NCMMSN3

RESPIRATORY SYSTEM

CLINICAL INSTRUCTOR:
Nellie R. De Vera, MAPsych, MANc, RN, LPT, ABPolS
Certified Mental Health First Responder Coach
Certified RESET Mental Health and Well-Being Coach
 OBJECTIVES

OBJECTIVES OF THE LESSON:

• 1. Describe the structures and functions of the upper and lower respiratory tracts.
• 2. Discriminate between normal and abnormal assessment findings of the
respiratory system.
• 3. Identify the diagnostic tests used to evaluate respiratory function.
• 4. Compare and contrast the URTI’s according to cause, incidence, clinical
manifestations, management and the significance of preventive health care.
• 5. Compare the various Lower Respiratory Tract Disorders with regard to
causes, clinical manifestations, nursing management, complications and
prevention.
• 6. Use the Nursing Process as framework for care of the patient with Respiratory
Disorders.
 A. OVERVIEW OF THE RESPIRATORY SYSTEM

2 PRIMARY FUNCTIONS

1. Provides O2 for metabolism in the tissues

2. Removes CO2, the waste product of metabolism
 SECONDARY FUNCTIONS

•It facilitates sense of smell, produces speech,

maintains acid-base balance, maintains body
water levels, maintains the balance of heat in
the body.
 THE RESPIRATORY PROCESS:

Inhaled air – URT – trachea– LRT – alveoli (gas

exchange) – oxygen is perfused in the body and
CO2 and other waste products -- exhaled
 RISK FACTORS FOR RESPIRATORY DISEASE

• Smoking, Use of chewing tobacco,

Allergies, Frequent respiratory
illnesses, Chest injury, Surgery,
Exposure to chemicals, pollutants,
Exposure to recreational and
occupational hazards, Family
history of infectious disease,
Geographic residence & travel to
foreign countries, Genetic Make up,
Vit D Deficiency, Obesity, Excessive
acetaminophen exposure
prenatally
ASSESSMENT OF RESPIRATORY FUNCTION:
 ASSESSMENT OF RESPIRATORY FUNCTION:
1. Health History: initially focuses on the presenting problem and
associated symptoms, with close attention to how all aspects of the
patient’s life, including ADLs and quality of life are impacted. Nurse
should explore the onset, location, duration, character, aggravating and
alleviating factors and timing of the presenting problem and associated
symptoms.
2. Past Health, Social and Family History: Specific questions are
asked about childhood illnesses, immunizations, medical conditions,
injuries, hospitalization, surgeries, allergies and current
medications/herbal remedies. Personal and social history issues such as
diet, exercise, sleep, recreational habits and religion including
psychosocial factors. The nurse assesses for risk factors and genetic
factors that may contribute to the patient’s presenting problems.
 ASSESSMENT OF RESPIRATORY FUNCTION:

3. Physical Assessment: Using IPPA and proper positioning

a. Inspection: includes general appearance, routine inspection requires
a light source. This assessment parameter assesses the structures of the
external upper airways. For inspection of the lower airways, nurse
assesses for color, turgor and loss of subcutaneous tissue. It is also
important to note for asymmetry and chest configuration. Breathing
patterns and respiratory rates are also considered.
b. Palpation: Nurse palpates the thorax for tenderness, masses, lesions,
respiratory excursion, and vocal fremitus. Direct palpation is used for skin
lesions and subcutaneous masses using the fingertips and for deeper
masses or generalized flank or rib discomfort using the ball of the hand.
 ASSESSMENT OF RESPIRATORY FUNCTION:

c. Percussion: Allows the nurse to determine whether

underlying tissues are filled with air, fluid or solid material.
Flat sounds are indicative of pleural effusion, dull sounds
indicate lobar pneumonia, Hyper resonant sounds maybe
diagnosed as emphysema or pneumothorax.
d. Auscultation: Assessment of airflow through the
bronchial tree or evaluates the presence of fluid or solid
obstruction of the lung with the use of a stethoscope. The
nurse auscultates for normal breath sounds, adventitious
sound or voice sounds.
 DIAGNOSTIC TESTS:

• 1. PULMONARY FUNCTION TESTS

(PFT) – Performed to assess
respiratory function, extent of
dysfunction, response to therapy and
as screening tests in potentially
hazardous industries such as coal
mining and those that involve
exposure to asbestos and noxious
irritants. Such tests include
measurements of lung volumes,
ventilatory function and the
mechanics of breathing, diffusion and
gas exchange.
 DIAGNOSTIC TESTS:

• 2. ARTERIAL BLOOD
GASES (ABG) – obtained
through an arterial puncture,
pain, infection and
hemorrhage are potential
complications that may be
associated with ABGs.
 DIAGNOSTIC TESTS:

3. PULSE OXIMETRY – a non-

invasive method of continuously
monitoring oxygen saturation of
hemoglobin. It is an effective tool
for monitoring subtle or sudden
changes in oxygen saturation.
Normal levels are 95-100%.
 DIAGNOSTIC TESTS:

• 4. SPUTUM STUDIES - obtained

for analysis to identify pathogenic
microorganisms and to determine
whether malignant cells are
present. They are ideally obtained
early in the morning before the
patient had anything to eat or
drink. Other methods of sputum
collection include endotracheal or
transtracheal aspiration or
bronchoscopic removal.
 DIAGNOSTIC TESTS:

• 5. CULTURES – Throat, nasal,

and nasopharyngeal cultures
can identify pathogens
responsible for respiratory
infections. Ideally, all cultures
should be obtained prior to the
initiation of antibiotic therapy.
Results usually take between
48-72 hours, with preliminary
reports available usually within
24 hours.
 DIAGNOSTIC TESTS:

6. IMAGING STUDIES – 6.1

CHEST X-RAY (CXR): routine
chest x-rays consists of two
views: the posterior-anterior
projection and the lateral
projection. They are usually
taken after a full inspiration
because the lungs are best
visualized when they are well
aerated. In addition, the
diaphragm is at its lowest
level and the largest expanse
of the lungs is visible.
 DIAGNOSTIC TESTS:

• 6.2 COMPUTED TOMOGRAPHY

(CT): method where the lungs are
scanned in successive layers by a
narrow beam x-ray. The images
produced provide a cross-sectional
view of the chest. It can distinguish
fine tissue density. Advancements
in CT scanning technology, referred
to as multi detection, spiral or
helical enable the chest to be
scanned quickly while generating
an extensive number of images that
can generate a three-dimensional
analysis.
 DIAGNOSTIC TESTS:

• 6.3 MAGNETIC
RESONANCE IMAGING
(MRI): magnetic fields and
radiofrequency signals are
used instead of radiation. It
is able to better distinguish
between normal and
abnormal tissue than CT
and is therefore yields a
more detailed diagnostic
image.
 DIAGNOSTIC TESTS:

• 6.4 FLOUROSCOPIC
STUDIES: allows live
x-ray images to be
generated via a
camera to a video
screen used to assist
with invasive
procedures, such as
chest needle biopsy or
transbronchial biopsy
that are performed to
identify lesions.
 DIAGNOSTIC TESTS:

• 6.5 PULMONARY
ANGIOGRAPHY: use to
investigate congenital
abnormalities of the
pulmonary vascular tree
and thromboembolic
diseases of the lungs
such as PE when less
invasive testing is
inconclusive or when
angioplasty is anticipated.
 DIAGNOSTIC TESTS:

• 6.6 RADIOISOTOPE
DIAGNOSTIC
PROCEDURES (LUNG
SCANS): used to
assess normal lung
functioning, pulmonary
vascular supply and
gas exchange.
Pregnancy is C/I in
these scans
 DIAGNOSTIC TESTS:

• ENDOSCOPIC PROCEDURES
• 6.7 BRONCHOSCOPY:
direct inspection and
examination of the larynx,
trachea and bronchi
through either a flexible
fiberoptic fiberscope or a
rigid bronchoscope.
 DIAGNOSTIC TESTS:

• 6.8 THORACOSCOPY:
pleural cavity is
examined with an
endoscope and fluid and
tissues can be obtained
for analysis.
 DIAGNOSTIC TESTS:

• 6.9 THORACENTESIS:
is the aspiration of fluid
from the pleural space
for diagnostic or
therapeutic reasons.
 RESPIRATORY CARE MODALITIES:

• A. NON-INVASIVE RESPIRATORY THERAPIES

1. OXYGEN THERAPY: the administration of oxygen at a concentration
greater than that found in the environmental atmosphere.
• Indications: a change in the patient’s respiratory rate, decrease in
arterial oxygen tension in the blood, changes in mental status,
dyspnea, increase in blood pressure, changes in heart rate,
cyanosis and diaphoresis.
• Toxicity: may occur when too high a concentration of oxygen is
administered for an extended amount of time. Symptoms of oxygen
toxicity include substernal discomfort, paresthesia, dyspnea,
restlessness, fatigue, malaise, progressive respiratory difficulty,
refractory hypoxemia and alveolar infiltrates evident on chest x-rays.
 RESPIRATORY CARE MODALITIES:

Methods of Oxygen
Administration
LOW FLOW
SYSTEMS:
1. Nasal Cannula 1-2/3-
5 LPM – lightweight,
comfortable,
inexpensive,
continuous with meals
and activity
 RESPIRATORY CARE MODALITIES:

2. Oropharyngeal catheter
1-6 LPM – inexpensive,
does not require a
tracheostomy
 RESPIRATORY CARE MODALITIES:

3. Simple face mask

6-8 LPM – simple to
use, inexpensive
 RESPIRATORY CARE MODALITIES:

4. Transtracheal catheter
¼-4 LPM – More
comfortable, concealed
by clothing, less oxygen
liters per minute than
nasal cannula. Surgically
implanted
 RESPIRATORY CARE MODALITIES:
RESERVOIR SYSTEMS:
1. Mask, partial re
breathing 8-11 LPM –
Moderate oxygen
concentration
 RESPIRATORY CARE MODALITIES:

2. Mask, non-rebreathing 12 LPM – High oxygen concentration

 RESPIRATORY CARE MODALITIES:
HIGH FLOW
SYSTEMS:
1. Venturi Mask
4-6 LPM – Mixes
O2 with room air
creating high
flow enriched O2
of a desired
concentration.
Must remove to
eat.
 RESPIRATORY CARE MODALITIES:

2. Aerosol mask
8-10 LPM –
good humidity,
accurate
fractional
inspired oxygen
concentration
 RESPIRATORY CARE MODALITIES:
2. INCENTIVE SPIROMETRY: method
of deep breathing that provides visual
feedback to encourage the patient to
inhale slowly and deeply to maximize
lung inflation and prevent or reduce
atelectasis. The purpose of an incentive
spirometer is to ensure that the volume
of air inhaled is increased gradually as
the patient takes deeper and deeper
breaths. It is often used after surgery,
especially thoracic and abdominal, to
promote lung expansion and prevent
atelectasis.
 RESPIRATORY CARE MODALITIES:
3. SMALL VOLUME NEBULIZER THERAPY: a
handheld apparatus that disperses a moisturizing
agent or medication such as a bronchodilator or
mucolytic agent, into microscopic particles and
delivers it to the lungs as the patient inhales. It is
usually air driven by means of a compressor
through connecting tubing. To be effective, a visible
mist must be available for the patient to inhale. The
use of nebulizers include difficulty in clearing
respiratory secretions, reduced vital capacity with
ineffective breathing and coughing, delivering
aerosol or expanding the lungs (Cairo and
Pilbeam, 2010).
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

• Upper airway infections (URIs) are the most common cause of

illnesses and affect most people on occasion. Some infections are
acute, with symptoms that last several days; others are chronic, that
last for weeks or months.

