NCM 112 - Care of Clients with Problems in Oxygenation Past Paper PDF

TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete UNIT 1: INTRODUCTION TO CARE OF CLIENTS WITH...

TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete UNIT 1: INTRODUCTION TO CARE OF CLIENTS WITH closing over the glottis during PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATION IN THE swallowing. RESPIRATORY SYSTEM Nurses encounter different respiratory system disorders in many heath care settings. Ranging from community care to Lower respiratory airway critical care units. To evaluate the respiratory system, the nurse Enables the exchange of gasses to regulate PaO2, PaCO2, and must possess the ability to distinguish between normal pH. evaluation results and abnormal ones. Developing and using sound evaluation techniques I essential for providing care for Located in front of the patients with both acute and long-term respiratory function and esophagus the importance of respiratory function and the importance of TRACHEA Branches into the right and abnormal diagnostic test outcomes is important. left mainstem bronchi at the carina CHAPTER 1: ASSESSMENT OF THE RESPIRATORY SYSTEM RESPIRATORY SYSTEM Begin at the carina It is composed of the upper and lower respiratory The right bronchus is tracts, which are responsible for ventilation- movement slightly wider, shorter and of air in and out of the airways more vertical than the left The upper tract, known as the upper airway, warms bronchus and filters inspired air so that the lower respiratory tract Divide into secondary or (the lungs) can accomplish gas exchange. lobar bronchi that enter MAINSTEM Gas exchange involves delivering oxygen to the each of the 5 lobes of the BRONCHI tissues through the bloodstream and expelling waste lung gases, such as carbon dioxide, during expiration. The bronchi are lined with cilia, which propel mucus up PRIMARY FUNCTIONS OF THE RESPIRATORY SYSTEM and away from the lower Provides oxygen for metabolism in the tissues airway to the trachea, where it can be Removes carbon dioxide – the waste product of expectorated or swallowed. metabolism. SECONDARY FUNCTIONS OF THE RESPIRATORY Branches from the SYSTEM secondary bronchi and Facilitates sense of smell subdivide into the small Produces speech terminal and respiratory Maintain acid-base balance bronchioles Maintains body water levels Contain no cartilage and BRONCHIOLES Maintains heat balance depend on the elastic recoil of the lung for patency UPPER RESPIRATORY AIRWAY The terminal bronchioles Filter, moistens, and warms air during inspiration. contain no cilia and do not participate in gas humidifies air, warms, and filters inspired NOSE exchange. air. air-filled cavities within the hollow bones Acinus (plural, acini) is a SINUSES that surround the nasal passages and term used to indicate all provide resonance during speech structures distal to the terminal Branch from the respiratory Passageway for the respiratory and bronchioles digestive tracts located behind the oral Alveolar sac, which arise and nasal cavities; divided into the: from the ducts contain PHARYNX ALVEOLAR cluster of alveoli which are Nasopharynx DUCTS AND the basic units of gas Oropharynx ALVEOLI exchange. Laryngopharynx Type II alveolar cells in the walls of the alveoli secrete Located just below the pharynx surfactant, a phospholipid at the root of the tongue that reduces the surface Commonly called as the “voice tension in the alveoli; box” without surfactant the LARYNX Contains 2 pairs of vocal cords; alveoli would collapse. false and true cords The opening between the true Located in the pleural cavity vocal cords is the glottis. in the thorax LUNGS Extend from just above the left-shaped elastic flap clavicles to the diaphragm, EPIGLOTTIS structure at the top of the larynx the major muscle of prevents food from entering the inspiration. tracheobronchial tree by 1 I DIOSES, Janah Marielle D. & REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete In the right lung, which is dioxide and water, to move from the alveoli in the lungs larger than the left is divided and atmosphere. into 3 lobes, the: 6. Effective gas exchange depends on distribution of gas o Upper lobe (ventilation) and blood (perfusion) in all portion of the o Middle lobe lungs. o Lower lobes The left lung, which is ASSESSMENT OF DIFFUSION AND PERFUSION narrower than the right lung Understanding and evaluating diffusion and perfusion accommodates the heart is is critical in assessing a patient's respiratory and divided into 2 lobes circulatory health. The respiratory structures These processes play key roles in maintaining the are innervated by the body's internal environment, ensuring that tissues phrenic nerve, the vagus receive adequate oxygen while waste products are nerve, and the thoracic efficiently removed. nerves The respiratory process consists of three components. The parietal pleura lines the Ventilation, diffusion and perfusion. inside of the thoracic cavity, including the upper surface VENTILATION of th diaphragm. It is the process by which air moves in and out of the The visceral pleura covers lungs. the pulmonary surfaces Ventilation consists of two pairs: inspiration and A thin fluid layer, which is expiration. produced by the cells lining the pleura, lubricates the DIFFUSION visceral pleura and the Is the process by which oxygen and carbon dioxide parietal pleura, allowing are exchanged at the air-blood interface. them to guide smoothly and It is he spontaneous movement of gases, without the painlessly during use of any energy or effort by the body, between the respiration. alveoli and the capillaries in the lungs. Blood flows throughout the This includes during: internal respiration and external lungs via the pulmonary respiration. circulation system The alveolar-capillary membrane is ideal for diffusion because of its large surface area and thin membrane. PERFUSION It involves blood circulation through tissues and organs, LUNG FUNCTION essential for delivering oxygen and nutrients. categorized as: tidal volume Pulmonary Perfusion LUNG VOLUMES It is the actual blood flow through the pulmonary inspiratory reserve volume expiratory reserve volume circulation residual volume The pulmonary artery divides into right and left evaluated in terms of: branches to supply both lungs. These two branches LUNG vital capacity divide further to supply all parts of each lung. Normally CAPACITY inspiratory capacity about 2% of the blood pumped by the right ventricle functional residual capacity does not perfuse the alveolar capillaries. This shunted total lung capacity blood drains into the left side of the heart without participating in alveolar gas exchange. The pulmonary circulation is considered a low- ACCESSORY MUSCLES pressure system because the systolic blood pressure Scalene Muscles Elevate the first 2 ribs in the pulmonary artery is 20 to30 mmHg, and the Sternocleidomastoid Raise the sternum diastolic pressure is 5 to 15 mmHg. Muscles Trapezius and Fix the shoulders GAS EXCHANGE Pectoralis Muscles Gas exchange occurs at two sites in the body: in the lungs , where oxyegn is picked up and carbon dioxide 1. The diaphragm descends into the abdominal cavity is released at the respiratory membrane, and at the during inspiration, causing negative pressure in the tissues, where oxygen is released, and carbon dioxide lungs. is picked up. 2. The negative pressure draws air from the area of External respiration: greater pressure, the atmosphere, into the area of o The exchange of gases with the external lesser pressure, the lungs environment occurs in the alveoli of the lungs. 