RESPIRATORY DISORDERS

1. MEDICAL SURGICAL NURSING
LOWER
RESPIRATORY
TRACT INFECTIONS
PNEUMONIA
BY NATIJUKA
ANDREW
15/BSU/BNS/016
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NEWSON:0775570748/0754755068

2. Review of Lung Anatomy
RU
L
RM
L
RL
L
LUL
LLL
Lingula
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3. 10/28/18 3
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4. Pneumonia
• 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 place the patient at risk for
• microbial invasion.
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5. Classification
• Pneumonia is classified into four:
community-acquired
• pneumonia (CAP) and hospital-
acquired pneumonia
• (HAP), pneumonia in the
immunocompromised host
• ,and aspirationpneumonia.
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6. Community-Acquired Pneumonia
• CAP occurs either in the community setting or within
• the first 48 hours after hospitalization.
• The causative agents for CAP that needs
hospitalization include streptococcus pneumoniae, H.
influenza, Legionella, and Pseudomonas
aeruginosa.
• Only in 50% of the cases does the specific etiologic
• agent become identified.
• Pneumonia is the most common cause of CAP in
people younger than 60 years of age.
• Viruses are the most common cause of pneumonia in
infants and children.
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7. Hospital-Acquired Pneumonia
• HAP is also called nosocomial pneumonia and is defined as
• the onset of pneumonia symptoms more than 48 hours
• after admission in patients with no evidence of infection at
• the time of admission.
• HAP is the most lethal nosocomial infection and the
• leading cause of death in patients with such infections.
• Common microorganisms that are responsible for HAP
• include Enterobacter species, Escherichia
• coli,influenza, Klebsiella species, Proteus, Serratia
• marcescens, S. aureus, and S. pneumonia.
• The usual presentation of HAP is a new pulmonary
• infiltrate on chest x-ray combined with evidence of infection.
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8. Pneumonia in the
Immunocompromised Host
• Pneumonia in immunocompromised hosts includes
• Pneumocystis pneumonia, fungal pneumonias and
• Mycobacterium tuberculosis.
• Patients who are immunocompromised commonly
• develop pneumonia from organisms of low
• virulence.
• Pneumonia in immunocompromised hosts may be
• caused by the organisms also observe in HAP and
• CAP.
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9. Pathophysiology
• Pneumonia arises from normal flora present in
• patients whose resistance has been altered or from
• aspiration of flora present in the oropharynx.
• An inflammatory reaction may occur in the alveoli,
• producing exudates that interfere with
• the diffusion of oxygen and carbon dioxide.
• White blood cells also migrate into the alveoli and fill the
• normally air-filled spacesDue to secretions and mucosal
• edema, there are areas of the lung that are not adequately
ventilated and cause partial occlusion of the alveoli or bronchi.
• Hypoventilation may follow, causing ventilation-perfusion
mismatch.
• Venous blood entering the pulmonary circulation passes through
the under ventilated areas and travels to the left side of the
heart deoxygenated.
• The mixing of oxygenated and poorly oxygenated blood can
result to arterial hypoxemia.
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10. k
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11. Epidemiology
• Pneumonia has affected a lot of people, especially those
• who have a weak immune system. Learning statistics on
• pneumonia could give you an idea about how many has
• fallen victim to this respiratory disease.
• Pneumonia and influenza account for nearly 60,000
• deaths annually.
• Pneumonia also ranks as the eighth leading cause of
• death in the United States.
• It is estimated that more than 915, 000 episodes of CAP
• occur in adults 65 years old and above in the United States.
• HAP accounts for 15% of hospital-acquired infections and is
• the leading cause of death in patients with such infections
• The estimated incidence of HAP 4 to 7 episodes per 1000
• hospitalizations.
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12. Causes
• Community-Acquired
• Pneumonia
• Streptococcus pneumoniae. This is the leading
• cause of CAP in people younger than 60 years of
• age
• without comorbidity and in those 60 years and
• older
• with comorbidity.
• Haemophilus influenzae. This causes a type of CAP
that frequently affects elderly people and those with
comorbid illnesses.
• Mycoplasma pneumoniae.
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13. Hospital-Acquired
Pneumonia
• Staphylococcus aureus. Staphylococcus pneumonia
• occurs through inhalation of the organism.
• Impaired host defenses. When the defenses of the
• body are down, several pathogens may invade the
• body.
• Comorbid conditions. There are several conditions
• that lower the immune system, causing bacteria to
• pool in the lungs and eventually result in pneumonia.
• Supine positioning. When the patient stays in a
• prolonged supine position, fluid in the lungs pools
• down and stays stagnant, making it a breeding place
• for bacteria.
• Prolonged hospitalization. The risk for hospital
infections or nosocomial infections increases the longer
the patient stays in the hospital.
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14. Common Bugs for Pneumonia
Community-Acquired
• Streptococcus pneumoniae
• Mycoplasma pneumoniae
• Chlamydophila psittaci or
pneumoniae
• Legionella pneumophila
• Haemophilus influenzae
• Moraxella catarrhalis
• Staphylococcus aureus
• Nocardia
• Mycobacterium tuberculosis
• Influenza
• RSV
• CMV
• Histoplasma, Coccidioides,
Blastomycosis
HCAP or HAP
• Pseudomonas aeruginosa
• Staphylococcus aureus
(Including MRSA)
• Klebsiella pneumoniae
• Serratia marcescens
• Acinetobacter baumanii
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15. CLINICAL MANIFESTATIONS
OF PNEUMONIA
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16. Clinical Manifestations
• Rapidly rising fever. Since there is inflammation of the
lung parenchyma, fever develops as part of the signs of
an infection.
• Pleuritic chest pain. Deep breathing and coughing
• aggravate the pain in the chest.
• Rapid and bounding pulse. A rapid heartbeat occurs
• because the body compensates for the low concentration
• of oxygen in the body.
• Tachypnea. There is fast breathing because the body
• tries to compensate for the low oxygen concentration in
• the body.
• Purulent sputum. The sputum becomes purulent
• because of the infection in the lung parenchyma which
• produced sputum-filled with pus.
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17. Prevention
• Pneumococcal vaccine. This
• vaccine can prevent
• pneumonia in healthy patients with an efficiency of
• 65% to 85%.
• Staff education. To help prevent HAP, the CDC (2004)
• encouraged staff education and involvement in infection
• prevention.
• Infection and microbiologic surveillance. It is
• important to carefully observe the infection so that
• there could be an appropriate application of prevention
• techniques.
• Modifying host risk for infection. The infection
• should never be allowed to descend on any host, so the
• risk must be decreased before it can affect one.
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18. Complications
• Shock and respiratory failure. These complications
• are encountered chiefly in patients who have received
• no specific treatment and inadequate or delayed
• treatment.
• Pleural effusion. In pleural effusion, the fluid is
• sent to the laboratory for analysis, and there are three
• stages: uncomplicated, complicated, and thoracic
empyema.
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19. 10/28/18 19
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20. Assessment and Diagnostic
Findings
• Assessment and diagnosis of pneumonia must be
.accurate since there are a lot of respiratory problems
• that have similar manifestations. The following are
assessments and diagnostic tests that could determine
pneumonia.
• History taking. The diagnosis of pneumonia is made through
history taking, particularly a recent respiratory tract infection.
• Physical examination. Mainly, the number of breaths
• per minute and breath sounds is assessed during physical
examination.
• Chest x-ray. Identifies structural distribution (e.g., lobar,
bronchial); may also reveal multiple
• abscesses/infiltrates, empyema (staphylococcus);
• scattered or localized infiltration (bacterial); or
diffuse/extensive nodular infiltrates (more often viral).
• In mycoplasmal pneumonia, chest x-ray may be clear.
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21. n• Fiberoptic bronchoscopy. May be both diagnostic
• (qualitative cultures) and therapeutic (re-expansion
• of lung segment).
• ABGs/pulse oximetry. Abnormalities may be
• present, depending on extent of lung involvement
• and underlying lung disease.
• Gram stain/cultures. Sputum collection; needle
• aspiration of empyema, pleural, and transtracheal or
• transthoracic fluids; lung biopsies and blood cultures
• may be done to recover causative organism. More
• than one type of organism may be present; common
• bacteria include Diplococcus pneumoniae
• , Staphylococcus aureus, a-hemolytic streptococcus,
• Haemophilus influenzae; cytomegalovirus(CMV).
• Note: Sputum cultures may not identify all offending
• organisms. Blood cultures may show transient
• bacteremia.
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22. i• CBC. Leukocytosis usually present, although a low white
• blood cell (WBC) count may be present in viral infection,
• immunosuppressed conditions such as AIDS, and
• overwhelming bacterial pneumonia. Erythrocyte
• sedimentation rate (ESR) is elevated.
• Serologic studies, e.g., viral or Legionella titers,
• cold agglutinins. Assist in differential diagnosis of
• specific organism.
• Pulmonary function studies. Volumes may be
• decreased (congestion and alveolar collapse); airway
• pressure may be increased and compliance decreased.
• Shunting is present (hypoxemia).
• Electrolytes. Sodium and chloride levels may be low.
• Bilirubin. May be increased.
• Percutaneous aspiration/open biopsy of lung
• tissues. May reveal typical intranuclear and cytoplasmic
• inclusions (CMV), characteristic giant cells (rubeola).
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23. Medical Management
• The management of pneumonia centers is a step-by-
• step process that zeroes on the treatment of the
• infection through identification of the causative agent.
• Blood culture. Blood culture is performed for
• identification of the causal pathogen and prompt
• administration of antibiotics in patients in whom CAP is
strongly suspected.
• Administration of macrolides. Macrolides are
• recommended for people with drug-resistant S.
pneumoniae.
• Hydration is an important part of the regimen because
• fever and tachypnea may result in insensible fluid
losses.
