Respiratory DISORDERS

IMPORTANT TERMS:

 Oxygenation- is the process of supplying

oxygen to the body’s cells.
 Ventilation- is the process of exchanging
oxygen and carbon dioxide, which is
 Ventilatory rate (minute volume) is tightly
essentially breathing. Oxygen comes in to
controlled and determined primarily by blood
the body via the airway; it’s offloaded
levels of carbon dioxide as determined by
onto the red blood cells while carbon metabolic rate.
dioxide diffuses across the membrane into
the alveoli and is then exhaled. Important!!!
 Diffusion- involves substances moving
across concentration gradients from areas  Chemoreceptors:
 These are receptors in the medulla and in the
of higher concentration to areas of lower
aortic and carotid bodies of the blood vessels
concentration. This is the process of gas
that detect changes in blood pH and signal the
exchange. medulla to correct those changes.
 Perfusion- is the body process of  The apneustic (stimulating) and
supplying oxygenated blood to the cells pnuemotaxic (limiting) centers of the pons
and is reliant on adequate cardiac output work together to control rate of breathing.
in order to be optimal.

Respiration
 The mechanism that controls respiration is
primarily the medulla oblongata.
 Respiration is the act of breathing that
involves:  The medulla sends signals to the muscles
 Inspiration – inhalation; breathing in of that initiate inspiration and expiration and
air controls non respiratory air movement
 Expiration – exhalation; breathing out of reflexes, like coughing and sneezing.
air  Respiratory control centers:
 The medulla which sends signals to the
Medulla Oblongata muscles involved in breathing
 The pons which controls the rate of
There are two regions in the medulla that control breathing.
respiration:
IMPORTANT
1. The ventral respiratory group stimulates
expiratory movements.
 Involuntary respiration is any form of
 The ventral respiratory group controls
respiratory control that is not under direct,
voluntary forced exhalation and acts to
conscious control.
increase the force of inspiration.
 Breathing is required to sustain life, so
2. The dorsal respiratory group stimulates
involuntary respiration allows it to happen
inspiratory movements.
when voluntary respiration is not possible
 (nucleus tractus solitarius) controls
such as during sleep.
mostly inspiratory movements and their
timing.
 Respiratory DISORDERS
 Involuntary respiration also has metabolic  Air moves out of the respiratory tract
functions that work even a person is
conscious.

The Upper Respiratory Tract

Cellular Respiration

 Is a set of metabolic reactions and processes

AIR that take place in the cells of organisms to
convert chemical energy from oxygen
 Filters molecules or nutrients into adenosine
 Moistens triphosphate, and then release waste products
 Warms
Problems Associated with
The Lower Tract Respiration

Signs and Symptoms of HYPOXIA

 Decreased energy
 Restlessness
 Rapid, shallow breathing
 Rapid heart rate
 Sitting to breathe
 Nasal flaring
 Use of accessory muscles to breathe
 Enables exchange of gases between blood and
 Increased BP
air to regulate serum PO2, PCO2 and pH
 Sleepiness, confusion, stupor, coma
During inspiration:  Cyanosis of skin, lips, nail beds

 Respiratory muscles contract Note:

 Thoracic cavity increases
 Diaphragm contracts and moves downward in  Hypoxia is a condition in which the body or a
the thorax region of the body is deprived of adequate
 Intra thoracic pressure decreases oxygen supply at the tissue level.
 Air moves in of the respiratory tract  Hypoxemia refers to the low level of oxygen
in blood.
During expiration:  Hypoxemia can cause hypoxia

 Respiratory muscles relax

 Thoracic cavity decreases
 Stretched elastic lung tissue recoils
 Intra thoracic pressure increases
 Respiratory DISORDERS
Common Diagnostic Tests: Other tests

Arterial Blood Gases (ABG) Pulse Oximetry

 Arterial blood is extracted to assess  Transcutaneous technique for assessing

oxygenation, ventilation and acid – base oxygen saturation of the blood
balance in blood
 Measures the PaO2, PaCO2, SaO2 and Pulmonary Function Test
pH of blood
 Test to determine lung volumes and
capacities

