FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1219 MEDICAL-SURGICAL NURSING 3
ACUTE BIOLOGIC CRISIS
MODULE 3 ALTERED VENTILATORY EMPHYSEMA
FUNCTION Two Types of Emphysema
Topic Outline 1. Panlobular Emphysema
1. Acute/Chronic Obstructive Pulmonary 2. Centrilobular (Centroacinar) Emphysema
Diseases
2. Acute Respiratory Distress Syndrome Manifestations
3. Pneumonia • Pink puffer
4. Pneumothorax • Mild production of Sputum
5. SARS-CoV 2/ Covid-19 Disease • Barrel Chest
• Dyspnea,
OVERVIEW • Cough may be present
This module tackles various discussions on the clinical
manifestations involved in the selected diseases of the CHRONIC BRONCHITIS
Respiratory System. Acute and Chronic Obstructive Manifestations
Pulmonary Diseases, Acute Respiratory Distress • Blue bloater
Syndrome, Pneumonia, Pneumothorax, and the recent • Productive Cough
COVID-19 Disease will be discussed thoroughly • Thick, gelatinous sputum
highlighting the nature of the disease, pathophysiology, • Wheezing might be present
defining characteristics, management, and relevant • Notable dyspnea
nursing care.
Diagnostic Procedures:
The respiratory diseases mentioned above entail • Spirometry
immediate management to prevent serious health
• ABG levels
complications. Death may arise if nurses will not
• Chest X-ray
immediately respond to the needs of the patients thus,
• Alpha1-antitrypsin assay
thorough understanding on all the principles involved is
a must to achieve the intended preservation of life. Early
MEDICAL MANAGEMENT
detection on the important defining characteristics will
pave way on the recovery of patients. Drugs
• Bronchodilators to relieve bronchospasm
The care of patients with respiratory diseases will • Inhaled and systemic corticosteroids
include health care collaboration. Nurses must be aware • Alpha1-antitrypsin augmentation therapy
that other members of the health care team will be • Antibiotic Agents
involved to help various clients recover faster. Multi- • Mucolytic agents
therapies will be instituted uniquely based on the • Antitussive agents
individual needs of the patients. With the complexity of • Vasodilators and
various health care management as planned, Nurses • Narcotics
must execute these complex interventions in a precise
and competent manner. Surgical Management
• Bullectomy
Though secondary and tertiary level of care are usually • Lung Volume Reduction Surgery
involved in emergency cases, primary level of
prevention must still be included to as part of the NURSING CARE MANAGEMENT
Teaching-coaching and helping role of Nurses. 1. Pulmonary rehabilitation to reduce symptoms,
Mastering the basic tenets on the care of critically-ill improve quality of life, and increase physical
patients with respiratory diseases using the nursing and emotional participation in everyday
process will be end point of this module. activities
2. Pursed-lip breathing helps slow expiration,
ACUTE/CHRONIC OBSTRICTIVE prevents collapse of small airways, and helps
PULMONARY DISEASES the patient control the rate and depth of
A disease characterized by airflow limitation that is not respiration
fully reversible.