3. In the lungs, air passes through the terminal o It occurs as a function of partial pressure bronchioles into the alveoli and diffuses into differences in oxygen and carbon dioxide surrounding capillaries, then travels to the rest of the between the alveoli and the blood in the body to oxygenate the body tissues pulmonary capillaries. 4. At the end of inspiration, the diaphragm and intercostal muscles relax and the lungs recoil. 5. As the lungs recoil, pressure within the lungs becomes higher than atmospheric pressure, causing the air, which now contains the cellular waste products carbon 2 I DIOSES, Janah Marielle D. & REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete 3. During inspiration stretch receptors stop sending signals to inspiratory neurons and inspiration stop sending signals to inspiratory neurons and inspiration is ready to start again. 4. Oxygen and carbon dioxide are exchanged across the alveolar capillary membrane by process of diffusion. 5. Neutral control of respiration is in the medulla. The respiratory center in the medulla is stimulated by the concentration of carbon dioxide in the blood, 6. Chemoreceptors, a secondary feedback system, located in the carotid arteries and aortic arch respond to hypoxemia. These chemoreceptors also stimulate the medulla 7. Ph regulation o Blood pH (partial pressure of hydrogen in blood) o Blood PaCO2 (partial pressure of carbon dioxide in arterial blood) o Blood PaO2 (partial pressure of oxygen in arterial blood) Internal Respiration: o When arterial pH rises or the arterial PaCO2 o It is the exchange of gases with the internal falls, hyperventilation occurs. environment and occurs in the tissues o The gas exchange that occurs at the level of body tissues. Similar to external respiration, internal respiration also occurs as simple diffusion due to a partial pressure gradient. However, the partial pressure gradients are opposite of those present at the respiratory membrane. NOTE: for effective gas exchange to occur, alveoli must be ventilated and perfused. Ventilation (V) refers to the flow of air into and out of the alveoli, which perfusion (Q) refers to the flow of blood to the alveolar capillaries. Individual alveoli have variable degrees of ventilation and perfusion in different regions of the lungs. Collective changes in ventilation and perfusion in the lungs are measured clinically using the ratio of ventilation to perfusion (V/Q). A ventilation-perfusion imbalance occurs from inadequate ventilation, inadequate perfusion, or both. o Note: the air we breathe is a geaseous mixture consisting mainly of nitrogen (78.62%) and oxygen (20.84%), with traces of carbon dioxide (0.4%), water vapor (0.05%), helium and argon. The atmospheric pressure at sea level is about760 mmHg. Partial pressure is the pressure exerted by each type of gas in mixture of gases SUMMARY OF PHYSIOLOGY OF THE RESPIRATORY SYSTEM 1. Basic gas-exchange unit of the respiratory system is the alveoli 2. Alveolar stretch receptors respond to inspiration by sending signals to inhibit inspiratory neurons in the brain stem to prevent lung over distention. 3 I DIOSES, Janah Marielle D. & REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete RESPIRATORY CARE MODALITIES, PROCEDURES AND o Maintain NPO status, until the gag reflex TREATMENTS returns ESSENTIAL DIAGNOSTIC PROCEDURES o Monitor for boody sputum o Monitor respiratory status 1. Chest X-ray film (Radiograph) o Monitor for complications such as Description: provides information regarding the anatomical bronchospasm or bronchial perforation location and appearance of the lungs/ o Notify the physician is signs of complication Nursing Responsibility; occurs Pre-Procedure: 4. Endobronchial Ultrasound (EBUS) o Remove all jewelry and other metal objects Description: tissue samples are obtained from central lung from the chest area massess and lymph nodes, using a bronchoscope with the help o Asses the client's ability to inhale or hold his/ of ultrasound guidance her breath. Nursing Responsibility: Post-procedure: post-procedure: o Help the client to get dressed. o the client is monitored for signs of bleeding Note: ask women regarding pregnancy or the possibility of and respiratory distress pregnancy before performing radiography studies, 5. Pulmonary Angiography 2. Sputum Specimen Description: it is most used to investigate thromboembolic Description: Specimen obtained b y expectoration or tracheal disease of the lungs, such as pulmonary emboli and congenital suctioning to assist in the identification of organisms or abnormalities of the pulmonary vascular tree. It involves the abnormal cells. rapid injection of a radiopaque agent into a vasculature of the Nursing Responsibiltiy: lungs fro radiographic studies of he pulmonary vessels. Pre-procedure: Nursing Responsibility: o Determine the specific purpose of collection Pre-procedure: and check institutional policy for the o Assess for allergies to iodine, seafood, or appropriate method for collection. other radiopaque dyes o Obtain an early monitoring specimen o Maintain NPO status as prescribed. collection o Assess results of coagulation studies. o Instruct the client to rinse mouth with water o Establish an IV access. before collection o Administer sedation as prescribed. o Instruct the client to take several deep breaths o Instruct the client to lie still during the and then cough deeply to obtain sputum procedure. post-procedure: o Instruct the client that he or she may feel an o if culture of sputum is prescribed, transport urge to cough, flushing, nausea, or a salty the specimen to the laboratory immediately. taste following injection of the dye. o Assist the client with mouth care o Have emergency resuscitation equipment Note: ensure that an informed consent was obtained for any available. invasive procedure. Vital signs are measured before the Post-procedure procedure and monitored post procedure to detect signs of o Avoid taking blood pressures for 24 hours in complications the extremity used for the injection. o Monitor peripheral neurovascular status of the 3. Laryngoscopy and bronchoscopy affected extremity. Description: direct visual examination of the larynx, trachea, o Assess insertion site for bleeding. and bronchi with a fiberoptic bronchoscope. The purposes of diagnostic bronchoscopy are: 6. Fluoroscopic Studies i. To examine tissue or collect secretions Description: Fluoroscopy is used to assist with invasive ii. To dedetermine th location and extent of pathologic procedures, such as a chest needle biopsy or transbronchial process and to obtain a tissue sample for diagnosis. biopsy, performed to identify lesions. It also may be used to iii. To determine if a tumor can be resected surgically. study the movement of the chest wall, mediastinum, heart, and iv. To diagnose bleeding sites (source of hemoptysis) diaphragm, to detect diaphragm paralysis, and to locate lung Therapeutic bronchoscopy is used to: masses. i. Remove foreign bodies from the tracheobronchial tree