Pulmonary "Volumes”

1. Tidal Volume:
 volume of air inspired or expired with each
normal breath, about 500ml
2. Inspiratory Reserve Volume
Arterial Blood Sampling  extra volume of air that can be inspired over
& beyond the normal tidal volume, about
 Technique is different from venous blood 3000ml
extraction. 3. Expiratory Reserve Volume
 Heparin is used to prevent blood clots  amount of air that can still be expired by
 Blood is extracted from an artery forceful expiration after the end of a normal
 No tourniquet is necessary tidal expiration
 Greater pressure is applied after the extraction  about 1100ml
(than with venous) as more bleeding is 4. Residual Volume
expected.  volume of air still remaining in the lungs
after the most forceful expiration, averages
Arterial Blood Gases about 1200ml

 Specimen: arterial blood Pulmonary "Capacities:"

 Pretest: obtain syringe with heparin,
rubber stopper, container with ice 1. Inspiratory Capacity
 equals TV + IRV, about 3500ml
 Intratest: Collect arterial sample (usually
radial artery is used)  amount of air that a person can breathe
beginning at the normal expiratory level &
 Post-test: Apply direct pressure on site
distending his lungs to maximum amount
for 5-10 minutes, send specimen with
occluded needle on ice 2. Functional Residual Capacity
 equals ERV + RV
Normal Values for ABG (Brunner)  about amount of air remaining in the lungs
at the end of normal expiration, about
Parameter Arterial Blood 2300ml
pH 7.35 – 7.45 3. Vital Capacity
PaCO2 35 – 45 mmHg  equals IRV + TV + ERV or 1C + ERV,
PaO2 80 – 100 mmHg  about 4600ml
HCO3ˉ 22 – 26 mEq/L
 -maximum amount of air that a person
Base excess/deficit +/- 2 mEq/L
 can expel from the lungs after filling the
Oxygen saturation > 94%
 lungs to their maximum extent &
 Respiratory DISORDERS
 expiring to the maximum extent
4. Total Lung Capacity
 maximum volume to which the lungs can be Oxygen Therapy: A Medical
expanded with the greatest possible effort Intervention
 volume of air in the lungs at this level is
equal to FRC (2300ml) in young adult  Also known as supplemental oxygen, is the
use of oxygen as a medical treatment for:
Promoting Oxygenation  low blood oxygen
 carbon monoxide toxicity
 as independent function  cluster headaches
 Maintenance of enough oxygen
Promoting Oxygenation: Independent while inhaled anesthetics are given.
Nursing Actions
Oxygen sources:
 Positioning
 Wall outlet: modern supply of O2
 High Fowler’s
 Portable tanks: can hold large volumes under
 Orthopneic
strong pressure (2,000Lbs/inch2)
 Liquid oxygen unit: converts cool liquid
 Breathing Techniques
oxygen to gas by passing through heat coils;
 Deep breathing
safe to be used at home
 Pursed lip breathing
 Oxygen concentrator: collects and
 Diaphragmatic breathing
concentrates oxygen from room air and stores
 Use of nasal strips
it
Pursed Lip Breathing
Equipment
 It is designed to make breaths slower and
more intentional, making them more Flow meter
effective.
 Measures the flow of oxygen in liters per
 Inhale by puckering the lips and exhale
minute
through them slowly and deliberately, often to
 A gauge to regulate the amount of
a count.
oxygen delivered
Diaphragmatic Breathing
Oxygen Analyzer
 As air enters the lungs, the chest does not
 Measures the percentage of delivered oxygen
rise and the belly expands during this type
to determine whether the client is receiving
of breathing
the amount prescribed by the doctor
Nasal Strips  Normal reading: 21%(room air)
 Near O2 source: >21%
 are made of flexible, spring-like bands that fit
right above the flare of the nostrils. Humidifier
 The underside is 3M adhesive so that once
positioned on the nose, they stay there.  Produces small water droplets and may be
used during oxygen administration to prevent
 As the bands attempt to straighten back to
drying of mucus membrane
their original shape, they lift the sides of the
nose and open the nasal passages.  Uses distilled water (not saline, not tap
water)
 Respiratory DISORDERS

