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P R E P A R E D B Y :
M A R I S O L J A N E T . J O M A Y A
I N S T R U C T O R
THE RESPIRATORY SYSTEM
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L A B O R A T O R Y A S S E S S M E N T
Diagnosis of Pulmonary
Function
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Routine Radiography
Integral part of the diagnostic evaluation ofdiseases involving the pulmonary
parenchyma, the pleura, and to a lesser extent,the airways and the mediastinum.
Usually involves a postero-anterior view and alateral view.
Lateral decubitus views are often useful fordetermining whether pleural deformitiesrepresent freely flowing fluid.
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Chest Radiography
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Computed Tomography
Offers several advantages over conventionalradiographs.
Use of cross-sectional images makes itpossible to distinguish between densities.
Better at characterizing tissue densities andproviding accurate size of lesions.
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Computed Tomography
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Computed Tomography
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Magnetic Resonance Imaging
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Pulmonary Function Tests
Objectively measure the ability of therespiratory system to perform gas exchange by
assessing ventilation, diffusion andmechanical properties.
Composed of the spirometry test andventilation-perfusion (V/Q) test.
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Pulmonary Function Tests
Indications:
Evaluation of the type and degree of pulmonarydysfunction (obstructive or restrictive)
Evaluation of dyspnea, cough and other symptoms Early detection of lung dysfunction
Surveillance in occupational settings
Follow-up or response to therapy
Preoperative evaluation
Disability assessment
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Pulmonary Function Tests
Spirometry Allows for the
determination of thepresence and severity ofobstructive and restrictive
pulmonary dysfunction. The hallmark of
obstructive pulmonarydysfunction is reduction ofairflow rates.
Restrictive pulmonarydysfunction ischaracterized by reductionin pulmonary volumes.
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Pulmonary Function Tests
Ventilation-PerfusionLung Scan (V/Q scan)
Measures the degree ofventilation of the individual
lung segments and theperfusion of respectivesegments to detect anyshunting or mismatch.
Finds utility in settingswhere possible pulmonaryembolism is suspected.
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Arterial Blood Gases
Measure of acid andbase balance in theblood.
Also check thesaturation of blood withoxygen.
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Biologic Specimen Collection
Sputum collection
Spontaneous expectorationor sputum induction
Percutaneous needleaspiration
Usually carried out underCT or ultrasound guidance.
Potential risks includeintrapulmonary bleedingand creation of apneumothorax.
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Biologic Specimen Collection
Thoracentesis
Sampling of pleuralfluid or for palliation ofdyspnea in patients with
pleural effusion.
Analysis of the fluid forcellular compositionand chemical
constituents likeglucose, protein andLDH.
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Biologic Specimen Collection
Bronchoscopy Provides for direct
visualization of thetracheobronchial tree.
Rigid bronchoscopy is
performed in an operatingroom on a patient undergeneral anesthesia.
Flexible bronchoscopy maybe done under localanesthesia / sedation.
Diagnostic uses includehistologic identification orneoplasms and identificationof sources of hemoptysis.
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Bronchoscopy
Therapeuticindications areretrieval of foreignbodies and control
of bleeding. Bronchoalveolar
lavage has beenused for the
recovery oforganisms that aredifficult to isolate inthe usual sputumrecovery methods.
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N E O N A T A L
C H I L D
Y O U N G A D U L T
A C R O S S T H E L I F E S P A N
Diseases of the Respiratory
System
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CHOANAL ATRESIA
Choanal atresia iscongenital obstructionof the posterior nares byan obstructingmembrane or bonygrowth, preventing anewborn from drawing
air through the nose anddown into thenasopharynx.
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CHOANAL ATRESIA
ASSESSMENT
Signs of respiratory distress at birth or immediatelyafter they quiet for the first time and attempt to
breathe through their nose. Failure of the catheter to pass bilaterally through the
nares to the stomach immediately after birth.
Air hunger when mouth is closed color improves
when mouth opens Cyanosis at feedings because the baby cannot suck
and breath through the mouth simultaneously
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CHOANAL ATRESIA
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CHOANAL ATRESIA
Management and Treatment
Local piercing of the obstructing membrane
Surgical removal of the bony growth.
Intravenous fluid to maintain their glucose and fluidlevel until surgery can be performed.
Oral airway inserted so they can continue to breathethrough their mouths.
Following surgery, children have no further difficultyor symptoms.
