FILNASA : RESPIRATORY SYSTEM & DISORDERS  divided into nasopharynx (purely air),

oropharynx (food) and laryngopharynx

ANATOMY & PHYSIOLOGY  glottis: for coughing, cover larynx
 cough: important defense mechanism
Primary Function  no person can breathe & swallow at the same
 2 phases, inhalation or inspiration and time
exhalation or expiration  Adam’s apple: thyroid cartilage, male
prominent, female not prominent
Secondary Function
 Acid-base Balance: respiratory acidosis & Lower Airway
alkalosis
1. Trachea
 Body water levels: exhale moist, fluid  in front of esophagus, branches out to left and
balance, exhale you are losing liquids but you right bronchi, Carina (branching out starts)
are not aware
2. Bronchi
 Sense of smell: nerve connected to brain  Right : slightly wider, shorter, more vertical, 3
lobar bronchi (upper, middle, lower)
 Speech production: larynx or voice box  Left: 2 lobar bronchi (upper and lower)
(sound production and vocalization), lips &  Lined with cilia to move mucous from lower to
tongue (words, speech), paranasal sinuses trachea for expectoration or swallowing
(resonating chamber)

 Respiratory and Cardiovascular have a secret affair

 PH – power of hydrogen
 Tachypnea – fast, shallow
 Hyperventilation – fast, deep

Upper Airway

1. Nose
 Humidifies (to prevent dryness), warms, filters
air
 External: nares, nostrils
 Internal: septum (divides left and right),
mucous (filter air), cilia (moves secretion) 3. Bronchioles
 Smokers: decrease number of cilia

2. Sinuses
 FES MAX Come in pairs : Frontal, Ethmoid,
Sphenoid, Maxillary

Terminal bronchioles (no cilia up to alveoli)

 Respiratory bronchioles (gas exchange)

 Paranasal sinus: common site of infection
 Air filled cavities, provides resonance during
speech

3. Pharynx
 passageway for respiratory and digestive tract
 located behind oral & nasal cavities
4. Alveolar ducts & Alveoli

 Alveolar Sacs: cluster of alveoli

 Alveoli: basic unit of gas exchange, 300M

Alveolar Cells:
Type I – Epithelial cells, alveolar walls
Type II- secrete surfactant
Type III – phagocytic cells, eat, engulf foreign object,
microorganisms, macrophages (defense mechanism to
Respiratory Process
prevent infection)
 During inspiration, diaphragm descend to
abdominal cavity to give lungs space to
 Surfactant: prevent lung collapse (atelectasis)
expand, negative pressure in lungs
5. Lungs
 (-) pressure draws air from atmosphere (
 Right: larger than left, 3 lobes
greater pressure), lungs (lesser pressure)
 Left: narrower for cardiac notch, 2 lobes
 Lungs: air diffuses into capillaries (blood), then
Pleural Membrane
travels to body for oxygenation
 Parietal: inside of thoracic cavity, outer part
from lungs, with sensory nerves
 Diffusion: higher to lower pressure
 Visceral: covers pulmonary surface, near to
lung, no sensory nerves
 End of inspiration: diaphragm and intercostal
 Pleural Fluid: lubricates membrane, prevent 2
muscle relax, lung recoils
membranes from rubbing, no pain
 Exhalation: pressure in lungs greater than
Accessory Muscles – asthmatic people & COPD
atmospheric pressure (dumami na air inside),
 Scalene : elevate 1st 2 ribs
expel CO2 to air
 Sternocleidomastoid: raise sternum
 Trapezius and Pectoralis: fix soulders
 Effective gas exchange: depends on
ventilation (airflow in & out), perfusion
(passage of fluid or blood in the circulatory
system)

Risk Factors for Respiratory Disorders:

 Allergies – asthma: avoid triggers (egg, strong

emotion)
 Chest injuries – blunt chest trauma (suntok),
penetrating (sharp, gun shot,saksak)
 Crowded living conditions – communicable
diseases
 Chemical exposure – perfume, gas smell
 Environmental pollutants – dust, use air purifier
 Family History – asthma
 Smoking – COPD
 Surgery – pulmonary embolism
Diagnostic Tests 2. Laryngoscopy & Bronchoscopy
- direct visual examination of larynx, trachea & bronchi
1. Chest X-ray (Radiograph) - Informed consent, invasive, remove gag reflex
 Provides information about anatomical location
& appearance of lungs Before:
 NPO as ordered (6hrs. prior), prevent risk for
 Before: aspiration
- remove jewelry, other metal objects from  Assess result coagulation studies (platelet, risk
chest area for bleeding 150,000 – 450,000)
- assess ability to inhale & hold breath  Remove dentures (can cause obstruction),
eyeglasses
 After:  IV access as needed (for sedation to reduce
- help client get dressed anxiety, to relax)
 Sedatives as ordered (side effect or
ALERT: always ask if woman is pregnant, especially predisposes to respiratory depression)
1st trimester (organogenesis & fetus development), if  Have emergency resuscitation equipment at
not sure ask to do PT), can wear lead apron bedside

