Respiratory System Notes PDF

**RESPIRATORY SYSTEM** **RESPIRATORY STUDIES. THERAPIES AND DISORDERS** **Respiratory** - We are talking about breathing - Breathing is used to synonymous to life - Associate breathing into life **Dyspnea** - Difficult of breathing due to mix emotions **Dyspnea can be experienced thr...

**RESPIRATORY SYSTEM** **RESPIRATORY STUDIES. THERAPIES AND DISORDERS** **Respiratory** - We are talking about breathing - Breathing is used to synonymous to life - Associate breathing into life **Dyspnea** - Difficult of breathing due to mix emotions **Dyspnea can be experienced through:** - Acute - Chronic - Mild - Severe **Respiration** - the process of gaseous exchange between the individual and environment - Main process - Breath in -- oxygen - Breath out -- carbon dioxide **Three Process of Respiration** 1. **Ventilation** - refers to the movement of gases in and out of the lungs - Process - Inspiration or inhalation -- **voluntary** - Expiration or exhalation -- **involuntary** 2. **Diffusion** - Exchange of gases from an area of higher pressure to an area of lower pressure 3. **Perfusion** - The availability and movement of blood - **Blood** - Gases - Nutrient - Waste products **Respiratory System** - The body system that is responsible for breathing and gas exchange, providing oxygen to the body and removing carbon dioxide. - Composed of different structures **STRUCTURES** 1. Air ways 2. Pleura 3. Lungs 4. Thorax and Diaphragm 5. Respiratory Centers **Air ways** - **Upper** - Passageway of the air going to the lower airway - They protect the lower area from foreign bodies - Acts as a humidifier, they moisten war and filter 1. Nasal Cavity 2. Vibrissae 3. Para Nasal Sinuses 4. Pharynx 5. Larynx (Voice Box) - **Lower** - Acts as a clearance mechanism (cough) - **Immunologic response** - there are cell mediated immunity that are presents in alveoli - Pulmonary protection to injury 1. Trachea 2. Epiglottis 3. **Carina** -- lower end of trachea where the bifurcation usually happen 4. Cilia 5. Right main bronchus 6. Left main bronchus 7. Segmental bronchi 8. Subsegmental bronchi 9. **Bronchioles end)** 10. **Alveoli** - are tiny, balloon-like air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place. - They are surrounded by a network of **capillaries** which are tiny blood vessels - oxygen from the air enters the alveoli and diffuses into the blood in the capillaries. At the same time, carbon dioxide from the blood diffuses into the alveoli to be exhaled. **UPPER PARTS** **Nares or nostrils** - Opening of the nose - Each of them leads to a cavity which is called vestibule **Vibrissae** - It is the hair that lines in the vestibule - Filters pollutants to prevent sick **Para Nasal Sinuses** - Open areas within the skull that are lined with mucous membranes - Helps us phonation - Frontal - Maxillary - Ethmoid - Sphenoid **Pharynx** - Funnel shaped tube that extends from the nose up to the larynx - Common opening between respiratory and digestive system - 3 sections - **Nasopharynx** - The upper part of the pharynx, located behind the nose. - **Function**: - **Oropharynx** - The middle section of the pharynx, located behind the mouth. - **Function**: - **Laryngopharynx** - The lower part of the pharynx, extending from the oropharynx to the larynx and esophagus. - **Function**: **Larynx** - The voice box - Acts as humidifier - Covered by the epiglottis **LOWER PARTS** **Epiglottis** - It closes when swallowing - It opens when speaking **Trachea** - Also called as wind pipe - Around 12cm or 4-5 inches long **Carina** - Point wherein it divides the left and right bronchi **Cilia** - Microscopic hairlike projection that are rapid and coordinated and unidirectional motion - Usually upward orientation - Just like vibrissae, the cilia sweats out debris and excessive mucous **Left Right Main Bronchi** - Right Shorter and broader than left - Right More vertical than left **PLEURA** - Serous membranes that encloses our lungs **Visceral Pleura** - Directly covers the lungs **Parietal Pleura** - Lines the cavity of the hemithorax **Pleural Cavity or Space** - Potential space between the two pleura which this contains few sims fluids that