St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
RESPIRATORY DISORDERS
 encompasses a wide range of medical
condition that affects the respiratory system
which includes the lungs, airways, and
other structures involved in breathing. It
can vary severity from mild to manageable
to severe and life-threatening
1. ASTHMA
 Is a chronic condition that causes
inflammation and narrowing of the airways.
It results in symptoms like wheezing,
coughing, shortness of breath and chest
tightness. Asthma symptoms can be
triggered by allergens, respiratory
infections of exercise.
2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
 a group of progressive lung diseases that
includes chronic bronchitis and
emphysema. It is often caused by a long-
term exposure to irritants like cigarette
smoke or environmental pollutants.
Symptoms include chronic cough,
increased mucus production, difficulty of
breathing.
3. PNEUMONIA
 an infection of the lung tissue, usually
caused by bacteria, viruses, fungi. It can
lead to symptoms such as fever, cough,
chest pain, difficulty breathing. Vaccines
and antibiotics commonly used for
prevention and treatment.
4. BRONCHITIS
 Acute bronchitis is often caused by a viral
infection and leads to inflammation of the
bronchial tubes. It results in symptoms like
a persistent cough, chest discomfort, and
mucus production. Chronic bronchitis if a
form of COPD.
5. INTERSTITIAL LUNG DISEASE (ILD)
 Group of disorders that cause scarring
(fibrosis) of the lung tissue. It can be
caused by various factors, including
exposure to environmental toxins,
autoimmune diseases, and certain
medications. Symptoms include
progressive shortness of breath and dry
cough.
6. LUNG CANCER
 Characterized by the uncontrolled growth
of abnormal cells in the lungs. It is often
linked to smoking but can also occur in
non-smokers. Symptoms may include a
persistent cough, chest pain, weight loss,
and coughing up blood.
7. PULMONARY EMBOLISM
 Occurs when a blood clot (usually from
deep veins in the legs) travels to the lungs
and blocks a pulmonary artery. This can be
life-threatening and presents with
symptoms like sudden shortness of breath,
chest pain, and coughing up blood.
8. SLEEP APNEA
 A disorder in which a person’s breathing is
repeatedly interrupted during sleep. It can
lead to excessive daytime sleepiness and
is associated with other health problems,
including heart disease.
9. CYSTIC FIBROSIS
 Genetic disorder that affects the production
of mucus, sweat, and digestive fluids. It
results in thick, sticky mucus that can block
airways and lead to respiratory infections.
10. TUBERCULOSIS (TB)
 A bacterial infection caused by
mycobacterium tuberculosis. It primarily
affects the lungs but can involve other
organs. Symptoms include persistent
cough, weight loss, night sweats, fatigue.
11. ALLERGIC RHINITIS
 Commonly known as hay fever, is an
allergic reaction to airborne allergens such
as pollen, dust mites, pet dander. It leads
to symptoms like sneezing, runny or stuffy
nose, and itchy or watery eyes.
12. PULMONARY FIBROSIS
 A progressive lung disease characterized
by scarring of the lung tissue. It can lead to
shortness of breath, a persistent dry cough,
and fatigue
13. PULMONARY HYPERTENSION
 Condition characterized by high blood
pressure in the arteries of the lungs. It can
lead to symptoms like shortness of breath,
chest pain, fatigue.
14. BRONCHIECTASIS
 Chronic condition characterized by the
widening and scarring of the airways,
making it difficult to clear mucus. It results
in chronic coughing and recurrent lung
infections.
MEDICAL & SURGICAL NURSING 1
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
15. SARCOIDOSIS
 An inflammatory disease that can affect
multiple organs, including the lungs. Lung
involvement can cause cough, shortness of
breath, chest pain.
16. PULMONARY EDEMA
 Condition in which fluid accumulates in the
lungs, making it difficult to breathe. It can
be caused by heart problems, infections, or
exposure to toxins.
17. ASBESTOSIS
 A lung disease caused by prolonged
exposure to asbestos fibers. It can leads to
scarring of lung tissue, resulting in
breathing difficulties.
18. OBSTRUCTIVE SLEEP APNEA (OSA)
 A subtype of sleep apnea characterized by
the repeated collapse of the upper airway
during sleep, leading to breathing
interruptions. It can result in loud snoring,
daytime sleepiness, and other health
issues.
19. PLEURAL EFFUSION
 Occurs when excess fluid accumulates in
the pleural space, the area between the
lungs and the chest wall. It can cause chest
pain and difficulty breathing.
20. LUNG ABSCESS
 A pocket of pus that forms in the lung. It is
often caused by a bacterial infection and
can lead to symptoms like fever, cough,
chest pain.
21. RESPIRATORY DISTRESS SYNDROME (RDS)
 A breathing disorder primarily affecting
premature infants. It results from
underdeveloped lungs and can lead to
severe breathing difficulties.
22. HANTAVIRUS PULMONARY SYNDROME (HPS)
 A rare but potentially severe respiratory
disease caused by exposure to
hantaviruses carried by rodents. Symptoms
include fever, muscle pain, and difficulty
breathing.
23. PULMONARY HYPOPLASIA
 A condition in which the lungs are
underdeveloped. It can occur in infants and
may lead to respiratory problems
24. SILICOSIS
 A lung disease caused by inhaling silica
dust, often in workplace settings. It results
in lung scarring and breathing difficulties.
25. PRIMARY CILIARY DYSKINESIA (PCD)
 Genetic disorder that affects the cilia in the
respiratory tracts. It can lead to chronic
respiratory infections and sinus problems.
HYPOXIA
 Condition of insufficient oxygen anywhere
in the body from the inspired gas to the
tissue. Cerebral function can tolerate
hypoxia for only 3-5 mins before permanent
damage.
 Is a medical condition characterized by a
deficiency of oxygen reaching the body’s
tissue and organs. It can result from
various underlying causes and can have
serious health implications.
TYPES OF HYPOXIA
1. HYPOXEMIC HYPOXIA
 Occurs when there is reduced oxygen
concentration in the arterial blood. It can be
caused by lung diseases (such as
pneumonia, pulmonary embolism, asthma)
that limit the exchange of oxygen in the
lungs, high-altitude exposure, breathing in
low-oxygen environments.
2. ANEMIC HYPOXIA
 Results from a decrease in the oxygen-
carrying capacity of the blood. This can be
due to conditions like anemia, which leads
to a reduced number of RBC or a
decreased ability of hgb to carry oxygen
effectively.
3. ISCHEMIC HYPOXIA
 Occurs when there is a reduced blood flow
to the body’s tissues and organs,
preventing an adequate supply of oxygen.
Conditions such as heart failure, shock, or
vascular disorders can cause ischemic
hypoxia.
4. HISTOTOXIC HYPOXIA
 Happens when the body’s cells are unable
to use the oxygen that is delivered to them
due to the presence of toxins or metabolic
inhibitors. Certain drugs or toxins, such as
cyanide, can lead to histotoxic hypoxia.
 Hypoxia, which characterized by a
deficiency of oxygen in the body’s tissues
and organs, can manifest with a range of
signs and symptoms. The severity and
specific symptoms can vary depending on
MEDICAL & SURGICAL NURSING 2
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
the degree of oxygen deprivation and the
underlying cause.
SIGNS & SYMPTOMS OF HYPOXIA
 Rapid pulse
 Rapid shallow respiration
 Increase restlessness
 Flaring nares
 Cyanosis
1. SHORTNESS OF BREATH (DYSPNEA)
 Feeling like you can’t get enough air or are
struggling to breathe is one of the most
common symptoms of hypoxia. It may be
accompanied by rapid or shallow breathing.
 RATIONALE: when oxygen levels in the
blood drop, the body responds by
increasing the RR and depth in an attempt
to take in more oxygen. This leads to a
feeling of breathlessness or SOB.
2. CONFUSION
 Hypoxia can affect cognitive function,
leading to confusion, difficulty
concentrating, memory problems, and
altered mental status.
 RATIONALE: reduced oxygen supply to
the brain can impair cognitive function.
Hypoxia can affect a person’s ability to
think clearly, concentrate, and make
decisions.
3. CYANOSIS
 Is a bluish or grayish discoloration of the
skin, lips, or nail beds. It occurs when
oxygen levels in the blood are significantly
low.
 RATIONALE: occurs when there is a
significant decrease in the oxygen
saturation of the blood. The bluish
discoloration is a visible sign that oxygen is
not reaching the tissues adequately.
4. RAPID HEART RATE (TACHYCARDIA)
 The heart may beat faster than normal as it
attempts to pump oxygen-rich blood to the
body’s tissues.
5. RAPID BREATHING (TACHYPNEA)
 Increased RR is another common response
to hypoxia as the body tries to compensate
for the lack of oxygen.
 NASAL FLARING - occurs when the
nostrils widen while breathing. It is often a
sign of trouble breathing. Nasal flaring may
be an indication of breathing difficulty, or
even respiratory distress in infants.
 RATIONALE: to compensate for the
decreased oxygen supply, the body often
increases the RR. This helps deliver more
oxygen to the tissues, even though the
oxygen content of each breath is reduced.
6. DIZINESS / LIGHTHEADEDNESS
 Individuals with hypoxia may experience
feelings of diziness or lightheadedness,
potentially leading to loss of balance.
 RATIONALE: reduced oxygen to the brain
can cause dizziness and lightheadedness,
often leading to a feeling of unsteadiness
or vertigo.
7. HEADACHE
 Hypoxia can cause headaches, often
described as throbbing or pulsating.
 RATIONALE: hypoxia can lead to dilated
blood vessels in the brain as the body tries
to increase blood flow to deliver more
oxygen. This dilation can cause
headaches.
8. CHEST PAIN
 Some individuals may experience chest
pain, which can be a result of the heart
working harder to compensate for low
oxygen levels.
 RATIONALE: hypoxia can put additional
strain on the heart, leading to chest pain,
especially in individuals with pre-existing
heart conditions.
9. COUGHING
 It may occur, especially in cases of hypoxia
caused by lung conditions like pneumonia
or asthma.
10. FATIGUE
 A general feeling of weakness, tiredness,
or lack of energy is common with hypoxia.
MEDICAL & SURGICAL NURSING 3
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
11. NAUSEA & VOMITING
 In severe cases of hypoxia, individuals may
feel nauseous and may vomit.
 RATIONALE: hypoxia can affect the
gastrointestinal system, leading to nausea
and sometimes vomiting. This is a result of
reduced oxygen delivery to the stomach
and intestines.
12. VISUAL CHANGES
 Hypoxia can affect vision, causing
blurriness or changes in visual perception.
13. DIFFICULTY SPEAKING
 Some individuals may have trouble
speaking clearly or may slur their words
due to decreased oxygen supply to brain.
14. LOSS OF COORDINATION
 Hypoxia can impair coordination and motor
skills, leading to unsteady movements.
 RATIONALE: when oxygen levels in the
brain drop to critically low levels, it can
result in loss of consciousness. Severe
hypoxia is a medical emergency and
requires immediate intervention.
15. BEHAVIORAL CHANGES
 Personality changes, irritability, and
emotional disturbances
TREATMENT OF HYPOXIA
1. OXYGEN THERAPY
 Supplemental oxygen is administered to
increase oxygen levels in the blood. This is
often done using nasal cannula or face
mask.
2. MECHANICAL VENTILATION
 In severe cases where the patient cannot
maintain.
3. TREATING UNDERLYING CONDITIONS
 Addressing the specific cause of hypoxia,
such as treating infections, managing heart
conditions, or removing toxins, is crucial.
4. HYPERBARIC OXYGEN THERAPY
 In cases of severe hypoxia, hyperbaric
oxygen therapy, which involves breathing
100% oxygen at increased atmospheric
pressure, may be used to increase oxygen
absorption by tissues.
NURSING DIAGNNOSIS
1. IMPAIRED GAS EXCHANGE
 RATIONALE: inadequate oxygenation and
ventilation can lead to impaired gas
exchage, resulting in hypoxemia (low
oxygen levels) and hypercapnia (high
carbon dioxide levels).