2. Sputum Specimen After:

 Not only for TB, asthma ( increase eosinophils)  Semi-fowler
 Expectoration or tracheal suctioning (if patient  NPO until gag reflex returns, ice chips then
cannot expectorate, invasive, depletes O2) liquid
 Identify organisms or abnormal cells  Monitor for bloody sputum (check bleeding)
 Monitor respiratory status if sedatives given
Before:
 Early morning sterile container (15ml), after  Monitor for complications (notify physician):
respiratory treatment if prescribed, but before
antibiotic treatment Bronchospasm or bronchial perforation
 Instructions: rinse with h20 only to decrease - hemorrhage, dysrhythmias (ecg), hypoxemia
contamination, deep breathe & cough, dbe 3x, (02 in blood & tissues), facial and neck
houghing cough (galling sa ilalim ubo) crepitus (grating, crackling or popping sounds)

Chest Physiotherapy CPT  Thrombus – blood clot stays in that area

 Percussion / vibration  Embolus – clot moves
 Before collection of sputum to loosen secretion
3. Pulmonary Angiography (Angio- blood vessels,
Inhalation – energy is used Graphy- image)
Exhalation – effortless  Insertion of catheter through antecubital or
femoral vein into pulmonary artery with
After: injection of iodine or radiopaque dye
 Transport specimen to laboratory immediately
 Assist client mouth care after

ALERT: Informed consent, VS before and after, to detect

signs of complication

Nursing Actions for Tracheal Suctioning:

 Assess
 Explain procedure
 Assist Semi Fowlers
 Hand hygiene, wear gloves
 Prepare suction equipment, turn on
 Hyper oxygenate client, resuscitation bag beside
Before:
 Sterile glove, lubricate catheter sterile water or
 Asses allergies: iodine content, seafood
lubricant
 NPO as ordered
 Insert catheter without suction
 Assess coagulation studies
 Apply suction intermittently while rotating and
 IV access – sedatives, decrease anxiety
withdrawing catheter (5-10 Seconds)
 Sedatives as ordered
 Hyper oxygenate client
 Emergency resuscitation bed side
 Listen to breathe sounds
 Instruction: don’t move as much as possible,
 Document procedure, client response and
lie still, might feel urge to sough, flushing,
effectiveness
nausea, salty taste
After:  Evaluated gas exchange, acid-base balance,
 Avoid BP x 24 hrs. extremity is used for lung volumes, ABG levels
injection
 Assess insertion site for bleeding Before:
 Monitor reaction to dye: itchiness, rashes  Consult need to withhold bronchodilators (will
(delayed reaction) mask & not identify the real problem)
 Increase OFI (facilitate removal of dye)  Void, wear loose clothing (proper breathing)
 Remove dentures (easy exhalation)
 Stop smoking and eating heavy meal (4-6
hours before)

After:
 Resume normal diet, bronchodilators &
4. Thoracentesis treatments
 Remove fluid (pus or blood) or air from pleural
space 6. Ventilation-perfusion (passage of fluid) Lung Scan

 Ventilation Scan: detects abnormalities in

Before: ventilation (in & out air)
 Prepare client for ultrasound or chest x-ray if  Perfusion Scan : evaluated blood flow to
ordered (to localize fluid or air, know puncture lungs
site)
 Check coagulation studies
 Position:

 Radionuclide may be injected

Before:
 Assess for allergies
 Sitting, arms and shoulders supported by table  Remove jewelry around chest area
 IV access
 Sedatives as ordered
 Emergency resuscitation bed side

After:
 Monitor client for reaction to radionuclide
(itchiness, headache, dizziness, nausea)
 Instruct client radionuclide clears from body,
increase OFI, dye clears in 8 hours

7. Skin Test
 ID injection help diagnose various infectious
 If client cannot sit, lying in bed toward diseases
unaffected side, affected side exposed, 30-45  Identify previous reactions
degrees head of bed elevated  Site free of excessive hair, inject upper 3rd,
 Instruct client: not to cough, breathe deeply, inner left, wait 20-30 minutes
move during procedure (to prevent trauma)  Circle & mark injection site, document date,
time and test site
After:  Instruct client not to scratch test site (prevent
 Monitor RR infection & abscess formation)
 Apply pressure dressing (prevent bleeding and  Avoid washing test site
air coming inside : pneumothorax)  Interpret reaction 103 days after giving test
 Assess puncture site for bleeding and crepitus antigen
 Assess site for induration (hard swelling),
5. Pulmonary Function Test erythema and vesiculation (small blister
 Spirometer elevations)
8. ABG
 Acid-base state, how well O2 is carried to the
body
 Obtain VS, determine if client has an arterial
line in place to avoid further puncture

