1. • Mr. Rewat singh is a 63 years old male, works in stone
mines as a labor, presented with the chief complaints of
shortness of breath which progressively increased in
severity for the past 7 days. There was also intermittent
chronic cough production for the past 3 years. And he is a
chronic smoker for the past 40 years and has been smoking
about 4 bundle of bidi per day and has been diagnosed with
HTN for the past 3 year and is currently on Tab amlodipine
10mg OD. On physical examination respiratory rate is
11. Anatomy and Physiology of
Lungs
The lungs are pyramid-shaped, paired organs that are
connected to the trachea by the right and left bronchi;
on the inferior surface, the lungs are bordered by the
diaphragm. The lungs are enclosed by the pleurae,
which are attached to the mediastinum. The right lung
is shorter and wider than the left lung, and the left
lung occupies a smaller volume than the right.
The cardiac notch is an indentation on the surface of
the left lung, and it allows space for the heart . The
apex of the lung is the superior region, whereas the
base is the opposite region near the diaphragm. The
costal surface of the lung borders the ribs. The
mediastinal surface faces the midline.
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12. CONTD…
Each lung is composed of smaller units called lobes. Fissures separate these lobes from each other. The right lung
consists of three lobes: the superior, middle, and inferior lobes. The left lung consists of two lobes: the superior and
inferior lobes. A bronchopulmonary segment is a division of a lobe, and each lobe houses multiple
bronchopulmonary segments. Each segment receives air from its own tertiary bronchus and is supplied with blood by
its own artery. Some diseases of the lungs typically affect one or more bronchopulmonary segments, and in some
cases, the diseased segments can be surgically removed with little influence on neighbouring segments. A pulmonary
lobule is a subdivision formed as the bronchi branch into bronchioles. Each lobule receives its own large bronchiole
that has multiple branches. An interlobular septum is a wall, composed of connective tissue, which separates lobules
from one another.
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38. Vocal fremitus and vocal resonance (vocal vibration are
felt or heard during clinical examination)
Is an increased in resonanc of voice sounds heard when auscultating the lung
66. Impaired Gas Exchange: Excess or deficit in oxygenation and/or carbon dioxide elimination at
the alveolar-capillary membrane
May be related to
Altered oxygen supply (obstruction of airways by secretions, bronchospasm; air-trapping)
Alveoli destruction
Alveolar-capillary membrane changes
Possibly evidenced by
Dyspnoea
Abnormal breathing
Confusion, restlessness
Inability to move secretions
Abnormal ABG values (hypoxia and hypercapnia)
Changes in vital signs
Reduced tolerance for activity
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NURSING INTERVENTIONS
• Assess and record respiratory rate, depth. Note the use of accessory muscles, pursed-lip breathing, inability to
speak or converse.
• Assess and routinely monitor skin and mucous membrane color.
• Monitor changes in the level of consciousness and mental status.
• Monitor vital signs and cardiac rhythm.
• Auscultate breath sounds, noting areas of decreased airflow and adventitious sounds.
• Monitor O2 saturation and titrate oxygen to maintain Sp02 between 88% to 92%.
68. Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide
adequate ventilation.
May be related to
Retained Secretions
Ineffective inspiration and expiration occurring with chronic airflow constraints
Possibly evidenced by
Wheezes/crackles on auscultation on both lung fields
Subcostal retraction
Nasal flaring
Presence of non-productive cough
Increase respiratory rate above the normal range
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Nursing Interventions
• Assess patient’s respiratory status every 2 to 4 hours as indicated and notify any abnormal findings.
• Auscultate breath sounds every 2 to 4 hours as indicated.
Therapeutic Intervention
• Place a pillow when the client is sleeping.
• Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over
the body as appropriate.
• Maintain a patent airway, suctioning of secretions may be done as ordered.
70. Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete
required or desired activity.
May be related to Imbalanced between oxygen supply and demand due to inefficient work of
breathing.
Possibly evidenced by
Exertional dyspnoea
Shortness of breath
Excessively increased or decreased Respiratory rate
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Nursing Assessment
• Assess the patient’s respiratory response to activity which includes monitoring of respiratory rate and depth,
oxygen saturation, and use of accessory muscles for respiration.
• Assess the patient’s nutritional status.
Nursing Interventions
Therapeutic Interventions
• Maintain prescribed activity levels.
• Provide at least 90 minutes of undisturbed rest in between activities.
• Teach and assist the patient with active ROM exercises.
• Teach the patient on excercises that enhances breathing capacity such as diaphragmatic and purse-lip breathing.
72. Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet
metabolic needs.
May be related to
Dyspnoea
Sputum production
Medication side effects
Anorexia
Nausea/vomiting
Decrease food intake due to fatigue
Possibly evidenced by
Weight loss; loss of muscle mass, poor muscle tone
Reported altered taste sensation; aversion to eating, lack of interest in food 25-02-2023
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Nursing Interventions
Nursing Interventions
Nursing Interventions
Nursing Assessment
Nursing Interventions
Nursing Interventions
Nursing Assessment
• Ascertain understanding of individual nutritional needs.
• Assess dietary habits, recent food intake. Note the degree of difficulty with eating. Evaluate weight and body size (mass).
• Auscultate bowel sounds.
• Weigh the patient daily as indicated.
Therapeutic Interventions
• Give frequent oral care, remove expectorated secretions promptly, provide a specific container for disposal of secretions
and tissues.
• Instruct the patient to frequently eat high caloric foods in smaller portions.
• Encourage a rest period of 1 hr before and after meals.
• Avoid gas-producing foods and carbonated beverages.
74. GENERALADVISE
Take the medications regularly as prescribed, if having any doubt
reach to the nearby hospital.
Exercise regularly every day or else at least 4 out of 7 days.
Remember to take vaccination regularly
Stay away from infections by maintaining good hygiene
Quit smoking
Eat a regular balanced diet
Drink plenty of plain fresh water at least 1.5l/day
Drink caffeinated drinks and alcohol in moderation
Get plenty of sleep
76. SUMMARY
In this seminar we discussed about what is Aspiration
PNEUMONIA causes sign symptoms diagnosis treatment risk
factor management, , surgical management, nursing
management and complications , recent research study,
summary, conclusion and bibliography.
77. REFERENCES
Brunner and suddharths. Textbook of medical and surgical nursing. 13th edition vol. I. .New
delhi: reed elsevier india pvt. Ltd.; 2014. Pg. No. 360- 395
Lewis. Medical surgical nursing. Assessment and management of clinical problems. 2015. New
delhi. Elsevier vol. I. Pg. No. 461-493
Joyce M. Black and jane hokanson; medical surgical nursing; volume 2, 8th edition, reed elsevier,
india pvt.
Https://www.Thoracic.Org/.../patient-resources/resources/copd-intro.Pdf
Https://www.Who.Int/medicines/areas/priority_medicines/BP6_13COPD
Research hyperlinks:
Altman, pablo et al. “Comparison of peak inspiratory flow rate via the breezhaler®, ellipta® and
handihaler® dry powder inhalers in patients with moderate to very severe COPD: a randomized
cross-over trial.” BMC pulmonary medicine vol. 18,1 100. 14 jun. 2018, doi:10.1186/s12890-
018-0662-0
Ali, lilas et al. “Need of support in people with chronic obstructive pulmonary disease.” Journal
of clinical nursing vol. 27,5-6 (2018): e1089-e1096. Doi:10.1111/jocn.14170