2. INEFFECTIVE BREATHING PATTERN
 RATIONALE: patients with hypoxia may
exhibit altered breathing patterns, such as
rapid or shallow breathing, which can
exacerbate oxygen deficits
3. ACTIVITY INTOLERANCE
 RATIONALE: hypoxia can limit a patient’s
ability to engage in physical activities due
to inadequate oxygen supply to muscles
and tissues.
4. RISK FOR ASPIRATION
 RATIONALE: patients with impaired gas
exchange may be at an increased risk for
aspiration due to difficulties in maintaining
an effective cough reflex.
5. RISK FOR DECREASED CARDIAC OUTPUT
 RATIONALE: hypoxia can strain the
cardiovascular system, potentially leading
to decreased cardiac output, elevated BP,
and other cardiovascular complications.
6. ANXIETY
 RATIONALE: hypoxia can cause anxiety
and distress in patients as they struggle to
breathe and experience symptoms like
shortness of breath and confusion.
7. DEFICIENT KNOWLEDGE (R/T HYPOXIA & SELF-CARE)
 RATIONALE: patients may lack adequate
knowledge about hypoxia, its causes, and
self-care strategies to manage and prevent
it.
8. RISK FOR FALLS
 RATIONALE: Patients with hypoxia may
experience dizziness, lightheadedness, or
altered mental status, increasing the risk of
falls.
9. INEFFECTIVE AIRWAY CLEARANCE
 RATIONALE: patients with hypoxia may
have difficulty clearing mucus and
secretions from their airways, leading to
airway obstruction and further respiratory
compramise.
10. IMPAIRED VERBAL COMMUNICATION
NURSING INTERVENTIONS
 Focus on improving oxygenation,
maintaining airway patency, and providing
supportive care to address the underlying
causes. These intervention may vary based
on the severity of hypoxia and the patient’s
specific needs
MEDICAL & SURGICAL NURSING 4
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
1. ASSESSMENT & MONITORING
 Continuously assess VS, including HR, RR,
BP and SpO2.
 Monitor the patient’s level of
consciousness, skin color, and respiratory
effort
 Observe the signs of respiratory distress,
such as increased use of accessory
muscles, nasal flaring or retractions.
2. OXYGEN THERAPY
 Administer supplemental oxygen as
prescribed to increase oxygen levels in the
blood.
 Monitor and adjust the oxygen flow rate to
maintain target oxygen saturation levels.
3. POSITIONING
 Position the client in a way that maximizes
ventilation. This often involves elevating the
head of the bed to promote lung expansion.
4. ADEQUATE HYDRATION
 Ensure the patient is well-hydrated, as
dehydration can thicken respiratory
secretions and worsen hypoxia.
5. MEDICATION ADMINISTRATION
 Administer bronchodilators or other
respiratory medications
6. RESPIRATORY SUPPORT
 Assist with non-invasive ventilation
techniques, such as continuous positive
airway pressure (CPAP) or bilevel positive
airway pressure (BiPAP) if prescribed and
indicated.
7. COUGH & SUCTIONING
 Teach and assist the patient with coughing
and deep breathing exercises to help clear
mucus and maintain airway clearance
 Use suctioning as necessary to remove
excessive respiratory secretions.
8. PROMOTE REST & COMFORT
 Encourage the patient to rest and avoid
excessive physical activity to conserve
energy and reduce oxygen demand.
9. PSYCHOLOGICAL SUPPORT
 Provide emotional support to alleviate
anxiety and fear associated with hypoxia.
 Educate the patient on their condition and
the importance of adherence to prescribed
medication.
10. EDUCATION
 Educate the patient and family on signs
and symptoms of worsening hypoxia and
when to seek immediate medical attention.
11. REGULAR FOLLOW-UP
 Ensure the patient has appropriate follow-
up appointments with healthcare providers
to monitor progress and adjust the
treatment plan as needed.
12. SAFETY PRECAUTIONS
 Implement fall prevention measures if the
patient is at risk due to dizziness or altered
mental status.
HYPOVENTILATION
 a type of breathing disorder that occurs
when the rate of respiration (breathing rate)
is slower than normal or depth of each
breath is shallow.
 Is a medical condition characterized by
inadequate ventilation or insufficient
exchange of oxygen and carbon dioxide in
the lungs. This can lead to an imbalance in
blood gas levels, with lower oxygen
(hypoxemia) and higher carbon dioxide
(hypercapnia) concentrations in the
bloodstream. Hypoventilation can result
from various causes and has several
potential consequences.
CAUSES OF HYPOVENTILATION
1. RESPIRATORY DISORDERS
 RATIONALE: conditions like COPD,
asthma, and restrictive lung diseases
reduce lungs’ ability to exchange oxygen
and carbon dioxide efficiently, resulting in
hypoventilation due to impaired gas
exchange.
2. NEUROMUSCULAR DISORDERS
 RATIONALE: neuromuscular conditions
affect the muscles or nerves responsible
for respiratory muscle function. Weakness
or paralysis of these muscles can lead to
reduced ventilation.
3. SEDATIVE MEDICATIONS
 RATIONALE: opioids can depress central
respiratory drive in the brain, slowing down
breathing rate and depth.
4. OBESITY
 RATIONALE: it can lead to obesity
hypoventilation syndrome (OHS), where
excess weight can compress the chest,
reduce lung expansion, and impair
respiratory function, especially during
sleep.
MEDICAL & SURGICAL NURSING 5
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
 Hypoventilation: inadequate alveolar
ventilation can lead to hypoxia may result
from disease of respiratory muscle, drug,
and anesthesia
 Breathing that is too shallow or tooslow to
meet the needs of the body. If a person
hypoventilates, the body’s carbon dioxide
level arises.
CONSEQUENCES OF HYPOVENTILATION
1. HYPOXEMIA
 RATIONALE: inadequate ventilation
results in reduced oxygen intake, leading to
low oxygen levels in the blood. This can
cause symptoms such as SOB, confusion,
cyanosis.
2. HYPERCAPNIA
 RATIONALE: insufficient removal of
carbon dioxide from the body results in
elevated level of CO2 in the blood, high
CO2 levels can lead to confusion,
headache, dizziness and in severe cases,
respiratory failure.
3. RESPIRATORY ACIDOSIS
 RATIONALE: accumulation of CO2 causes
a drop in blood pH, resulting in respiratory
acidosis. Acidosis can disrupt various
physiological processes in the body.
4. CARDIOVASCULAR EFFECTS
 RATIONALE: hypoventilation can strain
the cardiovascular system, leading to
elevated BP and potentially contributing to
heart problems over time.
NURSING DIAGNOSIS
1. INEFFECTIVE BREATHING PATTERN
 Hypoventilation often results from an
altered breathing pattern, characterized by
slow, shallow respirations. This diagnosis
addresses the need to improve the
effectiveness of the patient’s breathing to
ensure adequate oxygenation and removal
of CO2.
2. IMPAIRED GAS EXCHANGE
 Hypoventilation can lead to inadequate O2
intake and insufficient removal of CO2,
resulting in impaired gas exchange. This
diagnosis focuses on disruptions in the
patient’s ability to exchange O2 and CO2
effectively.
3. IMPAIRED VENTILATION
 This diagnosis highlights the patient’s
inability to ventilate the lungs adequately,
resulting in reduced oxygenation and
increased CO2 retention. It emphasizes the
need to improve ventilation and respiratory
function.
4. ALTERED MENTAL STATUS
 Prolonged hypoventilation can lead to
changes in mental status, including
confusion, drowsiness, decreased
responsiveness. This diagnosis addresses
the cognitive and neurological effects of
hypoventilation
5. ACTIVITY INTOLERANCE
 Hypoventilation may lead to fatigue and
reduced ability to engage in physical
activities due to limited O2 supply. Patients
may require interventions to manage their
energy levels and enhance activity
tolerance.
6. RISK FOR RESPIRATORY INFECTIONS
 Patients with hypoventilation may be at
increased risk of developing respiratory
infections due to the ineffective clearance
of respiratory secretions and the
compramised immune response. This
diagnosis addresses the potential risk of
infection.
7. RISK FOR ASPIRATION
 Hypoventilation can result in weakened
coughing and a higher risk of aspiration
(inhalong foreign material into the lungs).
this diagnosis is relevant when there’s a
risk of aspiration due to hypoventilation.
MEDICAL & SURGICAL NURSING 6
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
TREATMENT OF HYPOVENTILATION
 Treatment depends on the underlying
cause of hypoventilation but may include:
1. MECHANICAL VENTILATION
 In severe cases, mechanical ventilation
with a ventilator or positive pressure device
may be necessary to support breathing.
2. MEDICATION ADJUSTMENTS
 If hypoventilation is caused by medications,
adjusting or discontinuing them may help.
3. TREATMENT OF UNDERLYING CONDITIONS
 Managing respiratory, neuromuscular, or
obesity-related conditions is crucial
4. LIFESTYLE CHANGES
 Weight loss and lifestyle modifications may
be necessary for individuals with obesity
 Obesity Hypoventilation Syndrome
(OHS), also known as Pickwickian
Syndrome, is a medical condition
characterized by the combination of obesity
and hypoventilation, which is the
inadequate ventilation of the lungs. It
primarily affects individuals who are
significantly overweight or obese.
1. OBESITY
 The hallmark of OHS is obesity. People
with OHS are typically severely obese,
often with a BMI greater than 30 or 35. the
excess fat in the chest and abdominal
areas can affect the mechanics, making it
more difficult to inhale and exhale
effectively.
2. HYPOVENTILATION
 Means that a person is not breathing
adequately, leading to elevated levels of
CO2 (hypercapnia) and decreased O2
levels (hypoxemia) in the bloodstream. This
can result from shallow breathing,
decreased lung volume, or impaired
ventilation due to the mechanical effects of
obesity.
3. SYMPTOMS
 OHS include daytime sleepiness, fatigue,
morning headaches, difficulty
concentrating, and SOB. These symptoms
can affect a person’s overall quality of life
and may be misattributed to other causes
like sleep apnea.
4. PATHOPHYSIOLOGY
 The exact mechanisms of OHS are not fully
understood, but it is believed to involve
multiple factors. Obesity can lead to
increased resistance in the upper airway,
making it harder to breathe. Additionally,
the accumulation of fat in the chest can
reduce lung compliance, leading to
decreased lung expansion and ventilation.
5. RISK FACTORS
 OHS is more likely to affect people who
have a combination of severe obesity,
especially with central fat distribution, and
other risk factors such as sedentary
lifestyle, snoring, and a history of sleep
apnea.
6. TREATMENT
 The primary treatment for OHS is weight
loss. Losing excess weight can improve
ventilation and resolve symptoms. In some
cases, positive airway pressure (PAP)
therapy, which is commonly used to treat
sleep apnea, amy be employed to assist
with breathing. Patients may also require
treatment for co-existing conditions like
obstructive sleep apnea or other respiratory
conditions.
TREATMENT OF HYPOVENTILATION
1. MECHANICAL VENTILATION
 RATIONALE: In severe cases of
hypoventilation, mechanical ventilation is
required to provide adequate oxygenation
and ventilation when the patient’s natural
breathing is insufficient.
2. MEDICATION ADJUSTMENTS
 RATIONALE: If hypoventilation is induced
or exacerbated by medications, adjusting or
discontinuing them can help restore normal
respiratory function.
3. TREATMENT OF UNDERLYING CONDITIONS
 RATIONALE: Addressing the specific
underlying condition, whether it’s a
respiratory disorder, neuromuscular
disease, or obesity, is essential for
managing hypoventilation effectively.
4. LIFESTYLE CHANGES
 RATIONALE: Lifestyle modifications, such
as weight loss in cases of obesity
hypoventilation syndrome
MEDICAL & SURGICAL NURSING 7
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
HYPERCABNIA
 Accumulation of CO2 in the blood
 Hypercapnia or Hypercabnia, is when you
have too much CO2 in your bloodstream. It
usually happens as a result of
hypoventilation, or not being able to
breathe properly and get O2 into your
lungs.
