NURRSSIINNG CARE OF CCLLIIEENNTTSS

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VVEENNTTIILLAATTOORRYY
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Acute & Chronic
COPD

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 Acute
ACUTE & Chronic COPD
COPD:
 Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes the
phenomenon of sudden worsening in airway function and respiratory symptoms in
patients with COPD.

 Exacerbations are common among people living with COPD. It is a worsening or “flare
up” of your COPD symptoms. In many cases an exacerbation is caused by an infection
in the lungs, but in some cases, the cause is never known. The inflammation (irritation
and swelling) in the lungs during and after an exacerbation can cause some people to be
extremely ill and it often takes a month or longer to recover completely.
They can lead to serious complications, such as:
 a decline in quality of life
 temporary or permanent reduction in lung function
 reduced exercise capacity
 hospitalization 01:00 P.M
 in rare cases, death 10/02/23
 Acute & Chronic COPD

ACUTE COPD:
Symptoms
- The symptoms of an acute exacerbation of COPD can differ from person to person. An individual’s
symptoms may also vary among different episodes. Typically, exacerbation involve the worsening of a
person’s usual COPD symptoms, such as:
• breathlessness
• cough
• increased sputum production
• changes in sputum color from clear to deep yellow, green, or brown
• fatigue
• trouble sleeping
• headaches
• confusion
• difficulty waking up
• lower oxygen levels
• 01:00 P.M
fever
10/02/23
 Acute
ACUTE &
COPD: Chronic COPD
Causes
- The most common cause of acute exacerbation of COPD is a lung or
upper airway infection. Often, these infections are viral, but they may also
be bacterial. Sputum and bronchoscopy data have shown that Moraxella
catarrhalis, Haemophilus influenza, and Streptococcus pneumonia are the
most common
organisms associated with AECOPD episodes. Other bacteria (e.g.,
Pseudomonas and Staphylococcus) have also been implicated.

Other potential causes of exacerbation include:

 Allergens
 air pollution
 Dust
 chemical fumes or smoke
 weather changes 01:00 P.M
10/02/23
 Acute & Chronic COPD
ACUTE COPD:

01:00 P.M
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 Acute & Chronic COPD
COPD:
 Chronic obstructive pulmonary disease (COPD) is a common lung disease causing
restricted airflow and breathing problems. It is sometimes called emphysema or chronic
bronchitis.
Symptoms
• The most common symptoms of COPD are difficulty breathing, chronic cough
(sometimes with phlegm) and feeling tired. COPD symptoms can get worse quickly.
These are called flare-ups. These usually last for a few days and often require additional
medicine.

People with COPD also have a higher risk for other health problems. These include:
 lung infections, like the flu or pneumonia
 lung cancer
 heart problems
 weak muscles and brittle bones
01:00 P.M
 depression and anxiety. 10/02/23
 Acute & Chronic COPD
COPD:
Causes
• Several processes can cause the airways to become narrow and lead to COPD. There may be
destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway
lining.

 COPD develops gradually over time, often resulting from a combination of risk factors:
 tobacco exposure from active smoking or passive exposure to second-hand smoke;
 occupational exposure to dusts, fumes or chemicals;
 indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking
and heating in low- and middle-income countries with high levels of smoke exposure;
 early life events such as poor growth in utero, prematurity, and frequent or severe respiratory
infections in childhood that prevent maximum lung growth;
 asthma in childhood; and a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause
COPD at a young age.

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 Acute & Chronic COPD
COPD:
• DIAGNOSTIC AND LABORATORY TESTS
- Diagnosis and assessment of COPD must be done carefully since the
three main symptoms are common among chronic pulmonary disorders.
 Health history
 Pulmonary function test  Diffusing Capacity of Lung for
 Spirometry Carbon
 ABG. Arterial blood gas measurement Monoxide (DLCO) Test
 Chest x-ray  Bronchogram
 Screening for alpha1-antitrypsin  Lung scan
deficiency  Complete blood count (CBC)
 Total lung capacity (TLC),  Blood chemistry
functional residual capacity (FRC),  Sputum culture
and residual volume (RV  Electrocardiogram (ECG)
 Functional residual 01:00 P.M
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 Acute & Chronic COPD
COPD:
• THERAPEUTIC NURSING MANAGEMENT
 Assess/Monitor
- Management ofpatients with COPD should be incorporated with teaching and improving the
respiratory status of the patient. Learn
about the nursing care management of patients with
Chronic Obstructive Pulmonary Disease using the nursing process in this guide.

Assessment of the respiratory system should be done rapidly yet accurately.

 Assess patient’s exposure to risk factors.

 Assess the patient’s past and present medical history.
 Assess the signs and symptoms of COPD and their severity.
 Assess the patient’s knowledge of the disease.
 Assess the patient’s vital signs.
01:00 P.M
 Assess breath sounds and pattern
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Acute & Chronic COPD
COPD:
• THERAPEUTIC NURSING MANAGEMENT
 Nursing Interventions

Patient and family teaching is an nursing intervention to enhance

important self-
management in patients with any chronic pulmonary disorder.

