Ventilation Powerpoint

OXYGENATIONOXYGENATION

RESPIRATORY RESPIRATORY SYSTEMSYSTEM

TERMINOLOGIESTERMINOLOGIESVENTILATIONVENTILATION – MOVEMENT OF AIR IN & OUT OF THE – MOVEMENT OF AIR IN & OUT OF THE

LUNGSLUNGS

RESPIRATIONRESPIRATION – EXCHANGE OF GASES : EXTERNAL & – EXCHANGE OF GASES : EXTERNAL & INTERNALINTERNAL

EXTERNAL EXTERNAL –– BET. ALVEOLI & PULMONARY CAPILLARIES BET. ALVEOLI & PULMONARY CAPILLARIES

INTERNAL INTERNAL – – BET. SYSTEMIC CAPILLARIESBET. SYSTEMIC CAPILLARIES

PERFUSION PERFUSION – AVAILABILITY & MOVEMENT OF – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASESCAPILLARY BLOOD FOR EXCHANGE OF GASES

CASE STUDYCASE STUDY At the emergency room, patient Anna, 39 At the emergency room, patient Anna, 39

y.o,came, in respiratory distress, shouting for y.o,came, in respiratory distress, shouting for help, because of massive hemoptysis that help, because of massive hemoptysis that she is presently experiencingshe is presently experiencing

Vital signs are: Vital signs are: RR = 30,RR = 30, HR= 105, HR= 105, BP=130/80, BP=130/80, T= 36 CT= 36 C

CASE STUDYCASE STUDY

Her skin is cold and clammyHer skin is cold and clammy

You provided oxygen via nasal prongYou provided oxygen via nasal prong

What other nursing actions would you What other nursing actions would you do?do?

What nursing history would you extract?What nursing history would you extract?

CASE STUDYCASE STUDY You learned that patient has been experiencing You learned that patient has been experiencing

night sweats, easy fatiguability for about 1 night sweats, easy fatiguability for about 1 month.month.

There was on & off cough and fever, and There was on & off cough and fever, and patient self-medicated with low dose patient self-medicated with low dose AmoxycillinAmoxycillin

CASE STUDYCASE STUDY

With the above history, in which ward is With the above history, in which ward is your patient be admitted? your patient be admitted?

What are the possible diagnostics her What are the possible diagnostics her physician would order?physician would order?

What are your proposed nursing plan for What are your proposed nursing plan for the patient?the patient?

REVIEW OF ANATOMY REVIEW OF ANATOMY Divisions of the Respiratory Divisions of the Respiratory SystemSystem

Air Conducting System -Air Conducting System - nose …. terminal bronchioles nose …. terminal bronchioles

Gas-exchanging lung units – Gas-exchanging lung units – respiratory bronchioles alveolar ducts respiratory bronchioles alveolar ducts

alveolar sacs alveolialveolar sacs alveoli

REVIEW OF ANATOMYREVIEW OF ANATOMY Organs of the Respiratory Organs of the Respiratory SystemSystem

Each lung has 3 primary components: Each lung has 3 primary components: Air passagesAir passages Blood vessels – pulmonary artery (major Blood vessels – pulmonary artery (major

supply), bronchial arteriessupply), bronchial arteries Elastic connective tissueElastic connective tissue

PLEURA – Parietal and VisceralPLEURA – Parietal and Visceral

REVIEW OF PHYSIOLOGYREVIEW OF PHYSIOLOGY

Functions of the Respiratory SystemFunctions of the Respiratory System Parameters in the process of breathingParameters in the process of breathing

Atmospheric O2 is 21%, normal atmospheric Atmospheric O2 is 21%, normal atmospheric pressure 760 mmHgpressure 760 mmHg

Adequate ventilation or perfusion of the Adequate ventilation or perfusion of the alveoli alveoli

InspirationInspiration ExpirationExpiration


Parameters in the process of breathingParameters in the process of breathing Permeable alveoli-capillary membranePermeable alveoli-capillary membrane Adequate pulmonary and systemic circulationAdequate pulmonary and systemic circulation

Systemic Systemic circulationcirculation

Pulmonary Pulmonary CirculationCirculation

Decrease pO2Decrease pO2 VasodilatationVasodilatation vasoconstrictiovasoconstrictionn

MechanismMechanism More time for More time for gas exchangegas exchange

Shunting of Shunting of blood to better blood to better ventilated ventilated arteriesarteries


Parameters in the process of breathingParameters in the process of breathingAbility of the blood to transportO2 and CO2 between the Ability of the blood to transportO2 and CO2 between the

lungs and the tissueslungs and the tissues Ability of the cells to utilize O2 and eliminate CO2Ability of the cells to utilize O2 and eliminate CO2 Neural Control of RespirationNeural Control of Respiration

1.1. Medullary Rhythmicity AreaMedullary Rhythmicity Area

2.2. Apneustic Area – prolong and deepen respirationApneustic Area – prolong and deepen respiration

3.3. Pneumotaxic Area – inhibit inspirationPneumotaxic Area – inhibit inspiration

Pulmonary Volumes and CapacityPulmonary Volumes and Capacity

NURSING PATIENTS WITH THREATS NURSING PATIENTS WITH THREATS TO VENTILATIONTO VENTILATION

Nursing HistoryNursing History CoughCough Secretions – sputum, phlegmSecretions – sputum, phlegm Dyspnea – activity, time of the day, duration, Dyspnea – activity, time of the day, duration,

posture, onset & precipitating factorposture, onset & precipitating factor Chest painChest pain Cyanosis Cyanosis Voice qualityVoice quality StridorStridor


