DISORDERS of

ACUTE PHARYNGITIS
A sudden painful inflammation of the
pharynx, the back portion of the throat

the UPPER
that includes the posterior third of the
tongue,
soft palate, and tonsils

RESPIRATORY Commonly referred to as a sore throat

CHRONIC PHARYNGITS
Chronic pharyngitis is a persistent
inflammation of the pharyn common in
RHINITIS adults, who work in dusty surroundings,
A group of disorders characterized by use their voice to excess, suffer from
inflammation and irritation of the mucous chronic cough, or habitually use alcohol
membranes of the nose and tobacco.

Allergic rhinitis Three types of chronic pharyngitis

Further classified as seasonal rhinitis 1. Hypertrophic-characterized by general
(occurs during pollen seasons) or thickening and congestion of the
perennial rhinitis (occurs throughout the pharyngeal mucous membrane
year) 2. Atrophic-late stage of the first type
Commonly associated with exposure to (the membrane is thin, whitish, glistening,
airborne particles such as dust, dander, or and at times winkled)
plant pollens in people who are allergic to 3.Chronic Granular ("clergyman's sore
these substances throat") - characterized by numerous
swollen lymph follicles on the pharyngeal
VIRAL RHINITIS (COMMON COLD) wall
Most frequent viral infection in the general
population caused by coronavirus Clinical Manifestation
Highly contagious because virus is shed -Fiery-red pharyngeal membrane and
for about 2 days before the symptoms tonsils
appear and during the first part of the -Swollen lymphoid follicles
symptomatic phase -Enlarged and tender cervical lymph nodes
-Fever
Clinical Manifestation -Malaise
-Rhinorrhea (excessive nasal drainage, -Sore throat
runny -Constant sense of irritation or fullness in
nose) the at Muc..nat collects in the throat
-Nasal congestion Difficulty swallowing Chronic Granular
-Sneezing ("clergyman's sore throat") - characterized
-Pruritus of the nose, roof of the mouth, by numerous swollen lymph follicles on
throat, eyes, and ears the pharyngeal wall
-Low-grade fever
-Nasal c tion Management
-Rhinorri and nasal discharge -Pharmacologic Therapy
-Halitosis, sneezing -Penicillin is the treatment of choice
-Tearing watery eyes -Cephalosporins
-"Scratchy" or sore throat -Macrolides
-General malaise, chills -Gargles with benzocaine may relieve
-Headache and muscle aches symptoms
-Nasal sprays or medications containing
Management ephedrine sulfate or phenylephrine
-Antihistamines hydrochloride
-Corticosteroid nasal sprays -Antihistamine decongestant medications -
-Desensitizing immunizations Acetaminophen
-Symptomatic therapy
-Adequate fluid intake and rest Nursing interventions
-Prevention of chilling -Liquid or soft diet is provided during the
-Warm salt-water gargles to soothe the acute stage
sore -Cool beverages, warm liquids, and
throat flavored frozen desserts such as Popsicles
-NSAIDs to relieve aches and pains are often soothing
-Antihistamines are used to relieve -Warm saline gargles or throat irrigations
sneezing, -Increase oral fluid intake
rhinorrhea, and nasal congestion -Ice collar can relieve severe sore throats
-Inhalation of steam or heated, humidified -Instruct the patient about preventive
air measures
-Inst the patient to avoid contact witchers
until the fever subsides to prevent the -Odynophagia (a severe sensation of
spread of infection Avoidance of alcohol, burning, squeezing pain while swallowing)
tobacco, secondhand smoke, and -Dysphagia (difficulty swallowing)
exposure to cold or to environmental or -Otalgia (pain in the ear), tender and
occupational pollutants enlarged cervical lymph nodes
-Airway obstruction may occur
TONSILLITIS AND ADENOIDITIS
Acute inflammation/infection that is Management
usually caused by GABHS (group A beta- -Antimicrobial agents (Penicillin)
hemolytic streptococcus) -Corticosteroid therapy
-Needle aspirations are performed to
Clinical manifestations decompress the abscess
-Sore throat, fever, snoring and difficulty -Nursing Inter Hons
swallowing -Assist in pe.....ming intubation,
-Enlarged adenoids may cause mouth- cricothyroidotomy, or tracheotomy to treat
