The Human Respiratory System Respiratory System

TERMINOLOGY • Consists of a set of organs and tissues involved in the uptake

Dyspnea of oxygen from the atmosphere and the release of carbon
• Subjective sensation of breathlessness dioxide generated during aerobic respiration.
Hemoptysis • The gas exchange is also called breathing or external
• Coughing of blood respiration. It plays a crucial role in maintaining our body’s
Hypoxemia oxygen supply and removing waste gases.
• PaO2 less than normal
Hypoxia Upper Respiratory System - Filters, moistens and warms air
• Insufficient oxygenation at the cellular level during inspiration
Orthopnea • Nose
• Shortness of breath when reclining position • Mouth
Perfussion • Pharynx (Throat)
• Blood flow, carrying O2 and CO2 that passes by alveoli • Larynx (Voice Box)
Surfactant • Trachea(Wind Pipe)
• Fluid secreted by the alveolar cells that reduces tension
and aids in elasticity Nose and Nasal Cavity
Pleura • The nose serves as the primary entry point for air Inside the
• Serous membranes inclosing the lung nose, we find the nasal cavity, which filters Incoming air,
Ventilation removing dust and particles warns and humidifies the air
• Movement of AIR, in and out of the lung before it reaches the lungs, and contains olfactory receptors
for our sense of smell
Diffusion
• Movement of gas from area of higher concentration to
Mouth And Oral Cavity
lower concentration
• The mouth can also serve as an alternate entry point for air
The oral cavity plays a minor role in respiration but is
essential for speech and swallowing If the nasal passages are
blocked breathing through the mouth becomes essential
Pharynx (Throat) Bronchi
• The pharynx connects the nasal cavity and mouth to the
traches. It serves as a common pathway for both air and • The bronchi are the main airways into the lungs. When you
food. breathe, air enters your body through your mouth or nose and
• The epiglottis, a flap-like structure in the pharynx, prevents passes through the larynx and trachea. The trachea branches
food from entering the traches during swallowing into a bronchus in each lung
• The bronchi are equipped with tiny hair-like structures called
Larynx (Voice Box) cilia. Cilia help move mucus out of your lungs, keeping the
• The larynx is a touch, flexible segment of the respiratory bronchi clean and healthy.
tract that connects the pharynx (the back of the nose and
throat) to the trachea (windpipe) Bronchioles
• It allows air to pass through it while preventing food and • Bronchioles are small, branching air passages Inside the
drinks from blocking the airway. lungs. They serve as conduits for air, connecting the larger
bronchi to the alveoli
Trachea (Windpipe)
• Alveoli are where gas exchange occurs oxygen enters the
• The trachea is a wide, hollow tube that connects the larynx to
the bronchi (airway of the lungs. Its primary function is to bloodstream, and carbon dioxide is removed during
enable airflow to and from the lungs. This preparation exhalation Bronchioles deliver air to a diffuse network of
ensures that the air entering the lungs is at an optimal approximately 300 million alveoli
temperature and humidity level for efficient gas exchange.

Alveoli
• Alveoli are tiny, air sacs located at the end of the
Lower Respiratory System- Enables the exchange of gases to bronchioles. These structures play a crucial role in gas
regulate serum Pa02, PaC02 and PH exchange during breathing
• In the alveolus, oxygen molecules move through a single
• Bronchi layer of lung cells, entering the bloodstream.
• Bronchioles Simultaneously, carbon dioxide (CO₂) molecules pass from
• Alveoli the bloodstream into the alveolus
ASSESSMENT • Deric smear show presence of WBC, intra and extracellular
Dyspnea bacteria
• Characteristic acute or chronic, ask the patient rate of • Gram Stain shows either the Gram positive of Gram
dyspnea on scale of 1-10 negative
• Associated Factor productive or not? seasonal or not? • Culture identify specific presence of pathogen
• History chronic lung diseases? • Acid-fast detect presence of pathogen such as
Chest Pain Mycobacterium Tuberculosis
• Characteristic sharp dull, stabbing or aching? • Cytology identifies abnormal and possible malignant cells
• Associated Factor inspiration or expiration pain? Pleural Fluid Analysis
• History-smoking or environment exposure? • Pleural fluid is obtained by aspiration thoracentesis, the fluid
Cough is examined for cancerous cells, cellular make up, chemical
• Characteristic-dry hacking,loose,barky,wheezy, or more like content, and microorganisms
clearing the throat?
• Associated Factor- productive Consistency, amount, color, Radiology And Imaging
and odor of the sputum?
• History- Smoking? Allergy? Chest X-Ray
Hemoptysis • Normal pulmonary tissue is radiolucent and appears black on
• Characteristics-from lung or GI system or upper airway? firm. Thus, densities produced by tumors, foreign bodies,
• Associated Factor was there a salty tastes or burning or and infiltrates can be detected as lighter or white images
bubbling sensation Computed Tomography Scan
• History trauma or respiratory treatment chest percussion • Cross sectional X-ray of the lungs are taken from many
different angles and process through a computer to create a
Diagnostic Test three-dimensional images.
Arterial Blood Gas Magnetic Resonance Imaging
• Measure O2, CO2 and pH of blood, assessing Ventilation • A non-invasive procedure that uses a powerful magnetic
(PaCO2), metabolic status(pH) and oxygenation(PaO2) field, radio wave and a computer to produce detailed pictures
• Indicating if acidosis or alkalosis, respiratory or metabolic in of organs, soft tissue, bone and other internal structures
origin, and if compensated or uncompensated Bronchoscopy
Sputum Examination • Direct observation and inspection of upper and lower
• Gross appearance, microscopic examination, gram stain, respiratory tract through fiber optic(flexible)
culture and sensitivity, acid fast bacillus and cytology
Other Diagnostic Test

