Respiratory System1

NURS 3013
Plan
1. Review the structures and functions of the upper and lower
respiratory tracts.
2. Describe common disorders of affecting the RT & their
manifestation
3. Describe nursing implications for medications & treatment ordered
4. Plan and provide appropriate nursing care plan for clients with upper
respiratory disorders
4. Create concept map for the diseases of the respiratory system
Respiratory System
• Every tissue within the body requires oxygen to function.
• The respiratory system includes:
- air passages,
- pulmonary vessels,
- the lungs,
- and breathing muscles,
- provides oxygenated blood to the body tissues
- removes waste gases.
 Overview of A&P of the Respiratory System
• Composed of the upper and lower respiratory tracts.
• Responsible for ventilation
• The upper tract warms and filters inspired air
• The lower respiratory tract (the lungs) accomplish gas exchange.
• Gas exchange involves delivering oxygen to the tissues through the bloodstream
and expelling waste gases, such as carbon dioxide, during expiration
• Upper airway structures consist of the nose, sinuses and nasal passages, pharynx,
tonsils and adenoids, larynx, and trachea.
• The lower respiratory tract consists of the lungs, which contain the bronchial and
alveolar structures needed for gas exchange.
Neurologic Control of Ventilation

• The rhythm of breathing is controlled by respiratory centers in the

brain
• The inspiratory and expiratory centers in the medulla oblongata and
pons control the rate and depth of ventilation to meet metabolic
demands.
• The apneustic center in the lower pons stimulates the inspiratory
medullary center to promote deep, prolonged inspirations.
• The pneumotaxic center in the upper pons is thought to control the
pattern of respirations.
 Neurologic Control of Ventilation
• Chemoreceptors in the medulla respond to chemical changes in CSF as a result from
chemical changes in the blood.
• receptors respond to increase or decrease in pH and sends a message to lungs to change
the depth and rate of ventilation to correct imbalance
• The peripheral chemoreceptors in the aortic arch and the carotid arteries respond first to
changes in PaO2, then to PaCO2 and pH.
• Proprioceptors in the muscles and joints respond to body movements, such as exercise,
causing an increase in ventilation.
• ROM exercises in an immobile patient stimulate breathing.
• Baroreceptors, also located in the aortic and carotid bodies, respond to an increase or
decrease in arterial blood pressure and cause reflex hypoventilation or hyperventilation.
Glossary
• bronchoscopy: direct examination of larynx, trachea, and bronchi
using an endoscope
• cilia: short hairs that provide a constant whipping motion that serves
to propel mucus and foreign substances away from the lung toward
the larynx
• crackles: soft, high-pitched, discontinuous popping sounds during
inspiration caused by delayed reopening of the airways
• diffusion: exchange of gas molecules from areas of high concentration
to areas of low concentration
Glossary
• Dyspnea: labored breathing or shortness of breath

• Hemoptysis: expectoration of blood from the respiratory tract

• Hypoxemia: decrease in arterial oxygen tension in the blood

• Hypoxia: decrease in oxygen supply to the tissues and cells

• Orthopnea: inability to breathe easily except in an upright position

 Glossary
• Physiologic dead space: portion of the tracheobronchial tree that does not
participate in gas exchange

• Pulmonary perfusion: blood flow through the pulmonary vasculature

• Respiration: gas exchange between atmospheric air and the blood and between
the blood and cells of the body