 To achieve airway clearance

 To improve breathing pattern
 To improve activity intolerance
 To monitor and manage potential complications
Acute & Chronic COPD
COPD:

• PHARMACOLOGY
• Medical Management
Healthcare providers perform medical management by considering the assessment data
first and matching the appropriate intervention to the existing manifestation.

• Pharmacologic Therapy
 Bronchodilators relieve bronchospasm by altering the smooth muscle tone and reduce
airway
obstruction by allowing increased oxygen distribution throughout the lungs and improving
alveolar
ventilation.
 Corticosteroids. A short trial course of oral corticosteroids may be prescribed for
patients to
determine whether pulmonary function improves and symptoms decrease.
 Other medications. Other pharmacologic treatments that may be used in COPD include 01:00 P.M
alpha1- antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive
10/02/23
 MODULE 2

Pulmonary
embolism
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 Pulmonary embolism
• Overview
 Pulmonary embolism (PE) is a blood clot in the blood vessels of your lung. It usually happens when a
blood clot in the deep veins in your leg breaks off and travels to your lungs. A blood clot that

travels to another part of your body is called an embolus.

 This happens when a clot in another part of your body (often your leg or arm) moves through the
veins to your lung. A PE restricts blood flow to your lungs, lowers oxygen levels in your lungs and
increases blood pressure in your pulmonary arteries. Without quick treatment, a pulmonary embolism
can cause heart or lung damage and even death.

 Pulmonary embolism can arise from anywhere in the body, most commonly it arises from the calf
veins. The venous thrombi predominately originate in venous valve pockets (inset) and at other sites
of presumed venous stasis. To reach the lungs, thromboemboli travel through the right side of
the heart. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle.

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Pathophysiology of Pulmonaryembolism
Pulmonary Embolism
A series of happenings occur inside a patient’s body when he or she has emboli

 Obstruction - When a thrombus completely or partially obstructs the pulmonary artery or

its
branches, the alveolar dead space is increased.

 Impairment - The area receives little to no blood flow and gas exchange is impaired.

 Constriction - Various substances are released from the clot and surrounding area that
cause
constriction of the blood vessels and results in pulmonary resistance.

 Consequences - Increased pulmonary vascular resistance due to regional vasoconstriction

leading to increase in pulmonary arterial pressure and increased right ventricle
workload are the consequences that follow.

 Failure - When the workload of the right ventricle exceeds the limit, failure may occur. 01:00 P.M
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 Pulmonary embolism
Pathophysiology of Pulmonary Embolism

How serious is a pulmonary embolism?

• With proper diagnosis and treatment, a PE is seldom fatal. However, an untreated PE can

be serious, leading to other medical complications, including death. About 33% of

people with a pulmonary embolism die before they get a diagnosis and treatment.
A pulmonary embolism can:

 Cause damage to your lungs.

 Cause strain on your heart, causing heart failure.

 Be life-threatening, depending on the size of the clot 01:00 P.M

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 Pulmonary embolism
Pathophysiology of Pulmonary Embolism

Most commonly, pulmonary embolism is due to a blood clot or thrombus, but there are other types
of

emboli: fat, air, amniotic fluid, and septic.

 Fat emboli. Fat emboli are cholesterol or fatty substances that may clog the arteries when
fatty foods are consumed more.

 Air emboli. Air emboli usually come from intravenous devices.

 Amniotic fluid emboli. Amniotic fluid emboli are caused by the amniotic fluid that has
leaked

towards the arteries.

 Septic emboli. Septic emboli originate from a bacterial invasion of the thrombus.
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 Pulmonary embolism
CAUSES & SYMPTOMS
Warning signs of a pulmonary embolism?
 The first signs of pulmonary embolism are usually shortness of
breath and chest pains that get worse if you exert yourself or take a
deep breath. You may cough up bloody mucus.
 If you have these symptoms, get medical attention right away.
Pulmonary embolism is serious but very treatable. Quick treatment
greatly reduces the chance of death.
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 Pulmonary embolism
CAUSES & SYMPTOMS
Symptoms of a pulmonary embolism
 Symptoms of pulmonary embolism vary, depending on the severity of the clot. Although
most people with a pulmonary embolism experience symptoms, some don’t.
Pulmonary embolism symptoms may include:
• Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on the
extent
of embolization.
• Chest pain occurs suddenly and is pleuritic in origin.
• Tachycardia. Increase in heart rate occurs because the right ventricle catches up with its workload.
• Tachypnea. The most frequent sign is tachypnea.If you have any symptoms of pulmonary
embolism, get
medical attention immediately. 01:00 P.M
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 Pulmonary embolism

CAUSES & SYMPTOMS

Pulmonary embolism causes include:
• Trauma. Trauma anywhere in the body could cause PE especially if a clot is
released from the
venous system.
• Surgery. Certain surgical procedures such as orthopedic, major abdominal, pelvic,
and
gynecologic surgeries could cause PE.
• Hypercoagulable states. A patient with hypercoagulabilitydisorders would most
likely develop a clot that could result in PE.
01:00 P.M
• Prolonged immobility. Being unable to move for a prolonged time predisposes a person
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Pulmonary embolism
Complications:

1. Cardiogenic shock. The cardiopulmonary system is

endangered in a massive PE.

