NCM 203

NURSING CARE
MANAGEMENT: THE
RESPIRATORY
SYSTEM
Respiratory System
 Its primary function is delivery of oxygen
to the lungs and removal of carbon
dioxide from the lungs.
Thoracic Cavity
 The inside of the chest cage is called the
thoracic cavity.
 Contained within the thoracic cavity are
the lungs, cone-shaped, porous organs
encased in the pleura, a thin, transparent
double-layered serous membrane lining
the thoracic cavity.
The Physiology of the Lungs
 The right lung is larger than the left and is
divided into three sections or lobes:
upper, middle, and lower.
 The left lung is divided into two lobes:
upper and lower.
 The upper portion of the lungs is the
apex; the lower portion is the base.
Conducting Airways
 The conducting airways are tubelike
structures that provide a passageway for
air as it travels to the lungs.
 The conducting airways include the nasal
passages, mouth, pharynx, larynx,
trachea, bronchi, and bronchioles.
Pharynx Larynx Trachea
 The conducting airways that connect nasal
passages and mouth to the lower parts of the
respiratory tract.
 The passageway for air entering and leaving
the trachea and containing the vocal cords.
 Commonly known as the windpipe, this tube is
composed of connective tissue mucosa and
smooth muscle supported by C-shaped rings of
cartilage.
Bronchi, Bronchioles
 Two tubes, the right and left primary
bronchi, that each pass into its respective
lung.
 Within the lungs, the bronchi branch off
into increasingly smaller diameter tubes
until they become the terminal
bronchioles.
Respiration
 A process of gas exchange necessary to
supply cells with oxygen for carrying on
metabolism, and to remove carbon
dioxide produced as a waste by-product.
 Two types of respiration: external and
internal.
External & Internal Respiration
 The exchange of gases between the
inhaled air and the blood in the pulmonary
capillaries.
 The exchange of gases at the cellular
level between tissue cells and blood in
systemic capillaries.
Signs & Symptoms
1. Dyspnia
2. Cough
3. Sputum Production
4. Chest Pain
5. Wheezing
6. Hemoptesis
 Assessment
Health History
(allergies, occupation, lifestyle, health habits)

Inspection
(client's color, level of consciousness, emotional state)
(Rate, depth, quality, rhythm, effort relating to respiration)

Palpation and Percussion

Auscultation
(Listening for Normal and Adventitious Breath Sounds)
 Adventitious Breath Sounds
Abnormal sounds and some conditions associated
with them:
 Fine crackles (dry, high-  Sibilant wheezes (high-
pitched popping…COPD, pitched, musical … asthma,
bronchitis, emphysema,
CHF, pneumonia) tumor)
 Coarse crackles (moist,  Pleural friction rub (creaking,
low-pitched gurgling… grating… pleurisy,
pneumonia, edema, tuberculosis, abscess,
pneumonia)
bronchitis)  Stridor (crowing…croup,
 Sonorous wheezes (low- foreign body obstruction,
pitched snoring…asthma, large airway tumor).
bronchitis, tumor)
Common Diagnostic Tests for
Respiratory Disorders
1. Laboratory Tests (Hemoglobin; Arterial
blood gases; Pulmonary Function Tests;
“Sputum Analysis& culture”).
2. Radiologic Studies (Chest X-ray; Ventilation-
perfusion scan; CAT scan; Pulmonary
angiography).
3. Other (Pulse oximetry; Bronchoscopy;
Thoracentesis; MRI).
Respiratory Care Modilities
 O Therapy
The administration of O in concentration
greater than that found in environmental
atmosphere
 Indications
-change in respiratory rate
- hypoxemia
- hypoxia
O Therapy
 Cautions
1. O toxicity
2. Suppression of ventelation
3. Source of Cross infection
4. Fire Danger
 Method of Oxygen Administration
Chest Physiotherapy
 The Goal of chest physiotherapy is :
1. Remove bronchial secretion
2. Improve Ventilation
3. Increase efficiency of respiratory muscles
 Postural Drainage
 Chest Percussion &vibration
 Breathing exercise &retraining
Air Way Management
 Emergency management of upper airway
obstruction
 Causes
1. foreign body
2. Secretions
3. Vomiting or food particles
4. Enlarged tissue “edema, Ca, &abscesses”
 Assessment
Inspection , palpation,& Auscultation
Airway Management
 Emergency Measures
1. Opening airway by extend Pt neck back
2. Observe airway
3. Cross finger to clear airway
4. If no passage “Abd thrust”
5. Use resuscitation bag
guide lines p 499
Endotracheal Intubation
 Passing endotracheal tube through mouth
or nose into the trachea