Nursing HistoryNursing History

CYANOSIS – TYPESCYANOSIS – TYPES

1.1. Peripheral – extremities, nailbedsPeripheral – extremities, nailbeds

2.2. Central – lips, tongue, face and mucous Central – lips, tongue, face and mucous membranemembrane

3.3. Differential Differential


Nursing HistoryNursing HistoryCYANOSIS CYANOSIS

Factors that alter the presence of CyanosisFactors that alter the presence of Cyanosis1.1. Pigmentation and thicknessPigmentation and thickness2.2. Type of light used during assessment – Type of light used during assessment –

natural light is desirablenatural light is desirable3.3. Absolute amount of reduced hemoglobinAbsolute amount of reduced hemoglobin4.4. Observer’s perceptionObserver’s perception

1.1. Activity Activity 2.2. Duration 3. DistributionDuration 3. Distribution


Physical AssessmentPhysical Assessment Inspection – deformities, rate and rhythm of Inspection – deformities, rate and rhythm of

breathingbreathing Palpation - fremitusPalpation - fremitus Percussion - resonancePercussion - resonance Auscultation – Auscultation –

Normal breath soundsNormal breath sounds1.1. Vesicular – most of the lungVesicular – most of the lung

2.2. Bronchovesicular – mainstem bronchiBronchovesicular – mainstem bronchi

3.3. Bronchial/Tubular - tracheaBronchial/Tubular - trachea


Physical AssessmentPhysical Assessment

Abnormal Breath SoundsAbnormal Breath Sounds

1.1. Rales – moisture in the tracheobronchial tree; Rales – moisture in the tracheobronchial tree; heard on inspirationheard on inspiration

2.2. Wheeze – continuous, musical sound heard Wheeze – continuous, musical sound heard with movement of air through narrowed with movement of air through narrowed passage; heard on expirationpassage; heard on expiration

3.3. Friction Rubs – grating sound from inflammed Friction Rubs – grating sound from inflammed pleurapleura


Diagnostic AssessmentDiagnostic Assessment RADIOGRAPHICRADIOGRAPHIC

1.1. Chest XrayChest Xray

2.2. TomographyTomography

3.3. FluoroscopyFluoroscopy

4.4. Pulmonary Angiography Pulmonary Angiography – pulmonary embolism– pulmonary embolism

EVALUATIONEVALUATION

5.5. Bronchography – size, Bronchography – size, shape and number of shape and number of bronchibronchi

6.6. Pulmonary Pulmonary ScintiphotographyScintiphotography

7.7. Sinus XraySinus Xray


Diagnostic AssessmentDiagnostic Assessment

EXAMINATION BY DIRECT EXAMINATION BY DIRECT

1.1. RhinoscopyRhinoscopy

2.2. Laryngoscopy – indirect, Laryngoscopy – indirect, directdirect

3.3. BronchoscopyBronchoscopy

4.4. BronchofiberoscopyBronchofiberoscopy

VISUALIZATIONVISUALIZATION

5. Mediastinoscopy5. Mediastinoscopy

6. Transillumination6. Transillumination

7. Lung Biopsy – 7. Lung Biopsy – transtracheobronchial, transtracheobronchial, transthoracictransthoracic

8. Pleural Biopsy8. Pleural Biopsy


Diagnostic AssessmentDiagnostic Assessment

LABORATORY STUDIESLABORATORY STUDIES

1.1. HematologicHematologic

2.2. Cytological – sputum, tracheobronchial Cytological – sputum, tracheobronchial secretions, pleural fluidsecretions, pleural fluid

3.3. Bacteriological studiesBacteriological studies1.1. sputum studies : C & S, cytology sputum studies : C & S, cytology

2.2. thoracentesis thoracentesis

3.3. skin test for TBskin test for TB


Diagnostic AssessmentDiagnostic AssessmentTHORACENTESISTHORACENTESIS Site : Site :

Air : 2Air : 2ndnd /3 /3rdrd ICS, MCL ICS, MCL Fluid : 7Fluid : 7thth/8/8thth ICS, ICS,

PALPAL Position : Position :

over a bed tableover a bed table

straddling in a straddling in a chair, chair,

seated in bed seated in bed with affected with affected hand raised hand raised over the headover the head

Nursing ManagementNursing Management


Diagnostic AssessmentDiagnostic AssessmentSKIN TEST FOR P.T.B.SKIN TEST FOR P.T.B.