Oxygen toxicity Note:

 Is lung damage that happens from  Since the jets in venture masks
breathing too much (supplemental) oxygen. generally limit oxygen flow to 12 to 15
liters per minute, the total flow
 Also called oxygen poisoning.
decreases as the ratio decreases.
 Can cause coughing and trouble breathing.
 At an oxygen flow rate of 12 liters per
 Severe cases are fatal
minute and a 30% FiO2 setting, the total
flow would be 108 L/min.
Oxygen Delivery Devices
Face tent
Nasal cannula
 Administer oxygen to nose and mouth
 for low concentration administration (1–6
without mask
L/min)
 It is open and loose around the whole
 Simplest, does not interfere with eating or
face
talking
 Useful with facial trauma
Simple Face Mask  Oxygen delivered is inconsistent

 Allows atmospheric air to enter and exit Oxygen tent

through side ports (5 – 8L/min)
 Used more for very young patients
 Difficult for claustrophobic clients, interferes
 Oxygen concentration is difficult to
with eating and talking
control
 Ensure that the edges of the tent are
Partial Rebreather mask
tucked well
 Client inhales a mixture of atmospheric air,
Hyperbaric Oxygen
oxygen from the source and oxygen contained
within the reservoir bag (6-15L/min)
(Hyperbaric Oxygen Therapy HBOT)
 Provides high FIO2 since 1/3 of exhaled tidal
volume is rebreathed  It involves breathing pure oxygen in a
pressurized environment.
Non-rebreather mask  useful procedure for different infections,
particularly in deep and chronic infections
 All exhaled air leaves the mask rather than such as necrotizing fasciitis, osteomyelitis,
partially entering the reservoir bag. chronic soft tissue infections, and infective
 It is designed to deliver fraction inspired endocarditis.
oxygen by 90 – 100%
Terms
Venturi mask
 Asbestosis – diffuse lung fibrosisresulting
 Mixes a precise amount of oxygen and
from exposure to asbestos fiber
atmospheric air.
 Aspiration – entry of oro-pharyngeal or
 Adapters within its tube allow specific
gastric content into lower airways
amounts of room air to mix with oxygen
 Consolidation – lung tissue that has become
 Delivers exact desired selected
more solid in nature due to collapse of alveoli
concentrations of O2
or infection
 Respiratory DISORDERS
 Empyema – accumulation of purulent  Health education
material in the pleural space
 Pleural effusion – abnormal accumulation of Chronic Pharyngitis
fluid in pleural space (recall: cardiac
tamponade)  Persistent inflammation of the pharynx
 Restrictive lung disease – disease of the lung  3 types:
that causes a decrease in lung volumes  Hypertrophic – general thickening and
congestion of pharyngeal mucous
CONDITIONS of the UPPER membrane
 Atrophic – late stage of the first type,
RESPIRATORY TRACT membrane is thin, whitish and glistening
 Chronic granular – numerous swollen
Acute Pharyngitis lymph follicles on pharyngeal wall

 Sudden, painful inflammation of the

pharynx
 It includes the back of the throat, posterior
tongue, soft palate, and tonsils
 Peaks during winter and cold seasons
 Spreads fast via cough and droplet
transmission
 Commonly viral: adenovirus, influenza,
Manifestations:
Epsteinn-Barr and HSV
 About 10% is bacterial (beta haemolytic  Constant sense of irritation or fullness in
Streptococcus) the throat
 Strep throat – occurs from strep cause  Mucus collection in the throat
 Dysphagia
 Anorexia
 Intermittent postnasal drip

Management:

 Removal of irritants
 Treating other causes of cough
 Short term use of nasal spray
Strep Throat Symptoms:
 Antihistamine, decongestants, acetaminophen
 Throat pain  Tonsillectomy for recurrent pharyngitis
 Fever
 Edema
Tonsillitis
 Swelling in tonsil pillars, uvula and soft palate  Infection of the tonsils that may involve the
 Exudates may be present adenoids and pharynx
 Lymph nodes may swell  Commonly caused by bacteria: GABHS
(group A BHS)
Management:
 Viral: Epstein – Barr
 Common among children
 Viral – symptomatic
 Bacterial - antibiotics
Manifestations:
 Nutritional therapy
 Warm gargles
 Respiratory DISORDERS
 Sore throat  Aphonia
 Fever  Severe dry cough
 Snoring  Sore throat that worsens in the evening
 Dysphagia  Edematous uvula
 With enlarged adenoids: mouth breathing,  Sense of “tickle” in the throat that
otitis, ear discharges, bad breath, voice worsens by cold air or liquids
impairment
Management: Laryngitis
 Note: If left untreated may cause deafness
 Voice rest
Management:
 Avoidance of irritants
 Cool steam inhalation
 More fluids
 Medication like corticosteroids
 Salt water gargles
(beclomethasone)
 Rest
 Proton Pump Inhibitor (PPI) for reflux
 Analgesics
laryngitis (GERD) like omeprazole
 Penicillin for bacterial infection
 Tonsillectomy – if recurrent CONDITIONS of the LOWER
Laryngitis RESPIRATORY TRACT

 Inflammation of the larynx, often occurs as Infectious Condition:

a result of voice abuse or exposure to dust, Pulmonary Tuberculosis
chemicals, smoke, other pollutants or as part
of URI  Is caused by various strains of mycobacteria,
 Is also associated with GERD usually Mycobacterium tuberculosis.
 Common in the winter  Can also affect other parts of the body
 (TB of the bones, kidneys, etc)
Infection is usually associated with:
Mode of Transmission:
 Allergic rhinitis
 Pharyngitis Droplet

Usually associated with:  Causes tubercles, fibrosis, and calcification

within the lungs
 Exposure to sudden temperature changes
 Dietary deficiencies and malnutrition
Signs and Symptoms
 Immuno suppression
 Tightness of chest (dyspnea)
 Unusual weight loss
 Blood-tinged sputum
 Exhaustion or fatigue
 Recurrent afternoon fever
 Chronic cough
 Low resistance to other infection
 Extensive weakness
 Sweats and chills especially a night

Manifestations:

 Hoarseness
 Respiratory DISORDERS
1. Isoniazid
2. Rifampicin
Diagnostic Exam 3. Pyrazinamide
4. Ethambutol
 Radiology 5. Streptomycin
 Tuberculin Skin Test – The Mantoux
Method is preferred where 2”units” of FDC
tuberculin PPD RT23 is used.
 Direct Sputum Smear Microscopy -  Fixed – Dose Combination
microscopic examination and microbiological  Two or more first – line anti – TB drugs are
culture of sputum. combined in one tablet

Sputum Examination NOTE: Ordinary TB

 Mouthwash with plain water  Treatment success of 90% with good DOTS
 Deeply inhale x 2 then cough program
 Wear gloves  Treatment duration: 6 – 8 months
 Collect 1-2 Tbsp or 15-30 ml  Treatment side – effects: Mild to
 In case the patient cannot cough out his moderate(usually GI disturbances)
sputum, use of suction may be necessary for
as long as the nurse observes proper Multi-Drug Resistant TB (MDRTB)
techniques.
 Treatment success of about 80% with good
Categories of TB Cases MDR-TB programme
 Treatment duration: 18 – 24 months
1. New  Treatment side – effects: severe to toxic
2. Treatment Failure (hearing loss, psychosis, liver damage)
3. Relapse
4. Transfer – in Extensively Drug Resistant TB (XDR-
5. Return after default TB)
6. Other
 Treatment success of less than 50%; usually
incurable
 Treatment duration: exceeds 2 years
 Treatment side – effects: severe to toxic
(hearing loss, psychosis, liver damage)

Pneumonia
 Pneumonia is an inflammatory condition of
the lung, especially of the alveoli
TB – DOTS Center (microscopic air sacs in the lungs).
 This disease is associated with fever, chest
 Is a facility that is capable of delivering
symptoms, and consolidation on a chest
DOTS services (many health centers are
radiograph
DOTS centers)
Classification
Management:
Community – Acquired (CAP)
 Medication Therapy:
 Respiratory DISORDERS
 Occurs in the community setting or
within 48 hours after hospitalization or
institutionalization