2. Right ventricular failure. A sudden increase in pulmonary

resistance increases the work

of the right ventricle

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 Pulmonary embolism ANDR
INO
DIAGNOSTIC AND LABORATORY TESTS

1. CTPA or a computed tomographic angiography is a special type of X-ray that is the

most

common test used to diagnose PE because it uses contrast to analyze blood vessels

2. Pulmonary V/Q scan to show which parts of your lungs are getting airflow and blood
flow

3. D-Dimer blood tests to detect clot formation in your blood

4. Chest X-ray of your heart and lungs to rule out other conditions with similar symptoms
01:00 P.M
5. Pulmonary V/Q scan to show which parts of your lungs are getting airflow and blood
10/02/23
flow
 Pulmonary embolism ANDR
INO
DIAGNOSTIC AND LABORATORY TESTS
6. Ultrasound of the legs to measure blood flow and assess for clots in the veins

7. Pulmonary angiography to show the blood clots in the lungs

8. Electrocardiogram to record heart activity

9. Echocardiogram to measure heart function and assess for elevated pressure in the pulmonary

arteries.

10. MRI is usually reserved for pregnant people and individuals that may not be able to tolerate the

contrast used in other imaging tests. 01:00 P.M

10/02/23
 Pulmonary embolism ANDRINO

Pharmacology: Surgical Management:

a) Removal of the emboli may sometimes need surgical
a) Anticoagulation therapy. Heparin,
management.
and warfarin sodium has been
b) Surgical embolectomy. This is the removal of the actual clot
traditionally been the
and must be performed by a cardiovascular surgical
method for primary managing
team with the patient on cardiopulmonary bypass.
and PE. acute DVT
c) Transvenous catheter embolectomy. This is a technique in
b) Thrombolytic therapy. Urokinase,
which a vacuum-cupped catheter is introduced
streptokinase, alteplase are used in
transvenously into the affected pulmonary artery.
treating PE, particularly in patients
d) Interrupting the vena cava. This approach prevents
who are severely compromised.
dislodged thrombi from being swept into the lungs while
allowing adequate blood 01:00 P.M
flow. 10/02/23
 Pulmonary embolism ANDR
INO
THERAPEUTIC NURSING MANAGEMENT
• Assess/Monitor • Nursing Activities
a) Health history. Health history is assessed to a) Planning and goals for a patient with
determine any previous cardiovascular disease. pulmonary embolism include the following:
b) Family history. History of any cardiovascular b) Increase perfusion
disease in the family may predispose the patient c) Verbalize understanding of
to PE. therapy condition, regimen,
c) Medication record. There are certain effects. and medication
medications that can increase the risk for PE. side stability.
d) Display hemodynamic
d) Physical exam. Extremities are evaluated for e) Report pain is relieved or controlled.
warmth, redness, and inflammation. f) Follow prescribed pharmacologic regimen.
01:00 P.M
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 Pulmonary embolism ANDR
INO
THERAPEUTIC NURSING MANAGEMENT
• Nursing Interventions
Nursing care for a patient with pulmonary embolism includes:
 Prevent venous stasis. Encourage ambulation and active and passive leg exercises to prevent venous
stasis.
 Monitor thrombolytic therapy. Monitoring thrombolytic and anticoagulant therapy through INR or
PTT.
 Manage pain. Turn patient frequently and reposition to improve ventilation-perfusion ratio.
 Manage oxygen therapy. Assess for signs of hypoxemia and monitor the pulse oximetry values.
 Relieve anxiety. Encourage the patient to talk about any fears or concerns related to this frightening
episode. 01:00 P.M
10/02/23
 MODULE 2

ACUTE RESPIRATORY
DISTRESS SYNDROME/
b. Pulmonary c. Acute respiratory
a. Acute & ACUTE LUNGsyndrome/
embolism distress INJURY/ d. Respirat c COPD ory

acute NEONATAL
Chroni
lung injury failure

RESPIRATORY
DISTRESS SYNDROME
e. Pne horax
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ACA
DISTRESS SYNDROME
L
PATHOPHYSIOLOGY

• First phase - Damage of the alveolo-

capillary barrier leading to pulmonary edema.

• Proliferative phase - characterized

by improved lung function and healing.

• Final fibrotic phase - signaling the end of the

acute disease process.

01:00 P.M
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 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ACA
DISTRESS SYNDROME
L
PATHOPHYSIOLOGY
• Cellular Involvement in ARDS:
1. Neutrophils: Most in both the
abundant epithelial lining histological
and alveolar
2. specimens.Macrophages: These are the most
Alveolar
common cell type and with
interstitial macrophages play an
important role in defence
3. Epithelium: Contained within the alveolar
epithelial tissue are the highly metabolically
01:00 P.M
active type 2 alveolar cells.. 10/02/23
 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ALB
DISTRESS SYNDROME
A
OVERVIEW:
• Acute lung injury (ALI) and acute
respiratory distress syndrome (ARDS)
represent a spectrum of acute respiratory
failure with diffuse, bilateral lung injury
and severe hypoxemia caused by non-
cardiogenic pulmonary edema.