ALTERED BREATHING PATTERN
1. BREATHING PATTERN
 Rate, volume, rhythm, effort of respiration
2. NORMAL RESPIRATION (EUPNEA)
 Quiet, rhythmic and effortless
3. TACHYPNEA
 Rapid rate is seen with fevers, metabolic
acidosis, pain, hypercabnia
4. BRADYPNEA
 Slow respiration rate, seen with narcotics
and increase intracranial pressure from
brain injury.
5. HYPERVENTILATION
 Increase movement of air into and out of
the lung
6. DYSPNEA
 Difficult of breathing
7. ORTHOPNEA
 Inability to breathe except in an upright
position
OBSTRUCTED AIRWAY
 Partially or completely in upper and lower
respiratory tract.
 An airway obstruction is a blockage in any
part of the airway. The airway is a complex
system of tubes that conveys inhaled air
from your nose and mouth into your lungs.
An obstruction may partially or totally
prevent air from getting into your lungs.
CAUSES OF OBSTRUCTED AIRWAY
 The tongue is the most common cause of
upper airway obstruction, a situation seen
most often in patients who are comatose or
who have suffered cardiopulmonary arrest.
Other common causes of upper airway
obstruction include edema of the
oropharynx and larynx, trauma, foreign
body, and infection.
1. INHALING / SWALLOWING OF FOREIGN OBJECTS
 When an individual inhales or swallows a
foreign object, such as a piece of food, a
small toy, or any other item, it can obstruct
the airway, in the case of inhalation, the
foreign object may enter the trachea and
become lodged in the lower airway,
obstructing airflow to the lungs. If the object
is swallowed, it may become lodged in the
esophagus, leading to symptoms like
choking, coughing, and discomfort.
2. SMALL OBJECT LODGED IN THE NOSE/MOUTH
 If a small object becomes lodged in the
nose or mouth, it can obstruct the upper
airway. In the nose, this can lead to
breathing difficulties, especially in children.
If the object is in the mouth, it may block
the passage of air or cause choking. In
both cases, the obstruction can lead to
symptoms like stridor ( high-pitched
breathing sound), coughing, DOB.
3. TRAUMA TO THE AIRWAY FROM ACCIDENT
 In accidents, such as car crashes or falls,
direct trauma to the head, neck or chest
can lead to injury of the airway structures,
including the trachea and bronchi. This
trauma can result in airway obstruction due
to swelling, bleeding, or even the
displacement of structures
4. VOCAL CORD PROBLEMS
 Issues with the vocal cords, such as vocal
cord paralysis or vocal cord dysfunction,
can lead to a narrowed or blocked airway.
When the vocal cords don’t open properly
during inhalation, it can restrict the passage
of air, causing an obstruction.
5. INHALATION OF A LARGE AMOUNT OF SMOKE FROM FIRE
 Inhaling smoke from a fire can introduce
particulate matter and irritants into the
airway. This can lead to swelling and
inflammation of the airway lining, potentially
causing an obstruction and DOB.
6. VIRAL INFECTIONS
 Respiratory viruses, like influenza or the
common cold, can infect the respiratory
tract, leading to inflammation and the
production of mucus. In viral infections,
mucus production can increase, potentially
obstructing the airway.
7. BACTERIAL INFECTIONS
 Bacterial respiratory infections, such as
pneumonia, can cause inflammation in the
MEDICAL & SURGICAL NURSING 8
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
airways and lung tissues. This inflammation
can lead to the accumulation of mucus,
pus, and cellular debris, which can obstruct
the airway and hinder effective breathing.
ANAPHYLAXIS
 Allergic reaction
1. FOOD ALLERGIES
 Certain foods are common triggers for
anaphylaxis, with the most prevalent being
peanuts, tree nuts, shellfish, fish, milk,
eggs, and soy. In susceptible individuals,
even tiny amounts of these allergens can
induce a severe reaction.
2. INSECT STINGS
 Stings from insects like bees, wasps,
hornets, and fire ants can cause
anaphylactic reactions in some people.
Reactions are typically more severe in
individuals with a history of previous
allergic responses to insect stings.
3. MEDICATIONS
 Some medications, especially antibiotics
(penicillin, cephalosporins), NSAIDs, and
IV contrast agents used in medical
imaging, can trigger anaphylaxis is
susceptible individuals.
4. LATEX ALLERGY
 Exposure to latex, commonly found in
gloves, medical devices, and some
household products, can lead to
anaphylaxis in individuals with latex
allergies.
5. EXERCISE-INDUCED ANAPHYLAXIS
 Physical activity, especially when it follows
the consumption of certain foods or
medications, can lead to anaphylaxis
6. UNKNOWN TRIGGERS
 Anaphylaxis occurs without an identifiable
cause, which is referred to as idiopathic
anaphylaxis
NURSING DIAGNOSIS
 Ineffective airway clearance r/t
accumulation of secretion
 Ineffective breathing pattern r/t dyspnea
 Altered tissue perfusion r/t decrease
cardiac output
 Anxiety r/t ineffective airway clearance
IMPLEMENTATION
 Positioning the client to allow to maximum
chest expansion
 Encourage frequent changes in position
 Encourage ambulating
 Deep breathing exercise and coughing
 Hydration to maintain moisturing of
respiratory tract mucous membrane and
easily to move respiratory secretion and
decease incidence of infection
FOREIGN BODY OBSTRUCTION
 Anywhere from the larynx to bronchi
 Most common: 1-3 y.o, leading cause of
fatal injury in children less than 1 year old
 Example: hotdogs, candies, peanuts,
grapes, and popcorn
COMPLETE/ PARTIALLY OBSTRUCTED AIRWAY
PARTIAL OBSTRUCTION
 Low-pitched snoring during inhalation with
time interval, without signs and symptoms
COMPLETE OBSTRUCTION
 Extreme inspiratory effort with no chest
movement
 An emergency
COMPLETE AIRWAY OBSTRUCTION
 a life-threatening situation that requires
immediate intervention. It’s often caused by
a foreign object, or in some cases, severe
swelling or injury to the upper airway.
Prompt action, such as the Heimlich
maneuver (for choking on a foreign object)
or emergency medical assistance, is
essential to clear the obstruction and
restore normal breathing and O2 supply.
1. SUBSTERNAL RETRACTION
 Refers to the visible pulling in of the area
just below the ribcage (sub-sternum) during
inhalation. This occurs because the
diaphragm and intercostal muscles are
working harder to draw air in when there’s
a significant blockage in the upper airway,
often causing a vacuum effect in the chest.
2. INABILITY TO COUGH / SPEAK
 A complete airway obstruction typically
leaves very little or no space for air to pass.
This means that individuals may find it
MEDICAL & SURGICAL NURSING 9
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BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
impossible to generate the air pressure
needed for coughing or speaking.
3. INCREASE RESPIRATION & PULSE RATE
 When the airway is completely blocked, the
body recognizes the lack of O2 and
responds with an increased RR and
elevated HR. This is an emergency
response to try to compensate for the O2
deprivation.
4. CYANOSIS
 Bluish discoloration of the skin and mucous
membranes, which occurs when there’s
insufficient O2 in the bloodstream. In cases
of CAO, the body isn’t getting the O2 it
needs, resulting in cyanosis.
PARTIAL AIRWAY OBSTRUCTION
1. PERSISTENT RESPIRATORY INFECTION
 These symptoms could be caused or
exacerbated by inflammation or the
presence of mucous or pus, which can
further obstruct the airway.
A. INFLAMMATION - when the respiratory
system is infected, the body’s natural
response is to send immune cells to the
affected area. This immune response can
lead to inflammation. In the upper
respiratory tract (throat/larynx),
inflammation can narrow the airway by
causing swelling of the tissues. This
narrowing can lead to symptoms like
hoarseness and, in severe cases, stridor,
where the inflammed tissues obstruct the
passage of air.
B. MUCUS & PUS - infections often trigger an
increase in mucus production to help trap
and expel pathogens. However, when this
mucus becomes thick and excessive, it can
block the airway. Pus, which is a collection
of dead WBC and bacteria, can also
accumulate in the respiratory tract, forming
blockages. These obstructions can create
wheezing sounds as air tries to pass
through the narrowed or partially blocked
passages.
C. SECONDARY INFECTIONS - persistent
respiratory infections can lead to
complications such as bronchitis or
pneumonia, where inflammation and
mucus production are prominent. These
conditions can cause further airway
obstruction in the lower respiratory tract
which can produce wheezing.
2. HOARSENESS / GARBLED SPEECH
 Can occur when there’s an obstruction in
the larynx or vocal cords. This may be due
to inflammation, injury, or the presence of a
foreign object
3. WHEEZES
 Typically associated with lower airway
obstructions, often in the bronchi or
bronchioles. An obstruction can lead to
turbulent airflow and the production of
wheezing sounds as air passes through
narrowed or partially blocked airways.
4. STRIDOR
 High-pitched, noisy breathing sound that
often occurs during inspiration. It is most
commonly associated with upper airway
obstructions, such as the trachea or larynx.
When there’s an obstruction in these areas,
the flow of air becomes turbulent, causing
the characteristic stridor sound.
MANAGEMENT
PARTIAL AIRWAY OBSTRUCTION:
1. ENCOURAGE COUGHING - if the person is
conscious and able to cough, encourage them
to do so. Coughing is a natural reflex to clear
obstructions
2. MONITOR - keep a close eye on the person’s
condition. If the obstruction is not relieved, it
may worsen to a complete obstruction
3. CALL FOR HELP - if the obstruction persists or
if the person’s condition deteriorates, call
emergency services immediately.
COMPLETE AIRWAY OBSTRUCTION
 Start first aid
 Pull object out
 Small child turn upside down and deliver 5
quick, sharp back blows with heel of hands.
Turn over and deliver up to 5 quick chest
thrust like CPR
 Abdominal thrust 1 y.o above (Heimlich’s
maneuver)
1. PERFORM HEIMLICH MANEUVER (FOR
CONSCIOUS INDIVIDUALS) - stand behind the
person, wrap your arms around their waist, and
make a fist with one hand. Place the thumb
side of your fist against the person’s upper
abdomen, just below the ribcage. Grasp your
fist with your other hand and give quick, upward
MEDICAL & SURGICAL NURSING 10
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN

thrusts to force the object out. Continue until
the obstruction is cleared or the person
becomes unconscious.
2. BACK BLOWS & CHEST THRUSTS (FOR
INFANTS/UNCONSCIOUS INDIVIDUALS) - for
infants, place the infant face down on your
forearm, supporting the head, and give back
blows. For unconscious individuals, use chest
thrusts similar to the heimlich maneuver but
using chest compressions instead of abdominal
thrusts.
distressing sensation of not being able to
breathe. This diagnosis addresses the
emotional and psychological impact of the
condition.
6. RISK FOR INJURY
 The diagnosis can be relevant when there’s
a risk of injury related to the airway
obstruction, such as during efforts to clear
the obstruction, interventions, or
complications that may arise from the
obstruction itself.

3. CALL FOR HELP - even if the obstruction is CHRONIC OBSTRUCTIVE PULMONARY DISEASE
relieved, call for emergency assistance to (COPD)
ensure the person receives proper medical  Is a chronic inflammatory lung disease that
care. causes obstructed airflow from the lungs.
Symptoms include breathing difficulty,
4. PERFORM CPR (IF NEEDED) - if the person mucus (sputum) production and wheezing
becomes unconscious, begin CPR if you are
trained in it. Check for a pulse and breathing,  Also called Chronic Obstructive Lung
and if necessary, initiate chest compressions Disease results from emphysema, chronic
and rescue breaths. bronchitis, asthma, or a combination of this
disorder.
NURSING DIAGNOSIS
1. INEFFECTIVE AIRWAY CLEARANCE  It is a group of diseases secondary to
 This diagnosis is appropriate when a chronic limitation (CAL)
patient has difficulty clearing secretions,
foreign bodies, or obstructions from their
airway. It can be related to conditions such RISK FACTORS
as mucus accumulation or presence of a  Exposure to tobacco smoke. The most
foreign object in the airway. significant risk factor for COPD is long-term
2. IMPAIRED GAS EXCHANGE cigarette smoking
 This diagnosis is relevant when an  People with asthma
individual’s ability to exchange O2 and
CO2 in the lungs is compromised due to an
airway obstruction. It can lead to
inadequate oxygenation and ventilation.