ii. Remove secretions obstructing the tracheobronchial 7. Thoracentesis tree when the patient cannot clear them. Description: Removal of fluid or air from the pleural space via iii. Treat postoperative atelectasis transthoracic aspiration. Thoracentesis drains fluid from your iv. Destroy and excise lesions chest during the procedure, which usually lasts about 15 Nursing Responsibility: minutes. Pre-procedure: Nursing Responsibility: o Maintain NPO as prescribed Pre-procedure o Assess the results of coagulation studies o Prepare the client for ultrasound or chest o Remove ddentures and eyeglasss radiograph, if prescribed, before procedure. o Establish an IV access as necessary and o Assess results of coagulation studies. administer medication for sedation as o Note that the client is positioned sitting prescribed upright, with the arms and shoulders o Have emergency resuscitation equipment supported by a table at the bedside during the readily available procedure. Post-procedure: o If the client cannot sit up, the client is placed o Maintain the client in a Semi-Fowler's position lying in bed toward the unaffected side, with o Assess for the return of gag reflex the head of the bed elevated. DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete o Instruct the client not to cough, breathe 12. Ventilation-perfusion (V/Q) lung scan deeply, or move during the procedure. Description: The perfusion scan evaluates blood flow to the Post-procedure lungs. The ventilation scan determines the patency of the o Monitor respiratory status. pulmonary airways and detects abnormalities in ventilation. A o Apply a pressure, dressing and assess the radionuclide may be injected for the procedure. puncture site for bleeding and crepitus. Nursing Responsibility: Monitor for signs of pneumothorax, air Pre-procedure embolism, and pulmonary edema. o Assess the client for allergies to dye, iodine, or seafood. 8. Pulmonary function tests o Remove jewelry around the chest area. Description: Tests used to evaluate lung mechanics, gas o Review breathing methods that may be exchange, and acid-base disturbance through spirometric required during testing. measurements, lung volumes, and arterial blood gas levels. o Establish an IV access. Nursing Responsibility: o Administer sedation if prescribed. Pre-procedure: o Have emergency resuscitation equipment o Determine whether an analgesic that may available. depress the respiratory function is being Post-procedure administered. o Monitor the client for reaction to the o Consult with the HCP regarding withholding radionuclide. bronchodilators before testing. o Instruct the client that the radionuclide clears o Instruct the client to void before the procedure from the body in about 8 hours. and to wear loose clothing. o Remove dentures. 13. D-dimer o Instruct the client to refrain from smoking or Description: A blood test that measures clot formation and lysis eating a heavy meal for 4 to 6 hours before that results from the degradation of fibrin. the test Helps to diagnose (a positive test result) the presence Post-procedure: of thrombus in conditions such as deep vein thrombosis, o Client may resume a normal diet and any pulmonary embolism, or stroke; it is also used to diagnose bronchodilators and respiratory treatments disseminated intravascular coagulation (DIC) and to monitor the that were withheld before the procedure. effectiveness of treatment. The normal D-dimer level is less than or equal to 250 9. Pleural biopsy ng/mL (250 mcg/L) D-dimer units (DDU); normal fibrinogen is Description: is accomplished by needle biopsy of the pleura or 200 to 400 mg/dL (2 to 4 g/L) by pleuroscopy, a visual exploration through a fiberoptic bronchoscope inserted into the pleural space. Pleural biopsy is 14. Pulse Oximetry performed when there is incision over site pleural exudate of Description: Pulse oximetry is a noninvasive test that registers undetermined origin and when there is a need to culture or stain the oxygen saturation of the client's hemoglobin. The capillary the tissue to identify tuberculosis or fungi. oxygen saturation (Sa02) is recorded as a percentage. The normal value is 95% to 100%. After a hypoxic client uses up the 10. Lung biopsy readily available oxygen (measured as the arterial oxygen Description: A transbronchial biopsy and transbronchial needle pressure, Pa02, on arterial blood gas testing, the reserve aspiration may be performed to obtain tissue for analysis by oxygen, that oxygen attached to the hemoglobin (SaO2) is culture or cytological examination. An open lung biopsy is drawn to provide oxygen to the tissues. performed in the operating room. A pulse oximeter reading can alert the nurse to Nursing Responsibility: hypoxemia before clinical signs occur. If pulse oximetry readings Pre-procedure are below normal, instruct the client in deep breathing technique o Maintain NPO status as prescribed. and recheck the pulse oximetry. o Inform the client that a local anesthetic will be Procedure used for a needle biopsy but a sensation of A sensor is placed on the client's finger, toe, nose, pressure during needle insertion and earlobe, or forehead to measure oxygen saturation, aspiration may be felt which then is displayed on a monitor. o Administer analgesics and sedatives as Maintain the tranducer at heart level. prescribed. Do not select an extremity with an impediment to blood Post-procedure flow o Apply a dressing to the biopsy site and monitor for drainage or bleeding 15. Arterial blood gases (ABGs) o Monitor for signs of respiratory distress and Description: Measurement of the dissolved oxygen and carbon notify the HCP if they occur. dioxide in the arterial blood helps to indicate the acid-base state o Monitor for signs of pneumothorax and air and how well emboli and notify the HCP if they occur. / oxygen is being Prepare the client for chest radiography if carried to the body. prescribed Nursing Responsibility: 11. Spiral (helical) computed tomography (CT) scan Description: Frequently used test to diagnose pulmonary embolism. IV injection of contrast medium is used; if the client cannot have contrast medium, a ventilation perfusion (V/Q) scan will be done. The scanner rotates around the body, allowing for a 3-dimensional picture of all regions of the lungs DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete Pre-procedure: Collection of an ABG specimen carbon dioxide (CO2) is retained and the o Obtain vital signs. hydrogen ion concentration increases o Determine o Emphysema and COPD: Loss of elasticity of whether the client alveolar sacs restricts air flow in and out, has an arterial line primarily out, leading to an increased CO2 in place (allows for level. arterial blood o Administering high oxygen levels per nasal sampling without cannula to clients who are CO2 retainers further puncture to (example: emphysema and COPD). the client). o Hypoventilation: Carbon dioxide is retained o Perform the and the hydrogen ion concentration Allen's test to increases, leading to the acidotic state; determine the carbonic acid is retained and the pH presence of decreases. collateral circulation o Pneumonia: Excess mucus production and o Assess factors lung congestion cause airway obstruction, that may affect the accuracy of the results, resulting in inadequate gas exchange. such as changes in the O2 