01:00 P.M
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 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ACA
DISTRESS SYNDROME
L
 ACUTE RESPIRATORY DISTRESS SYNDROME/ ACUTE LUNG INJURY

SIGNS & SYMPTOMS: DIAGNOSIS:

 Fever  Acute
 Shortness of  Chest X-ray shows “white out” in both
breath
lungs
 Tachypnea
 PF ratio
 Chest pain
 ARDS is NOT DUE to Cardiac causes
 Hypotension
 Echocardiogram
 Hypoxia
 Pulmonary Capillary Wedge
 Cyanosis
 Shock 01:00 P.M
10/02/23
 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY AC
DISTRESS SYNDROME
AL
Nursing Management:
Pharmacology:
Assess breath sounds  Antibiotics
 Monitor saturation and  Anti-inflammatory (Corticosteroids)
oxygen
symptoms Complications:
 Assist the patient an upright position
 Multiple Organ Failure
 Provide Oxygen
 Lung Damage
 Provide a calm environment
 Pulmonary Fibrosis
 Suction as needed
 Ventilator-associated pneumonia

01:00 P.M
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 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ALB
DISTRESS SYNDROME
A
 NEONATAL RESPIRATORY DISTRESS SYNDROME (NRDS)

Risks Factors: Signs and

 Prematurity Symptoms:
1. May be asymptomatic
2. Initial Clinical Signs:
 Maternal Diabetes
- Dyspnea
 Caesarian Section Delivery
- Tachypnea
- Tachycardia
- Hypoxemia
3. Respiratory Failure
- Chest wall refractions - Nasal flaring

- Expiratory Grunting - Cyanotic

01:00 P.M
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 ACUTE RESPIRATORY DISTRESS SYNDROME/
ACUTE LUNG INJURY/ NEONATAL RESPIRATORY ALB
DISTRESS SYNDROME
A
Diagnosis
:  Radiography or CT scan
 Arterial Blood Gas (ABG)
 Amniocentesis
 Foam stability index
Treatment:
 Surfactant albumin ratio 1. Antenatal Corticosteroid therapy
2. Nasal Continuous airway
positive
pressure
3. Endotracheal Intubation and
Intratracheal surfactant therapy 01:00 P.M
10/02/23
 MODULE 2

Respiratory
failure
b. Pulmonary c. Acute respiratory
a. Acute & embolism distress syndrome/ d. Respirat c COPD
ory
Chroni
acute lung injury failure

e. Pne horax
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 REBAMONTE

Respiratory failure
 Respiratory failure or the lung failure
is a condition where you don’t have
enough oxygen in the tissues in your
body (hypoxia) or when you have too
much carbon dioxide in your blood
(hypercapnia). You might also hear
people use the term “acute hypoxemic
respiratory failure (AHRF)” to describe
it.

01:00 P.M
10/02/23
 REBAMONTE

Respiratory
Symptoms failure
 Symptoms of respiratory failure depend on the cause. Symptoms may include:
 Shortness of breath or feeling like you can’t get Restlessness.
enough air (dyspnea).  Pale skin.
 Rapid breathing (tachypnea).  Bluish skin, lips or nails (cyanosis).
 Extreme tiredness (fatigue).  Headaches.
 Fast heart rate (feeling like your heart’s racing)  Blurred vision.
or heart palpitations.  Agitation, confusion or being unable to
 Spitting or coughing blood or bloody mucus think

(hemoptysis). straight.

 Excessive sweating.  Behavioral changes, not acting like yourself.

01:00 P.M
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 REBAMONTE

Causes Respiratory failure Diagnostic

: Too little airflow
 or blood test:  Pulse oximetry
flow to your lungs.  Arterial Blood gas (ABG) Test
 Blockages, scarring or fluid in your  Lung Function Test
lungs.  Imaging
 Inability to breathe properly  Electrocardiogram
or
deeply enough.
 Abnormalities in the blood
way
flows through your heart.
01:00 P.M
10/02/23
 REBAMONTE

Respiratory
Management failure
and Treatment
 Mechanical Ventilation
 Extracorporeal membrane
oxygenation
 Oxygen Therapy
 Fluids
 Managing Underlying conditions

01:00 P.M
10/02/23
 REBAMONTE

Respiratory failure
Nursing care management

 Assess the patient’s tissue oxygenation status regularly.

 Evaluate ABG results and indices of end-organ perfusion.
 Keep in mind that the brain is extremely sensitive to O2 supply; decreased O2 can lead
to an altered mental status.
 Stay alert for conditions that can impair O2 delivery, such as elevated
temperature, anemia, impaired cardiac output, acidosis, and sepsis.

