OXYGENATION RESPIRATORY SYSTEM
TERMINOLOGIES <ul><li>VENTILATION  – MOVEMENT OF AIR IN & OUT OF THE LUNGS </li></ul><ul><li>RESPIRATION  – EXCHANGE OF GA...
CASE STUDY <ul><li>At the emergency room, patient Anna, 39 y.o,came, in respiratory distress, shouting for help, because o...
CASE STUDY <ul><li>Her skin is cold and clammy </li></ul><ul><li>You provided oxygen via nasal prong </li></ul><ul><li>Wha...
CASE STUDY <ul><li>You learned that patient has been experiencing night sweats, easy fatiguability for about 1 month. </li...
CASE STUDY <ul><li>With the above history, in which ward is your patient be admitted?  </li></ul><ul><li>What are the poss...
REVIEW OF ANATOMY  Divisions of the Respiratory System <ul><li>Air Conducting System - </li></ul><ul><ul><li>nose ….  term...
REVIEW OF ANATOMY  Organs of the Respiratory System <ul><li>Each lung has 3 primary components:  </li></ul><ul><ul><li>Air...
 
REVIEW OF PHYSIOLOGY <ul><li>Functions of the Respiratory System </li></ul><ul><li>Parameters in the process of breathing ...
REVIEW OF PHYSIOLOGY <ul><ul><li>Parameters in the process of breathing </li></ul></ul><ul><ul><ul><li>Permeable alveoli-c...
REVIEW OF PHYSIOLOGY <ul><ul><li>Parameters in the process of breathing </li></ul></ul><ul><ul><ul><li>Ability of the bloo...
 
NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>Cough </li></ul><ul><li>Secretions – sputum, phlegm <...
NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>CYANOSIS – TYPES </li></ul><ul><li>Peripheral – extre...
NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>CYANOSIS  </li></ul><ul><li>Factors that alter the pr...
NURSING PATIENTS WITH THREATS TO VENTILATION Physical Assessment <ul><li>Inspection – deformities, rate and rhythm of brea...
NURSING PATIENTS WITH THREATS TO VENTILATION Physical Assessment <ul><ul><li>Abnormal Breath Sounds </li></ul></ul><ul><ul...
NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>RADIOGRAPHIC </li></ul><ul><li>Chest Xray </li>...
NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>EXAMINATION BY DIRECT  </li></ul><ul><li>Rhinos...
NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>LABORATORY STUDIES </li></ul><ul><li>Hematologi...
NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>THORACENTESIS </li></ul><ul><li>Site  :  </li><...
NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>SKIN TEST FOR  P.T.B. </li></ul><ul><li>Mantoux...
NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>ASSESSMENT OF PULMONARY FUNCTION </li></ul><ul><li>SPIROMETRY </li></...
NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>SPIROMETRY </li></ul><ul><li>PULMONARY FUNCTION TEST </li></ul><ul><l...
NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>PULMONARY FUNCTION TEST </li></ul><ul><li>LUNG VOLUMES </li></ul><ul>...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>Planning for Health Promotion </li></ul><ul><li>Planning for...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><ul><li>Oxygen Therapy </li></ul></ul><ul><ul><li>Incentive Spir...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>OXYGEN THERAPY </li></ul><ul><li>Hypoxemia </li></ul><ul><li...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>OXYGEN THERAPY </li></ul><ul><li>Assessment for need for oxy...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>AEROSOL THERAPY </li></ul><ul><li>Distilled water and NSS </...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>ARTIFICIAL AIRWAY </li></ul><ul><li>Types: </li></ul><ul><li...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>MECHANICAL VENTILATION THERAPY </li></ul><ul><li>TYPES: </li...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST SURGERY </li></ul><ul><li>CHEST DRAINAGE </li></ul><ul...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><ul><li>Nursing Resposibilities...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><li>Nursing Responsibilities </...
NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><li>REMOVAL OF CATHETER </li></...
 
COMMON REPIRATORY PROBLEMS -  NOSE <ul><li>NOSE </li></ul><ul><li>Epistaxis </li></ul><ul><ul><li>causes : picking of the ...
COMMON REPIRATORY PROBLEMS -  SINUSES, THROAT <ul><li>SINUSES </li></ul><ul><ul><li>Sinusitis  </li></ul></ul><ul><ul><ul>...
TONSILLECTOMY <ul><ul><li>Nursing Care  </li></ul></ul><ul><ul><li>PRE-OP :  no fever,evaluate hemostasis,  ATROPINE  SULF...
TONSILLECTOMY <ul><li>Blood trickling down the throat/  FREQUENT SWALLOWING –  Hemorrhage </li></ul><ul><li>If conscious, ...
COMMON REPIRATORY PROBLEMS -  LARYNX <ul><li>LARYNX </li></ul><ul><li>Laryngitis </li></ul><ul><li>Cancer of the Larynx  <...
COMMON REPIRATORY PROBLEMS -  LARYNX <ul><ul><li>Cancer of the Larynx </li></ul></ul><ul><ul><ul><li>Diagnostics : Laryngo...
TOTAL LARYNGECTOMY <ul><li>NURSING CARE  – Pre –Op </li></ul><ul><li>Assist the physician in telling the patient: </li></u...
TOTAL LARYNGECTOMY <ul><li>NURSING CARE –  Post – Op </li></ul><ul><li>Constant attendance; no IV for the dominant arm </l...
TOTAL LARYNGECTOMY <ul><li>Avoid dusts or fumes , tracheostomy stoma has no mechanism for filtering and cooling air – neck...
TOTAL LARYNGECTOMY <ul><li>Minimal postop pain; narcotics contraindicated in Head & neck surgery </li></ul><ul><li>Self ca...
TOTAL LARYNGECTOMY <ul><li>11.Rehabilitation : aeg wear ID stating he has no vocal cord </li></ul><ul><li>12. Not smoke </...
CONDITIONS AFFECTING THE CHEST <ul><li>2 CLASSIFICATIONS  : </li></ul><ul><li>OBSTRUCTION  in the pathways of normal alveo...
<ul><li>All I’m asking for is a beautiful hair cut </li></ul>
CHRONIC  OBSTRUCTIVE  PULMONARY DISEASE (COPD) <ul><li>1.  EMPHYSEMA </li></ul><ul><li>2.  BRONCHIAL ASTHMA </li></ul><ul>...
C.O.P.D.  -  EMPHYSEMA Stretching and overdistention of the alveoli Loss of intralveolar septa, pulmonary elasticity  and ...