• Administration of antipyretics. Antipyretics are used
• to treat fever and headache.
• Administration of antitussives. Antitussives are
• used for treatment of the associated cough.
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24. r
• Bed rest. Complete rest is prescribed until signs of
• infection are diminished.
• Oxygen administration. Oxygen can be given if
• hypoxemia develops.
• Pulse oximetry. Pulse oximetry is used to determine
• the need for oxygen and to evaluate the effectiveness
• of the therapy.
• Aggressive respiratory measures. Other measures
• include administration of high concentrations of
• oxygen, endotracheal intubation, and mechanical
• ventilation
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25. Nursing Management
• Nurses are expected to perform both
dependent and
• independent functions for the patient
to aid him or her
• towards the restoration of their well-
being.
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26. Nursing Assessment
• Nursing assessment is critical in detecting pneumonia.
• Assess respiratory symptoms. Symptoms of fever,
• chills, or night sweats in a patient should be reported
• immediately to the nurse as these can be signs of
• bacterial pneumonia.
• Assess clinical manifestations. Respiratory
• assessment should further identify clinical
• manifestations such as pleuritic pain, bradycardia
• , tachypnea, and fatigue, use of accessory muscles for
breathing, coughing, and purulent sputum.
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27. l
• Physical assessment. Assess the changes in
temperature and pulse; amount, odor, and color of
secretions; frequency and severity of cough; degree of
tachypnea or shortness of breath; and changes in the
chest x-ray findings.
• Assessment in elderly patients. Assess elderly
• patients for altered mental status, dehydration,
• unusual behavior, excessive fatigue, and
• concomitant heart failure
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28. NURSING CARE PLAN
DIAGNOSIS GOALS INTERVENTI
ON
RATIONALE EVALUATION
1 Impaired
gaseous
exchange RT
ventilation
perfusion
imbalance EB
dyspnea,restless
ness.
2. Deficient
fluid volume RT
compromised
regulatory
mechanism EB
decreased BP,
dry skin.
1.To improve
gaseous
exchange in
15minutes
2.To improve
airway patency
in 3hours
3.To maintain
fluid balance in
2days.
1.Put patient in
SEMI-
FOWLERS
position to
promote rest and
breathing
2.To increase
fluid intake at
least 2L per day
1.To enhance
clearanc,pulmon
ary ventilation
and perfusion.
2.To replace
insensible fluid
loss.
1.Improved
airway patency
and gaseous
exchange after
4hours.
2.Maintained
adequate
hydration by
2days.
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29. Discharge and Home Care
Guidelines
• Patient education is crucial regardless of the setting
• because self-care is essential in achieving a patient’s
well-being.
• Oral antibiotics. Teach the patient about the proper
• administration, potential side effects, and symptoms to
report.
• Breathing exercises. Teach the patient breathing
• exercises to promote secretion clearance and volume
expansion.
• Follow-up check up. Strict compliance to follow-up
• checkups is important to check the latest chest x-ray
• result or physical examination findings.
• Smoking cessation. Smoking should be stopped
because it inhibits tracheobronchial ciliary action and
irritates the mucous cells of the bronchi.
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30. THANKS FOR LISTENING
BUT HAVE YOU RECEIVED
JESUS CHRIST AS YOUR
SAVIOR?,IF NOT REPENT
NOW .
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31. PNEUMOTHORAX
Presented by : TAYEBWA NOBERT
( 16/BSU/BNS/024)
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32. Tension pneumothorax
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33. Definition;
A pneumothorax is a pathological condition in
which air collects in the pleural space
( between the visceral pleura and parietal
pleura).The air pushes on the outside of your
lung and makes it collapse but in most cases
only a portion of the lung collapses.
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34. Examples of pneumothoraces
Spontaneous pneumothorax( primary and
secondary)
Tension pneumothorax
Closed pneumothorax
Open pneumothorax
Traumatic pneumothorax
Catamenial pneumothorax
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35. Definitions;
• Primary pneumothorax : occurs without an apparent cause and in
the absence of a significant lung disease whereas a secondary
pneumothorax occurs in the presence of an existing lung pathology.
• Traumatic pneumothorax: here the chest wall is pierced as is the
case in gunshot and stab wounds,it occurs in up to a half of all cases
of chest trauma with rib fractures being common in this group
• Catamenial pneumothorax accumulation of air in the pleural cavity
of women in reproductive age without concomitant respiratory
diseases. Women with this condition have recurrent episodes of
pneumothorax that occur within 72 hours before and after the start
of menstraution.
• Tension pneumothorax : air accumulates in the pleural cavity and
does not get out , compresses the lung causing it to collapse
,mediastinal shift and cardiopulmonary dysfunction can result
from this type of pneumothorax.
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36. Definitions continued;
• Closed pneumothorax: here the chest wall is
intact and the most common cause is a rib
fracture that punctures a lung,releasing air
into the pleural space.
• Open pneumothorax: chest wall is open due
to a penetrating trauma such as gunshot or
stab wound.
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37. Causes;
• Chest injury such as car crashes , physical assaults,
• Therapeutic medical procedures like needle aspiration
of fluid from the pleural space, a lung biopsy or
insertion of a large intravenous catheter into a vein
near the neck.
• Lung diseases like cystic fibrosis , lung cancer ,
pneumonia , tuberculosis and chronic obstructive
pulmonary disease.
• Opportunistic infections of the lungs especially those
caused by Pneumocystis jirovecii common in AIDS
patients.
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38. Causes cont’d
• Ruptured air blisters (blebs)_these form on
the surface of the lung and when they rupture
air is allowed to leak into the space that
surrounds the lungs
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39. Predisposing factors;
• height, in people who are tall the shape of the
lungs makes them susceptible to a
pneumothorax.
• Genetics, at times pneumothorax runs among the
family members
• A history of a pneumothorax especially between
one to two years of the first episode
• Lung diseases
• Mechanical ventilation
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40. Signs and symptoms ;
• Stabbing chest pain which radiates to the ipsilateral shoulder and
increases with inspiration.
• Tightness in the chest
• Jugular vein distention(especially in tension pneumpthorax)
• Respiratory distress
• Fast heart rate
• Low blood pressure especially in tension pneumothorax
• Cyanosis due to decreased blood oxygen levels
• Hyperresonance on percussion ( a rare finding)
• Coughing
• Shortness of breath
• Malaise( less common)
• anxiety
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41. pathophysiology
• In a healthy person the intra pleural pressure
is normally negative( less than the
atmospheric pressure).Intra pleural and extra
pleural injury causes air to leak into the
pleural space.when air accumulates in the
pleural cavity it presses against the lung
causing it to collapse.In most cases only a
portion of the lung collapses
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42. Medical management;
• Acetaminophen or other anti-inflamatory agents such as
ibuprofen to control pain
• Codein based cough syrups to control coughing
• Thoracotomy : Surgery to attach the lung to chest
wall,remove blebs or areas of scarring.
• Insertion of a chest tube to remove excess air , fluid or pus
around the lung
• Oxygen therapy: patients with tension pneumothorax
should immediately be given a high concentration of
supplemental oxygen to treat hypoxemia.
• Pleurodesis : a medical procedure in which the pleural
space is artificially obliterated ,and the two pleura adhered
to each other
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43. Nursing management;
• It includes the following steps: nursing
assessment, nursing diagnosis,nursing care
plan and goals ,interventions and evaluation
• Assessment:the nurse assess the patient for
tracheal alignment,expansion of the
chest,breath sounds
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44. Nursing care plan:DIAGNOSIS
Ineffective
breathing
pattern
related to
respiratory
distress
evidenced by
use of
accessory
muscles
GOAL
To establish a
normal and
effective
respiratory
pattern in 30
minutes
INTERVENTION
Instruct the
patient to
inhale and
strain against
the closed
glottis,to
expand the
lung and eject
air from the
thorax
RATIONALE
Maintain an
adequate
breathing
pattern
EVALUATION
Patient was able to
maintain an effective
breathing pattern
Ineffective
peripheral
tissue
perfusion
related to
severe
hypoxemia
evidenced by
cyanosis
To improve
peripheral
tissue
perfusion in 1
hour
Administer a
recommended
amount of
oxygen
Eliminate
cyanosis and
increase blood
oxygen levels
Patient’s skin was not
cyanosed after 1 hour
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45. Discharge and home care guidelines;
Care of the patient at home should include;
Asepsis : the site of incision should be handled using an
aseptic technique to avoid occurrence of infection.
Medications; the patient should take the prescribed
drugs ( antibiotics and analgesics)
Activity : patient should alternate rest and activity to
avoid over exhaustion and difficulty in breathing
Follow up :patient should attend follow up appointments
so that the physician assesses the surgical site and the
state of the respiratory system.
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46. HEMOTHORAX
Course unit :Medical Surgical Nursing
Presented by :TAYEBWA NOBERT
16/BSU/BNS/024
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47. Pneumothorax
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48. Definition;
It is the collection of blood between the chest
wall and the lungs (pleural cavity).This can
eventually make your lung collapse as the
blood pushes on the outside of the lung .It
usually occurs with pneumothorax in which
case it is termed as hemopneumothorax .
Many of its causes are similar to those of
pneumothorax.
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49. Causes;
Chest injuries or surgeries that include opening of the
chest wall.
Blurnt or penetrating chest trauma
Cancerous tumours in the chest wall.
Blood clotting defects
Lung cancer and pleural cancer.
Death of tissue around your lungs( pulmonary infarction).
Iatrogenically induced forexample during insertion of a
central venous catheter
tuberculosis
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50. Predisposing factors
Pleural cancer
Lung diseases(COPD’s)
Injury/trauma
Chest surgery
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51. pathophysiology
• A hemothorax occurs following extra pleural
or intra pleural injury that disrupts the tissues
of the chest wall , pleura or even intrathoracic
structures .This leads to leakage of blood into
the pleural cavity where it accumulates
,presses against the lung and causes it to
collapse .A physiologic resopnse occurs
following a hemothorax and includes both
hemodynamic and respiratory responses.
