NCM 112 PBL Group 1

St.
Paul University Philippines

TUGUEGARAO CITY, CAGAYAN 3500
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
SCHOOL OF NURSING
A.Y. 2023-2024
PRACTICE- BASED
LEARNING
GROUP 1
St. Paul University Philippines
SCHOOL OF NURSING
A.Y. 2023-2024
RESPIRATORY
COMPLICATIONS
SCHOOL OF NURSING
A.Y. 2023-2024
ANATOMY AND PHYSIOLOGY OF LUNGS

A major organ of the respiratory
system, each lung houses structures of
both the conducting and respiratory
zones. The main function of the lungs is
to perform the exchange of oxygen and
carbon dioxide with air from the
atmosphere. The lungs exchange
respiratory gases across a very large
epithelial surface area—about 70
square meters—that is highly
permeable to gases.
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A.Y. 2023-2024
PNEUMONIA
Pneumonia is an infection that inflames the air sacs in one or

both lungs. The air sacs may fill with fluid or pus (purulent
material), causing cough with phlegm or pus, fever, chills, and
difficulty breathing. A variety of organisms, including bacteria,
viruses and fungi, can cause pneumonia. Pneumonia can range
in seriousness from mild to life-threatening. It is most serious
for infants and young children, people older than age 65, and
people with health problems or weakened immune systems
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A.Y. 2023-2024
PNEUMONIA (CLASSIFICATION)
A) Classification (Based on transmission)

Pneumonia can be classified into four types; Community-acquired pneumonia
(CAP), health care–associated pneumonia (HCAP), hospital-acquired
pneumonia (HAP), and VAP (American Thoracic Society & Infectious Diseases
Society of America, 2005; File, 2016).
1) Community-acquired pneumonia (CAP)

-Pneumonia occurring in the community or ≤48 hours after hospital admission
or institutionalization of patients who do not meet the criteria for health care–
associated pneumonia (HCAP)
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2) Health care-associated pneumonia (HCAP)
-Pneumonia occurring in a nonhospitalized patient with extensive health care
contact with one or more of the following:
o Hospitalization for ≥2 days in an acute care facility within 90 days of

infection
o Residence in a nursing home or long-term care facility
o Antibiotic therapy, chemotherapy, or wound care within 30 days of current
infection
o Hemodialysis treatment at a hospital or clinic
o Home infusion therapy or home wound care
o Family member with infection due to multidrug-resistant bacteria
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A.Y. 2023-2024
3) Hospital-acquired pneumonia (HAP)

Pneumonia occurring ≥48 hours after hospital admission that did not
appear to be incubating at the time of admission
4) Ventilator-associated pneumonia (VAP):

A type of HAP that develops ≥48 hours after endotracheal tube intubation
The incidence of VAP increases with the duration of mechanical ventilation.
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Classsification (based on pathology)

1. Bacterial Pneumonia
-Bacteria cause most cases of community-acquired pneumonia in adults.
The most common bacterial pathogen of pneumonia is the S.pneumoniae, other
bacteria include S.aureus, Group A streptococci, Moraxella catarrhalis, and
Mycoplasma Pneumonia
2. Viral Pneumonia
-It accounts for about one third of pneumonia cases.
-The most common viral pathogen is the H.Influenzae, coronaviruses,
parainfluenza viruses, adenoviruses, Varicella zoster, and respiratory syncytial
virus
SCHOOL OF NURSING
A.Y. 2023-2024
3. Fungal Pneumonia
-A non-infectious lung infection caused by fungal spores. Primarily, fungal
pneumonia develops when fungal spores are inhaled. Each form of this disease
arises from a corresponding type of fungus that often are native to specific
regions. These fungi include:
o Coccidioides (Central America and South America.)
o Histoplasma (US, especially in Ohio and Mississippi)
o Cryptococcus neoformans (is found in soil and bird droppings in all parts of
the world.)
Blastomyces ((Midwestern, south-central, and south eastern states)
SCHOOL OF NURSING
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PNEUMONIA PATHOPHYSIOLOGY
Normally, the upper airway prevents potentially infectious particles from

reaching the sterile lower respiratory tract. Pneumonia arises from normal flora
present in patients whose resistance has been altered or from aspiration of flora
present in the oropharynx; patients often have an acute or chronic underlying
disease that impairs host defenses. Pneumonia affects both ventilation and
diffusion. An inflammatory reaction can occur in the alveoli, producing an
exudate that interferes with the diffusion of oxygen and carbon dioxide. White
blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally
air-filled spaces. Areas of the lung are not adequately ventilated because of
secretions and mucosal edema that cause partial occlusion of the bronchi or
alveoli, with a resultant decrease in alveolar oxygen tension.
SCHOOL OF NURSING
A.Y. 2023-2024
PNEUMONIA PATHOPHYSIOLOGY
Because of hypoventilation, a ventilation–perfusion (V./Q.) mismatch occurs in

the affected area of the lung. Venous blood entering the pulmonary circulation
passes through the underventilated area and travels to the left side of the heart
poorly oxygenated. The mixing of oxygenated and unoxygenated or poorly
oxygenated blood eventually results in arterial hypoxemia
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PNEUMONIA SIGNS AND SYMPTOMS
Cough, which may produce greenish, yellow or even bloody mucus