Arterial Line

 Allen’s Test:
 To determine presence of collateral circulation
 Explain procedure, apply pressure over ulnar &
radial artery simultaneously (same time), ask Respiratory Alkalosis
client open & close hand  PH high, C02 low
 Release pressure from ulnar while pressing  Hyperventilation (more 02 less C02)
radial  Paper bag breathing (to increase C02)
 Assess color of extremity distal to pressure  Signs: tachycardia, light headedness, loss of
point, document consciousness

 Asses factors affecting accuracy of results: 9. Pulmonary Oximetry (pulse oximeter)

 02 settings  Measures 02 saturation, 95-100 %
 Suctioning
 Clients activities  If below normal ( < 90 %)
 Place sensor on client’s finger
 Provide emotional support, assist with  Maintain transducer at heart lever
specimen draw, prepare heparinized syringe,  Don’t choose extremity with impending blood
apply pressure immediately to puncture site (5- flow
10 minutes) especially id patient taking
anticoagulant, label, transport on ice ALERT: If < 90% tell physician
 Sedative as ordered
MEDICATIONS:
ALERT: ABG first before suctioning
1. Inhalation Devices
PH = 7.35 – 7.45 a. Metered-dose inhaler (MDI)
C02 = 35-45
HCO3 = 21-28 meq/L
Pa O2 = 80-100 mmHg

Respiratory Acidosis
 PH low, High C02
 Hypoventilation (kulang 02) : C02 not exhaled
resulting to hypercapnia (high C02 in blood)
 Signs of hypercapnia: tachy-tachy
 Signs of Respiratory Acidosis:tachy-tachy,
hypertension, increase ICP
 C02 in blood: makes blood acidic  Uses chemical propellant to push medication
out of inhaler (Ventolin puff)
Interventions:
 Administer bronchodilators as ordered (di b. Nebulizer – delivers fine liquid mists through
makapasok 02, luwag paghinga, labas C02) tube or mask using air or 02 pressure, put
 Adequate fluid intake (2-3 L) as indicated medication into tube
(decrease secretions), contraindicated with
edema  If two inhaled medications ordered and one
 Supplemental 02 as needed contains glucocorticoid – B before C :
 Semi-Fowlers Bronchodilator first before glucocorticoid, short
 Prepare client for mechanical ventilation if acting before long acting, to open airway 1st
necessary
ALERT: 5 minutes interval – different drug production) and Erythromycin (for infection) BEC =
1-2 minutes – same drug increase effect of theophylline

2. Bronchodilators Barbiturates (CNS depressant, mild sedation to total

 Relax smooth muscle of bronchi and dilates anesthesia), Carbamazepine (anti-seizure)= decrease
airways for gas exchange effect of theophylline
 Treats asthma, bronchospasm, bronchitis,
restrictive airway diseases (ARDS) Side Effects
 ARDS: lung not compliant, lungs stiff (normal  Palpitations & tachycardia
elastic)  Dysrhythmias (abnormality in a physiological
rhythm, especially in the activity of the brain or
a. B2-Adrenergic Agonists - effects on smooth heart)
muscle, dilation of bronchial passages,  Restlessness, nervousness, tremors
vasodilation in muscle and liver, relaxation of  Anorexia, N & V
uterine muscle, and release of insulin. They are  Headache, dizziness
primarily used to treat asthma and other  Hyperglycemia
pulmonary disorders, such as COPD.  Mouth dryness, throat irritation with inhalers
(increase OFI)
Inhaled: FALS
 Formoterol Interventions
 Albuterol  Assess lung sounds
 Levalbuterol  Adequate hydration
 Salmeterol  Medication at regular intervals (regular
frequency, maintain therapeutic level)
Oral: AT  Oral medications with of after meals (prevent
 Albuterol GI irritation)
 Terbutaline  Monitor Therapeutic Serum Theophylline
Level (10-20 mcg/ml or 55.5-111 mcm d/L)
b. Methylxanthines - treatment of airway  IV Theophylline : administer slowly via
obstruction caused by conditions such as infusion pump
asthma, chronic bronchitis, or emphysema.
ALERT: Theophylline Toxicity: restlessness,
 Theophylline (oral) nervousness, tremors, palpitation, tachycardia
 Aminophylline
Client Teachings
Contraindications:  Not crush tablets or capsules, crushing
 Hypersensitivity increase risk of side effects
 PUD: peptic ulcer disease, GI irritation, gastric,  Avoid caffeine containing (coffee, tea, cola,
duodenal, esophageal ulcer chocolate)
 Cardiac disease, dysrhythmias  Monitor pulse, report abnormalities
 Hyperthyroidism  How to use inhaler, spacer of nebulizer

Esophageal ulcer – hematemesis & black tarry stool

Caution:
 Hypertension & diabetes (side effect of
medication id hyperglycemia), give with caution