settings, o Pulmonary edema: Extracellular suctioning within the past 20 minutes, and accumulation of fluid in pulmonary tissue client's activities. causes disturbances in alveolar diffusion and o Provide emotional support to the client. perfusion. o Assist with the specimen draw; prepare a o Pulmonary emboli: Emboli cause obstruction heparinized syringe (if not already pre- in a pulmonary artery resulting in airway packaged). obstruction and inadequate gas exchange Post-procedure Respiratory Alkalosis o Apply pressure immediately to the puncture o Fever: Causes increased metabolism, site following the blood draw; maintain resulting in overstimulation of the respiratory pressure for 5 minutes or for 10 minutes if the system. client is taking an anticoagulant Appropriately o Hyperventilation; Rapid respirations cause label the specimen and transport it on ice to the blowing off of carbon dioxide (CO2), the laboratory. leading to a decrease in carbonic acid. o On the laboratory form, record the client's o Hypoxia: Stimulates the respiratory center in temperature and the type of supplemental O2 the brainstem, which causes an increase in that the client is receiving. the respiratory rate to increase oxygen (02); this causes hyperventilation, which results in a decrease in the C02 level. o Hysteria: Often is neurogenic and related to a psychoneurosis; however, this condition leads to vigorous breathing and excessive exhaling of C02. Overventilation by mechanical ventilators: The administration of 02 and the depletion of CO2 can occur from mechanical ventilation, causing the client to be hyperventilated. o Pain: Overstimulation of the respiratory center Causes of Acid-Base Imbalance in the brainstem results in a carbonic acid Respiratory Acidosis: deficit o Asthma: Spasms resulting from allergens, Metabolic Acidosis irritants, or emotions cause the smooth o Diabetes mellitus or diabetic ketoacidosis: An muscles of the bronchioles to constrict, insufficient supply of insulin causes increased resulting in ineffective gas exchange. fat metabolism, leading to an excess o Atelectasis: excessive mucus collection, with accumulation of ketones or other acids; the the collapse of alveolar sacs caused by bicarbonate then ends up being depleted. mucous plug, infectious drainage, or o Excessive ingestion of acetylsalicylic acid: anesthetic medications, results in ineffective Causes an increase in the hydrogen ion gas exchange. concentration. o Brain Trauma: excessive pressure on the o High-fat diet: Causes a much too rapid respiratory center or medulla oblongata accumulation of the waste producis of fat depresses respiration. metabolism, leading to a buildup of ketones o Bronchiectasis: Bronchi become dilated and acids. because of inflammation, and destructive o Insufficient metabolism of carbohydrates: changes and weakness in the walls of the When the oxygen supply is not suficient for bronchi occur the metabolism of carbohydrates, lactic acid o Bronchitis: Inflammation causes airway is produced and lactic acidosis results. obstruction, resulting in inadequate gas o Malnutrition: Improper metabolism of exchange. nutrients causes fat catabolism, leading to an o Central nervous system depressants: excess buildup of ketones and acids. Depressants such as sedatives, opioids, and o Renal insufficiency, acute kidney injury, or anesthetics depress the respiratory center, chronic kidney disease: Increased waste leading to hypoventilation (excessive products of protein metabolism are retained; sedation from medications may require acids increase, and bicarbonate is unable to reversal by opioid antagonist medications); maintain acid-base balance. DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete o Severe diarrhea: Intestinal and pancreatic greater ambulation and allow the client to go secretions are normally alkaline: therefore, home with the chest tubes in place. excessive loss of base leads to acidosis. Nursing Responsibility: Metabolic Alkalosis Collection chamber: o Diuretics: The loss of hydrogen ions and o Monitor drainage; notify the HCP if drainage chloride from diuresis causes a compensatory is more than 70 to 100 mL/hour or if drainage increase in the amount of bicarbonate in the becomes bright red or increases suddenly blood, o Mark the chest tube drainage in the collection o Excessive vomiting or gastrointestinal at 1 to 4 hour intervals, using a piece of tape suctioning: Leads to an excessive loss of o If client has a known pneumothorax, hydrochloric acid. intermittent bubbling in the water seal o Hyperaldosteronism: Increased renal tubular chamber is expected as air is drained from the reabsorption of sodium occurs, with the chest, but continuous bubbling indicates an resultant loss of hydrogen ions. air leak in the system o Ingestion of and/ or infusion of excess sodium o Notidy the HCP if there is continuous bubbling bicarbonate: Causes an increase in the in the water seal chamber amount of base in the blood. Suction control chamber o Massive transfusion of whole blood: The An occlusive sterile dressing is maintained at the citrate anticoagulant used for the storage of insertion site blood is metabolized to bicarbonate A chest radiograph assesses the position of the tube and determines whether the lung has re-expanded 16. Chest Tube Drainage: Assess respiratory status and auscultate lung sounds. Description: this is used to restore negative pressure within the Assess chest tube dressing for drainage and palpate thoracic cavity. The system is used to remove abnormal surrounding tissue for crepitus. Monitor for signs of accumulations of air and fluid from the pleural space extended pneumothorax or hemothorax. The anterior chest tube is used to drain air. The Keep the drainage system below the level of the chest posterior chest tube is used to drain fluid. A chest tube, or a and the tubes free of kinks, dependent loops, or other smaller drain with a curled end (pigtail catheter) stays inside obstructions. Ensure that all connections are secure. patient's chest and drains fluid or air over a few days Encourage coughing and deep breathing. Types of test tube drainages: Change the client's position frequently to promote Drainage collection chamber: drainage and ventilation. o The drainage collection chamber is located Do not strip or milk a chest tube unless specifically where the chest tube from the client connects directed to do so by the HCP and if agency policy to the system allows it. o Drainage from the tube drains into and Keep a clamp (may be needed if the system needs to collects in a series of calibrated columns in be changed) and a sterile occlusive dressing at the this chamber bedside at all times. Water seal chamber Never clamp a chest tube without a written prescription o The tip of the tube is underwater, allowing from the HCP; also, determine agency policy for fluid and air to drain from the pleural space clamping a chest tube. and preventing air from entering the pleural space RESPIRATORY MANAGEMENT USED IN CLIENTS WITH o Water oscillates RESPIRATORY DISORDERS o Excessive bubbling indicated an air leak in the Chest physiotherapy (CPT) chest tube system Description: Percussion, vibration, and postural drainage Suction control chamber techniques are performed over the thorax to loosen secretions o The suction control