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Epistaxis
Common Causes:
Trauma in the form of finger nail trauma, nose injury,
fractures of middle third of the face or the base of the skull
Infections like acute sinusitis, viral rhinitis, nasal
diphtheria , atrophic rhinitis, tuberculosis, granulomatous
lesions of the nose like rhinosporidiasis
Any neglected foreign body in the nose .
Epistaxis may also occur in atmospheric changes like high
altitude
Deviated nasal septum -common cause of nose bleeding
Sites of bleeding
Most common: anterior septum
Pinch all the soft parts of the nose together between your thumb and index
finger.
Press firmly toward the face - compressing the pinched parts of the nose
against the bones of the face.
Lean forward slightly with the head tilted forward. Leaning back or tilting
the head back allows the blood to run back into your sinuses and throat
and can cause gagging or inhaling the blood.
Hold the nose for at least five minutes. Repeat as necessary until the nose
has stopped bleeding.
Sit quietly, keeping the head higher than the level of the heart. Do not lay
flat or put your head between your legs.
Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will
escape out the mouth and not through the nose.
Do not strain during bowel movements. Use a stool softener (for example, Colace).
Try to keep your head higher than the level of your heart.
Do not smoke.
Do not take any medications that will thin the blood [aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or
warfarin (Coumadin)]. If these have been prescribed by your physician, you need to contact them
regarding stopping these medications.
Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).
If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can temporarily use a
nasal decongestant spray, such as Afrin or Neo-Synephrine. These types of sprays constrict blood
vessels. (NOTE: If used for many days at a time, these can cause addiction and do not use if you have
high blood pressure.)
Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the doctor
and/or visit to the emergency room.
NURSING CARE OF PATIENTS WITH
EPISTAXIS
Assessment of bleeding
Monitor airway, breathing
Vital signs
Reduce anxiety
Patient teaching
Avoid nasal trauma, nose picking, nose blowing
Air humidification
Pressure on nose to stop bleeding; if bleeding
does not stop in 15 minutes, seek medical
attention
TREATMENT OF EPISTAXIS
Topical vasoconstrictors
Adrenaline
Cocaine HCl – local anesthetic to temporarily numb
areas of the mouth, nose, and throat (mucous
membranes).
This medication should be used with caution in
children and elderly because they may be more
sensitive to side effects (e.g., mental/ mood
changes). This medication should be used only when
clearly needed during pregnancy.
Phenylephrine
Antihistamines
Histamine,
Bronchospasm
Bradykinin,
Mucosal edema
PG, Serotonin,
Hypersecretion of mucus
Leukotrienes…
Respiratory Narrowing of AWs,
Exhaustion effort ↑ work of breathing
NSAIDs
Emphysema
Causes
Congenital weakness
Respiratory irritants: smoke, polluted air,
chemical irritants
Respiratory tract infections
Genetic predisposition res
pi
diso
rder
s
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Chronic
Smoking, RTI, Pollutants
Bronchitis
Inflammation
Excessive
bronchial Bradykinin, Histamine, PGs
mucus Capillary permeability
production
Fluid/Cellular Exudation
Chronic or Mucosal edema
recurrent
productive Hypersecretion of mucus
cough Persistent Cough
res
pi
diso
rder
s
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Smoking, heredity, Emphysema
nionoveno@yc
aging process
Destruction of elastin
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Disequilibrium between
elastase & antielastase alters alveolar walls
& narrows airways
Loss of elastic recoil
Overdistention of alveoli
Enlargement
of air spaces distal
CO2 retention
to terminal bronchioles
Hypoxia leads to coalesced alveoli
Respiratory acidosis & air trapping res
pi
diso
rder
s
Chronic
Emphysema
Bronchitis
eno@yc
No cyanosis (Pink) Cyanosis (Blue)
Thin appearance Edematous
Exertional dyspnea Exertional dyspnea
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Ineffective cough Recurrent cough w/
Barrel chest Sputum production
Pursed-lip breathing Digital clubbing
Prolonged expiration ↑Respiratory rate
Use of accessory muscles Use of accessory muscles
nionoveno@yc
Management
Rest: O2 demand of tissues
Fluid intake: 3 L/day
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Diet: calorie, CHON, CHO, vit. C
Low-flow O2 therapy: 1-3 LPM
Breathing exercises [pursed-lip]
Avoid cigarette smoking, alcohol, pollutants
CPT: postural drainage percussion
vibration
Bronchial hygiene measures: steam, aerosol,
medimist inhalation res
pi
Pharmacotherapy: Antitussives, bronchodilators,
diso
antihistamine, steroids, antimicrobials rder
s
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Bronchiectasis
Destruction of bronchial
mucosa with fibrous scar
tissue formation
Loss of resilience
& airway dilation causes
pooling of secretions
Obstruction of airflow res
pi
diso
rder
s
CYSTIC FIBROSIS
Cystic fibrosis (CF) is an inherited disease of the
mucus and sweat glands.
airless alveoli
collapse of part of lung
2. W/o surfactant
surface tension
Collapse of part of lung
OCCUPATIONAL LUNG DIS
Exposure to occupational / environmental dust
Respiratory disorder
Growth of granulomas
chronic inflammation
Fibrosis leads to dec elasticity & dec gas exchange
Shortness of breath (dyspnea) and a cough that
won't go away can be among the first
symptoms of sarcoidosis.
But sarcoidosis can also show up suddenly with
the appearance of skin rashes. Red bumps (
erythema nodosum) on the face, arms, or Shins
and inflammation of the eyes are also common
symptoms.
It is not unusual, however, for sarcoidosis
symptoms to be more general.
Weight loss, fatigue, night sweats, fever, or just
an overall feeling of ill health can also be clues
to the disease.
How is sarcoidosis diagnosed?
Preliminary diagnosis of sarcoidosis is based on the
patient's medical history, routine tests, a physical
examination, and a chest x- ray.
The doctor confirms the diagnosis of sarcoidosis by
eliminating other diseases with similar features.
These include such granulomatous diseases as
berylliosis (a disease resulting from exposure to
beryllium metal),
tuberculosis, farmer's lung disease (
hypersensitivity pneumonitis),
fungal infections,
rheumatoid arthritis,
rheumatic fever,
and cancer of the lymph nodes (lymphoma).
HOW IS SARCOIDOSIS TREATED?
Require no treatment. Symptoms are usually not disabling and
disappears spontaneously.
When therapy is recommended;
nionoveno@yc
Undissolved substance in pulmonary vasculature
obstructs blood flow
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Types: Fat, Air, Thrombus
Causes
Flat or long bone fractures
Thrombophlebitis
Venous stasis
res
pi
diso
rder
s
PULMONARY EMBOLISM
nionoveno@yc
Clinical Manifestations
Dyspnea, tachypnea, crackles
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Diagnostics
ABGs
Respiratory alkalosis, hypoxemia
Lung Scan
Pulmonary circulation & blood flow obstruction
Angiography
Location of embolus
Filling defect of pulmonary artery res
pi
diso
rder
s
PULMONARY EMBOLISM
nionoveno@yc
Management
77
Anticoagulants
Thrombolytics