Health – Care Associated (HCAP)

 Causative pathogens are often MDR

 Often difficult to treat

Hospital – Acquired (HAP)

 Develops 48 hours or more after Diagnostic Exams

admission and does not appear to be
incubating at the time of admission  Chest x – ray - consolidation
 Sputum smear and culture
Ventilator – Acquired (VAP)  Blood exams
 Others
 A subtype of HAP
 Occurs to patient who has been Management:
intubated and has received mechanical
ventilatory support for at least 48 hours  Pharmacology (depends on the causative
agent)
Aspiration Pneumonia  Antibiotic
 Antiviral
 Pulmonary consequences resulting from  Analgesics and anti-inflammatory
entry of endogenous or exogenous  Others
substances into the lower tract  Isolation
 Most common form is bacterial infection from  Aggressive respiratory management
aspiration of bacteria that normally reside in
 Hydration and nutritional therapy
the upper airways
 Influenza (Hib) vaccines and vaccines
against Streptococcus Pneumoniae help
Causative Agents
prevent development of pneumonia among
 Bacteria are the most common cause of children and adults.
community acquired pneumonia, with
Streptococcus pneumoniae isolated in nearly Pulmonary Embolism and
50% of cases. Infarction
 Virus – Rhinoviruses, Coronaviruses,
Thrombus in peripheral circulation detaches
Influenza virus
(ex.DVT)

 Pneumonia fills the lung's alveoli with ↓

fluid, hindering oxygenation.
 The alveolus on the left is normal, while on Embolus travels thru the heart then lodges in the
the right it is full of fluid from pneumonia. pulmonary artery

Hemorrhage and necrosis of lung tissues

Pulmonary tissue infarction

 Respiratory DISORDERS
Clinical Findings:  is a procedure that involves the drainage of
lung secretions using gravity
 Severe, sudden dyspnea  is used to treat a variety of conditions that
 Anxiety cause the build-up of secretions in the lungs
 Restlessness  Depending on the anatomical angle of the
 Sharp pleuritic pain lobes or segments of the lungs to be drained,
 Increased temperature the patient may be placed in sitting, prone,
 Increased pulse supine, side lying or in a head down tilt of
 Increased respiratory rate between 15 and 30 degrees.
 Violent coughing  The person lies or sits in various positions so
 Hemoptysis the part of the lung to be drained is as high as
 Diaphoresis possible.
 That part of the lung is then drained using
percussion, vibration and gravity.

Medical-Surgical Management CoViD – 19

 Anticoagulant therapy  Corona -Virus -Disease -19
 Thrombolytic therapy
 Angiography – embolectomy is done in The World Health Organization declared the
severe cases COVID-19 outbreak a public health emergency of
international concern (PHEIC) on 30 January 2020
 Vena cava interruption – a filter may be
and a pandemic on 11 March 2020
implanted in the inferior vena cava
preventing the passage of large thrombi
Signs and Symptoms
Nursing Management
 Fever
 Place in High Fowler’s position  Cough
 Administer oxygen  Fatigue
 Monitor for hypoxemia and right – sided  Shortness of breath/ dyspnea
heart failure  Anosmia- lack of smell
 Administer medications as prescribed  Loss of taste sensation
 Maintain calm environment  Diarrhea
 Provide health teachings  Other flu-like symptoms (myalgia, arthralgia)

Postural Drainage CoViD – 19 Complications:

 Respiratory DISORDERS
 Acute Respiratory Distress Syndrome 4. Delta Variant (formerly called the India
(ARDS) possibly precipitated by cytokine Variant and officially referred to as
storm B.1.617.2)
 Multi-organ failure
 Septic shock Resuscitation for CoViD-19 Patients
 Thrombo-embolism
American Heart Association, 2020

 Transmission: droplet  Don personal protective equipment (PPE)

 Incubation period: 5 – 14 days according to local guidelines and availability
 Most contagious during the first three days before beginning CPR.
after the onset of symptoms (some patients  Minimize the number of clinicians performing
are asymptomatic) resuscitation; use a negative-pressure room
whenever possible; keep the door to the
resuscitation room closed if possible.
 May use a mechanical device, if resources
and expertise are available, to perform chest
CoViD – 19 Diagnostic Test: compressions on adults and on adolescents
who meet minimum height and weight
 Real-time Reverse Transcription Polymerase requirements.
Chain  Use a high-efficiency particulate air
 Reaction (rRT-PCR) from a nasopharyngeal (HEPA) filter for bag-mask ventilation
swab (BMV) and mechanical ventilation.