1.1. Mantoux testMantoux test

2.2. PPDPPD

3.3. Multiple Puncture TestMultiple Puncture Test

4.4. Von Pirquet Scratch TestVon Pirquet Scratch Test

5.5. Volmer Patch TestVolmer Patch Test


ASSESSMENT OF PULMONARY ASSESSMENT OF PULMONARY FUNCTIONFUNCTION

1.1. SPIROMETRYSPIROMETRY2.2. ARTERIAL BLOOD GASARTERIAL BLOOD GAS

1.1. PhPh2.2. pCO2pCO23.3. pO2pO24.4. H2CO3H2CO3


SPIROMETRYSPIROMETRYPULMONARY FUNCTION TESTPULMONARY FUNCTION TEST LUNG CAPACITIESLUNG CAPACITIES

Vital CapacityVital Capacity Normal Lung CapacityNormal Lung Capacity Total Lung CapacityTotal Lung Capacity Inspiratory CapacityInspiratory Capacity Functional Residual CapacityFunctional Residual Capacity


PULMONARY FUNCTION TESTPULMONARY FUNCTION TEST LUNG VOLUMESLUNG VOLUMES

Tidal VolumeTidal Volume Inspiratory Reserve VolumeInspiratory Reserve Volume Expiratory Reserve Volume Expiratory Reserve Volume Residual VolumeResidual Volume Minute Volume Minute Volume


PlanningPlanning1.1. Planning for Health PromotionPlanning for Health Promotion

2.2. Planning for Health Restoration and Planning for Health Restoration and MaintenanceMaintenance

1.1. Maintaining Patent AirwayMaintaining Patent Airway1.1. Coughing techniquesCoughing techniques

2.2. SuctioningSuctioning

2.2. Reducing Metabolic DemandsReducing Metabolic Demands

3.3. Preventing and Controlling InfectionPreventing and Controlling Infection


PlanningPlanning4.4. Oxygen TherapyOxygen Therapy

5.5. Incentive SpirometryIncentive Spirometry

6.6. Aerosol TherapyAerosol Therapy

7.7. IPPB (Intermittent Positive Pressure Breathing)IPPB (Intermittent Positive Pressure Breathing)

8.8. Artificial AirwayArtificial Airway

9.9. Mechanical VentilationMechanical Ventilation

10.10. Chest SurgeryChest Surgery

11.11. Chest DrainageChest Drainage


PlanningPlanningOXYGEN THERAPYOXYGEN THERAPY HypoxemiaHypoxemia Hypoxia – Types :Hypoxia – Types :

Hypoxic hypoxiaHypoxic hypoxia Anemic hypoxiaAnemic hypoxia Ischemic hypoxiaIschemic hypoxia Histotoxic hypoxiaHistotoxic hypoxia


PlanningPlanningOXYGEN THERAPYOXYGEN THERAPY Assessment for need for oxygenAssessment for need for oxygen Planning for oxygen therapyPlanning for oxygen therapy

Promoting psychological and physical comfortPromoting psychological and physical comfort Promoting safetyPromoting safety Maintaining Adequate Oxygen Supply :Maintaining Adequate Oxygen Supply :

Low flow system – nasal cannula, face maskLow flow system – nasal cannula, face mask High Flow system – non-rebreathing mask, Venturri High Flow system – non-rebreathing mask, Venturri

maskmask Other ways: tracheostomy, portable oxygen, special Other ways: tracheostomy, portable oxygen, special

room, hyperbaric oxygenroom, hyperbaric oxygen


PlanningPlanningAEROSOL THERAPYAEROSOL THERAPY

1.1. Distilled water and NSSDistilled water and NSS

2.2. DetergentsDetergents

3.3. MucolyticsMucolytics

4.4. Others : bronchodilators, steroidsOthers : bronchodilators, steroids

Devices used to generate aerosols :Devices used to generate aerosols :

1.1. NebulizerNebulizer

2.2. HumidifierHumidifier


PlanningPlanningARTIFICIAL AIRWAYARTIFICIAL AIRWAY

Types:Types:

1.1. Oropharyngeal AirwayOropharyngeal Airway

2.2. Endotracheal : orotracheal, nasotrachealEndotracheal : orotracheal, nasotracheal

3.3. Tracheostomy : 3 main principles of care:Tracheostomy : 3 main principles of care:1.1. Maintain patent airway ( signs of occlusion)Maintain patent airway ( signs of occlusion)

2.2. Prevent InfectionPrevent Infection

3.3. Prevent drying and crusting of the mucosaPrevent drying and crusting of the mucosa


PlanningPlanningMECHANICAL VENTILATION THERAPYMECHANICAL VENTILATION THERAPY

TYPES:TYPES:

1.1. Pressure CycledPressure Cycled

2.2. Volume CycledVolume Cycled

ACCESSORY ATTACHMENTSACCESSORY ATTACHMENTS

1.1. Intermittent Mandatory VentilationIntermittent Mandatory Ventilation

2.2. Continuous Positive Airway PressureContinuous Positive Airway Pressure

3.3. Positive End Expiratory PressurePositive End Expiratory Pressure


PlanningPlanning CHEST SURGERYCHEST SURGERY CHEST DRAINAGECHEST DRAINAGE

Principle of negative pressure (NP)Principle of negative pressure (NP) Vacuum is needed to reestablish NPVacuum is needed to reestablish NP Closed water-sealed drainageClosed water-sealed drainage Types: 1- bottle, 2-bottle, 3-bottleTypes: 1- bottle, 2-bottle, 3-bottle Purpose: remove air and fluid, lung Purpose: remove air and fluid, lung

reexpansionreexpansion


PlanningPlanning CHEST DRAINAGECHEST DRAINAGE

Nursing ResposibilitiesNursing Resposibilities1-BOTTLE – operates by gravity only,1-BOTTLE – operates by gravity only, fluctuation/oscillation – stops : lung has fluctuation/oscillation – stops : lung has

reexpanded, or tube is kinked reexpanded, or tube is kinked intermittent bubbling – normal with expirationintermittent bubbling – normal with expiration Continuous bubbling – air leakContinuous bubbling – air leak Rapid bubbling – consid loss of airRapid bubbling – consid loss of air Chest Xray - reexpansionChest Xray - reexpansion