Lung Biopsy
• Transbronchial Biopsy – biopsy forceps inserted through
bronchoscope and specimen of lung tissue obtained
• Transthoracic Need Aspiration Biopsy- Specimen
obtained through needle aspiration under fluoroscopic
guidance
• Open Lung Biopsy- Specimen obtained through small
anterior thoracotomy used in making a diagnosis when other
biopsy methods have not been effective or are not possible

Artificial Airway

Oropharyngeal Airway
• Curved plastic device inserted through the mouth and
position in posterior pharynx
• Short term use to unconscious patient
• Does not protect against aspiration
Nasopharyngeal Airway
• Soft rubber tube inserted through the nose into posterior
pharynx
Laryngeal Airway Mask
• A tube with a cuffed mask like protection at the distal end;
inserted through the mouth into the pharynx; seal the larynx
and leaves distal opening just above glottis
Combitude
• Airway management device consisting of two lumens and
two inflation cuffs
Endotracheal Tube
• Flexible tube inserted into the mouth or nose and into the
trachea beyond the vocal chords
Nursing Care
1. Ensure adequate ventilation and oxygenation
2. Assess breath sounds every 2 hours. Note and record
3. Provide adequate humidity when the natural humidifying
pathway of oropharynx is bypassed
4. Provide adequate suctioning of oral secretions to prevent
aspiration and decrease oral microbial colorization
5. Use clean technique when inserting an oral or naso-pharyngeal
airway, and take it out and clean it with hydrogen peroxide and
rinse with water at least 11 hours
6. Perform frequent oral care with soft toothbrush or swabs and
antiseptic mouthwash or hydrogen peroxide diluted with water.
Frequent oral care will aid in prevention of ventilator-associated
pneumonia. The patient’s lips should be kept moisturized with
petroleum jelly to prevent them from becoming sore and cracked.
7. Ensure that aseptic technique is maintained when inserting an
an ET or tracheostomy tube. The artificial airway bypasses the
upper airway, and the lower airways are in below the level of the
vocal cords
8. Elevate the patient to a semi-fowlers or sitting position, when
possible; these positions result in improved lung compliance. The
patients position however should be changed at least every 2
hours to ensure ventilation of all lung segments and prevent
secretion stagnation and atelectasis. Position changes are also
necessary to avoid skin breakdown.
9. If an oral or nasopharyngeal airway is used, turn patient’s head
to the side to reduce the risk of aspiration because there is no cuff
to seal off the lower airway.
Respiratory Disorder Clinical Manifestation
• Rhinorrhea (excessive nasal drainage, runny nose)
Disorders of the Upper Respiratory
• Nasal congestion
Rhinitis • Sneezing
• Pruritus of the nose, roof of the mouth, throat, eyes, and ears
A group of disorders characterized by inflammation and irritation of • Low-grade fever
the membranes of the nose • Nasal congestion
Allergic rhinitis • Rhinorrhea and nasal discharge
Further classified as • Halitosis, sneezing
Seasonal rhinitis (occurs during pollen seasons) or • Tearing watery eyes
Perennial rhinitis (occurs throughout the year) • "Scratchy" or sore throat
• Commonly associated with exposure to airborne particles • General malaise, chills
such as dust, dander, or plant pollens in people who are • Headache and muscle aches
allergic to these substances
Management
• Antihistamines
Viral Rhinitis (Common Cold) • Corticosteroid nasal sprays
• Most frequent viral infection in the general population • Desensitizing immunizations
caused by coronavirus • Symptomatic therapy
• Adequate fluid intake and rest
• Highly contagious because virus is shed for about 2 days • Prevention of chilling
before the symptoms appear and during the first part of the
• Warm salt-water gargles to soothe the sore throat
symptomatic phase
• NSAIDs to relieve aches and pains
• Antihistamines are used to relieve sneezing, rhinorrhea, and
nasal congestion
• Inhalation of steam or heated, humidified air
Acute Pharyngitis
• A sudden painful inflammation of the pharynx, the back
portion of the throat that includes the posterior third of the
tongue, soft palate, and tonsils
• Commonly referred to as a sore throat