Theophylline – increase risk for digoxin toxicity (atrial

fibrillation, atrial flutter, and heart failure) and decrease
effect of lithium & phenytoin (anti-seizure)
 Smoking cessation (decrease serum level of
Digoxin toxicity theophylline)
- nausea, vomiting, abdominal pain, headache,  Monitor blood glucose levels if with diabetes
dizziness, confusion, delirium, vision disturbance (blurred (side effect hyperglycemia)
or yellow vision).
- Normal (tx for heart failure) 0.5 to 2 ng/ml 3. Anticholinergics
- Normal (tx for arrythmia) 1.5 and 2.5 ng/ml  treat various medical conditions that involve
contraction and relaxation of muscles
Theophylline + B2-adrenergic agonist = cardiac  bronchodilation
dysrhythmias  treats COPD (irreversible), allergy-induced
asthma (reversible), exercise-induced asthma
Beta Blockers (-olol), Cimetidine (Tagamet, histamine
H₂ receptor antagonist that inhibits stomach acid
  Ipatropium (inhaled)  Contraindications: hypersensitivity, breast-
 Tiotropium (inhaled) feeding mothers (can mix with breast milk)
 Caution: impaired hepatic function
 COPD can co-exist with asthma  Co-administration with inhaled
glucocorticoid: increase risk of upper
Side effects respiratory infection
 Dry mouth (increase OFI)
 Irritation of throat SGOT & SGPT – LFT
 Systemic effects (increase IOP, blurred vision, BUN & Creatinine – Kidney
tachycardia, cardiovascular event, urinary
retention, constipation) Side Effects:
 Constipation: increase OFI, high fiber diet, -headache
increase activity - N&V
- dyspepsia (indigestion)
Normal IOP = 10-21 mmhg, high might lead to - diarrhea
glaucoma (retina damage), measured by tonometer - generalized pain, myalgia (muscle pain)
- fever
ALERT: Check peanut allergy when taking Ipatropium - dizziness
they contain soylecithing
Interventions:
4. Glucocorticoids (corticosteroids)  Assess lung sounds for wheezing
 Regulates glucose, risk might develop  Assess LFT, Lab. Values
diabetes, side effect hyperglycemia  Monitor for cyanosis
 Anti-inflammatory agents, reduce edema of
airways Teachings:
 Treats asthma and other inflammatory  1 hour before & 2 hours after meals
respiratory conditions  Increase OFI
 Do not discontinue
 Inhaled
 Beclomethasone dipropionate 6. Expectorants & Mucolytics
 Budesonide
 Ciclesonide  Expectorant
 Fluticasone propionate  Guaifenesin
 Loosen bronchial secretions to be removed by
 Oral coughing
 Prednisone  For dry, unproductive cough
 Prednisolone  To stimulate bronchial secretions

Side effects:  Mucolytics

 Hyperglycemia  Acetylcystein
 Weight gain & edema: due to increase in fluid  Thin mucous secretions to help more
 GI irritation, peptic ulcer productive cough
 Hypocalcemia : excretes CA (osteoporosis)
 Anti-cough / cough suppressant /
Contraindications: known allergy antitussive
Caution: clients with diabetes  Dextromethorphan

Barbiturates (CNS depressant, mild sedation &  Do not give mucolytic with anti-cough
anesthesia), phenytoin (Dilantin anti-seizure), medication (dextromethorphan), and to COPD
Rifampin (antibiotic) – decrease effect of prednisone clients

-Corticosteroids increase potency (effect) of aspirin &  Do not give acetylcystein (mucolytic) to clients
NSAIDS : GI irritation with asthma : will increase airway resistance (di
naman secretions problem sa asthma, narrowing of
Interventions: avoid person with infection, airways problem)
immunosuppressive effect
Side effects
5. Leukotriene Modifiers  GI irritation
 Montelukast (oral)  Rash
 Zafirlukast (oral)  Oropharyngeal irritation

 Prophylaxis & treatment of chronic asthma Interventions:

 Inhibit bronchoconstriction, reduce airway  Acetylcystein (mucolytic) by nebulization:
edema, smooth muscle constriction do not mix with other meds.
- Bronchodilators 5 minutes before Acetylcystein  inhale nose, place hand over abdomen exhale
(mucolytic) as if whistling, blow pursed lip
- Side effects of Acetylcystein (mucolytic): N&V,  3x longer expiration (than inspiration) due to
stomatitis (singaw), runny nose (rhinorrhea), gastritis (GI) hypercapnia, out more C02

Teachings: 2. Huff coughing

 Take with full glass of water (loosen more  conserves energy, reduces fatigue, allows
secretions) mobilization of secretions
 Adequate OFI  3 to 4 deep breathes
 Cough, deep breathe  Lean slightly forward
 Cough 3 to 4x during exhalation
7. Inhaled Non-steroidal Anti-allergy
3. Chest Physiotherapy (CPT)
 Cromolyn Sodium (inhaled)  Percussion, vibration, postural drainage
(assume diff. positions, do percussion &
 Anti-asthma, antiallergic, mast cell stabilizer, vibration, head of bed lower than body or foot)
inhibit mast cell release after antigen exposure  Upon awakening, 1 hour before meals
 Pain, cyanosis, exhaustion: stop
 Bronchodilators as ordered : 15 minutes before
Drawing:  Percuss: 1-2 minutes
 Maintain position for 5 to 20 minutes after
procedure

