MEDICAL SURGICAL NURSING 112 LEC: OXYGENATION
RESPIRATORY EMERGENCY
A. PNEUMOTHORAX
- Is the accumulation of air in pleural
space. May occur spontaneously
following a trauma.
ETIOLOGY
I.SPONTANEOUS PNEUMOTHORAX
This result from a rupture of pleural
bled being a congenital defect of the
alveolar wall of the connective tissue.
Patients are typically tall, thin young
male. Male to female ration 6:1. They
usually apical affecting both lungs with
equal frequency.
II.SECONDARY PNEUMOTHORAX
It is occurring in patient with
underlying diseases such as COPD,
Tuberculosis, Pneumonia, Bronchial
Carcinoma, Sarcoidosis, Cystic Fibrosis.
They are very particularly common in
those patients with COPD. Where
Emphysematous Bullae can also be
spontaneous verse.
TREATMENT
The main aim of the treatment is to
get the patient back to active life as
soon as possible.
- Reestablish the negative airway or
pressure within the thoracic or
pleural space.
CLINICAL FEATURES / MANIFESTATIONS
- Different clinical features that can be
asymptomatic especially to those
patients who is young, fit, and small
pneumothorax.
1. Sudden onset unilateral pleuritic
chest pain
2. Increasing breathlessness
3. Sudden deterioration in existing
lung condition such as COPD
(Examination reveals in XRAY a
reduce chest expansion on the side
pneumothorax depending on the
side of pneumothorax)
4. Hyperresonance upon Percussion
over the pneumothorax
5. Reduce or Absence of breath sound
upon auscultation
INVESTIGATION
- CHEST XRAY will demonstrate an
area of an increased cardiolumency
without your lung markings. The
edge of the lung field maybe visible
away from the chest wall.
DIAGNOSTIC
- More on CHEST XRAY.
MANAGEMENT
- SMALL PNEUMOTHORAX often
required NO TREATMENT.
- 7 to 10 days following presentation
Patient with MODERATELY SIZE
PNEUMOTHORAX are admitted for
Simple Aspiration
- SIMPLE ASPIRATION- By a large bore
cannula G18 or G19 or any biggest
large bore cannula. To be inserted in
2nd Intercostal Space in Mid
Clavicular line on side of
Pneumothorax whether left or right.
Once the immediate pressure has
been relieved and patient stabilized,
it is drained with underwater seal
should be inserted. Chest drain,
connected to a water seal drainage
whether one way, two way or three-
way bottle. One way, two way or
 MEDICAL SURGICAL NURSING 112 LEC: OXYGENATION
three-way bottle are underwater
sealed chest drain. Which prevent
the re-entry of air going inside the
lungs.
B. ACUTE ASTHMA
- It is different from ordinary asthma. It is an
asthma that is acutely worsening over a
period of hours or days. This is not
responsive to patients’ normal medication. It
requires either increased in patient normal
treatment or more complex treatment the
preference of acute asthma. There are
77,000 hospital admission each year.
CLINICAL FEATURES / MANIFESTATIONS
- Mild to Moderate
• Talking: In terms of talking, there
is still a complete sentence
• Distress: Minimal
• Accessory Muscle: There’s no use
• Peplau: More than 50%
• Other: Tachycardic
- Severe
• Talking: Patient is unable to
complete sentence
• Distress: Marked distress
• Accessory Muscle: There is a use
of accessory muscle
• Peplau: 33% to 50%
• Others:
- Life Threatening
• Talking: Patient can’t talk at all.
• Distress: Severe
• Accessory Muscle: There is a use
of accessory muscle
• Peplau: less than 33%
• Others: Silent chest, Poor
respiratory airport, fatigue, and
comma.
MANAGEMENT
- Put patient in HIGH FLOW OXYGEN,
deliver AT 100%
- Give 4 to 6 Pak pack each inhaled
separately of Salbutamol or
Terbutaline (Metered dose inhaler
given every 10 to 20 mins, give it also
via nebulizer if the asthma is life
threatening.
- Give Prednisolone 40 to 60 mg orally
or if the patient can’t intake orally
give Parenteral Hydrocortisone for
400mg.
- If there’s a poor response to the
above the management, consider
Anticholinergic Bronchodilator
Ipratropium Bromide given at 0.5
mg 4 to 6 hours via nebulizer.
DISEASES OF THE RESPIRATORY
TRACT
UPPER RESPIRATORY TRACT
A. NOSE
INFECTIOUS RHINITIS
• Inflammation of mucosal
membrane lining the nose.
Inflammation Is usually seen in
common cold cause by several
viral infections can be caused by
Rhinovirus commonness cause
by Rhinovirus, Coronavirus,
Adenovirus, Parechovirus,
Respiratory Syncytial Virus
• Signs and Symptoms: Measle
obstruction, Rhinorrhea, Runny
nose, Sneezing.
 MEDICAL SURGICAL NURSING 112 LEC: OXYGENATION
• Complications: Sinusitis, Otitis
Media, Lower Respiratory Tract
Infection.
PATHOLOGY: There is an acute
inflammation w/ edema and there’s
glandular hypersecretion and loss of
surface epithelium.
TREATMENT
• Virus is self-limiting and no
medical treatment is required.
• Analgesia and Nasal
Decongestant is used to relieved
symptoms.
CHRONIC RHINITIS
• It may be developed following an
acute inflammatory episode.
• Predisposing Factors:
Inadequate drainage of sinuses,
nasal obstruction caused by
polyps, and enlargement of the
adenoid increased the risk of
developing chronic rhinitis.
ALLERGIC RHINITIS
• Inflammatory condition of nasal
mucosa caused by
immunoglobulin E mediated
response to your common
environmental allergens. It is
very common condition.
Prevalent is 15% to 20%.
• Signs and Symptoms: Most
commonly present in childhood
and adolescence. It is estimated
that 80% of people with
condition develops symptoms
before the age of 20.
• The prevalent of allergic rhinitis is
equally in Men and Women,
however the age of men and
women develops symptoms
varies differently. Men are more
likely to develop allergic rhinitis
in childhood. Whereas the peak
incidence in women occur during
adolescence. There’s
geographical variation in the
prevalence in allergic rhinitis. It is
much more common in
developed countries than in
developing countries.
• ETIOLOGY: The development of
allergic rhinitis cannot be
attributed to one single genetic
or environmental factors. It is
likely to arise as a result of
interaction between multiple
genes and specific environmental
variables. Environmental factor
plays an important role in
development of allergic rhinitis.
Hygiene Hypothesis accounts for
decreasing prevalence of allergic
rhinitis in western. Hygiene
Hypothesis suggest that lack of
exposure to bacteria or
microorganism in childhood thus
environment that is too clean
increases the risk of developing
allergic rhinitis and other atopic
diseases.
• CLASSIFICATION
§ MILD – skin
disturbance,
impairment of daily
 MEDICAL SURGICAL NURSING 112 LEC: OXYGENATION