Fever, sweating and shaking chills
Shortness of breath
Rapid, shallow breathing
Sharp or stabbing chest pain that gets worse when you breathe deeply or
cough
Loss of appetite, low energy, and fatigue
Nausea and vomiting, especially in small children
Confusion, especially in older people
Orthopnea
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PNEUMONIA
RISK FACTORS OF PNEUMONIA
1. Age 7. Recent viral infection (i.e., a cold or the flu)

2. Smoking cigarettes 8. Staying in a hospital, especially in the
3. Using drugs or alcohol intensive care unit (ICU), and being sedated or
4. Chemical, pollutant and toxic fume exposure on a breathing machine (ventilator)
5. Lung disease 9. Weak immune system
6. Malnourishment
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PNEUMONIA TREATMENT
The commonly recommended treatment for Pneumonia is a prescribed

pharmacologic therapy based on the causative agent identified through
bacterial culture and sensitivity tests.
a) Antibacterial
For patients with no known multidrug resistance, monotherapy with
ceftriaxone (Rocephin), ampicillin/sulbactam (Unasyn), levofloxacin
(Levaquin), or ertapenem (Invanz) is used.
b) Antivirals
Oseltamivir, Zanamivir
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PNEUMONIA TREATMENT
c) Antifungals
Fluconazole, Itraconazole
d) Analgesics
Acetaminophen, Ibuprofen
c) Cough suppressants
Dextromethorphan, Codeine
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PNEUMONIA
DIAGNOSIS
Blood tests Pleural Fluid culture

Chest X-ray Arterial blood gas test
Sputum culture test Bronchoscopy
CT scan
SCHOOL OF NURSING
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PNEUMONIA
COMPLICATIONS
1. Worsened chronic conditions. If you have certain preexisting health conditions, pneumonia
could make them worse. These conditions include congestive heart failure and emphysema. For
certain people, pneumonia increases their risk of having a heart attack.
2. Bacteremia. Bacteria from the pneumonia infection may spread to your bloodstream. This can
lead to dangerously low blood pressure, septic shock, and, in some cases, organ failure.
3. Lung abscesses. These are cavities in the lungs that contain pus. Antibiotics can treat them.
Sometimes they may require drainage or surgery to remove the pus.
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PNEUMONIA
COMPLICATIONS
3. Impaired breathing. You may have trouble getting enough oxygen when you breathe. You may
need to use a ventilator.
4. Acute respiratory distress syndrome. This is a severe form of respiratory failure. It’s a medical
emergency.
5. Pleural effusion. If your pneumonia isn’t treated, you may develop fluid around your lungs in
your pleura, called pleural effusion. The pleura are thin membranes that line the outside of your
lungs and the inside of your rib cage. The fluid may become infected and need to be drained.
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PNEUMONIA PREVENTION
Pneumonia can be generally prevented in three ways:

1) Immunization
Seasonal influenza, respiratory syncytial virus (RSV), and the virus that causes COVID-19
are common causes of pneumonia. Being up to date on your recommended vaccines like an
annual flu shot can help prevent pneumonia.
2) Hand Hygiene
-Wash your hands frequently, especially after coughing or blowing your nose, going to the
bathroom, diapering, and before eating or preparing foods.
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PNEUMONIA PREVENTION
3) Refrain from smoking/vaping

-Tobacco damages your lung's ability to fight off infection, and people who smoke have been found
to be at higher risk of getting pneumonia. Tobacco users are considered one of the high-risk
groups that are encouraged to get the pneumonia vaccine to help prevent pneumococcal
pneumonia.
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A.Y. 2023-2024
NURSING RESPONSIBILITIES
1.Administer oxygen as prescribed.

2.Monitor respiratory status.
3.Monitor for labored respirations, cyanosis, and cold and clammy skin.
4.Encourage coughing and deep breathing and use of incentive spirometer.
5.Position client in semi-Fowler position to facilitate breathing and lung expansion.
6.Change client’s position frequently and ambulate as tolerated to mobilize secretions
7.Perform nasotracheal suctioning if the client is unable to clear secreations.
8.Monitor pulse oximetry.
9.Monitor and record color, consistency, and amount of sputum.
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10.Encourage fluids up to 3 L a day to thin secretions unless contraindicated.