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LARYNGOTRACHEOBRONCHITIS (LTB)
ACUTELARYNGOTRACHEOBRONCHITIS (LTB)ANDSPASMODIC CROUP
Acute LTB is characterizedby inflammation andnarrowing of the laryngealand tracheal areas. It isthe most common form of
croup and usually affectschildren younger than 5
years old
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LARYNGOTRACHEOBRONCHITIS (LTB)
Spasmodic croup is similar to acute LTB, but it tendsto occur at night and recurs with respiratory tractinfection
Acute LTB is usually caused by virus Spasmodic croup is not caused by a virus, but may
have associated genetic, allergic, or emotionalpredisposing factors
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LARYNGOTRACHEOBRONCHITIS (LTB)
Acute LTB Gradual onset from URTI,
which progresses to signs ofdistress
Hoarseness Inspiratory stridor
Retractions
Severe respiratory distress
Low-grade fever Restlessness and irritability
Wheezing
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LARYNGOTRACHEOBRONCHITIS (LTB)
Spasmodic croup
Is characterized by S/S similar to acute LTB, but thechild is afebrile, the onset is sudden, and the child isawakened at night with a barklike cough
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INTERVENTIONS
Assess respiratory status, monitoring for nasal flaring,sternal retraction, and inspiratory stridor.
Monitor for pallor or cyanosis.
Elevate the head of the bed and provide bed rest.
Assesses for airway obstruction
Keep emergency equipment near the bedside
Administer oxygen and increase atmospheric humidity
Promote desired fluid intake Administer prescribed medications
Minimize fear and anxiety
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INTERVENTIONS
Provide humidified oxygenvia cool-mist tent for thehospitalized child.
Instruct the parents to use
a cool-air vaporizer orhumidifier at home; othermeasures include havingthe child breathe in thecool night air or the air
from an open freezer ortaking the child to a cool
basement or garage.
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BRONCHIOLITIS
is a disorder most commonly caused in infantsbyviral lower respiratory tract infection.
It is the most commonlower respiratory infection
in this age group. It is the inflammation of thebronchioles, the
smallest air passages of the lungs.
It is characterizedby acute inflammation, edema,
and necrosis of epithelial cells lining small airways,increased mucus production, and bronchospasm.
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BRONCHIOLITIS
Causes - most commonly
caused byrespiratorysyncytial virus (RSV, alsoknown as human
pneumovirus). - Other viruses
which may cause thisillness include
meta pneumovirus,influenza, parainfluenza,coronavirus, adenovirusand rhinovirus.
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BRONCHIOLITIS
Signs and symptoms are typically rhinitis,
tachypnea, wheezing, cough, crackles, use ofaccessory muscles,and/or nasal flaring
Treatment There is no effective specific treatment for
bronchiolitis. Therapy is principally supportive.
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INTERVENTIONS
Conservative measures Frequent small feeds are encouraged to maintain
hydration as evidenced by good urine output, andsometimes oxygen may be required to maintain bloodoxygen levels.
Suction of the nasopharynx is often performed tomaintain a clear airway.
In severe cases the infant may need to be fed via anasogastric tube or it may even need intravenous fluids.
In extreme cases, mechanical ventilation might benecessary. Bronchodilators Handwashing/Immunization (PALIVIZUMAB)
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TONSILLITIS
Tonsillitis is aninfection (usuallyviral) of the tonsils
If a child has many
infections, the tonsilsare surgicallyremoved
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TONSILLITIS
It is believed thattonsils help preventbacteria and other
pathogens fromentering the bodytherefore a removalmay increase the
number of illnesseslater in life
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TONSILLITIS
CAUSES In tonsillitis, structures that are already large become
inflamed due to an infectious agent and cause airway
obstruction, decreased appetite, and pain.
Infection is caused by bacterial or viral organisms, withviral organisms most commonly implicated.
Group A beta-hemolytic Streptococcus is the most
common bacterial cause.