01:00 P.M
10/02/23
 REBAMONTE

Respiratory failure
Nursing care management

 Take steps to improve V/Q matching, which is crucial for improving

respiratory
efficiency.
 To enhance V/Q matching, turn the patient on a regular and timely basis to rotate and
maximize lung zones.
 Regular, effective use of incentive spirometry
 Regular rotation of V/Q lung zones by patient turning and repositioning
 Suctioning
01:00 P.M
10/02/23
 MODULE 2

Pneumonia
a. Acute &
(community/b. Pulmonary

embolism distress syndrome/

c. Acute respiratory

d. Respirat c COPD
ory

ventilator)
Chroni
acute lung injury failure

acquired horax
e. Pne
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 ABELOSA
Pneumonia
(community/ventilator) acquired
Review of the Anatomy
There are few mechanisms suggested for
development of ventilator-associated pneumonia: most
commonly it is thought to be a progression from
colonization of the upper airway, leading to tracheal
colonization, then tracheitis, and finally pneumonia. This
depends on the number, type, and virulence of the bacteria
as well as natural host defenses such as mechanical factors
and humoral and cellular immunity. Mechanical defenses,
such as ciliary motion and mucus secretion, can be altered
in an intubated patient.
01:00 P.M
10/02/23
 ABELOSA
Pneumonia
(community/ventilator) acquired
Review of the Anatomy
Community-acquired pneumonia (CAP) is a
common and possibly fatal respiratory illness caused by
pathogens such as bacteria (e.g., Streptococcus
pneumoniae), viruses (e.g., influenza), or atypical
organisms (e.g., Mycoplasma pneumoniae). It mainly
affects people outside of healthcare settings and is
characterized by symptoms such as fever, cough, shortness
of breath, and chest pain.

01:00 P.M
10/02/23
 ABELOSA
Pneumonia
(community/ventilator) acquired
Diagnostic and Laboratory
tests
 Pulse Oximetry
 Physical Examination  Bronchoscopy
 Medical History  Urinary Antigen Tests
 Chest X-ray  Serologic Tests
 Blood Tests  CT Scan
 Sputum Culture

01:00 P.M
10/02/23
 ABELOSA
Pneumonia
(community/ventilator) acquired
Causes and Symptoms:
Pneumonia (community/ventilator) acquired can have various causes, and the symptoms may
vary
depending on the responsible pathogen. Common causes and typical symptoms of CAP include:
1. Bacterial Infections: 2. Viral Infections:
a. Streptococcus pneumonia a. Influenza viruses (flu)

b. Haemophilus influenza b. Respiratory syncytial virus

(RSV)
c. Mycoplasma pneumonia
c. Adenovirus:
d. Legionella pneumophila 3. Atypical Pathogens:

e. Staphylococcus aureus a. Chlamydia pneumonia

b. Mycobacterium tuberculosis
01:00 P.M
10/02/23
 BASE
Pneumonia
(community/ventilator) acquired

•Pharmacology
• The pharmacological management involves the use of antibiotics or antiviral medications
tailored to the suspected or identified causative pathogen. For typical bacterial CAP and VAP,
empiric antibiotic therapy is initiated based on the patient's clinical severity, local resistance
patterns, and risk factors, with common choices including macrolides (e.g., azithromycin), beta-
lactam antibiotics with or without macrolides (e.g., amoxicillin-clavulanate or ceftriaxone plus
azithromycin), or fluoroquinolones (e.g., levofloxacin). In cases of atypical pathogens like
Mycoplasma pneumoniae or Chlamydia pneumoniae, macrolides or tetracyclines may be preferred.
For viral causes such as influenza, antiviral agents like oseltamivir can be considered.
01:00 P.M
10/02/23
 BASE
Pneumonia
(community/ventilator) acquired

•Complications
• Complications of community-acquired pneumonia (CAP) and ventilator acquired pneumonia
(VAP) can encompass a range of medical issues, including respiratory complications such as
pleural effusion, lung abscess, or empyema, systemic complications like sepsis and septic shock,
cardiovascular complications like myocardial infarction, neurological complications leading to
confusion or delirium, renal complications resulting in acute kidney injury, metabolic
imbalances, respiratory failure necessitating mechanical ventilation, and specific
vulnerabilities in certain populations such as the elderly and pediatric patients. Prompt
recognition, appropriate treatment, and careful monitoring of CAP and VAP are crucial to
mitigate these complications and improve patient outcomes. 01:00 P.M
10/02/23
 BASE
Pneumonia
(community/ventilator) acquired
Therapeutic Nursing
Management
Assess/Monitor  Follow-Up Chest Imaging
 Initial Assessment  Laboratory Monitoring
 Diagnostic Tests  Clinical Response
 Oxygen Saturation  Complication Monitoring
 Vital Signs  Patient Education
 Respiratory Status  Discharge Planning
 Fluid Balance
 Antibiotic Therapy
 Pain Management
01:00 P.M
 Fever Control 10/02/23
 BASE
Pneumonia
(community/ventilator) acquired
Therapeutic Nursing
Management
 Assessment
Nursing Activities and Triage  Monitoring Vital Signs
 Patient Education  Patient Positioning
 Medication Administration:  Psychosocial Support
 Oxygen Therapy:  Patient Safety
 Infection Control  Discharge Planning
 Respiratory Care  Documentation
 Fluid Management
 Nutrition Support
 Pain Management 01:00 P.M
10/02/23
 MODULE 2

a. Acute &
Respiratoryb. Pulmonary

embolism distress syndrome/

c. Acute respiratory

d. Respirat c COPD
ory

Pandemics
Chroni
acute lung injury failure

e. Pne horax
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 PAÑA

Respiratory
A. Coronavirus Pandemics
Disease 2019 (COVID-19)
 Etiology:
 An infectious disease caused by a newly discovered coronavirus.