11.Provide a balance of rest and activity, increasing activity gradually.
12.Administer antibiotics as prescribed.
13.Administer antipyretics, bronchodilators, cough suppressants, mucolytic agents, and
expectorants as prescribed.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY TUBERCULOSIS
What to know about PULMONARY TB

TUBERCULOSIS IS A BACTERIAL INFECTION THAT CAN PASS
THROUGH THE AIR BETWEEN PEOPLE. WHEN IT AFFECTS THE
LUNGS, THE MEDICAL NAME FOR THIS IS PULMONARY
TUBERCULOSIS. IT CAN CAUSE CHEST PAIN, SEVERE COUGHING,
AND A RANGE OF OTHER SYMPTOMS.
SCHOOL OF NURSING
A.Y. 2023-2024
The main SYMPTOMS of pulmonary TB include:

a bad cough that lasts for at least 3 weeks
chest pain
coughing up blood or phlegm from the lungs
breathlessness
More general symptoms of TB can include:
weight loss
a loss of appetite
nausea and vomiting
low energy or fatigue
fever and chills
night sweats
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CAUSES
CLOSE CONTACT
LOW IMMUNITY
SUBSTANCE ABUSE
INADEQUATE HEALTH CARE
IMMIGRATION
OVERCROWDING
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TREATMENT
If you have pulmonary TB, your doctor may prescribe several
medicines. You'll need to take these drugs for six months or longer
for the best results.
The most common TB medicines are:
isoniazid
pyrazinamide
ethambutol (Myambutol)
rifampin (Rifadin)
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LABORATORY DIAGNOSIS
Sputum culture
Ziehl-Neelsen (acid-fast stain applied to a smear of body fluid)
Skin tests (purified protein derivative [PPD] or Old tuberculin [OT] administered by
intradermal injection [Mantoux])
Enzyme-linked immunosorbent assay (ELISA)/Western blot
Chest x-ray
CT or MRI scan
Bronchoscopy
Histologic or tissue cultures (including gastric washings; urine and cerebrospinal fluid [CSF];
skin biopsy)
Needle biopsy of lung tissue
Electrolytes
ABGs
Pulmonary function studies
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RISK FACTORS
the following that often house people with TB:
correctional facilities
group homes
nursing homes
hospitals
shelters
People also at risk for developing pulmonary TB disease are:
older adults
small children
people who smoke
people with an autoimmune disorder, such as lupus or rheumatoid arthritis
people with lifelong conditions, such as diabetes or kidney disease
people who inject drugs
people who are immunocompromised, such as those living with HIV, undergoing
chemotherapy, or taking chronic steroids
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PREVENTION
Following are a few tips for minimizing your risk for pulmonary TB:
Provide education on preventing TB like cough etiquette.
Avoid extended close contact with someone who has TB.
Air out rooms regularly.
Cover your face with a mask that is approved for protection against
TB.
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COMPLICATIONS
Respiratory failure
Pneumothorax
Pneumonia.
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The major goals for the patient include:
Promote airway clearance.
Adhere to treatment regimen.
Promote activity and adequate nutrition.
Prevent spread of tuberculosis infection.
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LUNG ABSCESS
a localized collection of pus caused by microbial infection (Weinberger

et al., 2014). It is generally caused by aspiration of anaerobic bacteria
such as Peptostreptococcus, Fusobacterium, Prevotella and
Bacteroides.
*can also be aerobic (e.g., streptococci, staphylococci, MRSA)
a common complication of bacterial pneumonia
may occur secondary to mechanical or functional obstruction of
the bronchi by a tumor, foreign body, or bronchial stenosis, or
from necrotizing pneumonias, TB, Pulmonary Embolism, Chest
trauma.
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LUNG ABSCESS
Risk factors
patient w/ impaired cough reflexes who cannot close the glottis
those with swallowing difficulties.
those with central nervous system disorders (e.g., seizure and
stroke), drug addiction, alcoholism, esophageal disease, or
compromised immune function; patients without teeth and those
receiving NGT feedings
patients with an altered state of consciousness due to anesthesia
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LUNG ABSCESS
Where am I usually found?
in areas of the lung that may be affected by aspiration such as the RLL,
Posterior RUL, Superior LL
site of the lung abscess is related to gravity and is determined by position
*patients who are confined to bed = the Posterior segment of an Upper lobe
& Superior segment of lower lobe are the most common areas. (PUSO)
Note: atypical presentations may occur, depending on the position of the