 It is a method of choice in emergency

 Providing airway for specific patients
 For mechanical ventilation
Tracheastomy
 It is a procedure in which an opening is made into
the trachea and indwelling tube is inserted into
the trachea
 Indication
1. To bypass an upper airway obstruction
2. To allow removal of tracheobroncheal secretions
3. For long term ventilation
4. To prevent aspiration
Complications “bleeding, pneumonia, air embolism
emphysema pneumothrax
Upper Respiratory Tract
Infections/Inflammatory Disorders
 Rhinitis (coryza,  Pharyngitis
common cold)  Tonsillitis
 Allergic rhinitis  Laryngitis
 Sinusitis
Upper Respiratory Tract
Infections/Inflammatory Disorders

 Are the common conditions that affect

most people on occasion, some infections
are acute and other are chronic
common cold
 Often is used when referring to a
symptoms of an upper respiratory tract
infection ch.ch.by nasal congestion ,sore
throat , & cough
 Cold referred to a febrile, infectious, acute
inflammation,of the mucus membranes of
the nasal cavity
common cold
 Clinical manifestations
1. Nasal congestion
2. Scratchy or sore throat
3. Sneezing & cough
4. Headache & muscle ache
5. Herpes simplex sore (cold sore )
common cold
 Medical Management (symptomatic management)
1. Fluid intake ,rest ,prevention of chills.
2. Aqueous decongestant,anti histamin, Vit. C.
3. Expectorant as needed
4. Analgesic for aches ,pain , & fever.
5. Antimicrobial to reduce incidence of
complications
 Nursing Management
1. Patient teaching of self care & prevention of
infection & break chain of infection
Rhinitis
 Inflammation of nose by viral ,
obstructive ,allergic reaction.
 Clinical manifestations
1. Rhinorrhea “ excessive nasal drainage”
2. Nasal congestion, Itching ,& sneezing
3. Headache may occur
Rhinitis
 Medical Management
1. Treatment of cause “antibiotics”
2. Decongestant agents
3. Antihistamine
4. In severe cases corticosteroids
 Acute Sinusitis