breathing, earache, draining ears, airway obstruction
frequent head colds, bronchitis, foul- -Assist in needle aspiration when indicated
smelling breath, voice impairment, and -Gentle gargling after the procedure with a
noisy respiration cool normal saline gargle may relieve
discomfort
Management -Provide cool liquids
-Penicillin (first-line therapy) or -Instruct the patient to refrain from or
cephalosporins cease smoking
-Tonsillectomy or adenoidectomy is -It is also important to reinforce the need
indicated if the patient has had repeated for good oral hygiene
episodes of tonsillitis despite antibiotic
therapy LARYNGITIS
An inflammation of the larynx, often
Nursing interventions (post-op) occurs as a result of voice abuse or
-In the immediate postoperative period, exposure to dust, chemicals, smoke and
the most cortable position is prone, with other pollutants. Most common cause i
the patient's head turned to the side to may be secondary s, bacterial invasion
allow drainage from the mouth and
pharynx Management
-Apply ice collar to the neck -Instruct the patient to rest the voice and
-Assess for post op bleeding such as avoid irritants (including smoking)
frequent swallowing -Inhaling cool steam or an aerosol is
-Instruct the patient to refrain from provided
coughing and too much talking
-Ice chips may be given to the patient -Administer antibacterial therapy as
-Alkaline mouthwashes and warm saline ordered
solutions are useful in coping with the -Topical corticosteroids may be given by
thick mucus and halitosis that may be inhalation
present after surgery Milk and milk -Increased oral fluid intake
products (ice cream and yogurt) may be
restricted Clint manifestations
-Hoarseness of voice - initial sign
- Provide soft, adequate diet -Aphonia (complete loss of voice)
- Instruct the patient to avoid vigorous -Severe cough
tooth brushing or gargling -Throat feels worse in the morning and
-Encourage the use of a cool-mist improves when the patient is in a warmer
vaporizer or humidifier in the home climate
-Instruct patient to avoid smoking and
heavy lifting or exertion for 10 days CANCER OF THE LARYNX
Etiology
PERITONSILLAR ABSCESS (QUINSY) -Most tumors of the larynx are squamous
Most common major suppurative cell carcinoma
complication of sore throat/tonsillitis. This -Men > women, age 60-70
collection of purulent exudate between -Cigarette smoking and alcohol
the tonsillar capsule and the sorrounding consumption are associated with laryngeal
tissues, including the soft palate, may cancer
develop after an acute tonsillar infection
at progress to a local cellulitis and abscess
Clinical Manifestations
Clinical Manifestations
-Severe sore throat, fever trismus -Hoarseness of voice for more than 2
(inability to open the mouth), and weeks
drooling. -Persistent cough and sore throat
-Severe pain, raspy voice -Dyspnea
-Dysphagia -Fatigue
-Pain radiating to ear and burning -Cyanosis (bluish color of the skin due to
sensation in the throat lack of oxygen)
-Weight loss
-Enlarged cervical lymph nodes -Swollen feet or ankles (from fluid
retention)
-Clubbing of the fingers (in advanced
Management cases)
-Radiation therapy
-Chemo Emphysema
Surgery:
Partial Laryngectomy - A portion of the is another form of COPD where the alveoli
larynx is removed, along with one vocal (tiny air sacs in the lungs) become
cord and the tumor damaged and lose their elasticity, making
Complication: change in voice quality or it difficult for the lungs to expel air. Over
hoarseness of voice time, the walls between alveoli break
Total Laryngectomy - Laryngeal down, reducing the surface area available
structures are removed, including the for gas exchange, which leads to difficulty
hyoid bone, epiglottis, cricoid cartilage, in breathing.
and two or three rings of the trachea
Complication: permanent loss of voice, Clinical Manifestations of Emphysema:
salivary leak, wound infection, stomal -Shortness of breath (dyspnea), often
stenosis and dysphagia more noticeable during exertion but can
become constant as the disease
progresses
-Wheezing