PlanningPlanning CHEST DRAINAGECHEST DRAINAGENursing ResponsibilitiesNursing Responsibilities

2 OR 3 BOTTLE SYSTEM2 OR 3 BOTTLE SYSTEM Suction – necessarySuction – necessary Periodic emptying of fluid/ bubbling in the Periodic emptying of fluid/ bubbling in the

control tube – indic proper fxningcontrol tube – indic proper fxning No Fluctuation with expiration – in water-No Fluctuation with expiration – in water-

sealed bottlesealed bottle Continuous bubbling – air leakContinuous bubbling – air leak


PlanningPlanning CHEST DRAINAGECHEST DRAINAGE

REMOVAL OF CATHETERREMOVAL OF CATHETER

1.1. PremedicationPremedication

2.2. During expiration or end of inspirationDuring expiration or end of inspiration

3.3. Wound covered with skin Wound covered with skin clips/PETROLEUM GAUZEclips/PETROLEUM GAUZE

PLEUREVACPLEUREVAC

COMMON REPIRATORY COMMON REPIRATORY PROBLEMS - PROBLEMS - NOSENOSE

NOSENOSE EpistaxisEpistaxis

causes : picking of the nose, DHF, HPN, causes : picking of the nose, DHF, HPN, cancer, sinusitis, deviated/perforated septum cancer, sinusitis, deviated/perforated septum

mgt: elevate, promote vasoconstriction, external mgt: elevate, promote vasoconstriction, external control. Ice collar, drugs - neosynephrinecontrol. Ice collar, drugs - neosynephrine

Nasal Polyp - Nasal Polyp - overgrowth of mucous membrane overgrowth of mucous membrane

causes : allergy, chronic sinusitiscauses : allergy, chronic sinusitis Deviated SeptumDeviated Septum

COMMON REPIRATORY COMMON REPIRATORY PROBLEMS - PROBLEMS - SINUSES, SINUSES, THROATTHROAT

SINUSESSINUSES Sinusitis Sinusitis

causes causes s/sx : pain, nasal congestion,general malaise, s/sx : pain, nasal congestion,general malaise,

fever fever treatment : bed rest, medications, treatment : bed rest, medications,

surgery : Caldwell-Luc operationsurgery : Caldwell-Luc operation THROATTHROAT

Tonsilitis Tonsilitis S/SxS/Sx Mgt Mgt

Surgery : TonsillectomySurgery : Tonsillectomy

TONSILLECTOMYTONSILLECTOMYNursing Care Nursing Care

PRE-OPPRE-OP: : no fever,evaluate hemostasis, no fever,evaluate hemostasis, ATROPINE ATROPINE

SULFATESULFATE

POST-OPPOST-OP1.1. Patient may have postnasal packPatient may have postnasal pack

2.2. HOB 45 degrees –local; prone with head to 1 side – HOB 45 degrees –local; prone with head to 1 side – generalgeneral

3.3. Temp – axilla, rectalTemp – axilla, rectal

4.4. Avoid clearing of throat or cough – bleedingAvoid clearing of throat or cough – bleeding

5.5. Aspirin, narcotics, ice collarAspirin, narcotics, ice collar

6.6. Vomiting small amnt of bloodVomiting small amnt of blood

TONSILLECTOMYTONSILLECTOMY

7.7. Blood trickling down the throat/ Blood trickling down the throat/ FREQUENT FREQUENT

SWALLOWING –SWALLOWING – Hemorrhage Hemorrhage

8.8. If conscious, no acidic drinks (burning sensation), If conscious, no acidic drinks (burning sensation), give ice chips and cold liquidsgive ice chips and cold liquids

9.9. NO STRAWNO STRAW – sucking can cause bleeding – sucking can cause bleeding

10.10. Alkaline mouthwashAlkaline mouthwash

COMMON REPIRATORY COMMON REPIRATORY PROBLEMS - PROBLEMS - LARYNXLARYNX

LARYNXLARYNX LaryngitisLaryngitis Cancer of the Larynx Cancer of the Larynx

Predisposing factor : heavy smoking and Predisposing factor : heavy smoking and drinking, family hx, chronic laryngitis, vocal drinking, family hx, chronic laryngitis, vocal abuse abuse

S/Sx persistent hoarseness -S/Sx persistent hoarseness -11STST AND EARLY, AND EARLY,

cough,enlarged cervical LN, pain in the Adam’s cough,enlarged cervical LN, pain in the Adam’s apple that radiates to the earapple that radiates to the ear

COMMON REPIRATORY COMMON REPIRATORY PROBLEMS - PROBLEMS - LARYNXLARYNX Cancer of the LarynxCancer of the Larynx

Diagnostics : Laryngoscopy, biopsyDiagnostics : Laryngoscopy, biopsy Mgt : Early : LaryngofissureMgt : Early : Laryngofissure