activities, impairment Haemophilus

of schoolwork and Influenzae.
troublesome § Dental extraction or
symptoms infection fracture
§ MODERATE to involving sinuses.
SEVERE – sleep • INVESTIGATION / DIAGNOSTIC
disturbance, § WBC and
impairment of daily, inflammatory
activities, leisure, or markers, erythrocytes
sport, impairment of sedimentation rates
schoolwork and maybe raise but not
troublesome open.
symptoms. § Sinus culture
ACUTE CORYZAL (COMMON COLDS) § Radiology of
• It is a highly contagious, it is self- Paranasal Sinuses
limiting condition with the • MANAGEMENT
highest incidence in children. § Analgesia and Nasal
ACUTE SINUSITIS Decongestant such as
• Affecting the upper respiratory Carbocestein
system, very common and it is an CHRONIC SINUSITIS
inflammatory process that • These is an inflammation of
involves the lining of the sinuses which has been present
paranasal sinuses, maxillary sinus for more than 4 weeks. Usually
most common clinically infected. occur after a recurrent acute
• CLINICAL FEATURES / sinusitis. Common in patient who
MANIFESTATION are commonly heavy smoker or
§ Purulent nasal patient who work on gas
discharges environment.
§ Body Malaise • CLINICAL FEATURES /
§ Sinus tenderness and MANIFESTATION
disturbed sense of § Like acute sinusitis but
smell. typically LESS severe.
• ETIOLOGY: • PATHOLOGY
§ Secondary Bacterial § Increase in euro
Infection that is vascular permeability,
caused by there is an edema and
Streptococcus hypertrophy of
Pneumoniae or mucosa, goblet cell
 MEDICAL SURGICAL NURSING 112 LEC: OXYGENATION

hyperplasia, chronic
cellular infiltrate,
ulceration of
epithelium resulting
in granulated tissue
formation.
• DIAGNOSTIC / INVESTIGATION
§ Sinus radiograph
§ High-definition
coronal section
computerized
topography
§ Diagnostic Endoscopy
• TREATMENT
§ It is difficult to treat,
and the treatments
are medical (broad
acting antibiotics and
decongestant)
surgical ( endoscopic
sinus surgery and
antral lavage)
B. LARYNX
• LARYNGITIS
§ Chronic Laryngitis
• NEOPLASM OF LARYNX