The document discusses various respiratory disorders including pneumonia, chronic obstructive pulmonary disease, asthma, acute respiratory distress syndrome, tuberculosis, bronchogenic carcinoma, and laryngeal carcinoma. It covers the classifications, causes, clinical manifestations, diagnostics, and management of each condition. Key points include different types of pneumonia based on causative organisms and location in the lungs. COPD encompasses chronic bronchitis and emphysema resulting from long-term inhalation of irritants like smoke. Asthma is characterized by bronchospasm, edema, and airway narrowing triggered by allergens or inflammation.

1. Respiratory Disorders Nio C. Noveno, RN ,MAN

2. Pneumonia Acute inflammatory process of the alveolar spaces  lung consolidation  exudate [alveoli] Classification CAP: most common; occurs in the community or 48 H before hospitalization S. pneumoniae, H. influenza, M. pneumoniae Nosocomial: onset of S/S is 48-72 H post-hospitalization P. aeruginosa, S. pneumoniae, K. pneumoniae Aspiration pneumonia S. pneumoniae, H. influenza, S. pneumoniae, gastric contents [email_address] respi disorders

3. Pneumonia Types Bacterial pneumonia Lobar [Strep] – constant dry, hacking cough, pleuritic pain, watery to rust-colored sputum Bronchopneumonia [Strep/Staph] – due to aspiration, productive cough w/ yellow or green sputum Alveolar pneumonia [viral] – scanty sputum Atypical pneumonia [rickettsial] – “walking”, non-productive cough [email_address] respi disorders

4. Pneumonia Clinical Manifestations Cough Chills Dyspnea Elevated temperature Crackles Rhonchi Pleural friction rub Sputum production Rusty, green, or bloody: pneumococcal Yellow-green: BPN [email_address] respi disorders

5. Pneumonia Pneumocystis carinii pneumonia Opportunistic infection Often related to HIV & other immunocompromised conditions Clinical Manifestations Increasing SOB Nonproductive cough Low-grade fever Treatment Cotrimoxazole Pentamidine [email_address] respi disorders

6. Pneumonia Management Increase OFI 3-4 L/day. Administer O 2 . Assess respiratory status. Monitor VS, I/O, lab studies, & pulse ox Monitor & record color, consistency, & amount of sputum Home care Recognize s/sx of infection. Avoid exposure to people with infections. Increase OFI at 3 L/day. [email_address] respi disorders

7. Chronic Obstructive Pulmonary Disease B ronchitis E mphysema Causes Congenital weakness Respiratory irritants: smoke, polluted air, chemical irritants Respiratory tract infections Genetic predisposition [email_address] respi disorders

8. Chronic Obstructive Pulmonary Disease Chronic Bronchitis Excessive bronchial mucus production Chronic or recurrent productive cough [email_address] respi disorders Smoking, RTI, Pollutants Mucosal edema Inflammation Bradykinin, Histamine, PGs Fluid/Cellular Exudation Hypersecretion of mucus Persistent Cough  Capillary permeability

9. Chronic Obstructive Pulmonary Disease Emphysema Destruction of elastin alters alveolar walls & narrows airways Enlargement of air spaces distal to terminal bronchioles leads to coalesced alveoli & air trapping [email_address] respi disorders Smoking, heredity, aging process Loss of elastic recoil Disequilibrium between elastase & antielastase Overdistention of alveoli CO2 retention Hypoxia Respiratory acidosis

10. [email_address] respi disorders Emphysema No cyanosis (Pink) Thin appearance Exertional dyspnea Ineffective cough Barrel chest Pursed-lip breathing Prolonged expiration Use of accessory muscles R-sided Heart Failure Pulmonary HPN Spontaneous pneumothorax Chronic Bronchitis Cyanosis (Blue) Edematous Exertional dyspnea Recurrent cough w/ Sputum production Digital clubbing Respiratory rate Use of accessory muscles R-sided Heart Failure Cor pulmonale

11. Chronic Obstructive Pulmonary Disease Management Rest:  O2 demand of tissues  Fluid intake: 3 L/day Diet:  calorie,  CHON,  CHO,  vit. C Low-flow O2 therapy: 1-3 LPM Breathing exercises [pursed-lip] Avoid cigarette smoking, alcohol, pollutants CPT: postural drainage  percussion  vibration Bronchial hygiene measures: steam, aerosol, medimist inhalation Pharmacotherapy: Antitussives, bronchodilators, antihistamine, steroids, antimicrobials [email_address] respi disorders

12. Chronic Obstructive Pulmonary Disease Bronchiectasis Destruction of bronchial mucosa with fibrous scar tissue formation  Loss of resilience & airway dilation causes pooling of secretions  Obstruction of airflow [email_address] respi disorders

13. Chronic Obstructive Pulmonary Disease [email_address] respi disorders Asthma ALLERGY (Extrinsic) INFLAMMATION (Intrinsic) Bronchospasm Mucosal edema Hypersecretion of mucus Histamine, Bradykinin, PG, Serotonin, Leukotrienes… Narrowing of AWs,  work of breathing Hypoxia & Respiratory Acidosis Respiratory effort Exhaustion Hypoventilation Air trapping

14. Chronic Obstructive Pulmonary Disease Clinical Manifestations Orthopnea Restlessness Dyspnea, tachypnea Tachycardia Nasal flaring Retractions Cough Chest tightness Cold clammy skin Wheezing Cyanosis [email_address] respi disorders Asthma Management Pharmacotherapy Beta agonists [Epinephrine, Terbutaline] Methylxanthines [Aminophylline] Corticosteroids Anticholinergics [Atropine] Mast cell inhibitors [Cromolyn] Oxygen via nasal cannula Fluids to 3L/day Breathing exercises Metered dose inhaler

