Respiratory System Overview PDF
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Summary
This document provides a detailed overview of the respiratory system, from the airways and lungs to the transport of oxygen. It describes the process of breathing, gas exchange, and the role of hemoglobin in oxygen transport. The text highlights the importance of oxygen for cellular function.
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WEEK 1 O xygen then moves into the lungs, passing through bronchioles to reach RESPIRATORY SYSTEM...
WEEK 1 O xygen then moves into the lungs, passing through bronchioles to reach RESPIRATORY SYSTEM the alveoli surrounded by capillaries. ○ Bronchioles are formed through T o understand the process of the repeated division of breathing bronchus. THORACIC CAVITY Oxygen diffuses into the capillaries, oxygenating the red blood cells L ocation of the main organs (RBCs) and changing their color from responsible for respiration bluish-purple to red. Carbon dioxide is released into the THORAX REGION alveoli and exhaled out through the bronchioles, bronchus, trachea, and Rib cage nostrils. Consist of pleural membranes which enclose the lungs OXYGEN TRANSPORT ○ right lung divided intothree lobes, T he respiratory system moves air the right superior through the nose, pharynx, larynx, right middle trachea, and bronchus to the alveoli for right inferior lobe. gas exchange. ○ left lung Oxygenated air travels through the smaller respiratory system, diffusing into the Has onlytwo lobes capillaries while carbon dioxide moves the left superior in the opposite direction for exhalation. the left inferior The process of inhalation involves the lobe. diaphragm contracting and the lungs ○ Both lungs expanding, while exhalation sees the are associated externally diaphragm relaxing and the lungs withsmall tubular contracting. bronchiwhichunite and Hemoglobin in red blood cells binds extend into the trachea with oxygen in the lungs, transporting it Diaphragm to tissues where it is released for dome shaped fibrous tissue cellular use. TRACHEA PROCESS OF BREATHING AND h as incomplete c-shaped rings of OXYGEN TRANSPORTATION cartilage which prevent the tracheal wall from collapsing O xygen enters the body through the leads into the pharynx which is nostrils. connected to the nostrils It travels down the pharynx and PROCESS OF BREATHING trachea to reach the bronchi. From the bronchi, oxygen moves into O xygen enters through the nostrils, the lungs. travels down the pharynx and trachea, The bronchi divide into smaller reaching the bronchi. passages called bronchioles. Oxygen reaches the alveoli, which are surrounded by capillaries. B lood containing red blood cells facilitated by the expansion and (RBCs) flows through the capillaries. contraction of the lungs. Oxygen diffuses from the alveoli into The bronchi branch into bronchioles, the capillaries, oxygenating the RBCs. leading to alveolar sacs at the end of The color of the RBCs changes from each bronchiole. bluish-purple to red upon oxygenation. Millions of single-layer alveoli cells in Blood moving into the alveoli contains the alveolar sacs facilitate the carbon dioxide, which is expelled exchange of oxygen and carbon during exhalation. dioxide with blood capillaries. Inhalation occurs when the diaphragm contracts, allowing air to fill the lungs Oxygen and Carbon Dioxide Exchange and inflate the alveoli. Exhalation happens when the O xygenated air travels from the nose diaphragm moves up, causing the to the alveoli, where oxygen diffuses lungs to contract and push air out, into the capillaries while carbon which is rich in carbon dioxide. dioxide moves from the capillaries to The process of inhalation and the alveoli for exhalation. exhalation is known as respiration, Diffusion occurs due to differences in occurring approximately 20 times per partial pressures, with oxygen moving minute. into the blood and carbon dioxide out of the blood. At the venous ends of pulmonary Respiratory System Overview capillaries, partial pressures equalize, T he respiratory system facilitates the halting further movement of oxygen and carbon dioxide. movement of air through various structures such as the nose, pharynx, larynx, trachea, and bronchus alveoli Hemoglobin and Oxygen Transport where gas exchange occurs between oxygen and carbon dioxide. H emoglobin in red blood cells plays