 It is inflammation of sinuses , it is resolved

promptly if their opening into nasal cavity .
 Clinical Manifestations
1. Pressure , pain over the sinus area
2. Tenderness
3. Purulent nasal secretions
 Acute Sinusitis
 Medical Management
1. Antimicrobial agent “Amoxicillin”
2. Oral & Topical Decongestant
3. Heated mist or Saline irrigation
 Nursing management
“Teaching patient self care”
 Complications
1. Meningitis &osteomylitis
2. Brain abscess
3. Ischemic infarction
Chronic Sinusitis
 It is an inflammation of sinuses that
persists for more than 8 weeks in adult
& or 2 weeks in children
 Clinical Manifestations
1. Impaired mucociliary clearness & ventilation
2. Chronic hoarseness & cough
3. Chronic Headache
4. Facial pain
Chronic Sinusitis
 Medical Management
1. Strong antibiotics (for 21 days )
2. Surgical intervention to remove obstruction cause
that cause block of drainage passage
 Nursing Management
1. Increase humidity
2. Increase fluid intake
3. Early signs of sinusitis
Acute Pharyngitis
 It is a febrile inflammation of throat ,caused by
virus about 70% , uncomplicated viral infection
usually subsided promptly within 3-10 days
 Clinical Manifestations
1. Fiery red pharyngeal membrane& tonsils
2. Lymphoid follicles that are swollen
3. Enlarge tender cervical lymph node
4. Fever & malaise
5. Sore throat , hoarseness,& cough
Acute Pharyngitis
 Medical Management
1. Supportive measures for viral infection
2. Pharmacologic therapy antibiotics for 10 days
“cephalosporin”analgesic for severe sore anti
tussive medications
3. Nutritional therapy liquid or soft diet
“If liquid can’t tolerated IV fluid administered “
4. Nursing Management (bed rest ,skin assessment,
mouth care &normal saline gargle & self care
teaching
Chronic Pharyngitis
 Common in adults who work or live in dusty
surrounding ,use the voice too excess , suffer
from chronic cough , & habitually use alcohol &
tobacco
 Types of pharyngitis
1. Hypertrophic :ch.ch.by general thickening&
congestion of pharyngeal mucus membrane
2. Atrophic : probably late stage of first type
3. Chronic Granular : ch.ch.by numerous swollen
lymph follicles on the pharyngeal wall
Chronic Pharyngitis
 Clinical Manifestations
1. Constant sense of irritation or fullness in throat
2. Mucus expelled by coughing
3. Difficulty in swallowing
 Medical Management
1. Relieving symptoms
Avoiding exposure to irritant
Correct respiratory & cardiac conditions
Chronic Pharyngitis
2. Antihistamine drugs
3. Decongestant
4. Controlling malaise
 Nursing Management
1. Patient teaching of self care
2. Avoid alcohol , tobacco , exposure to cold
3. Face mask to avoid pollutant
4. Warm fluids,&warm saline gargle
Tonsillitis
 The tonsils are composed of lymphatic tissue &
situated on each side of the oropharynx ,they
frequently are the site of acute infection (tonsillitis)
 Clinical Manifestations
 Tonsils : sore throat, fever , snoring & difficulty of
swallowing
 Adenoids : ear ache , mouth breathing , drainage
ear ,frequent cold , bronchitis, noisy respiration,
foul smelling breath &voice impairment
Tonsillitis
 Medical Management
1. For recurrent tonsillitis “tonsillectomy”
2. Conservative or symptomatic therapy
3. Antimicrobial therapy “penicillin” for 7 days
 Nursing Management
1. Provide post op. care :V/S ,hemorrhage , position head
turned to side,water or ice chips
2. Teaching patient :S&S of hemorrhage
3. Avoid too much talking or coughing
4. Liquid or semi liquid diet for several days
5. Alkaline mouth washing with warm saline
Laryngitis
 It is an inflammation of larynx ,often occur as
a result of voice abuse or exposure to dust ,
chemicals , smoke , & other pollutants
 Common in winter & easily transmitted
 The cause of infection is almost virus
 Clinical Manifestations
1. Hoarseness or aphonia
2. Severe cough
Laryngitis
 Medical Management
1. Resting voice & avoid smoking
2. Inhale cool steam or an aerosol
3. Conservative treatment
4. Antibiotics for bacterial organisms
 Nursing Management
1. Rest voice
2. Maintain a well humidified environment
3. Daily fluid intake
Pleurisy/Pleural Effusion
 Pleurisy is a painful condition that arises
from inflammation of the pleura, or sac
that encases the lung.
 Pleural effusion occurs when the inflamed
pleura secretes increased amounts of
pleural fluid into the pleural cavity.
Atelectasis
 Collapse or airless condition of the alveoli
caused byhypoventilation,obstruction of
airway or compression
 Clinical Manifestations
1. Cough & sputum production
2. Dyspnea ,tachypnea ,tachycardia
3. Sings of pulmonary infection may present
4. Fever
5. Central cyanosis
Atelectasis
 Management
1. First line measures :(turning , early
ambulation , lung volume expansion ,
coughing, spirometry ,breathing exercises
2. If there is no response : (PEEP , IPPB)
3. Bronchoscopy
4. Postural Drainage & percussion
5. If cause is compression remove the cause
Acute Tracheobronchitis
 An inflammation of the mucus membrane of
the trachea & the bronchial tree , often follow
upper respiratory tract infection
 Clinical Manifestations
1. Dry irritating cough “expectorate sputum”
2. Sternal soreness from coughing
3. Fever ,stress , night sweating
4. Headache & general malaise
5. As the infection progress the patient develop
(shortness of breath, noisy breath ,&purulent
sputum
Acute Tracheobronchitis
 Medical Management
1. Antibiotics depend on symptoms & culture
2. Expectorant may be prescribed
3. Increase fluid intake
4. Rest & cool therapy
5. Suctioning & Bronchoscopy
 Nursing Management
1. Patient teaching
2. Encourage fluid intake
3. Coughing exercises to remove secretions
4. Complete antibiotics course,
5. Prevent over exertion
Pneumonia
 An inflammation of the lung tissue that is caused
by microbial agent

 Community Acquired Pneumonia (CAP)