 No cure at present Pulmonary Edema

 Vaccines are available but do not provide
 An acute emergency condition characterized
 100% immunity (Herd immunity is the main
by a rapid accumulation of fluid in the
goal)Treatment is symptomatic; antivirals are
alveolar spaces resulting from increased
given for severe cases
pressure within the pulmonary system
 There is tentative evidence for efficacy by
remdesivir, and on 1 May 2020, the United
Possible Causes:
States Food and Drug Administration (FDA)
gave the drug an emergency use  Valvular disease
authorization for people hospitalized with  Left ventricular failure
severe COVID-19
 Circulatory overload
 Aspiration of gastric contents
CoViD – 19 Variants:
 Drowning
As of July 2021, there are four dominant
variants of SARS-CoV-2 spreading among global Clinical Findings:
populations:
Subjective cues:
1. Alpha Variant (formerly called the UK
Variant and officially referred to as B.1.1.7),  Premonitory symptoms: shortness of
first found in London and Kent breath
2. Beta Variant (formerly called the South  Paroxysmal nocturnal dyspnea
Africa Variant and officially referred to as  Wheezing
B.1.351)  Orthopnea
3. Gamma Variant (formerly called the Brazil  Acute anxiety
Variant and officially referred to as P.1)  Apprehension and restlessness
 Respiratory DISORDERS
Objective cues:  Avoidance of allergen
 Rest, positioning
 Rapid, thready pulse  Hydration
 Rapid respiration  Nutritional support
 Pink frothy sputum  Medications:
 Wheezing  Bronchodilators
 Crackles  Antihistamine- drowsiness- side effects
 Pallor or cyanosis  Oxygen
 Low PO2
 Elevated pulmonary capillary wedge Chronic Obstructive
pressure (PCWP) and central venous Pulmonary Disease
pressure (CVP)
 Is a group of diseases that results in chronic
airflow limitation (CAL); also called
Chronic Obstructive Lung Disease (COLD)