a The nasal cavity is lined with cilia, crucial role in transporting oxygen. mucous membranes, and blood Hemoglobin binds oxygen in the lungs capillaries which filter, moisten, and as oxyhemoglobin and releases it in warm the air. tissues as deoxyhemoglobin. Air passes through the pharynx, Red cells pick up dissolved oxygen in larynx, and trachea, with the epiglottis the blood, transport it bound to closing off the larynx during swallowing hemoglobin, and release it in tissues to prevent food entry. for cellular use. The trachea connects the larynx to the The oxygen dissociation curve of bronchial tree, with cartilage rings hemoglobin illustrates its ability to preventing collapse. release oxygen to tissues even under varying conditions of oxygen partial pressure. Gas Exchange in Alveoli T he lungs contain spongy tissue with Cellular Oxygen Delivery alveoli and blood capillaries where gas exchange occurs. Breathing is O xygen is essential for cell function, and its delivery involves uptake in the lungs, transportation in the blood, and Bronchi and Alveoli release to cells throughout the body. Cells receive oxygen from the blood B ronchi subdivide into bronchioles; through capillaries in the alveoli, where alveolar sacs are at the end of hemoglobin binds and transports bronchioles. oxygen for cellular use. Alveolar sacs contain millions of alveoli As red cells travel through tissues with where gas exchange occurs. low oxygen levels, hemoglobin releases oxygen, allowing it to diffuse into cells for cellular activities. Gas Exchange Mechanism Oxygen Transport Process O xygen diffuses from alveoli to capillaries; carbon dioxide moves from A ir moves through the respiratory capillaries to alveoli. system: nose → pharynx → larynx → Respiration process includes trachea → bronchus → alveoli. inhalation and exhalation. Gas exchange occurs in alveoli between oxygen and carbon dioxide. Nasal Cavity Functions Breathing Mechanism L ined with cilia, mucous membranes, D iaphragm contracts to inhale, ribcage and blood capillaries. expands; during exhalation, diaphragm Filters, moistens, and warms incoming relaxes, ribcage compresses. air. Partial Pressure Dynamics Pharynx and Larynx F resh air enters with PO2 of 160, P harynx serves as a common reduced to 104 in lungs; CO2 levels passageway for food and air. change from 0.3 to 40. Larynx contains vocal folds; epiglottis Diffusion occurs due to differences in prevents food from entering during partial pressures. swallowing. Oxygen Transport in Blood Trachea Structure O xygen enters blood via capillaries in C onnects the larynx to the bronchial alveoli; 98% is taken up by red blood tree; cartilage rings prevent collapse. cells. Hemoglobin in red cells binds oxygen; fully saturated hemoglobin is bright red Lung Anatomy (oxyhemoglobin). L ungs consist of spongy tissue with alveoli and blood capillaries. Oxygen Release Mechanism Breathing involves lung expansion and contraction. H emoglobin releases oxygen where tissue oxygen levels are low. O xygen diffuses from capillaries to aturation level, ensuring adequate s tissues based on partial pressure oxygen delivery to tissues. differences. Understanding the oxygen dissociation curve is essential in comprehending how oxygen is efficiently transported Oxygen Dissociation Curve by hemoglobin and delivered to tissues throughout the body, even in Illustrates theintricate relationship challenging between the oxygen bound to hemoglobin, oxygen saturation, and Importance of Oxygen the partial pressure of oxygen in arterial blood. This curve provides E ssential for cell survival and activities; valuable insights into how oxygen is requires efficient transport from lungs transported and released to the tissues to cells. under various physiological conditions. The curve's distinctive shape, characterized by a sharp upstroke and Assessment a flat plateau,demonstrates the efficiency of oxygen delivery to tissues. Common Symptoms Even when the partial pressure of Dyspnea oxygen in the blood is significantly ○ Shortness of breath reduced, such as in cases of lung Orthopnea disease or high altitude, hemoglobin ○ DOB while lying down remains predominantly saturated with ○ Relief in semi fowler of fowler oxygen. position Its shape means that although the Cough partial pressure of oxygen in the blood ○ Defense mechanism returning from the lungs and being Sputum