DISORDERS of -Barrel-shaped chest (due to overinflation

of the lungs)
-Use of accessory muscles to breathe

the LOWER -Pursed-lip breathing (to control

exhalation)
-Weight loss (due to the energy expended
RESPIRATORY in breathing)
-Reduced breath sounds on auscultation
-Prolonged expiratory phase
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD) Panlobular Emphysema-destruction of
Refers to a disease characterized by respiratory bronchiole, alveolar duct and
airflow limitation. airflow limitations is alveolus
generally is not fully reversible. The -All air spaces within the lobule are
progressive and is normally associated essentially enlar disease but there is little
with an inflammatory response of the inflammatory
lungs due to irritants, COPD include as -Hyperinflated (hyperexpanded) chest,
chronic bronchitis and pulmonary marked dyspnea on exertion, and weight
emphysema loss typically occur
Diagnostic Criteria: Cough of 3 months for -Negative pressure is required during
2 consecutive years inspiration to move air into and out of the
lungs Expiration becomes active and
Chronic Bronchitis requires muscular effort Centrilobular
(Centroacinar) Emphysema - pathologic
is a long-term inflammation of the bronchi,
changes take place mainly in the center of
the air passages that lead from the
the secondary lobule, preserving the
trachea into the lungs. It is a form of
peripheral portions of the acinus
chronic obstructive pulmonary disease
-There is a derangement of ventilation-
(COPD) often caused by long-term
perfusion rations, producing chronic
exposure to irritants like cigarette smoke
hypoxemia, hypercapnia, polycythemia,
or pollutants. Chronic bronchitis involves
and episodes of right-sided heart failure
excessive mucus production and
-Leads to central cyanosis and respiratory
persistent coughing, which can last for
failure, and patient also develops
months or recur over years.
peripheral edma
Clinical Manifestations of Chronic
Diagnostic Procedure for COPD
Bronchitis:
-Spirometry used to evaluate airflow
-Persistent cough, especially in the
obstruction
morning, producing thick mucus (sputum)
-ABG levels - decreased Pao2, pH, and
-Shortness of breath (dyspnea), especially
increased CO2
during physical activity
-Chest X-ray-in late stages, hyperinflation,
-Wheezing or crackles during auscultation
flattened diaphragm, increased
-Frequent respiratory infections
retrosternal space, decreased vascular
markings, possible bullae -Dyspnea
-Alpha-1-antitrypsin assay useful in -Wheezing
identifying genetically determined Chest tightness, diaphoresis, tachycardia,
deficiency in emphysema and a widened pulse pressure, hypoxemia
-Medical Management for COPD and central cyanosis
-Smoking cessation
-Br In odilators to relieve bronchospasm Pharmacologic Therapy
and systemic corticosteroids Alpha 1- There are two general classes of asthma
antitrypsin augmentation therapy medications:
-Antitussive agents, vasodilators and Quick relief medications for immediate
narcotics treatment of asthma symptoms and
exacerbations
Surgical Management
Bullectomy - surgical removal of -Short-acting beta2-adrenergic agonists
enlarged airspaces that do not contribute (albuterol [Proventil Ventolin], levalbuterol
to ventilation but occupy space in the [Xopenex], and pirbuterol [Maxair])
thorax -Long acting medications to achieve and
Lung Volume Reduction Surgery - maintain control of persistent asthma
removal of a portion of the diseased lung -Corticosteroids
parenchyma -Long-acting beta2-adrenegic agonists

Nursing Interventions For COPD -Leukotriene modifiers (inhibitors)