3. Instruct the patient to coordinate diaphragmatic • Supportive drugs includes surfactant
breathing with activities such as walking, replacement therapy, pulmonary
bathing, bending, or climbing stairs antihypertensive agents and antisepsis agent
4. Provide small frequent meals and offer liquid
nutritional supplements to improve caloric NURSING INTERVENTIONS
intake and counteract weight loss • Requires close monitoring in the intensive care
5. Administer low flow of oxygen (1-2L/min) as unit
ordered • Assess the patient’s status frequently to
6. Administer bronchodilator as prescribed evaluate the effectiveness of the treatment
7. Adequately hydrate the patient • Turn the patient frequently to improve
8. Instruct the patient to avoid bronchial irritants ventilation and perfusion in the lungs and
9. If indicated, perform CPT in the morning and at enhance drainage secretions
night as prescribed • Rest is essential for patient to limit oxygen
10. Encourage alternating activity with rest periods consumption and reduce oxygen needs
11. Teach relaxation technique or provide a • Adequate nutritional support is vital, 35 to 45
relaxation tape for patient kcal/kg/day is required to meet caloric
12. Enroll patient in pulmonary rehabilitation requirements
program where available • Identify problems with ventilation that may
13. Monitor respiratory status, including rate and cause anxiety reaction to the patient
pattern of respirations, breath sounds, and signs
and symptoms of acute respiratory distress PNEUMONIA
• Inflammation of the lung parenchyma
ACUTE RESPIRATORY DISTRESS • Two types:
SYNDROME o Community Acquired Pneumonia
Is a severe form of acute lung injury. This clinical (CAP)
syndrome is characterized by a sudden and progressive o Ventilatory Acquired Pneumonia
pulmonary edema, increasing bilateral infiltrates on (VAP)
chest x-ray, hypoxemia unresponsive to oxygen
supplementation regardless of the amount of MANIFESTATIONS:
Patients often demonstrate reduced lung compliance • Sudden onset, rapidly rising fever of 38.3° C to
40.5° C
MANIFESTATIONS • Cough productive of purulent sputum
• Typically develops over 4 to 48 hours • Pleuritic chest pain aggravated by deep
• severe dyspnea, severe hypoxemia respiration/coughing
• Arterial hypoxemia that does not respond to • Dyspnea, tachypnea accompanied by
supplemental oxygen respiratory grunting, nasal flaring, use of
• chest x-ray are similar to those seen with accessory muscles of respiration, fatigue
cardiogenic pulmonary edema • Rapid, bounding pulse
• increased alveolar dead space • Orthopnea
• Severe crackles and rhonchi heard on • Rusty, blood-tinged sputum
auscultation • Poor appetite
• Labored breathing and tachypnea • Diaphoresis
DIAGNOSTIC PROCEDURES DIAGNOSTIC PROCEDURES
• Clinical presentation and history of findings • Chest X-ray shows presence/extent of
• Hypoxemia on ABG despite increasing inspired pulmonary disease, typically consolidation.
oxygen level • Gram stain and culture and sensitivity tests of
• Chest x-ray shows bilateral infiltrates sputum may indicate offending organism.
• Plasma Brain Natriuretic Peptide (BNP) • Blood culture detects bacteremia (bloodstream
• Echocardiography invasion) occurring with bacterial pneumonia.
• Pulmonary Artery Catheterization
MANAGEMENT
MANAGEMENT • Administration of the appropriate antibiotic as
• Treatment of the underlying condition determined by the results of a Gram stain
• Optimize oxygenation • pneumoniae - macrolide antibiotic
• Intubation and mechanical ventilation (azithromycin, clarithromycin, or
• Sedation may be required erythromycin)
• Paralytic agents may be necessary • Pseudomonas infection – anti pneumococcal,
• Antibiotics, as indicated antipseudomonal beta-lactam
• PEEP usually improves oxygenation
• Treatment of viral pneumonia is primarily Surgical intervention by pleurodesis or
supportive thoracotomy with resection of apical blebs is advised
• Oxygen therapy if patient has inadequate gas for patients with recurrent spontaneous pneumothorax
exchange
Tension Pneumothorax
NURSING INTERVENTIONS • Immediate decompression to prevent
• Encourage coughing and deep breathing after cardiovascular collapse by thoracentesis or
chest-physio therapy, splinting the chest if chest tube insertion to let air escape
necessary • Chest tube drainage with underwater-seal
• Maintain semi-Fowler’s position suction to allow for full lung expansion and
• Monitor pulse oximeter healing
• Promote hydration(2-3L/day) to liquefy
secretions Open Pneumothorax
• Teach effective coughing techniques to • Close the chest wound immediately to restore
minimize energy expenditure; plan rest periods adequate ventilation and respiration
• Suction if necessary • Patient is instructed to inhale and exhale gently
• Instruct client to cover nose and mouth when against a closed glottis (Valsalva maneuver) as
coughing a pressure dressing (petroleum gauze secured
• Teach the need to continue entire course of with elastic adhesive) is applied. This maneuver
antimicrobial therapy which is usually seven to helps to expand collapsed lung
ten days • Chest tube is inserted and water-seal drainage
• Teach the patient about proper administration set up to permit evacuation of fluid/air and
of antibiotics and potential side effects. produce re-expansion of the lung
• Teach that findings are expected to be less • Surgical intervention may be necessary to
within 48 to72hours of initial therapy repair trauma
• Nutritionally enriched drinks or shakes maybe
helpful in maintaining nutrition NURSING INTERVENTIONS
1. Apply petroleum gauze to sucking chest wound
PNEUMOTHORAX 2. Assist with emergency thoracentesis or
• occurs when the parietal or visceral pleura is thoracostomy
breached and the pleural space is exposed to 3. Position patient upright if condition permits to
positive atmospheric pressure allow greater chest expansion
4. Maintain patency of chest tubes
TERMINOLOGIES 5. Assist patient to splint chest while turning or
• Simple/Spontaneous Pneumothorax coughing and administer pain medications as
• Traumatic Pneumothorax needed
• Open pneumothorax 6. Monitor oximetry and ABG levels to determine
• Tension Pneumothorax oxygenation.