production pumped out by the arteries may be Chest pain reduced to only 50% of the normal ○ Crushing value, say due to lung disease or high From the heart altitude, hemoglobin will still be 85% ○ Stabbing saturated with oxygen Air trapped in the lungs Hemoptysis Key points about oxygen dissociation ○ Presence of blood curve ○ Frotty It shows the relationship between From lungs oxygen saturation and partial pressure Pulmonary edema of oxygen in arterial blood. ○ Fresh blood na buo-buo The steep upstroke indicates rapid Wound in the lungs oxygen uptake by hemoglobin in the PTB lungs. ○ From stomach The flat plateau signifies the ability of Brown blood/vomit hemoglobin to release oxygen to Past Health and Family History tissues even under low oxygen Physical Assessment of the Respiratory Tract conditions. General Appearance Even at reduced oxygen levels, Upper Resp. Inspection hemoglobin maintains a high Lower Resp. Inspection ○ Thoracic inspection ○ Chest configuration c ○ hanges in temp. & humidity Barrel chest - COPD ○ odors, age, systemic disease, ○ Breathing patterns & resp rates infections usually caused by ○ Respiratory excursion GABHS or GAS Rate & lung expansion Allergic Rhinitis ○ Tactile Fremitus ○ Reaction to antigen/allergens Lahat ng vibration ay Viral Rhinitis walang bara A URTI that is self-limited ○ Diaphragmatic Excursion ○ coronavirus ○ Thoracic Auscultation ○ adenovirus WEEK 2: Upper Respiratory Disorders ○ Resp. syncytial virus ○ Influenza v. Affecting Oxygenation ○ parainfluenza v. Rhinitis inflammation of the mucous membrane of the nose due to allergens oR bacteria 1. Viral Rhinitis a. Inflammation of the mucous membrane of the nose due to viruses 2. Rhinosinusitis a. Inflammation of the paranasal sinuses of the nasal cavity due to bacteria or virus 3. Pharyngitis a. “Sore throat” b. Sudden painful inflammation of the pharynx due to exposure to viral agents 4. Tonsillitis/Adenoiditis a. Infection of the adenoids that leads to tonsillitis due to exposure to bacteria 5. Perotonsillar Abscess a. A major suppurative T he pathophysiologic processes are complication of sore throat. A similar in rhinitis and rhinosinusitis, collection of purulent exudate they affect different structures. between tonsils. In rhinitis, the mucous membranes 6. Laryngitis lining the nasal passages become a. Inflammation of the larynx due inflamed, congested, and edematous. to result of voice abuse, The swollen nasal conchae blocks the exposure to antigens/infection sinus openings, and mucus is discharged from the nostrils. Etiology Rhinosinusitis is also marked by Bacterial Rhinitis inflammation and congestion, with Non-Allergic Rhinitis thickened mucous secretions filling the s inus cavities and occluding the ○ O steomyelitis and mucocele openings. (cyst of the paranasal Causes of Rhinosinusitis sinuses) requires prolonged Vasomotor antibiotic therapy & ○ Idiopathic removal of necrotic bone ○ Abuse of nasal decongestants Intracranial complications ○ Psychological stimulation ○ although rare, include ○ Irritants (smoke, air pollution, cavernous sinus thrombosis, etc) meningitis, brain abscess, Mechanical ischemic brain infarction, and ○ Tumor severe orbital cellulitis. ○ Deviated septum Mucoceles ○ Crusting ○ may require surgical treatment ○ Hypertrophied turbinates to establish intranasal drainage ○ Foreign body or complete excision with ○ Cerebrospinal fluid leak ablation of the sinus cavity. Chronic inflammatory Brain abscesses occur by direct ○ Polyps (in cystic fibrosis) spread and can be ○ Sarcoidosis life-threatening. Frontal epidural ○ Wegener’s granulomatosis abscesses are usually ○ Midline granuloma quiescent but can be detected Infectious by CT scan. Acute viral infection NURSING MANAGEMENT: Acute or chronic Patient teaching: rhinosinusitis Avoid activities such as swimming, Rare nasal infections diving, air travel (syphilis, tuberculosis) Tobacco use to stop Hormonal Monitor and prevent complications Pregnancy Watch for fever, severe headache & Use of oral nuchal rigidity – sign of potential contraceptives complication Hypothyroidism Pt. with chronic symptoms not responding to TX in 4/52 = aspiration surgery Pharyngitis (Acute and Chronic) Etiology Viral ○ Adenovirus ○ Influenza Virus ○ Epstein-Barr virus ○ Herpes simplex Severy Complication if left untreated Bacterial ○ GABHS Local complications ○ Mycoplasma