• Ventilation: movement of air in and out of airways

• Wheezes: continuous musical sounds associated with airway narrowing or partial

obstruction
Diseases and conditions of the respiratory system
• Fall into Two Categories:
a. Viruses - influenza,
b. Bacterial pneumonia
- there is not much that can be done for viral infections but to let them run their
course.
- Antibiotics are not effective in treating viruses and the best thing to do is just
rest,
b. Chronic Diseases- asthma and chronic obstructive pulmonary disease
- COPD is the intersection of three related conditions — chronic bronchitis,
chronic asthma and emphysema.
- It is a progressive disease that makes it increasingly difficult for sufferers to
breath.
Influenza Viruses
• The flu is a contagious respiratory illness caused by influenza viruses
that infect the nose, throat, and lungs.
• It can cause mild to severe illness, and at times can lead to death.
• Spread mainly by droplets made when people with flu cough, sneeze
or talk
- Also by touching a surface or object that has flu virus on it and then
touching their own mouth, eyes or possibly their nose.
Onset of Symptoms
Prevention strategies
• flu vaccination staying away from people who are sick,
• covering coughs and sneeze
• Frequent handwashing
Management
• Avoid being face to face with the sick person.
• Spend the least amount of time in close contact with a sick person.
• Hand washing often and right way.
• Make sure to wash your hands after touching the sick person.
• Use instant hand sanitizers to stop the spread of germs.
• Use paper towels instead of sharing cloth towels.
• Wash after handling their tissues or laundry.
• Rest
• Drink plenty of water and other clear liquids to prevent fluid loss
(dehydration).
Influenza Virus A

•H1N1, which caused Spanish Flu in

1918, and Swine Flu in 2009

•H2N2, which caused Asian Flu in 1957

•H3N2, which caused Hong Kong Flu in

1968

•H5N1, which caused Bird Flu in 2004

Bacteria

• Bacteria are single-cell organisms.

• Some need oxygen to survive and others do not.
• Some love the heat, while others prefer a cold environment.
• Well-known bacteria include for instance salmonella and staphylococci.
• Approximately less than 1% of all bacteria are responsible for diseases

• Bacterial infections can be treated with antibiotics

Bacterial Infection
Spread by :
• Coughing and sneezing.
• Contact with infected people- especially through kissing and sex.
• Contact with contaminated surfaces, food, and water.
• Contact with infected creatures, including pets, livestock, and
insects such as fleas and ticks.
Causes of Increased Airway Resistance

• Common phenomena that may alter bronchial diameter, which affects

airway resistance, include:
• Contraction of bronchial smooth muscle—as in asthma
• Thickening of bronchial mucosa—as in chronic bronchitis
• Obstruction of the airway—by mucus, a tumor, or a foreign body
• Loss of lung elasticity—as in emphysema, which is characterized by
connective tissue encircling the airways, thereby keeping them open
during both inspiration and expiration
 Assessment

• Health History
- Reason – dyspnea, pain, accumulation of mucus, wheezing, hemoptysis, edema of the ankles
and feet, cough, and general fatigue and weakness
- S&S
- Psychosocial factors
• Clinical significance
-Dyspnea in a healthy person may indicate pneumothorax, acute respiratory obstruction,

In immobilized patients, sudden dyspnea may denote pulmonary embolism.

- Orthopnea - patients with heart disease and occasionally in patients with (COPD)
- presence of both inspiratory and expiratory wheezing usually signifies asthma if the patient
does not have heart failure.
- Treatment – O2 and rest in high Fowler’s position
In class activity

• List Common respiratory infections

Common respiratory conditions
• Upper Respiratory Infections: • Lower Respiratory Infections:
• Rhinitis (Common Cold), • Bronchitis,
• Sinusitis, • Bronchiolitis
• Pharyngitis, • Pneumonia
• Epiglottitis and
• Laryngo-tracheitis
Upper respiratory Infections & Inflammation
• Minor illness except in the frail older adults
• Pathophysiology
- Entrance into airway may result in acute inflammation of the Sinuses,
Pharynx or Larynx
- Edema of the airway mucosa with secretion of clear, yellow and
greenish exudates
- Bacterial infection may develop following the viral infection
Rhinitis (Common Cold)
• begin 2 - 3 days after infection
• S&S- include nasal discharge, obstruction of nasal breathing, swelling of
the sinus membranes, sneezing, sore throat, cough, and headache.
• Last from 2 - 14 days- 2/3 of people recover in a week.
• High fever, significantly swollen glands, severe facial pain in the sinuses,
and a cough that produces mucus, may require medical intervention
• Lead to secondary bacterial infections of the middle ear or sinuses,
requiring treatment with antibiotics
• Symptoms more than 2 weeks may be an allergy rather than a cold.
Allergy Symptoms