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TONSILLITIS
CLINICAL MANIFESTATIONS
OBSTRUCTIVE SLEEP APNEA
LOUDSNORINGORNOISYBREATHINGINSLEEP EXCESSIVEDAYTIMESLEEPINESS
MOUTHBREATHING
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TONSILLITIS
CHRONIC INFECTIONOF TONSILS
MOUTHBREATHINGORDIFFICULTYBREATHING
FREQUENTSORETHROAT
ANOREXIA, DECREASEDGROWTHVELOCITY FEVER
OBSTRUCTIONTOSWALLOWING/BREATHING
NASAL, MUFFLEDVOICE NIGHTCOUGH
OFFENSIVEBREATH
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Diagnostic Evaluation
Thorough ears, nose, and throat examination andappropriate cultures to determine presence and
source of infection; Preoperative blood studies to determine risk of
bleeding-clotting time, smear for platelets,prothrombin time, partial thromboplastin time
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SURGICAL MANAGEMENT
INDICATIONSFORTONSILLECTOMY
RECURRENTORPERSISTENTTONSILLITISWITHDOCUMENTEDSTREPTOCOCCALINFECTIONFOURTIMESIN
1YEAR
MARKEDHYPERTROPHYOFTONSILS,WHICHDISTORTS
SPEECHCAUSESSWALLOWINGDIFFICULTIES,ANDCAUSESSUBSEQUENTWEIGHTLOSS
TONSILLARMALIGNANCY
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Treatment - tonsillectomy
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INTERVENTIONS
Reducing fear Relieving parental anxiety Assess frequently for
bleeding postoperatively.Check all secretions andemesis for presence of fresh
blood.
Indications of hemorrhageinclude the following: Increased pulse Frequent swallowing Pallor
Restlessness Clearing of throat and
vomiting ,of blood Continuous slight oozing of
blood over a number of
hours Oozing of blood in back of
throat
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INTERVENTIONS
HAVESUCTIONEQUIPMENTANDPACKINGMATERIALREADILYAVAILABLEINCASEOFEMERGENCY.
PROVIDEADEQUATEFLUIDINTAKE.
GIVEICECHIPS 1 TO 2 HOURSAFTERAWAKENINGFROMANESTHESIA.
WHENVOMITINGHASCEASED,ADVANCETOCLEARLIQUIDCAUTIOUSLY.
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INTERVENTIONS
OFFERCOOLFRUITJUICESWITHOUTPULPATFIRSTBECAUSETHEYAREBESTTOLERATED; THENOFFERPOPSICLES, COOLWATERFORFIRST 12 TO 24 HOURS.
AVOIDRED/BROWNFLUIDS.
THEREISSOMECONTROVERSYREGARDINGINTAKEOFMILKANDICECREAMTHEEVENINGOFSURGERY.
EXPLAINANDWRITEINSTRUCTIONSCONCERNINGTHECAREOFTHECHILDATHOMEAFTERDISCHARGE.
DIETSHOULDSTILLCONSISTOFLARGEAMOUNTSOFFLUIDSANDSOFT, COOL, NONIRRITATINGFOODS.(SUPPLYLISTOFSUGGESTIONS.)
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INTERVENTIONS
EATINGHELPSPROMOTEHEALINGBECAUSEITINCREASESTHEBLOODSUPPLYTOTISSUES.
BEDRESTSHOULDBEMAINTAINEDFOR1 TO 2 DAYSANDTHENDAILYRESTPERIODSFORABOUT 1WEEK. RESUME
NORMALEATINGANDACTIVITIESWITHIN 2WEEKSAFTERSURGERY.
AVOIDCONTACTWITHPEOPLEWITHINFECTIONS.
DISCOURAGETHECHILDFROMFREQUENTCOUGHINGANDCLEARINGOFTHROAT.
AVOIDGARGLING. MOUTHODORMAYBEPRESENTFORAFEWDAYSAFTERSURGERY; ONLYMOUTHRINSINGISACCEPTABLE.
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LARYNGITIS
Laryngitis is aninflammation of thelarynx (vocal cords)
CAUSES: virus
allergiesstraining
of voice
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LARYNGITIS
When the larynx is inflamed, the vocal cordscant vibrate properly therefore the voice ishoarse or even non-existent
TREATMENT rest, fluids, no talking!!
i f i
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Upper Respiratory Tract Infections:Common Cold (Infectious Rhinitis)
Viral (rhinovirus) Spread through respiratory droplets Highly contagious Initially mucous membranes of nose,
pharynx swollen, increased secretions Signs Nasal congestion and watery discharge Mouth breathing
Change in tone of voice Sore throat, headache, slight fever Cough
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COMMON COLD
Treatment rest,fluids NOTantibiotics it is a
virus Presently, there is
no cure or vaccine
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COMMON COLD
The cold virus isspread eitherthrough droplets inthe air or direct
contact with aninfected person orcontaminated surface(1 day before
symptoms appearand up to 5 daysafter)
The best way to reduce the chances
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The best way to reduce the chancesof getting a cold
WASH HANDS!