chamber provides the in the affected area of the lungs and move them into more suction, which can be controlled to provide central airways negative pressure to the chest. o This chamber is filled with various levels of Nursing Responsibility: water to achieve the desired level or suction; without this control, lung tissue could be sucked into the chest tube Perform chest physiotherapy (CPT) in the morning on o Gentle bubbling in this chamber indicated that arising, 1 hour before meals, or 2 to 3 hours after there is suction and does not indicate that air meals. is escaping from the pleural space. Stop CPT if pain occurs. Dry suction system If the client is receiving a tube feeding, stop the o This is another type of chest drainage system. feeding and aspirate for residual before beginning Because this is a dry suction system, absence CPT. of bubbling is noted in the suction control Administer the bronchodilator (if prescribed) 15 chamber. minutes before the procedure. o A knob on the collection devices is used to set Place a layer of material (gown or pajamas) between the prescribed amount of suction; then the the hands or percussion device and the client's skin wall suction source dial is turned until a small Position the client for postural drainage based on orange floater valve appears in the window on assessment. the device. Percuss the area for 1 to 2 minutes. Portable chest drainage system Vibrate the same area while the client exhales 4 or 5 o Uses a control flutter valve to prevent deep breaths. backflow or air into the client's lung Monitor for respiratory tolerance to the procedure. o Principles of gravity and pressure, and the Stop the procedure if cyanosis or exhaustion occurs. nursing care involved, are the same for all types of systems, and these systems allow DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete Maintain the position for 5 to 20 minutes after the ▪ Nasal cannula for low flow – used for the client with procedure. Repeat in all necessary positions until the client no longer expectorates mucus. Dispose of sputum properly. Provide mouth care after the procedure. Contraindications: Unstable vital signs Increased intracranial pressure Bronchospasm History of pathological fractures Rib fractures f. Chest incisions Postural Drainage Description: A technique that involves positioning a patient in specific ways to assist in the mobilization and removal of secretions from different segments of the lungs. Incentive spirometry chronic airflow limitation and for long term Oxygen Description: It is used to facilitate a sustained slow deep breath. use Incentive spirometry is performed using devices, which provide ▪ Nasal high-flow (NHF) respiratory therapy - Used visual cues to the patients that the desired flow or volume has for hypoxemic clients in mild to moderate respiratory been achieved. The basis of incentive spirometry involves distress having the patient take a sustained, maximal inspiration ▪ Simple face mask - Used for short-term oxygen therapy or to deliver oxygen in an emergency Nursing Responsibility: ▪ Venturi mask - Used for clients at risk for or experiencing acute respiratory failure ▪ Partial rebreather mask- Useful when the oxygen Instruct the client to assume a sitting or upright concentration needs to be raised; not usually position prescribed for a client with chronic obstructive Instruct the client to around the mouthpiece of the pulmonary disease (COPD) device. ▪ Nonrebreather mask - Most frequently used for the Instruct the client to slowly to raise and maintain the client with a deteriorating respiratory statuswho might flow rate indicator between the 600 and 900 marks. require intubation Instruct the client to hold the breath for 5seconds and ▪ Tracheostomy collar and T-bar or T-piece - then to exhale through pursed lips. Tracheostomy collar is used to deliver high humidity Instruct the client to repeat this process 10 times every and the desired oxygen to the client with a hour while awake tracheostomy; the T-bar or T-piece is used to deliver the desired FiO2 to the client with a tracheostomy, Breathing Retraining laryngectomy, or endotracheal tube Description: This includes exercises to decrease use of the ▪ Face tent-Used instead of a tight-fitting mask for the accessory muscles of breathing, to decrease fatigue, and to client who has facial trauma or burns. promote carbon dioxide (C02) elimination. The main types of exercises include pursed-lip breathing and diaphragmatic breathing. Note: HUFF COUGHING – this is an effective coughing technique that conserves energy, reduces fatigue, and facilitates mobilization of secretions. The client should take3 or4 deep breaths using pursed-lip and diaphragmatic breathing. Leaning slightly forward, the client should cough 3-4 times during exhalation. Nursing Responsibility: Instruct the client to inhale slowly through the nose. Instruct client to place hand over the abdomen while inhaling: the abdomen should expand with inhalation and contract during exhalation The client should exhale 3 times longer than inhalation by blowing through pursed lips. Oxygenation Supplemental oxygen delivery systems DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete Mechanical Ventilation Nursing Responsibilities and Interventions: Types of Mechanical Ventilation Assess vital signs, lung sounds, respiratory status, and 1. Pressure-cycled ventilator - The ventilator pushes air into breathing patterns (the client will never breathe at a the lungs until a specific airway pressure is reached rate lower than the rate set on the ventilator). Monitor skin color, particularly in the lips and nail 2. Time-cycled ventilator - the ventilator pushes air into the beds. lungs until a preset time has elapsed Monitor the chest for bilateral expansion. Obtain pulse oximetry readings 3. Volume-cycled ventilator The ventilator pushes air into the Monitor ABG results. lungs until a preset volume is delivered. A constant tidal volume Assess the need for suctioning and observe the type, is delivered regardless of the changing compliance of the lungs color, and amount of secretions. and chest wall Assess ventilator settings. Assess the level of water in the humidifier and the temperature of the humidification system 4. Microprocessor ventilator A computer or microprocessor is Ensure that the alarms are set. built into the ventilator to allow continuous monitoring of If a cause for an alarm cannot be determined, ventilatory functions, alarms, and client parameters. Note: ventilate the client manually with a resuscitation bag resuscitation bag should be available at the bedside for all until the problem is corrected. clients receiving mechanical ventilation. Empty the ventilator tubing when moisture collects Turn the client at least every 2 hours or get the client Modes of ventilation out of bed, as prescribed per minute Have resuscitation equipment available at bedside 1. Noninvasive positive pressure ventilation or BiPAP Causes of Alarms o Ventilatory support given without using an invasive High-Pressure Alarm artificial airway (endotracheal tube or tracheostomy Increased secretions are in the airway. tube); or facial masks and nasal masks are used Wheezing or bronchospasms instead. The endotracheal tube is displaced. o An inspiratory positive airway pressure (IPAP) and an