serves as a lubricant **LUNGS** **Key Parts** - **Right lung** - has three lobes - broader and shorter than left lungs - **Left** **lung** - has two lobes - smaller and narrower due to presence of liver - Separated space two lungs which is called mediastinum - **Alveoli** -- approximately 300,00 million for both part of the lungs **VOLUME IN LUNGS** - **T**-otal - **L**-ung - **C**-apacity - **RV (Residual Volume)** - amount of air that remains in the lungs after forceful expiration prevents lung collapse or atelectasis - around 1,200 ml (air) - **TV (Tidal Volume)** - Amount of air that moves in and out of the lungs with each normal breathing - 500mL - **IRV (Inspiratory Reserve Volume)** - The amount of extra air that can be inhaled after normal breathing - around 3,000mL - **ERV (Expiratory reserve Volume)** - The amount of extra air that can be exhaled after normal breathing - Around 1,100mL - **FRC (Functional Residual Capacity)** - The amount of air that remains in the lungs after normal exhalation **Pneumocytes** - Cells in the lungs **Type 1** - Lines the alveoli - Serves as protection for alveoli **Type 2** - Produces of surfactant **Surfactants** - lipoproteins that lower the surface tension of the alveoli - reduces the amount of pressure needed to inflate the alveoli - decrease the tendency of the alveoli to collapse that can lead into atelectasis **THORAX AND DIAPHRAGM** **Thorax** - Made up of 12 pairs of ribs - In front it is bounded by the sternum - The ribs are by the vertebrae - Provides protection to our lungs, heart and great vessels like aorta also vena cavas **Diaphragm** - The main muscle for respiration specifically during inspiration - Phrenic nerve can be damaged due to vehicular accident - Being innervated or stimulates by the phrenic nerve which is composed by the - **C2** - The axis has a unique structure, including a bony projection called the odontoid process (or dens), which allows the head to rotate side to side. - **C3** - provides structural support and flexibility to the neck. It also serves as an attachment point for muscles and ligaments that help stabilize the cervical spine. - **C4** - Similar to C3, C4 contributes to the support and movement of the neck. **Muscles used in respiration** - Trapezius Muscle - Sternocleidomastoid Muscle - Pectoralis Major and Minor - Intercoastal Muscle - Parasternal Muscle **REMEMBER**: used only when breathing is labored **RESPIRATORY CENTERS** - Important structure for breathing - Main Parts: - Medulla Oblongata - Pons **Medulla Oblongata** - Primary respiratory center - Contains central chemo-receptors - Pag mataas ang carbon dioxide, maalert ang central chemoreceptors then the medulla oblongata is stimulated **Pons** Functions**:** - **Pneumotaxic** - Pons are responsible for rhythmic quality of breathing - **Apneustic** - Responsible for deep prolonged breathing **Peripheral Chemo Receptors** - Back up of central chemo receptors - Will work when the central chemoreceptors of the medulla is damaged - Just like central chemoreceptors, this is stimulated by low level of oxygen level - Gumagana kapag mataas ang bp that results into bradypnea which is slow respirations - When hypertensive, they are prone for respiratory acidosis - When patient has hypotension, they are prone to respiratory alkalosis **ANATOMY, BIOGRAPHY, CHIEF COMPLAINT, DIAGNOSTIC PROCEDURES** **(A, B, C, D)** **Biographical data (P, F, L, P , G, O)** - **Past medical history like**: - Asthma - **Primary complex** -- TB of child - **Pneumonia** -- normal sa bata - **Immunization** - **BCG** -- for TB - Anti influenza - Medications - Allergies which can cause anaphylaxis which is a type of shock - **Family History** - Smoking - Pulmonary Tuberculosis - **Lifestyle** - Check kung ilang dami ang nayoyosi sa isang araw - Pack Years - Years of smoking times number of packs per day - Check kung sumisinghot ng katol, katingko, rugby - **Psychosocial History** - **Second hand smoker** -- kapag nasinghot mo ang amoy ng yois - **Third hand smoker** -- kapag kumapit sa damit ang amoy ng yosi - **Geographical Location** - Pagnakatira sa city, due to pollution - Pag nakatira malapit sa coal plants which can cause cardiorespi