3. INEFFECTIVE BREATHING PATTERN
 Patients with airway obstruction may
exhibit irregular, shallow, or rapid breathing
patterns as they struggle to breathe. This
diagnosis is relevant when there’s an
alteration in the normal breathing.
4. RISK FOR ASPIRATION
 Airway obstruction can increase the risk of
aspiration, which is the inhalation of foreign
 Occupational exposure to dust and
material into the lungs. Patients who are at
chemicals
risk for aspiration may have difficulty
protecting their airway during swallowing.  Genetics
5. ANXIETY
 Individuals experiencing an airway ETIOLOGY
obstruction often exhibit anxiety due to the  Exposure to molds, fungi
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
 Exposure to allergens/allergic reactions
1. Tobacco Smoking:
 Cigarette smoking is the most significant
and common cause of COPD. The harmful
chemicals in tobacco smoke can irritate
and damage the airways and lung tissue,
leading to inflammation, mucus production,
and airway obstruction
2. Environmental Exposures:
 Long-term exposure to harmful airborne
pollutants and chemicals in the workplace
or at home can contribute to COPD. These
exposures may include industrial dust,
fumes, chemical vapors, and indoor air
pollution. Occupational exposures are often
seen in certain industries like construction,
mining, and manufacturing.
3. Biomass Fuel and Indoor Air Pollution:
 In some developing countries, the use of
biomass fuels for cooking and heating in
poorly ventilated spaces can lead to indoor
air pollution. This chronic exposure to
particulate matter and noxious gases is a
significant risk factor for
4. Genetic Factors:
 Although less common, genetic factors can
contribute to the development of COPD.
Alpha-1 Antitrypsin Deficiency is a
hereditary condition that can lead to early-
onset emphysema. Individuals with this
genetic deficiency are more prone to
COPD, especially if they smoke.
5. Respiratory Infections:
 Repeated lung infections, especially during
childhood, can contribute to lung damage
and increase the risk of developing COPD
later in life.
6. Aging:
 The natural aging process can lead to
changes in the lungs and airways, making
older individuals more susceptible to COPD.
ALLERGIC REACTIONS
 Many individuals are allergic to mold
spores, fungi, and various allergens found
in the environment. When exposed to these
substances, the immune system can mount
an allergic response. This immune reaction
can lead to symptoms like sneezing, runny
nose, itchy or watery eyes, and skin rashes.
These allergic reactions are often referred
to as allergic rhinitis or hay fever.
ASTHMA EXACERBATION
 Mold spores, in particular, can act as
potent asthma triggers. When inhaled by
individuals with asthma, they can cause
airway inflammation, bronchoconstriction,
and an increase in mucus production. This
can lead to asthma exacerbations,
characterized by symptoms like wheezing,
coughing, shortness of breath, and chest
tightness.
RESPIRATORY INFECTIONS
 Some molds and fungi produce mycotoxins,
which can be harmful to the respiratory
system. Prolonged exposure to indoor
molds or damp environments can increase
the risk of respiratory infections. In some
cases, these infections can be severe,
particularly in individuals with compromised
immune systems.
IRRITANT EFFECTS
 Even in individuals without allergies, the
presence of molds and allergens in the
environment can irritate the respiratory
tract and cause symptoms like coughing
and throat irritation.
ATOPIC DERMATITIS (ECZEMA)
 Allergens, including those found in dust
mites and pet dander, can exacerbate
atopic dermatitis, a form of eczema
characterized by itchy and inflamed skin.
RHINOSINUSITIS:
 Exposure to mold and fungal spores can
contribute to chronic rhinosinusitis, a
condition marked by inflammation of the
nasal and sinus passages. This can result
in symptoms like nasal congestion, facial
pain or pressure, and nasal discharge.
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
HYPERSENSITIVITY PNEUMONITIS
 Certain individuals may develop
hypersensitivity pneumonitis, an
inflammatory lung condition, in response to
repeated exposure to mold, fungi, and
allergens. It can lead to symptoms like
cough, shortness of breath, and fever.
SIGNS AND SYMPTOMS
1. CHRONIC COUGH
 Rationale: Chronic cough is often one of
the earliest and most persistent symptoms
of COPD. It occurs due to irritation of the
airways and increased mucus production,
which are characteristic features of the
disease.
2. INCREASED SPUTUM PRODUCTION
 Rationale: People with COPD often
produce more mucus, which can be thicker
and harder to clear. This is the body's
response to inflammation and irritation in
the airways, leading to increased sputum
production.
3. SHORTNESS OF BREATH (Dyspnea):
 Rationale: Shortness of breath is a
hallmark symptom of COPD and is usually
more pronounced during physical activity or
exertion. The narrowing of airways and
destruction of lung tissue reduces the
efficiency of air.
4. WHEEZING:
 Rationale: Wheezing is the result of air
flowing through narrowed airways and
encountering resistance. It is often heard
when people with COPD exhale and can
be indicative of obstructed airflow.
5. CHEST TIGHTNESS
 Rationale: Chest tightness is a sensation
of pressure or constriction in the chest. It
can result from in COPD.airway
inflammation and bronchoconstriction,
which occur
6. FREQUENT RESPIRATORY INFECTIONS
 Rationale: COPD impairs the ability of the
lungs to clear mucus and foreign particles,
making individuals more susceptible to
respiratory infections. Frequent infections
can exacerbate COPD symptoms.
7. BARREL CHEST (in severe cases):
 Rationale: In advanced stages of COPD,
the chest may take on a barrel-shaped
appearance due to overinflated lungs and
changes in the ribcage structure. This
occurs as a result of trapped air and
increased residual volume in the lungs.
8. CYANOSIS (Bluish Skin or Lips):
 Rationale: Cyanosis is a sign of severe
hypoxemia, which can occur in advanced
COPD when there is inadequate oxygen
exchange. Itis a late and serious
manifestation of the disease.
9. UNINTENDED WEIGHT LOSS:
 Rationale: People with COPD may
experience weight loss due to the
increased energy expenditure required for
breathing and the systemic inflammation
associated with the condition.
10. FATIGUE & REDUCED EXERCISE TOLERANCE:
 Rationale: Breathing difficulties and
reduced oxygen supply to the body can
result in fatigue and a decreased ability to
engage in physical activities, leading to a
sedentary lifestyle.
11. COR PULMONALE (Right Heart Failure):
 Rationale: In advanced cases of COPD,
chronic hypoxia and increased resistance
to blood flow through the lungs can lead to
a condition called cor pulmonale, where the
right side of the heart becomes strained.
MEDICAL & SURGICAL NURSING 13
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
TRIPOD POSITION
 The tripod position is a physical stance that
individuals, often those with respiratory
distress, adopt to help ease breathing
difficulties. It is characterized by the
following posture:
1. Sitting Upright
 The person sits with their upper body in an
upright position. This allows for better
expansion of the chest and improved lung
function.
2. Leaning Forward:
 The individual leans forward, placing their
hands on a support surface, such as their
knees or a table. This forward- leaning
posture further assists in expanding the
chest, which can alleviate some of the
pressure and discomfort associated with
respiratory distress.
3. Neck and Shoulders Extended:
 The neck is often extended slightly, and the
shoulders may be pushed forward. This
helps open the airways and allows for
easier airflow.
 The tripod position is commonly seen in
people with respiratory conditions: like
Chronic Obstructive Pulmonary Disease
(COPD), asthma, or severe shortness of
breath. It is a natural response to the
body's need for increased oxygen intake
when breathing is difficult
PURSED LIP
 Pursed lip breathing is a simple yet
effective breathing technique that can help
improve lung function and alleviate
shortness of breath, particularly for
individuals with respiratory conditions like
Chronic Obstructive Pulmonary Disease
(COPD).
1. Relax
 Find a comfortable sitting or standing
position.
2. Inhale
 Breathe in slowly through your nose for a
count of two.
3. Purse Your Lips
 Pucker your lips, as if you were about to
blow out a candle.
4. Exhale
 Exhale slowly and gently through your
pursed lips for a count of four. The
exhalation should take longer than the
inhalation.
5. Repeat
 Continue this pattern of slow inhalation
through the nose and prolonged exhalation
through pursed lips
PURSED LIP BREATHING HAS SEVERAL BENEFITS:
1. Improved Oxygen Exchange
 It helps to keep the airways open for a
longer period during exhalation, allowing
more time for the exchange of oxygen and
carbon dioxide in the lungs.
2. Reduced Respiratory Rate
 Pursed lip breathing naturally slows down
the breathing rate, reducing the work of
breathing and helping to alleviate shortness
of breath.
3. Enhanced Lung Function
 It can improve the efficiency of breathing
and increase oxygen saturation in the
blood.
4. Relaxation
 Pursed lip breathing promotes relaxation
and reduces anxiety associated with
difficulty breathing.
MEDICATIONS
 Bronchodilators. Bronchodilators are
medications that usually come in inhalers —
they relax the muscles around your airways.
 Inhaled steroids
 Combination inhalers
 Oral steroids
 Phosphodiesterase-4 inhibitors
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
 Theophylline
 Antibiotics
 For most people with COPD, short-acting
bronchodilator inhalers are the first
treatment used. Bronchodilators are
medicines that make breathing easier by
relaxing and widening your airways. There
are 2 types of short-acting bronchodilator
inhaler: beta-2 agonist inhalers – such as
salbutamol and terbutaline.
LATES TREATMENT
 Treatments like pulmonary rehabilitation,
medications such as bronchodilators and
corticosteroids. And lung volume reduction
surgery help many people living with COPD,
a new option called the Zephyr Valve, which
was FDA approved in 2018, is offering hope
for patients like Bright who have advanced
disease.
TYPES OF COPD
BRONCHIAL ASTHMA
 Reversible bronchospasm and increase
secretion lasting more than 1 hour,
bronchial obstruction characterized by
attacks lasting 30 – 60 minutes: Status
Asthmaticus
 Asthma is a chronic respiratory condition
that affects the airways in the lungs. It is
characterized by inflammation and
narrowing of the airways, which can lead to
a variety of symptoms and make breathing
difficult.
1. AIRWAY INFLAMMATION
 Asthma involves chronic inflammation of the
airways. This inflammation causes the
airways to become more sensitive to
various triggers, such as allergens,
respiratory infections, cold air, or irritants
like smoke
2. AIRWAY CONSTRICTION
 When exposed to triggers, the muscles
surrounding the airways may tighten or
constrict, further narrowing the air
passages.
3. INCREASED MUCUS PRODUCTION
 The inflammation can stimulate the
production of excess mucus, which can clog
the already narrowed airways
CAUSES OF BRONCHIAL ASTHMA
1. GENETICS
 Asthma tends to run in families, suggesting
a genetic predisposition. If one or both
parents have asthma or other allergic
conditions, a child is at a higher risk of
developing asthma
2. ENVIRONMENTAL ALLERGENS
 Exposure to allergens like pollen, dust
mites, pet dander, mold spores, and
cockroach droppings can trigger asthma
symptoms in susceptible individuals.
3. RESPIRATORY INFECTIONS
 Viral respiratory infections, especially during
early childhood, can increase the risk of
developing asthma.
4. OCCUPATIONAL EXPOSURES
 Certain workplace exposures to irritants or
allergens, like chemicals or dust, can
contribute to the development of
occupational asthma
5. TOBACCO SMOKE
 Exposure to second-hand smoke, especially
in childhood, is a risk factor for asthma
development. Smoking during pregnancy
can also increase the child’s risk
6. AIR POLLUTION
 Long-term exposure to air pollution, both
indoors and outdoors, is associated with an
increased risk of asthma
7. PHYSICAL ACTIVITY
 In some individuals, physical activity or
exercise, particularly in cold or dry
conditions, can trigger exercise-induced
bronchoconstriction (EIB), also known as
exercise-induced asthma.
8. OBESITY
 Obesity is a risk factor for asthma,
particularly in adults. It can worsen asthma
symptoms and reduce the effectiveness of
asthma medications.