Advanced : Laryngectomy, Advanced : Laryngectomy, RadiationRadiation

TOTAL LARYNGECTOMYTOTAL LARYNGECTOMYNURSING CARENURSING CARE – Pre –Op – Pre –Op- Assist the physician in telling the patient:Assist the physician in telling the patient:1.1. He will loose the following :He will loose the following :

1.1. voice, voice, 2.2. normal means of breathing, normal means of breathing, 3.3. sense of smell, blowing of nose, sense of smell, blowing of nose, 4.4. blowing of air from mouth, blowing of air from mouth, 5.5. sip soup,sucka straw, sip soup,sucka straw, 6.6. gargle, gargle, 7.7. whistle whistle 8.8. lift heavy objectlift heavy object

2. Breath through a permanent tracheostomy2. Breath through a permanent tracheostomy3. Know other methods of speech3. Know other methods of speech4. Visit a speech therapist4. Visit a speech therapist5. Tube feedings after surgery,temporary5. Tube feedings after surgery,temporary

TOTAL LARYNGECTOMYTOTAL LARYNGECTOMYNURSING CARE –NURSING CARE – Post – Op Post – Op1.1. Constant attendance; no IV for the dominant armConstant attendance; no IV for the dominant arm2.2. Avoid:Avoid:

1.1. raising tone of voices raising tone of voices 2.2. completing sentences verbally that the patient started to completing sentences verbally that the patient started to

write write 3.3. talking nervously and excessivelytalking nervously and excessively

3.3. Elevate HOB to: Elevate HOB to: 1.1. promote drainage promote drainage 2.2. facilitate respiration facilitate respiration 3.3. prevent strain on suture line prevent strain on suture line 4.4. minimize edemaminimize edema

TOTAL LARYNGECTOMYTOTAL LARYNGECTOMY4.4. Avoid dusts or fumes , tracheostomy stoma has no Avoid dusts or fumes , tracheostomy stoma has no

mechanism for filtering and cooling air – neck bibmechanism for filtering and cooling air – neck bib5.5. Observe post-op complications:Observe post-op complications:

1.1. Fistula formationFistula formation2.2. carotid artery rupturecarotid artery rupture3.3. Stenosis of tracheostomyStenosis of tracheostomy4.4. Atelectasis and pneumoniaAtelectasis and pneumonia5.5. ShockShock6.6. HemorrhageHemorrhage

6.6. IV,tube feeding, analgesic, antibiotic IV,tube feeding, analgesic, antibiotic 7.7. Care of Gomco or Hemovac drainage catheter: Care of Gomco or Hemovac drainage catheter:

remove fluid from potetial deadspace (space for larynx)remove fluid from potetial deadspace (space for larynx)

8.8. If catheter not used, pressure dressing.If catheter not used, pressure dressing.

TOTAL LARYNGECTOMYTOTAL LARYNGECTOMY9.9. Minimal postop pain; narcotics contraindicated Minimal postop pain; narcotics contraindicated

in Head & neck surgeryin Head & neck surgery

10.10. Self care teachings:Self care teachings:1.1. NGT, instruct self-feeding.NGT, instruct self-feeding.

2.2. Instruct removing and replacing Instruct removing and replacing laryngostomy laryngostomy tube :tube : breath in, hold, insert and resume normal breath in, hold, insert and resume normal resp.resp.

3.3. Caution when shaving : it takes 6 months for cut Caution when shaving : it takes 6 months for cut nerve endings to regeneratenerve endings to regenerate

Laryngostomy tube stays for 3-8 wks until stoma becomes Laryngostomy tube stays for 3-8 wks until stoma becomes permamnently formedpermamnently formed

TOTAL LARYNGECTOMYTOTAL LARYNGECTOMY11.Rehabilitation : aeg wear ID stating he has no 11.Rehabilitation : aeg wear ID stating he has no

vocal cordvocal cord

12. Not smoke12. Not smoke

13. Speech Rehab- A.S.A. mucous membrane 13. Speech Rehab- A.S.A. mucous membrane and muscles are completely healedand muscles are completely healed

14. Artificial Respiration : 14. Artificial Respiration : mouth to neck stoma breathingmouth to neck stoma breathing O2 administration to tracheostomy O2 administration to tracheostomy patient’s head should not be turned- may obstruct patient’s head should not be turned- may obstruct

trachtrach

CONDITIONS AFFECTING CONDITIONS AFFECTING THE CHESTTHE CHEST

2 CLASSIFICATIONS2 CLASSIFICATIONS : :

1.1. OBSTRUCTIONOBSTRUCTION in the pathways of in the pathways of normal alveolar ventilation by: normal alveolar ventilation by:

1.1. spasm spasm 2.2. mucus secretions mucus secretions 3.3. morphologic changesmorphologic changes

2.2. RESTRICTION RESTRICTION in the movement of thorax or in the movement of thorax or lungs associated with :lungs associated with :

1.1. Pathologic factorsPathologic factors2.2. Neurologic factorsNeurologic factors

All I’m asking for is a beautiful hair cut

CHRONIC CHRONIC OBSTRUCTIVEOBSTRUCTIVE PULMONARY DISEASE (COPD)PULMONARY DISEASE (COPD)