Chronic Pharyngitis
• Chronic pharyngitis is a persistent inflammation of the
pharynx. It is common in adults, who work in dusty
surroundings, use their voice to excess, suffer from chronic
cough, or habitually use alcohol and tobacco.
Three Types Of Chronic Pharyngitis
1. Hypertrophic
• characterized by general thickening and congestion of the
pharyngeal mucous membrane
2. Atrophic

• late stage of the first type (the membrane is thin, whitish,

glistening, and at times winkled)
3. Chronic Granular ("clergyman's sore throat")
• characterized by numerous swollen lymph follicles on the
pharyngeal wall
Clinical Manifestation Nursing Interventions
• Fiery-red pharyngeal membrane and tonsils • Liquid or soft diet is provided during the acute stage
• Swollen lymphoid follicles • Cool beverages, warm liquids, and flavored frozen desserts
• Enlarged and tender cervical lymph nodes such as Popsicles are often soothing
• Fever • Warm saline gargles or throat irrigations
• Malaise • Increase oral fluid intake
• Sore throat • Ice collar can relieve severe sore throats
• Constant sense of irritation or fullness in the throat Mucus • Instruct the patient about preventive measures
that collects in the throat • Instruct the patient to avoid contact with others until the
• Difficulty swallowing Chronic Granular ("clergyman's fever subsides to prevent the spread of infection
sore throat") - characterized by numerous swollen lymph • Avoidance of alcohol, tobacco, secondhand smoke, and
follicles on the pharyngeal wall exposure to cold or to environmental or occupational
pollutants
Management
Pharmacologic Therapy
• Penicillin is the treatment of choice
• Cephalosporins
• Macrolides
• Gargles with benzocaine may relieve symptoms
• Nasal sprays or medications containing ephedrine sulfate or
phenylephrine hydrochloride
• Antihistamine decongestant medications
• Acetaminophen
Tonsilitis and Adenoiditis Nursing Interventions (post-op)
• Acute inflammation/infection that is usually caused by GABHS • In the immediate postoperative period, the most comfortable
(group A beta-hemolytic streptococcus) position is prone, with the patient's head turned to the side to
allow drainage from the mouth and pharynx
• Apply Ice collar to the neck
Clinical Manifestations:
• Assess for post op bleeding such as frequent swallowing
• Sore throat, fever, snoring and difficulty swallowing • Instruct the patient to refrain from coughing and too much
• Enlarged adenoids may cause mouth-breathing, earache, talking
draining ears, frequent head colds, bronchitis, foul-smelling • Ice chips may be given to the patient
breath, voice impairment, and noisy respiration • Alkaline mouthwashes and warm saline solutions are useful
in coping with the thick mucus and halitosis that may be
Management: present after surgery
• Milk and milk products (ice cream and yogurt) may be
• Penicillin (first-line therapy) or cephalosporins restricted
• Tonsillectomy or adenoidectomy is indicated if the patient • Provide soft, adequate diet
has had repeated episodes of tonsillitis despite antibiotic • Instruct the patient to avoid vigorous tooth brushing or
therapy gargling
• Encourage the use of a cool-mist vaporizer or humidifier in
the home
• Instruct patient to avoid smoking and heavy lifting or
exertion for 10 days
Peritonsillar Abscess(Quinsy) Nursing Interventions
• Most common major suppurative complication of sore • Assist in performing intubation, cricothyroidotomy, or
throat/tonsillitis. This collection of purulent exudate between tracheotomy to treat airway obstruction
the tonsillar capsule and the surrounding tissues, including • Assist in needle aspiration when indicated
the soft palate, may develop after an acute tonsillar infection • Gentle gargling after the procedure with a cool normal saline
that progress to a local cellulitis and abscess. gargle may relieve discomfort
• Provide cool liquids
Clinical Manifestations: • Instruct the patient to refrain from or cease smoking
• Severe sore throat, fever trismus (Inability to open the • It is also important to reinforce the need for good oral
mouth), and drooling. hygiene
• Severe pain, raspy voice
• Odynophagia (a severe sensation of burning, squeezing pain Laryngitis
while swallowing) • An inflammation of the larynx, often occurs as a result of
• Dysphagia (difficulty swallowing) voice abuse or exposure to dust, chemicals, smoke and other
• Otalgia (pain in the ear), tender and enlarged cervical lymph pollutants. Most common cause is virus, bacterial invasion
nodes may be secondary
• Airway obstruction may occur Clinical manifestations
• Hoarseness of voice - initial sign
Management: • Aphonia (complete loss of voice)
• Antimicrobial agents (Penicillin) • Severe cough
• Corticosteroid therapy • Throat feels worse in the morning and Improves when the
• Needle aspirations are performed to decompress the abscess patient is in a warmer climate

