosal edema, and
mucus production
(appears because of
triggering factors)
Pathophysiology
➢ When allergen triggers
inflammatory process, it
will now react to 3:
increase airway
reaction, airway
limitation (because it
triggers mucosal edema
and mucus production,
narrowed airway=
wheezing sounds,
coughing, dyspnea,
chest tightness
Clinical Manifestations
▪ Coughing
▪ Chest tightness
▪ Diaphoresis (sweating)
▪ Tachycardia
▪ Hypoxemia (low O2)
▪ Restless
▪ Irritation
▪ Anxiety
▪ Hyperventilation – CO2
decreases
▪ Wheezing sound
Note: asthma attack happens
night or early in the morning (it is
because of the change of
temperature| lumalamig)
Initial Manifestation:
Hypocapnia- decrease in
alveolar and blood carbon
dioxide level below normal range.
Respiratory Alkalosis-(
hyperventilation)
Complications:
• can be progressive and
recurrent leads to status
asthmaticus, life
threatening.
• Respiratory failure
• Pneumonia
• atelectasis well as needed changes
in ventilator or oxygen
Assessment and Diagnostic settings.
Findings
❖ determine that episodic Normal Values
symptoms of airflow
obstruction
❖ positive family history
❖ environmental factors
❖ seasonal changes, high
pollen counts, mold, pet
dander, climate
changes
❖ occupation-related
chemicals
❖ Eosinophilia
❖ IgE
❖ allergy
Medical Management
Pharmacologic Therapy
1. quickrelief medications
a. immediate treatment of
asthma symptoms
b. Short-acting beta2-adrenergic
agonists
i. Albuterol, Proventil, Ventolin c.
ipratropium [Atrovent])
2. exacerbations and long-acting
medications
a. To achieve and maintain
control of persistent asthma
b. Corticosteroids
c. Long-acting beta2-agonists
(LABA)
i. Theophylline ii. Salmeterol
iii. formoterol
Nursing Management
1. assesses the patient’s
respiratory status
a. breath sounds, peak flow, pulse
oximetry, and vital signs.
2. Obtains a history of allergic
reactions to medications before
administering medications.
3. Identifies medications the
patient is taking.
4. Administers medications as
prescribed and
monitors the patient’s responses
to those medications.
5. Administers fluids if the patient is
dehydrated
Arterial Blood Gases (ABG)
❖ An ABG directly
measures the pH of the
blood, along with the
partial pressure of O2,
CO2, bicarbonate ion,
and saturation of Hgb.
❖ When these values are
abnormal, they can be
significant clues to
respiratory problems as