• Viruses, the most common cause of URIs, affect the upper

respiratory passages and lead to subsequent mucus membrane
inflammation (Williams, 2011).
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
1. RHINITIS
A group of disorders characterized by
inflammation and irritation of the mucous
membranes of the nose. These conditions
can have a significant impact on quality of
life and contribute to sinus, ear and sleep
problems and learning disorders. Rhinitis
often co-exists with other respiratory
disorders such as asthma (Wood, 2011).
Rhinitis maybe acute or chronic,
nonallergic or allergic. Allergic is further
classifies as seasonal or perennial.
MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

NURSING MANAGEMENT:
1. If patient has allergic rhinitis, give
instructions on how to avoid the
triggers
2. Teach patient on how to use
sprays/nasal medications
3. Review medical asepsis and other
airborne/droplet protocols
4. Stress the importance of yearly flu
vaccinations
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
2. COMMON COLDS/VIRAL RHINITIS The
most common viral infection in the general
population (Regan, 2008). The term common
cold is often used when referring to a URI that
is self-limited and caused by a virus. The term
cold refers to an infectious, acute
inflammation of the mucous membranes of
the nasal cavity characterized by nasal
congestion, rhinorrhea, sneezing, sore throat
and general malaise.
Colds are believed to be caused by as many
as 200 different viruses (National Institute of
Allergy and Infectious Diseases, 2011)
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
3. RHINOSINUSITIS Formerly called sinusitis,
is an inflammation of the paranasal sinuses
and nasal cavity. It is classified by duration of
symptoms as acute (less than 4 weeks),
subacute (4-12 weeks) and chronic (more
than 12 weeks). Rhinosinusitis can be caused
by a bacterial or viral infection.
• 3.1 ACUTE RHINOSINUSITIS – classified
as acute bacterial rhinosinusitis (ABRS).
Recurrent ABRS is characterized by four or
more acute episodes per year (Rosenfeld et
al., 2007).
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

• Nursing management: Instruct

on potential complications to
report, relief of congestion.
advise patient to avoid
swimming, driving and air
travel during acute infection,
how to use nasal sprays
correctly. Follow doctor’s
orders on Antibiotic therapy,
use of OTC for pain and
congestion
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

4. ACUTE
PHARYNGITIS Is a
sudden painful
inflammation of the
pharynx, the back
portion of the throat
that includes the
posterior third of the
tongue, soft palate and
tonsils. It is commonly
referred to as a sore
throat.
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
5. TONSILLITIS AND ADENOIDITIS
The tonsils are composed of lymphatic tissue and are situated on each side of the
oropharynx. They frequently serve as the site of acute infections. The adenoids
consist of lymphatic tissue near the center of the posterior wall of the nasopharynx.
Infection of the adenoids frequently accompanies acute tonsillitis. Frequently
occurring bacterial pathogens include GABHS/GAS, the most common organism.
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
Nursing care: (Post
operative care) Head turned
to side, low fowlers, do not
remove oral airway until gag
reflex returns, ice collar,
basin for expectoration,
patient is instructed to
refrain from talking,
coughing. Bleeding
precautions- frequent
swallowing.
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

6. LARYNGITIS An inflammation of the larynx, often occurs as a

result of voice abuse or exposure to dust, chemicals, smoke and
other pollutants or as part of a URI. It may also be caused by isolated
infection involving only the vocal cords. It is also associated with
gastroesophageal reflux (referred to as reflux laryngitis).
MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :
S/S: hoarseness, aphonia, severe cough.
Throat feels worse in the morning and
improves when the patient is indoors or
in a warmer environment, if with
allergies, uvula will be edematous.
“Tickle”
Medical: avoid irritants, resting, steam
inhalation, antibacterial therapy
Nursing: Rest, humidify environment,
expectorants, increase fluids, take
prescribed meds, continuous hoarseness
may be reported for malignancy issues.
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

Perioperative Nursing Management:

1. Providing Pre-op patient education
2. Reducing Anxiety
3. Maintain patent airway
4. Promoting alternative method of communication
5. Promoting adequate nutrition and hydration
6. Promoting self-care management
7. Monitoring and managing potential complications
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

7. EPISTAXIS -Simply put, a nosebleed is the loss of blood from the

tissue that lines the inside of your nose.
Follow these steps to stop a nosebleed:
• Sit upright and lean your body and your head slightly forward. Breathe
through your mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of
your nose. Make sure to pinch the soft part of the nose against the
hard bony ridge that forms the bridge of the nose. Squeezing at or
above the bony part of the nose will not put pressure where it can help
stop the bleeding.
 MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT
INFECTIONS: :