• Sneezing, watery eyes, or

cold symptoms that last
more than 10 days without
a fever
• Repeated ear and sinus
infections
• Loss of smell or taste
• Frequent throat clearing,
hoarseness, coughing, or
wheezing
• Dark circles under the eye
The classic symptoms
of acute sinusitis

nasal congestion, greenish nasal

discharge, facial or dental pain, eye
pain, headache, and a nighttime
cough fever, malaise (feeling ill),
bad breath, and a sore throat.
It is usually preceded by a cold,
which does not improve or worsens
after 5 - 7 days of symptoms.
 Rhinitis , Flu & Allergy
Symptoms Cold Flu Airborne Allergy
Fever Rare Usual, high (100-102 °F), Never
sometimes higher, especially
in young children); lasts 3-4
days

Headache Uncommon Common Uncommon

General Aches, Pains Slight Usual; often severe Never
Fatigue, Weakness Sometimes Usual, can last up to 3 weeks Sometimes

Extreme Exhaustion Never Usual, at the beginning of Never

the illness
Stuffy, Runny Nose Common Sometimes Common
Sneezing Usual Sometimes Usual
Sore Throat Common Sometimes Sometimes
Cough Common Common, can become severe Sometimes

Chest Discomfort Mild to moderate Common Rare, except for asthma

 Management
TreatmentGet plenty of rest.
Stay hydrated (Drink plenty of Stay hydrated.
fluids.)
Decongestants.
Aspirin (ages 18 and up),
acetaminophen,
or ibuprofen for aches and
pains
Prevention Wash your hands often.
Avoid close contact with
anyone
who has a cold.
Complications Sinus infection middle ear
infection, asthma
Get plenty of rest. Avoid allergens (things
that you’re allergic to)
Aspirin (ages 18 and up), Antihistamines
acetaminophen, Nasal steroids
or ibuprofen for aches, Decongestants
pains, and fever
Antiviral medicines (see
your doctor)
Get the flu vaccine each Avoid allergens, such as
year. pollen, house dust mites,
Wash your hands often. mold, pet dander,
Avoid close contact with cockroaches.
anyone
who has the flu.
Bronchitis, pneumonia; Sinus infection, middle
can be life-threatening ear infection, asthma
Treatment
• Most colds go away in a few days.
• Get plenty of rest and drink fluids.
• Over-the-counter cold and cough medicines may help ease symptoms
in adults and older children.
- They do not make your cold go away faster, but can help you feel
better.
- Over-the-counter (OTC) cough and cold medicines are not
recommended for children under age 4.
• Antibiotics should not be used to treat a common cold.
• Many alternative treatments have been tried for colds, such as
vitamin C, zinc supplements, and Echinacea.
• Talk to your doctor before trying any herbs or supplements.
Lower Respiratory Tract Infections
COPD
COPD vs Normal lung
 COPD

• COPD stands for chronic obstructive pulmonary disease.

• It is an inflammatory respiratory disease characterized by chronic and progressive

obstruction of airflow in the lungs
• The lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air
out of your body.
• COPD causes them to lose their elasticity and over expand, which leaves some air
trapped in your lungs when you exhale.
• Chronic bronchitis and Emphysema- 2 forms of COPD
• Healthcare workers sometimes refer to patients with chronic bronchitis as "blue
bloaters" and those with emphysema as "pink puffers“
S&S