 Used to treat allergic rhinitis, bronchial asthma,

exercise-induced asthma
 Contraindications: (check sa book)

 Cromolyn Sodium (oral) used with caution in

clients with impaired hepatic or renal
function  Dispose sputum properly
 Mouth care after
 Side effects: cough, sneezing following
inhalation, unpleasant taste in mouth  Contraindications:
 Unstable VS
 Interventions: monitor respirations and  Increase ICP
assess lung sounds (wheezing)  Bronchospasm
 History of pathologic fracture (from disease
 Client teachings: administer oral capsule 30 process)
minutes before meals, do not d/c abruptly  Rib fractures
 Chest incisions
ALERT: Sips of water before and after taking
medication, prevent coughing, mask unpleasant taste 4. Incentive Spirometry
 Sitting or upright
Ae : Asthma wheezing during expiration (can also be in  Place mouth tightly around mouthpiece
inspiration)  Inhale slowly to raise and maintain flow rate
indicator between 600-900 mark
Bi : Bronchitis wheezing during inspiration  Hold breathe 5 seconds, exhale pursed lip

Chest or thoracic – chest rise & fall 5. Oxygen

Diaphragmatic – abdomen rise & fall a. Supplemental 02 deliver Systems

RESPIRATORY TREATMENTS  Nasal Cannula

- low flow
1. Breathing retraining - client chronic airflow limitation
 Decrease use of accessory muscles, decrease - long term 02 use
fatigue, promote C02 elimination
 Simple Face Mask
 Pursed lip breathin - short term 02 therapy & emergency
 Venture Mask  If cause of alarm cannot be determined,
 Clients high risk of ARF (patient almost not ventilate manually until problem is corrected
breathing)  Turn every 2 hours to avoid complications of
immobility
 General Guidelines:
 Assess color, pulse oximeter, vs before &  Causes of Ventilator Alarms
during  Nurse responsible to be alert to alarm sound
 Place “Oxygen in use sign” (02 combustible) (check book):
 Assess presence of chronic lung problems
 Humidify oxygen if indicated
 Respond promptly, asses client immediately
ALERT: 1-2 L/min. – hypoxemic client (drive for
breathing)  High pressure alarm:
- increase secretions in airway
- displaced ET tube
- obstructed ventilator tube with water
- tube kinked
- coughing, gags, bites ET tube
- patient anxious

 Low pressure alarm:

- disconnection or leak
- cessation of spontaneous(natural) breathing

 Normal rate of breathing di dapat mababa sa

ventilator

 Complications:
-hypotension caused by positive pressure that
inhibits blood return to heart
- pneumothorax
- malnutrition
- infections
- ventilator dependence