15. Acute Respiratory Distress Syndrome Clinical syndrome of respiratory insufficiency Damaged capillary membranes Interstitial edema Intraalveolar hemorrhage Hypoxemia Causes Viral pneumonia Fat emboli Sepsis Decreased surfactant production [email_address] respi disorders

16. Acute Respiratory Distress Syndrome [email_address] respi disorders

17. Acute Respiratory Distress Syndrome [email_address] respi disorders Clinical Manifestations Dyspnea Tachypnea Crackles Rhonchi Anxiety  Breath sounds Management Intubation & mechanical ventilation using PEEP Pharmacotherapy Antibiotics Analgesics Steroids Neuromuscular blocking agents Diagnostics ABGs: Respiratory acidosis, hypoxemia CXR: interstitial edema

18. Chest Physiotherapy Postural drainage  Percussion  Vibration Nursing Care Perform before or 3-4 hrs after meal Bronchodilators 15-20 mins before Remove all tight clothing Percuss on area approx 3mins during I & E Vibrate on area during E Assist pt in coughing & positioning Provide good oral hygiene [email_address] respi disorders

19. Chest Physiotherapy Postural Drainage [email_address] respi disorders

20. Pulmonary Tuberculosis Airborne, infectious, communicable Acute or chronic Mycobacterium tuberculosis Clinical Manifestations Fatigue, malaise Anorexia, weight loss Night sweats Late afternoon low-grade fever Productive chronic cough Hemoptysis (advanced) [email_address] respi disorders

21. Pulmonary Tuberculosis Diagnostics Mantoux test Read after 48-72 H [>10 mm induration] Chest x-ray Calcified lesions Sputum exam Acid-fast bacillus [email_address] respi disorders Management TB medications [6-12 mos] INH, RIF, (6 mos); PZA, ethambutol, streptomycin (2 mos) Pt non-infectious 2-3wks of Tx 9 mos continuous therapy R IF : discoloration ; hepatotoxic I NH : peripheral neuropathy (B6), liver function test (AST, ALT) P ZA : thrombocytopenia, hyperurecemia -> ↑ OFI E THAMBUTOL : optic neuritis S TREPTOMYCIN : hepatotoxic, nephrotoxic, ototoxic, given IM

22. Pleural Effusion & Pneumothorax Causes Trauma Thoracic surgery Positive pressure ventilation Thoracentesis CVP line insertion Emphysema [email_address] respi disorders

23. Pleural Effusion & Pneumothorax Clinical Manifestations Sudden sharp chest pain Shortness of breath (SOB) Restlessness/anxiety Tachycardia, tachypnea Diminished/absent BS Chest asymmetry Tracheal deviation towards unaffected side Tympany [email_address] respi disorders Management High-Fowler’s Pain relief O2 therapy Chest tube insertion Thoracentesis Chest x-ray ABGs Monitor for shock

24. Pulmonary Embolism Undissolved substance in pulmonary vasculature obstructs blood flow Types : F at, A ir, T hrombus Causes Flat or long bone fractures Thrombophlebitis Venous stasis [email_address] respi disorders

25. Pulmonary Embolism Clinical Manifestations Dyspnea, tachypnea, crackles Diagnostics ABGs Respiratory alkalosis, hypoxemia Lung Scan  Pulmonary circulation & blood flow obstruction Angiography Location of embolus Filling defect of pulmonary artery [email_address] respi disorders

26. Pulmonary Embolism Management Intubation & mechanical ventilation Anticoagulants Thrombolytics Assess for (+) Homan’s sign Monitor PT & PTT WOF S/S of excessive anticoagulation [email_address] respi disorders

27. Bronchogenic Carcinoma Primary pulmonary tumors arising from bronchial epithelium; metastasis primarily by direct extension, via the circulatory or the lymphatic systems Incidence Men > 40 years; 1 out of 10 heavy smokers Right lung > Left lung Etiology Inhaled carcinogens [cigarette smoke, asbestos, nickel, iron oxides] Pre-existing pulmonary DO [COPD, TB] [email_address] respi disorders

28. Bronchogenic Carcinoma Clinical Manifestations Persistent cough [productive, blood-tinged] Chest pain, dyspnea Unilateral wheezing Friction rub Fatigue, anorexia Nausea & vomiting Pallor [email_address] respi disorders Diagnostics CXR Presence of tumor; metastasis Sputum for cytology Malignant cells Thoracentesis Pleural fluid with malignant cells

29. Bronchogenic Carcinoma Management Depends on cell type, stage of disease, and condition of the patient Radiation therapy Chemotherapy Surgery Provide support & guidance to client Relief/control of pain and nausea Meds as ordered, monitor effects [email_address] respi disorders

30. Lung Cancer Maybe metastatic or primary Leading cause of mortality Smoking-related Poor prognosis Dies in 5 years Adenocarcinoma Most prevalent type Small cell carcinoma Poorest prognosis [email_address] respi disorders

31. Laryngeal Carcinoma Types Glottic Hoarseness for >2 weeks Dyspnea Supraglottic Localized throat pain Burning when drinking hot liquids or orange juice Lump in the neck Dysphagia, odynophagia [email_address] respi disorders Risk Factors Cigarette smoking Chronic laryngitis Vocal abuse Alcohol abuse Familial tendency

32. Laryngeal Carcinoma Management Subtotal laryngectomy: retains voice Total: absolute loss of voice Tracheostomy: temporary or permanent Maintain patent airway HOB elevated 45º Assist patient in communicating; provide writing materials, etc. Practice swallowing Cover tracheostomy with porous material Avoid powder, spray, aerosol near trachea [email_address] respi disorders

33. Respiratory Disorders Nio C. Noveno, RN ,MAN THANK YOU!