atelectasis occurred when trapped air enter blood stream, and the airway obstruction or...

Atelectasis Occurred when trapped air enter blood stream,

and the airway obstruction or hypoventilation doesn’t allow air to enter the alveoli, thus alveoli become airless and collapse

Or compression (pleural effusion,pneumotharx, hemothorax ) on the alveoli

Common post OP, due to low TV during surgery, reluctant to cough due to pain which decrease sputum clearance.

Clinical Manifestations Cough & sputum production Dyspnea , tachypnea ,tachycardia Sings of pulmonary infection may present Fever Central cyanosis ١٤٤٤/١٠/١ 1Mr.Homood Alharbi

Management

First line measures :(turning , early ambulation , lung volume expansion , coughing, spirometry ,breathing exercises

If there is no response : (PEEP , IPPB)

Bronchoscopy (to clear secretions)

Postural Drainage (PT) & percussion

If cause is compression remove the cause

١٤٤٤/١٠/١ 2Mr.Homood Alharbi

Pneumonia An inflammation of the lung tissue that is caused by

microbial agent

Community Acquired Pneumonia (CAP)

Occurs either in community setting or within the first 48

hrs of hospitalization

Most common in people younger than 60 yrs

Most prevalent during winter & spring

Caused by pneumococcus & H influenza

Virus the cause in infants & children

Hospital Acquired Pneumonia (HAP) the onset of pneumonia symptoms more than 48 hrs after admission to hospital.

Ventilator Associated Pneumonia (VAP) also called nosocomial infection, in ventilated pt.

Common organism E.colli ,Klebsiella ,S.aurious It occurs when host defense impaired in certain conditions,

coma, malnutrition, prolonged hospitalization, high secretions, aspiration, NGT feeding.

Signs/Symptoms: 1. Sudden onset; shaking chill; rapidly fever of 38.3 – 40° C .

2. Cough productive of purulent sputum.

3. Pleuritic chest pain aggravated by respiration/coughing.

4. Dyspnea, tachypnea.

5. Rapid, pounding pulse

Medical Management Prevention Appropriate antibiotics depend on culture result Hydration (increase fluid intake ) Antipyretic for fever & Headache Warm moist inhalation to relieve irritation Antihistamine to relieve sneezing & rhinorrhea Oxygen & respiratory supportive measures

Complications : Shock & respiratory failure Atelectasis & plural effusion Super infection

Nursing Management: 1. Administer medications as prescribed (antibiotics,

antipyretics)

2. Improving gas exchange.

a. Observe for cyanosis, dyspnea, hypoxia, and

confusion.

b. Checking ABG’s.

c. Administer oxygen.

d. Place patient in an upright position.

١٤٤٤/١٠/١ Mr.Homood Alharbi 7

3. Improving airway patency. a. Encourage pt. to cough. b. Suctioning. c. Encourage increased fluid intake. d. Humidify air or oxygen therapy. e. Chest physiotherapy. f. Changing pt. position frequently. 4. Relieving pleuritic pain. a. Place patient in semi – Fowler position. b. Administer analgesics as prescribed. (avoid opioids in patient's with a history of COPD) c. Avoid suppressing a productive cough.5. Monitoring for complications.


Pleural effusionCollection of fluid in the pleural space

Usually secondary to other disease

Normal there is small amount of fluid (5-15ml )in the pleural space to act as lubricant that allow pleural space to move without friction.

Caused by heart failure, pneumonia, pulmonary embolism.

Manifestation is according to the underline causes.

Can detected by chest x-ray

Treated according to the underline cause, thoracentesis, pigtails.


Pulmonary EdemaA life-threatening condition characterized by accumulation of fluid in the lung tissue and /or alveoli.

Can result from severe left ventricle failure which cause back flow of blood to the lung, thus blood leaks to the interstial space and alveoli.

Also can be result from rapid administration of I.V. fluids.

chac. by dyspnea, anxious , foams (blood mixed with air), air hunger, and central cynosis.