problems - Kapag mahilig mag siga - Kapag malapit sa kaingin - **Occupation** - Street sweeper - Kapag nag titinda ng ihaw ihaw - Jeepney driver - Laboratories **CHIEF COMPLAINTS** - Dyspnea - SOB - Chest pains - **Cough** - Check for productivity and sputum characteristics - **Hemoptysis** - Coughing out loud - **Asthma** - Can hear wheezing **DIAGNOSTIC PROCEDURE** **MANTOUX TEST** - Done through intradermal skin testing - Uses PPD (Purified proteins derivatives) - The readings happens 48-72 hours - \+ 10 mm/exposure to Mycobacterium Tubercle - Not really recommended for PTB test - Can be used to detect HIV which is +5mm - PTB can be developed due to BCG **Nursing responsibilities** - Instruct the patients to keep the area dry - Can shower but protect the sight or area - Don't rub **QuantiFERON TB test** - Can be used as a screening for TB than Mandoux test - Same procedure and everything sa Mantoux test but different derivatives **CHEST X RAY** - Instruct the patient on deep breathing and hold breath - Remove metals from the Chest **FLOUROSCOPY** - Direct visualization of the lungs - Used to study the lungs and chest motions **BRONCHOGRAPHY** - Also called as bronchogram - Radiopaque medium instilled directly into trachea and bronchi and entire bronchial tree then or selected area XRAY - Dye is inserted **Nursing responsibilities** - Check allergies for seafood - Informed consent - NPO 6-8 hours to prevent aspiration - Prepare oxygen and anti spasmodic agents ready at bed side - Give pre op meds: - **Atropine sulfate ATSO4** - decreases body fluids - make sure that the air way is clear - **Diazepam** - Common brand name is valium - **Anxiolytics** -- reduces anxiety and make the person relax and calm - Not all doctors can give this medications, only psych doctors - **Topical Anesthesia** - Sprayed in the mouth specifically into the throat - **Local Anesthesia** - For us to depress the gag reflex **Nursing Intervention** - Side lying patient to prevent aspiration - Put patient into NPO until the cough and gag reflex return - Teach patient to do deep breathing and coughing exercises - Low grade fever is common complication **BRONCHOSCOPY** - Direct inspection of Larynx, Trachea and Bronchi through a flexible and rigid Bronchoscope - More on observation and visualization - Used to check excise small lesions - Location of pathologic process - Can be used as diagnostic and therapeutics - **Diagnostics** - para malaman - collects specimens for biopst - Collect secretions or specimen - **Therapeutics** - Remove aspirated foreign objects **Nursing Responsibilities** - Informed consent - Remove dentures prostheses to prevent obstruction - Give pre op meds: - **Atropine sulfate ATSO4** - decreases body fluids - make sure that the air way is clear - **Diazepam** - Common brand name is valium - **Anxiolytics** -- reduces anxiety and make the person relax and calm - Not all doctors can give this medications, only psych doctors - **Topical Anesthesia** - Sprayed in the mouth specifically into the throat - **Local Anesthesia** - For us to depress the gag reflex **Nursing Interventions** - Side lying patient to prevent aspiration - Put patient into NPO until the cough and gag reflex return - Watch out for possible perforation of bronchial tree - Cyanosis - Hypotension - Tachycardia - Tachypnea - Arrythmia - Hemoptysis - Dyspnea **LUNG SCAN** - Like X ray - Dye is inserted - We are using gamma rays - Following injection of radioisotope, scans are taken with scintillation camera - It measures blood perfusion through the lungs - Can be use for detection and confirmation of pulmonary embolism or other blood flow abnormalities **Nursing Responsibilities** - Instruct the client to remain still during the procedures - Informed consent **SPUTUM EXAMINATION** - Check for gross appearance especially color - Sputum culture and sensitivity - Done to detect the actual microorganism causing the respiratory infection **AFB** - Acid Fast Bacillus Staining - Used for PTB **Cytologic Examinations** - Assess for presence of cancer cells **Rusty Sputum** - kulay kalawang and brownish - May pneumonia si patient caused by pneumococcal **Greenish Sputum** - Walang ubo pero