RESPIRATORY

DISEASES
GROUP 3
PNEUMONIA
DESCRIPTION

• Is an inflammation of the lung parenchyma caused by various

microorganism including: bacteria, mycobacteria, fungi, and viruses.
• Pneumonias are classified as community acquired pneumonia (CAP),
hospital-acquired (nosocomial), pneumonia in the immunocompromised
host, and aspiration pneumonia.
SIGNS AND SYMPTOMS

• Fever, chills, or night sweats

• Pleuritic pain, bradycardia, tachypnea, and fatigue
• Change in temperature and pulse, odor, and color of secretion
• Assess elderly patients for altered mental status, dehydration, unusual
behavior, excessive fatigue and concomitant heart failure.
LABORATORY TESTS

• Chest X-ray
- To confirm the diagnosis by disclosing infiltrates
• Blood culture
- Should be obtained before administrating antibiotics
- Requires 24 hrs to incubate
- When positive, correlates well with the microbiological agent that
causes pneumonia
RISK FACTORS

• very young children and babies

• older people
• pregnant women
• people with diseases that weaken the immune system
• people with autoimmune diseases
• people with lung and respiratory conditions
PATHOPHYSIOLOGY

• -Normally, the upper airway prevents potentially infectious particles from

reaching the sterile lower respiratory tract.
-Pneumonia arises from normal flora present in patients whose resistance has
been altered or from aspiration of flora present in the oropharynx; patients
often have an acute or chronic underlying disease that impairs host defenses.
-Pneumonia may also result from bloodborne organisms that enter the
pulmonary circulation and are trapped in the pulmonary capillary bed.
-Pneumonia affects both ventilation and diffusion. An inflammatory reaction
can occur in the alveoli, producing an exudate that interferes with the diffusion
of oxygen and carbon dioxide.
• -Areas of the lung are not adequately ventilated because of secretions and mucosal
edema that cause partial occlusion of the bronchi or alveoli, with a resultant decrease
in alveolar oxygen tension.
-Bronchospasm may also occur in patients with reactive airway disease
- Venous blood entering the pulmonary circulation passes through the under ventilated
area and travels to the left side of the heart poorly oxygenated.-The mixing of
oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial
hypoxemia.
-The term bronchopneumonia is used to describe pneumonia that is distributed in a
patchy fashion, having originated in one or more localized areas within the bronchi and
extending to the adjacent surrounding lung parenchyma. Bronchopneumonia
NURSING INTERVENTIONS

• Give prescribed medications

• Encourage to increase fluid intake
• Promote rest and conserve energy
• Improve airway patency
• Monitor vital signs
MEDICATIONS

• Analgesic to relieve pleuritic chest pain

• Antibiotic for bacterial pneumonia
• Cough Medicine
ASTHMA
DESCRIPTION

• Asthma greek word – panting means childs distress

• Chronic reactive airway disorder involves episodic reversible airway
obstruction
• May occur at any age; 50% under the age of 10; 1/3 between 10 to 30
yrs old
• Disease shared with at least 1 immediate family member
SIGNS AND SYMPTOMS

• Mild wheezing (inspiratory & expiratory)

• Dyspnea
• Tachycardia
• Tachypnea
• Prolonged expiration
• Cyanosis, confusion, lethargy
LABORATORY TESTS

Arterial Blood Gas

• Evaluate ventilator process,acid base disturbances and effectiveness of therapy.
• Normal Values: pH adults (7.35-7.45); children: (7.36-7.44), PaCO2: 35-45mmHg,
HCO3 ̄: 22-26mEq/L or mmol/L, SaO2: oxygen saturation >95%, PaO2: >80-100 mm
Hg, BE ±2 mEq/L
• Decrease PaO2 = hypoxemia, Increase PaO2 = hypercapnia
• Procedure: Obtain arterial blood gas specimen (3-5mL) in heparinized syringe.
• Nursing responsibilities: Label the syringe with patients name,identification
number,date, time,whether on room air or oxygen and rate flow
Chest X-ray
• Evaluate suspected pulmonary or cardiac disease and trauma to chest.
• Check for pneumothorax after bronchoscopy and following biopsy.
• Normal: Normal positioned chest, bony thorax, soft tissues, mediastinum, lungs,
pleura , heart, aortic arch
• Procedure: Sustained full inspiration is required
• Nursing responsibilities: Explain the purpose and procedure then the patient must
remove all the jewelries and clothes to the waist and also screen for pregnancy
status.
Complete Blood Count