 Pathophysiology

A. Transmission of infection
 The transmission of infection is mainly person to person through respiratory droplets.
 Fecal–oral route is possible.
 The presence of the virus has been confirmed in sputum, pharyngeal swabs and feces.
 Vertical transmission of SARS-CoV-2 has been reported and confirmed by positive
nasopharyngeal
swab for COVID-19. 01:00 P.M
10/02/23
 PAÑA

Respiratory
A. Coronavirus Pandemics
Disease 2019 (COVID-19)
 The median incubation period of COVID-19 is 5.2 days; most patients will develop
symptoms in
11.5 to 15.5 days.
 Therefore, it has been recommended to quarantine those exposed to infection for 14 days.
B. Pathogenesis mechanisms
 The invasion of the virus to the lung cells, myocytes and endothelial cells of the vascular
system results in inflammatory changes including -edema, degeneration and necrotic changes.
 These changes contribute to lung injury pathogenesis, hypoxia-related myocyte injury,
body
immune response, increased damage of myocardial cells, and intestinal and
cardiopulmonary 01:00 P.M
10/02/23
changes.
 PAÑA

Respiratory
A. Coronavirus Pandemics
Disease 2019 (COVID-19)
 Medical Management
Viral testing:
• Performed by the RT-qPCR test, used for qualitative detection of the nucleic acid for SARS-CoV-2.
• Swabs are usually taken from nasal, nasopharyngeal, oropharyngeal, sputum or lower respiratory
tract aspirates or wash.

Serology testing:
• The test can assess prior exposure to virus and cannot be used in the diagnosis of current
infection.
• Cross-reactivity with other human coronaviruses may occur.
• The serology test is particularly useful:
- When the viral test is not available.
- Using the serology test together with the clinical picture could guide in decision making.
- Patients with late disease complications and their physicians need to make immediate
01:00 P.M
decisions. (Rapid test) 10/02/23
 PAÑA

Respiratory
A. Coronavirus Pandemics
Disease 2019 (COVID-19)
 Nursing Management
To prevent infection and to slow transmission of COVID-19, do the
following:
 Wash your hands regularly with soap and water, or clean them with alcohol-based hand rub.
 Maintain at least 1 metre distance between you and people coughing or sneezing.
 Avoid touching your face.
 Cover your mouth and nose when coughing or sneezing.
 Stay home if you feel unwell.
 Refrain from smoking and other activities that weaken the lungs.
 Practice physical distancing by avoiding unnecessary travel and staying away from large groups of people.
01:00 P.M
10/02/23
 PAÑA

Respiratory Pandemics
B. Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
 Etiology:
 A virus transferred to humans from infected dromedary camels.
 It is a zoonotic virus, meaning it is transmitted between animals and people, and it is contractable
through direct or indirect contact with infected animals.
 MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa and
South Asia.
 In total, 27 countries have reported cases since 2012, leading to 858 known deaths due to the
infection and related complications.

01:00 P.M
10/02/23
 PAÑA

Respiratory Pandemics
B. Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
 Pathophysiology

 One of the most important cells of the innate immune system is the macrophage.

 Its function is to eliminate pathogens, to present antigens to T cells, to produce cytokines and

chemokines to maintain homeostasis, and to modulate the immune response in tissues.

 The virus induces release of proinflammatory cytokines, leading to severe

inflammation and tissue damage, which may manifest clinically as severe pneumonia and

respiratory failure.
01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
B. Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
 Manifestations:

 MERS-CoV infections range from showing no symptoms (asymptomatic) or mild respiratory

symptoms to severe acute respiratory disease and death.
 A typical presentation of MERS-CoV disease is fever, cough and shortness of breath.
 Severe illness can cause respiratory failure that requires mechanical ventilation and support in
an intensive care unit.
 The virus appears to cause more severe disease in older people, people with weakened immune
systems and those with chronic diseases such as renal disease, cancer, chronic lung disease, and
diabetes.
01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
B. Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
 Nursing Management
 Wash hands often with soap and water for 20 seconds; if water and soap are not available, use an alcohol-

based hand sanitizer.

 Practice respiratory etiquette. Cover nose and mouth with a tissue or the inner elbow when coughing or

sneezing.

 Avoid touching eyes, nose, and mouth with unwashed hands.

 Avoid close contact with sick individuals, such as kissing, sharing cups, or sharing eating utensils.

 Clean and disinfect frequently touched surfaces, such as toys and doorknobs. 01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
C. Severe Acute Respiratory Syndrome (SARS)
 Etiology:

 Severe acute respiratory syndrome (SARS) is a viral respiratory disease caused by a SARS-
associated coronavirus.
 It was first identified at the end of February 2003 during an outbreak that
emerged in
China and spread to 4 other countries.
 SARS is an airborne virus and can spread through small droplets of saliva in a
similar way to the cold and influenza.

01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
C. Severe Acute Respiratory Syndrome (SARS)
 Pathophysiology
 The route of transmission of SARS-CoV-2 could be coughing and sneezing.
 The virus enters the lungs through the respiratory tract and attacks alveolar epithelial
type 2 (AT2) cells.
 AT2 produces a surfactant to decrease the surface tension within alveoli to reduce the
collapsing pressure.