Management
• Instruct the patient to rest the voice and avoid irritants
(including smoking)
• Inhaling cool steam or an aerosol is provided
• Administer antibacterial therapy as ordered
• Topical corticosteroids may be given by inhalation
• Increased oral fluid intake
Cancer of The Larynx Management:
• Radiation therapy
Etiology • Chemotherapy
• Most tumors of the larynx are squamous cell carcinoma
• Men > women, age 60-70 Surgery:
• Cigarette smoking and alcohol consumption are associated Partial Laryngectomy - A portion of the larynx is removed, along
with laryngeal cancer with one vocal cord and the tumor
Complication: change in voice quality or hoarseness of voice
Clinical Manifestations
• Hoarseness of voice for more than 2 weeks Persistent cough Total Laryngectomy - Laryngeal structures are removed, including
and sore throat the hyoid bone, epiglottis, cricoid cartilage, and two or three rings of
• Dyspnea the trachea
• Dysphagia
Complications:
• Pain radiating to ear and burning
• Permanent Loss Of Voice
• sensation in the throat
• Salivary Leak
• Weight loss
• Wound Infection
• Enlarged cervical lymph nodes
• Stomal Stenosis
• Unilateral nasal obstruction
• Dysphagia
Diagnostic Procedures
• Virtual endoscopy
• Optical Imaging
• CT scan MRI Direct laryngoscope examination
Chronic Obstructive Pulmonary Disease (COPD) Emphysema
• Refers to a disease characterized by airflow limitation that is • Complex lung disease characterized by destruction of the
not fully reversible. The airflow limitations is generally alveoli, enlargement of distal airspaces, and a breakdown of
progressive and is normally associated with an inflammatory alveolar walls. There is a slowly progressive deterioration of
response of the lungs due to irritants, COPD includes chronic lung function for many years before the development of
bronchitis and pulmonary emphysema illness
• Diagnostic Criteria: Cough of 3 months for 2 consecutive
Clinical Manifestations:
years
• Pink puffer
Chronic Bronchitis • Dyspnea, decreased exercise tolerance
• Chronic inflammation of the lower respiratory tract • Cough may be minimal, except with respiratory infection
characterized by excessive mucous secretion, cough, and • Sputum expectoration
dyspnea associated with recurring infections of the lower • Barrel chest - Increased anteroposterior diameter of chest
respiratory tract characterized by three primary symptoms: due to air trapping with diaphragmatic flattening
chronic cough, sputum production, and dyspnea on exertion
Clinical Manifestations:
• Blue bloater
• Usually insidious, developing over a period of years
• Presence of a productive cough lasting at least 3 months a
year for 2 successive years
• Production of thick, gelatinous sputum; greater amounts
produced during superimposed infections
• Wheezing and dyspnea as disease progresses
Panlobular Emphysema - destruction of respiratory bronchiole, Diagnostic Procedure for COPD
alveolar duct and alveolus • Spirometry - used to evaluate airflow obstruction

• All air spaces within the lobule are essentially enlarged, but
there is little inflammatory disease
• Hyperinflated (hyperexpanded) chest, marked dyspnea on
exertion, and weight loss typically occur
• Negative pressure is required during inspiration to move air • ABG levels - decreased Pao2, pH, and increased CO2
into and out of the lungs • Chest X-ray - in late stages, hyperinflation, flattened
• Expiration becomes active and requires muscular effort diaphragm, increased retrosternal space, decreased vascular
markings, possible bullae .
Centrilobular (Centroacinar) Emphysema - pathologic changes • Alpha-1-antitrypsin assay - useful in identifying
take place mainly in the center of the secondary lobule, preserving genetically determined deficiency in emphysema
the peripheral portions of the acinus
• There is a derangement of ventilation-perfusion rations, Medical Management for COPD
producing chronic hypoxemia, hypercapnia, polycythemia, • Smoking cessation
and episodes of right-sided heart failure • Bronchodilators to relieve bronchospasm
• Leads to central cyanosis and respiratory failure, and patient • Inhaled and systemic corticosteroids
also develops peripheral edema • Alpha 1-antitrypsin augmentation therapy
• Antibiotic agents, Mucolytic agents Antitussive agents,
vasodilators and narcotics