patient when the aspiration occurred, presentations may manifest signs
associated with other diseases
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LUNG ABSCESS
Initially, the cavity in the lung may or may not extend directly into a
bronchus. Eventually, the abscess becomes surrounded, or encapsulated,
by a wall of fibrous tissue. The necrotic process may extend until it
reaches the lumen of a bronchus or the pleural space and establishes
communication with the respiratory tract, the pleural cavity, or both. If
the bronchus is involved, the purulent contents are expectorated
continuously in the form of sputum. If the pleura is involved, the result
is an empyema.
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LUNG ABSCESS
Signs and Symptoms:
mild productive cough
fever, night sweats
moderate to copious amounts of foul-smelling, sometimes bloody, sputum
*fever and cough may develop insidiously; may have been present for
several weeks before diagnosis
Leukocytosis may be present
Pleurisy or dull chest pain
Dyspnea
Weakness
Anorexia and weight loss
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LUNG ABSCESS
Diagnostic technique/s:
Clinical signs. Px history and Physical assessment
- Dullness on percussion
- Decreased/absent breath sounds with an intermittent pleural friction rub
(grating or creaking sound) on auscultation. Crackles may be present.
Chest x-ray: infiltrate with an air-fluid level, shows cavitation (around 2cm)
Sputum/pleural fluid culture
Fiberoptic bronchoscopy (to exclude cancer, detect unusual pathogens)
Computed Tomography (CT) scan of chest may be required to provide more
detailed images of different cross- sectional areas of the lung
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LUNG ABCESS
Fiberoptic bronchoscopy
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LUNG ABCESS
Postural Drainage
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LUNG ABCESS
Prevention:
Appropriate antibiotic therapy before any dental procedures in
patients who must have teeth extracted while their gums and
teeth are infected
Adequate dental and oral hygiene
Appropriate antimicrobial therapy for patients with
pneumonia
Proper insertion and positioning of Nasogastric Tube for ngt
feeding
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LUNG ABCESS
Treatment:
Adequate drainage of the lung abscess may be achieved through
postural drainage and chest physiotherapy.
Some patients require insertion of a percutaneous chest catheter
for long-term drainage of the abscess
Therapeutic use of bronchoscopy to drain an abscess is uncommon
Surgical intervention: Pulmonary resection (lobectomy) is
performed if massive hemoptysis occurs or if there is little or no
response to medical management.
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LUNG ABCESS
Treatment:
IV antimicrobial therapy
usual drug choices:
- Clindamycin (Cleocin)
- Ampicillin-sulbactam (Unasyn)
- Carbapenem
Note: Large IV doses are usually required, because the antibiotic
must penetrate the necrotic tissue and the fluid in the abscess
Duration: 3 weeks or longer depending on severity of lung abcess
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LUNG ABSCESS
Complications:
Empyema
Pneumothorax
Sepsis
Pleural Effusion
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LUNG ABCESS
Treatment:
IV antimicrobial therapy
Once improvement is demonstrated, IV antibiotics are discontinued
and oral administration of antibiotic therapy is continued for an
additional 4 to 12 weeks and sometimes longer.
- Amoxicillin
- Clindamycin
Note: If treatment is stopped too soon, a relapse may occur.

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LUNG ABCESS
Nursing Responsibilities:
Administers antibiotics and IV treatments as prescribed and
monitors for adverse effects. Adhere to Rights of Medications
Provide patient education on drug-drug and food-drug
interactions (e.g, valproic acid and carbapenem, oral
contraceptives and ampicillin, alcohol and antibiotics).
Educate the client about the importance of adhering to the
prescribed medication regimen and completing the full course of
antibiotics as directed (reduces risk of relapse)
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LUNG ABCESS
Implement appropriate infection control measures, including hand
hygiene, standard precautions, and isolation precautions if
indicated based on the causative organism.
Educate the client and family members about proper hand hygiene
techniques and infection prevention strategies to reduce the risk of
transmission of infectious agents.
Chest physiotherapy is initiated as prescribed
Provides patient education on how to perform deep-breathing and
coughing exercises to help expand the lungs.
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LUNG ABCESS
Nursing Responsibilities (drug administration):
Ampicillin-Sulbactam -- should not exceed 12g a day
Educate client on the importance of strict adherence to
antibiotic treatment (remind not to skip, double-dose, or
suddenly stop if symptoms subsides)
ADHERE TO FULL COURSE OF THE THERAPY AS
ORDERED
Provide atient education on signs/symptoms of allergic rections
to drugs (e.g. urticaria, itchiness, DOB and the like)
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ATELECTASIS
the collapse of a lung or

part of a lung, is caused
by a blockage of the air
passages (bronchus or
bronchioles) or by
pressure on the lung.
SCHOOL OF NURSING
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ATELECTASIS
OBSTRUCTIVE NONOBSTRUCTIVE
ATELECTASIS ATELECTASIS
- occurs in adults as a
- it is happens when result of reduced
something physically blocks ventilation
your airway.
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ATELECTASIS
RISK FACTORS
Any condition that makes it hard to swallow.

Needing to stay in bed over a long time and not having enough changes of
position
Pain or injury that may make it painful to cough or cause weak breathing,
including stomach pain or a broken rib.
Smoking.
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ATELECTASIS
SIGNS AND SYMPTOMS

Breathing difficulty
Chest pain
Cough
low oxygen levels
increased heart rate
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ATELECTASIS
ASSESSMENT AND DIAGNOSTIC FINDINGS
• Chest X-ray
• CT Scan
• Bronchoscopy
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ATELECTASIS
Bronchoscopy
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ATELECTASIS
TREATMENT
Deep breathing exercises (incentive spirometry).
Removing obstructions in your lung (usually using bronchoscopy).
Physical therapy to help promote expansion of your lungs.
Treatment of tumor or chronic lung conditions.
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ATELECTASIS
• Teach patient how to use incentive spirometer
• ambulate 3x/day
• encourage patient to cough/deep breathe
• monitor temperature
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SARCOIDOSIS
A type of interstitial
lung disease that is also
an inflammatory
multisystem,
granulomatous disease of
unknown etiology.
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SARCOIDOSIS
RISK FACTORS
Genetic predisposition
·African-American
·Family members with sarcoidosis
Immune disorder
·CD4 disregulation
Environment
·Antigen of unknown, it may be some pollen, borellia burgdoferi, virus, and
mycobacterium tuberculosis
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SARCOIDOSIS
SIGNS AND SYMPTOMS