pneumoniae ○ Neisseria gonorrhoeae ○ Haemophilus influenzae type 3 Diagnostic ○ Throat swab ○ Rapid streptococcal antigen test (RSAT) Acute Pharyngitis S udden painful inflammation Lymphoid follicles ○ swollen with white purple exudate Complications Enlarged tender cervical lymph nodes Fever higher than 38 inusitis S Body malaise Otitis media Painful sore throat for 1-5 days Peritonsillar abscess (streptococcal infection) Mastoiditis Chronic Pharyngitis Cervical adenitis IN RARE CASES: P ersistent inflammation ○ Bacteremia Patient c/o constant sense of irritation ○ Pneumonia and fullness in the throat ○ Meningitis 3 types ○ Rheumatic fever ○ Hypertrophic ○ Nephritis general thickening and NURSING MANAGEMENT congestion VIRAL ○ atrophic symptomatic management whitish/wrinkled BACTERIAL ○ Chronic glandular (strep throat) numerous swollen lymph antibiotics follicles on the PATIENT TEACHING: pharyngeal wall Instruct patient of s/sx that warrant prompt contact w/ a doctor ○ Drooling, dyspnea, inability to swallow ○ Inability to fully open the mouth Assess for possible complications Teach/instruct proper hygiene ○ prevent the spread of infection. Teach proper throat irrigation ○ w ater temp. high enough as the patient tolerates ○ reduce pharyngeal muscle spasm and relieves sore throat. Mouth care ○ also inspect circumoral area for rashes Instruct/teach ○ the importance of the full course of antibiotics therapy. SYMPTOMS OF ADENOIDS/ADENOIDITIS FOR CHRONIC PHARYNGITIS ○ Stress the importance to avoid Breathing through the mouth smoking or second hand Earache smoking, Nasal discharge ○ Exposure to environmental or NURSING MANAGEMENT occupational pollutants, alcohol. Patients with no adverse events w/in ○ Encourage increase fluid intake 6O POST –OP , have low risk of bleeding and complications. TONSILLITIS Continuous monitoring is a must due ETIOLOGY to significant risk of hemorrhage. Infections of the adenoids frequently Post-op oral airway must not be accompany tonsillitis. removed until gag reflex is regained. CAUSES: Most comfortable position post-op is ○ Viral Epstein prone, head turned to side to allow Barr virus drainage of saliva. Cytomegalovirus (CMV) Must be alert of post-op complications- ○ Bacterial fever, throat pain, ear pain, bleeding. GABHS (most common) Signs of hemorrhage ○ Vomiting large amount of brown or bright red blood ○ B/P, PR Bleeding necessitates surgical intervention again. PATIENT TEACHING Make the patient/family aware of the s/sx of hemorrhage, as bleeding still can occur 8 days after surgery. Explain the importance & rationale of liquid diet and liquid medications for 3-5 days. Explain the importance of the full course of antibiotic therapy Instruct proper mouthwash with alkaline or warm saline solution – to address thick mucus and halitosis Patients and family are made aware that sore throat, stiff neck, minor ear ain, and vomiting may occur within p T each to do gentle gargling after 240 post-op. procedure and must be done at 1-2 Diet to progress into softness when intervals X 24 – 360 tolerated. Explain the importance that when PERITONSILLAR ABSCESS taking liquids – must be cool or at room temp. Etiology Observe for signs of complications The most common complication of LARYNGITIS tonsillitis The most common causative agent: ETIOLOGY GABHS Voice abuse Diagnostic: Exposure to dust, chemicals, smoke ○ Intraocular ultrasound and other pollutants ○ Transcutaneous cervical Can be as part of URI ultrasound Isolated infection Pathogens that commonly caused “common colds” and pharyngitis Often associated with allergic rhinitis or pharyngitis NURSING MANAGEMENT Instruct the patient about conservative management: ○ Resting the voice, avoiding irritants, avoiding smoking or Medical management smokes Antimicrobial + corticosteroid ○ Inhaling cool steam or aerosol For unresolved condition – surgical ○ Stay in a well humidified management Treatment of choice: environment (or use humidifier ○ Needle aspiration in the room) ○ I&D under LA or GA Instruct about the importance of ○ Drainage of abscess with increase fluid intake at least 2-3 simultaneous Tonsillectomy ltrs/day when not contraindicated NURSING MANAGEMENT Instruct patient about contacting the Support the patient – pre & post-op doctor when the following s/sx occur: procedures ○ Loss of voice with sore throat Explain what to do and what to expect ○ Difficulty swallowing saliva after procedure ○ Hemoptysis Nurse may assist the doctor during the ○ Noisy respiration procedure E xplain the importance of complete Absence of complications course of antibiotic therapy for patients NURSING INTERVENTIONS with associated bacterial infection Promoting comfort THE NURSING PROCESS Promoting communication PATIENTS WITH UPPER RESPIRATORY Encouraging fluid intake DISORDERS (HOME CARE) promoting home and community-based care ASSESSMENT ○ Preventive measures – infection Health history and determine when control practices was the start of symptoms determine ○ Relieving of symptoms any allergic history Monitoring and managing INSPECTION complications Inspect the site, and describe any deviations from normal in structure, WEEK 3 color, or evidence of drainage. PALPATION TELECTASIS A Palpate the frontal maxillary sinuses BSTRUCTIVE/NON-OBSTRUCTIVE O for tenderness Palpate the cervical lymph nodes for ETIOLOGY tenderness or enlargement Major surgery NURSING DIAGNOSIS FOR UPPER Plugs of tenacious sputum AIRWAY DISORDERS Foreign bodies Ineffective airway clearance related to Tumors excessive mucus production External pulmonary pressure secondary to retained secretions and ○ Pleural effusion/ pneumothorax/ inflammation. hemothorax Acute pain, related to upper airway Abnormalities of surfactant production irritation secondary to an infection. Resorptive atelectasis is caused by: ○ Bronchogenic Carcinoma Impaired verbal communication related ○ Bronchial obstruction from to physiologic changes and upper metastatic neoplasm airway irritation secondary to infection ○ Inflammatory etiology or swelling. PTB, fungal infection Deficient fluid volume related to ○ Aspirated foreign body decreased fluid intake and increased ○ Mispositioned ET tube fluid loss secondary to diaphoresis ○ Extrinsic compression of airway associated with a fever. by neoplasm – lymph Deficient knowledge regarding adenopathy, aortic aneurysm prevention of URIs, treatment regimen, cardiomegaly surgical procedure, or post-operative Diagnostics care. CXR NURSING GOALS CT scan Maintenance of patent airway ABG Relief of pain OBSTRUCTIVE ATELECTASIS Maintenance of effective means of communication M ost common type Normal hydration Causes: Knowledge on how to prevent airway ○ Foreign body infections ○ Tumor Mucus plugging ○ M iddle lobe syndrome is a disorder of Obstruction of a lobarbronchusislikely recurrent or fixed atelectasis involving to produce lobar atelectasis. the right middle lobe and/or lingula. Obstruction of a segmental bronchus is Causes – Obstruction likely to produce segmental atelectasis. ○ Extraluminal bronchial The rate at which atelectasis develops obstruction and Intraluminal and the extent ofatelectasisdependon bronchial obstruction collateral ventilation and composition of compression by inspired gas surrounding lymph nodes. ○ Non-obstruction NON-OBSTRUCTIVE ATELECTASIS Inflammatory processes and defects in the C aused by loss of contact between the bronchial anatomy and parietal and visceral pleurae, collateral ventilationhave compression, loss of surfactant, and been designated as the replacement of parenchymal tissue by nonobstructive causes of scarring or infiltrative disease. middle lobe syndrome. 1. Relaxation or passive atelectasis a. condition that eliminates contact ROUNDED ATELECTASIS between parietal and visceral pleurae. r epresents folded atelectatic lung tissue 2. Compression atelectasis with fibrous bands and adhesions to the a. condition that compresses the visceral pleura. Incidence is high in lungs and forces air out of the asbestos workers (65-70% of cases), alveoli. most likely due to a high degree of 3. Adhesive atelectasis pleural disease. a. results from surfactant deficiency. Patient is asymptomatic. 4. Cicatrization atelectasis a. results from diminution of volume as a sequela of parenchymal scarring, usually caused by granulomatous disease or necrotizing pneumonia. 