• Keep pinching your nose continuously for at least 5 minutes, apply an ice
pack to the bridge of your nose to further help constrict blood vessels
After the bleeding stops, DO NOT bend over, strain and/or lift anything
heavy. DO NOT blow or rub your nose for several days.
Call your doctor soon if:
• You get nosebleeds often.
• You have symptoms of anemia
• You have a child under two years of age who has had a nosebleed.
• You are taking blood thinning drugs (such as aspirin or warfarin) or have
a blood clotting disorder and the bleeding won’t stop.
• You get nosebleeds as well as notice unusual bruising all over your body.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
1. ACUTE RESPIRATORY
DISTRESS SYNDROME:
ARDS is a clinical syndrome
characterized by a severe
inflammatory process causing
diffused alveolar damage that results
in progressive pulmonary edema,
increasing bilateral infiltrates on
CXR, and unresponsive to oxygen
supplementation. Patients often
demonstrate decreased lung
compliance.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

PATHOPHYSIOLOGY:

Acute Lung Injury (Risk Factors) will initiate release of cellular and chemical
mediators will:
1. Increase capillary membrane permeability leading to loss of surfactant
due to alveolar flooding and eventual alveolar collapse
2. Decrease airway diameter increasing lung resistance but decreasing lung
compliance- tachypnea leading to alveolar hypoventilation
3. Injury to pulmonary vasculature leading to vasoconstriction, embolus
formation and pulmonary HPN increasing alveolar dead space and
decreasing cardiac output
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

NURSING MANAGEMENT
1. Close monitoring in the ICU
2. Positioning
3. Reduce anxiety
4. COVID-19 considerations
MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

2. PULMONARY EMBOLISM Refers to

the obstruction of one or more
pulmonary arteries by a thrombus (or
thrombi) originating usually in the deep
veins of the legs, the right side of the
heart, or rarely, an upper extremity
which becomes dislodged and is carried
through the pulmonary circulation.
Pulmonary infarction refers to necrosis
of lung tissue that can result from
interference with blood supply.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
3. OCCUPATIONAL LUNG DISEASES
TYPES
1. ASBESTOSIS is a diffuse interstitial fibrosis of the
lung caused by inhalation of asbestos dust and
particles. It is usually found in workers involved in
manufacturing, cutting, demolition of asbestos-
containing materials; asbestos fibers are inhaled and
enter the alveoli which in time, are obliterated by
fibrous tissue that surround the asbestos particles.
Fibrous pleural thickening and pleural plaque
formation produce restrictive lung disease, decrease
in lung volume, diminished gas transfer and
hypoxemia with subsequent development of cor
pulmonale.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

2. SLICOSIS is a chronic pulmonary fibrosis cause by inhalation of silica dust. Exposure to

silica dust is encountered in almost any form of mining because the earth’s crust is composed
of silica and silicates. Also, stone cutting, quarrying, manufacture of abrasives, ceramics,
pottery and foundry work. When silica particles are inhaled, nodular lesions are produced
throughout the lungs. These nodules undergo fibrosis, enlarge and fuse. Dense masses form
in the upper portion of the lungs where restrictive and obstructive lung disease results.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

3. Coal Workers Pneumoconiosis – a variety of lung disorders also

known as black lung disease. Dusts inhaled are a mixture of coal,
mica, kaolin and silica are deposited in the bronchioles and alveoli.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