-Pulmonary rehabilitation to reduce
symptoms, improve quality of life and Nursing Interventions
increased physical and emotional Assesses the patient's respiratory status
participation in everyday acthithles by monitoring the severity of symptoms,
-Pursed-lip breathing helps slow breath sounds peak flow, pulse oximetry,
expiration, preve helps the patient control and vital signs
the rate and depth of respiration collapse Administer medications as prescribed and
of small airways, and monitor the patient's responses to those
-Instruct the patient to coordinate medications
diaphragmatic breathing with activities Administer fluids if the patient is
such as dehydrated emphasize adherence to
prescribed therapy, preventive measures,
walking, bathing, bending, or climbing and the need to keep follow-up
stairs Provide small frequent meals and appointments with health care providers
offer liquid nutritional supplements to
improve caloric intake and counteract
weight loss BRONCHIECTASIS
-Administer low flow of oxygen (1-2L/min) A chronic, irreversible dilation of the
--Administer bronchodilator as prescribed bronchi and bronchioles
-Adequately hydrate the patient Etiology
-Instruct the patient to avoid bronchial Airway obstruction
irritants Diffuse airway injury
-If indicated, perform CPT int the morning Pulmonary infections and obstruction of
and at night as prescribed the bronchus or complications of long-
-Encourage alternating activity with rest term pulmonary infections
periods Generic disorders such as cystic fibrosis
-Teach relaxation technique or provide a Abnormal host defense (eg, ciliary
relaxation tape for patient dyskinesia or humoral immunodeficiency)
-Enroll patient in pulmonary rehabilitation Idiopathic causes
program where available
-Monitor respiratory status, including rate
Clinical Manifestations
and pattern of respirations, breath sounds,
Chronic cough with copious amount of
and signs and symptoms of acute
purulent sputum
respiratory distress
Hemoptysis
Clubbing of the fingers
BRONCHIAL ASTHMA
Repeated episodes of pulmonary infection
Chronic inflammatory disease of the
airways that causes airway
Diagnostic Procedure
hyperresponsiveness, mucosal edema,
CT
and mucus pr diffuse airway inflammation
scan-reveals
that leads to airway narro..ing tion is
bronchial
reversible and
dilation
Clinical Manifestations
Three most common symptoms of asthma:
Management
-Cough
Smoking cessation
Chest physiotherapy infections
Bronchoscopy to remove mucopurulent Bibasal crackles in asbestosis
sputum Antimicrobial therapy based on
result of culture and sensitivity of the
sputum Influenza and pneumococcal Management
vaccines There is no specific treatment; exposure is
Bronchodilators eliminated, and the patient is treated
Surgical interventions for patients who symptomatically
continue to expectorate large amount of Give prophylactic isoniazid (INH) to patient
sputum and hemoptysis despite with positive tuberculin test, because
adherence to treatment regimen silicosis is associated with high risk of TB
Persuade people who have been exposed
Nursing Intervention to asbestos fiber to stop smoking to
Assess the patient in alleviating the 5) ms decrease risk of lung cancer
and in clearing pulmonary secicions Keep asbestos worker under cancer
Encourage the patient in smoking surveillance; watch for changing cough,
cessation Educate the patient and his hemoptysis, weight loss, melena
family in performing postural drainage Bronchodilators may be of some benefit if
Instruct the patient to avoid exposure to any degree of airway obstruction is
people with upper respiratory or other present
infection
Assess nutritional status and ensure
adequate diet Nursing Interventions
Administer oxygen therapy as required
Administer or teach self-administration of

OCCUPATIONAL
bronchodilators as ordered
Encourage smoking cessation
Advise patient on pacing activities to

LUNG
prevent fatigue
Provide information to healthy workers on
prevention of occupational lung disease

DISEASES 3
TYPES PENETRATING
Asbestosis TRAUMA
is diffuse interstitial fibrosis of the lung ca
asbestos dust by inhalation of particles.
Found in workers involved in manufacture, Pneumothorax
cutting and demolition of asbestos- Pneumothorax occurs when the parietal or
containing materials visce leura is breached, and the pleural
spacu xposed to positive atmospheric
Silicosis pressure
is a chronic pulmonary fibrosis caused by
inhalation of silica dust Simple/Spontaneous Pneumothorax
-Exposure to silica dust is encountered in Occurs when air enters the pleural space
almost any form of mining because the through a breach of either the parietal or
earth's crust is composed of silica and visceral pleura. Most commonly, this
silicates (gold, coal, tin, copper mining); occurs as air enters the pleural space
also stone cutting, quarrying, manufacture through the rupture of a bleb or a
of abrasives, ceramics, pottery, and bronchopleural fistula
foundry work
Traumatic Pneumothorax
Sarcoidosis A traumatic pneumothorax occurs when
-Granulomatous disease in which clumps air escapes from a laceration in the lung
of pummatory epithelial cells occur in itself and enters the pleural space or from
many organs, primarily in lungs. a wound in the chest wall, it may result
from blunt trauma (eg, rib fractures),
- Lymph node enlargement seen on chest penetrating chest or abdominal trauma
X-ray (eg, stab wounds or gunshot wounds), or
diaphragmatic fear
Clinical Manifestations
Chronic cough; productive in silicosis
Dyspnea on exertion; progressive and Open Pneumothorax
Irreversible in asbestosis One form of traumatic pneumothorax. It
Susceptibility to lower respiratory tract
OC when a wound in the chest wall is lung
larynough to allow air to pass freely in and -Surgical intervention may be necessary to
out of the thoracic cavity with each repair trauma
attempted respiration