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52. Pathophysiology cont’d
• In a hemodynamic response loss of 750-1500 ml
will cause early symptoms of shock (tachycardia ,
tachypnea and a decrease in pulse pressure )
• .In a respiratory response accumulation of blood
may hamper normal respiratory movement and
oxygenation, something that can cause
respiratory dysfunction/arrest.
• NB: When blood remains in the pleural cavity for
a long time an infection called
empyema/pyothorax may occur.It involves
infection of the fluid around the lungs.
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53. Signs and symptoms
Dull resonance on percussion
Tachycardia
Cyanosis
Hypotension
Pale,cool,clamy skin
Fast heart rate
Restlessnes
Anxiety.
Unequal chest rise
Decreased chest expansion
Acute pain or feeling of heaviness in the chest
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54. Medical management
Draining of the blood using a thoracotomy tube
Use of numbing agents and sedatives before
inserting the chest tubes.
Administer pain relievers and anti-inflamatory
agents like ibuprofen,diclofenac etc.
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55. Nursing management
The nurse assesses the patient for;
Anxiety
Tachypnea
Bruising due to blurnt trauma
Hypotension
tachycardia
Breath sounds
Stupors
Restlessnes
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56. Concerns
• Ineffective breathing
Infection( empyema)
• Pain
• Anxiety
• Decreased cardiac output
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57. Care plan
DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION
Ineffective
breathing RT
build up of blood
in the pleural
cavity EB use of
accessory
muscles for
breathing.
Maintain an
effective
breathing pattern
in 30 minutes
Assist with chest
tube insertion if
indicated
Improve
ventilation
The patient’s
breathing pattern
normalised( patie
nt was nolonger
using accessory
muscles for
breathing)
Acute pain RT
positive pressure
in the pleural
cavity EB the
patient
verbalising a
sensation of pain
Reduce the pain
in 30 minutes
Administer
analgesics like
diclofenac
Relieve pain Patient
expressed
feelings of
reduced pain and
comfort
Risk for infection Patient should Insert a chest Eliminate Vital signs
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58. CORYZA
Presented by
Name:Agaba Dickson
Reg no:16/BSU/BNS/001
Course unit: Medical-surgical nursing
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59. Objectives
• By the end of this session, we should all be
able to;
Define coryza
Know the
causes,transmission,pathophysiology,signs
and symptoms plus the medical and nursing
management of coryza
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60. Introduction
Coryza also known as common
cold,nasopharyngitis,rhinopharyngiti
s,head cold or simply cold
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61. Definition
• Coryza is a viral infectious disease of the
upper respiratory tract involving the
inflammation of the mucous membranes in
the nose
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62. Causes and transmission
• Is a viral infection and the most commonly implicated
virus is rhino virus(30-80%),others include human corona
virus (~15%),influenza viruses(10-15%)and
adenoviruses(5%).Frequently more than one virus is
present
• Transmission is typically via airborne droplets(aerosals)
• Direct contact with infected nasal secretions or for mites
that are contaminated or person to person.
• The viruses may survive for prolonged periods in the
environment for over 18 hours for rhinoviruses and can
be picked up by peoples hands and subsequently carried
to their eyes or nose where infection occurs.
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63. Predisposing factors
• Weather-traditional folk theory states that a cold
can be caught by prolonged exposure to cold
weather such as rain or winter conditions and
this is how the disease got its name –More
viruses causing this are seasonal and occur more
frequently during cold or wet weather
• Immunosupressed patients
• Social factors like people staying in over crowded
areas like day care centers, school going children
and frequently poor hygienic areas.
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64. Pathopysiology of coryza
• The symptoms of the common cold are believed to
be primarily related to the immune response to the
virus .The mechanism of this immune response is
virus specific for example the rhino virus which is
typically acquired by direct contact; it binds to
human ICAM-1 receptors or CD 54 receptors
through unknown mechanisms to trigger the release
of inflammatory mediators
• These inflammatory mediators may bring about local
inflammation and cytokines may be responsible for
the symptoms of common cold.
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65. Continuation
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66. Clinical presentation of coryza
The most frequent symptoms are:
• Nasal discharge(runny nose)
• Nasal obstruction
• Sneezing
• Sore throat
• General malaise and cough
• Hoarseness, loss of taste and smell, mild
burning of the eyes and a feeling of pressure
in the ears or sinuses
• There may be a mild increase in body
temperature most especially infants and10/28/18 66
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67. Continuation
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68. Differential diagnosis
• ADULTS
• Allergic rhinitis: Nasal itching, sneezing watery
rhinorrhoea and nasal obstruction but often
accompanied by itchy and watery eyes.
• Non allergic rhinitis: presents with chronic
nasal symptoms.
• Influenza; initially presents with systemic
symptoms including
fever,rigors,headaches,myalgia,malaise and
anorexia
• Pharyngitis:Symptoms are more severe than10/28/18 68
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69. Children
• Consider a foreign body in the nose. The
discharge is unilateral,purulent,foul-smelling
and blood stained.
• Infants :Consider the possibility of a more
serious condition eg meningitis,septicaemia
and pneumonia.
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70. Medical management
• There are no drugs of proven benefit for the
prophylaxis or treatment of coryza
• Medical management is centered around
providing symptomatic relief and placebo effects
• 1-Nasal drops(Nacl 0.9%)for nasal congestion.
These may be useful for infants who are having
difficulty feeding.
• Over the counter
analgesia(paracetamol,ibuprofen)which may be
useful for sore throats, headaches and increased
temperatures.
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71. Nursing management
• Nursing concerns
• Anxiety
• Fluid volume deficit
• Imbalanced nutrition less than body
requirements due to loss of appetite
• Hyperthermia
• Infection spread
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72. Nursing care plan
Diagnosis goal Intervention Rationale Evaluation
1.Ineffectiveair
way clearance
due to nasal
congestion
To maintain a
clear airway
Assess
respiratory
status for
rate,depth,eas
e,use of
accessory
muscles and
work of
breathing
Changes may
vary minimal to
extreme
caused by
bronchial
swelling,
increased
mucus
secretions
hence
complicating
the current
condition
Patient will
achieve the
return of and
ability to
maintain
patent airways
and respiratory
status
baselines.
2.Deficient
fluid volume
RT
Decreased oral
To hydrate the
patient and
achieve the
body's fluid
Encourage
fluids up to 3-4
l/day
Provides
hydration and
helps to thin
secretions for
Imprisonment
will be noticed
on increased
skin turgor with
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73. Nursing care plan continuation
Risk of
infection
spread since
coryza is highly
infectious
To avoid
spread from
one person to
another.
Instruct
patient/family
to avoid
crowds and
persons with
common cold
when possible
Prevents
possible
transmission of
an infection to
the patient
who is already
immunocompr
omised
No spread of
an infection
Expressed
concerns about
changes in life
events and fear
of unspecified
consequences.
To reduce on
patients
anxiety and
copying
patterns
Assisting the
patient in
developing
new anxiety
reducing skills
like relaxation,
reassuring self
statements.
Provides the
patient with a
variety of ways
to manage
anxiety.
Patients
demonstrates
improved
concentration
and accuracy of
thoughts.
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74. Other nursing general advice on
management of coryza
• Provide advice about the usual natural history of the
illness and its average total length which is 10 days
• Address any underlying concerns .Taking time to
educate people that coryza is a self limiting and have
no specific curative treatment, this may reduce anxiety
and prevent unnecessary visits to the doctor in future.
• Advise hygiene measures to reduce spread: frequent
handwashing,avoiding sharing towels and toys etc.
• Rest though no need to take time off school and work.
• Advise people to return if their symptoms are
worsening or if they have not improved in two weeks.
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75. Complications
• Complications are usually due to viral spread or
secondary bacterial infection and they are more
likely in-smokers-young children born
prematurely-elderly people and those with
significant comorbidity,particulary
asthma,copd,DM,Cystic fibrosis and those with
significant cardiac, renal or liver disease.
• Common complications include
• -otitis media,sinusitis,chest infections
:bronchiolitis in the very young, pneumonia and
exacerbations of COPD or asthma.
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76. Prognosis
• In the majority, the common cold is a mild, self-limiting
illness
• Usually lasts around a week in adults and 10-14 days in
children
• Cigarette smokers are likely to have a more severe and
more prolonged illness than non smokers
• People with COPD who have a rhino virus infection are
more likely to have a longer duration of illness, a more
severe illness and to cough for longer afterwards than
those without lung disease.
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77. References
• www.https://patient.info>doctor>common
cold as at 15th
/august/2018
• https://www.ncbi.nlm.nih.gov>articles.
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78. THANKS FOR LISTENING
BE BLESSED
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79. RHINITIS
By jemba hajarah 16/BSU/BNS/005
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80. • Rhinitis refers to the inflammation of the nasal
mucosa and it
can be classified as;
Acute rhinitis
Chronic rhinitis
Allergic rhinitis(hay fever)
Acute rhinitis is defined as having two of the listed
symptoms for less than
one day or for two weeks while chronic rhinitis lasts
up to more than two weeks
a. blockage
b. Running nose
c. Sneezing including nasal itch10/28/18 80
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81. • Allergic • Infective • Other • As part of
systemic
disorder
• Seasonal • Acute
• Chronic
• Idiopathic
• Nares (non
allergic rhinitis
with eosiphilia )
• Drug induced:
-beta-blockers
-oral
contraceptives
-aspirin
-NSAIDS
-local
decongestants
• Autonomic
(responds to
anticholinergics)
• Atrophic
• Neoplastic
• Primary defect
in mucus
• -Cystic
fibrosis
• -Young’s
syndrome
• Primary ciliary
dyskinesia(Karta
gener’s
syndrome)
 Immunological
-systemic
lupus
-rheumatoid
arthritis
 AIDS
 Antibody
deficiency
 Granulomatous
disease
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82. Severity • Mild
• normal sleep and
• no impairment of daily activities,
sport, leisure and no impairment of
work and school and
• no troublesome symptoms
•
• Moderate-Severe
• abnormal sleep or
• impairment of daily activities, sport,
leisure or
• impaired work and school or 
troublesome symptoms
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83. Risk factors
• Maternal smoking
• Living n areas of high population
• Higher socioeconomic status
• Exposure to indoor allergens as a child
• Early introduction of food or formula as an infant
• Genetics
• personal history of asthma
• Family history of asthma and eczem
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84. Pathophysiology of allergic rhinitis(hay
fever)
• Allergic rhinitis results from a hypersensitivity reaction to
allergen e.g. pollen, dust etc. prior to sensitization and it
tends to occur seasonally.
