1. The document discusses diagnostic tests and management of various respiratory diseases including bronchitis, pneumonia, tuberculosis, pulmonary embolism, and asthma. It provides details on signs and symptoms, etiology, diagnostic testing, and treatment approaches for each condition. 2. Key diagnostic tests discussed are bronchoscopy, chest X-ray, pulmonary angiography, sputum culture and sensitivity, and arterial blood gas. Treatment approaches focus on relieving symptoms, treating underlying infections, and preventing exacerbations. 3. Nursing priorities for respiratory conditions include monitoring breathing, administering medications, suctioning secretions, providing education and promoting lifestyle changes to improve lung health.

1. Nursing Management for patient
with Respiratory Disease
Prepared By
Dr. Zuhair Rushdi Mustafa
Lecturer at University of Duhok/
College of Nursing

2. • Crucial Diagnostic Tests for Respiratory disease
1. Bronchoscopy
Bronchoscopy is used to view the bronchial tree and to remove
foreign obstructions, obtain tissues for biopsy, or for
suctioning fluid.
2. Chest X-ray
Used to detect the size and position
of the heart and structural
abnormalities of the lungs.
3. Pulmonary Angiography
• Provides a view of the pulmonary circulatory system so that
the physician can determine the condition of blood flow to
the lungs.

3. 4. Sputum Culture and Sensitivity
Sputum from the patient is cultured to determine which, if any,
bacteria is contained in the sputum and determine which
antibiotic kills the bacteria.
5. Thoracentesis
Removal of fluid from the pleural sac to drain fluid or identify
the contents of the fluid.
6. Pulmonary Function Test (PFT)
This test assesses the lungs’ ability to move air. Monitor
change from normal function; differentiate obstructive from
restrictive disease.

4. 7. Arterial Blood Gas (ABG)
This determines the patient’s ventilation, tissue oxygenation,
and acid-base status.
HOW DOES THE TEST WORK?
Three to five milliliters of blood is sampled from an artery in a
heparinized syringe. If the sample cannot be analyzed right
away, it should be placed on ice.
• The normal results are:
• pH 7.35–7.45
• PaO2 80–100 mmHg
• PaCO2 35–45 mmHg
• HCO3 22–26 mEq/L

5. 8. Mantoux Intradermal Skin Test (purified protein
derivative PPD)
• This determines if the patient has antibodies to the
Mycobacterium tuberculosis bacteria, which indicates that
the patient has been exposed to the bacteria.
9. Lung Biopsy
Removal of a tissue sample to be examined by the histology
lab for abnormalities.

6. Bronchitis
• Increased mucus production, caused by infection
and airborne irritants that block airways in the lungs,
results in the decreased ability to exchange gases.
• There are two forms of bronchitis:
1. acute bronchitis, where blockage of the airways is
reversible.
2. chronic bronchitis, where blockage is not
reversible.

7. • Patients with acute bronchitis are symptomatic
typically for 7 to 10 days often due to viral (but
sometimes bacterial) infection.
• Patients with chronic bronchitis will have symptoms
of a chronic productive cough for at least 3
consecutive months in 2 consecutive years.
• There is increased mucous production,
inflammatory changes, and, ultimately, fibrosis in
the airway walls.
• The patient with chronic bronchitis has an increased
incidence of respiratory infection.

8. Pathophysiology of Chronic bronchitis
• Chronic bronchitis characterised by an increase in mucus production
and damaged cilia in the bronchi. As a result, the bronchi become
clogged with mucus, then producing a cough. This chronic irritation
causes inflammation and the bronchial wall thickens, causing airway
obstruction. Secondary infections then occur, causing yet more
irritation and inflammation. As more and more airways become
blocked, external respiration is reduced and less oxygen is transferred
into the bloodstream.
Normal bronchiole
Narrowed and mucus-filled
bronchiole in bronchitis

9. • SIGNS AND SYMPTOMS of Bronchitis
1. Cough due to mucous production and irritation of
airways.
2. Shortness of breath.
3. Fever in acute episodes due to infection.
4. Accessory muscles are used for breathing
5. Productive cough due to irritation of airways.
6. Weight gain secondary to edema in chronic
bronchitis is due to right-sided heart failure.
7. Wheezing due to inflammation within the airways.

10. • TREATMENT
1. Acute bronchitis is treated in the short term with
symptomatic treatment and antibiotics when a
bacterial infection is present.
2. Chronic bronchitis is treated with a combination of
medications to keep the airways open, reduce
inflammation within airways, and prevent
complications or exacerbations.
3. Administer beta 2-agonists by inhaler or nebulizer
to dilate the bronchi such as albuterol
4. Administer anticholinergics which allow for
relaxation of bronchial smooth muscle such as
ipratropium inhaler

11. 5. Administer steroids to decrease inflammation within the
airways such as hydrocortisone, methylprednisolone
systemically beclomethasone inhalers
6. prednisolone, prednisone orally.
7. Administer methylxanthines to enhance bronchodilation
such as aminophylline and theophylline.
8. Administer diuretics to reduce fluid retention in patients
who develop right sided heart failure such as furosemide.
9. Administer expectorant to help liquefy secretions such as
Mucolyte.

12. 10. Administer antibiotics in acute exacerbation of chronic
bronchitis which is selected by culture and sensitivity study
11. Administer antacid such as antacids: aluminum
hydroxide/magnesium hydroxide, calcium carbonated, H2
blocker such as ranitidine, famotidine, cimetidine, or proton
pump inhibitor such as omeprazole, lansoprazole,
esomeprazole, rabeprazole, pantoprazole to decrease the
amount of acid in stomach, reducing possible ulcer formation
due to stress of disease or medication effects.

13. 12. Administer vaccines—to decrease chances of infection:
• influenza
• pneumonia
13. Give 3 liters of fluid per day to help liquefy secretions
14. Oxygen: 2 liters per minute via nasal canula to help meet
body’s needs.
15. Increase protein, calories, and vitamin C in diet to meet
body’s needs.
16. Administer the incentive spirometer to encourage
coughing and expelling of mucous.

14. • NURSING DIAGNOSES
• Ineffective airway clearance
• Activity intolerance
• Ineffective breathing pattern

15. NURSING INTERVENTION
1. Monitor respirations looking at rate, effort, use of accessory
muscles, skin color; listen to breath sounds.
2. Place patient in high Fowler’s position to ease respiration.
3. Weigh the patient daily. Excess fluid due to heart failure
will increase weight. Notify physician, of weight gain of 2
pounds in 24 hours.
4. Have the patient perform the turning, coughing, and deep-
breathing exercises to enhance lung expansion and expel
mucous.
5.Monitor sputum for changes in color or amount.
6. Monitor intake and output.
7. Increase fluids to keep mucous thinner and easier to expel.
8. administer oxygen as order.

16. • Pneumonia
• Pneumonia is an infection of the alveoli and small
airways. Inflammation and oedema cause the alveoli
to fill with debris and exudate that commonly
impairs gas exchange.

17. • Etiology
• Infectious pneumonia may be due to a variety of
microorganisms and can be community-acquired or
hospital-acquired (nosocomial).
• A patient can inhale bacteria, viruses, parasites, or
irritating agents, or a patient can aspirate liquids or
foods. There may be increased mucous production
and thickening alveolar fluid as a result of impaired
gas exchange. All of these can lead to inflammation
of the lower airways.
• Organisms commonly associated with infection include
Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus
influenza, Mycoplasma pneumoniae, Legionella pneumonia,
Chlamydia pneumoniae (parasite), and Pseudomonas aeruginosa

18. • Signs and symptoms
1. Shortness of breath due to inflammation within the lungs,
impairing gas exchange
2. Difficulty breathing (dyspnea) due to inflammation and mucus
within the lungs
3. Fever and Chills due to infectious process
4. Cough due to mucous production and irritation of the airways
5. Crackles due to fluid within the alveolar space and smaller
airways
6. wheezing due to inflammation within the larger airways

19. • Signs and symptoms
7. Discolored, possibly blood-tinged, sputum due to irritation
in the airways or microorganisms causing infection
8. Tachycardia and tachypnea as the body attempts to meet the
demand for oxygen
9. Pain on respiration due to pleuritic inflammation, pleural
effusion.
10. Headache, muscle aches (myalgia), joint pains, or nausea
may be present depending on the infecting organism

20. INTERPRETING TEST RESULTS
• Shadows on chest x-ray, indicating infiltration.
• Culture and sensitivity of the sputum to identify the infective
agent and the appropriate antibiotics.
• Elevated WBC (leukocytosis) showing sign of infection.
• Low oxygen saturation on pulse oximetry.
• Arterial blood gas may show low oxygen and elevated
carbon dioxide levels.

21. • Care and management
1. Administer oxygen as needed.
2. For bacterial infections, administer antibiotics such as
macrolides (azithromycin, clarithromycin), fluoroquinolones
(levofloxacin), beta-lactams (amoxicillin/clavulanate,
cefotaxime, ceftriaxone, ampicillin/sulbactam)
3. Administer antipyretics in patient with fever for comfort
such as acetaminophen, ibuprofen
4. Administer brochodilators to keep airways open, enhance
airflow if needed such as albuterol, levalbuterol via nebulizer

22. • Care and management
5. Increase fluid intake to help loosen secretions and
prevent dehydration.
6. Instruct the patient on how to use the incentive
spirometer to encourage deep breathing; monitor
progress.
7. placing the patient in an upright position will
promote diaphragm and intercostal muscle activity and
enhance ventilation.

23. Tuberculosis (TB)
An infectious disease spread by airborne route.
Infection is caused by inhalation of droplets that
contain the tuberculosis bacteria (Mycobacterium
tuberculosis).
An infected person can spread the small airborne
particles through coughing, sneezing, or talking.
Close contact with those affected increases the
chances of transmission.
Once inhaled, the organism typically settles into the
lung, but can infect any organ in the body.
The organism has an outer capsule.

24. • SIGNS AND SYMPTOMS
1. Weight loss and anorexia
2. Night sweats
3. Fever, possibly low-grade, due to infection
4. Productive cough with discolored, blood-tinged
sputum
5. Shortness of breath due to lung changes
6. Malaise and fatigue due to active illness affecting
lungs

25. INTERPRETING TEST RESULTS
1. Positive Mantoux (PPD) skin test shows exposure to
tuberculosis due to development of cell-mediated
immunity.
2. Chest x-ray may show areas of granuloma or
cavitation.
3. Sputum test identifies M. tuberculosis bacteria:
• Acid fast-staining done to initially screen for TB—
bacillus will hold stain.
• Culture confirms the diagnosis but is slow-growing

26. • TREATMENT
1. Initial treatment times generally range from 6 to 12
months.
2. Longer treatment plans may be necessary for those with
HIV infection or drug-resistant strains of TB.
3. Administer antitubercular medications to treat and
prevent transmission such as : isoniazid, rifampin,
pyrazinamide, ethambutol, streptomycin.
4. Respiratory isolation for in-hospital care—the bacteria is
spread by droplet.
5. Increase protein, carbohydrates, and vitamin C diet for
patients.

27. • NURSING DIAGNOSES
• Fatigue
• Ineffective airway clearance
NURSING INTERVENTION
1. Monitor respiration for rate, effort, use of accessory
muscles, and skin color changes.
2. Increase fluid intake to help liquefy any secretions.
3. Record fluid intake and output.
4. Explain to the patient:
A. How to prevent spreading the disease.
B. The importance of finishing all prescribed medication.
C. Plan for rest periods during the day.

28. Pulmonary Embolism
• Blood flow is obstructed in the lungs caused by
thrombus (blood clot), air, or fat emboli that become
stuck in an artery, causing impaired gas exchange.

29. • Pathophysiology
• Patients may be predisposed to clot formation, have
pooling of blood, or damage to vessel walls, or take
certain medications that increase the risk of
thrombus formation.
• Thrombus are commonly found in vessels in lower
extremities.
• When a thrombus loosens and travels in the
peripheral circulation, it is called an embolus.
• The embolus travels through the right side of the
heart and is sent to the lungs where it lodges in one
of the arteries.

30. SIGNS AND SYMPTOMS
1. Sudden difficulty breathing (dyspnea) happens when the
clot suddenly lodges in the artery
2. Heart rate greater than 100 beats per minute (tachycardia)
3. Respiration greater than 20 breaths per minutes (tachypnea)
as the body attempts to get more oxygen
4. Chest pain due to clot presence and area of atelectasis
5. Coughing with blood-tinged sputum (hemoptysis)
6. Crackles heard near area of clot

31. INTERPRETING TEST RESULTS
1. Chest x-ray may show dilated pulmonary artery or pleural
effusion.
2. CT scan will show clot in pulmonary arteries.
3. Pulmonary angiography will show presence of clot.
4. Arterial blood gases may show decreased oxygen (PaO2)
and carbon dioxide (PaCO2), depending on the size of the clot.
5. Lower extremity ultrasound is often done to test for
presence of thrombus

32. • TREATMENT
1. Supplemental oxygen therapy.
2. Administer thrombolytics to enhance breakdown of existing
clot such as urokinase, alteplase.
3. Administer anticoagulants to prevent further clot formation
sucha as heparin, warfarin
4. Administer analgesic for pain control such as morphine
5. Bed rest to prevent thrombus from breaking free from
lower extremities.
6. Surgical removal of the embolus may be necessary in some cases.

33. • NURSING INTERVENTION
• Explain to the patient:
1. To avoid sitting and standing for too long to decrease
chance of clot formation.
2. Not to cross legs to avoid constriction of vessels in the
lower extremities, decreasing the chances of clot formation.
3. How to identify side effects from using anticoagulants, such
as bleeding or bruising.
4. Explain that pulmonary embolism is an adverse effect from
using hormonal contraceptives and a different form of birth
control needs to be used in the future

34. • Asthma
• The airways become obstructed from either inflammation of
the lining of the airways or constriction of the bronchial
smooth muscles (bronchospasm).
• A known allergen, for example, pollen—is inhaled, causing
activation of antibodies that recognize the allergen. Mast
cells and histamine are activated, initiating a local
inflammatory response.
• Astimulus causes an inflammatory reaction, increasing the
size of the bronchial linings; this results in restriction of the
airways

35. • Types of Asthma
• There are two kinds of asthma:
1. Extrinsic asthma, also known as atopic, caused by
allergens such as pollen, animal dander, mold, or dust.
Often accompanied by allergic rhinitis and eczema;
this may run in families.
2. Intrinsic asthma, also known as nonatopic, caused
by a nonallergic factor such as following a respiratory
tract infection, exposure to cold air, changes in air
humidity, or respiratory irritants.

36. SIGNS AND SYMPTOMS
1. Wheezing initially present on expiration.
2. dyspnea as airways narrow due to inflammation.
3. Respiration greater than 20 breaths per minute (tachypnea)
4. Use of accessory muscles to breathe as the body tries
harder to get more air into the lungs.
5. Tightness in the chest due to narrowing of the airways
(bronchoconstriction).
6. Cough.
7. Tachycardia—heart rate greater than 100, as the body
attempts to get more oxygen to the tissues.

37. • TREATMENT
1. Administer oxygen
2. Identify and remove allergens and known triggers to avoid causing an
asthma attack.
3. Give patient 3 liters/day of fluid to help liquefy any secretions.
4. Administer short-acting beta2-adrenergic drugs to bronchodilate such
as albuterol, levalbuterol.
5. Administer steroids to decrease inflammation, which will help open
airways;these are not for acute symptoms such as hydrocortisone,
methylprednisolone intravenously, beclomethasone inhalers
prednisolone, prednisone orally
6. Administer aminophylline and theophylline
7. Administer antacid, H2 blocker, or proton pump inhibitor to decrease
the amount of acid in the stomach, reducing the possibility of ulcers due
to stress of disease or medication effects

38. • Emphysema
Emphysema is defined as the permanent enlargement
of airspaces beyond the terminal bronchiole and the
destruction of the alveolar wall.
Chronic inflammation reduces the flexibility of the walls of
alveoli, resulting in over-distention of the alveolar walls. This
causes air to be trapped in the lungs, impeding gas exchange.
Smoking is often linked to development of emphysema.

39. • SIGNS AND SYMPTOMS
1. Dyspnea due to air trapping, which retains CO2 and reduces
alveolar gas exchange.
2. Barrel chest develops over time as more air is trapped
within the distal airways.
3. Use of accessory muscles to breathe as the respiratory effort
increases.
4. Loss of weight as extra calories are needed to maintain
respiration.
5. Patients prefer a seated position which allows for greater
chest expansion.

40. Barrel chest

41. • INTERPRETING TEST RESULTS
1. Increased residual volume shown in pulmonary function
test due to air trapping.
2. Decreased O2 and increased CO2 in arterial blood gas as
gas
3. exchange is impaired due to air trapping; more pronounced
as disease progresses.
4. Chest x-ray shows over inflation of lungs and flattening of
the diaphragm.

42. • TREATMENT
1. Administer beta2-agonists to bronchodilate by inhaler or
nebulizer such as albuterol, levalbuterol.
2. Administer long-acting bronchodilating medications by
metered dose inhaler such as formoterol, salmeterol
3. Administer anticholinergics which allow for relaxation of
bronchial smooth muscle such as ipratropium inhaler.
4. Administer methylxanthines to dilate the bronchi such as
aminophylline and theophylline.

43. • TREATMENT
5. Administer steroids to decrease inflammation within the
airways such as hydrocortisone, methylprednisolone
systemically, prednisolone, prednisone orally.
6. Administer antacid such as antacids: aluminum
hydroxide/magnesium hydroxide, calcium carbonated, H2
blocker such as ranitidine, famotidine, cimetidine, or proton
pump inhibitor such as omeprazole, lansoprazole,
esomeprazole, rabeprazole, pantoprazole to decrease the
amount of acid in stomach, reducing possible ulcer formation
due to stress of disease or medication effects.

44. 7. Administer expectorant—to loosen secretions:
8. Administer diuretics to decrease fluid retention in patients
that are developing right-sided heart failure secondary to lung
disease such as furosemide (Lasix).
9. Administer vaccines—to prevent respiratory infections:
• influenza, pneumonia
10. Administer antibiotics based on results of culture and
sensitivity.
11. Administer oxygen, 2 liters per minute.
12. Give patient 3 liters of fluids per day to help liquefy
secretions.
13. Teach patient how to use the incentive spirometer to
encourage deep breathing and enhance coughing and expelling
of mucous..

45. Chronic obstructive pulmonary disease
• Is the most common chronic lung disease. COPD is an
umbrella term that could refer to emphysema and chronic
bronchitis and, more commonly, a combination of these
conditions.
• It has one major cause which is smoking.
Etiology
COPD may result from:
1. cigarette smoking
2. recurrent or chronic respiratory tract infection
3. allergies
4. familial and hereditary factors such as alpha1-antitrypsin
deficiency.

46. Sings & Symptoms
The typical COPD patient is asymptomatic until
middle age, when the following signs and symptoms
may occur:
1. reduced ability to exercise or do strenuous work
2. productive cough
3. dyspnea with minimal exertion.

47. Treatment
Treatment for COPD aims to relieve symptoms and prevent
complications.
1. Administer beta-agonist bronchodilators (albuterol or
salmeterol)
2. Anticholinergic bronchodilators (ipratropium [Atrovent]),
3. Corticosteroids (beclomethasone )
These drugs are usually given by metered dose inhaler.
4.smoking cessation advice
5. education on prescribed oxygen and bronchodilator
therapies – to maximise relief of breathlessness
5. dietary advice – severe weight loss is a feature of both emphysema
and chronic bronchitis
6. pulmonary rehabilitation

48. • Lung Cancer
Lung cancer is the abnormal, uncontrolled cell growth in lung
tissues, resulting in a tumor.
A tumor in the lung may be primary when it develops in lung
tissue. It may be secondary when it spreads (metastasizes)
from cancer in other areas of the body, such as the liver, brain,
or kidneys.
• Repetitive exposure to inhaled irritants increases a person’s
risk for lung cancer. Cigarette smoke, occupational
exposures, air pollution containing benzopyrenes, and
hydrocarbons have all been shown to increase risk.

49. • There are two major categories of lung cancer:
• small cell and non-small cell.
• Small cell:
• Oat cell—fast-growing, early metastasis
• Non-small cell:
• Adenocarcinoma—moderate growth rate, early metastasis
• Squamous cell—slow-growing, late metastasis
• Large cell—fast-growing, early metastasis

50. • PROGNOSIS
• Lung cancer is the leading cause of cancer death. Many
patients with lung cancer are diagnosed at a later stage,
leading to the long-term (5-year) survival rate of less than
20 %. Earlier diagnosis is more beneficial for treatment and
outcome.
• The longer the cancer has been in the lungs, the greater the
likelihood of metastasis to other areas.

51. • SIGNS AND SYMPTOMS
1. Coughing due to irritation from mass. Presence of mucous
or exudate may not be until later in disease.
2. Coughing up blood (hemoptysis).
3. Fatigue.
4. Weight loss due to the caloric needs of the tumor, taking
away from the needs of the body.
5. Anorexia.
6. Dyspnea caused by damaged lung tissue.
7. Chest pains as mass presses on surrounding tissue; may not
be feel until late in disease.
8. Sputum production.
9. Pleural effusion.

52. • INTERPRETING TEST RESULTS
1. Mass in lung shown on chest x-ray.
2. CT scan shows mass, lymph node involvement.
3. Bronchoscopy may show cancer cells on bronchoscopic
4.Cancer cells seen in sputum.
5. Biopsy through chest wall or tissue biopsy from lung will
show cell type.
6. Bone scan or CT scans shows metastasis of the disease.

53. TREATMENT
1. Surgical removal of affected area of the lung (wedge
resection, segmental resection, lobectomy) or total lung
(pneumonectomy).
2. Radiation therapy to decrease tumor size.
3. Chemotherapy such as : cyclophosphamide, vincristine,
etoposide, cisplatin
4. Oxygen therapy to supplement the needs of the body.
5. High-protein, high-calorie diet to meet the needs of the
body.
6. Administer antiemetics to combat side effects of
chemotherapy: ondansetron (Zofran), prochlorperazine
7. Administer analgesics for pain control such as morphine,
Tramadol.

54. • NURSING DIAGNOSES
• Anxiety
• Activity intolerance
• Impaired gas exchange

55. NURSING INTERVENTION
1. Monitor respiratory status, looking at rate, effort, use of
accessory muscles, and skin color; auscultate breath sounds.
2. Monitor pain and administer analgesics appropriately.
3. Monitor vital signs for changes, elevated pulse, elevated
respiration, change in BP, and elevated temperature, which
may signal infection.
4. Monitor pulse oximetery for decrease in oxygenation levels.
5. Assist patient with turning, coughing, and deep-breathing
exercises.
6. Place patient in semi-Fowler’s position to ease respiratory
effort.
7. Explain to the patient the importance of taking rest periods.