5% of individuals are asymptomatic
Systemic symptoms present in -45% of cases
Fever
Anorexia
Arthralgia (joint pain)
Common pulmonary complaints

Dyspnea on exertion
Cough
Chest pain
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SARCOIDOSIS
SIGNS AND SYMPTOMS

Physical examination findings
*Pulmonary findings
Crackles on auscultation
Chest radiography staging:
Stage 1-Bilateral Hilar Lymphadenopathy
(BHL)
Stage 2- BHL + Inflammatory infiltrates
Stage 3- Inflammatory infiltrates
Stage 4- Fibrosis
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SARCOIDOSIS
SIGNS AND SYMPTOMS

*Neurologic manifestations (rare)
*Ocular manifestations
Lymphocytic meningitis
Bilateral granulomas uveitis
Cranial nerve palsies
Hypothalamic-pituitary dysfunction
*Cardiac manifestations
Arrythmias
Heart Block *Endocrine abnormalities
Diabetes insipidus
Hyperprolactinemia
Hypogonadism
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SARCOIDOSIS
1.Laboratory studies
2.Imaging studies
3.Histologic findings
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SARCOIDOSIS

1. Laboratory studies
Serum markers of sarcoidosis
-Hypercalcemia
-Raised serum ACE level
2. Imaging studies
Chest X-ray- reveal pulmonary lesions
High resolution CT scan- may identify active alveolitis or
fibrosis
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SARCOIDOSIS

3. Histologic findings
Biopsy
-major histologic finding is non caseating granulomas with special
stains negative for fungi and mycobacteria
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SARCOIDOSIS
TREATMENT
Most patients require only symptomatic therapy with NSAIDS
Patients require treatment for chronic pulmonary disease
-Drug used:
-Corticosteroids- prednisolone
Non corticosteroids- used in steroid-resistant disease/intolerable
adverse effects with corticosteroids
-Common drugs used:
-methotrexate -azathioprine
-cyclophosphamide -infliximab
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SARCOIDOSIS
SARCOID
Skin: erythema nodosum
Arrythmia (sign of advanced disease)
Restrictive lung disease (interstitial fibrosis)
Calcium elevation (due to macrophage a-hydroxylase)
Ophthalmic inflammation (uveitis)
Immobile facial muscles (bell’s palsy)
vitamin D (activated and increased)
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ACUTE TRACHEOBRONCHITIS
An acute inflammation of the mucous

membranes of the trachea and the bronchi.
Tracheobronchitis is generally caused by a
viral (influenza, parainfluenza, and RSV),
bacterial (haemophilus influenzae,
streptococcus pneumoniae, and
mycoplasma), and fungal infection
(Aspergillus). Other causes includes
exposure to allergens and irritants.
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Risk Factors:
Factors that increase your risk of tracheobronchitis include:
Age
Being immunocompromised
Exposure to irritants on the job
Cigarette Smoking
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Signs and Symptoms:
dry, irritating cough

chest soreness
mild fever and headache
general malaise
sore throat
productive cough
shortness of breath
stridor and wheezing
hemoptysis
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Complication:
Pneumonia
Risk Factors:
Age
Smokers
Patients with heart or lung diseases
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Diagnostic Tests
Medical History and Physical Exam

Chest X-ray
Sputum Culture
Pulmonary Function Test
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Treatment:
It typically consists of medications and home-care measures to relieve
symptoms and make a person more comfortable. These may include:
Acetaminophen (Tylenol)
Steroids such as prednisone (Deltasone)
Expectorants such as guaifenesin (Mucinex)
Antibiotic
Use a humidifier or cool mist vaporizer
Drink plenty of fluids
Suctioning and bronchoscopy
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Prevention:
Avoid exposure to smoke, allergens, and other irritants

Practice good hygiene
Get vaccinated with recommended vaccines like flu shots
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Patient teaching
Encourage fluid intake and directed coughing to remove secretions.
Emphasize the need to complete the full course of antibiotics prescribed.
Caution the patient against overexertion.
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ACUTE RESPIRATORY DISTRESS SYNDROME
Is a severe lung condition due to non- cardiac pulmonary edema. It starts with
swelling of tissue in the lungs and buildup of fluid in the tiny air sacs that
transfer oxygen to the bloodstream. Which then lead to low blood oxygen
levels.
ARDS is similar to infant respiratory distress syndrome, but the causes and
treatments are different. ARDS can develop in anyone over the age of one year
old.
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The risk factors associated with ARDS include:

Sepsis
Trauma
Pneumonia
Pancreatitis
Inhalation of chemicals or water, such as a near-drowning event.
SCHOOL OF NURSING
A.Y. 2023-2024
The signs and symptoms of ARDS include:
Dyspnea
Rapid and shallow breathing
Tachycardia,
Cyanosis or pallor
Crackles
SCHOOL OF NURSING
A.Y. 2023-2024
Lab and Diagnostics include:
Arterial Blood Gases