Treated: by correcting the underline causes, vasodialtors, inotrops, diauretics, morphine, and oxygen

Nursing care: ventilator care, medications administration

Acute Respiratory Failure

failure of the respiratory system as a wholeIt is a sudden & life threatening deterioration

of gas exchange function of the lungAcute : a fall in arterial PaO2 to less than

50mmHg &a rise in arterial PaCo2to greater than 50mmHg

Causes Decrease respiratory derive “brain”Dysfunction of chest wall “nerves & muscles”Dysfunction of lung parenchyma “expansion”Postoperative & inadequate ventilation

Clinical Manifestations Impaired oxygenation & may be include

restlessness Fatigue & headache Dyspnea & air hunger Tachycardia &hypertension Confusion & lethargy Diaphoresis …… Respiratory Arrest Uses of accessory muscles

Medical management:Intubations and mechanical ventilation may be

required to maintain adequate ventilation and oxygenation while the case corrected

Nursing management:Monitoring patient responses and arterial blood

gases Monitoring vital signturning ,mouth car , skin care , and rang of motion

.Teaching about the underlying disorders Assists in intubations procedurePerform chest physiotherapy and suctioning to remove

mucus.

Pulmonary Embolism Obstruction of a pulmonary artery by a blood borne

substance. Deep vein thrombosis is a common cause of pulmonary

embolism.

Clinical Manifestations Dyspnea & Tachypnea Sudden & pluretic chest pain Fever & cough & hemoptesis Apprehension Diaphoresis

Medical Management Emergency Management Nasal O2 IV infusion for Medication Perfusion Scan ABGs &ECG Small dose of Morphine Intubation & mechanical Ventilation

Pharmacologic Management Anticoagulant therapy heparin 5000-

10000 bolus then 18u/kg/hrs. Warfarin for three months Thrombolytic therapy (TPA) Surgical Management (Surgical

Embolectomy)

Nursing Management:1. Administer prescribed medications. Anticoagulant (IV Heparin, followed by Warfarin) and Thrombolytic (streptokinase). Sedatives (Morphine) to relief pain. 2. Administer oxygen to relief hypoxemia, respiratory

distress, and cyanosis.3. Apply antiembolism stockings to help improve venous return.4. Instruct the pt. do not do activities that increase

venous stasis such as crossing legs, sitting or standing for long periods. Instruct pt. to elevate the legs above the level of heart.

5. Patient education.


Pneumothorax The underlying lung tissue is compressed and eventually collapses.

Types Simple Pnuemothrax Traumatic Pnuemothorax Tension

Clinical Manifestations

Sudden pluretic pain trachea deviation Anxious patient , dyspnea & air hunger Increase use of accessory muscles Central cyanosis Tympanic sound in percussion Absent of breath sound & tactile

fremetus Agitation Diaphoresis & hypotension

Medical Management Needle decompression High concentration supplemental O2 Chest tube for drainage An emergency thoractomy may also

performed

Chronic Obstructive pulmonary Disease (COPD) Disease state in which air flow is obstructed by

emphysema or bronchitis or both The airway obstruction is usually progressive &

irreversible

Clinical Manifestations Cough Increase work of breathing Severe dyspnea that interfere with patient activity

Nursing Management Patient Education About COPD Breathing exercise Inspiratory muscles training Self care activity Coping measures

Surgical Management:

1. Bullectomy: a surgical option for select patient’s with bullous emphysema. bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. 2. Lung Volume Reduction Surgery: involves the removal of a portion of the diseased lung parenchyma. 3. Lung Transplantation


Nursing Management:

1. Improving airway clearance

a. Encourage smoking cessation.

b. Keep patient’s room as dust free as possible.

c. Administer bronchodilators as prescribed.

d. Use postural drainage position.

e. Encourage coughing.

f. Encourage oral fluids intake.

2. Improving breathing pattern

a. Encourage breathing, coughing exercises.

b. Use pursed- lip breathing at intervals and during periods of dyspnea.

3. Administer antibiotics as prescribed.

4. Improving gas exchange

a. Check ABG’s.

b. Administer oxygen.

c. Inspiratory muscle training.