• Shortness of breath, especially during physical activities

• Wheezing
• Chest tightness
• Having to clear the throat first thing in the morning, due to excess mucus in lungs
• A chronic cough that may produce mucus (sputum) that may be clear, white,
yellow or greenish
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs
Chronic Bronchitis
• Caused by inhaled irritants- cigarette smoke
• The bronchial tubes become inflamed and
narrowed and your lungs produce more
mucus, further block the narrowed tubes.
• Expiratory air is 1st affected
• Ciliary function is impaired → inability to
clear mucus and pathogens
• Develop a chronic cough trying to clear the
airways.
• Enlarged heart, right sided heart failure,
distended neck veins, edema
Emphysema.
• This lung disease causes destruction
of the fragile walls and elastic fibers
of the alveoli.
• Air spaces enlarged and surface
area for gas exchange decreases
• Small airways collapse during
exhalation, trapping air into the
lungs.
• Increase AP diameter- Barrel Chest
• Uses accessory muscle
• Absent cough
• Distant / diminished breath sounds
• Thin & cachectic
• Assume sitting / leaning forward
position
Diagnosis
• Lung (pulmonary) function tests
• Chest X-ray (can show emphysema)
• CT scan of your lungs can help detect emphysema and determine if
surgery is an option
• ABGs
COPD
• The goal of therapy is to
- relieve symptoms,
- prevent disease progression,
- improve exercise tolerance and health status,
- prevent and treat complications and exacerbations,
- and reduce mortality
• Bronchodilators are the backbone of any COPD treatment regimen
• Oral and inhaled corticosteroids - temper the inflammation and positively
alter the course of disease. Not recommended in stable chronic COPD
Medications

• Influenza vaccine
• Broad spectrum antibiotic
• Inhaled bronchodilators (Atrovent, Ventolin)
• Combination inhalers (Salmeterol and fluticasone (Advair) and formoterol and
budesonide (Symbicort)
• Corticosteroids
• cough suppressants
• Sedative
• Oxygen therapy
• Surgery – Bullectomy (Large air spaces (bullae) form in the lungs when the walls
of the air sacs are destroyed)
- Removal of small wedges of damaged lung tissue
Management
• Bronchodilators are the backbone of any COPD treatment regimen
• Oral and inhaled corticosteroids - temper the inflammation and
positively alter the course of disease. Not recommended in stable
chronic COPD
• Antibiotics -dyspnea, sputum production, and sputum purulence
• Mucolytic agents
• Influenza vaccine
• Oxygen by continuous-flow nasal cannula
Nursing Management
• History
• Assessment be done rapidly yet accurately.
• Clear airway
• Stop smoking
• Monitor for possible complications- pneumonia, pneumothorax, respiratory
failure
- Change in skin color, elevated temperature, increase lung sounds/ decrease
breath sounds, decrease O2 levels, changes in mental status, LOC.
- Health promotion – maintaining clear airway, fluid, nutrition, coping
strategies, avoid irritants, exercise , prescribed medication.
Nursing management
• History
• Assessment be done rapidly yet accurately.
- Impaired gas exchange due to chronic inhalation of toxins.
- Ineffective airway clearance related to bronchoconstriction, increased
mucus production, ineffective cough, and other complications.
- Ineffective breathing pattern related to shortness of breath, mucus,
bronchoconstriction, and airway irritants.
- Self-care deficit related to fatigue.
Nursing Management

• Goals to achieve in patients with COPD include:

• Improvement in gas exchange.
• Achievement of airway clearance.
• Improvement inbreathing patterns
• Independence in self-care activities.
• Improvement in activity intolerance
• Ventilation/oxygenation adequate to meet self-care needs.
• Nutritional intake meeting caloric needs.
• Infection treated/prevented.
• Disease process/prognosis and therapeutic regimen understood.
• Plan in place to meet needs after discharge.
Nursing Priorities

• Maintain airway patency.

• Assist with measures to facilitate gas exchange.
• Enhance nutritional intake.
• Prevent complications, slow progression of condition.
• Provide information about disease process/prognosis and treatment
regimen
Risk factors for COPD
Risk Factors for Respiratory Disease

• Smoking (the single most important contributor to lung disease)

• Personal or family history of lung disease
• Occupation
• Allergens and environmental pollutants
• Recreational exposure
Quiz

1. A client with COPD reports steady weight loss and being “too tired
from just breathing to eat.”
Which of the following nursing diagnoses would be most appropriate
when planning nutritional interventions for this client?

a. Altered nutrition: Less than body requirements related to fatigue.

b. Activity intolerance related to dyspnea.
c. Weight loss related to COPD.
d. Ineffective breathing pattern related to alveolar hypoventilation.
Explanation
• The client’s problem is altered nutrition—specifically, less than
required.
• The cause, as stated by the client, is the fatigue associated with the
disease process.
• Activity intolerance is a likely diagnosis but is not related to the
client’s nutritional problems.
• Weight loss is not a nursing diagnosis.
• Ineffective breathing pattern may be a problem, but this diagnosis does
not specifically address the problem of weight loss described by the
client.
2. Which of the following physical assessment findings would the nurse
expect to find in a client with advanced COPD?