01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
C. Severe Acute Respiratory Syndrome (SARS)
 Manifestations:

 The incubation period of SARS is usually 2-7 days but may be as long as 10 days.
 The first symptom of the illness is generally fever (>38°C), which is often high, and sometimes
associated with chills and rigors.
 It may also be accompanied by other symptoms including headache, malaise, and muscle pain.
 At the onset of illness, some cases have mild respiratory symptoms.
 After 3-7 days, a lower respiratory phase begins with the onset of a dry, non-productive cough or
dyspnea (shortness of breath) that may be accompanied by, or progress to, hypoxemia
(low blood oxygen levels).
01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
C. Severe Acute Respiratory Syndrome (SARS)
 Medical-Surgical Management:
 There is no cure or vaccine for SARS and treatment should be supportive and based on the patient’s symptoms.
 Controlling outbreaks relies on containment measures including:
-Prompt detection of cases through good surveillance networks and including an early warning system;
- Isolation of suspected of probably cases;
- Tracing to identify both the source of the infection and contacts of those who are sick and may be at risk
of contracting the virus;
- Quarantine of suspected contacts for 10 days;
- Exit screening for outgoing passengers from areas with recent local transmission by asking questions and
temperature measurement; and
- Disinfection of aircraft and cruise vessels having SARS cases on board using WHO guidelines.
01:00 P.M
10/02/23
 ARISTOZA

Respiratory Pandemics
C. Severe Acute Respiratory Syndrome (SARS)
 Nursing Management:

 Personal preventive measures to prevent the virus include frequent hand

spread of
washing using soap or alcohol-based disinfectants.

 For those with a high risk of contracting the disease, such as health care workers,

use of personal protective equipment, including a mask, goggles and an apron is

mandatory.

 Whenever possible, household contacts should also wear a mask.

01:00 P.M
10/02/23
 MODULE 2

Pulmonary b. Pulmonary c. Acute respiratory

a. Acute &
Chroni hypertension
embolism distress syndrome/

acute lung injury

d. Respirat c COPD

failure
ory

e. Pne horax
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 BERONIO

PULMONARY HYPERTENSION
 Pulmonary hypertension is a type of high
blood pressure that affects the arteries in the
lungs and the right side of the heart.

 Pulmonary hypertension (PH) is a general

diagnosis that means you have high blood
pressure in your pulmonary arteries. These are
the blood vessels that carry oxygen-poor blood
from your heart to your lungs.

01:00 P.M
10/02/23
 BERONIO

PULMONARY
CAUSES & SYMPTOMS
HYPERTENSION
 Pulmonary hypertension symptoms include:
 Shortness of breath
 Blue or gray skin color
 Chest pressure or pain.
 Dizziness or fainting spells.
 Fast pulse or pounding heartbeat.
 Fatigue.
 Swelling in the ankles, legs and belly area.

01:00 P.M
10/02/23
 BERONIO

PULMONARY
CAUSES & SYMPTOMS
HYPERTENSION
 Pulmonary hypertension is classified into five groups, depending on the cause.

Group 1: Pulmonary arterial hypertension (PAH)

Causes include:
 idiopathic pulmonary arterial hypertension.
 heritable pulmonary arterial hypertension.
 methamphetamine.
 congenital heart defect.
 scleroderma, lupus and chronic liver disease such as cirrhosis.
01:00 P.M
10/02/23
 BERONIO

PULMONARY
CAUSES & SYMPTOMS
HYPERTENSION
 Pulmonary hypertension is classified into five groups, depending on the cause.

Group 2: Pulmonary hypertension caused by left-sided heart disease

This is the most common form of pulmonary hypertension. Causes include:
 Left heart failure.
 Left-sided heart valve disease such as mitral valve or aortic valve disease.
Group 3: Pulmonary hypertension caused by lung disease
Causes include:
 Pulmonary fibrosis.
 Chronic obstructive pulmonary disease.
 Long-term exposure to high altitudes in people who may be at higher risk of pulmonary hypertension.
01:00 P.M
10/02/23
 BERONIO

PULMONARY
CAUSES & SYMPTOMS
HYPERTENSION
 Pulmonary hypertension is classified into five groups, depending on the cause.

Group 4: Pulmonary hypertension caused Group 5: Pulmonary hypertension triggered

by
by chronic blood clots or blockages in the
other health conditions
pulmonary artery
Causes include:
Causes include:
 polycythemia vera and essential thrombocythemia.
 Pulmonary emboli.
 sarcoidosis.
 Tumors that block the pulmonary artery.
 glycogen storage disease.
 Kidney disease.
01:00 P.M
10/02/23
 BERONIO

PULMONARY HYPERTENSION
Diagnostic and Laboratory tests
 Ask you questions about your health and your medical history.
 Ask about your symptoms.
 Check the size of the veins in your neck. Bulging neck veins (jugular venous
distention)
could be a sign of right-sided heart failure.
 Check the size of your liver by feeling the upper right area of your tummy.
 Listen to your heart and lungs with a stethoscope.
 Look at your belly, ankles and legs for edema.
 Measure your blood pressure.
01:00 P.M
 Measure the oxygen level in your blood using a pulse oximeter. 10/02/23
 ALBA