The ventilator tube is obstructed because of water or expiratory positive airway pressure (EPAP) are set on a kink in the tubing. a large ventilator or a small flow generator ventilator Client coughs, gags, or bites on the oral endotracheal with a desired pressure support and positive end- tube. expiratory pressure (PEEP) level. Note: This allows Client is anxious or fights the ventilator. more air to move into and out of the lungs without the normal muscular activity needed to do so. Low-Pressure Alarm 2. Controlled Mode Disconnection or leak in the ventilator or in the client's airway cuff occurs. The client stop spontaneous breathing The client receives a set tidal volume at a set rate. Least used f the client attempts to initiate a Alarm safety and alarm fatigue breath, the ventilator locks out the client's It is the responsibility of the nurse to be alert to the inspiratory effort. sound of the alarm because this signals client problem 3. Assist-control Mode The nurse needs to respond promptly to an alarm and immediately assess the client. According to The Joint Commission (TJC), the most Most used mode of MV common contributing factor related to alarm-related Tidal volume and ventilatory rate are preset on sentinel events is alarm fatigue, which results when the ventilator. The ventilator is programmed to the numerous alarms and resulting noise tends to respond to the client's inspiratory effort if the desensitize the nursing staff and cause them to client does initiate a breath. The ventilator ignore alarms or even disable them. delivers the preset tidal volume when the client initiates a breath while allowing the client to control the rate of breathing. If the client's Complications spontaneous ventilatory rate increases, the Hypotension caused by the application of pressure ventilator continues to deliver a preset tidal Respiratory complications such as pneumothorax or volume with each breath subcutaneous emphysema Gastrointestinal alteration such as stress 4. Synchronized intermittent mandatory ventilation Malnutrition if nutrition is not maintained (SIMV) Infections Muscular deconditioning Ventilator dependence or inability to wean Like assist-control ventilation in that the tidal volume and ventilatory rate are preset on the ventilator. Allows the client to breathe spontaneously at her or his own ESSENTIAL DRUGS USED IN CLIENTS WITH rate and tidal volume between the ventilator breath. RESPIRATORY ORDERS When SIMV is used as a weaning mode, the number of SIMV breaths is decreased gradually, and the client gradually resumes spontaneous breathing DIOSES, Janah Marielle D. TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete DIOSES, Janah Marielle D.  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete CHAPTER 3: MANAGEMENT FOR CLIENTS WITH UPPER Some patients may also have headaches, periorbital RESPIRATORY TRACT DISORDERS edema (swollen eyelids), coughing, and wheezing, particularly if sinusitis is also present. Many upper airway disorders are relatively minor, and their effects are limited to mild and temporary discomfort and Diagnostic Procedures: inconvenience for the patient. However, the other airway 1. SKIN-PRICK TESTING: it is considered the primary disorders are acute, severe, and life-threatening and may method for identifying specific allergic triggers of require permanent alterations in breathing and speaking. Thus, rhinitis. the nurse must have good assessment skills, an understanding It involves placing a drop of a commercial extract of the wide variety of disorders that may affect the upper airway, of a specific allergen on the skin of the forearms or and an awareness of the impact of these alterations on patients. back, then pricking the skin through the drop to introduce the extract into the epidermis. Within 15- Upper respiratory tract infections are prevalent diseases that 20 minutes, a wheal-and-flare response (an sometimes affect the majority of individuals. Certain infections irregular blanched wheal surrounded by an area of have an acute nature, characterized by symptoms that last for a redness) will occur if the test is positive. few days, while others display a chronic one, with acute nature, 2. ALLERGEN-SPECIFIC IGE TESTS characterized by symptoms that last for a few days, while others Immunosorbent assay – previously performed by display a chronic one, with symptoms that endure for a radioallergosorbent tests (RASTs) prolonged period or reoccur. Patients afflicted with these illnesses seldom need hospitalization. Nevertheless, nurses Medical- Surgical and Pharmacological Management: working in community settings or long term care institutions may The treatment goal for allergic rhinitis is relief of come across patients who are afflicted with these illnesses. symptoms Therefore, it is crucial for the nurse to identify the indications and manifestations and provide suitable treatment. second-generation oral antihistamines and intranasal corticosteroids are the mainstay of the treatment. UPPER AIRWAY INFECTIONS Allergen immunotherapy (also called desentization immunotherapy). It helps build long-term tolerance to RHINITIS specific environmental triggers, but they may take The word rhinitis means “inflammation of the nose” months or years to become fully effective. it is the inflammation of the nasal mucosa and often the Therapeutic options available to achieve goal includes mucous in the sinuses that can be caused by infection avoidance measures, use of nasal saline, irrigation, (viral or bacterial) or allergens. intranasal corticosteroids, combination intranasal corticosteroids/ antihistamine sprays; leukotriene This is a condition characterized by inflammation and receptor antagonists (LTRA), and allergen swelling of the mucous membrane in the nose immunotherapy (also called desensitization Rhinitis is most often caused by colds and allergies, immunotherapy). and the diagnosis is generally made by evaluating the NOTE: antibiotics do not relieve symptoms of symptoms allergic rhinitis. rhinitis may be categorized as either acute, which refers to a brief duration, or chronic, which indicated a Non-Allergic Rhinitis long-lasting condition. Also known as Vasomotor Rhinitis It is classified as allergic or non allergic rhinitis. It is described a syndrome of chronic symptoms of nasal congestion and rhinorrhea, unrelated to a Allergic Rhinitis specific allergen. called hay fever, causes congestion, sneezing, sore throat and itchy nose. Pathophysiology: it results from the immune system of the body it is partly due to an imbalance between responding to an external stimulus. Common environmental triggers include dusts, molds, pollens, parasympathetic and sympathetic inputs on the nasal mucosa. grasses, trees, and animals. NOTE: the most critical factor in attaining a proper Pathophysiology: diagnosis of vasomotor rhinitis is a comprehensive history and physical assessment. the presence of an allergen causes histamine and leukotrienes release (responsible for arteriolar Etiology: dilation, increased vascular permeability, itching, the cause of vasomotor rhinitis is not well rhinorrhea, mucous secretion, and smooth muscle understood, it is thought to be associated with the contraction in the lung) and other mediators in the dysregulation of sympathetic, parasympathetic, and nasal mucosa. nociceptive