C.O.P.D.  -  EMPHYSEMA <ul><li>Predisposing Factors :  </li></ul><ul><li>Cigarette smoking  </li></ul><ul><li>Pollution </...
C.O.P.D. -  BRONCHIAL ASTHMA <ul><li>Viral respiratory Infection/ allergens </li></ul><ul><li>Bronchial spasm and bronchia...
These lungs appear essentially normal, but are normal-appearing because they are the hyperinflated lungs of a patient who ...
This cast of the bronchial tree is formed of inspissated mucus and was coughed up by a patient during an asthmatic attack....
C.O.P.D. -  BRONCHIECTASIS <ul><li>Dilation of medium-sized bronchi </li></ul><ul><li>Loss of bronchial elasticity </li></...
C.O.P.D. CHRONIC BRONCHITIS <ul><li>Inflammation of bronchioles </li></ul><ul><li>Causes : infection, respiratory irritant...
COPD - MANAGEMENT <ul><li>IMPROVING VENTILATION </li></ul><ul><ul><li>Oxygen, </li></ul></ul><ul><ul><li>IPPB, </li></ul><...
RESTRICTIVE  DISEASES <ul><li>CLASSIFICATION : </li></ul><ul><li>NEUROMUSCULAR </li></ul><ul><li>THORACIC DEFORMITY </li><...
RESTRICTIVE  DISEASE  NEUROMUSCULAR DISORDERS <ul><li>MYASTHENIA GRAVIS </li></ul><ul><ul><li>Generalized muscular weaknes...
RESTRICTIVE   DISEASES   NEUROMUSCULAR DISORDERS <ul><li>3.  GUILLAIN BARRE SYNDROME </li></ul><ul><ul><li>Acute infectiou...
RESTRICTIVE DISEASES THORACIC DEFORMITY <ul><li>KYPHOSCOLIOSIS </li></ul><ul><ul><li>Abnormal convex curvature of the spin...
RESTRICTION TO LUNG and/or ALVEOLAR EXPANSION <ul><li>DISEASES OF THE PLEURA </li></ul><ul><li>PNEUMOTHORAX </li></ul><ul>...
RESTRICTION TO LUNG and/or ALVEOLAR EXPANSION <ul><li>PLEURISY </li></ul><ul><ul><li>Inflammation of the pleura with chang...
PLEURISY <ul><ul><li>PLEURAL EFFUSION </li></ul></ul><ul><ul><ul><li>Sero-fibrinous fluid </li></ul></ul></ul><ul><ul><ul>...
PLEURISY <ul><li>EMPYEMA </li></ul><ul><ul><ul><li>Purulent exudate </li></ul></ul></ul><ul><ul><ul><li>From preexisting i...
The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. Pneumonia may be complicated by a...
PLEURISY <ul><ul><ul><li>FIBRINOUS / DRY PLEURISY </li></ul></ul></ul><ul><ul><ul><li>Lack of lubricating serous secretion...
PLEURISY <ul><ul><ul><li>FIBRINOUS / DRY PLEURISY </li></ul></ul></ul><ul><ul><ul><li>MANAGEMENT </li></ul></ul></ul><ul><...
RESTRICTIVE DISEASES <ul><li>INFILTRATIVE DISEASES </li></ul><ul><ul><li>Pulmonary Tuberculosis </li></ul></ul><ul><ul><li...
RESTRICTION DUE TO LOSS OF FUNCTIONING  PULMONARY TISSUE CHANGE IN ALVEOLAR CAPILLARY SURFACES DECREASED SURFACES FOR BLD ...
RESTRICTION DUE TO LOSS OF FUNCTIONING  PULMONARY TISSUE <ul><li>PULMONARY INFARCTION </li></ul><ul><li>LUNG ABSCESS </li>...
<ul><li>PULMONARY INFARCTION </li></ul><ul><li>Loss of pulmonary tissue from occlusion of pulmonary artery by an embolus <...
This is a rare finding that may complicate a term pregnancy at delivery. Seen here in a pulmonary artery branch is an amni...
This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do)....
<ul><li>PNEUMONIA </li></ul><ul><li>Acute pulmonary infection </li></ul><ul><li>Pneumococcus, Streptococcus, Haemophilus <...
This is a lobar pneumonia in which consolidation of the entire left upper lobe has occurred. This pattern is much less com...
<ul><li>PULMONARY FIBROSIS </li></ul><ul><li>Pathological increase in lung connective tissue </li></ul><ul><li>Diffuse / l...
Regardless of the etiology for restrictive lung diseases, many eventually lead to  extensive fibrosis . The gross appearan...
<ul><li>PNEUMOCONIOSES </li></ul><ul><li>Chronic, fibrotic </li></ul><ul><li>Inhalation of irritant dusts: </li></ul><ul><...
<ul><li>PULMONARY TUBERCULOSIS </li></ul><ul><li>Mycobacterium TB </li></ul><ul><li>Cough, hemoptysis, malaise, weight los...
Here is the gross appearance of a lung with tuberculosis. Scattered tan granulomas are present, mostly in the upper lung f...
On closer inspection, the granulomas have areas of caseous necrosis. This is very extensive granulomatous disease. This pa...
The Ghon complex is seen here at closer range. Primary tuberculosis is the pattern seen with initial infection with tuberc...
<ul><li>PULMONARY EDEMA </li></ul><ul><li>Excessive amount of fluid in the alveoli and pulmonary interstitial tissues </li...
MANAGEMENT –  RESTRICTIVE LUNG DISEASE <ul><li>Antibiotics </li></ul><ul><li>Oxygenation </li></ul><ul><li>Hemodynamic mon...
<ul><li>The nurse enters the room of a client who has a chest tube attached to a water-seal drainage system & noticed the ...