• Use WBCs as guide to indicate the severity of the disease process

• Normal value: WBC 4500-10,500 cells/mm³
• Increased WBC = increased in eosinophil count caused by allergies.
RISK FACTORS

• Animal dander
• House dust or molds
• Pollen
• Viral infection
• Exercise
• History of asthma
• Age
• Emotional stress
• Cold air
• Sensitivity to allergens
PATHOPHYSIOLOGY

• Asthma primarily affects the small airways and involves three separate
processes bronchospasm , inflammation of the bronchial mucosa,
increased bronchial secretions (mucous)
• All three processes act to reduce the size of the airway lumen, leading
to acute respiratory distress
• Asthma
NURSING INTERVENTIONS

• Assess history
• Assess respiratory status
• Give prescribed medications
• Administer fluids if patient is dehydrated
• Encourage to increase fluid intake
• Monitor vital signs
MEDICATIONS

• Inhaled anti-inflammatory corticosteroid (fluticasone [Flovent]) daily for

some children that has persistent but mild asthma
• -For children have a moderate persistent symptoms are prescribed a
long-acting bronchodilator ( at bedtme) in addition to inhaled anti-
inflammatory corticosteroid daily
• -For severe persistent asthma symptoms take a high dose of both
corticosteroid (oral & inhaled) daily as well as a long-acting
bronchodilator at bedtime.
INFLUENZA
DESCRIPTION

• Characterized inflammation and infection of the major airways.

• Caused by the orthomyous influenza type A B or C
SIGNS AND SYMPTOMS

• fever
• Cough
• Fatigue
• Aching pains
• Sore throat
• Chills
• Nasal itchiness
• General Malaise
• Vomiting
• Diarrhea
LABORATORY TESTS

• Rapid antigen test

- test that is able to detect the presence of pathogen
• Rapid Influenza Detecting Tests
- Test that can identify the presence of influenza A and B viral
nucleoprotein antigens in respiratory specimens.
• Physical Examination
RISK FACTORS

• Young children under age 5

• Older than age 65
• Residents of nursing homes and other long-term care facilities
• Pregnant women
• People with weakened immune systems
• People who have chronic illnesses
• People who are very obese
PATHOPHYSIOLOGY

• Influenza virus attachment to the cell membrane

• Influenza virus replication Production of cytokines granzymes and
cytotoxic factors
• Damage of airway epithelial cells and endotjelial cells airway
hypersensitivity narrowing and alvelolitis
• exacerbatin of bronchialasthma and COPD
• Damage of alveotes endomethial cells pneumonia
NURSING INTERVENTIONS

• Give prescribed medications

• Monitor vital sign
• Reposition to semifowler position
• Tepid Sponge bath
MEDICATIONS

• Acetaminophen (Tylenol) for fever and pain relief

• Antihistamines (Ceterizine) for sneezing, itching and nasal discharge
• Decongestant for nasal congestion
• Cough Medicine
TUBERCULOSIS
DESCRIPTION

• Tuberculosis is a highly contagious pulmonary disease.

• The causative agent is Mycobacterium tuberculosis (tuberclebacillus).
• The mode of transmission is inhalation of infected droplets.
• The incubation period is 2 to 10 weeks.
SIGNS AND SYMPTOMS

• Chronic Cough
• Weight loss
• Hemoptysis (coughing blood)
• Night sweats
• Low-grade fever
• Chronic fatigue
LABORATORY TESTS

• Chest X-Ray
Chestt X-ray shows nodular lesions, patchy infiltrates (mainly in the upper lobes), cavity
formation, scar tissue, and caalcium deposits; however, it may not be able to distinguish
active from inactive TB
• Tuberculin skin test
Tuberculin skin test detects exposure to TB. Intermediate-strength purified protein derivative
or 5 tuberculin units (0.1ml) are injected intradermally on the forearm. The test results are
read in 48 to 72 hours; a positive reaction (in duration of greater than or equal to 10 mm,
depending on risk factors) develops 2 to 10 weeks after infection in active and inactive TB.
However, severely immunosuppressed patients may never develop a positive reaction.
RISK FACTORS