ASSESSMENT CONSIDERATIONS

1.Exposure to an agent known to cause an occupational disorder

2.Length of time from exposure of agent to onset of symptoms
3.Congruence of symptoms with those of known exposure-related
disorder
4.Lack of other more likely explanations of the signs and symptoms
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
4. CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
A preventable and treatable slowly
progressive disease of airflow
obstruction involving the airways,
pulmonary parenchyma or both (Global
Initiative for Chronic Obstructive Lung
Disease, 2019). The airflow obstruction
is not fully reversible. Most patients with
COPD present with overlapping signs
and symptoms of emphysema and
chronic bronchitis, which are two distinct
disease processes.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
CHRONIC BRONCHITIS: a disease of airways, is defined as the
presence of cough and sputum production for at least 3 months in
each of 2 consecutive years. In many cases, smoke or other
environmental pollutants irritate the airways resulting in inflammation
and hypersecretion of mucus.
EMPHYSEMA: impaired oxygen and carbon dioxide exchange results
from destruction of the walls of overdistended alveoli. In addition, a
chronic inflammatory response may include disruption of the
parenchymal tissue. This end-stage process progresses slowly for
many years. As the walls of the alveoli are destroyed, the alveolar
surface area in direct contact with the pulmonary capillaries
continually decreases.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
MEDICAL MANAGEMENT:
1. Risk reduction- reduce modifiable factors
2. Oxygen Therapy- to improve ventilation and perfusion
3. Pharmacologic therapy- mainstays are the bronchodilator drugs
PMDI(Pressurized metered dose inhalers), SVN(Small Volume nebulizer),
DPI(Dry Powder Inhalers: Handihaler, Diskus, Turbuhaler); corticosteroids
“SONE”
4. Treatment of exacerbation
5. Surgical management- Bullectomy
6. Nutritional therapy-
7. Palliative Care- manage symptoms and improve quality of life
MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

NURSING MANAGEMENT:
Assessing the patient, achieving
airway clearance, CPT with chest
percussion and vibration,
improving breathing patterns,
promoting self care, improving
activity tolerance, encourage
effective coping, monitoring and
managing potential complications
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
5. BRONCHIECTASIS A chronic irreversible
dilation of the bronchi and bronchioles that
result from destruction of muscles and elastic
connective tissue. It may be caused by a variety
of conditions including: airway obstruction,
diffuse airway injury, complications of long-term
pulmonary infections, congenital disorders,
genetic disorders, abnormal host defense,
idiopathic causes. People may be predisposed
to bronchiectasis, as a result of recurrent
respiratory infections in early childhood,
measles, influenza, tuberculosis or
immunodeficiency disorders.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

MEDICAL MANAGEMENT: CPT, Bronchoscopy, Antibiotic therapy,

Nebulization, Bronchodilators, Lobectomy, segmental resection (VATS) and
Pneumonectomy as surgical management.
NURSING MANAGEMENT: Smoking cessation programs, CPT with
percussion and vibration, conservation of energy, allaying anxiety and
discuss strategies on nutritional support and to WOF potential
complications
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
6. BRONCHIAL ASTHMA (BA)
Asthma is a chronic inflammatory disease
of the airways that causes airway
hyperresponsiveness, mucosal edema,
and mucus production. This inflammation
ultimately leads to recurrent episodes of
symptoms such as cough, chest
tightness, wheezing and dyspnea. The
most common childhood chronic disease,
it can occur at any age. For most
patients, asthma is a disruptive disease
affecting school and work attendance,
occupational choices, physical activity
and quality of life.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:
MEDICAL MANAGEMENT: Preventing impairment, minimizing symptoms and
exacerbations, treatment of anxiety, pharmacologic therapy (Go back to drug
therapy on COPD)
NURSING MANAGEMENT: Educate patient on self-care, continuing an transitional
care
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

7. Pneumonia
Is an inflammatory process
that involves the terminal
airways, alveoli of the lungs
caused by infectious agents.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

CLASSIFICATIONS:
1. CAP (COMMUNITY ACQUIRE PNEUMONIA)
2. HEALTH-CARE ASSOCIATED PNEUMONIA
3. HOSPITAL ACQUIRED PNEUMONIA
4. VENTILATOR-ASSOCIATED PNEUMONIA
5. PNEUMONIA IN THE IMMUNOCOMPROMISED HOST
6. ASPIRATION PNEUMONIA
DX: Hx, CXR, Blood culture, sputum exam, fiberoptic bronchoscopy,
MEDICAL MANAGEMENT: Prescribing appropriate antibiotics, rest and
hydration, managing complications and supplemental oxygenation
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

NURSING MANAGEMENT:
1. Improving airway patency
2. Promoting rest and conserving energy
3. Promoting fluid intake
4. Maintaining nutrition
5. Promoting patient’s knowledge
6. Monitoring and managing potential complications
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

