ALTERATION IN VENTILATORY FUNCTION 7.

Shock – any cause

 ACUTE AND CHRONIC PULMONARY DISEASE 8. Trauma – pulmonary contusion, multiple f(x), head injury
 PULMONARY EMBOLISM
9. Major surgery
 ACUTE LUNG INJURY
 RESPIRATORY FAILURE 10. Fat/ Embolism
 PNEUMONIA
 COMMONLY ACQUIRED VENTILATOR 11. COVID-19
 RESPIRATORY PANDEMICS Dx Tests:
 PULMONARY HYPERTENSION
 PNEUMOTHRORAX 1. BNP (Brain Natriuretic Peptide) levels

ACUTE & CHRONIC PULMONARY DISEASE 2. CXR (Chest X-ray)

ACUTE PULMONARY DISEASES 3. ECG

– are conditions that develop suddenly and worsen rapidly 4. CT Scan

– short duration but can be life-threatening
*Question: What the golden standard or definitive?
– includes ARDS (acute respiratory distress syndrome)
Clinical Manifestations:
ACUTE RESPIRATORY DISTRESS SYNDROME
1. Rapid onset of Dyspnea <72hrs
- Noncardiogenic pulmonary edema (fluids build up in alveoli)
- Progressive decrease in arterial oxygen - hypoxemia (low levels 2. SOB
of O2 in blood) 3. Bilateral pulmonary infiltrates (reticulogranular pattern) a ground
Rt Factors to Development/Causes: glass appearance on X-ray -cause from severe inflam which results in
pulmonary edema which is why there is Pulmonary Infiltrates
1. Sepsis – most common cause
4. Hypoxemia (PaO2 of 50-60 mmHg) -- low O2 so bluish color, tired
2. Aspiration – gastric secretions, drowning, hydrocarbons)
5. Increased alveolar dead space
3. Drug ingestion or overdose
6. Decreased pulmonary compliance (“stiff lungs”; difficult to ventilate)
4. Hematologic disorders – DIC, massive transfusions, cardiopulmonary
bypass Mngmt:

5. Prolonged inhalation of high concentration of high concentrations of 1. Supportive therapy: ET, mechanical intubation
O2, smoke, corrosive substances
6. Met Disorders – pancreatitis
 2. Provide adequate ventilation initially, as disease progresses use P – Polycythemia vera – increase RBC counts  Pink
PEEP (positive-end-expiratory pressure) – low FiO2 since goal is PaO2 Buffers
should be >60mmHg or O2Sat of >90% *So, what’s the Breathing exercise? – Pursed-lip breathing
(Rationale: To increase
3. Circulatory support (Inotropic or vasopressor agents for hypovolemia;
removal of CO2)
sedatives for pain)
D – DOB
4. Adequate fluids; IV - Chronic Bronchitis (BLUE BLOATER) B-ronchitis - BLUE
= (+) airway inflammation
5. Nutritional (35-45 kcacl/kg/day to meet caloric demands) =Chronic cough since stimulates GOBLET CELLS which produces
Nursing Considerations: mucous
= increase mucous
1. Close monitor: O2 administration, Positioning for O2 – Prone; ET, =S/Sx:
Mech Vent, Suctioning, Bronchoscopy C – Chronic productive cough; increase CO2
O – low O2 =Cyanosis- blue bloaters
2. Rest
Compx: Pulmonary HTN - Pulmonary Congestion (Tubig
3. Reduce pt’s anxiety (since this increase O2 demand) sa Lungs) – Edema – Ascites
- Dx Tests/Assessment:
CHRONIC PULMONARY DISEASES
=Spirometry
- Are long-term conditions that persist overtime and worsen gradually =ABG
=CXR
COPD (Chronic Obstructive Pulmonary Disease) - Mngmt for COPD:
- Long-term breathing difficulties or airflow obstruction 1. Smoking cessation
2. Low O2 flow administration (Why? You don’t want to kill the pt!;
- Common Cause: SMOKING
O2 makes them breath; if you give O2; brain will stop stimulation of
- Types: EMPHYSEMA, CHRONIC BRONCHITIS
Hypoxic drive to breath - DEATH) ; Precise: use venturi mask and
- Emphysema (PINK BUFFER) emPINKsyma
nasal cannula
=air trapping of CO2 in Alveoli
3. Pulmonary Toileting/Hygiene: DBE – to expel phlegm; CPT – 3-4x
=overdistention of Alveoli (cause by impaired O2 and CO2 exhange)
day before meals
=S/sx:
4. Diet: LOW CARBS (End product if metabolized—> increased
C – chronic cough; CO2 increase --
CO2); High Calories (since decreased wt ni COPD); High protein;
hypercapnia/hypercardia -- Respi Acidosis
SFF (small frequent feeding) to avoid Diaphragmatic Compression)
O – low O2 -- Hypoxia (so stimulation of breathing) -
5. Prevention: Yearly Vax against Flu: PCV
Hypoxic drive of COPD
6. Pharmacologic Content: Bronchodilators and Corticosteroids
Overdistention of alveoli - Barrel Chest (Check for the AP
diameter: should be 1:2; in Barrel Chest – 1:1)
PULMONARY EMBOLISM 3. Pulmonary Angiography – MOST DEFINITIVE TEST; specifically
MDCTA (multidetector-row computed tomography angiography)
- is an obstruction of the pulmonary arterial bed by a dislodged *Death of PE may occur within 1hr after onset, so early recognition!
thrombus, heart valve growths, or a foreign substances -Mngmt:
- Causes: DVT 1. Pharma: Anticoagulant (Heparin: fast-acting and Warfarin: slow
- Risk Factors: acting); Thrombolytics (Alteplase)
1. Trauma 2. Surgical: Thrombectomy – removal of blood clot
2. Surgery Vena Cava Filter – filter blood going to lungs
3. Pregnancy 3. Nursing Considerations:
4. Heart Failure - Bed rest
5. Age: Older than 50 yrs -O2 nasal or mask
6. Prolonged Immobility -Assess for cardiopulmonary status
7. Obesity -If stable, encourage to move often, assist in isometric and
8. Smoking ROM exercises
9. Oral contraceptives -IV line maintain
4. Prevention of PE: Active leg exercises, early ambulation! & use of
-Clinical Manifestations: anti-embolism stockings
1. Dyspnea – common
2. Chest pain – common and is usually sudden (mimics MI and ACUTE LUNG INJURY (ALI):
angina)
- Serious medical condition characterized by sudden onset of
Others s/sx:
significant inflammation and damage to lung tissues.
3. Anxiety
- Precursor to ARDS (Acute Respiratory Distress Syndrome – severe
4. Fever
na compare to ALI)
5. Tachycardia
- Pulmonary manifestations of acute systemic inflam process
6. Apprehension
7. Cough - Causes: Bacterial/viral infection, trauma, sepsis, aspiration of gastric
8. Diaphoresis contents, inhalation of harmful substances, severe pneumonia
9. Hemoptysis -Clinical manifestations:
10. Syncope
1. DOB
-Compx: Pulmonary Infarction (death of lung tissue) & Pulmonary 2. Respi distress
HTN
-Dx Tests: 3. Hypoxemia
1. D-Dimer – elevated
4. Cough
2. CT Scan – Lung scan shows perfusion defects in areas of
occluded vessels; but doesn’t rule out Microemboli 5. Confusion and fatigue
 -Mngmt:
-Dx Tests: -CXR, Blood tests, Lung biopsy 1. PRIORITY: Mouth-to-mouth resuscitation!
-Mngmt: 2. Assisting in mechanical vent and intubation
1. Supportive Care 3. O2 Therapy
2. Mechanical vent 4. Position and mobilization: HOB (for lung expansion)
3. O2 Supplementation 5. Fluids and electrolytes: IV maintain
RESPIRATORY FAILURE (RF) 6. Suctioning