nerves innervating the nasal mucosa. The mediators bind to blood vessel receptors causing capillary leakage, which leads to local Pathophysiology edema or swelling. The imbalance among mediators results in increased the release of mediators and cytokines at the first stage vascular permeability and mucus secretion from the of an immune response to an allergen leads to a submucosal nasal glands subsequent cellular inflammatory response during the Mucous secretions is regulated primarily by the following 4-8 hours. this late-phase inflammatory parasympathetic nervous system, whereas the response causes recurring symptoms, often nasal sympathetic nervous system controls vascular tone congestion, which frequently persists. Acetylcholine is the primary sympathetic Clinical Manifestations: neurotransmitter that regulates mucus secretion and pruritus (itching), frequent sneezing, rhinorrhea, nasal rhinorrhea congestion, and pruritus and lacrimation. Norephinephrine and neuropeptide Y are sympathetic neurotransmitter that control the vascular tone of 1 I DIOSES, Janah Marielle D. and REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete vessels in the nasal mucosa and modulate the Complications: Laryngitis, Sinusitis, Otitis Media, parasympathetic system inhaled infections. Tonsillitis, and Lung Infection Sensory neuropeptides and nociceptive type C fibers of the trigeminal nerve contribute to mast cell Medical-Surgical and Pharmacological Management: degranulation as well as the ithcing/ sneezing reflexes. Providing adequate fluid intake, encouraging rest, preventing chilling Clinical Manifestations: the symptoms like hay fever's but Instruct to increase intake of Vitamin C it is not caused by allergies Warm salt water gargle soothe the sore throat The exact case is unknown. It can affect children and Stuffiness is relieved by decongestants. adults but it's more common after age 20. Antihistamines taken by mouth or as a nasal spray Triggering factors of nonallergic rhinitis include: sometimes help control a runny nose, but some cause o Irritants in the air, weather, infections, food drowsiness and most cause of other problems, and drinks, some medicines, hormonal especially in older people. Other medications such as changes. mast-cell stabilizers, some of which also act as Nonallergic rhinitis might be linked to nasal polyps and antihistamines, can control symptoms od allergic sinusitis rhinitis Zinc lozenges Diagnostic Procedures: Amantadine (Symmetrel) or rimantadine (Flumadine) is 1. Nasal cytology: it provides information about cell types prescribed prophylactically to decrease signs and composing the mucosa and helps to identify the presence of symptom of common colds. inflammatory markers. Note: antibiotics are not effective for acute viral Scrapings form interior turbinate, nasal lavage, or nose rhinitis. blowing can provide epithelial cells for analysis. The presence of 5 to 25 eosinophils in high- powered fields is compatible with the diagnosis of nonallergic rhinitis with eosinophilia syndrome (NARES), a subset of nonallergic rhinitis. SINUSITIS Often called “rhinosinusitis”, an inflammation of the 3. Nasal provocation testing : involves exposing patient mucous membranes of one or more of the sinuses, to a respective allergen, assessing the clinical usually the maxillary or frontal sinus. response, and collecting objective data with Swelling of the mucosa can block the drainage rhinomanometry and acoustic rhinometry. secretions, which can cause a sinus infection It often occurs after rhinitis and can be associated with a deviated nasal septum, nasal polyps, inhaled air pollutants or cocaine, facial trauma, dental infections, Medical-Surgical and Pharmacological Management or loss of immune function Educating the patient on avoiding environmental Rhinosinusitis is classified as: triggers o Acute Sinusitis – symptoms lasting less than Limiting exposure to inciting factors such as perfumes, 4 weeks tobacco smoke, and cleaning supplies o Subacute Sinusitis – symptoms last Topical nasal corticosteroids – considered as first-line between 4 and 12 weeks medication, especially for congestion and obstructive o Chronic Sinusitis – symptoms lasting more symptoms. than12 weeks Fluticasone propionate and beclomethasone are o Recurrent Sinusitis – four episodes lasting currently the only topical steroid preparations approved less than 4 weeks with complete symptom by the FDA for vasomotor rhinitis resolution between episodes. Budesonide also shows to be efficacious and is Etiology currently the only topical steroid agent with a Viruses are the most common cause of acute pregnancy category B rating. rhinosinusitis Anticholinergic medications can provide relief from The viral rhinosinusitis (VRS) pathogens include unrelenting rhinorrhea. A topical anticholinergic like rhinovirus, adenovirus, influenza virus, and ipratropium bromide is the first choice for rhinorrhea. parainfluenza virus. The therapeutic insertion of the vidian nerve is a well- The most common cause of acute bacterial known surgical option for vasomotor rhinitis. The rhinosinusitis (ARBS) are Streptococcus pneumoniae, technique aims to disrupt the autonomic nerve supply Haemophiliis influenzae, and Moraxella catarrhalis. of the nasal cavity, thus decreasing nasal secretions. Chronic sinusitis is multifactorial in nature and can include infectious, inflammatory, or structural factors. ACUTE VIRAL RHINITIS Also known as “common cold” Pathophysiology Is often used when referring to an upper respiratory ✓ Infection of the paranasal sinuses that frequently tract that is self limited and caused by a virus. develops as a result of an upper respiratory infection, Virus that invades the upper respiratory tract. such as unresolved viral or bacterial infection, or an exacerbation of allergic rhinitis Clinical Manifestations: ✓ Nasal congestion, caused by inflammation, edema, Symptoms consist of sore throat (about 50% of and transudation of fluid, leads to obstruction of the patients develop a sore throat, which is often the first sinus cavities. This provides an excellent medium for symptom to appear because it can occur as early as bacterial growth. 10 hours after the infection), runny nose, sneezing, ✓ There is a narrowing or obstruction in the ostia of the general malaise, congestion, postnasal drip, cough, frontal, maxillary, and anterior ethmoid sinuses caused and a low-grade fever. by infection. This rests in stagnant secretions, an ideal medium for infection. 