Surgical Management
• Bullectomy - surgical removal of enlarged airspaces that do
not contribute to ventilation but occupy space in the thorax
• Lung Volume Reduction Surgery - removal of a portion of
the diseased lung parenchyma
Nursing Interventions For COPD Bronchial Asthma
• Pulmonary rehabilitation to reduce symptoms, improve • Chronic inflammatory disease of the airways that causes
quality of life and increased physical and emotional airway hyperresponsiveness, mucosal edema, and mucus
participation in everyday activities production is reversible and diffuse airway inflammation that
• Pursed-lip breathing helps slow expiration, prevents collapse leads to airway narrowing
of small airways, and helps the patient control the rate and
depth of respiration Clinical Manifestations
• Instruct the patient to coordinate diaphragmatic breathing Three most common symptoms of asthma:
with activities such as walking, bathing, bending, or • Cough
climbing stairs • Dyspnea
• Provide small frequent meals and offer liquid nutritional • Wheezing
supplements to improve caloric intake and counteract weight • Chest tightness, diaphoresis, tachycardia, and a widened
loss pulse pressure, hypoxemia and central cyanosis.
• Administer low flow of oxygen (1-2L/min)
• Administer bronchodilator as prescribed
• Adequately hydrate the patient
• Instruct the patient to avoid bronchial irritants
• If indicated, perform CPT int the morning and at night as
prescribed
• Encourage alternating activity with rest periods
• Teach relaxation technique or provide a relaxation tape for
patient
• Enroll patient in pulmonary rehabilitation program where
available
• Monitor respiratory status, including rate and pattern of
respirations, breath sounds, and signs and symptoms of acute
respiratory distress
Pharmacologic Therapy Nursing Interventions
There are two general classes of asthma medications: • Assesses the patient's respiratory status by monitoring the
Quick-relief medications for immediate treatment of asthma severity of symptoms, breath sounds peak flow, pulse
symptoms and exacerbations oximetry, and vital signs
• Short-acting beta2-adrenergic agonists (albuterol [Proventil • Administer medications as prescribed and monitor the
Ventolin], levalbuterol [Xopenex], and pirbuterol [Maxair]) patient's responses to those medications
Long-acting medications to achieve and maintain control of • Administer fluids if the patient is dehydrated emphasize
persistent asthma adherence to prescribed therapy, preventive measures, and
• Corticosteroids the need to keep follow-up appointments with health care
• Long-acting beta2-adrenegic agonists providers
• Leukotriene modifiers (inhibitors)
• Antileukotrienes, Montelukast (Singulair), zafirlukast
(Accolate), and zileuton (Zyflo)
Bronchiectasis Management
• A chronic, irreversible dilation of the bronchi and • Smoking cessation
bronchioles • Chest physiotherapy
Etiology • Bronchoscopy to remove mucopurulent sputum
• Airway obstruction • Antimicrobial therapy based on result of culture and
• Diffuse airway injury sensitivity of the sputum
• Pulmonary infections and obstruction of the bronchus or • Influenza and pneumococcal vaccines
complications of long-term pulmonary infections • Bronchodilators
• Generic disorders such as cystic fibrosis • Surgical interventions for patients who continue to
• Abnormal host defense (eg, ciliary dyskinesia or humoral expectorate large amount of sputum and hemoptysis despite
Immunodeficiency) adherence to treatment regimen
• Idiopathic causes
Nursing Intervention
Clinical Manifestations • Assess the patient in alleviating the symptoms and in
• Chronic cough with copious amount of purulent sputum clearing pulmonary secretions
• Hemoptysis • Encourage the patient in smoking cessation
• Clubbing of the fingers • Educate the patient and his family in performing postural
• Repeated episodes of pulmonary infection drainage
• Instruct the patient to avoid exposure to people with upper
Diagnostic Procedure respiratory or other infection
• CT scan - reveals bronchial dilation
Occupational Lung Diseases 3 Types Sarcoidosis
• Asbestosis • Granulomatous disease in which clumps of inflammatory
• Silicosis epithelial cells occur in many organs, primarily in lungs.
• Sarcoidosis • Lymph node enlargement seen on chest X-ray

Asbestosis Clinical Manifestations:

• is diffuse interstitial fibrosis of the lung caused by inhalation • Chronic cough; productive in silicosis
of asbestos dust and particles. • Dyspnea on exertion; progressive and irreversible in
• Found in workers involved in manufacture, cutting and asbestosis Susceptibility to lower respiratory tract Infections
demolition of asbestos-containing materials • Bibasal crackles in asbestosis

Management
• There is no specific treatment; exposure is eliminated, and the
patient is treated symptomatically
• Give prophylactic isoniazid (INH) to patient with positive
tuberculin test, because silicosis is associated with high risk of
TB
• Persuade people who have been exposed to asbestos fiber to
stop smoking to decrease risk of lung cancer
Silicosis • Keep asbestos worker under cancer surveillance; watch for
• is a chronic pulmonary fibrosis caused by inhalation of silica changing cough, hemoptysis, weight loss, melena
dust • Bronchodilators may be of some benefit if any degree of airway
• Exposure to silica dust is encountered in almost any form of obstruction is present
mining because the earth's crust is composed of silica and
silicates (gold, coal, tin, copper mining); also stone cutting, Nursing Interventions:
quarrying, manufacture of abrasives, ceramics, pottery, and • Administer oxygen therapy as required
foundry work • Administer or teach self-administration of bronchodilators as
ordered
• Encourage smoking cessation
• Advise patient on pacing activities to prevent fatigue
• Provide information to healthy workers on prevention of
occupational lung disease
Penetrating Trauma Open Pneumothorax
Open Pneumothorax • Close the chest wound immediately to restore adequate
• One form of traumatic pneumothorax. It occurs when a ventilation and respiration
wound in the chest wall is large enough to allow air to pass • Patient is instructed to inhale and exhale gently against a
freely in and out of the thoracic cavity with each attempted closed glottis (Valsalva maneuver) as a pressure dressing
respiration (petroleum gauze secured with elastic adhesive) is applied.
This maneuver helps to expand collapsed lung
• Chest tube is inserted and water-seal drainage set up to
permit evacuation of fluid/air and produce re- expansion of
the lung
• Surgical Intervention may be necessary to repair trauma