- Sudden and life-threatening deterioration of the gas exchange *Assess respi status: level of responsiveness, ABG, Pulse Oximeter,
(secondary to atelectasis) and VS
- PaO2 = less 60mmHg (HYPOXEMIA); PaCO2= greater than
*Question: What’s the difference between ARDS, ALI, RF?
50mmHg (HYPERCAPNEA; pH= less 7.35
- Types: Hypoxemia, Hypercapnea, Periop, Shock PNEUMONIA
- Clinical Manifestations:
- An inflammatory condition of the lung affecting the alveoli
Early s/sx are: Restlessness, fatigue, headache, dyspnea, air
hunger, tachycardia, increased BP - Agent: Streptococcus pneumoniae
As Hypoxemia progresses s/sx are: - S/sx:
1. Confusion 1. ABRUPT onsent of fever, chills, dyspnea, and productive cough
2. Lethargy 2. Rust-colored sputum or hemoptysis (According to Sir:
3. Tachycardia transparent)
4. Tachypnea 3. Use of intercostal muscles
5. Central Cyanosis 4. Chest-in drawing
6. Diaphoresis In Children: Determine DGS (VCDD) – vomits everything,
7. Respi Arrest (DEATH) convulsion, DOB, DOSwallowing, Lethargy
*No pneumonia if cough and colds only
- Dx Tests: *Pneumonia – cough and cold = tachypnea
*Severe Pneumonia
-ABG
-Pulse Oximetry – PRIMARY ASSESSMENT -Dx Tests:
1. CXR
-CXR 2. Blood culture
-ECG 3. Sputum Exam
-RF:
1. Conditions that produce mucus or bronchial obstruction and
interfere with normal lung drainage (e.g. Cancer, smoking, COPD)
2. Immunosuppressed pts
3. Smoking
4. Prolonged immobility and shallow breathing patterns
5. Depressed cough reflex, NPO, NGT
6. Supine positioning
7. Antibiotic therapy
8. Alcohol intoxication
9. Gen anesthetic, sedative, and opioid prep
10. Advance age
11. Transmission of organisms from HCP

-Mngmt:
1. Culture and sensitivity – if not untreated to target specific
antibiotics/determine resistant for less S/E
2. DOG: PenG (adult) Others: gentamycin, streptomycin, amoxicillin
(7days), Azithromycin (highest level given to severe pneumonia)
3. Nursing Considerations:
-Monitor respi status
-Assess ability and effectiveness of cough
-Encourage fluid intake and nutrition
-Observe sputum color, viscosity and odor
-Assess lung sounds and VS
-Encourage rest
-Prevent spread: Handwashing and proper disposal of secretions