• On first exposure to an allergen, the body is said to be
sensitized, antigen presenting cells present the allergen
to a B cell and IgE antibodies a produced against it.
• On subsequent exposure, the formed IgE antibodies
cross link the allergen to mast cells and basophils causing
degranulation.
• Chemical dilators such as histamines are released which
cause the manifestations of rhinitis.
• They result in vasodilation hence there is increased
blood flow resulting in reddening of the mucosa and
swelling.10/28/18 84
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85. • Leaking of fluids into interstitial spaces resulting
in watery mucous running through the nose.
• If the mucosal inflammation is bad enough, it can
cause occlusion of the nasolacrimal duct so the
individual gets teary eyes, it can also cause fluid
backing up into the Eustachian tube causing
stuffiness.
• Irritation of the nerve endings in the nose causes
itchiness
• On auscultation, rhonchi can be heard due to air
passing over wet surfaces
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86. 10/28/18 86
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87. Acute and chronic rhinitis
• More than 200 strains of virus cause upper respiratory infections
including rhinovirus, adenoviruses, parainfluenza and corona virus.
• It can be spread by direct contact by coughing and sneezing and by
aerosolized droplet nuclei.
• The virus attaches to receptors on the cells of the upper respiratory
tract.
• Local immunologic defenses e.g. IgA attempt to inactivate the antigen.
• The nasal passages swell and become hyperemic and engorged.
• Mucus secreting glands become hyperactive. Viscous mucous
secretion in the upper respiratory tract trap invading organisms
preventing contamination of more vulnerable areas.
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88. Signs And Symptoms
• Clear runny nose and coughing
• Sneezing and nasal congestion
• Watery eyes
• Frequent clearing of the throat
• Stuffiness
• Erythematous mucous membranes
• Swelling
• Sore throat
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89. Systemic manifestations
• Low grade fever
• Head ache
• Malaise
• Muscle aches
Symptoms last for a few days up to weeks.
Its symptoms become mild and self limiting but its
effects on the immune system can result into
more serious bacterial infections such as sinusitis
and otitis media.
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90. Diagnosis
• The diagnosis is made through history taking
and performing a physical examination of the
nose.
• If bacterial infection is suspected, white blood
cell count maybe performed to rule out
leukocytosis.
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91. Medical management
• Since the condition is self limiting, medical treatment is
required only when complications arise but some times
medication to relieve symptoms and to shorten the
duration can be given.
• These include;
• Mild decongestants such as pseudoephedrine and
phenylephrine
• Nasal decongestants
• Antihistamines such as cetirizine and loratadine
• Aromatherapy with oils e.g. cedarwood and eucalyptus
• Complementary therapies such as garlic and Echinacea can
be given.
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92. Nursing management of symptoms
• Adequate rest
• Maintaining fluid intake
• Avoid chilling
• Avoiding allergen for allergic rhinitis.
• Vitamin supplements
• Advise to avoid crowds and to cover mouth and
nose with tissue to prevent spread of infection.
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93. concerns
• Headache
• Difficult breathing
• Swelling
• Anxiety
• Fever
• Imbalanced nutrition less than body
requirements due to loss of appetite
• Infection spread
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94. NURSING CARE PLAN
Diagnosis goal intervention rationale
1.Ineffective
airway clearance
related to
excessive mucus
as evidenced by
restlessness.
2. Risk for
infection related
to decrease in
ciliary action
3.Deficient fluid
volume
RT
Decreased oral
intake and runny
To establish a
clear air way
with in 50
minutes.
To prevent
infection
through out
period of the
condition.
Hydrate and
achieve body
fluid
requirement
Ask the patient
to assume a
semi sitting
posture .
Use mechanical
ventilation.
Encourage
adequate
nutrition
Encourage
It aids lung
expansion.
Increasing
oxygen supply.
Boost immunity
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95. EPISTAXIS
PRESENTATION BY ASIIMIRE
ALLION
16/BSU/BNS/003
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96. LEARNING OBJECTIVES
DEFINE EPISTAXIS
LIST CAUSES OF EPISTAXIS
PREDISPOSING FACTORS OF EPISTAXIS
PATHOPHYSIOLOGY
CATEGORIES OF EPISTAXIS
MANIFESTATIONS
DESCRIBE MANAGEMENT OF EPISTAXIS
NURSING CARE PLAN OF EPISTAXIS
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97. DEFINITION:
Refers to bleeding from the nostrils, nasal
cavity or nasal pharynx. Nosebleeds are due to
the bursting of blood vessels with in the nose.
This may be spontaneous or caused by trauma.
Nose bleeds are one of the most common
problems treated in an emergency department.
Nose bleeds can be a sign of an underlying
pathological disease such as hemorrhagic
fevers, Ebola etc. and therefore caution should
be taken when a patient comes in with nose
bleed.
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98. Local causes: these are the most common causes
• Nose picking/trauma
• Intranasal neoplasms
• Irritants like cigarette smoke
• Medications like topical corticosteroids
• Rhinitis, sinusitis,
• Septal deviation and septal perforation
SYSTEMIC CAUSES:
• Hematological disorders like hemophilia, leukemia,
platelet dysfunction and thrombocytopenia
• Hypertension
• Liver disease like cirrhosis
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99. PREDISPOSING FACTORS
• congestive heart failure
• Hypertension
• Diabetes mellitus
• Use of some medications like aspirin, NSAIDS etc.
• Atmospheric changes- high altitudes, dry climatic
conditions, cold weather are known to dry out the
nasal mucosa membranes leading to crusts which can
cause a nosebleed
• Smoking and alcoholism
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100. PATHOPHYSIOLOGY
 Bleeding typically occurs when the mucosa is eroded
and vessels become exposed and subsequently break.
 Bleeding can be classified as posterior and anterior
depending on the site of bleeding
Anterior nosebleed:
This is the most common, this arises from little's area
where the kiesselbach plexus forms on the septum. It
may also originate anterior the the inferior turbinate.
Posterior nosebleed:
These arise further back in the nasal cavity, are usually
more profuse and are often of arterial origin for
example from branches of the sphenopalatine artery in
the posterior nasal cavity.
A posterior source presents a greater risk of airway
compromise ,aspiration of blood, and greater difficulty
controlling bleeding.
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101. Cont.
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102. MANIFESTATIONS
• The most common manifestation is blood
loss from the nose,
Bleeding usually starts from one nostril. In case
of heavy bleeding it may fill up both the
nostrils and over flow the nasopharynx.
In certain cases blood may drip back from the
nose through the throat to the stomach, a
person is likely to vomit.
• Excess blood loss may cause:
 Dizziness
 Fainting
 Confusion loss of alertness
 Light headedness
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103. NURSING MANAGEMENT
• Nosebleed is a medical emergency, it should therefore
be attended to as quickly as possible and basic
protective wears should be used such as gloves to avoid
direct contact with the patient.
• Quickly assess the ABCs and support them as
indicated. Reassure the patient
• Have the patient sit upright with her head tilted
forward and instruct her to apply direct external digit
pressure to the nares with her index figure and the
thumb. Tell her to breathe through the mouth while
she holds firm pressure on the soft flesh of her nose for
at least 10 minutes. If bleeding persists, cotton pledgets
soaked in vasoconstrictor and anesthetic will be placed
in the anterior nasal cavity and direct pressure should
be applied at both sides of the nostrils
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104. Cont.
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105. Cont.
• Ensure bedside suction. Provide an emesis basin
and tissues. Tell her to spit blood into the basin if
necessary. This helps prevent nausea and
vomiting and lets you estimate the amount of
bleeding.
• Obtain vital signs and assess her breath sounds.
Administer supplemental oxygen through a
facemask if necessary.
• Assess for signs and symptoms of hemodynamic
instability including change in mental status,
pallor, diaphoresis, hypotension, tachycardia and
tachypnea.
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106. Cont.
• If bleeding is significant, establish vascular access, place
the patient on a cardiac monitor and begin fluid
resuscitation with a crystalloid solution as prescribed
• Obtain a focused health history, including previous
nosebleeds, other bleeding episodes, medicine use,
especially use of aspirin, NSAIDS, antiplatelet agent,
warfarin, and herbal products family history.
• If bleeding persists, assist in preparing an epistaxis tray
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107. MEDICAL MANAGEMENT
 Epistaxis is a medical emergency and there needs prior
attention.
 quickly asses the patient and take a focused history such
as trauma etc. in order to manage the patient carefully.
 Assess ABC’s and act accordingly
 Monitor vital signs especially blood pressure to rule out
hypertension
 Tell the patient to apply pressure by pinching the nose for
about 10-15 min in order to arrest hemorrhage while seated
upright and leaning forward.
 If bleeding persists, pack the nostrils with cotton
impregnated with phenylephrine solution.
 Do tests such as CBC to look out for platelet levels,
heamoglobin etc
 In severe blood loss establish an iv line and administer fluids.
 Refer patient to ENT specialist.