 Weaning – process of going from ventilator

dependence to spontaneous breathing

COMMON SYMPTOMS OF RESPIRATORY

DISORDER

 Dyspnea – DOB
6. Mechanical Ventilation  Cough – due to secretion, reflex

ALERT: at bed side resuscitation bag (manually  Sputum production

ventilate patient) a. Purulent – pus, thick, yellow or green
(bacterial)
ALERT: alarm sound: check patient 1st then ventilator
b. Thin – mucoid, virus
ALERT: never turn off alarm c. Gradually increasing – COPD
d. Pink mucoid – Lung tumor
 Interventions: e. Frothy – with bubbles, pulmonary edema
 Assess respiratory status & breathing patterns f. Foul smelling – lung abscess
 Monitor skin color, lips & nail bed
 Monitor bilateral chest expansion (both lungs)
 Obtain pulse oximetry readings (< 90  Chest pain – COPD, muscle strain
emergency)  Wheezing – Ae, Bi
 ABG : respiratory acidosis  Hemoptysis
 Assess need for suctioning, observe type, - coughing of blood, infection, CA, embolus
color, amount of secretions - dx test: x-ray, bronchoscopy, angiography
 Assess ventilator settings - priority: identify source of bleeding
 Ensure alarm is set
- Lungs: bright red, frothy, with bubbles,
alkaline
- Stomach: vomit (hematemesis), coffee ground (mixed - Monitor pulse oximetry (95-100 %, <90%
with gastric juice), acidic (Hcl acid) call physician)
- Respiratory treatments & CPT
(percussion & vibration, 15 minutes before
COPD
give bronchodilators)
 Other names: Chronic lung disease, chronic airflow - DBE (diaphragmatic & abdominal), pursed
limitation lip breathing (maximal C02 expiration)
 Airflow obstruction or limitation, abnormal - Record amount, consistency and color of
inflammatory response, completely not reversible sputum, suction if necessary to clear
airway and prevent infection
1. Chronic Bronchitis - Monitor weight
- Small frequent meals, maintain nutrition,
 Risk Factors:
prevent dyspnea
- Smoking - High calorie diet, high protein for repair
- Passive smoking - Encourage oral fluid intake (2-3L per day
- Dust to keep secretions thin, unless
- Chemical contraindicated)
- Fowler’s, leaning forward (orthopneic
 Too much secretion position)
- Activity as tolerated (activity-rest-activity)
 Impaired ciliary function (too much secretion,
- Bronchodilators as indicated (short-acting)
drowned) - Corticosteroids as ordered for
 Hyperplasia of mucous glands (increase no.) exacerbation (worsen)
 Infection - Mucolytics to thin secretions
- Antibiotics for infection
Hypertrophy – increase in size
 COPD Client Teachings
2. Emphysema - Balance activity and rest
 No alpha 1 anti-trypsin (protects lungs, - Avoid gas forming foods (cabbage, makes
surfactant) you bloated), spicy foods (increase
acidity, acid reflux, vomit, increase
 Hyperinflation of alveoli, lacks lung elasticity
symptoms of COPD), extremely hot or
and recoil (barrel chest) cold foods
 Destruction of alveolar wall - Avoid crowds (immunosuppressed, wear
 Overdistention, hyperinflation of alveolar walls mask), exposure to persons with
 Impaired gas exchange infections
- WOF: signs and symptoms of respiratory
Asthma – reversible infection and hypoxia
Chronic Bronchitis & Emphysema – continuous - Stop smoking: single most effective way,
Remission – gone, reduced it irritates mucous glands (keeps on
Exacerbation - return spitting)
URTI – dry cough
Bronchial Asthma – cough at night ASTHMA
Post nasal drip – worsening when supine, secretion  Chronic airway inflammation,
drips at the back of throat hyperresponsiveness to stimuli or triggers,
reversible
 COPD Manifestations / Assessment
- Cough  Risk Factors
- Exertional dyspnea (exert energy, carry  Allergens: dust, molds, pollen, grasses
object then DOB)  Environmental irritants: perfumes, weather
- Sputum production changes, smoke, fireplaces, animal dander
- Wheezing & crackles (fur)
- Weight loss (hinga lang ng hinga, di maka  Medications: acetylsalicylic acid (aspirin),
eat) NSAIDS, B-adrenergic blockers
- Barrel chest  Chemicals, wood dusts, plastics
- Accessory muscles for breathing  Food additives: beer, wine, shrimp,
- Prolonged expiration (due to hypercapnia) processed potatoes, msg
- Orthopnea (DOB when supine, must sit  Exercise
up)  Nuts, milk, cheesed, dairy products
- Cardiac dysrhythmias)  Strong emotions: anger, laughing, crying
- X-ray (over distention of alveoli)
- ABG (hypoxemia, respiratory acidosis)

 COPD Interventions:
- Oxygen as ordered
 Status Asthmaticus - Corticosteriods: inflammation
– life-threatening, refractory (doesn’t respond - Anti-allergy meds.
to treatment) to treatment, may result in: - NSAIDS
pneumothorax, acute cor pulmonale (right - long acting B2 agonists: bronchodilation
sided heart failure, problem in pulmonary - leukotriene modifiers: prevent
artery), respiratory arrest bronchospasm

 Normal PACO2 during asthma attack – sign c. Nebulizer, metered dose inhaler (MDI)
of impending respiratory failure, if with asthma - Mixed with NSS, nebulization (3ml saline
PACO2 is compromised, bring to hospital + nebule)
immediately - Use MDI with spacer when giving
corticosteroids (to prevent oral thrush,
 Manifestation of Asthma yeast infection, rinse mouth)