5. Replacement atelectasis a. occurs when the alveoli of the entire lobe are filled by tumors resulting to loss of volume. MIDDLE LOBE SYNDROME mount of expiratory a resistance. CPT+ postural drainage Nebulizer Compression atelectasis ○ (pleural effusion) ○ decompress ○ thoracentesis or insertion of chest tubes. Chronic atelectasis ○ remove the obstruction or compression patients who have experienced chronic, long-term collapse, it may not be possible to reopen the airways and reaerate the area of the lung RESPIRATORY INFECTIONS A CUTE TRACHEOBRONCHITIS PNEUMONIA ○ COMMUNITY/HOSPITAL ACQUIRED PNEUMONIA ○ IMMUNOCOMPROMISED PERSONS ASPIRATION PNEUMONIA SARS PTB LUNG ABSCESS MEDICAL MANAGEMENT Goal– improve ventilation & remove secretions. Strategies to prevent atelectasis – first line measures: ○ frequent turning when able few hours after OR ○ Early ambulation ○ Lung volume expansion strategy Deep breathing exercises Incentive spirometry Cough ( if tolerated) ○ For patient who do not respond to first line measures: - second line measures (PEEP) – one way oxygen valve providing various frequently affects NURSING MANAGEMENT elderly and those Encourage bronchial hygiene with comorbidity. Increase fluid intake Mycoplasma pneumoniae Encourage patient to sit up frequently to ○ spread by infected respiratory cough effectively and to prevent droplets through person to retention of mucopurulent sputum. person contact Emphasize the importance of completing ○ spread throughout entire antibiotic therapy. respiratory tract Caution patient about overexertion that ○ causing earache and meningitis. may lead to exacerbation. May impair V/Q ratio. . 2 HOSPITAL ACQUIRED (HAP) PNEUMONIA Pseudomonas pneumonia Staphylococcal pneumonia Inflammation of the lung parenchyma Klebsiella pneumonia Pneumonitis is a more general term that Also known as nosocomialpneumonia. describes an inflammatory process in Defined as the onset of pneumonia 48 the lungs hrs after admission in patients with no Penumonia and influenza are the most evidence of infection at times of common causes of death from infectious admission. diseases. ○ Ventilator- assisted pneumonia – PNEUMONIA CLASSIFICATION ET intubation and mechanical ventilator (Bacterial) 1. C OMMUNITY ACQUIRED ○ Precipitating factors: PNEUMONIA Comorbid conditions Streptococcal pneumonia Supine positioning, Haemophilus pneumonia Aspiration, coma Legionnaire's Disease Malnutrition Mycoplasma pneumoniae Prolonged hospitalization Viral pneumonia Hypotension Chlamydial pneumonia Metabolic disorders Acquired in the community , or within 48 Other equipment of device hrs after hospitalization transmission Hospitalization depends on the severity associated with a high mortality rate, in of the condition. part because of the virulence of the Causative agents organisms, their resistance to antibiotics, ○ S. pneumonae, H.influenzae, and the patient’s underlying disorder. legionella, pseudomonas a., and The common organisms responsible other gram negative rods, - found for HAP include the pathogens like: 50% of most cases. ○ Enterobacter species, S. pneumonae ○ Escherichia coli, most common ○ H. influenzae, cause of CAP in ○ Klebsiella species, people below 60y/o ○ Proteus, Serratia marcescens, w/o comorbidity, ○ P. aeruginosa, and above 60 y/o methicillin-sensitive or with comorbidity. methicillin-resistant H. influenzae Staphylococcus aureus (MRSA), and S. pneumoniae. (MRSA- v ery virulent) – contact precaution. 3. IMMUNOCOMPROMISED PNEUMONIA Pneumocystis pneumonia Fungal pneumonia Tuberculosis Causative agents– pneumocystis pneumonia – (pneumocystis jiroveci) (PCP), fungal pneumonias, and mycobacterium tuberculosis. ○ PCP is often the initial AIDS-defining complications. ○ PCP has subtle onset, with progressive dyspnea, and non-productive cough. Precipitating factors ○ the use of corticosteroids, and immunosuppressive agents, chemotherapy, nutrition depletion . 4 PNEUMONIA FROM ASPIRATION Organisms ○ Anaerobic bacteria Aspiration pneumonia refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway. The most common form of aspiration HOW TO OBTAIN SPUTUM SAMPLE: pneumonia is bacterial infection from The sputum sample is obtained by aspiration of bacteria that normally having patients do the following: reside in the upper airways. Aspiration 1. rinse the mouth with water to minimize pneumonia may occur in the community contamination by normal oral flora, or hospital setting. 