1. EMPHYSEMA1. EMPHYSEMA

2. BRONCHIAL ASTHMA2. BRONCHIAL ASTHMA

3. BRONCHIECTASIS3. BRONCHIECTASIS

4. CHRONIC BRONCHITIS4. CHRONIC BRONCHITIS

C.O.P.D. - C.O.P.D. - EMPHYSEMAEMPHYSEMAStretching and overdistention of the alveoliStretching and overdistention of the alveoli

Loss of intralveolar septa, pulmonary elasticity Loss of intralveolar septa, pulmonary elasticity

and alveolar capillary surfaceand alveolar capillary surface

Loss of pulmonary compliance + partial obstructionLoss of pulmonary compliance + partial obstruction

No effective inhalationNo effective inhalation

C.O.P.D. - C.O.P.D. - EMPHYSEMAEMPHYSEMAPredisposing Factors : Predisposing Factors : 1.1. Cigarette smoking Cigarette smoking 2.2. PollutionPollution3.3. Chronic long term infectionChronic long term infectionS/SxS/Sx1.1. CoughCough2.2. WeaknessWeakness3.3. LethargyLethargy4.4. Barrel chestBarrel chest5.5. BronchospasmsBronchospasms6.6. AsthmaAsthma7.7. Forced expirationsForced expirations

C.O.P.D. - C.O.P.D. - BRONCHIAL BRONCHIAL ASTHMAASTHMA

Viral respiratory Infection/ allergensViral respiratory Infection/ allergens Bronchial spasm and bronchial constrictionBronchial spasm and bronchial constriction STATUS ASTHMATICUSSTATUS ASTHMATICUS S/Sx :S/Sx :

dyspnea, dyspnea, cough,cough, wheezing wheezing prolonged expirationprolonged expiration

These lungs appear essentially normal, but are normal-appearing because they are the hyperinflated lungs of a patient who died with status asthmaticus.

This cast of the bronchial tree is formed of inspissated mucus and was coughed up by a patient during an asthmatic attack. The outpouring of mucus from hypertrophied bronchial submucosal glands, the bronchoconstriction, and dehydration all contribute to the formation of mucus plugs that can block airways in asthmatic patients.

C.O.P.D. - C.O.P.D. - BRONCHIECTASISBRONCHIECTASIS Dilation of medium-sized bronchiDilation of medium-sized bronchi Loss of bronchial elasticityLoss of bronchial elasticity Excessive mucusExcessive mucus Chronic productive coughChronic productive cough S/Sx :S/Sx :

Abundant sputum – maybe blood-tinged ( trauma Abundant sputum – maybe blood-tinged ( trauma to bronchial walls)to bronchial walls)

C.O.P.D.C.O.P.D.

CHRONIC BRONCHITISCHRONIC BRONCHITIS

Inflammation of bronchiolesInflammation of bronchioles Causes : infection, respiratory irritantsCauses : infection, respiratory irritants S/Sx S/Sx ::

coughcough Excessive mucus production and retentionExcessive mucus production and retention DyspneaDyspnea Hyperinflated chestHyperinflated chest Concurrent emphysemaConcurrent emphysema

COPD - MANAGEMENTCOPD - MANAGEMENT IMPROVING IMPROVING

VENTILATIONVENTILATION Oxygen,Oxygen, IPPB,IPPB, nebulization, nebulization, suctioning secretionssuctioning secretions Medications: Medications:

bronchodilators, steroidsbronchodilators, steroids

STRENGTHENING STRENGTHENING RESPIRATORY RESPIRATORY MUSCLESMUSCLES Breathing exercisesBreathing exercises

OTHER CONCERNS :OTHER CONCERNS : hydration, hydration, prevention or treatment prevention or treatment

of infection(antibiotics)of infection(antibiotics) cough medications,cough medications, nutrition, nutrition, providing emotional and providing emotional and

physical restphysical rest Incentive spirometryIncentive spirometry

RESTRICTIVERESTRICTIVE DISEASES DISEASESCLASSIFICATION :CLASSIFICATION : NEUROMUSCULARNEUROMUSCULAR THORACIC DEFORMITYTHORACIC DEFORMITY RESTRICTION TO LUNG OR ALVEOLAR RESTRICTION TO LUNG OR ALVEOLAR

EXPANSIONEXPANSION INFILTRATIVE DISEASEINFILTRATIVE DISEASE OBESITYOBESITY LOSS OF FUNCTIONING PULMONARY TISSUELOSS OF FUNCTIONING PULMONARY TISSUE

RESTRICTIVERESTRICTIVE DISEASE DISEASE NEUROMUSCULAR DISORDERSNEUROMUSCULAR DISORDERS

1.1. MYASTHENIA GRAVISMYASTHENIA GRAVIS Generalized muscular weaknessGeneralized muscular weakness There is difficulty in swallowing – aspirationThere is difficulty in swallowing – aspiration Respiratory muscle paralysis with dse progressionRespiratory muscle paralysis with dse progression Tracheostomy and mech ventilatorTracheostomy and mech ventilator

2.2. BULBAR POLIOMYELITISBULBAR POLIOMYELITIS Viral infectionViral infection 99thth – 12 – 12thth CN – paralysis of laryngeal muscles –trach CN – paralysis of laryngeal muscles –trach SPINAL TYPE – SPINAL TYPE – paralysis of respiratory musclesparalysis of respiratory muscles