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Ventilation Powerpoint

  1. 1. OXYGENATION RESPIRATORY SYSTEM
  2. 2. TERMINOLOGIES <ul><li>VENTILATION – MOVEMENT OF AIR IN & OUT OF THE LUNGS </li></ul><ul><li>RESPIRATION – EXCHANGE OF GASES : EXTERNAL & INTERNAL </li></ul><ul><li>EXTERNAL – BET. ALVEOLI & PULMONARY CAPILLARIES </li></ul><ul><li>INTERNAL – BET. SYSTEMIC CAPILLARIES </li></ul><ul><li>PERFUSION – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASES </li></ul>
  3. 3. CASE STUDY <ul><li>At the emergency room, patient Anna, 39 y.o,came, in respiratory distress, shouting for help, because of massive hemoptysis that she is presently experiencing </li></ul><ul><li>Vital signs are: </li></ul><ul><ul><li>RR = 30, </li></ul></ul><ul><ul><li>HR= 105, </li></ul></ul><ul><ul><li>BP=130/80, </li></ul></ul><ul><ul><li>T= 36 C </li></ul></ul>
  4. 4. CASE STUDY <ul><li>Her skin is cold and clammy </li></ul><ul><li>You provided oxygen via nasal prong </li></ul><ul><li>What other nursing actions would you do? </li></ul><ul><li>What nursing history would you extract? </li></ul>
  5. 5. CASE STUDY <ul><li>You learned that patient has been experiencing night sweats, easy fatiguability for about 1 month. </li></ul><ul><li>There was on & off cough and fever, and patient self-medicated with low dose Amoxycillin </li></ul>
  6. 6. CASE STUDY <ul><li>With the above history, in which ward is your patient be admitted? </li></ul><ul><li>What are the possible diagnostics her physician would order? </li></ul><ul><li>What are your proposed nursing plan for the patient? </li></ul>
  7. 7. REVIEW OF ANATOMY Divisions of the Respiratory System <ul><li>Air Conducting System - </li></ul><ul><ul><li>nose …. terminal bronchioles </li></ul></ul><ul><li>Gas-exchanging lung units – </li></ul><ul><ul><li>respiratory bronchioles alveolar ducts alveolar sacs alveoli </li></ul></ul>
  8. 8. REVIEW OF ANATOMY Organs of the Respiratory System <ul><li>Each lung has 3 primary components: </li></ul><ul><ul><li>Air passages </li></ul></ul><ul><ul><li>Blood vessels – pulmonary artery (major supply), bronchial arteries </li></ul></ul><ul><ul><li>Elastic connective tissue </li></ul></ul><ul><ul><li>PLEURA – Parietal and Visceral </li></ul></ul>
  9. 10. REVIEW OF PHYSIOLOGY <ul><li>Functions of the Respiratory System </li></ul><ul><li>Parameters in the process of breathing </li></ul><ul><ul><li>Atmospheric O2 is 21%, normal atmospheric pressure 760 mmHg </li></ul></ul><ul><ul><li>Adequate ventilation or perfusion of the alveoli </li></ul></ul><ul><ul><ul><ul><li>Inspiration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Expiration </li></ul></ul></ul></ul>
  10. 11. REVIEW OF PHYSIOLOGY <ul><ul><li>Parameters in the process of breathing </li></ul></ul><ul><ul><ul><li>Permeable alveoli-capillary membrane </li></ul></ul></ul><ul><ul><ul><li>Adequate pulmonary and systemic circulation </li></ul></ul></ul>Shunting of blood to better ventilated arteries More time for gas exchange Mechanism vasoconstriction Vasodilatation Decrease pO2 Pulmonary Circulation Systemic circulation
  11. 12. REVIEW OF PHYSIOLOGY <ul><ul><li>Parameters in the process of breathing </li></ul></ul><ul><ul><ul><li>Ability of the blood to transportO2 and CO2 between the lungs and the tissues </li></ul></ul></ul><ul><ul><ul><li>Ability of the cells to utilize O2 and eliminate CO2 </li></ul></ul></ul><ul><ul><ul><li>Neural Control of Respiration </li></ul></ul></ul><ul><ul><ul><li>Medullary Rhythmicity Area </li></ul></ul></ul><ul><ul><ul><li>Apneustic Area – prolong and deepen respiration </li></ul></ul></ul><ul><ul><ul><li>Pneumotaxic Area – inhibit inspiration </li></ul></ul></ul><ul><ul><li>Pulmonary Volumes and Capacity </li></ul></ul>
  12. 14. NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>Cough </li></ul><ul><li>Secretions – sputum, phlegm </li></ul><ul><li>Dyspnea – activity, time of the day, duration, posture, onset & precipitating factor </li></ul><ul><li>Chest pain </li></ul><ul><li>Cyanosis </li></ul><ul><li>Voice quality </li></ul><ul><li>Stridor </li></ul>
  13. 15. NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>CYANOSIS – TYPES </li></ul><ul><li>Peripheral – extremities, nailbeds </li></ul><ul><li>Central – lips, tongue, face and mucous membrane </li></ul><ul><li>Differential </li></ul>
  14. 16. NURSING PATIENTS WITH THREATS TO VENTILATION Nursing History <ul><li>CYANOSIS </li></ul><ul><li>Factors that alter the presence of Cyanosis </li></ul><ul><li>Pigmentation and thickness </li></ul><ul><li>Type of light used during assessment – natural light is desirable </li></ul><ul><li>Absolute amount of reduced hemoglobin </li></ul><ul><li>Observer’s perception </li></ul><ul><ul><li>Activity </li></ul></ul><ul><ul><li>Duration 3. Distribution </li></ul></ul>
  15. 17. NURSING PATIENTS WITH THREATS TO VENTILATION Physical Assessment <ul><li>Inspection – deformities, rate and rhythm of breathing </li></ul><ul><li>Palpation - fremitus </li></ul><ul><li>Percussion - resonance </li></ul><ul><li>Auscultation – </li></ul><ul><ul><li>Normal breath sounds </li></ul></ul><ul><ul><ul><li>Vesicular – most of the lung </li></ul></ul></ul><ul><ul><ul><li>Bronchovesicular – mainstem bronchi </li></ul></ul></ul><ul><ul><ul><li>Bronchial/Tubular - trachea </li></ul></ul></ul>