Tension Pneumothorax
• Occurs when air is drawn into the pleural space from a
lacerated lung or through a small opening or wound in the
chest wall. It may be a complication of other types of
pneumothorax. The air that enters the chest cavity with each
inspiration is trapped. this causes the lung to collapse and the
heart, the great vessels, and the trachea to shift toward the
unaffected side of the chest (mediastinal shift) Tension Pneumothorax
• Immediate decompression to prevent cardiovascular collapse
by thoracentesis or chest tube insertion to let air escape
• Chest tube drainage with underwater-seal suction to allow
for full lung expansion and healing
Clinical Manifestations Spontaneous Pneumothorax
Hyperresonance; diminisher breath sounds Treatment is generally nonoperative if pneumothorax is not too
Reduced mobility of affected half of thorax extensive.
• Observe and allow for spontaneous resolution for less than
Tracheal deviation away from affected side in tension 50% pneumothorax in otherwise healthy person.
pneumothorax • Needle aspiration or chest tube drainage may be necessary to
• Clinical picture of open or tension pneumothorax is one of achieve re-expansion of collapsed lung if greater than 50%
air hunger, agitation, hypotension, cyanosis and profuse pneumothorax
diaphoresis Surgical intervention by pleurodesis or thoracotomy with resection
of apical blebs is advised for patients with recurrent spontaneous
Mild to moderate dyspnea and chest discomfort may be present pneumothorax
with spontaneous pneumothorax
Pleural Condition Management:
• Treatment of underlying disease
Pleural Effusion • Thoracentesis of chest tube drainage is performed
• Collection of fluid (transudate or exudate) in the pleural • Surgical pleurectomy for pleural effusion caused by
space, Maybe a complication of heart failure, pulmonary malignancy
infection or nephrotic syndrome, Usually caused by Pleuroperitoneal shunt - fluids from the pleural space is drain to
underlying disease the peritoneum

Clinical Manifestations
• Dyspnea
• Difficulty lying on flat
• Coughing/fever
• Chills
• Pleuritic chest pain
Nursing Interventions
Diagnostic Procedure • Assist in thoracentesis
• CT scan • Record the amount of fluid aspirated and send it to the
• Lateral Decubitus X-ray laboratory
• Administer medications as ordered such as analgesics and
antibiotics
• Assist the patient in a comfortable position
Hemothorax Pleurisy (Pleuritis)
• Blood in pleural space as a result of penetrating or blunt • Inflammation of both layers of the pleurae (parietal and
chest trauma visceral)
• Accompanies a high percentage of chest Injuries • May develop in conjunction with pneumonia or an upper
• Can result in hidden blood loss respiratory tract infection, TB or collagen disease
• Patient may be asymptomatic, dyspneic, apprehensive, or in • When the inflamed pleural membranes rub together during
shock respiration (intensified on Inspiration), the result is severe,
sharp, knifelike pain Pleural
Management
• Assist with thoracentesis to aspirate blood from pleural space Clinical Manifestations
• Assist with chest tube insertion and set up drainage system • Pleuritic pain during deep breath, coughing or sneezing
for complete and continuous removal of blood and air • Pain is limited in distribution rather than diffuse
• Auscultate lungs and monitor for relief of dyspnea • Pleural friction rub can be heard with stethoscope
• Monitor amount of blood loss in drainage
• Replace volume with I.V. fluids or blood products Diagnostic Procedures
• Chest X-ray
• Sputum Analysis
• Thoracentesis
• Pleural Biopsy
Nursing Interventions Empyema Thoracis
• Instruct the patient in heat/cold application for pain relief • Accumulation of purulent fluid in the pleural space
• Instruct the patient to turn onto the affected side to splint the • Occur as complication of bacterial pneumonia, lung abscess
chest wall and reduce the stretching of the pleurae or chest trauma
• Teach the patient to use hands or pillow to splint the ribcage • Patient is acutely ill and has signs and symptoms similar to
while coughing acute respiratory Infection
• Diagnosis is established by chest CT
Management • Main objective is to drain the fluid in the pleural cavity
• Treatment of underlying condition causing pleurisy • Thoracentesis is done if fluid is not too thick
• Topical applications of heat or cold • Tube Thoracostomy is done to patients with loculated or
• Indomethacin for pain relief complicated pleural effusions
• Intercostal Nerve Block if pain is severe • Open chest drainage via thoracotomy is done to remove
thickened pleura, pus and debris