Tension Pneumothorax
Occurs when air is drawn into the pleural
space from a lacerated lung or through a PLEURAL
small opening or wound in the chest wall.
It may be a complication of other types of
pneumothorax. The air that enters the
CONDITION
chest cavity with each inspiration is
trapped. this causes the lung to collapse PLEURAL EFFUSION
and the heart, the great vessels, and the Collection of fluid (transudate or exudate)
trachea to shift toward the unaffected side in the pleural space, Maybe a complication
of the chest (mediastinal shift) of heart failure, pulmonary infection or
nephrotic syndrome, Usually caused
Clinical Manifestations underlyig disease
Hyperresonance; diminisher breath
sounds Reduced mobility of affected half Clinical Manifestations
of thorax Dyspnea
Tracheal deviation away from affected Difficulty lying on flat
side in tension pneumothorax Clinical Coughing/fever
picture of open or tension pneumothorax Chills
is one of air hunger, agitation, Pleuritic chest pain
hypotension, cyanosis and profuse
diaphoresis
Diagnostic Procedure
Mild to moderate dyspnea and chest
CT scan
discomfort may be present with
Lateral Decubitus
spontaneous pneumothorax

Management
Treatment of underlying disease
Spontaneous pneumothorax
Thoracentesis or chest tube drainage is
Treatment is generally nonoperative if performed
pneumothorax is not too extensive.
-Observe and allow for spontaneous Surgical pleurectomy for pleural effusion
resolution for less healthy person. 0% caused by malignancy
pneumothorax in otherwise
Pleuroperitoneal shunt - fluids from the
-Needle aspiration or chest tube drainage
pleural space is drain into the peritoneum
may be necessary to achieve re-expansion
of collapsed lung if greater than 50%
Nursing Intervention
pneumothorax
Assist in thoracentesis
Surgical intervention by pleurodesis or
Record the amount of fluid aspirated and
thoracotomy with resection of apical blebs
send it to the laboratory
is advised for patients with recurrent
Administer medications as ordered such
spontaneous pneumothorax
as analgesics and antibiotics
Assist the patient in a comfortable position
Tension Pneumothorax
Immediate decompression to prevent
HEMOTHORAX
cardiovascular collapse by thoracentesis
Blood in pleural space as a result of
or chest tube insertion to let air escape
penetrating or blunt chest trauma
Chest tube drainage with underwater-seal
Accompanies a high percentage of chest
suction to allow for full lung expansion and
injuries
healing
Can result in hidden blood loss
Patient may be asymptomatic, dyspneic,
Open Pneumothorax
apprehensive, or in shock
Close the chest wound immediately to
restore adequate ventilation and
Management
respiration
Assist with thoracentesis to aspirate blood
-Patient is instructed to inhale and exhale
from pleural space
gently against a closed glottis (Valsalva
Assist with chest tube insertion and set up
maneuver) as a pressure dressing
drainage system for complete and
(petroleum gauze secured with elastic
continuous removal of blood and air
adhesive) is applied. This maneuver helps
Auscultate lungs and monitor for relief of
to expand collapsed lung
dyspnea
-Chest tube is inserted and water-seal
Monitor amount of blood loss in drainage
drainage set up to permit evacuation of
Replace volume with I.V. fluids or blood
fluid/air and produce re- expansion of the
products