• Close contacts of persons exposed to contagious cases of TB

• Foreign-born persons, including children, who have immigrated within the
last 5 years from areas that have a high TB incidence
• Residents and employees of high-risk congregate settings
• Healthcare workers who serve high-risk clients
• Infants, children, and adolescents exposed to adults in high-risk categories
• Persons who inject illicit drugs or any other locally identified high-risk
substance users
PATHOPHYSIOLOGY

• Transmission occurs when an infected person coughs or sneezes, spreading infected droplets
• When someone without immunity inhales these droplets, the bacilli are deposited in the lungs.
• The immune system responds by sending leukocytes, and inflammation results
• After a few days, leukocytes are replaced by macrophages
• Bacilli are then ingested by the macrophages and carried off by the lymphatics to the lymph
nodes.
• Macrophages that ingest the bacilli fuse to form epitheliod cell tubercles, tiny nodules surrounded
by lymphocytes.
• Within the lesion, necrosis develops and scar tissue encapsulates the tubercle.
• The organism may be killed in the process
NURSING INTERVENTIONS

• Isolate the infectious patient in a quiet, well-ventilated room until he’s

no longer contagious.
• Remind the patient to get plenty of rest and to eat balanced meals.
• Monitor vital signs
• Give/Administer prescribed medications
MEDICATIONS

• Isoniazid (INH) 5mg/kg (300mg max daily) – antibiotic for tuberculosis

• Rifampin 10mg/kg (600mg max daily) – antibiotic for tuberculosis
• Pyrazinamidee 15-30mg/kg (2.0g max daily) – antibiotic for
tuberculosis
• Ethambutol 15-25 - antibiotic for tuberculosis
• Vitamin B6 for neuropathy of hands/feet
ACUTE
NASOPHARYNGITIS
DESCRIPTION

• Also known as common cold

• Most frequent disease in children
• Mostly occurs in school-age and adolescents
• Caused by one of several viruses:
-rhinovirus -adenovirus
-coxsackie virus -parainfluenza
-RSV -influenza
SIGNS AND SYMPTOMS

• runny or stuffy nose

• sneezing
• coughing
• sore or scratchy throat
• watery or itchy eyes
LABORATORY TESTS

• Physical Examination
• WBC count
- detect hidden infection within the body and undiagnosed medical
conditions such as autoimmune disease, immune deficiencies.
RISK FACTORS

• Age (younger than 6 years.)

• Weakened immune system
• smoking /lifestyle
NURSING INTERVENTIONS

• Monitor Vital signs

• Administer prescribed medicine
• Position the patient in a semi-fowlers position
• Encourage to increase fluid intake
• Increase room humidity
MEDICATIONS

Antipyretics
• Acetaminophen (Tynelol)
Antihistamines
• Ibuprofen Motrin
• inaifenesin (Mucinex)
BRONCHITIS
DESCRIPTION

• inflammation of the bronchi and trachea

• it can be acute ( symptoms last for a few weeks) or chronic ( keeps
coming back or doesn’t go away that last for many weeks or even
months)
• common in preschool and school aged children
• presence of cough and sputum production for at least a combination
total of 3 months in each of 2 consecutive years
SIGNS AND SYMPTOMS

• Fever
• dry and hacking cough
• rhonchi and crackles can be heard
• mild upper respiratory tract infection
LABORATORY TESTS

Chest X-ray
• Used to demonstrate the appearance of lungs, mediastinum, bony
thorax, diaphragm, chest wall, cardiac silhouette and thyroid gland.
Sputum cultures
• Sample of material expelled from the respiratory passages taken for
laboratory analysis to determine the presence of pathogens. A
specimen of mucus from the lungs expectorated through the mouth or
obtained via tracheal suctioning with an in-line trap or bronchoscope.
Pulmonary function testing (PFT) Spirometry
• Used to evaluate the nature and extent of pulmonary disease and to
identify the underlying ventilator impairment.
Complete Blood Count
• To identify the cause of the infection. A high white blood cell count or
the presence of abnormal cells is an indication of a viral infection. If it’s
low, you could be at risk for infection.
RISK FACTORS