9. GASTROESOPHAGEAL REFLUX DISEASE (GERD)
 There is a link between GERD and asthma.
Acid reflux from the stomach can irritate the
airways and trigger asthma symptoms.
MEDICAL & SURGICAL NURSING 15
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
SIGNS & SYMPTOMS
1. SHORTNESS OF BREATH
 People with asthma may experience
difficulty breathing and a feeling of tightness
in the chest, especially during or after
physical activity
2. WHEEZING
 Wheezing is a high-pitched whistling sound
that occurs when breathing. It’s often more
pronounced during exhalation and is a
hallmark symptom of asthma.
3. COUGHING
 A persistent, dry cough, particularly at night
or early in the morning, is common in
people with asthma.
4. CHEST TIGHTNESS
 Asthma can cause a sensation of tightness
or pressure in the chest, making it
uncomfortable to breathe.
 Bronchial asthma is a medical condition
which causes the airway path of the lungs
to swell and narrow. Due to this swelling,
the air path produces excess mucus making
it hard to breathe, which results in coughing,
short breath, and wheezing. The disease is
chronic and interferes with daily working.
NURSING DIAGNOSIS
1. INEFFECTIVE AIRWAY CLEARANCE
 This diagnosis relates to the difficulty the
patient has in clearing mucus and
secretions from their airways due to
bronchoconstriction and inflammation,
leading to impaired airflow.
2. IMPAIRED GAS EXCHANGE
 Asthma can result in inadequate
oxygenation and ventilation due to airway
obstruction. This diagnosis addresses the
disruptions in the patient’s ability to
exchange oxygen and carbon dioxide
effectively
3. ANXIETY
 Many asthma patients experience anxiety
related to the fear of acute attacks and the
sensation of breathlessness. Anxiety can
exacerbate asthma symptoms, making this
diagnosis relevant.
4. INEFFECTIVE BREATHING PATTERN
 Patients with asthma often exhibit irregular,
shallow, or rapid breathing patterns due to
the distressing sensation of breathlessness.
This diagnosis addresses alterations in the
patient’s normal breathing pattern.
5. ACTIVITY INTOLERANCE
 Asthma can lead to fatigue and reduced
ability to perform physical activities due to
limited oxygen supply. Patients may require
interventions to conserve energy and
enhance their activity tolerance.
6. RISK FOR ALLERGIC REACTIONS
 Some asthma patients have allergic asthma
triggered by specific allergens. This
diagnosis addresses the risk of developing
allergic reactions and managing allergen
exposure.
7. RISK FOR NONCOMPLIANCE WITH MEDICATION REGIMEN
 Patients may struggle with adhering to
prescribed medication and treatment
regimens. This diagnosis relates to the risk
of noncompliance, which can lead to
uncontrolled asthma symptoms.
8. INEFFECTIVE COPING
 Chronic asthma can have a significant
impact on the patient’s daily life and
psychological well-being. This diagnosis
addresses the emotional and psychological
MEDICAL & SURGICAL NURSING 16
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
aspects of coping with a chronic respiratory
condition.
MANAGEMENT
1. BRONCHODILATORS (SHORT-ACTING BETA AGONISTS –
SABA)
 EXAMPLES: Albuterol, Levalbuterol
 RATIONALE: SABAs provide quick relief
during acute asthma symptoms. They work
by relaxing the muscles around the airways,
rapidly dilating the bronchioles, and easing
the breathlessness and wheezing
associated with bronchoconstriction
2. BRONCHODILATORS (LONG-ACTING BETA AGONISTS –
LABA)
 EXAMPLES: Formoterol, Salmeterol
 RATIONALE: LABAs are used as long-term
control medications in combination with
inhaled corticosteroids. They help maintain
bronchodilation and improve overall asthma
control.
3. INHALED CORTICOSTEROIDS (ICS)
 EXAMPLES: Beclomethasone,
Budesonide, Fluticasone
 RATIONALE: ICS are anti-inflammatory
medications that reduce airway
inflammation and mucus production. They
are considered the cornerstone of asthma
therapy and help prevent exacerbations.
4. ORAL CORTICOSTEROIDS
 EXAMPLES: Prednisone,
Methylprednisolone
 RATIONALE: In cases of severe asthma
exacerbations, oral corticosteroids may be
prescribed to rapidly reduce airway
inflammation. They are usually used for
short durations to regain asthma control.
5. LEUKOTRIENE MODIFIERS
 EXAMPLES: Montelukast, Zafirlukast
 RATIONALE: Leukotrienes are
inflammatory mediators that contribute to
bronchoconstriction and inflammation in
asthma. Leukotriene modifiers help block
these mediators, reducing airway
constriction and inflammation
6. MAST CELL STABILIZERS
 EXAMPLES: Cromolyn Sodium,
Nedocromil
 RATIONALE: Mast cell stabilizers prevent
the release of inflammatory substances
from mast cells in the airways, reducing
inflammation and bronchoconstriction
7. MONOCLONAL ANTIBODIES (BIOLOGICS)
 EXAMPLES: Omalizumab, Mepolizumab,
Dupilumab
 RATIONALE: Biologics are used in severe,
uncontrolled asthma. They target specific
immune system components responsible for
allergic or eosinophilic inflammation, helping
to reduce exacerbations and improve
control.
8. THEOPHYLLINE
 RATIONALE: Theophylline is a
bronchodilator with both anti-inflammatory
and bronchodilating effects. It relaxes the
airway muscles and may improve airflow.
9. COMBINATION INHALERS
 EXAMPLES: Fluticasone/Salmeterol
(Advair), Budesonide/Formoterol
(Symbicort)
 RATIONALE: Combination inhalers provide
the benefits of both corticosteroids and
LABAs in a single device, simplifying
medication regimens and enhancing
asthma control.
CHRONIC BRONCHITIS
 Inflammation of
bronchial wall with
goblet cell
hypertrophy
characterized by
chronic cough.
MEDICAL & SURGICAL NURSING 17
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN

CAUSE & ETIOLOGY 8. IMPAIRED IMMUNE FUNCTION

1. TOBACCO SMOKING  RATIONALE: People with weakened
 RATIONALE: Smoking is the leading cause immune systems are more susceptible to
of chronic bronchitis. It exposes the airways respiratory infections, which can contribute
to irritants and toxins, leading to to the development of chronic bronchitis
inflammation and damage to the bronchial
lining. This results in increased mucus SIGNS & SYMPTOMS
production and airway obstruction.
2. LONG-TERM EXPOSURE TO AIR POLLUTANTS
 RATIONALE: Prolonged exposure to indoor
and outdoor air pollutants, such as dust,
fumes, and chemicals, can irritate and
damage the airways, contributing to chronic
bronchitis.
3. RESPIRATORY INFECTIONS
 RATIONALE: Repeated respiratory
infections, especially during childhood, can
damage the airway linings and result in
chronic inflammation. This makes the
airways more prone to mucus production
and narrowing
4. OCCUPATIONAL EXPOSURES
 Rationale: Working in certain industries with
exposure to airborne irritants, like dust,
fumes, or chemicals, can lead to
occupational bronchitis. The repeated
inhalation of such substances can cause
airway inflammation and mucus
overproduction.
5. GENETIC FACTORS
 RATIONALE: In some cases, genetic
factors may contribute to an increased
susceptibility to airway inflammation and
mucus production. This genetic 1. CHRONIC COUGH
predisposition can be a risk factor for  Rationale: The chronic cough is a hallmark
developing chronic bronchitis. symptom of chronic bronchitis. The
6. AGE persistent cough is the result of irritation
 RATIONALE: As people age, the risk of and inflammation in the airways, which lead
developing chronic bronchitis increases. to increased mucus production and the
This is partly due to the cumulative effects need to clear it from the lungs
of exposure to irritants and infections 2. INCREASED MUCUS PRODUCTION
overtime  Rationale: Chronic bronchitis causes the
7. GASTROESOPHAGEAL REFLUX DSE (GERD) goblet cells in the airway lining to produce
 RATIONALE: GERD, characterized by the more mucus than normal. This increased
backflow of stomach acid into the mucus production is the body’s response to
esophagus and airways, can irritate the inflammation and serves as a defense
airways, leading to inflammation and mechanism against inhaled irritants.
chronic cough, a common symptom in 3. PRODUCTIVE COUGH
chronic bronchitis.  Rationale: The cough in chronic bronchitis
is often productive, meaning it results in the
expulsion of mucus or sputum. This is a

MEDICAL & SURGICAL NURSING 18

 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
sign that the airways are trying to clear
excess mucus and irritants.
4. WHEEZING
 Rationale: Wheezing is a high-pitched
whistling sound that occurs when breathing
and is due to narrowed airways. In chronic
bronchitis, inflammation and mucus
production can obstruct the airways,
causing wheezing during both inhalation
and exhalation.
5. SHORTNESS OF BREATH
 Rationale: Chronic bronchitis can lead to
narrowing of the airways, making it harder
for air to flow in and out of the lungs. This
results in shortness of breath, especially
during physical activity or exertion.
6. CHEST DISCOMFORT / TIGHTNESS
 Rationale: The inflammation and increased
mucus production can cause a sensation of
tightness or pressure in the chest making it
7. FATIGUE
 Rationale: The increased work of breathing
and the body’s constant effort to clear
mucus can lead to fatigue, impacting the
patient’s overall energy levels.
8. CYANOSIS
 Rationale: In severe cases of chronic
bronchitis, especially during acute
exacerbations, inadequate oxygen
exchange can result in cyanosis, a bluish
discoloration of the skin and lips, due to a
lack of oxygen in the blood.
9. FREQUENT RESPIRATORY INFECTIONS
 Rationale: The chronic inflammation and
excess mucus in the airways make
individuals with chronic bronchitis more
susceptible to respiratory infections, leading
to recurrent bouts of bronchitis.
NURSING DIAGNOSIS
1. INEFFECTIVE AIRWAY CLEARANCE
 Rationale: Due to excessive mucus
production and inflammation, the patient
may have difficulty clearing airway
secretions, leading to airway obstruction
and potential respiratory distress.
2. IMPAIRED GAS EXCHANGE
 Rationale: Chronic bronchitis can lead to
decreased oxygen exchange and carbon
dioxide removal, resulting in hypoxemia.
This diagnosis reflects the patient’s
compromised respiratory function
3. INEFFECTIVE BREATHING PATTERN
 Rationale: The patient may exhibit
abnormal breathing patterns due to the
effort required to overcome airway
obstruction and clear mucus, which can
exacerbate the underlying condition
4. ACTIVITY INTOLERANCE
 Rationale: Due to breathlessness and
reduced oxygen supply, the patient may
experience limitations in physical activity
and daily life, impacting their quality of life.
5. ANXIETY
 Rationale: Chronic bronchitis can cause
anxiety related to the fear of acute
exacerbations and breathlessness
6. IMBALANCED NUTRITION: LESS THAN BODY
REQUIREMENTS
 Rationale: Chronic bronchitis can lead to
unintended weight loss due to increased
energy expenditure from breathing
difficulties and systemic inflammation.
7. KNOWLEDGE DEFICIT: SLEF-CARE R/T CHRONIC
BRONCHITIS
 Rationale: Patients may require education
on symptom management, medication
administration, and lifestyle modifications to
effectively manage their chronic bronchitis.
8. RISK FOR INFECTION
 Rationale: Chronic bronchitis makes
individuals more susceptible to respiratory
infections, which can lead to exacerbations.
This diagnosis relates to the risk of
developing infections.
9. RISK FOR HOSPITALIZATION
 Rationale: Individuals with chronic
bronchitis may be at an increased risk of
hospitalization during acute exacerbations,
especially if they have difficulty managing
their symptoms at home.
TREATMENT
1. SMOKING CESSATION
 If the patient is a smoker, the most crucial
step is quitting smoking. This is the single
most effective intervention to slow the
progression of chronic bronchitis and
improve lung function.
MEDICAL & SURGICAL NURSING 19
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
2. MEDICATIONS:
 BRONCHODILATORS - These medications,
including short-acting and long-acting beta-
agonists and anticholinergics, help relax the
airway muscles and open the airways,
making it easier to breathe.