2. breathe deeply several times, Common pathogens are: 3. cough deeply, and ○ S. pneumoniae, H. influenzae, 4. expectorate the raised sputum into a and sterile container ○ S. aureus. MEDICAL MANAGEMENT Substances other than bacteria may be Management of CAP includesblood aspirated into the lung, such as gastric cultures performed quickly for contents, exogenous chemical contents, identification of the causal pathogen and or irritating gases. prompt administration of antibiotics (within 4 hours)in patients in whom CAP is strongly suspected. In the outpatient setting,empirical treatment of CAPis often used, that is, treatment based on the clinician’s A ntihistamines may provide benefit with estimation of likely causative organisms. reduced sneezing and rhinorrhea. In previously healthy people with no risk Nasal decongestants may also be used factors for drug-resistant S. to treat symptoms and improve sleep; pneumoniae, a macrolide antibiotic however, excessive use can cause (azithromycin, clarithromycin, or rebound nasal congestion. erythromycin) is recommended. Bed rest is prescribed until the infection For acutely ill ICU patients, management shows signs of clearing. includes abeta-lactam agent plus If hospitalized, the patient is observed azithromycin or a fluoroquinolone. carefully until the clinical condition For Pseudomonas infection,an improves. antipneumococcal, antipseudomonal If the patient is seriously ill, aggressive beta-lactam is used plus either therapy may include hemodynamic and ciprofloxacin or levofloxacin. ventilatory support is instituted to: For community acquired MRSA, ○ combat peripheral collapse, vancomycin or linezolidshould be added ○ maintain arterial blood pressure, to the regimen. and Inpatients should be switched from ○ provide adequate oxygenation. intravenous (IV) to oral therapy when A vasopressor agent may be they are hemodynamically stable, are administered by continuous IV infusion improving clinically, are able to take and at a rate adjusted in accordance medications/fluids by mouth, and have a with the pressure response. normally functioning gastrointestinal Corticosteroids may be administered tract. parenterally to combat shock and toxicity In suspected HAP or nosocomial in patients who are extremely ill with pneumonia, treatment is usually initiated pneumonia and at apparent risk for with a broad-spectrum IV antibiotic and death from the infection. may be monotherapy or combination COMPLICATIONS therapy. Severe complications of pneumonia With known multidrug resistance, a three includehypotension and shock and drug combination therapy may be used; respiratory failure (especially with this drug regimen may include: gram-negative bacterial disease in 1. an antipseudomonal elderly patients). cephalosporin or ceftazidime Complications are encountered in 2. antipseudomonal carbapenem or patients who have received no specific piperacillin tazobactam treatment or inadequate or delayed 3. antipseudomonal fluoroquinolone treatment. or aminoglycoside plus linezolid Also encountered when the infecting or vancomycin. organism is resistant to therapy, when a Treatment of viral pneumonia is primarily comorbid disease complicates the supportive. pneumonia, or when the patient is Hydration is a necessary part of therapy, immunocompromised. because fever and tachypnea may result PLEURAL EFFUSION in insensible fluid losses. Antipyretics may be used to treat T horacentesis is performed to remove headache and fever fluid, the nurse assists in the procedure antitussive medications may be used for and explains it to the patient. After the associated cough. thoracentesis, the nurse monitors the Warm, moist inhalations are helpful in patient for pneumothorax or recurrence relieving bronchial irritation. of pleural effusion. If a chest tube needs to be inserted, the nurse monitors the URSING MANAGEMENT/NURSING N patient’s respiratory status. PROCESS Ineffective airway clearance related to CONFUSION copious tracheobronchial secretions Activity intolerance related to impaired A patient with pneumonia is assessed respiratory function for confusion and other more subtle Risk for deficient fluid volume related to changes in cognitive status. fever and a rapid respiratory rate Confusion and changes in cognitive Imbalanced nutrition: less than body status resulting from pneumonia are requirements poor prognostic signs. Deficient knowledge about the treatment Confusion may be related to hypoxemia, regimen and preventive health fever, dehydration, sleep deprivation, or measures developing sepsis. Improve patent airway The patient’s underlying comorbid Promote rest and conserve energy conditions may also play a part in the Promote fluid intake development of confusion. Maintain