a. Increased anteroposterior chest diameter

b. Underdeveloped neck muscles
c. Collapsed neck veins
d. Increased chest excursions with respiration
Explanation
• Increased anteroposterior chest diameter is characteristic of
advanced COPD.
• Air is trapped in the overextended alveoli, and the ribs are fixed in an
inspiratory position.
• The result is the typical barrel-chested appearance.
• Overly developed, not underdeveloped, neck muscles are associated
with COPD because of their increased use in the work of breathing.
• Distended, not collapsed, neck veins are associated with COPD as a
symptom of the heart failure that the client may experience
secondary to the increased workload on the heart to pump into
pulmonary vasculature.
• Diminished, not increased, chest excursion is associated with COPD.
Asthma

• Asthma is a chronic inflammatory disorder of the airway characterized

by recurrent episodes of wheezing, breathlessness, chest tight
tightness, and coughing
• When the airways become inflamed and narrowed, it is difficult to
move air in and out of the lungs.
• Causing increasing amounts of deaths

• Adult-onset asthma also called Occupational Asthma

Pathysiology
• The pathophysiology of asthma is complex and involves
- airway inflammation,
- intermittent airflow obstruction,
- and bronchial hyper-responsiveness.

- Video :https://youtu.be/2ur1XreTiNg
- Asthma
Asthma – Overview
What Causes Asthma?
• The exact cause of asthma isn't known.
• Researchers think some genetic and environmental factors interact to
cause asthma, most often early in life.
• These factors include:
• An inherited tendency to develop allergies, called atopy
• Parents who have asthma
• Certain respiratory infections during childhood
• Exposure to irritants (tobacco smoke)
Sign & Symptoms
• Coughing
• Wheezing.
• Chest tightness.
• Shortness of breath.
• Severity of symptoms may vary over time
• Diagnosis - lung function test (Spirometer), a medical
history and a physical exam.
Causes
• Many things can trigger or worsen asthma symptoms. Triggers may
include:
 Allergens
 Irritants
 Medicines
 Sulfites
 Viral upper respiratory infections, such as colds
 Physical activity, including exercise

Asthma is different for each person.

Diagnostic Evaluation
• Pulmonary function tests (PFTs)- measurements of lung volumes, ventilator
function, and the mechanics of breathing, diffusion, and gas exchange.
• Arterial blood gas studies
• Pulse oximetry
• Throat culture & Sputum
• Imaging studies- x-rays, CT, scans, MRI
• Fluoroscopic Studies- chest needle biopsy or trans-bronchial biopsy
• Pulmonary angiography- thromboembolic disease of the lungs, such as pulmonary
emboli and congenital abnormalities
• Lung scans
• Endoscopic procedures- Bronchoscopy
Asthma- Diagnosis
- History
- Manifestation
- triggers
- Peak expiratory flow rate- assesses airflow restriction & effectiveness
of treatment
- Pulse oximetry & ABGs- evaluate oxygenation
A spirometer is a more advanced peak flow monitoring
device
Peak Expiratory Flow Rate
Green zone: 80 to 100 percent of
•your usual flow rate
Yellow zone: 50 to 80 percent of
your usual flow rate
Red zone: less than 50 percent of
your normal rate
This is the ideal zone. It means
your condition is under control.
Your airways may be starting to
narrow. Talk to your doctor about
how to handle yellow zone results.
Your airways are severely
narrowing. Take your rescue
medications and contact
emergency services
Medical management
• Medications are individualized depending on - age, symptoms,
asthma triggers and what works best to keep your asthma under
control.
• Preventive, long-term control medications reduce the inflammation
in your airways that leads to symptoms.
• Quick-relief inhalers (bronchodilators) quickly open swollen airways
that are limiting breathing.
• Allergy medications are necessary sometimes
Long-term asthma control medications
• Asthma under control on a day-to-day basis and make it less likely you'll have an
attack
• Low risk of side effects and are generally safe for long-term use.
• Inhaled corticosteroids - anti-inflammatory drugs include
- fluticasone (Flonase, Flovent HFA),
- budesonide (Pulmicort Flexhaler, Rhinocort),
- flunisolide (Aerospan HFA),
- ciclesonide (Alvesco, Omnaris, Zetonna),
- beclomethasone (Qnasl, Qvar),
- mometasone (Asmanex)
- fluticasone furoate (Arnuity Ellipta).
Long-term asthma control medication

• Leukotriene modifiers help relieve asthma symptoms for up to 24 hours.