 INHALED CORTICOSTEROIDS - These anti-
inflammatory medications reduce airway
inflammation and mucus production. They
are often used in combination with
bronchodilators for more severe cases
 PHOSPHODIESTERASE-4 INHIBITORS -
Medications like roflumilast are used in
some cases to reduce airway inflammation
and improve lung function.
 PULMONARY REHABILITATION - This
program involves a combination of exercise
training, education, and counseling to help
patients improve their lung function,
manage symptoms, and enhance their
quality of life.
 OXYGEN THERAPY
 MUCOLYTICS - These medications can help
make mucus less sticky and easier to clear
from the airways.
 COUGH SUPPRESSANTS - For patients with a
persistent, dry, and unproductive cough,
cough suppressants may be used to
alleviate symptoms
 ANTIBIOTICS - If a bacterial respiratory
infection is suspected during an
exacerbation, antibiotics may be prescribed.
2. VACCINATIONS
 Yearly influenza vaccinations and
pneumonia vaccinations are recommended
to reduce the risk of respiratory infections
that can exacerbate chronic bronchitis
3. LIFESTYLE MODIFICATION
 Patients are encouraged to avoid exposure
to irritants and allergens, maintain a healthy
diet, stay hydrated, and engage in regular
physical activity. Avoiding cold air and
staying indoors during extreme weather can
also help.
4. SUPPORTIVE CARE
 Managing chronic bronchitis often involves
managing symptoms and addressing
complications as they arise. This includes
treating acute exacerbations
5. NUTRITIONAL SUPPORT
 In cases of significant weight loss or
malnutrition, dietary interventions or
supplements may be recommended to
maintain or regain body weight and strength
MANAGEMENT
1. BRONCHODILATORS
 SABA – Examples include Albuterol and
Levalbuterol. These provide rapid relief by
relaxing airway muscles and quickly dilating
the bronchioles, making it easier to breathe
during acute symptoms.
 LABA - Examples include Formoterol and
Salmeterol. LABAs provide sustained
bronchodilation and are often used in
combination with other medications for long-
term control
2. INHALED CORTICOSTEROIDS
 Examples: Beclomethasone, Budesonide,
Fluticasone. These anti-inflammatory
medications help reduce airway
inflammation and mucus production and are
a key component of long-term control
therapy.
3. MUCOLYTICS
 Example: N-acetylcysteine. Mucolytics help
make mucus less viscous and easier to
clear from the airways, which can relieve
cough and discomfort.
4. ANTICHOLINERGICS
 Examples: Ipratropium, Tiotropium. These
medications help relax airway muscles and
reduce mucus production, improving airflow.
5. PHOSPHODIESTERASE-4 INHIBITORS
 Example: Roflumilast. This medication is
used in some cases to reduce airway
inflammation and improve lung function.
6. ANTIBIOTICS
 Antibiotics may be prescribed if there is
evidence of a bacterial respiratory infection
during an exacerbation. Common antibiotics
include amoxicillin, doxycycline, or
azithromycin.
7. COUGH SUPRESSANTS
 Cough suppressants can be used to
alleviate a persistent, dry, and unproductive
MEDICAL & SURGICAL NURSING 20
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
cough, although they should be used with
caution.
8. SUPPLEMENTAL OXYGEN
 In cases of severe chronic bronchitis with
low oxygen levels in the blood (hypoxemia),
supplemental oxygen therapy may be
necessary to maintain adequate oxygen
levels.
 Bronchodilator Medications Inhaled as
aerosol sprays or taken orally,
bronchodilator medications may help to
relieve symptoms of chronic bronchitis by
relaxing and opening the air passages in
the lungs.
 Steroids Inhaled as an aerosol spray,
steroids can help relieve symptoms of
chronic bronchitis.
EMPHYSEMA
 A pathologic
accumulation of air
in tissue or organs.
 Emphysema is a
lung condition that
causes shortness
of breath. In people
with emphysema,
the air sacs in the
lungs (alveoli) are
damaged. Over
time, the inner
walls of the air
sacs weaken and
rupture — creating
larger air spaces
CAUSES & ETIOLOGY
1. CIGARETTE SMOKING
 Rationale: Smoking is the leading cause of
emphysema. The toxins in cigarette smoke
irritate and inflame the air sacs in the lungs,
leading to tissue damage and a breakdown
of the walls of the air sacs, reducing their
elasticity
2. SECONDHAND SMOKE EXPOSURE
 Rationale: Inhaling secondhand smoke
from others’ cigarettes or tobacco products
can also contribute to the development
3. OCCUPATIONAL EXPOSURES
 Rationale: Long-term exposure to
workplace irritants and toxins, such as dust,
fumes, chemicals, or pollutants, can lead to
occupational lung diseases, including
emphysema. Certain industries, such as
mining, construction, and manufacturing,
have higher risks of exposure.
4. ALPHA-1 ANTITRYPSIN DEFICIENCY
 Rationale: This is a rare genetic condition
that can lead to emphysema. Alpha-1
antitrypsin is a protein that helps protect the
lungs. Deficiency of this protein can result in
lung tissue damage.
SIGNS & SYMPTOMS
1. SHORTNESS OF BREATH (DYSPNEA)
 Rationale: The enlargement of air sacs and
the loss of elasticity in lung tissue make it
difficult to exhale fully. This leads to air
trapping in the lungs and causes the
sensation of breathlessness.
2. CHRONIC COUGH
 Rationale: Coughing is a common
response to clear mucus and irritants from
the airways. In emphysema, chronic
inflammation and mucus production lead to
persistent coughing.
3. WHEEZING
 Rationale: As the airways narrow due to
inflammation and loss of elastic recoil,
wheezing can occur during both inhalation
and exhalation.
4. INCREASED MUCUS PRODUCTION
 Rationale: Emphysema causes increased
mucus production in the airways. This
mucus is thicker and more difficult to clear,
contributing to chronic cough and
discomfort.
MEDICAL & SURGICAL NURSING 21
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
5. CHEST TIGHTNESS
 Rationale: The persistent inflammation in
the airways and the increased effort
required to breathe can lead to a sensation
of tightness or pressure in the chest.
6. BARREL CHEST APPEARANCE
 Rationale: Over time, the enlargement of
the lungs and the expansion of the ribcage
can lead to a ―barrel chest‖ appearance,
where the chest becomes more rounded
and the diaphragm flattens.
7. FINGER CLUBBING
 Rationale: In some severe cases,
individuals with emphysema may develop
finger clubbing, where the fingertips and
nails take on a characteristic appearance.
This can be a sign of chronic low oxygen
levels in the blood
8. REDUCED EXERCISE TOLERANCE
 Rationale: Breathlessness and difficulty
exhaling make physical activity more
challenging, leading to a reduction in
exercise tolerance.
9. WEIGHT LOSS
 Rationale: The increased effort required for
breathing and a heightened metabolic rate
can lead to unintended weight loss,
particularly in advanced cases.
10. FATIGUE
 Rationale: The increased work of breathing
and the body’s constant effort to maintain
oxygen levels can lead to fatigue and a
general sense of tiredness
NURSING DIAGNOSIS
1. INEFFECTIVE BREATHING PATTERN
 Rationale: Emphysema causes air trapping
and difficulty in exhaling, leading to
ineffective breathing patterns and
breathlessness.
2. IMPAIRED GAS EXCHANGE
 Rationale: The destruction of lung tissue in
emphysema impairs the exchange of
oxygen and carbon dioxide, leading to
hypoxemia. This diagnosis reflects the
patient’s compromised respiratory function.
3. INEFFECTIVE AIRWAY CLEARANCE
 Rationale: Chronic inflammation and
mucus production in emphysema can lead
to difficulty in clearing airway secretions,
increasing the risk of respiratory distress.
4. ACTIVITY INTOLERANCE
 Rationale: Breathlessness and reduced
exercise capacity are common in
emphysema. Patients may experience
limitations in physical activity, impacting
their quality of life.
5. ANXIETY
 Rationale: Chronic breathlessness and the
fear of acute exacerbations can lead to
anxiety, which can exacerbate symptoms
6. IMBALANCED NUTRITION
 Rationale: Increased energy expenditure
from breathing difficulties and systemic
inflammation can result in unintended
weight loss.
7. RISK FOR INFECTION
 Rationale: Patients with emphysema are
more susceptible to respiratory infections,
increasing the risk of complications
8. IMPAIRED COPING
 Rationale: Chronic emphysema can have a
significant impact on a patient’s daily life
and psychological well-being. This
diagnosis addresses the emotional and
psychological aspects of coping
TREATMENT
 Medications. Bronchodilator Medications.
 Vaccines. Patients with emphysema should
receive a flu shot annually and pneumonia
shot every five to seven years to prevent
infections.
 Oxygen Therapy
 Surgery or Lung Transplant
MEDICAL & SURGICAL NURSING 22
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN

 Protein Therapy unproductive cough although they should

 Pulmonary Rehabilitation be used with caution
9. SUPPLEMENTAL NUTRITIONAL SUPPORT
MEDICATION  Rationale: In cases of significant weight
1. BRONCHOILATORS loss or malnutrition, dietary interventions or
 SABA – Examples include Albuterol and supplements may be recommended to
Levalbuterol. These medications provide maintain or regain body weight and
quick relief by relaxing airway muscles, strength.
making it easier to breathe during acute 10. PSYCHOLOGICAL SUPPORT
symptoms or exarcebations  Rationale: Some patients may benefit from
 LABA - Examples include Formoterol and medications to manage anxiety or
Salmeterol. LABAs provide sustained depression that can be associated with
chronic respiratory
bronchodilation and are often used in
combination with other medications for long- BRONCHIECTASIS
term control.  A chronic dilatation of
2. INHALED CORTICOSTEROIDS one or more bronchi
secondary to infection
 Examples: Beclomethasone, Budesonide,
obstruction.
Fluticasone. These anti-inflammatory
medications help reduce airway
 Bronchiectasis is a
inflammation and mucus production, making
condition where the
them an important part of long-term control
bronchial tubes of your
therapy
lungs are permanently
3. ANTICHOLINERGICS
damaged, widened,
 Examples: Ipratropium, Tiotropium. These and thickened. These
medications help relax airway muscles and damaged air passages
reduce mucus production, improving airflow. allow bacteria and
4. PHOSPHODIESTERASES-4 INHIBITORS mucus to build up and
 Example: Roflumilast. This medication is pool in your lungs. This
used in some cases to reduce airway results in frequent
inflammation and improve lung function. infections and
5. OXYGEN THERAPY blockages of the
 Rationale: In severe cases, or when airways.
patients experience low oxygen levels in the
blood (hypoxemia), supplemental oxygen
therapy is necessary to ensure adequate CAUSES & ETIOLOGY
oxygen supply 1. INFECTIONS:
6. MUCOLYTICS  RECURRENT RESPIRATORY INFECTIONS -
 Rationale: Mucolytics help make mucus Frequent or severe respiratory infections,
less viscous and easier to clear from the particularly in childhood, can damage the
airways, which can alleviate cough and airways and lead to bronchiectasis.
discomfort.  TUBERCULOSIS - A history of tuberculosis,
7. VACCINATIONS especially if not treated adequately, can
 Rationale: Yearly influenza vaccinations result in bronchiectasis.
and pneumonia vaccinations are 2. CYSTIC FIBROSIS
recommended to reduce the risk of  Rationale: Cystic fibrosis is a genetic
respiratory infections that can exacerbate condition that affects the body’s ability to
emphysema. produce normal mucus. Thick, sticky mucus
8. COUGH SUPRESSANTS can obstruct the airways and lead to
 Rationale: Cough suppressants may be bronchiectasis.
used to alleviate a persistent, dry, and
MEDICAL & SURGICAL NURSING 23
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
3. IMMUNODEFICIENCY DISORDERS
 Rationale: Conditions that weaken the
immune system, such as HIV/AIDS or
primary immunodeficiency disorders, can
make individuals more susceptible to
respiratory infections and bronchiectasis
4. AUTOIMMUNE DISORDERS
 Rationale: Some autoimmune diseases,
like rheumatoid arthritis or Sjögren’s
syndrome, can cause inflammation and
damage to the airways.