nutrition Addressing the underlying factors and Promoting patient’s knowledge ensuring patient safety are important Monitoring and managing potential nursing interventions. complications PNEUMONIA IN ELDERLY PATIENTS Promote home and community-based care P neumonia in elderly may occur as a ○ Teaching patients self-care primary diagnosis or as a complication Medication of a chronic disease. Nutrition Pulmonary infections in older people Exercise frequently aredifficult to treat and result Hygiene in a higher mortality rate than in younger Rest people. Avoid precipitating factors General deterioration, weakness, ASPIRATION PNEUMONIA abdominal symptoms, anorexia, confusion, tachycardia, and tachypnea A spiration of stomach contents into the may signal the onset of pneumonia. lungs is a serious complication that can Thediagnosis of pneumonia may be cause pneumonia and result in the missed because the classic symptoms following clinical picture: of cough, chest pain, sputum production, ○ Tachycardia and fever may be absent or masked in ○ Dyspnea elderly patients.Also, the presence of ○ central cyanosis some signs may be misleading. ○ Hypertension Abnormal breath sounds, for example, ○ hypotension, and finally death. may be caused by microatelectasis that ○ It can occur when the protective occurs as a result of decreased mobility, airway reflexes are decreased or decreased lung volumes, or other absent due to a variety of factors. respiratory function changes. PEOPLE WHO ARE AT RISKS Chest x-rays may be needed to ○ Seizure activity differentiate chronic heart failure, which ○ Brain injury and neurological is often seen in the elderly, from disorders pneumonia as the cause of clinical signs ○ Decreased level of and symptoms. consciousness from trauma, drug r alcohol intoxication, excessive o S ARS develops in people who either sedation, or general anesthesia have close contactwith a person who ○ Nausea and vomiting in the has been diagnosed with the disease or patient with a decreased level of a history of travel or residence in an consciousness area with known cases. ○ Endotracheal intubation; tube It istransmitted via respiratory droplets malposition; high residual when an infected personcoughs or volumes sneezes; the droplets may bedeposited ○ Flat body positioning on the mucous membranes(mouth, ○ Stroke nose, eyes) of a nearby person. ○ Swallowing disorders – abnormal SARS may also be spread when a swallowing reflex person touches a surface or object ○ Cardiac arrest contaminated by the droplets and then ○ Throat surgery touches his or her mucous membranes. ○ Esophageal disorders The virus may be transmitted in other ○ Silent aspiration – Patients on ways,including sewage and water, but continuous NGT feeding these methods of transmission are unclear at this time. PREVENTION Positioning Dietary changes Drugs oral hygiene and tube feeding precaution – assess feeding tube placement, feed by positioning patient at 450 angle. Compensating for absent reflexes – suctioning to stimulate pharyngeal gag Identify delayed stomach emptying – INTERVENTION determine residual gastric volume. Currently, no definitive medication Manage effects of prolonged intubation protocol specific to SARS has been – encourage phonation and exercise developed, although various treatment laryngeal muscles – speech therapist regimens have been tried without proven SEVERE ACUTE RESPIRATORY FAILURE success. The CDC recommends that patients S evere acute respiratory syndrome suspected of or confirmed as having (SARS) is aviral respiratory illness SARS receive the same treatment that caused by a coronavirus, called would be administered if they had any SARS-associated coronavirus s erious, community-acquired FUNCTION pneumonia. ○ serves as lubricant to allow the two layers of the pleura to glide PLEURAL CONDITION smoothly past each other during respiration. d isorders that involve the membranes EXUDATE covering the lungs (visceral pleura)and the surface of the chest wall (parietal fluid that leaks around the cells of the pleura) ordisordersaffectingthepleural capillaries, and is caused by space. inflammation ○ Visceral Pleural - closest sa Tea color organs ○ Pleural space - separates TRANSUDATE visceral and parietal space fluidpushedthroughthecapillarydueto high pressure within the capillary Transparent DIAGNOSING PLEURAL EFFUSION Physical examination ○