PULMONARY HYPERTENSION
Diagnostic and Laboratory tests
These tests measure the blood pressure in your pulmonary arteries:
 Right heart catheterization
 Doppler echocardiogram

These tests look for the underlying cause of pulmonary hypertension:

 Blood tests
 Chest CT scan
 Chest X-ray
 Polysomnogram (PSG)
 Pulmonary ventilation/perfusion (VQ) scan 01:00 P.M
10/02/23
 ALBA

PULMONARY HYPERTENSION
Pharmacology Complications
 Prostacyclin  Right-sided heart
enlargement and
 Epoprostenol
heart failure.
 Treprostinil
 Blood clots.
 Iloprost
 Irregular heartbeats.
 Bleeding in the lungs.
 Pregnancy complications.

01:00 P.M
10/02/23
 ALBA

PULMONARY HYPERTENSION
Therapeutic Nursing Management
Assess/Monitor
 Assess and monitor the patient’s status every 2 hours. Document the
respiratory
respiratory rate
 Assess and monitor the patient’s oxygen saturation.
 Educate the patient about diaphragmatic breathing and pursed-lip breathing.
 Educate the patient about proper coughing techniques
 Educate the patient about chest physiotherapy or postural drainages
 Educate about fluid restrictions of 2 liters per day.
 Educate the patient and significant others about warning signs
01:00 P.M
 Educate patient on stress management
10/02/23
 ALBA

PULMONARY HYPERTENSION
Therapeutic Nursing Management
Nursing Activities
 Administer prescribed medications for pulmonary hypertension.
 Administer supplemental oxygen, as prescribed
 Elevate the head of the bed if the patient is short of breath.
 Assist the patient in a sitting, semi-fowler’s, or high Fowler’s position as tolerated.
 Assist the patient in ambulation and frequent position changes with proper body alignment.
 Provide a safe and ensuring environment during acute episodes of respiratory distress.
 Assist the patient in a high Fowler’s position.
 Provide a bedside commode and stool softeners as ordered.
01:00 P.M
10/02/23
 MODULE 2

a. Acute &
Pneumothorax b. Pulmonary

embolism distress syndrome/

c. Acute respiratory

d. Respirat c COPD
ory
Chroni
acute lung injury failure

e. Pne horax
(community/v
acquired
umonia f. Respiratory g. Pulmonary h. Pneumot entilator)

pandemics hypertension
01:00 P.M
TOPIC
10/02/23
 ANDRADA

Pneumothorax
Review of the
Anatomy:

01:00 P.M
10/02/23
 ANDRADA

Overview: Pneumothorax
A pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A pneumothorax occurs when
air leaks into the space between your lung and chest wall. This air pushes on the outside of your
lung and makes it collapse. A pneumothorax can be a complete lung collapse or a collapse of only
a portion of the lung.

01:00 P.M
10/02/23
 ANDRADA

Pneumothorax
Overview:
Types of Pneumothorax
• Primary spontaneous pneumothorax
• Secondary spontaneous pneumothorax
• Injury-related pneumothorax
• Iatrogenic pneumothorax
• Catamenial pneumothorax

01:00 P.M
10/02/23
 Pneumothorax
Causes and
Symptoms:
Symptoms
• Chest Injury
Causes
• Shortness of
• Lung disease such as COPD, breath
Cystic
• Increase heart rate
Fibrosis, Lung Cancer or
Also, Cystic lung such as
pneumonia. • Sudden chest pain
disease and
• Cyanosis
Lymphangioleiomyomatosis Birt-
Hogg-Dube Syndrome.
• Mechanical
Ruptured airVentilation
blisters 01:00 P.M
10/02/23
 Pneumothorax
Diagnostic and Laboratory Test

• Chest x-ray

• Other test such as CBC, plasma alcohol

level, arterial blood gas, and CT scan

01:00 P.M
10/02/23
•Therapeutic Nursing
ManagementPneumothorax
Nursing Activities
1.Apply a dressing over an open
•Assess/Monitor
chest wound.
1. Monitor chest tube drainage
system. 2.Administer oxygen as prescribed.
2. Monitor for subcutaneous 3.Position the client in high fowler’s
emphysema. position.
3. Assess tracheal alignment 4. Prepare for chest tube placement
4. Assess expansion of the chest until the
5. Assess breath sounds lung has expanded fully.
6. Assess percussion of the chest 01:00 P.M
10/02/23
 Pneumothorax

Pharmacology
No routine pharmacologic measures will treat pneumothorax, but the patient may need
antibiotics, local anesthesia agents for procedures, and analgesics, depending on the extent and nature
of the injury. Analgesia is administered for pain once the patient’s pulmonary status has stabilized.

Complications
 Respiratory failure or arrest  Pneumoperitoneum
 Cardiac arrest  Pneumohemothorax
 Pyopneumothorax  Bronchopulmonary fistula
 Empyema  Damage to the bundle during tube
neurovascular
 Rexpansion pulmonary edema
thoracostomy 01:00 P.M
 Pneumopericardium  Pain and skin infection at the site of tube
10/02/23
thoracostomy