8. CHEST INJURIES/TRAUMA
8.1 PNEUMOTHORAX – Air in
the pleural space occurring
spontaneously or from trauma.
When there is a large open hole
in the chest wall, the patient will
have to “steal” in ventilation of
other lung. A portion of the tidal
volume will move back and forth
in the hole along the chest wall,
rather than the trachea as it
normally does.
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

8.2. HEMOTHORAX –
Blood in pleural space as a
result of penetrating or
blunt chest trauma,
accompanies a high
percentage of chest
injuries. Can result in
hidden blood loss. Patient
may be asymptomatic,
dyspneic, apprehensive or
in shock.
MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

8.3 FLAIL CHEST- Loss of

stability of chest wall as a result of
multiple rib fractures. When this
occurs, one portion of the chest
has lost its bony connection to the
rest of the rib cage. During
respiration, the detached part of
the chest will be pulled in on
inspiration and blown out on
expiration (paradoxical
movement).
 MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

8.3 FLAIL CHEST- Loss of

stability of chest wall as a
result of multiple rib fractures.
When this occurs, one portion
of the chest has lost its bony
connection to the rest of the
rib cage. During respiration,
the detached part of the chest
will be pulled in on inspiration
and blown out on expiration
(paradoxical movement).
MANAGEMENT OF PATIENTS WITH CHEST AND LOWER
RESPIRATORY TRACT DISORDERS:

9. RESPIRATORY FAILURE
An alteration in the function
of the respiratory system
that causes the PaO2 to fall
below 50mmHg (hypoxemia)
or the PaCO2 to rise above
50mmHg (hypercapnia), as
determined by ABG
analysis.
TYPES:
• OXYGENATION FAILURE:
1. Primary problem is inability to adequately oxygenate the blood
resulting in hypoxemia.
2. Hypoxemia occurs because damage to the alveolar-capillary
membrane causes leakage of fluid in the interstitial spaces or into
the alveoli and slows or prevents oxygen from the alveoli to the
pulmonary capillary blood.
3. Etiology: Cardiogenic Pulmonary edema, ARDS, Pneumonia,
post-cardiopulmonary bypass, metabolic disorders, infectious
diseases, shock, trauma.
VENTILATORY FAILURE:
1. Primary problem is insufficient respiratory center stimulation or
insufficient chest wall movement.
2. the CO2 not excreted by the lungs combines with H2O to form
carbonic acid leading to acidemia.
3. Hypoxemia occurs as a result of hypercapnia.
4. Etiology: drug intoxication, general anesthesia, , vascular
disorders, insufficient chest wall function, trauma, kyphoscoliosis,
COPD, BA.
 OBJECTIVES

• Coronavirus Disease (COVID-19) is the

illness that is caused by the coronavirus
SARS CoV-2 that was first identified in
December 2019 in Wuhan, China. In
February 2020, the World Health
Organization (WHO) formally named it
COVID-19. CO stands for corona, VI for
virus, and D for disease. We do know
that SARS CoV-2 easily spreads from
person to person via respiratory droplets
produced from coughs, sneezes, and
even while speaking.
COVID-19 vaccines
• COVID-19 vaccines available in the United States
effectively protect people from getting seriously ill,
being hospitalized, and even dying—especially people
who are boosted. As with vaccines for other diseases,
you are protected best when you stay up to date. CDC
recommends that everyone who is eligible stay up to
date on their COVID-19 vaccines.

• There are four categories of vaccines in clinical trials

(WHO): WHOLE VIRUS (INACTIVATED, LIVE
ATTENUATED OR JUST THE GENETIC MATERIAL),
VIRAL VECTOR (PROTEIN), NUCLEIC ACID (RNA
AND DNA-GENETIC APPROACH), ADENOVECTOR
Nursing Assessment
Careful assessment is essential in the evaluation
and management of patients who may have
COVID-19, and particularly in those with fever,
acute respiratory illness, and other symptoms of
infection. Nursing assessments of these patients
should include:
Travel history – a detailed travel history should
include travel to other countries, states, or cities
with active COVID-19 cases; resources such as
Johns Hopkins Coronavirus Resource Center can
be helpful in determining geographic “hotspots” in
the United States and worldwide.
Physical examination – careful documentation
of the patient’s signs and symptoms, which may
develop 2 to 14 days after exposure to the virus.