2 I DIOSES, Janah Marielle D. and REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete 5. Nasal steroids should be used with or without nasal saline Clinical Manifestations irrigation. The treatment should last at least eight to 12 Major symptoms: purulent anterior nasal weeks with proper usage discharge. Purulent or discolored posterior nasal 6. Broad-spectrum antibiotics, such as amoxicillin, are used discharge, nasal obstruction or congestion, facial on a limited basis for a confirmed causative bacterial congestion or fullness, facial pain or pressure, pathogen. hyposmia (decreased sense of smell) or anosmia Note: Anti-fungal empiric therapy should not be given. (partial or full loss of smell), fever (for acute Pain relief medications include NSAIDs, acetaminophen, sinusitis only). and aspirin. Chronic sinusitis with polyps should be Minor symptoms: headache, ear pain or treated with topical nasal steroids. If severe or pressure or fullness, halitosis, dental pain, cough, unresponsive to therapy after 12 weeks, a short course of fever (for subacute or chronic sinusitis), and oral steroids which is the Leukotriene antagonists can be Fatigue considered. Note: The cardinal symptoms of sinusitis which are purulent nasal discharge, facial or dental pain, and Nursing Management: nasal obstruction 1. Encourage the use of steam humidification, sinus Note: Acute bacterial rhinosinusitis (ABRS) can be irrigation, saline nasal sprays, and hot and wet packs differentiated from viral rhinosinusitis (VRS) using the to relieve sinus congestion and pain. following clinical guidance: 2. Teach the client to increase fluid intake and rest. Duration of symptoms for more than ten days 3. Discourage air travel, swimming, and diving. High fever (over 39 C or 102 F) with purulent nasal 4. Encourage cessation of tobacco use in any form. discharge or facial pain that last for 3 to 4 5. Instruct the client on correct technique for sinus consecutive days at the beginning of the illness irrigation and self-administration of nasal sprays. Double worsening of symptoms within 6. Instruct patient that sinus irrigation and saline nasal the first ten day sprays are an effective alternative to antibiotics for relieving nasal congestion. Diagnostic Procedures: 7. Educate the patient to contact the care provider for 1. CT scan or sinus x-rays – to confirm the manifestations of a severe headache, neck stiffness diagnosis, which is typically based upon findings (nuchal rigidity), and high fever, which can indicate and physical assessment. possible complications. 2. Nasal endoscopy – indicated to rule out underlying diseases such as tumors and sinus PHARYNGITIS mycetomas (fungus balls). The fungus ball is Commonly known as “sore throat” usually a brown or greenish-black material with An inflammation of the pharynx, resulting in a sore the consistency of peanut butter or cottage throat. cheese. Pharyngitis is a symptom, rather than a condition. 3. Conventional diagnostic criteria for rhinosinusitis Etiology: in adults is the patient having at least two major In most cases, the cause is an infection, either bacterial or one major plus two or more minor symptoms. or viral. And other less causes of include allergies, The criteria in children are similar except that trauma, cancer, reflux and certain there is more of an emphasis on nasal discharge Viral: predominantly rhinovirus, influenza, adenovirus, (rather than nasal obstruction) coronavirus, and parainfluenza while less common viral pathogens include herpes, Epstein-Barr virus, Complications: human immunodefieciency virus and coxsackievirus. Complications of sinusitis are severe orbital Bacterial: Group A beta-hemolytic streptococci- the cellulitis, subperiosteal abscess, cavernous most common bacterial infection. Other bacterial sinus thrombosis, meningitis and etiology include Group B and C streptococci, encephalitis (if pathogens enters the Chlamydia pneumoniae, Mycoplasma pneumoniae, bloodstream from the sinus cavity), and Corynebacterium diptheriae. ischemic infarction Classification: Acute Pharyngitis and Chronic Pharyngitis Medical – Surgical and Pharmacological Management: 1. Endoscopic sinus cavity lavage or surgery to relieve the ACUTE PHARYNGITIS obstruction, correct structural deformities that obstruct the Most cases of acute pharyngitis are caused by viral ostia of the sinus, and promote drainage of secretions. infection. The goal of this surgery is to relieve obstructions, restore When group A beta-hemolytic streptococcus, the most drainage and mucociliary clearance, and to ventilate the common bacterial organism, causes acute pharyngitis, sinuses. the condition is known as strep throat 2. Excising and cauterizing nasal polyps, correcting a CHRONIC PHARYNGITIS deviated septum, incising and draining the sinuses, A persistent inflammation of the pharynx. aerating the sinuses, and removing tumors are some of It is common in adults who work or live in dusty the specific procedures performed. surroundings, use their voice to excess, suffer from 3. Nasal decongestants, such as phenylephrine, are used to chronic cough, and habitually use alcohol and tobacco. reduce swelling of the mucosa. Three types of chronic pharyngitis are recognized: 4. Nursing Consideration: 1. Hypertrophic: characterized by general o Clients should be encouraged to begin over-the- thickening and congestion of the pharyngeal counter decongestant use at the first mucous membrane manifestation of sinusitis. 2. Atrophic: probably a late stage of the first o Signs of rebound nasal congestion may occur if type (the membrane is thin, whitish, decongestants are used for more than 3 to 4 glistening, and at times wrinkled) days. 3 I DIOSES, Janah Marielle D. and REGLOS, Jolo  TARLAC STATE UNIVERSITY BACHELOR OF SCIENCE IN NURSING BATCH 2026 NCM 112- Care of Clients with Problems in Oxygenation Prof. Elice Jude T. Rosete 3. Chronic granular (“clergyman’s sore hydrochloride (Neo-Synephrine) – to relieve nasal throat”): characterized by numerous swollen congestion lymph follicles on the pharyngeal wall Antihistamine – for history of allergies Lozenges – to keep the throat moistened Pathophysiology: Note: Antibiotics for pharyngitis are usually used for Bacteria and viruses can cause direct invasion of the patients with Group A beta-hemolytic streptococcal pharyngeal mucosa. In almost all cases, there is a local pharyngitis invasion of the pharyngeal mucosa which also results in excess secretion and edema. Note: Antibiotics should only be used for Group A beta- The body responds by triggering an inflammatory hemolytic streptococci-positive patients, particularly if they response in the pharynx. This results in pain, fever, are children, based on a positive culture or a rapid antigen vasodilation, edema, and tissue damage, manifested detection test. by redness and swelling in the tonsillar pillars, uvula, and soft palate. A creamy exudate may be present in Note: The disease is no longer infectious after 24 hours of the tonsillar pillar antibiotics Uncomplicated viral infections usually subside promptly, within 3 to 10 days after the onset. However, Note: A 10-day course of oral penicillin is recommended to pharyngitis caused by more virulent bacteria such as ensure the eradication of bacterial carriage and the group A beta-hemolytic streptococci is a more severe prevention of rheumatic fever. illness Note: A full course of antibiotic therapy is indicated in Clinical manifestations: patients with group A beta-hemolytic streptococcal Acute Pharyngitis: A fiery-red pharyngeal membrane infection in view of the possible development of and tonsils, lymphoid follicles that are swollen and complications such as nephritis and rheumatic fever, which flecked with white - purple exudate, and enlarged and may have their onset 2 or 3 weeks after the pharyngitis has tender cervical lymph nodes, fever, malaise, sore subsided throat and no cough. Chronic pharyngitis: Patient complain of a constant Note: Resistance may develop during treatment with sense of irritation or fullness in the throat, mucus that azithromycin and clarithromycin, and it is not considered a