1. Occurs either in community setting or within the
first 48 hrs of hospitalization
2. Most common in people younger than 60 yrs
3. Most prevalent during winter & spring
4. Caused by pneumococcus & H influenza
5. Virus the cause in infants & children
Pneumonia
 Hospital Acquired Pneumonia (HAP) the
onset of pneumonia symptoms more than 48
hrs after admission to hospital. Also called
nosocomial infection
 Common organism E.colli ,Klebsiella ,S.aurious
 It occurs when host defense impaired in certain
conditions
 Pneumonia in the Immuno compressed host
 Caused by organisms also observed in
CAP,HAP.
 Has subtle onset with progressive dyspnea ,
fever , &productive cough
Pneumonia
 Clinical Manifestations
1. Sudden onset of shaking chills
2. Rapidly increase in body temperature 38-40 C
3. Chest pluratic pain increased by deep
breathing
4. Patient looks severely ill with marked
tachypnea
5. Shortness of breath
6. Orthopnea
7. Poor appetite
8. Diaphoresis &tires easily
9. Purulent sputum
Pneumonia
 Medical Management
1. Appropriate antibiotics depend on culture
result
2. Hydration (increase fluid intake )
3. Antipyretic for fever & Headache
4. Warm moist inhalation to relieve irritation
5. Antihistamine to relieve sneezing & rhinorrhea
6. Oxygen & respiratory supportive measures
 Complications : Shock & respiratory failure ,
Atelectasis & plural effusion
Super infection
Chronic Obstructive pulmonary
Disease (COPD)
 Disease state in which air flow is obstructed
by emphysema or bronchitis or both
 The airway obstruction is usually progressive
& irreversible
 Clinical Manifestations
1. Cough
2. Increase work of breathing
3. Severe dyspnea that interfere with patient
activity
Chronic Obstructive pulmonary
Disease (COPD)