  16. 18. NURSING PATIENTS WITH THREATS TO VENTILATION Physical Assessment <ul><ul><li>Abnormal Breath Sounds </li></ul></ul><ul><ul><ul><li>Rales – moisture in the tracheobronchial tree; heard on inspiration </li></ul></ul></ul><ul><ul><ul><li>Wheeze – continuous, musical sound heard with movement of air through narrowed passage; heard on expiration </li></ul></ul></ul><ul><ul><ul><li>Friction Rubs – grating sound from inflammed pleura </li></ul></ul></ul>
  17. 19. NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>RADIOGRAPHIC </li></ul><ul><li>Chest Xray </li></ul><ul><li>Tomography </li></ul><ul><li>Fluoroscopy </li></ul><ul><li>Pulmonary Angiography – pulmonary embolism </li></ul><ul><li>EVALUATION </li></ul><ul><li>Bronchography – size, shape and number of bronchi </li></ul><ul><li>Pulmonary Scintiphotography </li></ul><ul><li>Sinus Xray </li></ul>
  18. 20. NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>EXAMINATION BY DIRECT </li></ul><ul><li>Rhinoscopy </li></ul><ul><li>Laryngoscopy – indirect, direct </li></ul><ul><li>Bronchoscopy </li></ul><ul><li>Bronchofiberoscopy </li></ul><ul><li>VISUALIZATION </li></ul><ul><li>5. Mediastinoscopy </li></ul><ul><li>6. Transillumination </li></ul><ul><li>7. Lung Biopsy – transtracheobronchial, transthoracic </li></ul><ul><li>8. Pleural Biopsy </li></ul>
  19. 21. NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>LABORATORY STUDIES </li></ul><ul><li>Hematologic </li></ul><ul><li>Cytological – sputum, tracheobronchial secretions, pleural fluid </li></ul><ul><li>Bacteriological studies </li></ul><ul><ul><li>sputum studies : C & S, cytology </li></ul></ul><ul><ul><li>thoracentesis </li></ul></ul><ul><ul><li>skin test for TB </li></ul></ul>
  20. 22. NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>THORACENTESIS </li></ul><ul><li>Site : </li></ul><ul><ul><li>Air : 2 nd /3 rd ICS, MCL </li></ul></ul><ul><ul><li>Fluid : 7 th /8 th ICS, PAL </li></ul></ul><ul><li>Position : </li></ul><ul><ul><li>over a bed table </li></ul></ul><ul><ul><ul><li>straddling in a chair, </li></ul></ul></ul><ul><ul><ul><li>seated in bed with affected hand raised over the head </li></ul></ul></ul><ul><li>Nursing Management </li></ul>
  21. 23. NURSING PATIENTS WITH THREATS TO VENTILATION Diagnostic Assessment <ul><li>SKIN TEST FOR P.T.B. </li></ul><ul><li>Mantoux test </li></ul><ul><li>PPD </li></ul><ul><li>Multiple Puncture Test </li></ul><ul><li>Von Pirquet Scratch Test </li></ul><ul><li>Volmer Patch Test </li></ul>
  22. 24. NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>ASSESSMENT OF PULMONARY FUNCTION </li></ul><ul><li>SPIROMETRY </li></ul><ul><li>ARTERIAL BLOOD GAS </li></ul><ul><ul><li>Ph </li></ul></ul><ul><ul><li>pCO2 </li></ul></ul><ul><ul><li>pO2 </li></ul></ul><ul><ul><li>H2CO3 </li></ul></ul>
  23. 25. NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>SPIROMETRY </li></ul><ul><li>PULMONARY FUNCTION TEST </li></ul><ul><li>LUNG CAPACITIES </li></ul><ul><ul><li>Vital Capacity </li></ul></ul><ul><ul><li>Normal Lung Capacity </li></ul></ul><ul><ul><li>Total Lung Capacity </li></ul></ul><ul><ul><li>Inspiratory Capacity </li></ul></ul><ul><ul><li>Functional Residual Capacity </li></ul></ul>
  24. 26. NURSING PATIENTS WITH THREATS TO VENTILATION <ul><li>PULMONARY FUNCTION TEST </li></ul><ul><li>LUNG VOLUMES </li></ul><ul><ul><li>Tidal Volume </li></ul></ul><ul><ul><li>Inspiratory Reserve Volume </li></ul></ul><ul><ul><li>Expiratory Reserve Volume </li></ul></ul><ul><ul><li>Residual Volume </li></ul></ul><ul><ul><li>Minute Volume </li></ul></ul>
  25. 27. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>Planning for Health Promotion </li></ul><ul><li>Planning for Health Restoration and Maintenance </li></ul><ul><ul><li>Maintaining Patent Airway </li></ul></ul><ul><ul><ul><li>Coughing techniques </li></ul></ul></ul><ul><ul><ul><li>Suctioning </li></ul></ul></ul><ul><ul><li>Reducing Metabolic Demands </li></ul></ul><ul><ul><li>Preventing and Controlling Infection </li></ul></ul>
  26. 28. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><ul><li>Oxygen Therapy </li></ul></ul><ul><ul><li>Incentive Spirometry </li></ul></ul><ul><ul><li>Aerosol Therapy </li></ul></ul><ul><ul><li>IPPB (Intermittent Positive Pressure Breathing) </li></ul></ul><ul><ul><li>Artificial Airway </li></ul></ul><ul><ul><li>Mechanical Ventilation </li></ul></ul><ul><ul><li>Chest Surgery </li></ul></ul><ul><ul><li>Chest Drainage </li></ul></ul>
  27. 29. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>OXYGEN THERAPY </li></ul><ul><li>Hypoxemia </li></ul><ul><li>Hypoxia – Types : </li></ul><ul><ul><li>Hypoxic hypoxia </li></ul></ul><ul><ul><li>Anemic hypoxia </li></ul></ul><ul><ul><li>Ischemic hypoxia </li></ul></ul><ul><ul><li>Histotoxic hypoxia </li></ul></ul>
  28. 30. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>OXYGEN THERAPY </li></ul><ul><li>Assessment for need for oxygen </li></ul><ul><li>Planning for oxygen therapy </li></ul><ul><ul><li>Promoting psychological and physical comfort </li></ul></ul><ul><ul><li>Promoting safety </li></ul></ul><ul><ul><li>Maintaining Adequate Oxygen Supply : </li></ul></ul><ul><ul><ul><li>Low flow system – nasal cannula, face mask </li></ul></ul></ul><ul><ul><ul><li>High Flow system – non-rebreathing mask, Venturri mask </li></ul></ul></ul><ul><ul><ul><li>Other ways: tracheostomy, portable oxygen, special room, hyperbaric oxygen </li></ul></ul></ul>
  29. 31. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>AEROSOL THERAPY </li></ul><ul><li>Distilled water and NSS </li></ul><ul><li>Detergents </li></ul><ul><li>Mucolytics </li></ul><ul><li>Others : bronchodilators, steroids </li></ul><ul><li>Devices used to generate aerosols : </li></ul><ul><li>Nebulizer </li></ul><ul><li>Humidifier </li></ul>
  30. 32. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>ARTIFICIAL AIRWAY </li></ul><ul><li>Types: </li></ul><ul><li>Oropharyngeal Airway </li></ul><ul><li>Endotracheal : orotracheal, nasotracheal </li></ul><ul><li>Tracheostomy : 3 main principles of care: </li></ul><ul><ul><li>Maintain patent airway ( signs of occlusion) </li></ul></ul><ul><ul><li>Prevent Infection </li></ul></ul><ul><ul><li>Prevent drying and crusting of the mucosa </li></ul></ul>
  31. 33. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>MECHANICAL VENTILATION THERAPY </li></ul><ul><li>TYPES: </li></ul><ul><li>Pressure Cycled </li></ul><ul><li>Volume Cycled </li></ul><ul><li>ACCESSORY ATTACHMENTS </li></ul><ul><li>Intermittent Mandatory Ventilation </li></ul><ul><li>Continuous Positive Airway Pressure </li></ul><ul><li>Positive End Expiratory Pressure </li></ul>
  32. 34. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST SURGERY </li></ul><ul><li>CHEST DRAINAGE </li></ul><ul><ul><li>Principle of negative pressure (NP) </li></ul></ul><ul><ul><li>Vacuum is needed to reestablish NP </li></ul></ul><ul><ul><li>Closed water-sealed drainage </li></ul></ul><ul><ul><li>Types: 1- bottle, 2-bottle, 3-bottle </li></ul></ul><ul><ul><li>Purpose: remove air and fluid, lung reexpansion </li></ul></ul>
  33. 35. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><ul><li>Nursing Resposibilities </li></ul></ul><ul><ul><li>1-BOTTLE – operates by gravity only, </li></ul></ul><ul><ul><li>fluctuation/oscillation – stops : lung has reexpanded, or tube is kinked </li></ul></ul><ul><ul><li>intermittent bubbling – normal with expiration </li></ul></ul><ul><ul><li>Continuous bubbling – air leak </li></ul></ul><ul><ul><li>Rapid bubbling – consid loss of air </li></ul></ul><ul><ul><li>Chest Xray - reexpansion </li></ul></ul>
  34. 36. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><li>Nursing Responsibilities </li></ul><ul><li>2 OR 3 BOTTLE SYSTEM </li></ul><ul><li>Suction – necessary </li></ul><ul><li>Periodic emptying of fluid/ bubbling in the control tube – indic proper fxning </li></ul><ul><li>No Fluctuation with expiration – in water-sealed bottle </li></ul><ul><li>Continuous bubbling – air leak </li></ul>
  35. 37. NURSING PATIENTS WITH THREATS TO VENTILATION Planning <ul><li>CHEST DRAINAGE </li></ul><ul><li>REMOVAL OF CATHETER </li></ul><ul><li>Premedication </li></ul><ul><li>During expiration or end of inspiration </li></ul><ul><li>Wound covered with skin clips/PETROLEUM GAUZE </li></ul><ul><li>PLEUREVAC </li></ul>
  36. 39. COMMON REPIRATORY PROBLEMS - NOSE <ul><li>NOSE </li></ul><ul><li>Epistaxis </li></ul><ul><ul><li>causes : picking of the nose, DHF, HPN, cancer, sinusitis, deviated/perforated septum </li></ul></ul><ul><ul><li>mgt: elevate, promote vasoconstriction, external control. Ice collar, drugs - neosynephrine </li></ul></ul><ul><li>Nasal Polyp - overgrowth of mucous membrane causes : allergy, chronic sinusitis </li></ul><ul><li>Deviated Septum </li></ul>
  37. 40. COMMON REPIRATORY PROBLEMS - SINUSES, THROAT <ul><li>SINUSES </li></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><ul><li>causes </li></ul></ul></ul><ul><ul><ul><li>s/sx : pain, nasal congestion,general malaise, fever </li></ul></ul></ul><ul><ul><ul><li>treatment : bed rest, medications, </li></ul></ul></ul><ul><ul><ul><ul><li>surgery : Caldwell-Luc operation </li></ul></ul></ul></ul><ul><li>THROAT </li></ul><ul><ul><li>Tonsilitis </li></ul></ul><ul><ul><ul><li>S/Sx </li></ul></ul></ul><ul><ul><ul><li>Mgt </li></ul></ul></ul><ul><ul><ul><ul><li>Surgery : Tonsillectomy </li></ul></ul></ul></ul>
  38. 41. TONSILLECTOMY <ul><ul><li>Nursing Care </li></ul></ul><ul><ul><li>PRE-OP : no fever,evaluate hemostasis, ATROPINE SULFATE </li></ul></ul><ul><ul><li>POST-OP </li></ul></ul><ul><ul><li>Patient may have postnasal pack </li></ul></ul><ul><ul><li>HOB 45 degrees –local; prone with head to 1 side – general </li></ul></ul><ul><ul><li>Temp – axilla, rectal </li></ul></ul><ul><ul><li>Avoid clearing of throat or cough – bleeding </li></ul></ul><ul><ul><li>Aspirin, narcotics, ice collar </li></ul></ul><ul><ul><li>Vomiting small amnt of blood </li></ul></ul>
  39. 42. TONSILLECTOMY <ul><li>Blood trickling down the throat/ FREQUENT SWALLOWING – Hemorrhage </li></ul><ul><li>If conscious, no acidic drinks (burning sensation), give ice chips and cold liquids </li></ul><ul><li>NO STRAW – sucking can cause bleeding </li></ul><ul><li>Alkaline mouthwash </li></ul>
  40. 43. COMMON REPIRATORY PROBLEMS - LARYNX <ul><li>LARYNX </li></ul><ul><li>Laryngitis </li></ul><ul><li>Cancer of the Larynx </li></ul><ul><ul><li>Predisposing factor : heavy smoking and drinking, family hx, chronic laryngitis, vocal abuse </li></ul></ul><ul><ul><li>S/Sx persistent hoarseness - 1 ST AND EARLY, cough,enlarged cervical LN, pain in the Adam’s apple that radiates to the ear </li></ul></ul>
  41. 44. COMMON REPIRATORY PROBLEMS - LARYNX <ul><ul><li>Cancer of the Larynx </li></ul></ul><ul><ul><ul><li>Diagnostics : Laryngoscopy, biopsy </li></ul></ul></ul><ul><ul><ul><li>Mgt : Early : Laryngofissure </li></ul></ul></ul><ul><ul><li> Advanced : Laryngectomy, Radiation </li></ul></ul>
  42. 45. TOTAL LARYNGECTOMY <ul><li>NURSING CARE – Pre –Op </li></ul><ul><li>Assist the physician in telling the patient: </li></ul><ul><li>He will loose the following : </li></ul><ul><ul><li>voice, </li></ul></ul><ul><ul><li>normal means of breathing, </li></ul></ul><ul><ul><li>sense of smell, blowing of nose, </li></ul></ul><ul><ul><li>blowing of air from mouth, </li></ul></ul><ul><ul><li>sip soup,sucka straw, </li></ul></ul><ul><ul><li>gargle, </li></ul></ul><ul><ul><li>whistle </li></ul></ul><ul><ul><li>lift heavy object </li></ul></ul><ul><li>2. Breath through a permanent tracheostomy </li></ul><ul><li>3. Know other methods of speech </li></ul><ul><li>4. Visit a speech therapist </li></ul><ul><li>5. Tube feedings after surgery,temporary </li></ul>
  43. 46. TOTAL LARYNGECTOMY <ul><li>NURSING CARE – Post – Op </li></ul><ul><li>Constant attendance; no IV for the dominant arm </li></ul><ul><li>Avoid: </li></ul><ul><ul><li>raising tone of voices </li></ul></ul><ul><ul><li>completing sentences verbally that the patient started to write </li></ul></ul><ul><ul><li>talking nervously and excessively </li></ul></ul><ul><li>Elevate HOB to: </li></ul><ul><ul><li>promote drainage </li></ul></ul><ul><ul><li>facilitate respiration </li></ul></ul><ul><ul><li>prevent strain on suture line </li></ul></ul><ul><ul><li>minimize edema </li></ul></ul>
  44. 47. TOTAL LARYNGECTOMY <ul><li>Avoid dusts or fumes , tracheostomy stoma has no mechanism for filtering and cooling air – neck bib </li></ul><ul><li>Observe post-op complications: </li></ul><ul><ul><li>Fistula formation </li></ul></ul><ul><ul><li>carotid artery rupture </li></ul></ul><ul><ul><li>Stenosis of tracheostomy </li></ul></ul><ul><ul><li>Atelectasis and pneumonia </li></ul></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><li>IV,tube feeding, analgesic, antibiotic </li></ul><ul><li>Care of Gomco or Hemovac drainage catheter: remove fluid from potetial deadspace (space for larynx) </li></ul><ul><li>If catheter not used, pressure dressing. </li></ul>
  45. 48. TOTAL LARYNGECTOMY <ul><li>Minimal postop pain; narcotics contraindicated in Head & neck surgery </li></ul><ul><li>Self care teachings: </li></ul><ul><ul><li>NGT, instruct self-feeding. </li></ul></ul><ul><ul><li>Instruct removing and replacing laryngostomy tube : breath in, hold, insert and resume normal resp. </li></ul></ul><ul><ul><li>Caution when shaving : it takes 6 months for cut nerve endings to regenerate </li></ul></ul><ul><ul><li>Laryngostomy tube stays for 3-8 wks until stoma becomes permamnently formed </li></ul></ul>
  46. 49. TOTAL LARYNGECTOMY <ul><li>11.Rehabilitation : aeg wear ID stating he has no vocal cord </li></ul><ul><li>12. Not smoke </li></ul><ul><li>13. Speech Rehab- A.S.A. mucous membrane and muscles are completely healed </li></ul><ul><li>14. Artificial Respiration : </li></ul><ul><ul><li>mouth to neck stoma breathing </li></ul></ul><ul><ul><li>O2 administration to tracheostomy </li></ul></ul><ul><ul><li>patient’s head should not be turned- may obstruct trach </li></ul></ul>
  47. 50. CONDITIONS AFFECTING THE CHEST <ul><li>2 CLASSIFICATIONS : </li></ul><ul><li>OBSTRUCTION in the pathways of normal alveolar ventilation by: </li></ul><ul><ul><li>spasm </li></ul></ul><ul><ul><li>mucus secretions </li></ul></ul><ul><ul><li>morphologic changes </li></ul></ul><ul><li>RESTRICTION in the movement of thorax or lungs associated with : </li></ul><ul><ul><li>Pathologic factors </li></ul></ul><ul><ul><li>Neurologic factors </li></ul></ul>
  48. 51. <ul><li>All I’m asking for is a beautiful hair cut </li></ul>
  49. 52. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) <ul><li>1. EMPHYSEMA </li></ul><ul><li>2. BRONCHIAL ASTHMA </li></ul><ul><li>3. BRONCHIECTASIS </li></ul><ul><li>4. CHRONIC BRONCHITIS </li></ul>
  50. 53. C.O.P.D. - EMPHYSEMA Stretching and overdistention of the alveoli Loss of intralveolar septa, pulmonary elasticity and alveolar capillary surface Loss of pulmonary compliance + partial obstruction No effective inhalation
  51. 54. C.O.P.D. - EMPHYSEMA <ul><li>Predisposing Factors : </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>Pollution </li></ul><ul><li>Chronic long term infection </li></ul><ul><li>S/Sx </li></ul><ul><li>Cough </li></ul><ul><li>Weakness </li></ul><ul><li>Lethargy </li></ul><ul><li>Barrel chest </li></ul><ul><li>Bronchospasms </li></ul><ul><li>Asthma </li></ul><ul><li>Forced expirations </li></ul>
  52. 55. C.O.P.D. - BRONCHIAL ASTHMA <ul><li>Viral respiratory Infection/ allergens </li></ul><ul><li>Bronchial spasm and bronchial constriction </li></ul><ul><li>STATUS ASTHMATICUS </li></ul><ul><li>S/Sx : </li></ul><ul><ul><li>dyspnea, </li></ul></ul><ul><ul><li>cough, </li></ul></ul><ul><ul><li>wheezing </li></ul></ul><ul><ul><li>prolonged expiration </li></ul></ul>
  53. 56. These lungs appear essentially normal, but are normal-appearing because they are the hyperinflated lungs of a patient who died with status asthmaticus.
  54. 57. This cast of the bronchial tree is formed of inspissated mucus and was coughed up by a patient during an asthmatic attack. The outpouring of mucus from hypertrophied bronchial submucosal glands, the bronchoconstriction, and dehydration all contribute to the formation of mucus plugs that can block airways in asthmatic patients.
  55. 58. C.O.P.D. - BRONCHIECTASIS <ul><li>Dilation of medium-sized bronchi </li></ul><ul><li>Loss of bronchial elasticity </li></ul><ul><li>Excessive mucus </li></ul><ul><li>Chronic productive cough </li></ul><ul><li>S/Sx : </li></ul><ul><ul><li>Abundant sputum – maybe blood-tinged ( trauma to bronchial walls) </li></ul></ul>
  56. 59. C.O.P.D. CHRONIC BRONCHITIS <ul><li>Inflammation of bronchioles </li></ul><ul><li>Causes : infection, respiratory irritants </li></ul><ul><li>S/Sx : </li></ul><ul><ul><li>cough </li></ul></ul><ul><ul><li>Excessive mucus production and retention </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Hyperinflated chest </li></ul></ul><ul><ul><li>Concurrent emphysema </li></ul></ul>
  57. 60. COPD - MANAGEMENT <ul><li>IMPROVING VENTILATION </li></ul><ul><ul><li>Oxygen, </li></ul></ul><ul><ul><li>IPPB, </li></ul></ul><ul><ul><li>nebulization, </li></ul></ul><ul><ul><li>suctioning secretions </li></ul></ul><ul><ul><li>Medications: bronchodilators, steroids </li></ul></ul><ul><li>STRENGTHENING RESPIRATORY MUSCLES </li></ul><ul><ul><li>Breathing exercises </li></ul></ul><ul><li>OTHER CONCERNS : </li></ul><ul><ul><li>hydration, </li></ul></ul><ul><ul><li>prevention or treatment of infection(antibiotics) </li></ul></ul><ul><ul><li>cough medications, </li></ul></ul><ul><ul><li>nutrition, </li></ul></ul><ul><ul><li>providing emotional and physical rest </li></ul></ul><ul><ul><li>Incentive spirometry </li></ul></ul>
  58. 61. RESTRICTIVE DISEASES <ul><li>CLASSIFICATION : </li></ul><ul><li>NEUROMUSCULAR </li></ul><ul><li>THORACIC DEFORMITY </li></ul><ul><li>RESTRICTION TO LUNG OR ALVEOLAR EXPANSION </li></ul><ul><li>INFILTRATIVE DISEASE </li></ul><ul><li>OBESITY </li></ul><ul><li>LOSS OF FUNCTIONING PULMONARY TISSUE </li></ul>
  59. 62. RESTRICTIVE DISEASE NEUROMUSCULAR DISORDERS <ul><li>MYASTHENIA GRAVIS </li></ul><ul><ul><li>Generalized muscular weakness </li></ul></ul><ul><ul><li>There is difficulty in swallowing – aspiration </li></ul></ul><ul><ul><li>Respiratory muscle paralysis with dse progression </li></ul></ul><ul><ul><li>Tracheostomy and mech ventilator </li></ul></ul><ul><li>BULBAR POLIOMYELITIS </li></ul><ul><ul><li>Viral infection </li></ul></ul><ul><ul><li>9 th – 12 th CN – paralysis of laryngeal muscles –trach </li></ul></ul><ul><ul><li>SPINAL TYPE – paralysis of respiratory muscles </li></ul></ul>
  60. 63. RESTRICTIVE DISEASES NEUROMUSCULAR DISORDERS <ul><li>3. GUILLAIN BARRE SYNDROME </li></ul><ul><ul><li>Acute infectious polyneuritis </li></ul></ul><ul><ul><li>Headache, aching limbs, gen’d body malaise, fever </li></ul></ul><ul><ul><li>Progression: </li></ul></ul><ul><ul><ul><li>numbness and tingling of digits </li></ul></ul></ul><ul><ul><ul><li>muscular weakness and paralysis </li></ul></ul></ul>
  61. 64. RESTRICTIVE DISEASES THORACIC DEFORMITY <ul><li>KYPHOSCOLIOSIS </li></ul><ul><ul><li>Abnormal convex curvature of the spine </li></ul></ul><ul><li>PECTUS EXCAVATUM </li></ul><ul><ul><li>“funnel chest” </li></ul></ul><ul><ul><li>Concave deformity resulting from depression of the sternum </li></ul></ul>
  62. 65. RESTRICTION TO LUNG and/or ALVEOLAR EXPANSION <ul><li>DISEASES OF THE PLEURA </li></ul><ul><li>PNEUMOTHORAX </li></ul><ul><ul><li>Spontaneous: primary, secondary </li></ul></ul><ul><ul><li>Traumatic </li></ul></ul><ul><ul><li>Causes : unknown, pulmonary lesion, iatrogenic </li></ul></ul><ul><ul><li>Dyspnea, cough, chest pain, decreased chest movements, mediastinal shift to affected side </li></ul></ul><ul><li>HYDROTHORAX </li></ul><ul><ul><li>Serous fluid; lymphatic obstruction </li></ul></ul><ul><li>HEMOTHORAX </li></ul><ul><ul><li>traumatic </li></ul></ul>
  63. 66. RESTRICTION TO LUNG and/or ALVEOLAR EXPANSION <ul><li>PLEURISY </li></ul><ul><ul><li>Inflammation of the pleura with changes in its serous secretion </li></ul></ul><ul><ul><li>Types : </li></ul></ul><ul><ul><ul><li>Pleural effusion </li></ul></ul></ul><ul><ul><ul><li>Empyema </li></ul></ul></ul><ul><ul><ul><li>Fibrinous </li></ul></ul></ul>
  64. 67. PLEURISY <ul><ul><li>PLEURAL EFFUSION </li></ul></ul><ul><ul><ul><li>Sero-fibrinous fluid </li></ul></ul></ul><ul><ul><ul><li>Dyspnea, limited movement of chest </li></ul></ul></ul><ul><ul><ul><li>Mediastinal shift away from affected side </li></ul></ul></ul><ul><ul><ul><li>TB, Pneumonia, malignancy, cardiac failure </li></ul></ul></ul>
  65. 68. PLEURISY <ul><li>EMPYEMA </li></ul><ul><ul><ul><li>Purulent exudate </li></ul></ul></ul><ul><ul><ul><li>From preexisting infections in the lung,ribs or subphrenic space </li></ul></ul></ul><ul><ul><ul><li>Lung collapse of affected side </li></ul></ul></ul><ul><ul><ul><li>Dull pain and persistent tenderness </li></ul></ul></ul><ul><ul><ul><li>limited chest movements </li></ul></ul></ul>
  66. 69. The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. Pneumonia may be complicated by a pleuritis. Initially, there may just be an effusion into the pleural space. There may also be a fibrinous pleuritis. However, bacterial infections of lung can spread to the pleura to produce a purulent pleuritis. A collection of pus in the pleural space is known as empyema.
  67. 70. PLEURISY <ul><ul><ul><li>FIBRINOUS / DRY PLEURISY </li></ul></ul></ul><ul><ul><ul><li>Lack of lubricating serous secretion </li></ul></ul></ul><ul><ul><ul><li>Fibrinous exudates causes friction rubs </li></ul></ul></ul><ul><ul><ul><li>Pain </li></ul></ul></ul><ul><ul><ul><li>rapid shallow respiration </li></ul></ul></ul><ul><ul><ul><li>Restricted ventilatory efficiency </li></ul></ul></ul>
  68. 71. PLEURISY <ul><ul><ul><li>FIBRINOUS / DRY PLEURISY </li></ul></ul></ul><ul><ul><ul><li>MANAGEMENT </li></ul></ul></ul><ul><ul><ul><li>Thoracentesis </li></ul></ul></ul><ul><ul><ul><li>Chest Tube </li></ul></ul></ul><ul><ul><ul><li>Pleurodesis </li></ul></ul></ul>
  69. 72. RESTRICTIVE DISEASES <ul><li>INFILTRATIVE DISEASES </li></ul><ul><ul><li>Pulmonary Tuberculosis </li></ul></ul><ul><ul><li>Bronchogenic Carcinoma </li></ul></ul><ul><li>OBESITY </li></ul><ul><ul><li>Pickwickian Syndrome – extreme obesity </li></ul></ul><ul><ul><li>Ascites - </li></ul></ul>
  70. 73. RESTRICTION DUE TO LOSS OF FUNCTIONING PULMONARY TISSUE CHANGE IN ALVEOLAR CAPILLARY SURFACES DECREASED SURFACES FOR BLD GASES & DECREASED PRODUCTION OF SURFACTANT ALVEOLAR COLLAPSE ATELECTASIS
  71. 74. RESTRICTION DUE TO LOSS OF FUNCTIONING PULMONARY TISSUE <ul><li>PULMONARY INFARCTION </li></ul><ul><li>LUNG ABSCESS </li></ul><ul><li>BRONCHOGENIC CARCINOMA </li></ul><ul><li>PULMONARY FIBROSIS </li></ul><ul><li>PNEUMOCONIOSES </li></ul><ul><li>PNEUMONIA </li></ul><ul><li>PULMONARY TUBERCULOSIS </li></ul><ul><li>PULMONARY EDEMA </li></ul>
  72. 75. <ul><li>PULMONARY INFARCTION </li></ul><ul><li>Loss of pulmonary tissue from occlusion of pulmonary artery by an embolus </li></ul><ul><li>Long bone fracture; obstetric patients </li></ul><ul><li>LUNG ABSCESS </li></ul><ul><li>Aspiration of foreign body </li></ul><ul><li>Lung obstruction </li></ul><ul><li>Pneumonia </li></ul><ul><li>BRONCHOGENIC CARCINOMA </li></ul><ul><li>Smoking, pollutants </li></ul><ul><li>Cough, wheeze, hemoptysis, dyspnea </li></ul>
  73. 76. This is a rare finding that may complicate a term pregnancy at delivery. Seen here in a pulmonary artery branch is an amniotic fluid embolus that has layers of fetal squames. Amniotic fluid embolization can have the same outcome
  74. 77. This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface.
  75. 78. <ul><li>PNEUMONIA </li></ul><ul><li>Acute pulmonary infection </li></ul><ul><li>Pneumococcus, Streptococcus, Haemophilus </li></ul>
  76. 79. This is a lobar pneumonia in which consolidation of the entire left upper lobe has occurred. This pattern is much less common than the bronchopneumonia pattern. In part, this is due to the fact that most lobar pneumonias are due to Streptococcus pneumoniae (pneumococcus)
  77. 80. <ul><li>PULMONARY FIBROSIS </li></ul><ul><li>Pathological increase in lung connective tissue </li></ul><ul><li>Diffuse / localized </li></ul><ul><li>Secondary to other pulmonary diseases </li></ul>
  78. 81. Regardless of the etiology for restrictive lung diseases, many eventually lead to extensive fibrosis . The gross appearance, as seen here in a patient with organizing diffuse alveolar damage, is known as &quot;honeycomb&quot; lung because of the appearance of the irregular air spaces between bands of dense fibrous connective tissue.
  79. 82. <ul><li>PNEUMOCONIOSES </li></ul><ul><li>Chronic, fibrotic </li></ul><ul><li>Inhalation of irritant dusts: </li></ul><ul><ul><li>Silica </li></ul></ul><ul><ul><li>Asbestos </li></ul></ul><ul><ul><li>Coal </li></ul></ul>
  80. 83. <ul><li>PULMONARY TUBERCULOSIS </li></ul><ul><li>Mycobacterium TB </li></ul><ul><li>Cough, hemoptysis, malaise, weight loss, low grade afternoon fever easy fatigability, night sweats </li></ul><ul><li>Anti TB drugs, quadruple therapy </li></ul>
  81. 84. Here is the gross appearance of a lung with tuberculosis. Scattered tan granulomas are present, mostly in the upper lung fields. Some of the larger granulomas have central caseation. Granulomatous disease of the lung grossly appears as irregularly sized rounded nodules that are firm and tan. Larger nodules may have central necrosis known as caseation--a process of necrosis that includes elements of both liquefactive and coagulative necrosis).
  82. 85. On closer inspection, the granulomas have areas of caseous necrosis. This is very extensive granulomatous disease. This pattern of multiple caseating granulomas primarily in the upper lobes is most characteristic of secondary (reactivation) tuberculosis. However, fungal granulomas (histoplasmosis, cryptococcosis, coccidioidomycosis) can mimic this pattern as well.
  83. 86. The Ghon complex is seen here at closer range. Primary tuberculosis is the pattern seen with initial infection with tuberculosis in children. Reactivation, or secondary tuberculosis, is more typically seen in adults.
  84. 87. <ul><li>PULMONARY EDEMA </li></ul><ul><li>Excessive amount of fluid in the alveoli and pulmonary interstitial tissues </li></ul><ul><li>Congestive Heart Failure, Chronic Renal Failure </li></ul>
  85. 88. MANAGEMENT – RESTRICTIVE LUNG DISEASE <ul><li>Antibiotics </li></ul><ul><li>Oxygenation </li></ul><ul><li>Hemodynamic monitoring </li></ul><ul><li>Diuresis /phlebotomy– pulmonary edema </li></ul><ul><li>Ventilatory support </li></ul>
  86. 89. <ul><li>The nurse enters the room of a client who has a chest tube attached to a water-seal drainage system & noticed the chest tube is dislodged from the chest. The most appropriate nursing intervention is to: </li></ul><ul><li>Notify the physician </li></ul><ul><li>Insert a new chest tube </li></ul><ul><li>Cover the insertion site with petroleum gauze </li></ul><ul><li>Instruct client to breathe deeply until help arrives </li></ul>
  87. 90. GOD BLESS YOU
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