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CYSTIC FIBROSIS
Genetic condition An abnormal gene
causes the cells liningthe alveoli to secrete
a thick, sticky mucus Mucus attracts
bacteria andnumerous infections
result
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CYSTIC FIBROSIS - treatments
There is no cure lifeexpectancy is usuallylow early 30s
Medicines are used to
thin the mucus Antibiotics are given
for infections
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Diagnostic Tests Pilocarpine iontophoresis sweat
chloride test
Pulmonary function tests
ABG and oxygen saturation levels
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Quantitative Sweat Chloride Test The production of sweat is stimulated (pilocarpine
iontophoresis), the sweat is collected, and thesweat/electrolytes are measured (a minimum of 50mg of is needed).
Normally, sweat chloride concentration is less thanpositive test result.
Chloride concentrations of 40 to 60 mEq/L arehighly suggestive of cystic fibrosis and require arepeat test.
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Medications Immunizations against respiratory infections,
influenza vaccine
Bronchodilators Antibiotics
Dornase alfa, as aerosol breaks down excess DNA insputum
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INTERVENTIONS
RESPIRATORYSYSTEM GOALSOFTREATMENTINCLUDEPREVENTINGAND
TREATINGPULMONARYINFECTIONBYIMPROVINGAERATION, REMOVINGSECRETIONS,ANDADMINISTERINGANTIMICROBIALMEDICATIONS.
CHESTPHYSIOTHERAPY(PERCUSSIONANDPOSTURALDRAINAGE) ONAWAKENINGANDINTHEEVENING (MORE
FREQUENTLYDURINGPULMONARYINFECTION). CHESTPHYSIOTHERAPYSHOULDNOTBEPERFORMED
BEFOREORIMMEDIATELYAFTERAMEAL.
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ILLUSTRATIONS FORPOSTURAL DRAINAGE
UPPER LOBES FRONT
ILLUSTRATIONS FORPOSTURAL DRAINAGE
UPPER LOBES BACK
O S
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INTERVENTIONS
BRONCHODILATORMEDICATIONBYAEROSOLOPENSTHEBRONCHIFOREASIEREXPECTORATION (ADMINISTEREDBEFORETHECHESTPHYSIOTHERAPYWHENTHECHILDHASREACTIVEAIRWAYDISEASEORISWHEEZING).
ADMINISTRATIONOFRECOMBINANTHUMANDEOXYRIBONUCLEASE
(DNASE), KNOWNGENERICALLYASDORNASEALFA(PULMOZYME),WHICHDECREASESTHEVISCOSITYOFMUCUS.
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INSTRUCTTHEPARENTSNOTTOGIVECOUGHSUPPRESSANTS, FORTHEYWILLINHIBITEXPECTORATIONOFSECRETIONSANDPROMOTEINFECTION.
TEACHTHECHILDFORCEDEXPIRATORYTECHNIQUE(HUFFING) TOMOBILIZESECRETIONS.
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DEVELOPAPHYSICALEXERCISEPROGRAMWITHTHEAIMOFESTABLISHINGAGOODHABITUALBREATHINGPATTERN.
ADMINISTERANTIBIOTICSASPRESCRIBED,WHICHMAYBEPRESCRIBEDPROPHYLACTICALLYORWHENPULMONARYSYMPTOMSDEVELOP.
ADMINISTEROXYGENASPRESCRIBEDDURINGACUTE
EPISODES; MONITORCLOSELYFOROXYGENNARCOSIS.
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MONITORFORHEMOPTYSIS; GREATERTHAN 300 MLIN 24 HOURSFORTHEOLDERCHILD (LESSFORA
YOUNGERCHILD) NEEDSTOBETREATEDIMMEDIATELY.
HEMOPTYSISMAYBECONTROLLEDBYBEDREST,COUGHSUPPRESSANTS,ANTIBIOTICS,ANDVITAMINK; IFHEMOPTYSISPERSISTS, THESITEOFBLEEDINGMAYBECAUTERIZEDOREMBOLIZED.
LUNGTRANSPLANTATIONISAFINALTHERAPEUTICOPTIONFORTHECHILDWITHEND-STAGEDISORDER.
INTERVENTIONS
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INTERVENTIONS
GASTROINTESTINALSYSTEM THEGOALOFTREATMENTFORPANCREATIC
INSUFFICIENCYISTOREPLACEPANCREATICENZYMES;ADMINISTEREDWITHMEALSANDSNACKS (ORWITHIN
30 MINUTESOFEATINGMEALSANDSNACKS) TOENSURETHATDIGESTIVEENZYMESAREMIXEDWITHFOODINTHEDUODENUM.
THEAMOUNTOFPANCREATICENZYMESADMINISTERED
ISADJUSTEDTOACHIEVENORMALGROWTHANDADECREASEINTHENUMBEROFSTOOLSTOTWOORTHREEPERDAY.