greenish - Due to pseudomonas infection **Blood Tinged** - Due to PTB or pulmonary tuberculosis **2-3 days cough** - Pwede magasgas and magka blood tinge **PTB** - 2 weeks or more cough - Blood tinged - Night sweats **Nursing Responsibilities** - Know how to collect sputum for examination - Should be done early in the morning because sputum accumulates when sleeping - They may or may not rinse their mouth with plain water - Do not use mouth wash due to alcohol content - Use sterile container - If AFB, it is done 3 consecutive morning. usually 5:30AM - Sputum for CandS or sputum culture and sensitivity, collected before 1st dose of Antimicrobial to accurately detect actual pathogen present **LUNG BIOPSY** Transbronchoscopic Biopsy - done during bronchoscopy - If may bukol kinukaha na din Percutaneous Needle Biopsy - Done with the use of aspirating needle sa tabi ng lungs or mid axillary Open Lung Biopsy - Done during surgery - Common - Whole lung or lobe is the main specimen **LUNG BIOPSY** - Test for metastasis - The most common lymph node for biopsy is Cervicomediastinal Node **PULMONARY FUNCTION** **STUDIES** - We use Spirometry - May bolang hinihipan - To assess the volume of air in our lung **Vital Capacity** - maximum volume of air that can be exhaled after maximum inhalation - Reduced vital capacity in COPD **Tidal Volume** - volume of air inhaled and exhaled with normal quiet breathing - 500ml **IRV (Inspiratory Reserve Volume)** - The amount of extra air that can be inhaled after normal breathing - around 3,000mL **ERV (Expiratory reserve Volume)** - The amount of extra air that can be exhaled after normal breathing - Around 1,100mL **FRC (Functional Residual Capacity)** - The amount of air that remains in the lungs after normal exhalation **ARTERIAL BLOOD GAS (ABG)** - Used to assess ventilation and acid-base balance - Radial artery common site for getting blood - We need to do Allen test Before performing or withdrawing the blood: **Allens Test** - to assess adequacy of collateral circulation of the hand - To check the ulnar artery if kaya ba niyang mag supply ng blood sa parts ng hands natin kapag hindi nag supply si radial artery **How to perform Allen Test** - We need to press the on both radial and ulnar arteries - Ask patient to close open until mamuti - Once blanched, we need to release only the ulnar artery - After releasing ulnar artery asses, the time when the hands turns to pinkish color - Normal is within 6 seconds: we can perform ABG on the radial artery. But if it took longer time, we can't use the hand and check the other hand instead - Prepare 10mL pre-heparinized syringe to prevent clotting (anti-coagulant) - If sa bahay, put the specimen into container with ice to prevent hemolysis - Without ice the C02 and 02 will escape - Lysis- destruction - Check 02sat - normal 95 to 100% - Index finger or ear lobe - Reading can be affected by sunlight - Document and evaluate **THORACENTESIS** - Aspiration of fluid, blood or air from the pleural space up to pleural cavity - Considered as minor case **Pleural Effusion** - Excess fluid at the pleural space **Pulmonary Edema** - Nasa lungs ang water **Pneumothorax** - Excess air in the pleural space **Hemothorax** - If there is blood in the lungs **Nursing Responsibilities** - Informed consent - Have baseline data and monitor VS because it can cause hypovolemia - Position the patient into up right position lean over bed (orthopneic position or tripod position) - If hindi abot ang sahig, provide foot stool for comfort - Instruct the patient to remain still - Instruct to avoid coughing during the insertion of the needle - Tell the patient that pressure sensation can be felt during the insertion of the needle lalo na kapag papasok na siya sa lungs due to topical anesthesia **During the Procedure** - Assist the patient and doctor **After the Procedure** - Position the patient into side lying in unaffected site to prevent leaking - Instruct the patient to have bed rest until the VS is stable because it is common for them to have postural or orthostatic hypotension - Instruct patient to report expectoration of blood - Assess the VS that can cause Hypovolemic shock **PULSE OXIMETER** - Used