General respiratory conditions

General
respiratory
diseases
BY C.SETTLEY
COMPILED BY C SETTLEY

Outcomes
1. Apply knowledge regarding: Patho-physiology, disease process, clinical
manifestations, specific diagnostic and therapeutic interventions (diagnostic tests and
examinations)
- Distinguish between the different health problems: medical and surgical conditions
of various body systems, Pneumonia, Cancer of the lungs and bronchi
2. Application of key concepts by using the nursing process. provision and facilitation
of nursing care for individuals / groups through the total life span
3.Evaluate, analyse and solve problems in familiar and unfamiliar context in the
Comprehensive Health Care system
4. Understand the relationship between social, cultural and economic factors that may
impact significantly on the health status of clients / patients and groups. (Health
education)
5. Ability to apply knowledge of emergency and trauma management principles in
Thoracic/ chest trauma

Organs of the
Respiratory System

The respiratory system

Upper and lower
Respiratory tract
•The upper respiratory tract includes the mouth,
nose, sinus, throat, larynx (voice box), and
trachea (windpipe).
•Upper respiratory infections are often referred
to as "colds."
•The lower respiratory tract includes the
bronchial tubes and the lungs.
•Bronchitis and pneumonia are infections of the
lower respiratory tract.

Upper Respiratory Tract

Trachea & surrounding
structures

Lower Respiratory Tract

Bronchial Tree
• The branching system of bronchi and bronchioles, conducting air from
the windpipe into the lungs.

Alveoli
•Gas exchanges between the
air and blood occur within the
alveoli.
•Alveolar pores allow air to
pass from one alveolus to
another.

Diffusion Across
Respiratory Membrane
•In summary, gas
exchange is the
movement of oxygen
into the blood and
carbon dioxide out of
the blood across the
respiratory membrane
in the lungs.

Respiratory Membrane
•Gas exchange occurs across this
membrane. Diffusion of oxygen
into and carbon dioxide out of the
blood.
•The respiratory membrane is
highly permeable to gases; the
respiratory and blood capillary
membranes are very thin; and
there is a large surface area
throughout the lungs.

Lungs
• Located on either side of the chest (thorax).

Inspiration & Expiration
•The process of breathing (respiration) is divided into two distinct
phases, inspiration (inhalation) and expiration (exhalation).

Major Events in Inspiration

Major Events in Expiration

Respiratory Center
•The respiratory centers (RCs) are located in the
medulla oblongata and pons, which are parts of
the brainstem.
•The RCs receive controlling signals of neural,
chemical and hormonal nature and control the
rate and depth of respiratory movements of the
diaphragm and other respiratory muscles.

Oxygen Transport
•Oxygen is not carried in the plasma, but is carried by the red blood cells.
These contain a red substance called haemoglobin, which joins onto
oxygen and carries it around the body in the blood.
•Oxygen diffuses into cells from the capillaries.
•Haemoglobin is the protein molecule in red blood cells that carries
oxygen from the lungs to the body's tissues and returns carbon dioxide
from the tissues back to the lungs.
•A low hemoglobin count is generally defined as less than 13.5 grams
of hemoglobin per deciliter (135 grams per liter) of blood for men and
less than 12 grams per deciliter (120 grams per liter) for women.

Video
- What happens when you breathe
- Gas exchange

Diagnostic tests- pg. 566
•Sputum (MC&S)
◦ Smear: Smear microscopy of sputum is often the first
TB test. Taken for microscopy, culture and sensitivity

Diagnostic tests- pg.566
• CXR
• To help find the underlying cause of respiratory failure.
• Reveals tumours and abnormalities

Diagnostic tests
•Blood gas
• The blood gas test can determine how well your lungs are
able to move oxygen into the blood and remove carbon
dioxide from the blood.
• Imbalances in the oxygen, carbon dioxide, and pH levels of
your blood can indicate the presence of certain medical
conditions.
Partial pressure of oxygen (PaO2): 75 to 100 mm Hg
Partial pressure of carbon dioxide (PaCO2): 38 to 42 mm Hg
Arterial blood pH: 7.38 to 7.42.
Oxygen saturation (SaO2): 94% to 100%

Diagnostic tests
•Pulse oximetry
• To check the health of a person with any condition that
affects blood oxygen levels.
• To check the percentage of oxygen that is bound to
haemoblobin.
•CT
• The lungs are scanned in layers by means of a computer.
•MRI
• Three dimensional image scanning the lung tissue.

Diagnostic tests
•Ba swallow
• To outline the oesophagus and reveal any abnormalities.
•Bronchoscopy
• A technique of visualizing the inside of the airways for
diagnostic and therapeutic purposes.
• An instrument is inserted into the airways, usually through
the nose or mouth, or occasionally through a tracheostomy.
• Therapeutic bronchoscopy would be carried out in order to
remove secretions or a foreign body, and also to excise
some lesions.

Diagnostic tests
•Pleural fluid
• A needle is used to aspirate fluid from the pleural space,
which lies between the lungs and the chest wall

Classification of respiratory
disorders- pg. 583
•Infective
• May be bacterial, fungal or viral.
• May involve any part of the respiratory tract.
• Infections may be acute or chronic, e.g. Influenza
•Inflammatory
• May be due to chronic irritation, usually caused by
environmental factors.
• E.g. asthma & chronic obstructive pulmonary disease

End of session

Pneumonia- pg. 585
•Pneumonia is an inflammatory condition of the lung affecting
primarily the small air sacs known as alveoli.
•Air sacs are filled with fluid/pus
•Inflammation may affect both lungs (double pneumonia ) or only
one (single pneumonia ).

Pneumonia: Causes- pg. 585
•Caused by a variety of pathogens, including viruses, fungi
& bacteria.

Pneumonia: Classification- pg. 585
1. INFECTIVE
• Bacterial
Gram positive e.g. streptococcus
pneumonia & staphylococcus
aureus
Gram negative e.g. klebsiella,
haemophillus
• Viral
Influenza viruses
• Fungi
Common in
immunocompromised patients
2. DISTRIBUTION
• Bronchopneumonia
Involves the smaller bronchi,
terminal bronchi and adjacent
alveoli.
• Lobar Pneumonia
This infection involves an entire lobe
of a lung, and sometimes the whole
lung.

3. MANNER OF ACQUIRING THE INFECTION
• Community acquired pneumonia
• Community-acquired pneumonia develops in people with limited or no
contact with medical institutions or settings.
• The most commonly identified pathogens are Streptococcus pneumoniae,
Haemophilus influenza, atypical bacteria and viruses.
• Doctors diagnose community-acquired pneumonia by listening to the lungs
with a stethoscope and by reading x-rays of the chest.
• Antibiotics, antiviral drugs, or antifungal drugs are used depending on
which organism doctors believe has caused the pneumonia.
• http://pulmonology.co.za/wp-content/uploads/2017/07/CAP-Guideline-
GR-J-Thoracic-Diseases-2017.pdf

3. MANNER OF ACQUIRING THE INFECTION
• Hospital acquired/nosocomial pneumonia
• Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to
any pneumonia contracted by a patient in a hospital at least 48–72 hours
after being admitted.
• It is thus distinguished from community-acquired pneumonia.
• It is usually caused by a bacterial infection, rather than a virus.
• Pneumonia acquired in the hospital or in another health care setting is usually
more severe than pneumonia acquired in the community because the infecting
organisms tend to be more aggressive.
• They are also less likely to respond to antibiotics (called resistance) and are,
therefore, harder to treat.
• Additionally, people in hospitals and nursing homes and those who have
contact with medical settings tend to be sicker even without pneumonia than
those living in the community and therefore are not as able to fight the
infection.
• https://www.fidssa.co.za/Content/Documents/cap2007.pdf

Pneumonia: Risk factors- pg. 585
•Malnutrition and chronic alcoholism.
•Chronic illnesses such as cancer, DM, renal diseases and
cardiac failure.
•Chronic pulmonary diseases such as emphysema, chronic
bronchitis, asthma or pulmonary TB.
•Upper respiratory infections especially if neglected and
the causative agent is virulent.

•Artificial airway.
•Immunosuppression.
•Immobile individuals.
•Individuals with an increased level of consciousness.
•Impaired swallowing or gag reflex.
•WHY?
•Pneumonia may occur after surgery, because the pain of those conditions
keeps people from breathing deeply and from coughing. If people do not
breathe deeply and cough, microorganisms are more likely to remain in the
lungs and cause infection. Other people who do not breathe deeply and
cough include those who are bedridden, paralyzed, or unconscious. Such
people are also at risk of pneumonia.

•A person whose immune system is impaired may not
respond as well to treatment as someone whose immune
system is healthy. People who may have an impaired
immune system include those who:
•Use certain drugs (such as corticosteroids or
chemotherapy drugs)
•Have certain diseases, such as AIDS or various types of
cancer
•Have an undeveloped immune system, as is the case of
infants and toddlers

•Have an immune system that is worn down by
severe illness, as is often the case with older
people
•Another condition that predispose people to
pneumonia include chronic obstructive pulmonary
disease because this disorder weaken the lungs'
defence mechanisms or the immune system.

Examples of the body’s natural
defence mechanisms?

Pneumonia:
Pathophysiology- pg. 585
Infection- inflammation- alveoli fills with inflammatory
exudates- consolidation of the lung tissue follows (A pulmonary
consolidation is a region of a lung tissue that has filled with liquid, a condition marked by
swelling or hardening of normally soft tissue)- impaired gas exchange due to
inflammation- mucus and leukocytes form thick secretions-
this blocks small airways and alveoli and further impairs gas
exchange- the thick exudates provide an excellent medium
for bacterial growth

Pneumonia:
Clinical manifestations- pg. 585
•Flu like symptoms such as chills, fever
•Dry painful cough
•Chest pain
•Dyspnoea
•Cyanosis
•Productive cough develops (first rusty
brown then yellow that becomes
difficult to cough up)
•If untreated, there is a crises after 7-10
days followed by recovery, provided
that no complications occur and that
the patient has not developed hypoxia
and respiratory failure.
•Diagnosis is made based on history of
signs and symptoms

Pneumonia:
Management- pg. 586
•Pharmacological management
• Anti microbial agent, depending on the causative organism.
• Narrow spectrum antibiotic
• E.g. benzyl penicillin & amoxicillin, flagyl
• Prescribed nebulizer/bronchodilator
• Suppressant or expectorant coughing syrup?
• Cough Suppressants, also known as antitussives, work in an entirely
different manner than expectorants. Instead of helping to remove
phlegm from the lungs, suppressants actually block the cough reflex.
• An expectorant is often one of the ingredients and works by loosening
and clearing mucus and phlegm from the lungs, bronchi, and trachea.
• Physiotherapist

Pneumonia:
Management- pg. 586
•O2 and ventilation
• Depending on arterial blood gas results
• If severe- mechanical ventilation may be required
•Fluid and electrolyte balance
• IV therapy (this includes prescribed meds like antibiotics
and electrolyte replacement for the treatment of
pneumonia)
• Oral fluid intake should be encouraged where possible to
assist in coughing up mucus
• Monitoring intake and output
• Pyrexia

Pneumonia:
Management- pg. 586
•Nutrition
• Nutritional requirements increases due to increased metabolism
caused by a febrile illness (A fever is a natural reaction of the body to an illness
such as infection due to a virus or bacteria. In most cases, the temperature itself is not
harmful. It actually helps the body fight infections)
• Encourage patient to take as much nutrition as possible
•Rest and sleep
• Mild analgesics for muscular aches and pains
•On-going monitoring
• Respiration, ventilation, fluid balance

Pneumonia:
General nursing care plan- pg. 587
PROBLEM NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTIONS
EVALUATION
Difficulty
in
breathing
Altered
breathing
pattern, poor
ventilation
related to
pain and
decrease in
gas exchange
in lungs and
presence of
inflammatory
exudates
Normal
breathing
Skin colour
normal
Position patient
upright
O2
Monitor
respiratory status
Ventilated?
Monitor
Administer meds
as prescribed
Respiratory
rate normal
Blood gases
within normal
ranges

Pneumonia:
PROBLEM NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTIONS
EVALUATION
Ineffective
coughing
Ineffective
airway
clearance
due to pain
and thick
mucus
Mucus
removed
Airway
patient
Breathing
normal
Normal skin
colour
Encourage
patient to cough
Support chest
wall
Physiotherapy,
breathing
exercises
Administer meds
as prescribed
Nebs, fluids
Observe sputum
Chest x ray
shows clear
lungs + on
auscultation
Secretions are
being
coughed up
without
difficulty

Pneumonia:
PROBLEM NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTIONS
EVALUATION
Poor
appetite
Altered
nutrition due
to dyspnoea,
pyrexia,
malaise, pain
Normal food
intake
Small balanced
meals
Smaller meals,
more frequent
Encourage
coughing up of
mucus
Normal meal
intake
Optimum
body weight

Pneumonia:
PROBLEM NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTIONS
EVALUATION
Inadequate
fluid intake
Sweating,
fluid loss
Normal
hydration
Vital signs
normal
Intake and output
Serve food and
fluids frequently
Optimum
fluid balance
Vital signs
normal

Pneumonia:
PROBLEM NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTIONS
EVALUATION
Fear and
anxiety
Due to
feelings of
suffocation,
pain
Calm patient Explain, educate,
assist
Calm and
understands
condition.
Health
education

Pneumonia:
Complications- pg. 588
- Pleural effusion
- Carditis, nephritis, organ failure
- Shock, respiratory distress
- Hypoxia
- Confusion
- High body temperatures

Pneumonia:
Prevention- pg. 588
•Educate
•Good nutrition
•Exercise, tobacco
•Regular exams
•Screening tests to monitor for risk factors
•Immunization
•Controlling potential hazards at home and work
•Prevention of low birth weight and breastfeeding education

Pneumonia:
Essential health information- pg. 589
Good nutrition (grains, fruit & vegetables, foods high in protein)
Regular exercise
Adequate rest
Maintain efficacy of the immune system and keep infections at bay
Dangers of smoking cannot be overemphasized
Avoid pollutants. It irritate the lungs and weakens defence mechanisms
People at risk should avoid infection.
Upper respiratory diseases should be treated immediately
Annual flu vaccine
Pneumonia – VIDEO*

Activity:
Mrs Ellis, 75 years old is admitted to the ward complaining of difficulty
in breathing. She`s been on bed rest for more than two weeks due to
the flu but struggles to recover completely. She is a known diabetic and
smoker but according to her, she stopped smoking six weeks ago.
1. From the scenario identify risk factors for Mrs Ellis for developing
pneumonia.
2. Mrs Ellis is diagnosed with pneumonia. Plan the nursing interventions
that are necessary to manage his dyspnoea. Include rationale.

Question 1
Answers:
•Chronic illnesses / Diabetes Mellitus
•Smoking – she was a smoker, recently
•Exposure to upper respiratory infections/Influenza
•Age – the elderly more prevalent – she is 75 years old &
•Immobility / she has been on bed rest for 2 weeks.

Question 2
Answers:
•Nurse patient in semi-/fowlers position
• to increase chest expansion / to improve breathing
•Administer 40% O₂ via facemask
• to improve O₂ saturation and gases exchange
•Monitor respiration 4 hourly for rate rhythm and depth
• to determine if treatment is effective
•Monitor O₂ saturation
• to determine if treatment is effective
•Administer prescribed nebulizer/bronchodilator as prescribed
• to improve breathing.
•Administer antibiotic e.g. flagyl.as prescribed
• to treat infection

Pneumonia in children- pg. 589
•These children present with coughing and difficulty in breathing
•The mother may describe the child’s breathing as being fast and noisy
•Breathing may be rapid for the child’s age
•Wheezing may be heard on auscultation
•Fever, headaches & tiredness
•Stridor and chest in drawing due to swelling of the larynx, trachea or
epiglottis
•May obstruct breathing and be life threatening
•Treated with amoxicillin or ceftriaxone as prescribed
•Refer to hospital

•Assessment of a child with Pneumonia- VIDEO

•According to the World Health Organization
(WHO), pneumonia claims the life of a child every
20 seconds and accounts for 16 percent of all
deaths of children under age 5.
•While 99 percent of pneumonia-related deaths
occur in low- and middle-income countries, it's still
important to recognize how the symptoms show up
in children.

E.N.T
(Ear, nose & throat)
•A canal that links the middle ear with the back of the nose.
•The eustachian tube helps to equalize the pressure in the middle ear.
Having the same pressure allows for the proper transfer of sound
waves. The eustachian tube is lined with mucous, just like the inside of
the nose and throat.
•Sinus cavities in the skull are not only for filtering and warming air
before that air reaches the lungs. These air pockets are connected with
your throat and ears.
•When the passages become congested through inflammation or mucus
accumulation, our ears hurt. The open connection between nose, ear
and throat allows for the exchange of fluids, permitting the
transformation of a cold into an excruciatingly painful ear infection.

VIDEO- Examination of the lungs
VIDEO- Lung Sounds (Abnormal) Crackles (Rales) Wheezes (Rhonchi)
Stridor Pleural Friction Rub Breath Sounds
VIDEO- Chest in drawing

Cancer of the lungs and bronchi-
pg. 597
•Definition
•Defined as being a malignant growth or
neoplasm in those structures.

pg. 597
•Causes
•Carcinogens in cigarettes
• Substances and exposures that can lead to cancer are called carcinogens. Some carcinogens do not affect DNA directly, but lead to cancer
in other ways. For example, they may cause cells to divide at a faster than normal rate, which could increase the chances that DNA
changes will occur
•Active or passive
• Frequent exposure to other people's smoke increases the risk of lung cancer, even for a
non-smoker. Passive smoking also increases the risk of coronary heart disease. Coronary
heart disease can cause a heart attack, angina (chest pain) and heart failure.
• Law on smoking in SA? Legislation governing South African smokers has tightened considerably
since 2000 when the Tobacco Products Control Amendment Act banned smoking in public places.
Smoking in partially enclosed public places were prohibited in 2009. Smoking in cars with
passengers younger than 12 was also declared illegal.
•Environmental pollutants
•Peak ages 55-65
•More men affected than women

pg. 597
•Classification
•Squamous carcinoma (1)
• This type of lung cancer begins in the squamous cells—thin, flat cells that look like fish scales
when seen under a microscope. They line the inside of the airways in the lungs.
• Squamous cell lung cancer usually is diagnosed after the disease has spread. The overall
prognosis for squamous cell lung cancer is poor; only about 16% of patients survive five
years or longer. The survival rate is higher if the disease is detected and treated early.

pg. 597
•Classification
•Small cell carcinoma (2)
• Small-cell carcinoma is a type of highly malignant cancer that most
commonly arises within the lung, although it can occasionally arise in other
body sites, such as the cervix, prostate, and gastrointestinal tract.

pg. 597
•Classification
•Adenocarcinoma (3)
• Adenocarcinoma of the lung is a common histological form of lung cancer
that contains certain distinct malignant tissue architectural, cytological, or
molecular features, including significant amounts of mucus.

pg. 597
•Classification
•Large cell carcinoma (4)
• Large cell lung cancers tend to grow quickly and spread. The cancer may
spread into nearby lymph nodes and into the chest wall. It also can spread to
more distant organs, even when the tumour in the lung is relatively small.
•Combination of these tumours

•Pathophysiology
• Lung cancer gives rise to disease
• This is due to local tumour growth and invasion
of adjacent structures
• It spreads to regional lymph nodes
• Typically grows over a few years
• By the time it is diagnosed, the tumour might not
be localised anymore
• Therefore making a successful outcome less likely

•Pathophysiology
• The pathophysiology of lung cancer development is complexed.
• The genes influenced in the pathogenesis of lung cancer produce proteins
involved in cell growth and differentiation, cell cycle processes, apoptosis,
angiogenesis, tumor progression, and immune regulation.
• Apoptosis: the death of cells which occurs as a normal and controlled part of an organism's
growth or development.
• Angiogenesis: Angiogenesis is the formation of new blood vessels. This process is a normal part
of growth and healing. It is also plays a role in several diseases, including cancer. A tumour needs
nutrients and oxygen to grow and spread. These are available in the blood.

•Clinical manifestations
• Cough, often with pyrexia
• Haemoptysis (the coughing up of blood)
• Wheezing, stridor & dyspnoea due to obstruction of air passages
• Lung abscess due to necrosis of tumour
• Tracheal obstruction
• Dysphagia
• Hoarseness
• Phrenic nerve paralysis
• Sympathetic nerve paralysis causing Horner’s syndrome (A disrupted nerve pathway on one side from the
brain to the face and eye)
• Para neoplastic syndromes: Paraneoplastic syndromes are rare disorders that are triggered by an altered
immune system response to a neoplasm
• Systemic syndromes
• Endocrine syndromes

•Can be seen on chest x-ray
•Confirmed by cytology (the study of cells)
•Biopsy from bronchi
•Trans bronchial biopsy
•Needle biopsy

•Treatment
•Lung resection
•Surgery may be combined with radiation and chemotherapy
•Extent of surgery depends on size and findings at exploration
•Radiation is curative in 10 % of patients. Therapy may improve quality of
life and may allow patient to survive longer.
•Chemotherapy offers survival benefits

•Essential health information
•Smoking
•Emphasise on passive smoking
•Programmes to help stop smoking
•Government regulations should be reinforced
•Healthcare workers have an obligation to be seen adhering to
regulations

•Mesothelioma – pg.598
• A tumour of the tissue that lines the lungs, stomach, heart and other organs.

Thoracic/chest trauma- pg.262
A chest injury is any form of physical injury to the chest including the
ribs, heart and lungs.

Anatomy of the chest

•Fractured Ribs
• Breaks or cracks in the ribs
• Associated with blunt injuries from MVA’s, assaults or
falls
• The ribs play a protective role. Protects organs such
as the heart and lungs
• The ribcage also encloses the thoracic cavity and
helps protect the heart and lungs from damage.
There are 24 ribs in the human body, divided into
two sets of 12 curved, flat bones. Each one is
attached by cartilage at the back to the thoracic
vertebrae.

Thoracic/chest trauma:
Anatomy of the ribs- pg. 262

Thoracic/chest trauma:
Fractured ribs - pg. 262
A rib fracture is a crack or break in one of
the bones of the rib cage. ... The most
common cause of a fractured rib is a
direct blow to the chest, often from a car
accident or a fall. Coughing hard can also
fracture a rib

•Fractured Ribs: Assessment findings
• Pain during expiration and inspiration
• Shallow respiration and hypoventilation
• On inspection there will be bruising on the affected
area
• On palpation there will be irregularity and local
tenderness on the affected site
• Chest x ray will show fractured ribs

•Emergency management
• Bed rest
• Fowler’s position
• Apply a cold compress locally to reduce pain and swelling
• Analgesics as prescribed
• Encourage splinting of the chest during coughing or deep
breathing
• To minimize pain while moving and coughing.

Free floating ribs- pg.262
The phrase floating rib refers to the two lowermost, the eleventh and twelfth, rib
pairs; so-called because they are attached only to the vertebrae–and not to the
sternum or cartilage of the sternum. These ribs are relatively small and delicate,
and include a cartilaginous tip.

Fail chest- pg.263
•Flail chest is a life-threatening medical condition that occurs when a
segment of the rib cage breaks due to trauma and becomes detached
from the rest of the chest wall.
• It occurs when multiple adjacent ribs are broken in multiple places,
separating a segment, so a part of the chest wall moves independently.

Fail chest- pg.263
•Patho physiology
• During breathing, the flail segments are not able
to hold the rib cage
• On inspiration, the flail segments move inward
and the diaphragm descends during expiration
• This causes a paradoxical chest movement
• Leads to alteration in normal pattern of breathing
• VIDEO

Fail chest- pg.263
•Assessment findings
• Paradoxical movement of the chest during breathing
• Abrasions, lacerations
• Decreased breath sounds on affected side
• Crackly feeling over ribs when palpated
• Severe pain with inspiration and on palpation
• Hypoventilation
• Hypoxemia
• Dyspnoea, tachycardia and respiratory failure
• X rays
• Intrapulmonary shunting with reduced cardiac output
• A pulmonary shunt is a pathological condition which results when the alveoli of
the lungs are perfused with blood as normal, but ventilation (the supply of air)
fails to supply the perfused region.

Fail chest- pg.263
•Emergency care
• Fowler’s position for chest expansion
• Administer oxygen, monitor oxygen saturation and
blood gases
• Pain control
• Rest
• Chest support
• Prepare for endotracheal intubation
• Prepare for underwater seal drainage

Pulmonary contusion- pg. 263
•A pulmonary contusion, also known as lung contusion, is a bruise of the
lung, caused by chest trauma. As a result of damage to capillaries, blood
and other fluids accumulate in the lung tissue. The excess fluid
interferes with gas exchange, potentially leading to inadequate oxygen
levels (hypoxia).

• Tenderness of the chest wall when palpated
• Ecchymosis and bruises on the chest wall on
inspection
• Wheezing on ausculation
• Tachypnea and impaired respiration
• Hypoxia resulting in restlessness and memory loss
• Severe chest pain
• Lung infiltrates that will be clearly visible on x ray.

•Emergency care
• Oxygen, monitor oxygen saturation and blood gases
• Pain control
• Prepare for endotracheal intubation if assisted
ventilation is indicated

Pneumothorax- pg. 263
•Pneumothorax: A pneumothorax is a collapsed lung. A pneumothorax
occurs when air leaks into the space between the lung and chest wall.
This air pushes on the outside of the lung and makes it collapse. In
most cases, only a portion of the lung collapses.

•Pathophysiology
•Air enters the pleural space through a hole in
the chest wall or diaphragm, or from
punctured alveoli or bronchus resulting in
sudden increase in the intra thoracic pressure.
•When air is trapped in the pleural space,
tension pneumothorax occurs.

• Sudden sharp chest pain on affected side
• Coughing
• Shortness of breath, dyspnoea, tachypnoea, respiratory distress &
cyanosis
• Anxiety and restlessness
• Tachycardia and distended neck veins
• On auscultation there is decreased or absent breath sounds over the
affected lung
• On palpation there is surgical emphysema (trapped air)
• On inspection one can see the symmetric chest expansion
• Chest x ray

•Emergency care
• Oxygen through face mask
• Prepare for intubation and mechanical ventilation
• Emergency thoracocentesis
• Emergency surgery (thoracotomy)

TENSION
PNEUMOTHORAX
• When air is trapped in
pleural space and
cannot escape.
• It is called a "closed
pneumothorax" when the chest
wall is intact. With an intact chest
wall, a pneumothorax can be
caused by several things, but the
most frequently encountered
cause is from trauma resulting in
a rib fracture that punctures a
lung, releasing air into the pleural
space.
OPEN
PNEUMOTHORAX
•Developed from
penetrating injuries such as
a bullet wound.
•Opening to the chest
•The opening leads to
disequilibrium between the
pleural space and the
atmospheric pressure thus
causing air to move freely

Tension pneumothorax
• Patho physiology
•Pneumothorax is defined as the presence of air or
gas in the pleural cavity (i.e., the potential space
between the visceral and parietal pleura of the
lung), which can impair oxygenation and/or
ventilation.
•The clinical results are dependent on the degree of
collapse of the lung on the affected side.

Tension pneumothorax
• Assessment findings
• Severe air hunger, dyspnoea and tachypnoea
• Free air can be palpated in the tissues of the neck and upper chest
• Sever cyanosis
• Acute chest pain
• Hypotension
• Hypoxia resulting in nervous system signs
• Distended neck veins (As a result, the chambers can't fill with blood
properly, so blood can back up into veins, including the jugular veins)
• Tracheal and laryngeal deviation away from the affected side

Open pneumothorax
• Assessment findings
• A sucking sound and bleeding from the wound
• Gas bubbles at the wound site
• Subcutaneous emphysema
• Subcutaneous emphysema is when gas or air is in the layer under the skin.
Subcutaneous refers to the tissue beneath the skin, and emphysema refers to
trapped air.

Haemothorax
• A collection of blood in the space between the chest wall and the
lung (the pleural cavity).

Haemothorax
• On percussion there will be dullness
• On auscultation there will be decreased breath
sounds
• Dyspnoea and shortness of breath
• Tachycardia and hypotension
• Shock and increased jugular vein pressure resulting in
distended neck veins

Haemothorax
•Emergency care
• Intercostal drain if necessary
• Monitor drainage
• Hb levels
• Blood transfusions if needed

Stabbed chest - pg. 265
•Penetrating wounds of the chest in civilian practice are
caused primarily by stabbing with knives or ice picks and
gunshots with pistols.

Reference list
ohttp://erwinadr.blogspot.co.za/2010/09/x-ray.html
ohttps://www.fastbleep.com/biology-notes/14/171
ohttp://healthlifemedia.com/healthy/understanding-the-human-chest-thorax-anatomy/
ohttp://diseasespictures.com/broken-rib-rib-fracture-symptoms-causes-treatment/
ohttp://www.healthcaretip.com/2017/01/pulmonary-contusion-icd-10-diagnosis-recovery-
complications.html
ohttp://simplebiologyy.blogspot.co.za/2015/01/mechanism-and-events-occurring-during-
breathing.html
ohttps://www.britannica.com/science/pulmonary-alveolus
ohttps://opentextbc.ca/anatomyandphysiology/chapter/22-4-gas-exchange/
o
https://www.hopkinsmedicine.org/healthlibrary/conditions/otolaryngology/ear_nose_and_throat_fac
ts_85,P00448
ohttp://www.fprmed.com/Pages/Trauma/Open_Pneumothorax.html

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