• include-
- montelukast (Singulair),
- zafirlukast (Accolate)
- zileuton (Zyflo) —

• In rare cases, these medications have been linked to psychological reactions,

such as agitation, aggression, hallucinations, depression and suicidal thinking.
• Seek medical advice right away for any unusual reaction.
Long-term asthma control medication
• Long-acting beta agonists. inhaled medications open the airways-
salmeterol (Serevent) and formoterol (Foradil, Perforomist),.

• Some research shows that they may increase the risk of a severe
asthma attack, so take them only in combination with an inhaled
corticosteroid.

• And because these drugs can mask asthma deterioration, don't use
them for an acute asthma attack.
Long-term asthma control medication
• Combination inhalers contain a long-acting beta agonist along with a
corticosteroid— such as fluticasone-salmeterol (Advair Diskus),
budesonide-formoterol (Symbicort) and formoterol-mometasone
(Dulera).
• Because these combination inhalers contain long-acting beta agonists,
they may increase your risk of having a severe asthma attack.
• Theophylline- is a daily pill that helps keep the airways open
(bronchodilator) by relaxing the muscles around the airways. It's not
used as often now as in past years. Theophylline (Theo-24, Elixophyllin,
others)
Quick-relief (rescue) medications

• Can be taken using a portable, hand-held inhaler or a nebulizer

• Include- Albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex).
• Pratropium (Atrovent)- acts quickly to immediately relax your airways, making it
easier to breathe.
-Ipratropium is mostly used for emphysema and chronic bronchitis, but it's
sometimes used to treat asthma attacks.

• Oral and intravenous corticosteroids- prednisone and methylprednisolone

- relieve airway inflammation caused by severe asthma.
- can cause serious side effects when used long term,
- used only on a short-term basis to treat severe asthma symptoms.
Nursing intervention
Focuses on:-
- Maintaining airway
- Managing pain and other symptoms
- Communication
- Psychological support ( Client, Relatives)
Nursing management
• The goal of nursing care in a patient’s having an asthma attack is to make
sure there is adequate oxygen intake.
1) Evaluate respiratory rate/depth and breath sounds
2) Assist client to maintain a comfortable position
3) Encourage/instruct in deep-breathing and directed coughing exercises
4) Obtain history of recent medication use (steroids and inhalers).
5)Obtain baseline data on respiratory function, using a peak flow meter,
listen to breath sounds
Nursing management
6) Follow physician order to:
-Administer inhaled rapid acting bronchodilators to open up theairways.
-Administer corticosteroids such as prednisone to reduce inflammation in
the airways.
-Administer low flow humidified oxygen to prevent hypoxemia.
-Administer intravenous fluids to prevent dehydration and oral intake looses
secretions in the airways.
7) Ensure that long term asthma medications like inhaled corticosteroids
long acting bronchodilators are administered as prescribed by the physician.
Nursing management
8)Check results of diagnostic procedures .
9)Assess vital signs every 15 to 30 minutes in initial treatment period; retake
temperature at least once;
10)observe for changes in level of consciousness (e.g., depression due to
hypoxemia or excitation due to aminophylline and/ or epinephrine
11)Removing any potential allergen or trigger from environment like flowers or
perfumes
12)Maintaining a quite calm environment to reduce anxiety and promote normal
respiratory rate
13)Monitoring the side effects of administered medications
14)Monitoring the arterial blood gases as an indication of improve mentor
deterioration
15)Prepare for mechanical ventilation if patient cannot breathe on his own
The treatment goals
• Live an active, normal life
• Prevent chronic and troublesome symptoms
• Attend work or school every day
• Perform daily activities without difficulty
• Stop urgent visits to the doctor, emergency room, or hospital
• Use and adjust medications to control asthma with little or no side effects
 Physical assessment of the respiratory
structures and breathing
Four main deformities of the chest
1. Barrel Chest- occurs as a result of over inflation of the lungs (Emphysema).
2. Funnel Chest-depression in the lower portion of the sternum (Pectus
excavatum)
3. Pigeon Chest-occurs as a result of displacement of the sternum
4. Kyphoscoliosis - is characterized by elevation of the scapula and a
corresponding S-shaped spine.
Ans 1 - a
2. When providing discharge teaching to a patient who is newly diagnosed
with asthma, which of these points should the healthcare provider
emphasize?