PLEURISY (PLEURITIS)
INFECTIOUS
DISEASES OF
Inflammation of both layers of the pleurae
(parietal and visceral)
May develop in conjunction with
pneumonia or an upper respiratory tract
infection, TB or collagen disease
When the inflamed pleural membranes
THE LOWER
rub together during respiration (intensified
on inspiration), the result is severe, sharp, RESPIRATORY
knifelike pain

Clinical Manifestations
SYSTEM
Pleuritic pain during deep breath,
coughing or sneezing limited in PNEUMONIA
distribution rather than dihuse Inflammation of the lung parenchyma
Pleural friction rub can be heard with caused by various microorganisms,
stethoscope including bacteria, mycobacteria, fungi
Diagnostic Procedures and viruses
Chest X-ray
Sputum Analysis Community-Acquired Pneumonia
Thoracentesis Occurs either in the community setting or
Pleural Biopsy within the first 48 hours after
hospitalization or institutionalization
Nursing Interventions
Instruct the patient in heat/cold Hospital-Acquired Pneumonia
application for pain relief Also known as nosocomial pneumonia, is
Instruct the patient to turn onto the defined as the onset of pneumonia
affected side to splint the chest wall and symptoms more than 48 hours after
reduce the stretching of the pleurae admission in patients with no evidence of
Teach the patient to use hands or pillow to infection at the time of admission
splint the ribcage while coughing
Aspiration Pneumonia
Management Refers to the entry pulmonary
Treatment of underlying condition causing consequences resulting from entry of
pleurisy endogenous or exogenous substances into
Topical applications of heat or cold the lower airway
Indomethacin for pain relief
Intercostal Nerve Block if pain is severe
Diagnostic Procedure
Chest X-ray shows presence/extent of
EMPYEMA THORACIS pulmonary disease typically consolidation.
Accumulation of purulent fluid in the Gram stain and culture and sensitivity test
pleural space of sputum may indicate offending
Occur as complication of bacterial organism Blood culture detects
pneumonia, lung abscess bacteremia (bloodstream invasion)
Patient is acutely ill and has signs and occurring with bacterial pneumonia
symptoms similar to acute respiatory
infection Clinical Manifestation
Diagnosis is established by chest CT Sudden onset, rapidly rising fever of
Main objective is to drain the fluid in 38.3°C to 40.5°C
the pleural cavity Cough productive of purulent sputum
Thoracentesis is done if fluid is not too Pleuritic chest pain aggravated by deep
thick respiration/coughing
Tube Thoracostomy is done to patients Dyspnea, tachypnea accompanied by
with loculated or complicated pleural respiratory grunting, nasal flaring use of
effusions thickened pleura, pus and debris accessory muscles of respiration fatigue
Open chest drainage via thoracotomy is Rapid, bounding pulse
done to remove Orthopnea
Rusty, blood-tinged sputum
Nursing intervention: provide care
Poor appetite, diaphoresis
specific to the method of drainage of the
pleural fluid
Management
Administration of the appropriate
antibiotic as determined be results of a
Gram stain