5. Improving nutrition.

a. Encourage frequent small meals if pt. is dyspneic.

b. Avoid foods producing gas and abdominal discomfort.

c. Monitor body weight.

6. Increasing activity tolerance.

a. Encourage pt. to carry out regular exercise program.

b. Encourage use of portable oxygen system for

ambulation for patient’s with hypoxemia.١٤٤٤/١٠/١ Mr.Homood Alharbi 24

Complications

Pneumonia

Atelectasis

Pneumothrax

Respiratory insufficiency & failure

Chronic Bronchitis

It is a productive cough that lasts in each of 2 consecutive years in a patient whom other causes of cough is excluded

Clinical Manifestations Chronic productive cough in winter Increase frequency of respiratory infection

Chronic BronchitisMedical Management to keep the bronchioles opened &

functioning Antibiotics therapy for recurrent

infection Bronchodilators to remove secretion Postural Drainage & chest percussion Hydration & fluid intake Corticosteroid may be used Smoker patient should stop smoking

Emphysema Damage to the alveoli. Smoking is the major cause of

Emphysema

Signs/Symptoms: 1. Dyspnea, decreased exercise tolerance.

2. Cough may be minimal, except with respiratory

infection.

3. Sputum expectoration.

4. Increased anteroposterior diameter of chest (barrel

chest)


Clinical Manifestations Increase dyspnea on exertion Anoroxia & Weight loss Weakness & Inactivity Increase cough, wheezing, sputum &

occasionally fever

Medical Management Bronchodilators Antimicrobial Agents Oxygen therapy Pulmonary rehabilitation Smoking cessation Corticosteroids

AsthmaA condition characterized by intermittent airway

obstruction in response to a variety of stimuli. “inflammatory”

Asthma differ from COPD in that it is reversible process either spontaneously or with treatment

Allergy is the strongest predisposing factor for the development of asthma

Clinical Manifestations1. The most three common symptoms are:

cough, dyspnea, and wheezing2. Hypoxemia may occur along with

cyanosis, diaphoresis , tachycardia , widened pulse pressure

Prevention : allergic test to identify the substances cause the symptoms and avoid it as possible

Complications: Asthmaticus Rib fracture Pneumonia Atelectases

Medical Management

Pharmacologic Therapy (long term)

Corticosteroid :most effective ant inflammatory medication (inhaled form)

Peak flow monitoring

Nursing Management

Immediate care based on severity of symptoms

Assessment & Allergic History Administer medication & observe

patient response Antibiotics as prescribed for infection Assist in intubations procedure if needed Psychological support for patient & his

family

TuberculosisInfectious disease that primarily affects the lungs; may be

transmitted to other parts of the bodyPulmonary infiltrates accumulate, cavities develop, &

masses of granulated tissue form within the lungsPrimary infectious agent-Mycobacterium Bacilli

Transmitted by inhalation of droplets (talking, coughing, sneezing, & singing)

Risk factors: immune system disorder, preexisting medical conditions, institutionalized, health care workers


Diagnostic:Sputum culture + acid-fast bacilli (AFB)Skin testing-PPDCBC-WBC elevatedCXRBronchoscopy

Nursing Diagnosis:Ineffective airway clearance r/t thick, tenacious secretionsIneffective breathing pattern r/t airway inflammationAltered nutrition less than body requirements r/t

anorexia and fatigueAnxiety r/t social isolation secondary to isolation

protocols١٤٤٤/١٠/١ Mr.Homood Alharbi 36

Planning: Clients OutcomesMaintain clear airway,normal RR, achieve weight gain,

anxiety decreased

Interventions:Maintain respiratory isolation-infectious period -diversional

activitiesPromote airway clearance-bedrest, increase fluid intake,

high humidityPharmacology (INH, Rifampin, Streptomycin, Ehtambutol,

& Pyrazinamide for 4 months)


Conclusion

Any question?


atelectasis occurred when trapped air enter blood stream, and the airway obstruction or...

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