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108. CONT.
Management principles:
Although most patients with epistaxis can be treated as out
patients, hospital admission and close observation should be
considered for elderly and patients with posterior bleeding.
Admission may also be prudent for patients with complicating
conditions like severe hypertension or significant anemia.
Anterior epistaxis:
If a single anterior bleeding site is found, vasoconstriction is
attempted with topical application of phenylephrine solution.
For bleeding that is likely to require more aggressive treatment,
local anesthetic like 4%xylocaine solution should be used.
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109. cauterization
• Larger vessels generally respond more
rapidly to electro cautery. However it must
be performed with caution to avoid
excessive destruction of healthy surrounding
tissues.
• Use of electro cautery on both sides of the
septum may increase the risk of septal
perforation
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110. Anterior nasal packing
 Anterior nasal cavity should be packed from posterior
to anterior with ribbon gauze impregnated with
petroleum jelly. Bayonet forceps and a nasal speculum
are used to approximate the layers of the gauze which
should extend as far back into the nose as possible.
 Each layer should be pressed down firmly before the
next layer is inserted.
 Once the cavity has been packed so completely as
possible, a gauze drip pad may be taped over the
nostrils and changed periodically.
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111. cont.
Cont.
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112. Posterior epistaxis
 Much less common than anterior bleeding. Posterior
packing may be accomplished by passing a catheter
through one nostril(or both), through the nasal
pharynx, and out to the mouth.
 A gauze pack is then secured to the end of the Cather
and positioned in the posterior nasophyryx by pulling
back on the catheter until the pack is seated in the
posterior choana, sealing the posterior nasal passage
and applying pressure to the site of posterior bleeding.
 It requires special training and usually is performed by
an otolaryngologist
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113. Cont.
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114. Cont.
Packing is left in place for 48 to 72 hours
After the bleeding has been controlled,
instruct they patient to use nasal saline
spray and antibiotic ointment and to
avoid strenuous activities for 7-10 days
If packing does not control bleeding,
arterial embolism and other surgical
procedures may be required
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115. NURSING CARE PLAN
DIAGNOSIS GOAL INTERVENTION/RA
TIONALE
EVALUATION
Anxiety rt blood
loss from the
nostril eb patient
restlessness and
asking many
questions
To relieve anxiety Answer patients
questions and
explain to them
about the
pathology
Patient was calm
by end of dialogue.
Risk for deficient
fluid volume rt
active blood loss
through the nostril
To increase fluid
volume and reduce
fluid loss
Administer iv fluids
to increase blood
volume.
Arrest hemorrhage
to avoid blood loss
Hemostasis was
achieved
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116. Sinusitis
by
MUHINDO JULIAN
15/BSU/BNS/012
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117. Presentation Outline
• Classification
• Etiology
• Presentation and
Treatment
• Complications
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118. Paranasal sinuses
• Are four pairs of mucus lined hallow
spaces inside bones face and skull.
• Located n either sides f the nose as
follows.
 Frontal sinuses
 Ethemoid sinus
 Sphenidal sinus
 Maxillary sinus
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119. Functions of the sinuses
• Humidity and filters inhaled air-greatly
contributes to air filtration.
• Regulate pressure within the nose
• Contributes t immune defense
• Give raiseness to the voice
• Contributes to the facial growth.
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120. cont
• By producing half to one litre of mucus
per day into the nasal cavity.
• Cilia or tiny hair propel the mucus into
the meatus or canal of the nasal cavity
to the tiny openings called Ostia.
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121. Drainage
• Ethemiod and sphenoid sinuses they empty
the mucus into superior meatus.
• Maxillary and frontal sinuses empty the
mucus into middle meatus
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122. Rhino sinusitis/sinusitis
• Is the inflammation or swelling of one or more
paraansal sinuses
Causes of sinusitis
 Infections
 Allergy
 Irritants like pollens, tobacco smoke
,perfumes,household chemicals
 Anatomical obstruction e.g. deviated septum
e.g. nasal prolapse and nasal tumors,i.e
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123. Etiology
• Acute sinusitis in immunocompetent patients in
the community is almost always viral (eg,
rhinovirus, influenza, parainfluenza). A small
percentage develop secondary bacterial
infection with streptococci, pneumococci,
Haemophilus influenzae, Moraxella catarrhalis,
or staphylococci. Occasionally, a periapical
dental abscess of a maxillary tooth spreads to
the overlying sinus. Hospital-acquired acute
infections are more often bacterial, typically
involving Staphylococcus aureus, Klebsiella
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124. Chronic sinusitis
• involves many factors that combine to create
chronic inflammation. Chronic allergies,
structural abnormalities (eg, nasal polyps),
environmental irritants (eg, airborne pollution,
tobacco smoke), mucociliary dysfunction, and
other factors interact with infectious organisms
to cause chronic sinusitis.
• The organisms are commonly bacterial
(possibly as part of a biofilm on the mucosal
surface) but may be fungal. Many bacteria have
been implicated, including gram-negative bacilli
and oropharyngeal anaerobic microorganisms;
polymicrobial infection is common. In a few
cases, chronic maxillary sinusitis is secondary
to dental infection. Fungal infections
(Aspergillus, Sporothrix,
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125. Risk factors
• Common risk factors for sinusitis include
factors that obstruct normal sinus
drainage
• (eg, allergic rhinitis ;an allergic reaction
to substances such as dust, pollen, and
animal hair
• nasal polyps small growths in the nasal
passage that can lead to inflammation ;,
nasogastric or nasotracheal tubes), and
immunocompromised states (eg,
diabetes, HIV infection). Other factors
include prolonged ICU stays, severe
burns, cystic fibrosis, and ciliary
dyskinesia
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126. Complications
• The main complication of sinusitis is
local spread of bacterial infection,
causing periorbital or orbital
cellulitis, cavernous sinus
thrombosis, or epidural or brain
abscess.
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127. Signs and symptoms
• Facial pain or pressure or fullness
• Nasal congestion, discharges
• Diminished sense of smell
• Pyrexia
Minor symptoms
• Headache
• Halitosis
• Cough
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128. Pathophysiology
• In a URI, the swollen nasal mucous membrane
obstructs the ostium of a paranasal sinus, and
the oxygen in the sinus is absorbed into the) is
painful. If the vacuum is maintained, a
transudate from the mucous membrane
develops and fills the sinus; the transudate
serves as a medium for bacteria that enter the
sinus through the ostium or through a blood
vessels of the mucous membrane. The
resulting relative negative pressure in the sinus
(vacuum sinusitis spreading cellulitis or
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129. Patrick J. Lynch (Wikimedia
Comomns)
Paranasal Sinuses:
Anterior View
Frontal sinus
Ethmoidal air
cells
Maxillary sinus
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130. 1. Frontal
Sinuses
2. Ethmoid
Sinuses
(Ethmoidal
Air Cells)
3. Sphenoid
Sinuses
4. Maxillary
Sinuses
Location of
Sinuses
Patrick J. Lynch (Wikimedia
Comomns)
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131. 131
Patrick J. Lynch (Wikimedia
Comomns)
Frontal
sinus
Anterior
ethmoid air
cells
Maxillary
sinus
Middle
Meatus
Inferior
meatus
Frontal
sinus Posterior
ethmoid air
cells
Superior
turbinate
Sphenoid
sinus
Middle
turbinate
Inferior
turbinate
Maxillary
sinus
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132. Acute Sinusitis
Usual Clinical
Presentation• Symptoms progress over 2 to 3
days
• Nasal congestion & discharge
(usually thick & colored, not
clear)
• Localized pain +/- referred pain
• Tenderness or pressure sensation
over sinuses
• Headache
• Cough due to postnasal drip
• Halitosis 13210/28/18 132
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133. Usual aPhysical
Findings With Acute
Sinusitis• Erythematous edematous nasal
mucosa
• Purulent secretions in middle
meatal area
• May be absent if ostia
completely blocked
• Percussion tenderness
• Over the involved sinuses
• Over the maxillary molar +/-
premolar teeth
• Halitosis
• +/- fever
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134. Acute Sinusitis
Predisposing
Conditions (cont.)• Systemic
• Diabetes
• Immunocompromise
(AIDS)
• Malnutrition
• Blood dyscrasias
• Cystic fibrosis
• Chemotherapy
• Long term steroid Rx
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135. Pain Patterns with
Acute Sinusitis
• Maxillary sinusitis
• Unilateral pain over
cheekbone
• Maxillary toothache
• Periorbital pain
• Temporal headache
• Pain worse if head upright
• Pain better if head supine
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136. Pain Patterns with Acute
Sinusitis
(cont.)• Ethmoid sinusitis
• Medial canthal pain
• Medial periorbital or temporal
headache
• Pain worsened by Valsalva or
if supine
• Sphenoiditis
• Retroorbital, temporal, or
vertical headache
• Often deep seated headache
with multiple foci
• Pain worse supine or bending
forward
• Frontal
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137. 137
Patrick J. Lynch (Wikimedia
Comomns)
Frontal sinus
Ethmoidal
sinus
Maxillary
sinus
Paranasal sinuses and locations of referred pain
(shaded orange)
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138. medical
management
Acute Sinusitis
Use of
Cultures
• Routine culture of nasal
secretions not useful
• Poor correlation between non-
directed nasal or
nasopharyngeal culture isolates
& sinus aspirate cultures
• Sinus aspirate cultures useful
only for protracted or
nonresponsive sinusitis
• Require endoscopy or needle
puncture of sinus
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139. General Treatment
for
Acute Sinusitis
• Oral antibiotic
• Topical and systemic
decongestants
• Pain medications
• Optional or secondary
medications:
• Guaifenesin (1200 mg po
q 12h)
• warm nasal saline
irrigations qid
• Antihistamine orally : only
in the small % of patients
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140. First - Line Antibiotic
Therapy
for Acute Sinusitis
• Treatment duration should be 10
to 14 days (one recent study
indicated 3 days may be OK)
• Amoxicillin 500 mg po q 8 h
• Augmentin 500 mg po q 8 h
• Trimethoprim / Sulfamethoxazole
DS one po bid
• Azithromycin 500 mg po then 250
mg po q d x4
• Pediazole (Erythromycin -
sulfisoxazole) QID may be best14010/28/18 140
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141. Antibiotic Therapy in Acute
Sinusitis
if Staph. aureus is
suspected
• Also useful if patient fails
Rx with antibiotics on
previous slide
• Cefuroxime axetil 500 mg
po q 12h
• Cefprozil 500 mg po q 12h
• Cefpodoxime 200 mg po
12h
• Loracarbef 400 mg po q
12h
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142. Use of Topical
Decongestants for Rx
of Acute Sinusitus• Ephedrine sulfate 1 % 2 sprays
each nostril q 4h
• Phenylephrine HCl 0.25 to 0.5
% 2 sprays q 4h
• Oxymetazoline HCl 0.05 % 2
sprays q 12h
Limit use to 3 to 5 days to
avoid rebound
vasodilatation and "rhinitis
medicamentosa" 14210/28/18 142
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143. Use of Oral
Decongestants for Rx
of Acute Sinusitis
• Phenylpropanolamine HCl
12.5 mg po q 4h or 75
mg q 12h (now not
available in U.S.A.)