Nursing intervention: Provide care specific to the method of

drainage of the pleural fluid
Infectious Diseases of the Lower Respiratory System Clinical Manifestation
• Sudden onset, rapidly rising fever of 38.3°C to 40.5°C
Pneumonia • Cough productive of purulent sputum
• Inflammation of the lung parenchyma caused by various • Pleuritic chest pain aggravated by deep respiration/coughing
microorganisms, including bacteria, mycobacteria, fungi and • Dyspnea, tachypnea accompanied by respiratory grunting,
viruses nasal flaring use of accessory muscles of respiration fatigue
• Rapid, bounding pulse
Community-Acquired Pneumonia • Orthopnea
• Occurs either in the community setting or within the first 48 • Rusty, blood-tinged sputum
hours after hospitalization or institutionalization • Poor appetite, diaphoresis
Hospital-Acquired Pneumonia
Management:
• Also known as nosocomial pneumonia, is defined as the
Administration of the appropriate antibiotic as determined by the
onset of pneumonia symptoms more than 48 hours after
results of a Gram stain
admission in patients with no evidence of infection at the
• S. pneumonia-macrolide antibiotic (azithromycin,
time of admission
clarithromycin, or erythromycin)
Aspiration Pneumonia • Pseudomonas infection-anti pneumococcal, antipseudomonal
beta lactam
• Refers to the entry pulmonary consequences resulting from
entry of endogenous or exogenous substances into the lower • Treatment of viral pneumonia is primarily supportive
airway • Oxygen therapy if patient has inadequate gas exchange