 Medical Management
1. Inhaled bronchodilators to improve airway
2. Oxygen therapy as prescribed
3. Pulmonary rehabilitation emotional &
physiologic needs ,breathing exercises
,&methods of symptoms elevation
Chronic Obstructive pulmonary
Disease (COPD)
 Nursing Management
 Patient Education About COPD
1. Breathing exercise
2. Inspiratory muscles training
3. Self care activity
4. Coping measures
 Complications
1. Pneumonia
2. Atelectasis
3. Pneumothrax
4. Respiratory insufficiency & failure
 Chronic Bronchitis
 It is a productive cough that lasts in
each of 2 consecutive years in a patient
whom other causes of cough is
excluded
 Clinical Manifestations
1. Chronic productive cough in winter
2. Increase frequency of respiratory
infection
Chronic Bronchitis
 Medical Management the objective of
treatment are to keep the bronchioles opened
& functioning
1. Antibiotics therapy for recurrent infection
2. Bronchodilators to remove secretion
3. Postural Drainage & chest percussion
4. Hydration & fluid intake
5. Corticosteroid may be used
6. Smoker patient should stop smoking
Emphysema
 A complex and destructive lung disease
wherein air accumulates in the tissues of the
lungs.
 Smoking is the major cause of Emphysema
 Classification
1. Panlobular : destruction of the respiratory
bronchiole,alevular duct &alveoli
2. Centrilobular : pathogenic changes take
place mainly in the center of secondary
lobule
Emphysema
 Clinical Manifestations
1. Increase dyspnea on exertion
2. Anoroxia & Weight loss
3. Weakness & Inactivity
4. Pursed –lip- breathing
5. Increase cough wheezing purulent
sputum & occasionally fever
Emphysema
 Medical Management
1. Bronchodilators
2. Antimicrobial Agents
3. Oxygen therapy
4. Pulmonary rehabilitation
5. Smoking cessation
6. corticosteroids
 Asthma
 A condition characterized by intermittent
airway obstruction in response to a
variety of stimuli. “inflammatory”
 Asthma differ from COPD in that it is
reversible process either spontaneously
or with treatment
 Allergy is the strongest predisposing
factor for the development of asthma
Asthma
 Clinical Manifestations
1. The most three common symptoms are:
a- coug b- dyspnea
c- wheezing
2. Hypoxemia may occur along with
a- cyanosis b- diaphoresis
c- tachycardia d- widened pulse
pressure
Asthma
 Prevention : allergic test to identify the
substances cause the symptoms and
avoid it as possible
 Complications
1. Asthmaticus
2. Rib fracture
3. Pneumonia
4. Atelectases
Asthma
 Medical Management
 Pharmacologic Therapy (long term)
1. Corticosteroid :most effective ant
inflammatory medication (inhaled form)
2. Long-acting beta2adrenergic agonist mild to
moderate bronchodilator (theophilline
3. Quick relive medications (short acting beta2
adrenergic agonists
4. Peak flow monitoring
Asthma
 Nursing Management
1. Immediate care based on severity of
symptoms
2. Assessment & Allergic History
3. Administer medication & observe patient
response
4. Antibiotics as prescribed for infection
5. Assist in intubations procedure if needed
6. Psychological support for patient & his family
 Acute Respiratory Failure
 Conditions wherein there is a failure of the
respiratory system as a whole.
 It is a sudden & life threatening
deterioration of gas exchange function of
the lung
 Acute : a fall in arterial PaO2 to less than
50mmHg &a rise in arterial PaCo2to
greater than 50mmHg
Acute Respiratory Failure
 Causes
1. Decrease respiratory derive “brain”
2. Dysfunction of chest wall “nerves &
muscles”
3. Dysfunction of lung parenchyma
“expansion”
4. Postoperative & inadequate ventilation
Acute Respiratory Failure
 Clinical Manifestations
1. Impaired oxygenation & may be include
restlessness
2. Fatigue & headache
3. Dyspnea & air hunger
4. Tachycardia &hypertension
5. Confusion & lethargy
6. Diaphoresis …… Respiratory Arrest
7. Uses of accessory muscles
Acute Respiratory Failure
 Medical management:
Intubations and mechanical ventilation may
be required to maintain adequate
ventilation and oxygenation while the
case corrected
Acute Respiratory Failure
 Nursing management:
1. Monitoring patient responses and
arterial blood gases
2. Monitoring vital sign
3. turning ,mouth car , skin care , and rang
of motion .
4. Teaching about the underlying disorders
5. Assists in intubations procedure
Pulmonary Embolism
 Obstruction of a pulmonary artery by a
bloodborne substance.
 Deep vein thrombosis is a common cause of
pulmonary embolism.
 Other types (Air , Fat , Septic )
 Clinical Manifestations
1. Dyspnea & Tachypnea
2. Sudden & pluretic chest pain
3. Fever & cough & hemoptesis
4. Apprehension Diaphoresis & syncope
Pulmonary Embolism
 Medical Management
1. Emergency Management
i. Nasal O2
ii. IV infusion for Medication
iii. Perfusion Scan
iv. ABGs &ECG
v. Small dose of Morphine
vi. Intubation & mechanical Ventilation
Pulmonary Embolism
Pharmacologic Management
i. Anticoagulant therapy
heparin 5000-10000 bolus then 18u/kg/hrs
warfarin for three months
ii. Thrombolytic therapy (STK , Actylase (TPA))
iii. Surgical Management (Surgical Embolectomy)
Pulmonary Embolism
 Nursing Management
1. Preventing thrombus formation
2. Monitoring thrombolytic therapy
3. Providing post operative nursing care
4. Managing O2 therapy
5. Preventing anxiety
6. Monitor for complications+
Pneumothorax/Hemothorax
 Traumatic disorders of the respiratory
tract wherein the underlying lung tissue
is compressed and eventually collapses.
 Types
1. Simple Pnuemothrax
2. Traumatic Pnuemothorax
3. Tension
Pneumothorax/Hemothorax
 Clinical Manifestations
1. Sudden pluretic pain
2. Anxious patient , dyspnea & air hunger
3. Increase use of accessory muscles
4. Central cyanosis
5. Tympanic sound in percussion
6. Absent of breath sound & tactile fremetus
7. Agitation Diaphoresis & hypotension
Pneumothorax/Hemothorax
 Medical Management
1. High concentration supplemental O2
2. Chest tube for drainage
3. In emergency anything may be use to fill the
chest wound
4. Heavy dressing
5. Needle aspiration thoracenthesis
6. Connecting chest tube to water seal drainage
7. An emergency thoractomy may also
performed
 Pulmonary Edema
 A life-threatening condition characterized
by a rapid shift of fluid from plasma into
the pulmonary interstitial tissue and the
aveoli, resulting in markedly impaired gas
exchange.
 Can result from severe left ventrical
failure, rapid administration of I.v. fluids,
inhalation of noxious gases, or opiate or
barbiturate overdose.
 Adult Respiratory Distress
Syndrome
 A life-threatening condition characterized
by severe dyspnea, hypoxemia, and
diffuse pulmonary edema.
 Usually follows major assault on multiple
body systems or severe lung trauma.
 Bronchiectasis
 A chronic dilation of the bronchi.
 Main causes of this disorder are
pulmonary TB infection, chronic upper
respiratory tract infections, and
complications of other respiratory
disorders of childhood, particularly cystic
fibrosis.
Neoplasms of the Respiratory
Tract
 Benign neoplasms.
 Lung cancer.
 Cancer of the larynx.
Epistaxis
 A hemorrhage of the nares or nostrils.
 May be unilateral (most common) or
bilateral.
 Blood loss can be minimal to severe.
Smoking
 Cigarette smoking is indicated as a major
causative factor in the development of
respiratory disorders, such as lung
cancer, cancer of the larynx, emphysema,
and chronic bronchitis.