RESTRICTIVERESTRICTIVE DISEASESDISEASES NEUROMUSCULAR DISORDERSNEUROMUSCULAR DISORDERS

3. GUILLAIN BARRE SYNDROME3. GUILLAIN BARRE SYNDROME Acute infectious polyneuritisAcute infectious polyneuritis Headache, aching limbs, gen’d body Headache, aching limbs, gen’d body

malaise, fevermalaise, fever Progression: Progression:

numbness and tingling of digits numbness and tingling of digits muscular weakness and paralysismuscular weakness and paralysis

RESTRICTIVE DISEASESRESTRICTIVE DISEASESTHORACIC DEFORMITYTHORACIC DEFORMITY

1.1. KYPHOSCOLIOSISKYPHOSCOLIOSIS Abnormal convex curvature of the spineAbnormal convex curvature of the spine

2.2. PECTUS EXCAVATUMPECTUS EXCAVATUM ““funnel chest”funnel chest” Concave deformity resulting from Concave deformity resulting from

depression of the sternumdepression of the sternum

RESTRICTIONRESTRICTIONTO LUNG and/or ALVEOLAR TO LUNG and/or ALVEOLAR

EXPANSIONEXPANSIONDISEASES OF THE PLEURADISEASES OF THE PLEURA1.1. PNEUMOTHORAXPNEUMOTHORAX

Spontaneous: primary, secondarySpontaneous: primary, secondary TraumaticTraumatic Causes : unknown, pulmonary lesion, iatrogenicCauses : unknown, pulmonary lesion, iatrogenic Dyspnea, cough, chest pain, decreased chest Dyspnea, cough, chest pain, decreased chest

movements, movements, mediastinal shift to affected sidemediastinal shift to affected side

2.2. HYDROTHORAXHYDROTHORAX Serous fluid; lymphatic obstructionSerous fluid; lymphatic obstruction

3.3. HEMOTHORAXHEMOTHORAX traumatictraumatic

RESTRICTIONRESTRICTIONTO LUNG and/or ALVEOLAR TO LUNG and/or ALVEOLAR

EXPANSIONEXPANSION

4.4. PLEURISYPLEURISY Inflammation of the pleura with changes in its Inflammation of the pleura with changes in its

serous secretionserous secretion

Types : Types : Pleural effusionPleural effusion EmpyemaEmpyema FibrinousFibrinous

PLEURISYPLEURISY

PLEURAL EFFUSIONPLEURAL EFFUSION Sero-fibrinous fluidSero-fibrinous fluid Dyspnea, limited movement of chestDyspnea, limited movement of chest Mediastinal shift away from affected sideMediastinal shift away from affected side TB, Pneumonia, malignancy, cardiac TB, Pneumonia, malignancy, cardiac

failurefailure

PLEURISYPLEURISY

EMPYEMAEMPYEMA Purulent exudatePurulent exudate From preexisting infections in the lung,ribs or From preexisting infections in the lung,ribs or

subphrenic spacesubphrenic space Lung collapse of affected sideLung collapse of affected side Dull pain and persistent tenderness Dull pain and persistent tenderness limited chest movementslimited chest movements

The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. Pneumonia may be complicated by a pleuritis. Initially, there may just be an effusion into the pleural space. There may also be a fibrinous pleuritis. However, bacterial infections of lung can spread to the pleura to produce a purulent pleuritis. A collection of pus in the pleural space is known as empyema.

PLEURISYPLEURISY

FIBRINOUS / DRY PLEURISYFIBRINOUS / DRY PLEURISYLack of lubricating serous secretionLack of lubricating serous secretionFibrinous exudates causes friction Fibrinous exudates causes friction

rubsrubsPainPain rapid shallow respirationrapid shallow respirationRestricted ventilatory efficiencyRestricted ventilatory efficiency

PLEURISYPLEURISY

FIBRINOUS / DRY PLEURISYFIBRINOUS / DRY PLEURISY

MANAGEMENTMANAGEMENTThoracentesisThoracentesisChest TubeChest TubePleurodesisPleurodesis

RESTRICTIVE DISEASESRESTRICTIVE DISEASES

INFILTRATIVE DISEASESINFILTRATIVE DISEASES Pulmonary TuberculosisPulmonary Tuberculosis Bronchogenic CarcinomaBronchogenic Carcinoma

OBESITYOBESITY Pickwickian Syndrome – extreme obesityPickwickian Syndrome – extreme obesity Ascites -Ascites -

RESTRICTION DUE TORESTRICTION DUE TO

LOSS OF FUNCTIONING LOSS OF FUNCTIONING PULMONARY TISSUEPULMONARY TISSUE

CHANGE IN ALVEOLAR CAPILLARY SURFACESCHANGE IN ALVEOLAR CAPILLARY SURFACES

DECREASED SURFACES FOR BLD GASES &DECREASED SURFACES FOR BLD GASES &DECREASED PRODUCTION OF SURFACTANTDECREASED PRODUCTION OF SURFACTANT