Chest X-ray
Echocardiography
Blood Test
SCHOOL OF NURSING
A.Y. 2023-2024
Treatment:
Treating the underlying cause or injury
Providing support until the lungs heal:
Mechanical ventilation
Monitoring blood chemistry and fluid levels
SCHOOL OF NURSING
A.Y. 2023-2024
Medication:
Bronchodilators
Corticosteroids
Antibiotics
Diuretics
Sedatives andAnalgesics
SCHOOL OF NURSING
A.Y. 2023-2024
Frequently assess his respiratory status.
Observe and document the hypoxemic patient's neurologic status.
Maintain a patent airway by suctioning patient as needed.
Evaluate the patient.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
is the abnormal accumulation of

fluid in the interstitial spaces
and alveoli of the lungs. It is a
diagnosis associated with acute
decompensated HF that can lead
to acute respiratory failure and
death.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Causes
Cardiogenic pulmonary edema means fluid backs up in your lungs from a heart
problem. Most common cardiogenic cause is left sided heart failure.
Left ventricles become unhealthy
Blood backs up in left atrium, pulmonary

veins, and pulmonary capillaries
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Causes
Cardiogenic pulmonary edema means fluid backs up in your lungs from a heart
problem. Most common cardiogenic cause is left sided heart failure.
Left ventricles become unhealthy
Blood backs up in left atrium, pulmonary

veins, and pulmonary capillaries
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Causes
Noncardiogenic pulmonary edema occurs when other diseases cause fluid to
accumulate in your lungs. Blood vessels in your lungs became inflamed or
injured.
Pulmonary edema can be from:

pulmonary infections
trauma
inhalation of toxic substances
sepsis
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Signs and symptoms include:

Dyspnea Tachycardia
Orthopnea
Cough: A persisten cough, may produce frothy or pink-tinged sputum.
Tachypnea
Wheezing or crackling sounds
Cyanosis
Anxiety or restlessness
Fatigue
Swelling (edema)
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Risk factors
Pulmonary edema can be caused by a variety of factors, including:
heart failure
kidney problems
lung diseases
hypertension
toxic exposures
obesity
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
If pulmonary edema continues, the pressure in the pulmonary artery can rise
(pulmonary hypertension). Eventually, the heart becomes weak and begins to
fail, and pressures in the heart and lungs go up.
Pulmonary edema complications may include:
Breathing difficulty
Swelling of the legs, feet and belly area
Pleural effusion
Congestion and swelling of the liver
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Assessment and diagnostic findings

auscultation reveals crackles
chest x-ray reveals increased interstitial markings
patient may be tachycardic
pulse oximetry values begin to fall
ABG demonstrates increasing hypoxemia
increased respiratory rate
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Chest x-ray
Normal With pulmonary edema

SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Prevention
take medications as directed if a patient has a heart condition

see healthcare provider regularly if you have problems in breathing
eat a healthy diet low in salt
maintain a healthy weight
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Medical management
Oxygen therapy
is given in concentrations adequate to relieve hypoxemia and dyspnea.
Non-invasive positive pressure ventilation if respiratory failure is severe or

persists.
Endotracheal intubation are required for some patients

SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Medical management
Diuretics
promote the excretion of sodium and water by the kidneys.
Furosemide or other loop diuretics is given by IV push or continuous infusion

for rapid diuretic effect. If the clinical manifestations stabilizes, switch to oral
diuretics (Bumetanide) .
*Closely monitor blood pressure as the urine output increases.

*Monitor intake and output, daily weights, serum electrolytes, and creatinine.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Medical management
Vasodilators
may enhance symptom relief in pulmonary edema such as:
IV nitroglycerin
IV nitroprusside
*Blood pressure is continually assessed in patients receiving IV vasolidator

infusions.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EDEMA
Nursing responsibilities
Position the patient upright, preferably with legs dangling over the side of
the bed to promote circulation.
Provide psychological support
Monitor medications
Monitor urine output preferably with the use of indwelling catheter
Frequent measurements of vital signs
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY HYPERTENSION
Pulmonary hypertension (PH) is a type of high

blood pressure that affects the arteries in the
lungs and the right side of the heart. In PH,
the blood vessels in the lungs become
narrowed, blocked, or destroyed, making it
harder for blood to flow through them. This
increases the pressure within the pulmonary
arteries, causing the right side of the heart to
work harder to pump blood through the lungs.
SCHOOL OF NURSING
A.Y. 2023-2024
SCHOOL OF NURSING
A.Y. 2023-2024
signs and symptoms: Complications:
Dyspnea Right-sided heart enlargement
Fatigue and heart failure.
Chest pain Blood clots.
Edema Irregular heartbeats.
Dizziness Bleeding in the lungs.
Pregnancy complications.
SCHOOL OF NURSING
A.Y. 2023-2024
assessment and diagnostic:

physical assessment
Bloodtest
echocardiogram
electrocardiogram
chest x-ray
Right heart catherization
SCHOOL OF NURSING
A.Y. 2023-2024
medications:
Vasodilator Therapy:
Some vasodilators used in the treatment of PH include:
Calcium channel blockers
Endothelin receptor antagonists (e.g., bosentan, ambrisentan,
macitentan):
Phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil):
Soluble guanylate cyclase stimulators (e.g., riociguat):
SCHOOL OF NURSING
A.Y. 2023-2024
medications: surgery or other procedures:

warfarin Atrial septostomy
digoxin lung or heart-lung transplant
diuretics
oxygen therapy
SCHOOL OF NURSING
A.Y. 2023-2024
nursing management:
identify patients at high risk for PH, such as those with COPD,
PE, congenital heart disease, and mitral valve disease
The nurse must be alert for signs and symptoms.
administer oxygen therapy
instruct the patient and family about the use of home oxygen
therapy.
proper administration and dosing of the medication,
Emotional and psychosocial aspects of this disease must be
addressed.
provide contact details for support services for patients and
families.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
Pulmonary embolism (PE) refers to the obstruction of the pulmonary artery or

one of its branches by a thrombus (or thrombi) that originate(s) somewhere in
the venous system or in the right side of the heart.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
CLINICAL MANIFESTATIONS
DYSPNEA
CHEST PAIN
TACHYPNEA
TACHYCARDIA
ANXIETY
DIAPHORESIS
HEMOPTYSIS
SYNCOPE
APPREHENSION
COUGH
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
RISKS FACTORS
Having surgery, especially joint replacement surgery.

Certain medical conditions, including :
Cancers
Heart diseases
Lung diseases
A broken hip or leg bone or other trauma
Hormone-based medicines
Pregnancy and childbirth
Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
Age.
Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
Assessment and Diagnostic findings

* chest Xray
* ABGs Analysis
* D- Dimer assay
* V/Q scan
* Pulmonary angiography
Assessment and diagnostic findings

SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
V/Q scan
V
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
Medical management
PHARMACOLOGIC THERAPY
Surgical Embolectomy
Catheter-assisted
Anticoagulant therapy
thrombus removal Thrombolytic thepray
vena cava filter
SCHOOL OF NURSING
A.Y. 2023-2024
PULMONARY EMBOLISM
Nursing Management
Monitor the patient response to thrombolytic and anticoagulant therapy
A semi Fowler position provides a more comfortable position for breathing
Continue to turn patients frequently and reposition them to improve V/Q
The Nurse must assess the patient frequently for signs of hypoxemia an monitors the pulse
oximetry
Educate on medication adherence and side effects.
Provide emotional support and reassurance.
Monitor vital signs regularly
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
According to WHO, COVID-19, also called

Coronavirus disease 2019, is an infectious
disease caused by a virus called Severe Acute
Respiratory Syndrome Coronavirus 2 (SARS-
CoV-2). Most people infected with the virus
will experience mild to moderate respiratory
illness and recover without requiring special
treatment. However, some will become
seriously ill and require medical attention.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
Causative Agent: Severe Acute

Respiratory Syndrome Coronavirus 2
(SARS-CoV-2)
Incubation Period: 5 days with a range
of 2–14 days after initial exposure.
Period of communicability: 8–10 days
post symptom-onset in index cases.
Mode of transmission: Contact (direct or
indirect), droplet, airborne, and fomite.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
SIGNS
AND
SYMPTOMS
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
SIGNS
AND
SYMPTOMS
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
RISK FACTORS
Close contact with someone who Older adults.
has COVID-19, especially Heart disease.
someone with symptoms. Diabetes and obesity.
Being coughed or sneezed on by Lung diseases.
an infected person. Chronic kidney disease.
Being near an infected person Immunocompromised Individuals.
when in an indoor space with Smoking.
poor airflow.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
COMPLICATIONS
Pneumonia and Acute Respiratory Distress Syndrome
Myocarditis.
Blood clots.
Acute Kidney Injury (AKI).
Organ failure in several organs.
SCHOOL OF NURSING
A.Y. 2023-2024
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
PREVENTIONS
Get vaccinated.
The COVID-19 vaccines available in the Philippines are:

Pfizer-BioNTech COVID-19 vaccine. It is available for people aged 6 months
and older.
Moderna COVID-19 vaccine. It is available for people aged 6 months and older.
AstraZeneca COVID-19 vaccine. It is available for people aged 18 and older.
J&J COVID-19 vaccine. It is available for people aged 18 and older.
Sinovac COVID-19 vaccine. It is available for people aged 18 and older.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
PREVENTIONS
Avoid close contact with anyone who is sick or has symptoms.
Keep distance between yourself and others when you're in indoor public
spaces.
Avoid crowds and indoor places that have poor airflow, also called
ventilation.
Wash your hands often with soap and water for at least 20 seconds.
Wear a face mask in indoor public spaces if you're in an area with a high
number of people with COVID-19 in the hospital.
SCHOOL OF NURSING
A.Y. 2023-2024
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
PREVENTIONS
Improve the airflow indoors.
Cover your mouth and nose when coughing or sneezing.
Avoid touching your eyes, nose, and mouth.
Avoid sharing dishes, glasses, towels, bedding and other household
items if you're sick.
Clean and disinfect high-touch surfaces.
Stay home from work, school, and public areas, and stay home in
isolation if feeling sick, unless going to get medical care.
SCHOOL OF NURSING
A.Y. 2023-2024
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
LAB DIAGNOSTICS
RT-PCR test, also called a molecular test, this COVID-19 test detects
genetic material of the virus using a lab technique called reverse
transcription polymerase chain reaction (RT-PCR).
Rapid antigen test detects certain proteins in the virus.
Antibody (or serology) tests look for antibodies in the blood that the
immune system produced in response to SARS-CoV-2, the virus that
causes COVID-19.
SCHOOL OF NURSING
A.Y. 2023-2024
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
TREATMENTS AND MEDICATIONS