a. “Measure and record your peak flow meter readings every month.”
b. “Eliminate or reduce exposure to known asthma triggers.”
c. “When you feel an attack is imminent, use your inhaled corticosteroid.”
d. “Take a nonsteroidal anti-inflammatory agent daily as part of your
treatment.”
Ans 2 – b
3. The healthcare provider prepares to administer a corticosteroid to a
patient with a diagnosis of asthma.
What is the rationale for administering this drug to this patient?

A Promote bronchodilation
B. Promote expectoration of mucus
C. Prevent respiratory infections
D. Decrease airway swelling
Ans 3- d
4. The healthcare provider is teaching a patient who has asthma how to
use a spacer attached to the handheld inhaler. Which of these provides
the rationale for using a spacer?

• The spacer focuses the medication to the back of the throat.

• A spacer will generate a greater force for medication delivery.
• Using a spacer ensures more medication is delivered to the lungs.
• Sterility of the mouthpiece is maintained by the spacer.
• Ans– 4- c
Tuberculosis
• Tuberculosis is a chronic, recurrent infectious disease that usually affects the
lungs.
• Caused by Mycobacterium tuberculosis
• Droplet
• Contagious
• 2 types – latent & active
• Latent TB - the bacteria remain in the body in an inactive state.
- They cause no symptoms and are not contagious, but they can become active.
- Active TB - the bacteria do cause symptoms and can be transmitted to others.
- Multi -Drug resistant TB
• Mostly affects young adults and people living in developing countries
Pathophysiology
S&S
• While latent TB is symptomless, the symptoms of active TB include the
following:

• Coughing, dry / sometimes with mucus or blood

• Chills
• Fatigue
• low grade afternoon Fever
• Loss of weight
• anorexia
• Night sweats
Interdisciplinary management
• Focus:-
- Early detection
- Accurate diagnosis
- Effective treatment
- Prevention

- Screening - tuberculin skin Test (Mantoux test)

- o.1 ml of purified protein derivative injected intradermal
- Read 48-72 hours later- diameter of raised area in millimeters
- positive response- development of immune response
Diagnosis
• History
• Assessment
• Mantoux test
• Chest X-Ray
• Sputum smear- acid-fast-bacilli
• Drug resistant
Medication
• These are the TB drugs that generally have the greatest activity
against TB bacteria when taken together

• First line drugs

• Isoniazid (H/Inh)
• Rifampicin (R/Rif)
• Pyrazinamide (Z/Pza)
• Ethambutol (E/Emb)
• and Streptomycin (S/Stm)
The aims of TB treatment are:

• To cure the patient of TB and restore their quality of life and productivity
• to prevent relapse of TB;
• to reduce the transmission of TB to others;
• to prevent the development and transmission of drug resistant TB.
Nursing management
• Isolation (negative air flow)
• Standard precautions for staff & patients & visitors
• Assessment -Vital signs, general appearance, lung sounds, fatigue, weight loss,
night sweats, cough, chest pains,
• Monitor lab values ( sputum & liver function test)
• Chest x-ray
• Inform all care givers
• Enforce coughing into tissue – disposal in closed bag
• Provide knowledge for deficient areas- clear written instructions
• Refer to public health department
RESPIRATORY SYSTEM 11 - SURGICAL
NURSING INTERVENTIONS