ALVEOLAR COLLAPSEALVEOLAR COLLAPSE

ATELECTASISATELECTASIS

RESTRICTION DUE TORESTRICTION DUE TO

LOSS OF FUNCTIONING LOSS OF FUNCTIONING PULMONARY TISSUEPULMONARY TISSUE

1.1. PULMONARY INFARCTIONPULMONARY INFARCTION

2.2. LUNG ABSCESSLUNG ABSCESS

3.3. BRONCHOGENIC CARCINOMABRONCHOGENIC CARCINOMA

4.4. PULMONARY FIBROSISPULMONARY FIBROSIS

5.5. PNEUMOCONIOSESPNEUMOCONIOSES

6.6. PNEUMONIAPNEUMONIA

7.7. PULMONARY TUBERCULOSISPULMONARY TUBERCULOSIS

8.8. PULMONARY EDEMAPULMONARY EDEMA

PULMONARY INFARCTIONPULMONARY INFARCTION Loss of pulmonary tissue from occlusion of Loss of pulmonary tissue from occlusion of

pulmonary artery by an emboluspulmonary artery by an embolus Long bone fracture; obstetric patientsLong bone fracture; obstetric patients

LUNG ABSCESSLUNG ABSCESS Aspiration of foreign bodyAspiration of foreign body Lung obstructionLung obstruction PneumoniaPneumonia

BRONCHOGENIC CARCINOMABRONCHOGENIC CARCINOMA Smoking, pollutantsSmoking, pollutants Cough, wheeze, hemoptysis, dyspneaCough, wheeze, hemoptysis, dyspnea

This is a rare finding that may complicate a term pregnancy at delivery. Seen here in a pulmonary artery branch is an amniotic fluid embolus that has layers of fetal squames. Amniotic fluid embolization can have the same outcome

This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface.

PNEUMONIAPNEUMONIA Acute pulmonary infectionAcute pulmonary infection Pneumococcus, Streptococcus, HaemophilusPneumococcus, Streptococcus, Haemophilus

This is a lobar pneumonia in which consolidation of the entire left upper lobe has occurred. This pattern is much less common than the bronchopneumonia pattern. In part, this is due to the fact that most lobar pneumonias are due to Streptococcus pneumoniae (pneumococcus)

PULMONARY FIBROSISPULMONARY FIBROSIS Pathological increase in lung connective Pathological increase in lung connective

tissuetissue Diffuse / localizedDiffuse / localized Secondary to other pulmonary diseasesSecondary to other pulmonary diseases

Regardless of the etiology for restrictive lung diseases, many eventually lead to extensive fibrosis. The gross appearance, as seen here in a patient with organizing diffuse alveolar damage, is known as "honeycomb" lung because of the appearance of the irregular air spaces between bands of dense fibrous connective tissue.

PNEUMOCONIOSESPNEUMOCONIOSES Chronic, fibroticChronic, fibrotic Inhalation of irritant dusts:Inhalation of irritant dusts:

SilicaSilica AsbestosAsbestos CoalCoal

PULMONARY TUBERCULOSISPULMONARY TUBERCULOSIS Mycobacterium TBMycobacterium TB Cough, hemoptysis, malaise, weight loss, Cough, hemoptysis, malaise, weight loss,

low grade afternoon fever easy low grade afternoon fever easy fatigability, night sweatsfatigability, night sweats

Anti TB drugs, quadruple therapyAnti TB drugs, quadruple therapy

Here is the gross appearance of a lung with tuberculosis. Scattered tan granulomas are present, mostly in the upper lung fields. Some of the larger granulomas have central caseation. Granulomatous disease of the lung grossly appears as irregularly sized rounded nodules that are firm and tan. Larger nodules may have central necrosis known as caseation--a process of necrosis that includes elements of both liquefactive and coagulative necrosis).

On closer inspection, the granulomas have areas of caseous necrosis. This is very extensive granulomatous disease. This pattern of multiple caseating granulomas primarily in the upper lobes is most characteristic of secondary (reactivation) tuberculosis. However, fungal granulomas (histoplasmosis, cryptococcosis, coccidioidomycosis) can mimic this pattern as well.

The Ghon complex is seen here at closer range. Primary tuberculosis is the pattern seen with initial infection with tuberculosis in children. Reactivation, or secondary tuberculosis, is more typically seen in adults.

PULMONARY EDEMAPULMONARY EDEMA Excessive amount of fluid in the alveoli Excessive amount of fluid in the alveoli

and pulmonary interstitial tissuesand pulmonary interstitial tissues Congestive Heart Failure, Chronic Renal Congestive Heart Failure, Chronic Renal

FailureFailure

MANAGEMENT – MANAGEMENT – RESTRICTIVE LUNG DISEASERESTRICTIVE LUNG DISEASE

AntibioticsAntibiotics OxygenationOxygenation Hemodynamic monitoringHemodynamic monitoring Diuresis /phlebotomy– pulmonary edemaDiuresis /phlebotomy– pulmonary edema Ventilatory supportVentilatory support

The nurse enters the room of a client who The nurse enters the room of a client who has a chest tube attached to a water-seal has a chest tube attached to a water-seal drainage system & noticed the chest tube is drainage system & noticed the chest tube is dislodged from the chest. The most dislodged from the chest. The most appropriate nursing intervention is to:appropriate nursing intervention is to:

a.a. Notify the physicianNotify the physician

b.b. Insert a new chest tubeInsert a new chest tube

c.c. Cover the insertion site with petroleum gauzeCover the insertion site with petroleum gauze

d.d. Instruct client to breathe deeply until help Instruct client to breathe deeply until help arrivesarrives

Ventilation Powerpoint

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