S. pneumonia - macrolide antibiotic

(azithromycin, ithromycin, or extent of disease
erythromycin) Pseudomonas infection - Tuberculin skin test (purified protein
anti pneumococcal, antipseudomonal derivative [PPD] or Mantoux test)
beta- lactam
Nursing Intervention
Treatment of viral pneumonia is primarily Instructs the patient to increase fluid
supportive intake and about correct positioning to
Oxygen therapy if patient has inadequate facilitate airway drainage
gas exchange Discuss the medications schedule and side
effects of the drugs
Complications Instructs the patient to take the
Shock and respiratory failure medication either on an empty stomach or
Pleural Effusion at least 1 hour before meals because food
interferes with medication absorption
Patients taking INH should avoid foods
NURSING INTERVENTIONS that contain tyramine and histamine
Encourage coughing and deep breathing because it may result in headache,
after chest physiou py, splinting the chest flushing, hypotension, lightheadedness,
if necessary palpitations, and diaphoresis Monitors for
Maintain semi-Fowler's position side effects of anti-TB drugs
Promote hydration (2-3 L/day) to liquefy Encourage rest and avoidance of exertion
secretions Provide nutritional plan that allows for
Teach effective coughing techniques to small, frequent meals
minimize energy expenditure; plan rest Instruct the patient about important
periods hygiene measures, including mouth care,
Suction if necessary covering the mouth and nose when
coughing and sneezing, proper disposal of
Instruct client to cover nose and mouth tissues, and hand washing
when coughing
Teach the need to continue entire course
of antimicrobial therapy which is usually ACUTE RESPIRATORY DISTRESS
seven SYNDROME (ARDS)
to ten days Severe form of acute lung injury. This
Teach the patient about proper clinical syndrome is charated by a sudden
administration of antibiotics and potential and progressive pulmonary edema,
side effects increasing bilateral infiltrates on chest x-
Teach that findings are expected to be ray, hy, da unresponsive to oxygen
less within 48 to 72 hours of initial therapy supplementation regardless of the amount
Nutritionally enriched drinks or shakes of Positive End-Expiratory Pressure (PEE)
maybe helpful in maintaining nutrition and the absence of an elevated left atrial
pressure
PULMONARY TUBERCULOSIS
Tuberculosis (TB) is an infectious disease DIAGNOSTICS
that primarily affer the lung parenchyma. Clinical presentation and history of
It also may be transmitted to other parts findings
of the body, including the men ,kidneys, Hypoxemia on ABG despite increasing
bones and lymph nodes The primary inspired oxygen level
infectious agent, M, tuberculosis, is an Chest x-ray shows bilateral infiltrates
acid-fast aerobic rod that grows slowly and Plasma Brain Natriuretic Peptide (BNP)
is sensitive to heat and ultraviolet light Echocardiography
spreads from person to person by airborne Pulmonary Artery Catheterization
transmission

Clinical Manifestations Management

Fatigue, anorexia, weight loss, low-grade Treatment of the underlying condition
fever, night sweats
Some patients have acute febrile illness, nize oxygenation
chills, and flu-like symptoms Incubation and mechanical ventilation
Cough (insidious onset) progressing in Sedation may be required
frequency and producing mucoid or Paralytic agents may be necessary
mucopurulent sputum Antibiotics, as indicated
Hemoptysis, chest pain, dyspnea PEEP usually improves oxygenation
(indicates extensive involvement) Supportive drugs includes surfactant
replacement therapy, pulmonary
Diagnostic Evaluation antihypertensive agents and antisepsis
Sputum smear/Sputum culture confirms a agent
diagnosis of TB
Chest X-ray to determine presence and Nursing Intervention
Requires close monitoring in the intensive
care unit
Assess the patient's status frequently to
evaluate the effectiveness of the
treatment
Turn the patient frequently to improve
ventilation and 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

PULMONARY EMBOLISM
Refers to the obstruction of the pulmonary
artery or one of its branches by a
thrombus (or thrombi) that originates
somewhere in the venous system in the
righ of the heart Often associated with
trauma, surgery (orthopedic, major
abuinal, pelvic, gynecologic, pregnancy,
heart failure, age older than 50 years,
hypercoagulable states, and prolonged
immobility

Diagnostic Procedures
Chest x-ray-shows infiltrates, atelectasis,
elevation of the diaphragm on the affected
side
ECG-shows sinus tachycardia, PR-interval
depression and nonspecific T-wave
changes
Arterial blood gas analysis - shows
hypoxemia and hypocapnia
Spiral computed CT scan of the lung

Management
Treatment goal is to dissolve the existing
emboli
Improve respiratory and vascular status,
anticoagulation therapy, thrombolytic
therapy, and surgical intervention
Stabilize the cardiopulmonary system
Nasal oxygen is administered immediately
to relieve hypoxemia, respiratory distress,
and central cyanosis
Intravenous infusion lines are inserted to
establish routes for medications or fluids
that will be needed
Hypotension is treated by a slow infusion
of dobutamine (Dobutrex), which has a
dilating effect on the pulmonary vessels
and bronchi, or dopamine (Intropin)
Small doses of IV morphine or sedatives
are administered to relieve patient
anxiety, to alleviate chest discomfort, to
improve tolerance of the endotracheal
tube, and to ease 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