General Respiratory conditions
• Diagnostic tests p 566
o Sputum (MC&S)
Smear
Culture
o CXR
o Blood gas
o Pulse oximetry
o CT
o MRI
o Ba swallow
o Bronchoscopy
o Pleural fluid
• Classification of respiratory disorders p 583
o Infective
o Inflammatory
Pneumonia p 585 PCCM p 64
• Definition
• Causes
• Classification
• Risk factors
• Specific pathophysiology
• Clinical manifestations
• Management p 586 PCCM p64
o Lobar PCCM p 61
o Broncho PCCM 64
• General nursing care plan p 587
o SOB
o Coughing
• Complications p 588
• Prevention p 588
• Essential health information
Pneumonia in children p 589 PCCM p 63
• Bronchopneumonia
o Clinical features
In small infants
Infants
Small children
o Management
Cancer of the lungs and bronchi p 597
• Definition
• Causes
• Pathophysiology
• Clinical manifestations
• Treatment
• Essential health information
Thoracic / chest trauma p 262 (T&E Periods)
• # ribs PCCM p 275
• Flail chest
• Pulmonary contusion
• Pneumothorax
• Tension pneumothorax PCCM p 272
• Haemothorax
• Stabbed chest PCCM p 272
Small group presentation which was done during our physiology days under the guidance of Prof. Sampath Gunawardena senior lecturer in department of Physiology, Faculty of Medicine University of Ruhuna.
Small group presentation which was done during our physiology days under the guidance of Prof. Sampath Gunawardena senior lecturer in department of Physiology, Faculty of Medicine University of Ruhuna.
The lower respiratory system, or lower respiratory tract, consists of the trachea, the bronchi and bronchioles, and the alveoli, which make up the lungs. These structures pull in air from the upper respiratory system, absorb the oxygen, and release carbon dioxide in exchange.
this is detailed study on lower respiratory diseases
please comment
thank you
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Abortion and other Causes of Early Pregnancy Bleeding.pdfChantal Settley
Describe common causes of bleeding in early pregnancy.
Describe the clinical classifications of abortion, the legal aspects of abortion in Ethiopia, and the safe methods used in health facilities.
Identify the warning signs and the emergency treatment required before referral for early pregnancy bleeding.
Describe the features of woman-friendly comprehensive post-abortion care, including the post-abortion family planning service
List the advantages of regionalised perinatal care.
Describe the functioning of a perinatal-care clinic.
Communicate better with patients and colleagues.
Safely transfer a patient to hospital.
Determine the maternal mortality rate.
Medical problems during pregnancy, labour and the puerperium.pdfChantal Settley
Diagnose and manage cystitis.
Reduce the incidence of acute pyelonephritis in pregnancy.
Diagnose and manage acute pyelonephritis in pregnancy.
Diagnose and manage anaemia during pregnancy.
Identify patients who may possibly have heart valve disease.
Manage a patient with heart valve disease during labour and the puerperium.
Manage a patient with diabetes mellitus.
Explain the wider meaning of family planning.
Give contraceptive counselling.
List the efficiency, contraindications and side effects of the various contraceptive methods.
List the important health benefits of contraception.
Advise a postpartum patient on the most appropriate method of contraception.
Define the puerperium.
List the physical changes which occur during the puerperium.
Manage the normal puerperium.
Assess a patient at the 6-week postnatal visit.
Diagnose and manage the various causes of puerperal pyrexia.
Recognise the puerperal psychiatric disorders.
Diagnose and manage secondary postpartum haemorrhage.
Teach the patient the concept of ‘the mother as a monitor’.
Uterine contractions continue, although less frequently than in the second stage.
The uterus contracts and becomes smaller and, as a result, the placenta separates.
The placenta is squeezed out of the upper uterine segment into the lower uterine segment and vagina. The placenta is then delivered.
The contraction of the uterine muscle compresses the uterine blood vessels and this prevents bleeding. Thereafter, clotting (coagulation) takes place in the uterine blood vessels due to the normal clotting mechanism.
Identify the onset of the second stage of labour.
Decide when the patient should start to bear down.
Communicate effectively with the patient during labour.
Use the maternal effort to the best advantage when the patient bears down.
Make careful observations during the second stage of labour.
Assess the fetal condition during the time the patient bears down.
Accurately evaluate progress in the second stage of labour.
Manage a patient with a prolonged second stage of labour.
Diagnose and manage impacted shoulders.
Monitoring the condition of the fetus during the first stage of labour.pdfChantal Settley
Monitor the condition of the fetus during labour.
Record the findings on the partogram.
Understand the significance of the findings.
Understand the causes and signs of fetal distress.
Interpret the significance of different fetal heart rate patterns and meconium-stained liquor.
Manage any abnormalities which are detected.
1.1 Define and use correctly all of the key terms
1.2 Describe the signs of true labour and distinguish between true and false labour
1.3 Explain to the mother how to recognise the onset of true labour
1.4 Describe the characteristic features and mechanisms of the four stages of labour
1.5 Describe the seven cardinal movements made by the baby as it descends the birth canal in a normal labour
10.2 Preterm labour and preterm rupture of the membranes.pdfChantal Settley
Define preterm labour and preterm rupture of the membranes.
Understand why these conditions are very important.
Understand the role of infection in causing preterm labour and preterm rupture of the membranes.
List which patients are at increased risk of these conditions.
Understand what preventive measures should be taken.
Diagnose preterm labour and preterm rupture of the membranes.
Manage these conditions.
Understand why an antepartum haemorrhage should always be regarded as serious.
Provide the initial management of a patient presenting with an antepartum haemorrhage.
Understand that it is sometimes necessary to deliver the fetus as soon as possible, in order to save the life of the mother or infant.
Diagnose the cause of the bleeding from the history and examination of the patient.
Correctly manage each of the causes of antepartum haemorrhage.
Diagnose the cause of a blood-stained vaginal discharge and administer appropriate treatment.
Define hypertension in pregnancy.
Give a simple classification of the hypertensive disorders of pregnancy.
Diagnose pre-eclampsia and chronic hypertension.
Explain why the hypertensive disorders of pregnancy must always be regarded as serious.
List which patients are at risk of developing pre-eclampsia.
List the complications of pre-eclampsia.
Differentiate pre-eclampsia from pre-eclampsia with severe features.
Give a practical guide to the management of pre-eclampsia.
Provide emergency management for eclampsia.
Manage gestational hypertension and chronic hypertension during pregnancy.
7.2 New Microsoft PowerPoint Presentation (2).pdfChantal Settley
Welcome the woman and ask her to sit near you and facing you.
Smile and make good eye contact with her.
Reassure her that you will always maintain her privacy and confidentiality
Without her permission, do not include a third person in the meeting.
Use simple non-medical language and terminologies throughout that she can understand, and check frequently that she has really understood.
Actively listen to her, using gestures and verbal communication to show her that you are paying attention to what she says.
Encourage her to ask questions, express her needs and concerns, and seek clarification of any information that she does not understand.
6.4 Assessment of fetal growth and condition during pregnancy.pdfChantal Settley
When you have completed this unit you should be able to:
• Assess normal fetal growth.
• List the causes of intra-uterine growth restriction.
• Understand the importance of measuring the symphysis-fundus height.
• Understand the clinical significance of fetal movements.
• Use a fetal-movement chart.
• Manage a patient with decreased fetal movements.
• Understand the value of antenatal fetal heart rate monitoring.
What possible complications to look for:
Antepartum haemorrhage
Pre-eclampsia
proteinuria and a rise in the blood pressure.
Cervical changes
Symphysis-fundus height measurement
below the 10th centile?
above the 90th centile?
To review and act on the results of the screening or special investigations done at the booking visit.
2. To perform the second assessment for risk factors.
If possible, all the results of the screening tests should be obtained at the first visit.
Assess normal fetal growth.
List the causes of intra-uterine growth restriction.
Understand the importance of measuring the symphysis-fundus height.
Understand the clinical significance of fetal movements.
Use a fetal-movement chart.
Manage a patient with decreased fetal movements.
Understand the value of antenatal fetal heart rate monitoring.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. 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
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5. 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.
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9. Bronchial Tree
• The branching system of bronchi and bronchioles, conducting air from
the windpipe into the lungs.
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10. Alveoli
•Gas exchanges between the
air and blood occur within the
alveoli.
•Alveolar pores allow air to
pass from one alveolus to
another.
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13. 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.
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14. 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.
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15. Lungs
• Located on either side of the chest (thorax).
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16. Inspiration & Expiration
•The process of breathing (respiration) is divided into two distinct
phases, inspiration (inhalation) and expiration (exhalation).
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19. 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.
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21. 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.
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23. Diagnostic tests- pg. 566
•Sputum (MC&S)
◦ Smear: Smear microscopy of sputum is often the first
TB test. Taken for microscopy, culture and sensitivity
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24. Diagnostic tests- pg.566
• CXR
• To help find the underlying cause of respiratory failure.
• Reveals tumours and abnormalities
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25. 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%
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26. 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.
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27. 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.
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28. Diagnostic tests
•Pleural fluid
• A needle is used to aspirate fluid from the pleural space,
which lies between the lungs and the chest wall
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29. 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
COMPILED BY C SETTLEY
31. 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 ).
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32. Pneumonia: Causes- pg. 585
•Caused by a variety of pathogens, including viruses, fungi
& bacteria.
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33. 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.
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34. Pneumonia: Classification- pg. 585
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
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35. Pneumonia: Classification- pg. 585
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
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36. 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.
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37. Pneumonia: Risk factors- pg. 585
•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.
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38. Pneumonia: Risk factors- pg. 585
•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
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39. Pneumonia: Risk factors- pg. 585
•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.
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40. Examples of the body’s natural
defence mechanisms?
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41. 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
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42. 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
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43. 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
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44. 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
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45. 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
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46. 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
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47. Pneumonia:
General nursing care plan- pg. 587
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
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48. Pneumonia:
General nursing care plan- pg. 587
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
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49. Pneumonia:
General nursing care plan- pg. 587
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
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50. Pneumonia:
General nursing care plan- pg. 587
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
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51. Pneumonia:
Complications- pg. 588
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- Pleural effusion
- Carditis, nephritis, organ failure
- Shock, respiratory distress
- Hypoxia
- Confusion
- High body temperatures
52. 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
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53. 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*
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54. 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.
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55. 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.
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56. 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
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57. 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
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58. 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
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59. Pneumonia in children- pg. 589
•Assessment of a child with Pneumonia- VIDEO
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60. Pneumonia in children- pg. 589
•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.
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61. 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.
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62. VIDEO- Examination of the lungs
VIDEO- Lung Sounds (Abnormal) Crackles (Rales) Wheezes (Rhonchi)
Stridor Pleural Friction Rub Breath Sounds
VIDEO- Chest in drawing
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64. Cancer of the lungs and bronchi-
pg. 597
•Definition
•Defined as being a malignant growth or
neoplasm in those structures.
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65. Cancer of the lungs and bronchi-
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
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66. Cancer of the lungs and bronchi-
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.
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67. Cancer of the lungs and bronchi-
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.
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68. Cancer of the lungs and bronchi-
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.
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69. Cancer of the lungs and bronchi-
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
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70. •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
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71. •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.
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72. •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
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73. •Can be seen on chest x-ray
•Confirmed by cytology (the study of cells)
•Biopsy from bronchi
•Trans bronchial biopsy
•Needle biopsy
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74. •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
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75. •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
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76. •Mesothelioma – pg.598
• A tumour of the tissue that lines the lungs, stomach, heart and other organs.
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78. Thoracic/chest trauma- pg.262
A chest injury is any form of physical injury to the chest including the
ribs, heart and lungs.
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80. Thoracic/chest trauma- pg.262
•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.
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82. 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
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83. Thoracic/chest trauma- pg.262
•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
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85. Thoracic/chest trauma- pg.262
•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.
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86. Free floating ribs- pg.262
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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.
87. 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.
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89. 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
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90. 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.
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91. 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
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92. 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).
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93. Pulmonary contusion- pg. 263
•Assessment findings
• 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.
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94. Pulmonary contusion- pg. 263
•Emergency care
• Fowler’s position
• Oxygen, monitor oxygen saturation and blood gases
• Pain control
• Prepare for endotracheal intubation if assisted
ventilation is indicated
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95. 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.
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96. Pneumothorax- pg. 263
•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.
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97. Pneumothorax- pg. 263
•Assessment findings
• 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
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98. Pneumothorax- pg. 264
•Emergency care
• Fowler’s position
• Oxygen through face mask
• Prepare for intubation and mechanical ventilation
• Emergency thoracocentesis
• Emergency surgery (thoracotomy)
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99. Pneumothorax- pg. 264
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
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100. Pneumothorax- pg. 264
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.
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101. Pneumothorax- pg. 264
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
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102. Pneumothorax- pg. 265
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.
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103. Pneumothorax- pg. 265
Haemothorax
• A collection of blood in the space between the chest wall and the
lung (the pleural cavity).
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104. Pneumothorax- pg. 265
Haemothorax
•Assessment findings
• 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
COMPILED BY C SETTLEY
106. 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.
COMPILED BY C SETTLEY