- Cough  Asthma Client Teachings

- Wheezing or crackles - Identify triggers & eliminate them
- Correct use of peak flow meter
- Restlessness
- Absent or diminished lung sounds PULMONARY EMBOLISM
- Accessory muscles for breathing  Thrombus forms (stagnant blood clot,
- Tachypnea & hyperventilation common in deep vein), detaches and travels to
- Prolonged exhalation right side of heart, lodges in pulmonary artery
- Tachycardia  Embolus: causes obstruction, movable
- Diaphoresis  DVT: do not massage
- Cyanosis: late sign, central, hypoxemia
 Risk Factors:
- Decrease 02 sat  Prolonged immobilization – comatose patient
(move every 2 hours, for proper circulation)
 Interventions:  Surgery
- monitor: vs, pulse oximetry  Obesity – fats
 Pregnancy – amniotic fluid
- monitor peak flow (highest airflow during  Heart failure
 Advanced age
forced expiration
 History of thromboembolism – may repeat itself
Green: 80-100%, patient doing well  Fracture – yellow bone marrow or fats may
Yellow: 60-80%, condition worsening enter blood vessel, long bone fracture
Red: <60%, bring to hospital, emergency
 Assessment:
- Assist with breathing during acute asthma - Restlessness
attack by: - Blood-tinged sputum
 High fowler’s position - Chest pain – common
 02 as ordered - Cough
 Stay with client to decrease anxiety - Crackles & wheezes
 Bronchodilators as ordered - Cyanosis
 Corticosteroids as prescribed - Distended neck veins
 Auscultate lung sounds before, - Dyspnea exacerbated by inspiration
during & after treatments - Feeling of impending doom
 Record color, amount, consistency - Hypotension
of sputum - Petechiae over chest & axilla
- Tachypnea & tachycardia
 Medications:
a. Quick Relief / Rescue  Interventions:
- Asthma attacks - Notify physician
- treat symptoms & exacerbations - Elevated head of bead
- short acting B2 agonists: - 02
bronchodilation - VS & check lung sounds
- anticholinergics: bronchospasm - ABG
- Corticosteroids: reverse airflow - Heparin Therapy (IV anticoagulant, WOF
obstruction signs of bleeding, prevent more clots to
- DOC (B2 adrenergic agonist): albuterol happen, no clot yet)
(Ventolin), levalbuterol, pirbuterol - Oral Warfarin
- Oral first then IV
b. Long Term (preventer) - Embolectomy
- Prevent asthma
- Maintain control of inflammation
 - Vena Cava Filter: green field filter, CHEST INJURIES
prevent clot reaching lungs, filter blood  Rib Fracture
going to heart - Direct blunt chest trauma (5th-9th rib most
common)
- Impaired ventilation, inadequate
clearance of secretions due to pain with
movement and chest splinting

- Assessment:
 Pain & tenderness at injury site,
increase with inspiration
 Shallow respirations – due to pain,
tachypnea, shallow
- Proper documentation, interventions &  Client splints chest, hands, pillow to
response minimize pain
- Thrombolytics: -kinase, there is already  Fractures noted on chest x-ray
clot, streptokinase, urokinase
- Embolic stockings - Interventions:
 Fowlers
 Deep Vein Thrombosis (DVT)  Pain medication as ordered for
- + Homan’s sign ventilatory support, breathe properly
 Monitor for increased respiratory
distress
 Self-splint, with hands, arms or pillow

 Flail Chest
- Blunt chest trauma, accidents
- May result in hemothorax and rib fractures
- Paradoxical expansion and contraction
of chest wall (inward during inspiration,
outward during expiration, baliktad sa
normal movement of lungs)

- Ways to prevent DVT:

 Pumping leg exercise (like driving)
 Avoid prolonged sitting, lying in bed
 Avoid crossing of legs for prolonged time
 Do not wear constrictive clothing
 Avoid dangling of legs

 Virchow’s Triad - Severe chest pain

- Dyspnea
- - Cyanosis: late sign, clubbing of fingers or
toes
- Tachycardia, hypotension, tachypnea,
shallow respiration, diminished breath
sounds