• Allergies
• Lack of pertussis immunization
• Malnutrition (particularly in children)
• Exposure to chemicals, fumes, and dust
• History of Chronic sinusitis
PATHOPHYSIOLOGY

• Microorganism enter respiratory tract by droplet inhalation

• Widespread inflammation occurs
• Thin mucous lining of the bronchi can become irritated and swollen
• Cells that make up this lining may leak in response to the inflammation
• Coughing as a reflex that works to clear secretions from the lungs
• Alveolar fluid increase
• Narrowing of airways
• Ventilation decreases as secretion thickens
• Mucus within the airways resistance in small airways and can cause severe ventilation-perfusion
imbalance
NURSING INTERVENTIONS

• Encourage mobilization of secretion through ambulation, coughing, and deep breathing.

• Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by
fever and tachypnea.
• Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.
• Instruct the patient to complete the full course of prescribed antibiotics and explain the
effect of meals on drug absorption
• Monitor vital signs
• Administer prescribe medications
MEDICATIONS

• Azithromycin is an antibiotic that fights bacteria that used to treat

many different types of infections caused by bacteria, such as
respiratory infections, skin infections, ear infections, eye infections, and
sexually transmitted diseases.
• Albuterol inhalation will help dilate and minimize inflammation of the
bronchial tubes.
• Prednisone is a common prescription medication that enhances the
anti-inflammatory effects of the steroids produced within the body by
the adrenal glands.
ATELECTASIS
DEACRIPTION

• Atelectasis is the collapse of lung alveoli

• It may occur in children as a primary or secondary condition
• It considered as a possibility in all children with respiratory distress
SIGNS AND SYMPTOMS

• Cyanosis
• Difficulty of breathing
• Coughing
• Increased heart rate
• Chest pain
LABORATORY TESTS

Bronchoscopy
• A procedure that look at your lungs and air passages. It is use to detect
the cause of breathing difficulties and lung problems
Chest X-ray
RISK FACTORS

• Older age
• Any condition that makes it difficult to swallow
• Confinement to bed with infrequent changes of position
• Lung diseases
• Recent abdominal or chest surgery
• Recent general anesthesia
• Medications that may cause shallow breathing
• Pain or injury that may make it painful to cough or cause shallow breathing, including
stomach pain or rib fracture
• Smoking
PATHOPHYSIOLOGY

• Reduced ventilation or blockage

• Obstruction of passage of air from and to alveoli
• Trapped alveolair air absorbed into bloodstream
• Affected portiin of alveoli becomes airless
• Alveoli collapse
NURSING INTERVENTIONS

• Position the patient to a semi-fowler position

• Give prescribed medications
• Monitor vital signs
• Encourage to perform deep breathing exercises
• Tap on the patient’s chest to loosen mucus
MEDICATIONS

• Bronchodilators
- Decreases muscle tone in both the small and large airways in the
lungs, thereby increasing ventilation.
• Mucolytic Agents
- Therapy with mucolytics may promote sputum removal of thick
mucous plugs
CYSTIC FIBROSIS
DESCRIPTION

• Sometimes called mucoviscidosis

• Chronic disease
• Generalized dysfunction of the exocrine glands that affects multiple
organ systems
SIGNS AND SYMPTOMS

• Productive cough
• Wheezing
• Sinusitis
• Nasal polyps
LABORATORY TESTS

• Chest X-ray
- It indicates early signs of obstructive lung disease
• Fecalysis
- It indicates the absence of trysin, suggesting pancreatic insufficiency
• Sweat Test
- Two sweat tests (to detect elevated sodium chloride levels) using a pilocarpine
solution (a sweat inducer) and presence of an obstructive pulmonary disease,
confirmed pancreatic insufficiency or failure to thrice, or a family history of cystic
fibrosis confirm the disorder
RISK FACTORS

• Family History
• Race
- most common in white people of Northern European ancestry.
PATHOPHYSIOLOGY
NURSING INTERVENTIONS

• Give prescribed drugs

• Promote a patent airway and prevent development of complications
through maintaining oxygenation, hydration, and adequate nutrition
• Monitor vital signs
MEDICATION

• Dornase alpha (Pilmozyme) nebulized medication

• Nebulized antibiotics such as tobramycin (TOBI), cikustub (Colimycin),
gentamicin (Garamycin), and Ceftazidime (Fortaz, Ceptaz)