1. Home Isolation and Symptomatic Treatment
Symptomatic treatment may include rest, staying hydrated, and using
over-the-counter medications to manage symptoms like fever and cough.
2. Hospitalization and Oxygen Therapy

Oxygen therapy is provided as needed to maintain proper oxygen levels
in the blood.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19

3. Antiviral Medications
Remdesivir: An antiviral drug, may be used in certain hospitalized
patients to reduce the severity and duration of symptoms.
The World Health Organization (WHO) recently made a strong
recommendation for using nirmatrelvir and ritonavir (Paxlovid)—to
treat mild and moderate COVID-19 patients at the highest risk of
hospital admission.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19

4. Corticosteroids
Dexamethasone: Used to reduce mortality in severe cases by
suppressing the immune system's overactive response.
5. Other supportive medications

Paracetamol (Acetaminophen): Used for reducing fever and alleviating
mild to moderate pain.
SCHOOL OF NURSING
A.Y. 2023-2024
COVID-19
NURSING INTERVENTIONS
Monitor vital signs.
Maintain respiratory isolation.
Ensure adequate hydration by encouraging fluid intake.
Enforce strict hand hygiene.
Provide emotional support to the patient.
Administer supplemental oxygen and medications as prescribed for
symptom relief.
Educate the patient.

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Paul University Philippines

ANATOMY AND PHYSIOLOGY OF LUNGS

Pneumonia is an infection that inflames the air sacs in one or

A) Classification (Based on transmission)

1) Community-acquired pneumonia (CAP)

o Hospitalization for ≥2 days in an acute care facility within 90 days of

3) Hospital-acquired pneumonia (HAP)

4) Ventilator-associated pneumonia (VAP):

Classsification (based on pathology)

Normally, the upper airway prevents potentially infectious particles from

Because of hypoventilation, a ventilation–perfusion (V./Q.) mismatch occurs in

PNEUMONIA SIGNS AND SYMPTOMS

Cough, which may produce greenish, yellow or even bloody mucus

RISK FACTORS OF PNEUMONIA

1. Age 7. Recent viral infection (i.e., a cold or the flu)

The commonly recommended treatment for Pneumonia is a prescribed

Blood tests Pleural Fluid culture

Pneumonia can be generally prevented in three ways:

3) Refrain from smoking/vaping

1.Administer oxygen as prescribed.

10.Encourage fluids up to 3 L a day to thin secretions unless contraindicated.

What to know about PULMONARY TB

The main SYMPTOMS of pulmonary TB include:

a localized collection of pus caused by microbial infection (Weinberger

Note: atypical presentations may occur, depending on the position of the

Note: If treatment is stopped too soon, a relapse may occur.

the collapse of a lung or

Any condition that makes it hard to swallow.

SIGNS AND SYMPTOMS

ASSESSMENT AND DIAGNOSTIC FINDINGS

ASSESSMENT AND DIAGNOSTIC FINDINGS

SIGNS AND SYMPTOMS

Common pulmonary complaints

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

ASSESSMENT AND DIAGNOSTIC FINDINGS

ASSESSMENT AND DIAGNOSTIC FINDINGS

ASSESSMENT AND DIAGNOSTIC FINDINGS

An acute inflammation of the mucous

Signs and Symptoms:

dry, irritating cough

Medical History and Physical Exam

Avoid exposure to smoke, allergens, and other irritants

ACUTE RESPIRATORY DISTRESS SYNDROME

ACUTE RESPIRATORY DISTRESS SYNDROME

The risk factors associated with ARDS include:

ACUTE RESPIRATORY DISTRESS SYNDROME

The signs and symptoms of ARDS include:

ACUTE RESPIRATORY DISTRESS SYNDROME

Lab and Diagnostics include:

Arterial Blood Gases

ACUTE RESPIRATORY DISTRESS SYNDROME

ACUTE RESPIRATORY DISTRESS SYNDROME

ACUTE RESPIRATORY DISTRESS SYNDROME

is the abnormal accumulation of

Left ventricles become unhealthy

Blood backs up in left atrium, pulmonary

Left ventricles become unhealthy

Blood backs up in left atrium, pulmonary

Pulmonary edema can be from:

Signs and symptoms include:

Assessment and diagnostic findings