5. ASPIRATION
 Rationale: Aspiration, where stomach
contents enter the lungs, can lead to
recurrent infections and bronchiectasis
6. ALLERGIES
 Rationale: Severe allergic reactions,
particularly allergic bronchopulmonary
aspergillosis, can cause inflammation and
damage to the airways.
7. ENVIRONMENTAL & OCCUPATIONAL EXPOSURES
 Rationale: Long-term exposure to
environmental irritants, such as air pollution,
dust, fumes, or chemicals, can contribute to
bronchiectasis. This is more common in
certain occupational settings, like coal
mining or agriculture
8. GASTROESPHAGEAL REFLUX DSE (GERD)
 Rationale: GERD, characterized by
stomach acid entering the esophagus and
airways, can lead to irritation and
inflammation of the bronchi
9. STRUCTURAL ABNORMALITIES
 Rationale: Structural abnormalities in the
airways, either present at birth or acquired,
can interfere with normal mucus clearance
and contribute to bronchiectasis.
10. UNKNOWN CAUSES (IDIOPATHIC)
 In some cases, the cause of bronchiectasis
remains unknown, and the condition is
referred to as idiopathic bronchiectasis.
NURSING DIAGNOSIS
1. INEFFECTIVE AIRWAY CLEARANCE
 This diagnosis is relevant for patients with
conditions like bronchiectasis, where mucus
build-up or airway obstructions hinder
effective breathing.
2. RISK FOR INFECTION
 Applicable to patients with compromised
immune systems, surgical wounds, or
invasive medical devices that increase the
risk of infection.
3. IMPAIRED GAS EXCHANGE
 This diagnosis relates to conditions that
affect the exchange of oxygen and carbon
dioxide in the lungs, such as pneumonia or
chronic obstructive pulmonary disease
(COPD).
4. ACUTE PAIN
 Appropriate for patients experiencing pain
due to injuries, surgeries, or various medical
conditions.
5. ANXIETY
 Relevant when a patient exhibits signs of
anxiety or stress related to their health or
hospitalization.
6. IMBALANCED NUTRITION
 This diagnosis applies to individuals with
malnutrition or those unable to consume
sufficient nutrients
7. RISK FOR FALLS
 Especially important for elderly or physically
impaired patients to prevent fall-related
injuries.
8. INEFFECTIVE COPING
 For patients experiencing difficulty in
dealing with stress, health issues, or life
changes.
MANAGEMENT
1. MEDICATIONS:
 ANTIBIOTICS – Used to treat and prevent
bacterial infections.
 MUCOLYTICS – Help to thin and loosen
mucus, making it easier to clear from the
airways.
 BRONCHODILATORS – These can help relax
the airway muscles and improve airflow.
2. AIRWAY CLEARANCE TECHNIQUES
 CHEST PHYSIOTHERAPY – Techniques like
postural drainage and percussion can help
mobilize and remove mucus from the lungs
 POSITIVE EXPIRATORY PRESSURE (PEP)
DEVICES – These devices assist in clearing
mucus from the airways
 EXERCISE – Regular physical activity can
help improve lung function and overall
health.
MEDICAL & SURGICAL NURSING 24
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
3. VACCIANTIONS
 Staying up to date on vaccines, including
the flu and pneumonia vaccines, can help
prevent infections that can exacerbate
bronchiectasis.
4. PULMONARY REHABILITATION
 This program may include exercise,
education, and support to help individuals
5. LIFESTYLE MODIFICATIONS
 Avoiding tobacco smoke, maintaining good
hygiene, and staying hydrated can help
reduce the risk of exacerbations
6. NUTRITIONAL SUPPORT
 In some cases, individuals with
bronchiectasis may require dietary support,
especially if malnutrition is a concern.
7. SURGICAL INTERVENTION
 In severe cases or when other treatments
are ineffective, surgery may be considered
to remove damaged lung tissue
8. MANAGEMENT OF UNDERLYING CAUSES
 If bronchiectasis is secondary to another
condition, such as cystic fibrosis
 Antibiotics are the most common treatment
for bronchiectasis. Oral antibiotics are
suggested for most cases, but harder to
treat infections may require intravenous (IV)
antibiotics. Macrolides are a specific type of
antibiotics that not only kill certain types of
bacteria but also reduce inflammation in the
bronchi.
PULMONARY EMBOLUS
 A pulmonary embolus, or pulmonary
embolism (PE), is a serious medical
condition where a blood clot (usually
originating in the deep veins of the legs,
known as deep vein thrombosis or DVT)
travels through the bloodstream and
becomes lodged in the pulmonary arteries
of the lungs. This can result in a blockage of
blood flow to the lungs, causing potentially
life-threatening complications.
CAUSES & ETIOLOGY
1. DEEP VEIN THROMBOSIS (DVT)
 DVT is a common precursor to PE. When a
blood clot forms in the deep veins of the
legs (often in response to factors like
immobility, surgery, or trauma), it can
dislodge and travel to the lungs through the
bloodstream.
 Rationale: The formation of a clot in a deep
vein can obstruct blood flow. When this clot
breaks free and travels to the lungs, it can
become lodged in the pulmonary arteries,
causing a PE.
2. PROLONGED IMMOBILITY
 Extended periods of immobility, such as
during long-distance travel or bed rest, can
lead to blood stasis in the lower extremities
and increase the risk of clot formation.
 Rationale: Lack of movement reduces the
natural pumping action of calf muscles that
helps return blood to the heart Stagnant
blood in the legs can predispose individuals
3. SURGERY
 Major surgeries, especially those involving
the hip, knee, or abdomen, can increase the
risk of blood clot formation. The body’s
response to surgical trauma and immobility
contributes to clot development.
 Rationale: Surgical procedures can lead to
blood vessel injury, activation of the clotting
system, and reduced physical activity post-
surgery, all of which promote clot formation.
4. HYPERCOAGULABLE STATES
 Certain medical conditions, genetic factors,
and medications can make the blood more
prone to clot formation. These conditions
are known as hypercoagulable states.
 Rationale: Hypercoagulable states can lead
to an increased tendency for clot formation
in the deep veins, which can eventually
travel to the lungs and cause a PE
5. CANCER
 Individuals with cancer, especially certain
types like lung, pancreatic, or ovarian
cancer, have a higher risk of PE due to
factors related to both the cancer and its
treatment.
MEDICAL & SURGICAL NURSING 25
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
 Rationale: Cancer can promote clot
formation by releasing substances into the
bloodstream that activate clotting.
Additionally, some cancer treatments can
affect blood clotting.
6. PREGNANCY & CHILDBIRTH
 Pregnancy, especially during the
postpartum period, is associated with an
increased risk of blood clots due to changes
in blood composition and slower blood flow.
 Rationale: Hormonal changes, pressure on
pelvic veins, and a higher likelihood of bed
rest during pregnancy can contribute to clot
formation.
7. OBESITY
 Excess body weight can increase the risk of
DVT and PE because it can put pressure on
the veins in the pelvis and legs, impeding
blood flow.
 Rationale: Obesity is associated with
increased inflammation and changes in the
body’s clotting system, making clot
formation more likely.
SIGNS & SYMPTOMS
1. SUDDEN SHORTNESS OF BREATH
 The presence of a clot in the pulmonary
arteries obstructs the flow of oxygenated
blood from the lungs to the rest of the body.
As a result, the body receives less oxygen,
leading to a rapid onset of breathlessness.
2. CHEST PAIN
 Chest pain is often described as sharp and
pleuritic, meaning it worsens with deep
breaths or coughing. This pain occurs
because the clot is causing an infarction
(death of lung tissue) or inflammation in the
lung, irritating the pleura (the lining around
the lung).
3. RAPID / IRREGULAR HEARTBEAT
 In response to decreased oxygen levels and
as a way to compensate for the decreased
cardiac output, the heart beats faster. An
irregular heartbeat may occur due to the
strain on the heart.
4. COUGH
 A persistent cough can develop due to the
irritation of the lung tissue or the presence
of inflammatory substances caused by the
clot.
5. BLOODY-TINGED SPUTUM
 This can result from lung tissue damage or
small amounts of bleeding in the lungs due
to the clot. It’s a concerning sign and may
be seen in some, but not all, cases of PE
6. LEG SWELLING, WARMTH / TENDERNESS
 These are symptoms of deep vein
thrombosis (DVT), which is often associated
with PE. A clot in the deep veins of the legs
may dislodge and travel to the lungs,
causing a pulmonary embolism
DIAGNOSTIC TEST
 Pulmonary embolisms are typically
diagnosed through imaging tests like CT
pulmonary angiography. Prompt treatment
is essential and often involves blood
thinners (anticoagulants) to prevent the clot
from growing and to allow the body to break
it down. In some cases, more aggressive
treatments like thrombolytic therapy or
surgery may be necessary
PREVENTION
 Prevention includes measures to reduce the
risk of blood clots, such as staying active,
using compression stockings, and taking
anticoagulant medication as prescribed,
particularly after surgery or when at risk for
DVT. Early diagnosis and treatment are
crucial to improve the chances of recovery
and reduce the risk of complications.
MANAGEMENT
1. ANTICOAGULANT MEDICATIONS
 Anticoagulants, often referred to as blood
thinners, are the first-line treatment for PE.
They prevent the clot from growing larger
and inhibit the formation of new clots.
Commonly used anticoagulants include
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
heparin and warfarin, or newer direct-acting
oral anticoagulants (DOACs).
2. THROMBOLYTIC THERAPY
 In severe cases of PE with significant
hemodynamic instability, thrombolytics may
be used. These medications help dissolve
the clot quickly and improve blood flow in
the pulmonary arteries. This approach
carries a higher risk of bleeding and is
typically reserved for critical cases
3. PULMONARY EMBOLECTOMY
 In life threatening situations where
anticoagulants and thrombolytics are not
effective or are contraindicated, surgical
removal of the clot (embolectomy) may be
necessary
4. INFERIOR VENA CAVA (IVC) FILTER
 In cases where anticoagulation is
contraindicated, an IVC filter may be
inserted to prevent blood clots from
reaching the lungs. This is a temporary
measure and not a long-term solution.
5. OXYGEN THERAPY
 Oxygen is often administered to relieve
hypoxia (low oxygen levels) and help
patients breathe more easily
6. PAIN MANAGEMENT
 Pain relief is provided, especially in cases
where chest pain is a prominent symptom.
7. SUPPORTIVE CARE
 Monitoring and managing vital signs, such
as blood pressure and heart rate, are
essential. Fluid management may also be
necessary.
8. PREVENTIVE MEASURES
 After the acute phase, patients may be
advised on preventive measures to reduce
the risk of recurrent PE. This often includes
continued use of anticoagulant medications.
9. MANAGEMENT OF UNDERLYING CAUSES
 Addressing and managing the underlying
causes of PE, such as DVT or cancer, is
crucial for preventing recurrence.
10. LIFESTYLE CHANGES
 Encouraging patients to adopt a healthier
lifestyle, including regular exercise and a
balanced diet, to reduce the risk of blood
clots.
11. PATIENT EDUCATION
 Providing education on the signs and
symptoms of PE and DVT and promoting
early detection.
12. FOLLOW-UP CARE
 Patients who have experienced a PE
require long-term follow-up to monitor their
condition, adjust medications, and assess
for complications or recurrences.
 Patients with COPD are accustomed to an
increase residual CO2 level and do not
respond to increase CO2 concentration as
the normal respiratory stimulant (hypoxemic
drive) instead they respond to decrease in
O2 concentration in blood.
 May precipitate pulmonary HPN, Cor
Pulmonale,and rv heart failure.
COR PULMONALE
 Cor pulmonale, also known as pulmonary
heart disease, is a condition in which the
right side of the heart becomes enlarged
and strained due to long-term high blood
pressure in the pulmonary arteries and the
right ventricle. This elevated pressure in the
pulmonary circulation is often caused by
underlying lung disease or conditions that
affect the lungs.