• Before the procedure, a signed consent form is obtained ,

• Preoperative management
• Post op – NPO until cough reflex returns, offer ice chips and eventually
fluids.
- observes for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis,
and dyspnea.
- educate care givers to report any SOB or bleeding immediately
Tracheostomy
• Is an incision into the trachea to opens the airway and aids breathing.
• Temporary or permanent.
• Performed for the following conditions:
• Obstruction of the mouth or throat
• Breathing difficulty caused by edema ,injury or pulmonary conditions
• Airway reconstruction following tracheal or laryngeal surgery
• Airway protection from secretions or food because of swallowing problems
• Airway protection after head and neck surgery
• Long-term need for ventilator (breathing machine) support
Tracheostomy
• care includes:
- assessment of patency
- changing of inner cannula
- stoma care/dressing change
- changing of tracheostomy tube holders
- Aseptic
 Thoracoscopy

• Examination of the pleural cavity by an endoscope

• Small incisions into the pleural cavity in an intercostal space (depends on
the clinical and diagnostic findings).
• Flowing aspiration the fiberoptic mediastinoscope is inserted into the
pleural cavity, and its surface is inspected
• After the procedure, a chest tube may be inserted,
• pleural cavity is drained by negative-pressure water-seal drainage.
• indicated in the diagnostic evaluation of pleural effusions, pleural disease,
and tumor staging
Nursing Intervention
• monitoring the patient for shortness of breath (which might indicatea
pneumothorax),
• and minor activity restrictions, depending on the intensity of the
procedure.
• If a chest tube is in place-
- monitoring the chest drainage system and insertion site is essential
THORACENTESIS
• Aspiration of pleural fluid for diagnostic or therapeutic purposes.
• Studies - include Gram’s stain C&S, acid-fast staining and culture,
differential cell count,
• cytology, pH, specific gravity, total protein, and lactic dehydrogenase.
Management
• Pre- consent form, X-rays, allergies
- Reinforce to patient – immobility during procedure,
position, to avoid coughing , coldness of cleaning solution
- Administer medications
• Post
- monitor for SOB, bleeding, and infection.
- Discharge plan – immediately report any pain, SOB, visible bleeding/
redness of the biopsy site or pus
Chest Pains
• Chest pain or discomfort may be associated with pulmonary or cardiac
disease
• Associated with pulmonary conditions - sharp, stabbing, intermittent, dull,
aching, and persistent.
• Felt on the side where the pathologic process is located, (referred pain)
• Lung disease does not always produce thoracic pain because the lungs
and the visceral pleura lack sensory nerves and are insensitive to pain
stimuli
• The parietal pleura has a rich supply of sensory nerves that are
stimulated by inflammation and stretching of the membrane
- Sharp stabbing pain
 Clinical Significance

• may occur with pneumonia, pulmonary embolism with lung infarction, pleurisy,
bronchogenic carcinoma
• Assessment includes- the quality, intensity, radiating of pain
- identifies and explores precipitating factors,(patient’s position).
- Also, the relationship of pain to the inspiratory and expiratory phases of
respiration.
- Relief - Analgesic, Nonsteroidal anti-inflammatory drugs (NSAIDs)
( avoid drugs that depress the respiratory center)
Quiz
• 1. A client has just returned to a nursing unit following bronchoscopy.
A nurse would implement which of the following nursing
interventions for this client?

a. Encouraging additional fluids for the next 24 hours

b. Ensuring the return of the gag reflex before offering foods or fluids
c. Administering atropine intravenously
d. Administering small doses of midazolam (Versed)
Ans 1- b
2. A nurse is assessing a client with chronic airflow limitation and notes
that the client has a “barrel chest.” The nurse interprets that this client
has which of the following forms of chronic airflow limitation?

a. Chronic obstructive bronchitis

b. Emphysema
c. Bronchial asthma
d. Bronchial asthma and bronchitis
Ans 2- b

• Explanation: The client with emphysema has hyperinflation of the

alveoli and flattening of the diaphragm. These lead to increased
anteroposterior diameter, which is referred to as “barrel chest.” The
client also has dyspnea with prolonged expiration and has hyper
resonant lungs to percussion.