- Interventions:
 Fowlers
 02 as ordered, cannula or mask
24-36 hours
 Monitor increased respiratory
distress
 Coughing and DBE (3-4x
breathing, 3-4x huff coughing
 Pain medication as ordered
  Bed rest and limit activity,  Sharp chest pain during breathing
decrease demand of oxygen  Sucking sound with open chest
 Prepare for intubation, with wound
mechanical ventilation, with  Tachycardia, tachypnea, tracheal
PEEP for severe flail chest, deviation to unaffected side
associated with respiratory
failure and shock  Interventions:
 (+) End Expiratory Pressure: - Apply non-porous (no holes, prevent air to
prevent atelectasis, airway enter) dressing over open chest wound
open, prevent lung collapse - 02 as ordered
- Fowlers
PULMONARY CONTUSION - Chest tube placement – remove fluid, air,
- Bruises, nabugbog blood, remains in place until lungs has
- Interstitial hemorrhage (surrounding cells, fully expanded
internal hemorrhage), decreased - Monitor chest tube drainage (returns
pulmonary compliance negative pressure to intrapleural space)
- Major complication: ARDS – stiff lungs,
restrictive ALERT: Client with respiratory disorder position with
head of bed elevated
- Assessment:
 Dyspnea ACUTE RESPIRATORY FAILURE
 Restlessness  Insufficient 02 is transported to the blood or
 Increased bronchial secretions inadequate carbon dioxide is removed from
 Hypoxemia lungs
 Hemoptysis
 Decreased breath sounds  Causes: impaired respiratory muscles (not
 Crackles and wheezes helping patient to breathe), defect in
respiratory centers (pons & medulla
- Interventions: oblongata), chest wall abnormalities (flail
 Maintain patent airway, adequate chest)
ventilation
 Fowlers  Characterized by: Pa02 <60 mmHg (N 80-
 02 as ordered, mask, cannula 24-36 100), 02 Sat <90% (N 95-100), Pa C02 >50
hours mmHg (N 35-45) = Respiratory Acidosis
 Decrease 02 demand
 Monitor increases respiratory distress  Assessment:
 Bed rest, limit activity  Dyspnea
 Prepare mechanical ventilation, PEEP  Headache
if required  Restlessness
 Confusion
PNEUMOTHORAX  Tachycardia
 Air outside, enter pleural space  Hypertension
 150 ml physiologic dead space – air pockets  Dysrhythmias
in lungs not related to gas exchange  Decreased LOC
 Loss of (-) pressure resulting to atelectasis  Alterations in respirations & breathe
 Spontaneous / Simple Pneumothorax: sounds
rupture of pulmonary bleb (air pockets inside
lungs not related to gas exchange)  Interventions:
 Open Pneumothorax: opening through chest  Identify & treat cause
wall allows air into pleural space, gunshot  02 (maintain Pa02 level >60-
wound, stab wounds 70mmHg)
 Tension Pneumothorax: blunt chest injury,  Fowlers
mechanical ventilation with PEEP, positive  DBE
pressure build up in pleural space, due to  Bronchodilators as ordered
procedures done to patient, mechanical  Mechanical ventilation if
ventilation supplemental 02 cannot maintain
 Diagnosis: chest x-ray acceptable Pa02, Pa c02 levels
 Assessment:
 Absent breath sound on affected ACUTE RESPIRATORY DISTRESS SYNDROME
side  Lungs stiff, not compliant, don’t expand
 Cyanosis normally, refractory hypoxemia
 Decreased chest expansion  Doesn’t respond to 02
unilaterally  Prepare for intubation
 Dyspnea  Form of acute respiratory failure caused by
 Hypotension diffuse lung injury
  Major site of injury: alveolar capillary  Recurrent:
 ABG: respiratory acidosis
 Chest x-ray: bilateral infiltration (R & L
presence of fluid) Pleurectomy
 Causes: - stripping of pleural membrane (parietal pleura away
 Fluid overload – heart failure, kidney from visceral)
failure, sodium attracts water - inflammatory reaction, causing adhesion between two
 Burns – fluid shifting layers during healing
 Aspiration – swimming, drowning,
eating supine Pleurodesis
 Toxic substance inhalation – - procedure that causes the membranes around the
gasoline, fire, plastic, chemicals lungs to stick together and prevents the buildup of fluid
 Drug ingestion in the space between the membranes (pleural space)
- instillation of sclerosing agent into pleural space via
Pulmonary edema – low sodium diet (sodium attracts thoracotomy
water) - creates inflammatory response, sclerosis tissues
together
 Assessment
 Tachypnea EMPYEMA
 Dyspnea (12-48 hours after initial  collection of pus (infection) within pleural cavity
event)  fluid is thick & foul smelling
 Decreased breathe sounds  Common Cause: pulmonary infection, lung
 Deteriorating ABG levels abscess, chest surgery and chest trauma
 Hypoxemia despite high  Treatment goals: control & treat infection,
concentration of 02 empty empyema (remove pus, thoracentesis),
 Decreased pulmonary compliance – re-expand lung
stiff lungs, loss of recoil
 Pulmonary infiltrates (fluid)  Assessment:
 Chest pain
 Interventions:  Cough
 Identify and treat cause (ex: fluid  Dyspnea
overload)  Anorexia & weight loss
 02 as ordered  Malaise
 Fowlers  Fever & chills
 Restrict OFI as ordered  Night sweats
 DBE, Huff coughing, CPT, Incentive  Chest x-ray: pleural exudates
spirometry
 Diuretics (furosemide),  Interventions:
anticoagulants, corticosteroids  Monitor breath sounds
 Prepare for intubation, mechanical  Semi or high fowlers
ventilation, PEEP (prevent  Coughing & DBE
atelectasis)  Antibiotics: danger multi drug
resistant, take as prescribed
PLEURAL EFFUSION  Splint chest as necessary
 Collection of fluid (other than pleural fluid) in  Thoracentesis or chest tub insertion
pleural space to promote drainage and lung
 Assessment: expansion
 Pleuritic pain (inspiration)
 Progressive dyspnea PLEURISY
 Dry non-productive cough due to  Inflammation of visceral & parietal membranes,
bronchial irritation or mediastinal shift pulmonary infarction or pneumonia (with
 Tachycardia friction)
 Elevated temperature (due to  Pleural membranes rub together during
infection), increase WBC respiration, cause pain
 Decreased breath sounds on  1 side of chest – low lateral portions
affected area  Assessment:
 Chest x-ray (confirmatory)  Knife-like pain, worsen by DBE,
coughing (localized, radiates)
 Interventions:  Dyspnea
 Identify & treat cause  Pleural friction rub on auscultation
 Monitor breathe sounds
 Fowlers  Interventions:
 Coughing & DBE  Identify & treat cause
 Thoracentesis  Monitor lung sounds
  Analgesics as ordered: DOC –
Indomethacin (NSAID)
 Hot and cold as ordered – temporary
pain management
 Coughing & DBE
 Lie on affected side

90 degrees – high fowlers

45 degrees – semi fowlers
15 degrees – low fowlers

After 2-3 weeks anti TB drugs – you’re not infectious