7. Provide oxygen as needed
MANIFESTATIONS
• Hyperresonance
• Diminished breath sounds. SARS-COV 2/ COVID-19 DISEASES
• Reduced mobility of affected half of thorax. • Newly discovered Corona Virus originated
• Tracheal deviation from Wuhan, China (December 2019). This
• Air hunger, agitation, hypotension, cyanosis serious disease attacks the respiratory system
and profuse diaphoresis that may lead to imminent death.
• Mild to moderate dyspnea and chest discomfort • Incubation period: 2-14 days
may be present with spontaneous
pneumothorax PREDISPOSING FACTORS
The Host (Individual)
MANAGEMENT • Age (Older Population)
Spontaneous Pneumothorax • Smokers
Treatment is generally nonoperative if pneumothorax is • Immunosuppressed individuals
not too extensive. • Existing Comorbidities (Serious Medical
1. Observe and allow for spontaneous resolution Condition)
for less than 50% pneumothorax in otherwise 1. Heart Disease
healthy person. 2. Diabetes
2. Needle aspiration or chest tube drainage may be 3. Lung Disease
necessary to achieve re-expansion of collapsed • Family Life and Culture (wild life diet
lung if greater than 50% pneumothorax. practices)
• Lack of Discipline and Education References
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever,
The Environment K. H. (2013). Brunner and Suddarth’s textbook of
• Population Density (crowded) medical-surgical nursing (13th ed.). Philadelphia:
• High level exposure to wet market with Lippincott Williams & Wilkins.
wildlife animal trading Sole, M. L., Klein, D. G., & Moseley, M. J.
(2013). Introduction to critical care nursing. St.
The Agent Louis, Mo: Elsevier/Saunders.
• k.a: SARS-CoV-2 World Health Organization E-Manual
• attaching protein spikes in the lungs Centers for Disease Control and Prevention E-Manual
• Phases of Attack
1. Viral Replication
2. Hyperactivity of Pulmonary System
3. Pulmonary Destruction
MANIFESTATIONS
• Cough
• Sore Throat
• Headache
• Diarrhea
• Fever
• Loss of Smell
• Loss of Taste
• Difficulty of Breathing
• Shortness of Breath
• Haziness and tiny white spots in the X-ray
Result
DIAGNOSTIC TEST
SWAB TEST: rt-PCR (Real-Time Polymerase Chain
Reaction)
MANAGEMENT
Drugs
• Tocilizumab
• Remdesivir
• Baricitinib+Remdesivir
• Low dose Heparin or Enoxapin
Management:
• Supportive Care
• Providing fluids
• Providing oxygen
• Ventilatory support (Mechanical Ventilator) if
indicated
General Measures to Prevent COVID-19
1. Educate the general public regarding the
disease
2. Encourage people to practice healthy lifestyle
3. Vaccination
Specific Measures to Prevent COVID-19
1. Hand washing
2. Alcohol based Sanitizers
3. Avoid crowded places
4. Avoid travelling to high risk places
5. Avoid touching eyes, nose, and mouth
6. At least 1ft away from a person with
symptoms