to determine oxygen saturation - Pulse oximeter sensor is placed in the index finger, ear lobe, or over the nose - Low than 95 -- position the patient into semi or high fowler - 80 -- oxygen therapy is needed with the use of facial mask - Lower than 80 -- intubate **Nursing Responsibilities** - Make the fingers warm - If exposed to bright sunlight, cover the pulse ox - Remove nail polish - Record the document and result **Two Types** - Intermittent - Continuous - Ililipat every 8 hours to prevent soreness **COMMON RESPIRATORY INTERVENTIONS** - Oxygen Therapy - Normal gauge is 2-3 if adult - Facial mask has higher percentage than cannula - Tracheobronchial Suctioning - Semi fowler position or high fowler - Use gloves - Hyperventilate before and after suctioning we are using 100% oxygen - Insert suction catheter around 3-5 inches - Don't apply suction when inserting - During withdrawal rotate catheter and apply intermittent suctioning - Usually 10 seconds, maximum is 15 per cycle - Reassess the patient, check breath sounds and color of the patient - Una ang mouth bago sa ilong - Bronchial Hygiene measures - Mouth and nose suctioning - Suob or steam - Nebulizer **CHEST PHYSIOTHERAPHY** - It is a combination - postural drainage - percussions - vibration - Use gravity and dislodge the secretions - It depends on the area of secretions - Needs doctor's order **Nursing Interventions** - We need to verify the doctor's order - Assess the accumulation of mucus secretions - Place the patient to allow expectoration of mucus secretions by gravity - Each position is 10-15 mins - After that is do the percussion then vibration - Gradual changes of position due to prostatic hypotension - Whole therapy will only last between 60-90mins - Should be done 1 hour before meal time - Make sure to provide good oral hygiene **THORACOSTOMY TUBE OR CLOSE CHEST DRESS** - Used to remove the air or fluids from the pleural spaces or cavity - To reestablish lung expansion and negative pressure **Plural effusion** -- Fluids in pleural spaces - **Hydrothorax** -- water in pleural space - **Pyothorax or Empyema** -- puss cells in pleural space - **Hemothorax -** blood in pleural space **Principles of CCD** - **Drainage by gravity** - Make sure that the bottles should be 2-3 feet below the chest level - Never put the bottles on the same level of the chest or above the chest - Clamp it if the patient is going to be transported to prevent reflux - **Displacement Principle** - Always has one tube opening which acts as air vent to reduce air pressure - An air vent will expel the air from the bottle as drainage occupies the space in the bottle - **Suction or Negative Pressure** - It aids in removing the air or fluid from the pleural spaces **Different types of CCD** - One bottle system - Two bottle system - Three bottle system - These three types will use all the principle **One Bottle System** - This bottle serves as the drainage or collection bottle and as water-seal bottle - The bottle has sterile or plain NSS - Make sure that the tube is immerse on sterile NSS - 2-3cm ang nakasawsaw sa PNSS - There should be intermittent bubbling during exhalation but pag continuous, double check the bottle - If there's no bubbling - It is not patent then try to assess if there's kinking of the tube - Check if there's blood clot, milk it towards the bottle. - The patient's lung re-expanded then X ray the patient **REMEMBER**: Avoid frequent milking and clamping to prevent tension pneumothorax **Two Bottle System** - Can be connected or not connected with suction apparatus or machine - **Without Suction Machine** - Bottle one will be our drainage and collection bottle - Bottle two will serves as water seal - On the second bottle, observe fluctuation and intermittent bubbling with each respiration - Check the first bottle for the drainage amount every 8 hours or every shift - **With Suction Machine** - Bottle one will serve as drainage and water seal bottle, tube should be immersed in water - Second bottle will act as suction control bottle - Expect continues bubbling for the second bottle due to suction - Maintain the negative pressure on the lungs **Three Bottle System** - Bottle one is for drainage - Bottle two is for water-seal - Bottle three is for suctioning **Nursing Interventions** - Teach and encourage to perform deep breathing and coughing exercises to promote the drainage - Turn the patient side to side with frequent intervals every 2 hours - Encourage them of activity daily living like ambulation, range of motion exercises especially on the arms - Do not forget to mark the amount of drainage in regular basis - Avoid milking and kinking frequently that can case pressure pneumothorax - Removal of the chest tube should be performed by the doctor with X ray - Always prepare the lungs before removing the tube **Removal of the Tube** - Prepare anesthesia - Petrolatum gauze (may gamot na gasa) - Sterile suturing kit - Needle - Needle holder - Scissors - Kelly - Sterile gauze - Adhesive tape - Position the patient into semi fowler or side lying - Instruct patient to do deep exhalation exercises and Valsalva maneuver - Do not forget for possible complications like - Respiratory distress - Subcutaneous emphysema **Inspection** - Nasal flaring - Tachypnea - Use of accessory muscle - Check inhalation and exhalation - Check for speech pattern - Check for types of chests like pigeon, barrel - Cyanosis - Buccal cavity **Palpation** - Check for tenderness - Check for bounding pule - Chek for tactile fremitus **Percussion** - Normal is resonance - Check for dullness **Auscultation** - First check for posterior then anterior - Start from top to bottom - Check for breath sounds - **Normal breath sounds** - Tracheal - Bronchial - **Abnormal breath sound** - Wheezes - Crackles **DIFFERENT DISEASES IN UPPER RESPIRATORY** **DEVIATED SEPTUM** - Deflection of the normally straight septum - Bending of the nasal septum - Can have breathing problems **Etiology** - Trauma - Accident - Boxing - Congenital disproportions **Manifestation** - Obvious facial changes - Difficulty of breathing due to obstruction - Epistaxis - Nose bleeding - Nasal Edema due to trauma **Management** - Nasal Septoplasty - Ice compress for epistaxis or after the trauma to minimize bleeding and edema - Give nasal allergy control **NASAL FRACTURE** - Cause by substantial blow on the middle of the face - Can be - **Unilateral** - One side has fracture - There are little to no displacement at all - **Bilateral** - Both side has fracture - The most common - Give the nose to flatten more - **Complex** - Involves subsequent damage of adjacent facial structures - Common affected is the zygomatic bone, maxilla and teeth **Etiology** - Trauma - Due to sports **Possible Complications** - Epistaxis - Septal hematoma - Airway obstruction **Signs and Symptoms** - Obvious facial deformity - Can have epistaxis and hematoma - Can have edema - **Ecchymosis** - Kasamahan ng petechiae - Mukang may black eye si patient - With zygomatic bone fracture - With racoon's eye (parang black eye) **Nursing Responsibilities** - Check if there's drainage coming out - It's okay to have red drainage - Greenish can be caused by pseudomonas - Clear drainage is caused by CSF and it is not normal - If the drainage is clear, go for CSF is positive for glucose **Management** - Keep the patient on upright position to maintain the airway - Apply ice compress to minimize edema and bleeding - Provide emotional support - Prevent complications like - Bleeding - Infections - Surgery - **Nasal Septoplasty** - To realigned nasal septum - **Rhinoplasty** - If the bone is truly broken **EPISTAXIS** **Etiology** - Trauma - Environmental trauma - Hypertension - Dengue - Polyps and nasal cancer - Leukopenia - Rheumatoid Disease - Let the patient sit up and ask them to lean forward then head tip to prevent aspiration - Apply pressure in soft tissue up to 5-10 mins - Give cold compress or ice pack over the nose to promote vasoconstriction - Apply nasal pack with neosenephrine for about 3-5 days to promote vasoconstriction - Liquid and soft diet to facilitate swallowing - Instruct the patient to not blow the nose for 2 days to prevent further complications - Tell the patient to notify the physicians to check if there underlying condition **SINUSITIS** - Inflammation on the sinus lining **Etiology/Pathophysiology** - Upper respiratory tract