Medical – Surgical Management

Possible etiologies include:
 Medications that will decrease cardiac
workload and improve cardiac output:  Pollution – particularly air pollution
 Morphine Sulfate  Allergic reactions
 Digitalis  Chronic respiratory infection
 Diuretics  Exposure to molds and fungi
 Vasodilators  Smoking
 Bronchodilators
 High Concentrated O2 or by PEEP COPD - Types
 Hemodynamic monitoring
Chronic Bronchitis
Nursing Management
 Inflammation of the bronchial walls
 Place in Orthopneic, High Fowler’s or semi- with hypertrophy of the mucous goblet
Fowler’s position with legs dependent cells
 Monitor VS, cardiac activity and I & O  Characterized by chronic cough
 Maintain patent airway – suction PRN
Emphysema
 Administer medications as prescribed
 Maintain calm environment  Characterized by distended, inelastic or
 Provide health teachings destroyed alveoli with bronchiolar
obstruction and collapse
Asthma  Alterations greatly impair the diffusion of
gases through the alveolar capillary
 Reversible bronchospasms and increased membrane
secretions that lasts minutes to several hours
 Obstruction of the bronchioles is Bronchiectasis
characterized by attacks that occur suddenly
and last from 30 – 60 minutes  Chronic dilatation of the bronchi and
 An asthmatic attack that is difficult to control bronchioles as a result of infection or
is called STATUS ASTHMATICUS obstruction
 Results to loss of elasticity
Treatment:
 Respiratory DISORDERS
 Clients with COPD become accustomed to an  Reduces the surface area for gaseous
elevated residual carbon dioxide level exchange and leads to hypoxia and retention
 They do not respond to high CO2 of carbon dioxide
concentrations as the normal respiratory
stimulant Types:
 They respond instead to a drop in oxygen
concentration in the blood  Spontaneous
 Open
Clinical Findings  Hemothorax
 Hydrothorax
 Fatigue  Tension
 Weakness
 Dyspnea 1. Spontaneous (closed)
 Headache  Thought to occur when a weakened area
 Impaired sensorium of the lung (bleb) ruptures
 Orthopnea, expiratory wheezing,  Air then moves from the lung to the intra
abnormal breathing sounds, cough pleural space causing collapse
 Distended neck veins, peripheral edema  Highest incidence in men (20 – 40 years
(right heart failure) old)
 Barrel chest, cyanosis, clubbing of 2. Open
fingers, use of accessory muscles, pursed  Occurs with laceration through the chest
lip breathing wall into the intra pleural space
 Occurs with stab wound and similar
Laboratory Findings injuries
3. Hemothorax
 Increased PCO2  Collection of blood within the pleural
 Decreased PO2 cavity
 Polycythemia 4. Hydrothorax
 Accumulation of fluid in the pleural
Management cavity
5. Tension Pneumothorax
 Steroids – to reduce inflammation  Build up of pressure as air accumulates
 Antibiotics – prevent or treat infection within the pleural space
 Bronchodilators  The pressure increase is likely to induce a
 Mucolytics and expectorants mediastinal shift
 Oxygen at 1 – 2 Liters even if hypoxia is
severe
Mediastinal shift:
 Respiratory therapy program: nebulizer
therapy, postural drainage, exercise  May occur toward the uninvolved side as
 High CHON soft diet, small but frequent a result of increased pressure within the
feedings pleural space; this involves the trachea,
esophagus, heart and great vessels
Pneumothorax
Flail chest:
 Collapse of the lung resulting from
disruption of the negative pressure that  Instability of chest wall related to
normally exists within the intra pleural space fractures of the ribs or detached
 caused by the presence of air in the pleural sternum;
cavity; may be associated with fractured ribs  Caused by crashing chest injuries
 Respiratory DISORDERS
Atelectasis  Pulmonary capillary damage with loss of
fluid and interstitial edema
 Occurs with collapse of one or more  Impaired alveolar gas exchange and tissue
areas in a lung hypoxia resulting from pulmonary edema
 Alteration in surfactant production; collapse
Subjective Cues:
of alveoli
 Atelectasis resulting in labored and
 Chest pain – sharp and increasing on
exertion inefficient respiration
 Dyspnea
Subjective Cues:
 Drowsiness
 Restlessness
 Anxiety
 Dyspnea

Objective Cues: Objective Cues:

 Tachycardia  Tachycardia
 Hypotension  Grunting respirations
 Rapid and shallow respirations  Intercostal retractions
 Diminished or absent breath sounds on  Cyanosis
the affected side  PCO2 – increased initially and later
 With flail chest: loose segments move decreased
inward with inspiration and outward with  Decreased PO2
expiration  Pulmonary edema

Management Management

 Bed rest  Mechanical ventilation with PEEP to

 Analgesics and antibiotics maintain positive pressure within the lungs
 Chest tube insertion to water – sealed at the end of expiration, which increases the
drainage system residual capacity, reducing hypoxia
 Restoration of blood volume  Corticosteroids
 Volume controlled ventilation  Relieve underlying cause

Acute Respiratory SURFACTANTS line the alveoli to lower

surface tension, thereby preventing atelectasis
Distress Syndrome during breathing.
Respiratory failure as a complication of:
Special Feature: Lung Transplant
 Trauma
 or pulmonary transplantation, is a surgical
 Aspiration
procedure in which a patient's diseased lungs
 prolonged mechanical ventilation are partially or totally replaced by lungs
 severe infection which come from a donor.
 open-heart surgery  Donor lungs can be retrieved from a living
 fat emboli donor or a deceased donor. A living donor can
 shock, etc. only donate one lung lobe.

ARDS involves the following: