This document provides information about interstitial lung diseases (ILD). It begins with objectives of providing detailed knowledge about ILD and being able to define, classify, identify causes, signs/symptoms, risk factors, clinical manifestations and complications of various types of ILD. It then defines ILD, discusses types including idiopathic pulmonary fibrosis and hypersensitivity pneumonitis. Diagnostic studies and medical management including antibiotics, corticosteroids and lung transplant are covered. Nursing management focuses on improving breathing, promoting gas exchange, and providing health education.

1. KRISHNA INSTITUTE OF
NURSING SCIENCES KARAD
SUBJECT:- MEDICAL SURGICAL NURSING
TOPIC:- INTERSTITIAL LUNG DISEASES
PRESENTED BY:-
POOJA MHALATKAR
2ND YEAR MSC (N)
KINS KARAD

2. GENERAL OBJECTIVES
At the end of the class the student will get detailed
knowledge regarding interstitial lung diseases.

3. SPECIFIC OBJECTIVES
At the end of the class the student will be able to:-
1) Define the interstitial lung diseases
2) Types of Interstitial lung diseases
3) classification, causes, signs and symptoms, risk factors,
clinical manifestation and complications of ILD
4) Medical, nursing management of interstitial lung
diseases.

4. INTRODUCTION
Interstitial lung diseases(ILD), or diffuse
parenchymal lung diseases, is a group of lung
diseases affecting the interstitium ( the tissue and
space around the alveoli (air sacs of the lungs).
It concerns alveolar epithelium, pulmonary capillary
endothelium, basement membrane, and perivascular
and perilymphatic tissues.
It may occur when an injury to the lungs triggers an
abnormal healing response.

5. DEFINITION
 Interstitial lung diseases includes many different
lung conditions. All interstitial lung diseases affects
the interstitium, a part of the lungs.
 The interstitium is a lace like network of tissues
that extends throughout the lungs.
 The interstitium provides support to the lungs
microscopic air sacs ( alveoli).

6. Tiny blood vessels travel through the interstitium,
allowing gas exchange between blood and the air in
the lungs.
 Normally, the interstitium is so thin it cannot be
seen on chest x-rays or CT scans.

7. TYPES
All form of interstitial lung diseases cause thickening
of the interstitium. The thickening can be due to
inflammation, scarring, edema. Some forms of
interstitial lung diseases are short- lived; others are
chronic and irreversible.
INTERSTITIAL PNEUMONIA:-
Bacteria, viruses, or fungi may infect the interstitium
of the lung. Bacterium called mycoplasma pneumonia
is the most common cause.

8. IDOPATHIC PULMONARY FIBROSIS:-
A chronic, progressive form of fibrosis(scarring) of
the interstitium of the lungs. Its cause is unknown.
NONSPECIFIC INTERSTITIAL
PNUEMONITIS:-
Interstitial lung diseases that is often present with
autoimmune conditions (such as rheumatoid arthritis
or scleroderma).

9. HYPERSENSITIVITY PNEUMONITIS:-
Interstitial lungs caused by ongoing inhalation of dust,
mold, or other irritants.
CRYTOGENIC ORGANIZING PNEUMONIA
(COP):-
pneumonia like interstitial lung diseases but without
an infection present. COP is also called bronchitis
obliterans with organizing pneumonia (BOOP).

10. ACUTE INTERSTITIAL PNEUMONITIS:-
A sudden, severe interstitial lung diseases, often
requiring life support.
DESQUAMATIVE INTERSTITIAL PNEUMONITIS:-
An interstitial lung diseases that is partially caused
by smoking.

11.  SARCOIDOSIS:-
A condition caused interstitial lung diseases along
with swollen lymph nodes, and sometimes heart, skin,
nerve, or eye involvement.
ASBESTOSIS:-
Interstitial lung diseases caused by asbestos
exposure.

12. CLASSIFICATION

13. CAUSES
Bacteria, viruses, and fungi are known to cause
interstitial pneumonias. Regular exposures to inhaled
irritants at work or during hobbies can also cause
some interstitial lung diseases. These irritants
include:-
 Asbestos
 Silica dust

14. Talc
 Coal dust, or various other metal dusts from
working in mining
 Grain dust from farming
 Bird proteins ( such as from exotic birds, chickens,
or pigeons)
 Drugs such as nitrofurantoin, amiodarone,
bleomycin, and many others can rarely cause
interstitial lung diseases.

15. SIGNS AND SYMPTOMS
 Shortness of breath, especially with exertion.
 Fatigue and weakness.
 Loss of appetite.
 Loss of weight.
 Dry cough that does not produce phlegm.
 Discomfort in the chest.
 Labored breathing.
 Hemorrhage in the lungs.

16. RISK FACTORS
Factors that may make you more susceptible to
interstitial lung disease include:-
AGE
Interstitial lung disease is much more likely to
affect adults, although infants and children
sometimes develop the disorder.

17. EXPOSURE TO OCCUPATIONAL AND
ENVIRONMENTAL TOXINS
If you work in mining, farming or construction or for
any reason are exposed to pollutants known to damage
your lungs, your risk of interstitial lung disease is
increased.
GASTROESOPHAGEAL REFLUX DISEASE
If you have uncontrolled acid reflux or indigestion,
you may be at increased risk of interstitial lung
disease.

18. SMOKING
Some forms of interstitial lung disease are more
likely to occur in people with a history of
smoking, and active smoking may make the
condition worse, especially if there is associated
emphysema.
RADIATION AND CHEMOTHERAPY
Having radiation treatments to your chest or
using some chemotherapy drugs makes it more
likely that you'll develop lung disease.

19. CLINICAL MANIFESTATION:-
The most common symptoms of all forms of
interstitial lung diseases is shortness of breath.
Nearly all people with interstitial lung diseases will
experience breathlessness, which may get worse
overtime.
Other symptoms of interstitial lung diseases include:-
• Cough, which is usually dry and nonproductive.
• Weight loss, most often in people with COPD or
BOOP.

20. In most forms of interstitial lung diseases, the
shortness of breath develops slowly (over months). In
interstitial pnuemonias or acute interstitial
pneumonitis, symptoms come or more rapidly ( in hours
or days).

21. COMPLICATIONS
Interstitial lung disease can lead to a series of life-
threatening complications, including:-
HIGH BLOOD PRESSURE IN YOUR LUNGS
(PULMONARY HYPERTENSION)
Unlike systemic high blood pressure, this condition
affects only the arteries in your lungs.

22. It begins when scar tissue or low oxygen levels
restrict the smallest blood vessels, limiting blood
flow in your lungs.
This in turn raises pressure within the pulmonary
arteries.
 Pulmonary hypertension is a serious illness that
becomes progressively worse.

23. RIGHT-SIDED HEART FAILURE (COR
PULMONALE)
This serious condition occurs when your heart's
lower right chamber (right ventricle) — which is less
muscular than the left — has to pump harder than
usual to move blood through obstructed pulmonary
arteries.
Eventually the right ventricle fails from the extra
strain.
This is often a consequence of pulmonary
hypertension.

24.  RESPIRATORY FAILURE
In the end stage of chronic interstitial lung disease,
respiratory failure occurs when severely low blood
oxygen levels along with rising pressures in the
pulmonary arteries and the right ventricle cause
heart failure.

25. DIAGNOSTIC STUDIES:-
1) CHEST X-RAY:-
A simple chest x-ray is the first
test in the evaluation of most
people with a breathing problem.
Chest x-ray films in people with
interstitial lung diseases may
show fine lines in the lungs.

26. 2) COMPUTED TOMOGRAPHY (CT SCAN):-
A CT scanner takes multiple x-rays of the chest and a
computer creates detailed images of the lungs and
surrounding structures. Interstitial lung diseases can
usually be seen on a CT scan.
3) HIGH RESOLUTION CT SCAN:-
If interstitial lung diseases is suspected, using certain
CT scanner settings can improve the images of the
interstitium. This increases the CT scan’s ability to
detect interstitial lung diseases.

28. 4) PULMONARY FUNCTION TESTING:-
A person sits in a sealed plastic booth and breathes
through a tube.
People with interstitial lung diseases may be reduced
total lung capacity.
They may also have a decreased ability to transfer
oxygen from their lungs into their blood.

29. 5) LUNG BIOPSY:-
Often, obtaining lung tissue to
examine under a microscope is the
only way to determine which type of
interstitial lung diseases a person
has.
There are several ways to collect
lung tissue, which is called a lung
biopsy.

30. 6) BRONCHOSCOPY:-
An endoscope is advanced through the mouth or nose
into the airways. Tiny tools on the endoscope can
take a sample of lung tissue.
7) VIDEO-ASSISTED THORACOSCOPIC
SURGERY (VATS):-
Using tools inserted through small incisions, a
surgeon can sample multiple areas of lung tissue.

32. 8) OPEN LUNG BIOPSY
(THORACOTOMY):-
In some cases, traditional surgery
with a large incison in the chest is
needed to obtain a lung biopsy.

33. MEDICAL MANAGEMENT:-
ANTIBIOTICS:-
These are effective treatments for most
interstitial pneumonias.
Azithromycin (Zithromax) and Levaquin) eliminate
the bacteria that cause most interstitial pneumonias.
Viral pneumonias are usually self limiting.
Fungal pneumonias are rare, but can be treated with
antifungal drugs.

34. CORTICOSTEROIDS:-
 In some forms of interstitial lung diseases, ongoing
inflammation in the lungs causes damage and
scarring.
 Corticosteroids like prednisone and
methylprednisolone reduce the activity of the
immune system.
This reduces the amount of inflammation in the
lungs and the rest of the body.

35. LUNG TRANSPLANT:-
In advance interstitial lung diseases causing severe
impairment, a lung transplant may be the best option.
Most people undergoing lung transplant for
interstitial lung diseases make large gains in quality of
life and their ability to exercise.
AZATHIOPRINE(IMURAN):-
This drug also suppresses the immune system. it has
never been proven to improve interstitial lung
diseases, but some studies suggest it might help.

36. N-ACETYLCYSTEINE (MUCOMYST):-
This potent antioxidant may slow the decline of lung
function in some forms of interstitial lung diseases. It
does not improve people’s survival from interstitial
lung diseases, however.

37. NURSING MANAGEMENT
IMPROVING BREATHING PATTERN
Administer oxygen therapy as required.
Administered or teach self-administration of
bronchodilators as ordered.
Encourage smoking cessation.

38. PROMOTING GAS EXCHANGE:-
Encourage mobilization of secretions through hydration
and breathing and coughing exercises.
Advice patient on pacing activities to prevent fatigue.
HEALTH EDUCATION:-
Provide information about the importance of smoking
cessation as well as methods of smoking cessation.

39. Instruct patient about methods of health
maintenance, such as adequate nutrition and
exercise, so additional medical problems can be
avoided.
Advice patient that compensation may be obtained
for impairement related to occupational lung
diseases through the ‘ workers Compensation Act”.

40. Provide information to healthy workers on prevention of
occupational lung diseases.
• Enclose toxic substances to reduce their concentration
in the air.
• Employ engineering controls to reduce exposure.
• Monitor air samples.
• Ventilate the environment properly to reduce dust
content of work atmosphere.
• Use protective devices, such as face masks, respirators,
hoods.

41. SUMMARY
Today we have seen regarding,
The definition of interstitial of lung diseases
Types of Interstitial of lung diseases
Classification of lung diseases
Causes, signs and symptoms, Clinical manifestation,
risk factors, complications.
Diagnostic studies
Medical management, Nursing management.

42. CONCLUSION
Interstitial lung diseases is a term encompassing a
diverse range of lung conditions that primarily affect
the lung interstitium.
ILD should be considered in any person presenting with
breathlessness or cough along with abnormal chest
radiography or lung function testing.
High resolution computed tomography is the best imaging
modality.

43. Lung biopsy is often for diagnosis.
Referral to a respiratory specialists and involvement of
multidiscliplinary are the mainstays of management.
Specific management varies according to the underlying
diagnosis.
General management strategies; pulmonary rehabilitation,
smoking cessation, oxygen therapy as required, and
treatment of commonly associated diseases

44. BIBLIOGRAPHY
P.Hariprasath, “Textbook of Cardiovascular &
Thoracic Nursing”, First Edition 2016, Jaypee
Brothers Medical Publishers (P) Ltd, page no. 523-
532.
 Javed Ansari, Davinder Kalir;”Text Book of Medical
Surgical Nursing- I” Part A, Published by PV Books,
2015 edition, Pageno. 17 – 19.

45. Suzanne C. Smelter, Brenda Bare, “Brunner and
Suddarth’s Textbook of Medical Surgical Nursing”,
10th edition, published by Lippincott Williams and
Wilkins, page no.
 Janice L Hinkle, Kerry H Cheever,” Brunner and
Suddarth’s Textbook of Medical Surgical Nursing”,
volume 1, 13th edition, published by, Wolters Kluwer,
New Delhi, page no.29-31.