infection - Cigarettes smoker - Allergic rhinitis - Edema of mucous membrane - Hyper secretion of mucus - Infection - Bacteria - Fungi **Signs and Symptoms** - Fever - Clogged nose - Headaches - Facial pain - **Frontal** - Above eyebrows - **Maxillary** - Cheek, Upper teeth - **Ethmoid** - Around eyes - **Sphenoid** -- Behind eye, occiput, top of general malaise - Nasal drip - Halitosis due to persistent cough **Management** - Provide rest and sleep - Increase oral fluid intake - Provide hot or warm wet packs - Can give pain reliever, common is codeine. **AVOID ASPIRIN** which can increase nasal polyps - Give Amoxicillin or anti-infectives, acute 7 to 10 days, chronic, 21 days - Nasal decongestants (Dimetapp for Americans) 72 hours, common is neozep, decolgen - Irrigation of maxillary sinuses with warm or room temperature NSS - **Ethmoidotomy** - Ethmoidectomy - **Sphenoidectomy** - Butas mus muna sa ethmoid bago sa sphenoid - **Functional** **endoscopic sinus sx(fess)** - Cadwell- luc surgery (radical antrum ), incision between upper gum and upper lip - Flap Surgery **Nursing Responsibilities** - Tell the patient not to chew on the affected site - Perform oral hygiene but be cautious on the prevent trauma on the affected site - After procedure, tell the patient not to use their dentures for 10 days - Do not blow their nose and avoid sneezing for 2 weeks, if the patient is going to sneeze ask the patient to open their mouth **TOSILLITIS** - Inflammation of tonsils and adenoid Adenoiditis **Common Reason** - Sweet foods - Cold foods - iwasan na magkameron ng tonsillitis ang mga bata because the microorganism that causes tonsillitis can also cause rheumatic heart disease **Manifestations** - Sore throat - Fever - Dysphagia - Mouth breather - Halitosis due to mouth breathing - Hoarseness of voice - Noisy respirations -- due to obstruction of airways - Loud snore during sleeping - Draining ears -- due to pressure **Management** - Provide rest and sleep - Increase oral fluid intake-8 glasses or more - Gargle warm water with salt - Give pain relivers like acetaminophen, and Tylenol - Give antimicrobial like amoxicillin - Surgery - tonsillectomy and adenoidectomy (madugo) also thyroidectomy **Pre-op care** - Asses if the patient has upper respiratory tract infection - Assess if the patient has cough due to secretions - Check the partial prothrombin time for us to know how fast is clotting. kapag matagal mag clot need ng coagulant **During Operation** - Act as an assistant - Check and monitor vital signs - Make sure to maintain sterility of the area **Post Operative** - Lateral position or prone with pillow under the chest and head tilt at one side - Once the patient is awake place in Semi Fowlers, promote Respiratory Functions - NGT should be intact until gag reflex return - Monitor VS - Assess for any signs of hemorrhage - Frequent Swallowing - Frequent clearing of throat - Bright Red Vomitus - Dark red -- may dugo - Check for HypoTachTach that may results into hypovolemic shock **Nursing Diagnosis** - Alter thermoregulation - Pain due to sore throat - Infection - Infected oral breathing pattern **Management** - Administer pain reliever as prescribed - Instruct them to do deep breathing exercises - Use ice collars - Don't give hot and solid food - Give bland diet and no spicy food - If the gag reflex returned, give soft and cold foods - Ice-cream - Ice chips - Popsicle - For 1-2 weeks, no red and dark beverages **REMEMBER**: DO NOT ENCOURAGE COUGHING **ATELECTASIS** - Lung collapse - Kahit alveoli lang ang nag collapse, consider pa din siyang lung collapse **Etiology** - Trauma - More compressed lungs - Masyadong nag expand - Secondary to bronchospasm, tumor which lead to airway obstruction - Pag umunti ang pumapasok na oxygen, mag dedecrease din ang surfactant - After that it will result into hypoventilation - Progressive regional hypoventilation **Signs and Symptoms** - Restlessness - early sign of hypoxia - Pain -- can be felt where lung collapse happened - Tachypnea - shallow breathing -- due to obstruction of alveoli - Tachycardia - Dullness on percussion - Absent bronchial breathing which is normal - Normal adventitious breath sound is crackles **Nursing Diagnosis** - Impaired gas exchange -- dahil mas maraming nilalabas na carbon dioxide kesa sa pumapasok na oxygen - Pain - Fear **Nursing Interventions to relieve Hypoxia** - Frequent respiratory assessment - Do respiratory hygiene measures like deep breathing and coughing exercises to promote lung expansion - Check spirometry every hour to measure inhalation - Maintain oxygen inhalation - Position the patient on the unaffected site - Usually mataas ang ulo ni patient **Nursing interventions to Prevent complications** - Give medications such as antibiotics or anti microbial - Encourage ambulation and deep breathing exercises to promote lung expansion - Increase oral intake **Health Teachings** - Report any signs and symptoms - Encourage deep breathing and coughing exercises and ambulation to promote lung expansion **PULMONARY EDEMA** - Mas mabilis makapatay - Overhydration or over accumulation of fluid - Hindi tinatagilid ang patient kapag nasa ospital - Classical sign is pink frothy sputum due to blood - Sudden transudation pf fluid from pulmonary capillaries into alveoli **Pathophysiology** - Increase pulmonary capillary permeability - Increase hydrostatic pressure - Decrease blood colloidal osmotic pressure - Fluid accumulation in alveoli - Decrease diffusion of gas - Hypoxia **Signs and Symptoms** - Fear and anxiety - Restlessness -- early sign of hypoxia - Verbalize their fear - Dyspnea - Orthopnea - Fatigue - Increase heart rate - Increase pulse rate - Pale skin - Positive for crackles and wheezes - Diaphoresis - Pink frothy sputum - Right ventricular heart failure - Left - more on lungs - Dyspnea - Abnormal breath sound - Right - systemic - Peripheral edema - Weight gain - Cyanosis - Jugular vein distension **Nursing Interventions to relive anxiety** - Give medications like morphine sulfate also as pain medication - Stay with the client - Encourage to do deep breathing exercises to have frequent rest periods **To improve cardiac functions** - Give oxygen inhalation - Kapag 7 days na at nag durugo na sa nasal cannula, apply water based lubricant - Give aminophylline to increase cardiac - Give D5W - High fowler position - Nitroglycerin to remove pain - Digitalis - Low sodium diet and decrease oral fluid intake - Give diuretics **Health Teachings** - Compliance to medications - Let them rest - Stick to diet - Give possible complications that is usually connected to heart **PULMONARY EMBOLISM** - Undissolved mass that travels in bloodstream or occludes a blood vessel - Obstruction of blood flow going to lungs - Thrombophlebitis - Surgery - Obesity - Mataas cholesterol - Increase pressure on pulmonary artery or reflex constriction of pulmonary blood vessels - Decrease pulmonary circulation - Can lead to pulmonary infarction **Manifestation** - Chest pain in substernal area - Crushing - Sharp - Stabbing - Sudden onset of dyspnea - Restless - Temperature will be decreased - Crackles - HypoTachTach **Nursing Diagnosis** - Pain - Ineffective breathing pattern - Impaired gas exchange **Nursing Interventions for monitoring** - Auscultation, kapag may pulmonary edema, may decrease to absence of breath sounds - elevate the head of the bead - monitor ABG - monitor 02 Sat - monitor blood coagulation (Prothrombin time) give anticoagulant - Encourage ambulation - Embolectomy to remove embolism **Health teachings** - Prevent further occurrence - Instruct them the importance of using ant embolic stockings - Avoid birth control pills that increase pulmonary embolism - Medications - Follow up Care **Voice Sounds** Egophony - Increase resonance of a voice sound - Ask patient to say "e" - Can hear muffled "e" - Not normal can hear clear "a" Lung Consolidation - Occurs when the normal airfield spaces of the lungs are filled of product of disease Whispered pectoriloquy - Increase loudness of whispering noted during - Auscultation of the lungs - Ask the patient 3 consecutive number like "1,2,3' - Faint and muffled sounds - Clear and loud - suggest lung consolidation Bronchophony - The increase / abnormal increase in amplitude and clarity of the vocal sounds - State "99" or "ninety-nine" - Soft and muffled sound - Clear and loud -- lung consolidation