SIGNS & SYMPTOMS
1. SHORTNESS OF BREATH
 Dyspnea occurs due to impaired lung
function in chronic lung diseases like
chronic obstructive pulmonary disease
(COPD). As the lungs lose their ability to
exchange oxygen and carbon dioxide
efficiently, the body becomes oxygen-
deprived, leading to increased respiratory
effort and shortness of breath.
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
2. CHRONIC COUGH
 A chronic cough is often seen in patients
with underlying lung disease, particularly in
COPD. The persistent cough is the result of
bronchial inflammation and excessive
mucus production
3. FATIGUE
 Fatigue is a common symptom due to the
body’s increased demand for oxygen,
leading to reduced energy levels. The heart
has to work harder to pump blood through
the lungs, which contributes to fatigue.
4. CHEST PAIN
 Chest pain can occur as a result of
increased pressure in the right side of the
heart. This may lead to heart strain and
discomfort, especially during physical
exertion.
5. SWELLING (EDEMA)
 Right heart failure can cause blood to back
up into the venous system. This can lead to
fluid accumulation in the legs, ankles, and
feet due to increased venous pressure and
reduced venous return to the heart.
6. ABDOMINAL SWELLING (ASCITES)
 Ascites is a consequence of elevated right-
sided heart pressure causing fluid to
accumulate in the abdominal cavity. The
increased pressure in the hepatic circulation
can lead to the development of ascites
7. CYANOSIS
 Cyanosis is a sign of poor oxygenation in
the blood, which occurs due to inefficient
gas exchange in the lungs. Reduced
oxygen levels cause bluish discoloration of
the lips and skin
8. WHEEZING & CRACKLES
 Wheezing can result from narrowing
airways in lung diseases like COPD.
Crackles may occur due to fluid
accumulation in the lungs and decreased
lung compliance.
9. ENLARGED LIVER (HEPATOMEGALY)
 Increased pressure in the hepatic
circulation, secondary to right heart failure,
leads to liver congestion and hepatomegaly.
The liver becomes enlarged and tender.
10. INCREASED HR (TACHYCARDIA)
 Tachycardia is the heart’s compensatory
response to maintain cardiac output in the
face of reduced pumping efficiency. The
heart beats faster to ensure an adequate
supply of oxygen to the body.
11. ELEVATED JUGULAR VENOUS PRESSURE (JVP)
 Elevated JVP is a sign of increased right
heart pressure and can be assessed
visually by examining the jugular veins in
the neck. It indicates impaired right heart
function
12. IRREGULAR HEARTBEAT (ARRYTHMIAS)
 Arrhythmias can develop as the heart
struggles to cope with the increased
workload and pressure. The irregular heart
rhythm can further compromise cardiac
output.
CAUSES & ETIOLOGY
1. COPD
 COPD, including chronic bronchitis and
emphysema, is a leading cause of cor
pulmonale. The chronic inflammation and
narrowing of the airways in COPD lead to
increased pulmonary vascular resistance.
2. PULMONARY HYPERTENSION
 Primary pulmonary hypertension or
secondary pulmonary hypertension due to
various underlying conditions, such as
pulmonary embolism, connective tissue
diseases, or congenital heart diseases, can
cause cor pulmonale.
3. INTERSTITIAL LUNG DSE
 Conditions like idiopathic pulmonary
fibrosis, sarcoidosis, and pneumoconiosis
can lead to cor pulmonale by impairing lung
function and increasing pulmonary vascular
resistance.
4. SEVERE SLEEP APNEA
 Severe obstructive sleep apnea can result
in chronic low oxygen levels (hypoxia)
during sleep, leading to pulmonary
vasoconstriction and cor pulmonale over
time.
5. CHRONIC EXPOSURE TO HIGH ALTITUDE
 Long-term residence at high altitudes with
lower oxygen levels can cause chronic
hypoxia leading to increased pulmonary
vascular
6. THROMBOEMBOLIC DSE
 Chronic thromboembolic disease,
characterized by recurrent blood clots in the
pulmonary arteries, can result in increased
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
pulmonary vascular resistance and right
heart strain.
7. CYSTIC FIBROSIS
 This genetic disorder can lead to chronic
lung infections and damage, causing
pulmonary vascular changes that contribute
to cor pulmonale.
8. BRONCHIECTASIS
 This condition involves the chronic dilation
of bronchial tubes, often due to recurrent
infections, which can lead to cor pulmonale.
9. KYPHOSCOLIOSIS
 Severe curvature of the spine can restrict
lung expansion and lead to chronic hypoxia,
contributing to cor pulmonale.
10. NEUROMUSCULAR DISORDERS
 Conditions like amyotrophic lateral sclerosis
(ALS) and muscular dystrophy can weaken
respiratory muscles, resulting in impaired
ventilation and hypoxia, which can lead to
cor pulmonale.
11. IDIOPATHIC
 In some cases, the exact cause of cor
pulmonale remains unknown, and it is
classified as idiopathic.
DIAGNOSTIC TESTS
1. CHEST X-RAY
 A chest X-ray can reveal changes in the
size and shape of the heart, including right
ventricular enlargement. It can also identify
lung conditions such as chronic obstructive
pulmonary disease (COPD) or interstitial
lung disease that may be contributing to cor
pulmonale.
2. ELECTROCARDIOGRAM (ECG/EKG)
 An ECG can detect signs of right ventricular
hypertrophy and strain, which are common
in cor pulmonale. It can help differentiate
between cor pulmonale and other causes of
heart failure.
3. ECHOCARDIOGRAPHY
 Echocardiography provides detailed images
of the heart’s structure and function,
allowing the assessment of right ventricular
size and function. It can help confirm the
diagnosis of cor pulmonale and assess the
severity
4. PULMONARY FUNCTION TESTS (PFTs)
 PFTs, including spirometry and lung volume
measurements, can reveal underlying lung
conditions like COPD, restrictive lung
disease, or obstructive sleep apnea. These
tests help identify the cause of increased
pulmonary vascular resistance.
5. ARTERIAL BLOOD GAS (ABG) ANALYSIS
 ABG analysis provides information about
oxygen and carbon dioxide levels in the
blood. In cor pulmonale, hypoxemia (low
oxygen levels) and hypercapnia (high
carbon dioxide levels) are common due to
impaired gas exchange in the lungs.
6. CT PULMONARY ANGIOGRAPHY (CTPA) OR V/Q SCAN
 These tests are used to rule out pulmonary
embolism, a condition that can increase
pulmonary vascular resistance. CTPA
directly visualizes pulmonary vessels, while
a V/Q scan evaluates lung ventilation and
perfusion.
7. VENTILATION-PERFUSION (V/Q) SCAN
 A V/Q scan can identify areas of the lung
with reduced or absent ventilation and
perfusion, which may suggest pulmonary
embolism or other lung abnormalities
contributing to cor pulmonale.
8. CHEST CT / MRI
 These imaging studies can provide detailed
images of the chest and help identify
structural lung abnormalities, such as lung
fibrosis or bronchiectasis, which may lead to
cor pulmonale.
9. POLYSOMNOGRAPHY (SLEEP STUDY)
 Polysomnography is used to diagnose sleep
apnea, a condition that can lead to chronic
hypoxia and pulmonary vasoconstriction,
contributing to cor pulmonale.
10. LABORATORY TESTS
 Blood tests can help identify the underlying
cause of cor pulmonale. For example,
elevated D-dimer levels may suggest
pulmonary embolism, and markers of
inflammation may be elevated in cases of
lung disease.
11. RIGHT HEART CATHETERIZATION
 Right heart catheterization is considered the
gold standard for diagnosing and assessing
cor pulmonale. It directly measures
pulmonary artery pressure, right atrial
pressure, and cardiac output, providing
definitive information about the severity of
the condition.
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 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN
12. VENTILATION & PERFUSION SCINTIGRAPHY
 This test can evaluate the distribution of air
and blood in the lungs, helping to diagnose
and differentiate the causes of pulmonary
hypertension, which is often associated with
cor pulmonale
NURSING DIAGNOSIS
1. IMPAIRED GAST EXCHANGE
 Related to ventilation-perfusion imbalance
due to chronic lung disease, as evidenced
by shortness of breath, decreased oxygen
saturation, and abnormal arterial blood
gases
2. INEFFECTIVE BREATHING PATTERN
 Related to decreased lung compliance and
increased airway resistance, as evidenced
by labored breathing, use of accessory
muscles, and an increased respiratory rate
3. ACTIVITY INTOLERANCE
 Related to decreased oxygenation and
fatigue, as evidenced by the inability to
perform routine activities
4. FLUID VOLUME EXCESS
 Related to right sided heart failure, as
evidenced by peripheral edema, weight
gain, and elevated central venous pressure.
5. CHRONIC PAIN
 Related to chest pain or discomfort
associated with cor pulmonale, as
evidenced by patient reports of pain,
restlessness, or grimacing
6. ANXIETY
 Related to the fear and stress associated
with chronic respiratory problems and
limited physical activity, as evidenced by
restlessness, worry, and vital sign changes
7. DEFICIENT KNOWLEDGE
 Related to the understanding of the disease
process, medications, and self-care
measures, as evidenced by a lack of
knowledge or misunderstanding of
prescribed treatments
MANAGEMENT
1. TREAT UNDERLYING LUNG DSE
 Addressing the primary lung condition
contributing to cor pulmonale is crucial. This
may involve bronchodilators,
corticosteroids, or specific treatments for
conditions like COPD, pulmonary fibrosis, or
obstructive sleep apnea.
2. OXYGEN THERAPY
 Supplemental oxygen is often necessary to
improve oxygen levels in the blood
(oxygenation). It helps reduce the workload
on the right side of the heart and alleviate
symptoms of hypoxemia.
3. PULMONARY REHABILITATION
 Pulmonary rehabilitation programs can help
improve lung function, reduce
breathlessness, and enhance overall
physical fitness. These programs often
include exercise, education, and breathing
techniques.
4. MEDICATIONS
 Medications may be prescribed to address
specific symptoms and complications.
Diuretics can help manage fluid retention,
while vasodilators may reduce pulmonary
vascular resistance
5. ANTICOAGULATION
 If pulmonary embolism or deep vein
thrombosis is contributing to cor pulmonale,
anticoagulants (blood thinners) may be
prescribed to prevent further clot formation
6. POSITIVE AIRWAY PRESSURE (PAP) THERAPY
 In cases of obstructive sleep apnea, PAP
therapy, including continuous positive
airway pressure (CPAP) or bilevel positive
airway pressure (BiPAP), can help maintain
open airways during sleep.
7. LUNG TRANSPLANTATION
 In severe cases where lung damage is
irreversible, lung transplantation may be
considered as a treatment option.
8. NUTRITION & FLUID MANAGEMENT
 Dietary adjustments may be necessary to
manage fluid retention and maintain proper
nutrition. In some cases, a low sodium diet
is recommended.
9. SURGICAL INTERVENTIONS
 Rarely, surgical procedures like pulmonary
thromboendarterectomy may be required to
address chronic thromboembolic pulmonary
hypertension (CTEPH).
10. REGULAR FOLLOW-UP
 Patients with cor pulmonale require regular
follow-up with healthcare providers to
monitor their condition, adjust medications,
and assess the progression of the disease
MEDICAL & SURGICAL NURSING 30
 St. Joseph College of Cavite Inc.
BACHELOR OF SCIENCE IN NURSING
NCM 112 – MEDICAL & SURGICAL NURSING
Mrs Liza N. Roa, RM, RN, MAN

11. SYMPTOM MANAGEMENT

 Addressing symptoms like dyspnea, fatigue,
and chest pain is essential. Patients may
benefit from symptom-relieving measures
and lifestyle modifications to conserve
energy
12. LIFESTYLE CHANGES
 Lifestyle modifications, including smoking
cessation, weight management, and
exercise, can have a positive impact on
both the lung condition and cor pulmonale.
13. PSYCHOSOCIAL SUPPORT
 Coping with a chronic condition can be
emotionally challenging. Providing
psychosocial support and counseling can
help patients and their families manage the
psychological aspects of the disease.

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