Complications
Diagnostic Procedure • Shock and respiratory failure
• Chest X-ray shows presence/extent of pulmonary disease • Pleural Effusion
typically consolidation
• Gram stain and culture and sensitivity test of sputum may
indicate offending organism
• Blood culture detects bacteremia (bloodstream Invasion)
occurring with bacterial pneumonia
Nursing Interventions Clinical Manifestations
• Encourage coughing and deep breathing after chest • Fatigue, anorexia, weight loss, low-grade fever, night sweats
physiotherapy, splinting the chest if necessary • Some patients have acute febrile Illness, chills, and flu-like
• Maintain semi-Fowler's position symptoms
• Promote hydration (2-3 L/day) to liquefy secretions • Cough (Insidious onset) progressing in frequency and
• Teach effective coughing techniques to minimize energy producing mucoid or mucopurulent sputum
expenditure; plan rest periods • Hemoptysis, chest pain, dyspnea (Indicates extensive
• Suction if necessary involvement)
• Instruct client to cover nose and mouth when coughing
• Teach the need to continue entire course of antimicrobial Diagnostic Evaluation
therapy which is usually seven to ten days • Sputum smear/Sputum culture confirms a diagnosis of TB
• Teach the patient about proper administration of antibiotics • Chest X-ray to determine presence and extent of disease
and potential side effects • Tuberculin skin test (purified protein derivative [PPD] or
• Teach that findings are expected to be less within 48 to 72 Mantoux test)
hours of initial therapy
• Nutritionally enriched drinks or shakes maybe helpful in Classification of Tuberculosis
maintaining nutrition Data from the history, physical examination, TB test, chest x-ray,
and microbiologic studies are used to classify TB into one of five
Tuberculosis (TB) classes. A classification scheme provides public health officials with
• is an infectious disease that primarily affects the lung a systematic way to monitor epidemiology and treatment of the
parenchyma. It also may be transmitted to other parts of the disease
body, including the meninges, kidneys, bones and lymph • Class 0: no exposure; no infection
nodes • Class 1: exposure; no evidence of infection
• The primary infectious agent, M, tuberculosis, is an acid-fast • Class 2: latent infection; no disease (eg, positive PPD
aerobic rod that grows slowly and is sensitive to heat and reaction but no clinical evidence of active TB)
ultraviolet light spreads from person to person by airborne • Class 3: disease; clinically active
transmission • Class 4: disease; not clinically active
• Class 5: suspected disease; diagnosis pending
Management Nursing Intervention
• Pulmonary TB is treated primarily with antituberculosis • Instructs the patient to increase fluid intake and about correct
agents for 6 to 12 months positioning to facilitate airway drainage
• The initial phase consists of a multiple- medication regime of • Discuss the medications schedule and side effects of the
INH, rifampin, pyrazinamide, and ethambutol and is drugs Instructs the patient to take the medication either on an
administered daily for 8 weeks empty stomach or at least 1 hour before meals because food
• Continuation phase of treatment include INH and rifampicin interferes with medication absorption
and lasts for an additional 4 or 7 months • Patients taking INH should avoid foods that contain tyramine
• Vitamin B (pyridoxine) is usually administered with INH to and histamine because it may result in headache, flushing,
prevent IHN- associated peripheral neuropathy hypotension, lightheadedness, palpitations, and diaphoresis
• Monitors for side effects of anti-TB drugs
First-Line Commonly Antituberculosis Medications • Encourage rest and avoidance of exertion
Commonly Used Adult Daily Dosage Most Common Side • Provide nutritional plan that allows for small, frequent meals
Agents Effects • Instruct the patient about important hygiene measures,
Isoniazid (INH) 5 mg/kg (300 mg Peripheral neuritis, including mouth care, covering the mouth and nose when
maximum daily) hepatic enzyme coughing and sneezing, proper disposal of tissues, and hand
elevation, hepatitis, washing
hypersensitivity
Rifampicin 10 mg/kg (600 mg Hepatitis, febrile
maximum daily) reaction, purpura
(rare), nausea,
vomiting
Pyrazinamide 15-30 mg/kg(2.0 g Hyperuricemia,
maximum daily) hepatotoxicity, skin
rash, arthralgias, GI
distress
Ethambutol 15-25 mg/kg (no Optic neuritis (may
(Myambutol) maximum daily dose, lead to blindness; very
but base on lean body) rare at 15 mg/kg), skin
rash
Acute Respiratory Distress Syndrome Diagnostics
• Severe form of acute lung injury. This clinical syndrome is • Clinical presentation and history of findings oxygen level
characterized by a sudden and progressive pulmonary edema, • Hypoxemia on ABG despite increasing inspired
increasing bilateral Infiltrates on chest x-ray, hypoxemia • Chest x-ray shows bilateral infiltrates
unresponsive to oxygen supplementation regardless of the • Plasma Brain Natriuretic Peptide (BNP)
amount of Positive End-Expiratory Pressure (PEE) and the • Echocardiography
absence of an elevated left atrial pressure • Pulmonary Artery Catheterization
• Patients often demonstrate reduced lung compliance PORT
Management
• Treatment of the underlying condition
• Optimize oxygenation
• Intubation and mechanical ventilation
• Sedation may be required
• Paralytic agents may be necessary
• Antibiotics, as Indicated
Clinical Manifestations • PEEP usually improves oxygenation
• Typically develops over 4 to 48 hours • Supportive drugs includes surfactant replacement therapy,
• Severe dyspnea, severe hypoxemia pulmonary antihypertensive agents and antisepsis agent
• Arterial hypoxemia that does not respond to supplemental
Nursing Intervention
oxygen Chest x-ray are similar to those seen with
cardiogenic pulmonary edema • Requires close monitoring in the intensive care unit
• Increased alveolar dead space • Assess the patient's status frequently to evaluate the
effectiveness of the treatment
• Severe crackles and rhonchi heard on auscultation
• Turn the patient frequently to improve ventilation and
• Labored breathing and tachypnea
perfusion in the lungs and enhance drainage secretions
• Res is essential for patient to limit oxygen consumption and
reduce oxygen needs
• Adequate nutritional support is vital, 35 to 45 kcal/kg/day is
required to meet caloric requirements
• Identify problems with ventilation that may cause anxiety
reaction to the patient
Pulmonary Embolism Management
• Refers to the obstruction of the pulmonary artery or one of • Treatment is to dissolve the existing emboli
its branches by a thrombus (or thrombi) that originates • Improve respiratory and vascular status, anticoagulation
somewhere in the venous system in the right side of the heart therapy, thrombolytic therapy, and surgical intervention
• Often associated with trauma, surgery (orthopedic, major • Stabilize the cardiopulmonary system
abdominal, pelvic, gynecologic, pregnancy, heart failure, age • Nasal oxygen is administered immediately to relieve
older than 50 years, hypercoagulable states, and prolonged hypoxemia, respiratory distress, and central cyanosis
immobility • Intravenous infusion lines are inserted to establish routes for
medications or fluids that will be needed
Diagnostic Procedures • Hypotension is treated by a slow infusion of dobutamine
• Chest x-ray - shows infiltrates, atelectasis, elevation of the (Dobutrex), which has a dilating effect on the pulmonary
diaphragm on the affected side vessels and bronchi, or dopamine (Intropin)
• ECG-shows sinus tachycardia, PR-interval depression and • Small doses of IV morphine or sedatives are administered to
nonspecific T-wave changes relieve patient anxiety, to alleviate chest discomfort, to
• Arterial blood gas analysis - shows hypoxemia and improve tolerance of the endotracheal tube, and to ease
hypocapnia Spiral computed CT scan of the lung adaptation to the mechanical ventilator
• Anticoagulant therapy (heparin, warfarin sodium
• Coumadin has traditionally been the primary method for
managing PE
• Thrombolytic therapy (urokinase, streptokinase, alteplase) is
used in treating PE, particularly in patients who are severely
compromised Surgical embolectomy is performed if the
patient has massive PE
Nursing Intervention Clinical Manifestations
• Monitor oxygen therapy and assess the patient for hypoxia • Dyspnea is the most frequent symptom
Watch patient for signs of discomfort and pain • Chest pain (sudden and pleuritic), may be substernal and any
• Assess patient for bleeding related to anticoagulant or mimic angina pectoris or a myocardial infarction.
thrombolytic therapy • Petechiae over the chest
• Advise patient of the possible need to continue taking • Anxiety, fever, tachycardia and apprehension
anticoagulant therapy • Cough, diaphoresis, hemoptysis, and syncope. The most
• Monitor for potential complication of cardiogenic shock or frequent sign is tachypnea
right ventricular failure
• Encourage ambulation and active/passive leg exercises to
prevent venous stasis
• Advise the patient not to sit or lie in bed for prolonged
periods, not to cross the legs, and not to wear constrictive
clothing