• Pseudoephedrine HCl 60
mg po q 6h or 120 mg q
12h
Usually should be
continued for 4 weeks
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144. Treatment of Frontal
Sinusitis
• Usually should be admitted for
initial IV antibiotic Rx
• Higher incidence of intracranial
complications
• Give IV Cefuroxime 2 gm IV q
8h or Ceftriaxone 2 gm IV q d
and decongestants
• If not resolving in 24 to 48
hours of Rx may need surgical
intervention ( frontal sinus
trephination or external 14410/28/18 144
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145. General Management of
Complications of Acute
Sinusitis• Hospitalization
• CT scan of sinuses ( +/-
cranial CT)
• IV antibiotics with
anerobic coverage
• ENT consult
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146. Sinusitis
Complications :
Mucocele• Most common in frontal
sinus
• Expansive mucus
accumulation causes
progressive pressure
necrosis
• Signs:
• soft tissue mass over sinus
• proptosis
• ophthalmoplegia
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147. Antibiotics to
Consider for Rx of
Sinusitis
Complications• Ceftriaxone 1 gm IV q
12h
• Cefotaxime 2 gm IV q 4h
• Ceftizoxime 4 gm IV q 8h
+ metronidazole 30
mg/Kg/d
• Ampicillin / sulbactam 3
gm IV q 6h
• Vancomycin 500 mg q 6h
+ aztreonam 1 gm q 8h
or chloramphenicol ( for 14710/28/18 147
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148. General Contributors
to Chronic Sinusitis
• Resistant infectious
organisms
• Underlying systemic illness
(esp. diabetes)
• Immunodeficiency
• Irreversible mucosal changes
• Anatomic abnormality
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149. CHRONIC SINUSITIS
• Most cases of acute sinusitis resolve but
some progress to chronicity. This is
particularly likely to happen if there is an
abnormality of the anatomy, allergy,
polyps or immune deficit.
• SYMPTOMS
• Patients with chronic maxillary sinusitis
usually have very few symptoms.
• There is usually nasal obstruction and 14910/28/18
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150. SIGNS
• Mucopus in the middle
meatus under the middle
turbinate.
• Nasal mucosa congested.
• Imaging shows fluid level
or opacity, or mucosal
thickening within the
sinus.
TREATMENT
• Medical
• A further course of
treatment with antibiotics,
vasoconstrictor nose 15010/28/18
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151. Nursing careconce
rn
dx Goal intervention ration
al
evalu
tion
pain Acute
pain,head,throat
and sinuses
related to the
inflammation of
the nose
evidenced by
grimacing and
verbalizing the
sensation of pain
To
reliev
e pain
in
30min
to relieve
pain by
giving
panadol 1g
tds ,advise
patient have
a rest
To
promo
te
confor
tibility
of the
patien
t
anxiet
y
Related to lack of
clients knowledge
about diseases and
medical
procedures e.g.
sinus irrigation or
operation
evidenced by the
patient getting
To
reduc
e the
anxiet
y in
one hr
Increase the
confortabilit
y by
assuring the
patient e.g.
showing
empathy
thru
touching the
Increa
se
patien
t
aware
ness
of the
conditi
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152. Ineffect
ive
airway
clearan
ce
Related to
build up of
secretion in
the air way
or nasal
obstruction
sec to
inflammati
on of the
sinuses
evidenced
by
breathing
thru the
mouth
Coughi
ng,
clearan
ce of
air way
in abt
30mins
Rest the
patient,
perform
steam
inhalation,
prepare the
patient for
surgery if the
condition if
condition
needs
surgical
intervention
Promote
normal
airway
breathing,a
voisd
spread of
infection to
other
organs like
lungs
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153. TB
TB is an airborne disease caused by the bacterium
Mycobacterium tuberculosis (M. tuberculosis) . M.
tuberculosis and seven very closely related
mycobacterial species (M. bovis, M. africanum, M.
microti, M. caprae, M. pinnipedii, M. canett and M.
mungi) together comprise what is known as the M.
tuberculosis complex. the majority of TB cases are
caused by M. tuberculosis. M. tuberculosis organisms
are also called tubercle bacilli
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154. Transmission of TB
M. tuberculosis is carried in airborne particles, called droplet
nuclei, of 1– 5 microns in diameter. Infectious droplet nuclei are
generated when persons who have pulmonary or laryngeal TB
disease cough, sneeze, shout, or sing. Depending on the
environment, these tiny particles can remain suspended in the air
for several hours. M. tuberculosis is transmitted through the air,
not by surface contact. Transmission occurs when a person inhales
droplet nuclei containing M. tuberculosis, and the droplet nuclei
traverse the mouth or nasal passages, upper respiratory tract, and
bronchi to reach the alveoli of the lungs .
M. tuberculosis is carried in airborne particles, called droplet
nuclei
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155. TB is spread from person to person through
the air. The dots in the air represent droplet
nuclei containing tubercle bacilli
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156. Factors that Determine the
Probability of Transmission of M.
tuberculosis
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157. • Susceptibility -Susceptibility (immune status) of
the exposed individual
• Infectiousness- Infectiousness of the person
with TB disease is directly related to the
number of tubercle bacilli that he or she expels
into the air. Persons who expel many tubercle
bacilli are more infectious than patients who
expel few or no bacilli.
• Environment - Environmental factors that
affect the concentration of M. tuberculosis
organisms
• Exposure - Proximity, frequency, and duration
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158. Pathogenesis of TB
• Infection occurs when a person inhales droplet nuclei
containing tubercle bacilli that reach the alveoli of the
lungs. These tubercle bacilli are ingested by alveolar
macrophages; the majority of these bacilli are destroyed or
inhibited. A small number may multiply intracellularly and
are released when the macrophages die. If alive, these
bacilli may spread by way of lymphatic channels or through
the bloodstream to more distant tissues and organs
(including areas of the body in which TB disease is most
likely to develop: regional lymph nodes, apex of the lung,
kidneys, brain, and bone). This process of dissemination
primes the immune system for a systemic response.
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159. Droplet nuclei containing tubercle bacilli are
inhaled, enter the lungs, and travel to the
alveoli
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160. Tubercle bacilli
multiply in the alveoli.
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161. • A small number of tubercle bacilli enter the
bloodstream and spread throughout the
body. The tubercle bacilli may reach any
part of the body, including areas where TB
disease is more likely to develop (such as
the brain, larynx, lymph node, lung, spine,
bone, or kidney).
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162. • Within 2 to 8 weeks, special immune cells called
macrophages ingest and surround the tubercle bacilli.
The cells form a barrier shell, called a granuloma, that
keeps the bacilli contained and under control (LTBI).
• If the immune system cannot keep the tubercle bacilli
under control, the bacilli begin to multiply rapidly (TB
disease). This process can occur in different areas in
the body, such as the lungs, kidneys, brain, or bone
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163. Sites of TB Disease
TB disease can occur in pulmonary and extrapulmonary sites.
•Pulmonary
TB disease most commonly affects the lungs; this is referred to as
pulmonary TB. Patients with pulmonary TB usually have a cough
and an abnormal chest radiograph, and may be infectious.
Although the majority of TB cases are pulmonary, TB can occur in
almost any anatomical site or as disseminated disease.
•Extra pulmonary
Extra pulmonary TB disease occurs in places other than the lungs,
including the larynx, the lymph nodes, the pleura, the brain, the
kidneys, or the bones and joints. In HIV-infected persons, extra
pulmonary TB disease is often accompanied by pulmonary TB.
Persons with extrapulmonary TB disease usually are not infectious
unless they have 1) pulmonary disease
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164. • Miliary TB
Miliary TB occurs when tubercle bacilli enter the
bloodstream and disseminate to all parts of the
body, where they grow and cause disease in
multiple sites. This condition is rare but serious.
“Miliary” refers to the radiograph appearance
of millet seeds scattered throughout the lung. It
is most common in infants and children
younger than 5 years of age, and in severely
immunocompromised persons. Miliary TB may
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165. • Central Nervous System
When TB occurs in the tissue surrounding the brain
or spinal cord, it is called tuberculous meningitis.
Tuberculous meningitis is often seen at the base
of the brain on imaging studies. Symptoms
include headache, decreased level of
consciousness, and neck stiffness. The duration
of illness before diagnosis is variable and relates
in part to the presence or absence of other sites
of involvement. In many cases, patients with
meningitis have abnormalities on a chest
radiograph consistent with old or current TB, and
often have miliary TB.
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166. Persons at Increased Risk for
Progression of LTBI to TB Disease
Persons infected with HIV;
Children younger than 5 years of age;
Persons who were recently infected with
M. tuberculosis (within the past 2 years);
Persons with a history of untreated or
inadequately treated TB disease.
Persons who are receiving
immunosuppressive therapy such as10/28/18 166
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167. • Persons with silicosis, diabetes mellitus, chronic renal failure, leukemia,
or cancer of the head, neck, or lung;
• Persons who have had a gastrectomy or jejunoileal bypass;
• Persons who weigh less than 90% of their ideal body weight;
• Cigarette smokers and persons who abuse drugs and/or alcohol; and
• Populations defined locally as having an increased incidence of disease
due to
M. tuberculosis, including medically underserved, low-income populations.
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168. Drug-Resistant TB (MDR and XDR)
• Drug-resistant TB is caused by M.
tuberculosis organisms that are resistant
to the drugs normally used to treat the
disease . Drug-resistant TB is transmitted
in the same way as drug-susceptible TB.
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169. Multidrug-Resistant TB
• Multidrug-resistant TB (MDR TB) is caused by
organisms resistant to the most effective anti-
TB
drugs, isoniazid and rifampin. These drugs are
considered first-line drugs and are used to
treat most
persons with TB disease
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170. Extensively Drug-Resistant TB
• Extensively drug-resistant TB (XDR TB) is a
relatively rare type of drug-resistant TB. XDR
TB is resistant to isoniazid and rifampin, plus
any fluoroquinolone and at least one of three
injectable second-line drugs (i.e., amikacin,
kanamycin, or capreomycin).
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171. Common Symptoms of TB
• Cough (2-3 weeks or more)
• Coughing up blood
• Chest pains
• Fever
• Night sweats
• Feeling weak and tired
• Losing weight without trying
• Decreased or no appetite
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172. DIAGNOSIS OF TB
• Sputum culture: Positive for Mycobacterium
tuberculosis in the active stage of the disease.
• Ziehl-Neelsen (acid-fast stain applied to a smear of
body fluid): Positive for acid-fast bacilli (AFB).
• Skin tests (purified protein derivative [PPD] or Old
tuberculin [OT] administered by intradermal
injection [Mantoux]): A positive reaction (area of
induration 10 mm or greater, occurring 48–72 hr after
interdermal injection of the antigen) indicates past
infection and the presence of antibodies but is not
necessarily indicative of active disease.
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173. CONTN OF DIAGNOSIS
• Enzyme-linked immunosorbent assay (ELISA)/Western blot:
• Chest x-ray: May show small, patchy infiltrations of early lesions in
the upper-lung field, calcium deposits of healed primary lesions, or
fluid of an effusion.
• CT or MRI scan: Determines degree of lung damage and may
confirm a difficult diagnosis.
• Bronchoscopy: Shows inflammation and altered lung tissue.
• Histologic or tissue cultures (including gastric
washings; urine and cerebrospinal fluid [CSF]; skin biopsy)
•
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174. Medical management of TB
• To ensure that these goals are met, TB
disease must be treated for at least 6
months and in some cases even longer.
Most of the bacteria are killed during the
first 8 weeks of treatment.
• The standard of care for initiating
treatment of TB disease is four-drug
therapy.
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175. Directly Observed Therapy (DOT)
• DOT is a component of case
management that helps ensure patients
adhere to therapy. It is the method
whereby a trained health-care worker or
another trained designated person
watches a patient swallow each dose of
anti-TB drugs and documents it.
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176. Self-Administered Therapy
• Patients on self-administered therapy should
be asked routinely about adherence at
follow-up visits.
Pill counts should be performed consistently,
and urine or blood tests can be used
periodically to check for the presence of urine
drug metabolites or appropriate blood serum
level of the drugs. In addition, the response
to treatment should be monitored closely for
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177. TB Disease Treatment Regimens
• First-line drugs
Isoniazid (INH)
Rifampin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB)
• Rifabutin* (RBT)
May be used as a substitute for RIF in the
treatment of all forms of TB caused by
organisms that are known or presumed to be susceptible to this
agent.
• Rifapentine (RPT)
May be used once weekly with INH in the
continuation phase of treatment for HIV-negative patients with
noncavitary, drug-susceptible pulmonary TB who have negative
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178. Second-line drugs
• Streptomycin (SM)
SM was formerly considered to be a first-
line drug and in some instances, is still
used in initial treatment.
Increasing prevalence of resistance to SM
in many parts of the world has decreased
its overall usefulness.
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179. • Cycloserine
These drugs are reserved for
special situations such as drug intolerance
or resistance.
• Capreomycin
• ρ-Aminosalicylic acid
• Levofloxacin*
• Moxifloxacin*
• Gatifloxacin*10/28/18 179
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180. Treatment Interruption During Initial
Phase
If the interruption occurred during the initial
phase, the following guidelines apply
•Lapse is ≥14 days–restart treatment from the
beginning
•Lapse is <14 days–continue treatment to
complete planned total number of doses (as
long as all doses are completed within 3
months)
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181. Nursing care plan
CONCERN
Abnormal
breathing
pattern
DIAGNOSIS
Ineffective
airway clearance
related to thick
viscous or
bloody
secretions
evidenced by
coughing
GOAL
To promote
airway clearance
INTERVENTION
Instruct the
patient about
correct
poisitioning,to
facilitate
drainage and
increase fluid
intake to
promote
systemic
hydration
RATIONALE
To increase
surface area
within the lungs
Susceptibility to
TB disease
Risk for infection
related to
inadequate
primary defenses
and lowered
resistance
evidenced by
Adhere to
treatment
regimen
Adherence to
the treatment
regimen. Teach
the patient that
TB is a
communicable
disease and
Improved body
immunity
towards TB
infection.
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182. PREVENTION OF TB
• Identification and treatment. Early identification
and treatment of persons with active TB.
• Pernal hygiene. Prevention of spread of
infectious droplet nuclei by source control
methods and by reduction of microbial
contamination of indoor air.
• Surveillance. Maintain surveillance for TB
infection among health care workers by routine,
periodic tuberculin skin testing.
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183. • THANKS
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184. THORACOTOMY
PRESENTATION
BY
KATUSIIME EMILLY
16/BSU/BNS/028
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185. DEFINITION
A thoracotomy:
is a surgical procedure performed by surgeons or
emergency physicians, to gain access to the thoracic
organs, most commonly the heart, the lungs, or the
esophagus, or for access to the thoracic aorta or the
anterior spine (the latter may be necessary to access
tumors in the spine).
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186. ANATOMY OF THE THORAX.
• In mammals, the thorax is the region of the
body formed by the sternum, the
thoracic vertebrae, and the ribs.
• It extends from the neck to the diaphragm,
and does not include the upper limbs.
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187. Cont,
• The thorax contains organs like: heart ,lungs and thymus
gland;(the major and minor pectoral muscles, trapezius and
neck muscles);internal structures such as the diaphragm,
esophagus trachea and part of sternum known as xiphoid
process; Arteries and veins (aorta, superior vena cava,
inferior venacava and pulmonary artery) ;Bones (the
shoulder socket containing the upper part of the humerus,
the scapula, sternum, thoracic portion of the spine, collar
bone, and the rib cage and floating ribs)
• External structures are the skin and nipples.
• The inner organs are protected by the rib cage and the
sternum.
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188. DIAGRAM OF THE HUMAN THORAX
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189. FORMS OF THORACOTOMY
• Median sternotomy provides wide access to
the mediastinum and is the incision of choice
for most open-heart surgeries and access to
the anterior mediastinum
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190. CONT,
• Posterolateral thoracotomy:
Is an incision through an intercostal space on the
back, and is often widened with rib spreaders.
• It is a very common approach for operations on the
lungs or posterior mediastinum, including the
esophagus.
• When performed over the fifth intercostal space, it
allows optimal access to the pulmonary hilum
(pulmonary artery and pulmonary vein) and therefore
is considered the approach of choice for pulmonary
resection (pneumonectomy and lobectomy).
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191. Cont.
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192. CONT.
• Axillary thoracotomy -
• In an axillary thoracotomy, surgeons gain
access to the chest through an incision near
the armpit.
• This is commonly done for treating
a pneumothorax (collapsed lung), but may also
be performed for some heart and lung
surgeries.
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193. Cont,
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194. Cont,
• Anterolateral thoracotomy -
This procedure is an emergency
procedure involving an incision along the front
of the chest.
• It may be done following major chest trauma,
or to allow direct access to the heart after a
cardiac arrest.
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195. CONT,
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196. IMPORTANCE
• The purpose of a thoracotomy is the first step
used to facilitate thoracic surgeries including
lobectomy or pneumonectomy for lung cancer or
to gain thoracic access in major trauma.
• It’s used to treat problems with the heart or
other structures in the chest, such as the
diaphragm.
• Thoracotomy can also be used to diagnose
diseases. For example, it can enable a surgeon to
remove a piece of tissue for further examination
(biopsy).
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197. INDICATIONS
• An injury to the chest wall that causes
bleeding around the lungs
• Infection in the pleural space.(pneumonia or
another lung infection that has caused fluid to
build up in the space around the lungs)
• Collapsed lung (pneumothorax)
• Malignant pleural effusion.
• Fluid that collects in the lungs during chest
surgery
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198. CONT,
• Lung cancer surgery
• Esophageal cancer surgery
• Heart/aortic surgery
• Chest trauma
• Management of COPD(chronic condition in which
there is slow progressive obstruction of airflow into or
out of the lungs)
• Tuberculosis(treatment of pulmonary TB)
• Biopsy and evaluation of an unknown mediastinal
mass
• Surgery to the anterior spine
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199. CONTRAINDICATIONS
•Bleeding disorder or anticoagulation that
cannot be corrected
•Acute cardiac ischemia
•Instability or insufficiency of major organ
systems
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200. Pre-operative care for
thoracotomy
• Counsel the patient about the procedure, its benefits, risks and try
as much as possible to answer their questions as this relieves
anxiety.
• Explain the procedure to the patient and let them sign the consent
form.
• Monitor the patients vital signs as anxiety may lead to a rise in
blood pressure and do the required tests as ordered.
• Ensure NPO for about 6-12 hours prior to surgery. An enema can
also be given.
• Establish an iv line and administer fluids as required.
• Administer prophylaxis (antibiotics), pain killers, and other
necessary medications as required.
• Clean the patient, provide a gown,catheterise a few hours prior to
surgery.
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201. EQUIPMENT USED
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202. PROCEDURE
• The patient is given a general anesthesia before having this
surgery. -The anesthesia ensures that the patient is
asleep and pain-free during the procedure. The patient is
also put an epidural, which is a small tube in spine, to
deliver medication for pain relief during the surgery.
• While the patient is positioned on the side, the surgeon
makes a 6- to 8-inch incision below the shoulder blade,
between the ribs. The surgeon then divides the muscles
and spreads or removes ribs to reach the lungs or another
part of the chest.
• If the patient is having surgery on the lung, the affected
lung is deflated with a special tube so the surgeon can work
on it. A breathing tube called a ventilator keeps the other
lung working.
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204. CONT.
• Depending on the type of disease or disorder a patient has been
diagnosed with, a surgeon will perform a thoracotomy followed by
another surgical procedure, such as a:
• Lobectomy (removal of one or more lobes of the lungs)
• Esophagectomy (removal of all or part of the esophagus)
• Wedge resection (removal of part of a lung lobe)
• Pneumonectomy (removal of an entire lung)
• Decortication (removal of an organ’s membrane or covering)
• Open heart surgery
• Heart or lung transplant
• Tumor removal
• Tissue biopsy
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205. INTRA-OPERATIVE CARE
•Ensure iv fluids are administered as required.
•Put the patient in a required and comfortable position.
•Ensure sterilty in theater
•Cover the patient with a drape
•Arrange necessary instruments to be used.
•Monitor all fluid loss
•Before closure of a patient, ensure all instruments and
other equipments used such as gauze, moppers are
counted so that nothing is left in the patient.
•Transfer the patient to recovery room and ensure
patient is awake.
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206. Some tubes are left in the patient.
• Chest tube--this is a tube that is used to drain the
liquid that builds up in the lungs normally, that
may/will increase after a part of the lung has been
removed or manipulated.
-It is also used to remove air that may be collecting in
the chest after surgery.
NOTE: Most of the time both of these need to stop
before we can safely remove the tube.
-At times a special one way valve is put in place of the
chest tube drainage system, if the patient has an air
leak that may take longer to resolve. The patient may
go home with this one way valve.
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207. Cont.
• Epidural
Is a small catheter that is put in the space
around the spine. It is used for pain control
(The catheter delivers pain medication)
• The epidural catheter is placed just prior to
the surgery and is also used after surgery to
help control the pain.
• The catheter is small enough for the patient
to lie on the back after surgery..
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208. CONT,
• Foley catheter-
• This is a tube placed into the bladder during surgery
and used to monitor your urine output.
• Sequential Compression Devices(SCDs)-
– These are wraps that are placed around the legs
and used to keep the blood from pooling in the
calves. (If the blood remains there for a period of
time without movement, it can cause a blood clot.)
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209. CONT,
• Intravenous Catheter(IV)-This is catheter introduced to a patient to
help deliver fluids into the veins during surgery and after as needed.
• Incentive spirometer (IS) -This is a breathing exercise device along with
coughing and walking, it helps to prevent collapse of the lungs and pneumonia. This device
helps the patient to breathe more deeply and fully thus preventing lung collapse.
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210. Post operative care
• Receive the patient and put them in a post operative bed.
Ensure comfortable position to allow drainage of fluids.
• Encourage full bed rest for about24 hours.
• Administer iv fluids as required.
• Monitor vital signs and fluid input and output.
• Ensure NPO until bowel sounds have returned to normal.
• Manage pain according to severity using the recommended
analgesics.
• Ensure patient comftability.
• Restrict aggressive and vigorous exercises and activities
until full recovery.
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211. Pre-operative care plan
diagnosis goal Intervention/ratio
nale
evaluation
Anxiety rt fear of
the procedure to
be done EB patient
and care takers
asking many
questions
To relieve anxiety Answer all patients
questions. Provide
comfort to patient
to relieve anxiety
All patients
questions were
answered. Patient
agreed to the
procedure and
signed the consent
form
Ineffective airway
clearance rt
exudates in the
alveoli eb
alteration in
respiratory rate
To achieve normal
breath patterns of
12-20b/m
Encourage
coughing. Sunction
to remove the
exudates
Patient was
breathing without
use of accessory
muscles.
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212. Intra-operative care plan
diagnosis goal Intervention/
rationale
evaluation
Hypothermia rt
anesthetics agents
eb patient
shivering
To have an
increase in body
temperature
To administer
warm iv fluids
during the
procedure. To
cover the patient
and expose only
the part for surgery
in order to avoid
loss of body heat
Patient did not
shiver during
procedure
Risk for bleeding rt
to procedure being
done where there
are major blood
vessels such as
aorta
To minimize blood
loss
Administer iv
fluids, transfuse
with blood if
necessary. Arrest
hemorrhage to
minimize blood
There was less
blood loss.
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213. Post operative care plan
diagnosis goal Intervention/ratin
ale
evaluation
Pain rt surgical
procedure done eb
patient
verbalization and
facial flownig
To reduce pain
from a scale of 6-3
in the next 40 min
Administer an
analgesic such a im
diclofenac to cntrol
pain
Patient verbalized
that pain had
reduced from 6- 3
using the visual
numerical scale
Risk for infection rt
loss of tissue
integrity
To prevent
infection Daily wound
dressing at incision
site.
•Administer
antibiotics.
• Ensure sterilty
Wound healing was
achieved .
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214. COMPLICATIONS
• Complications are greater than those for any other
pulmonary biopsy procedure because of the risks of
general anesthesia, surgical trauma, and a longer hospital
stay with more postoperative discomfort. The greatest
hazards are
• Hemorrhage
• Pneumothorax- The chest tubes are used to drain air and
fluid until the patient heals enough to take them out
(usually a few days)but Complications such as
pneumothorax, tension pneumothorax, or subcutaneous
emphysema can occur if these chest tubes become
clogged.
• Respiratory failure
• Complications of general anesthesia.
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215. CONT,
•Heart attack or arrhythmias
•Vocal cord dysfunction or paralysis
•Bronchopleural fistula - This is a complication in
which an abnormal passageway forms between a
bronchial tube and the space between the
membranes (pleura) lining the lungs
•Postpneumonectomy syndrome or post-
thoracotomy pain syndrome - Pain in the region
of a thoracotomy may sometimes persist for a
long time after surgery
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216. spirometry
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217. references
• https://wwww.msdmanuals.com/Disorders/P
ulmonary
• Www.healthline.com/health/thoracotomy
• surgery.med.umich.edu/thoracic/pdf/preparin
gforyourthoracotomy.pdf
• Nursing Diagnoses (NANDA)
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218. Shock. Is not a disease but rather a clinical syndrom leading to reduced perfusion of tissue
and organs and enventually organ dysfunction and failure
shock.Can be classified into three categories basing on the predisposing factor
I. 1.Distributive shock. This kind of shock consists of
A. Neulogenic shock
B. Septic shock
C. Anaphylactic shock
2.Cardiogenic shock.
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219. 3.Hypovolemic shock
shock has high mortality rate ounce the body’s compensatory mechanism fails.
Causes of neulogenic shock
 Spinal cord injury
 Spinal cord anesthesia
 Severe pain
 Medication
 Hypoglycemic
Causes of septic shock
 Gram positive bacteria
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220. Gram negative bacteria
virus
parasites
protozoa
causes ofanaphlactic shock
medication
venom
foods
ABO incompatible blood
Causes of cardiogenic shock. Cardiogenic shock is caused by the following
Myocardial infarction
Heart failer
Cardio myopathy
Arrthymias
Cardiac tapenade
Pneumothorax
Pulmonary embolism
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221. 4.Causes of hypovolemic shock
renal loss
blood loss
ascitis
peritonitis
Explanation for different kinds of shock
1.neulogenic shock. loss of sympathetic
vasoconstriction tone in the vascular smooth muscles and reduced
autonomic function that will cause wide spread of arterial and venous
vasodilatation .venous return is reduced leading to the reduced cardiac
out put leading to hypotension
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222. 2.Septic shock.
An immune response is triggered when the bacteria enters the human body and releases
endotoxines
in response to macrophages. The macrophages will release cytokines like TNF
andINTERLEUKINES these cytokine their mediators in which they will trigger the release of
platelet activating factor for example prostaglandins, neukotrienes . Thromboxane. Kinin
and complement
The consequently are vasodilatation and vasoconstriction and elevated cardiac out
put .
Endotoxines also stimulates the release of histamine further increasing capillary
permeability .more ever output falls .resulting in multisystem failure
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223. Anaphylactic shock .this is triggered by allergic reaction
when an individual is exposed to an antigen to which he has already sentised. This result from
production of IGEby the plasma cell that binds to the membrane receptors on the mast cells and
basophiles and on re exposure the antigen binds to IGE cross linked IGE receptor triggering
release of chemical mediators from the mast cells for example bradykinin,leukotrienes;
These chemical mediators will induce vascular collapse by stimulating the group smooth muscles
by increasing vascular permeability to decrease vascular resistance and plasma leaking into
the extracellular tissue by reducing blood volume and causing hypotension finally
shork.bronch spasms , edema.
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