INTERVENTIONS
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INTERVENTIONS
ENTERIC-COATEDPANCREATICENZYMESSHOULDNOTBECRUSHEDORCHEWED.
PANCREATICENZYMES
SHOULDNOTBEGIVENIFTHECHILDISTORECEIVENOTHINGBYMOUTH.
ENCOURAGEAWELL-BALANCED, HIGH-
PROTEIN, HIGHCALORIEDIET; MULTIVITAMINSANDVITAMINS A, D E,AND KAREALSOADMINISTERED.
INTERVENTIONS
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INTERVENTIONS
ASSESSWEIGHTANDMONITORFORFAILURETOTHRIVE. MONITORFORCONSTIPATIONANDINTESTINALOBSTRUCTION.
ENSUREADEQUATESALTINTAKEDURINGEXTREMEHOTWEATHERORIFTHECHILDHASAFEVER; INCLUDEFLUIDSSUCHAS GATORADEOREXCEED,WHICHPROVIDEANADEQUATESUPPLYOFELECTROLYTES.
CYSTIC FIBROSIS
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CYSTIC FIBROSIS
New treatmentsinclude gene therapy
An inhaler is used tospray healthy
versions of theabnormal gene thehealthy genes canthen make propermucus
PULMOZYME
NOSE FRACTURE
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NOSE FRACTURE
A fractured nose is the mostcommon facial fracture.
It usually results from ablunt injury and is often
associated with other facialfractures. The bruisedappearance usuallydisappears after 2 weeks.
Nose injuries and neckinjuries are often seentogether
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Serious nose injuriescause problems that
require immediateprofessional attention.However, for minornose injuries, thedoctor may prefer to
see the victim after theswelling subsides. Occasionally, plastic
surgerymay benecessary to correct a
deformity of the noseor nasal septum causedby a trauma.
NOSE FRACTURE
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NOSE FRACTURE
First Aid Reassure the patient and try to keep the patient
calm.
Have the patientbreathe through the mouth and
lean forward in a sitting position in order tokeep blood from going down the back of the throat.
Applycold compresses to the nose to reduceswelling. If possible, the patient should hold the
compress so that excessive pressure is not applied. To help relieve pain, acetaminophen is
recommended.
NOSE FRACTURE
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NOSE FRACTURE
DO NOT try to straighten a broken nose. DO NOT move the person if there is reason to
suspect a head or neck injury.
Call immediately for emergency medicalassistance if
You suspect a neck or head injury
Bleeding will not stop
Clear fluid keeps draining from the nose
The person is having difficulty breathing
NOSE FRACTURE
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NOSE FRACTURE
Prevention Protective headgear should be worn while playing
contact sports, riding bicycles, skateboards, roller-skates, or roller blades.
Seat belts and appropriate car seats should be used.
DEVIATED SEPTUM
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DEVIATED SEPTUM
Definition The nasal septum
is a thin structure,separating the twosides of the nose.If it is not in themiddle of the nose,then it is deviated.
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It is common for apatient to complainthat he/she can
breathe through only
one nostril. Then thediagnosis is easy.
A deviated septummay also contribute
to snoring, sleepapnea, and other
breathing disorders.
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As a palliative, saline drops and sprays are veryhelpful in loosening mucus in the obstructed side andpreventing drying in the other side, where all the air
blows.
Hot peppers, such as jalapenos, can produce enoughtears and discharge to flush out a stopped-up nose.
An even more effective treatment is called a nasallavage, often done using a small pot with a spout.
Nasospecific, a procedure where a deflated balloon is
inserted in the nostril and inflated to a large enoughdegree to adjust the septal deviation, can be analternative to surgery.
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Treatment The definitive treatment is surgical repositioning of
the septum, accomplished by breaking it loose andfixing it in a proper place while it heals.
Decongestants likepseudoephedrine orphenylpropanolamine will shrink the membranesand thereby enlarge the passages.
Antihistamines, nasal cortisone spray, and otherallergy treatments may also be temporarily
beneficial.
NASAL POLYPS
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NASAL POLYPS
NASALPOLYPSAREPOLYPOIDALMASSESARISINGMAINLYFROMTHEMUCOUSMEMBRANESOFTHENOSEANDPARANASALSINUSES.THEYAREOVERGROWTHSOFTHEMUCOSATHATFREQUENTLYACCOMPANYALLERGICRHINITIS. THEYAREFREELYMOVEABLEANDNON-TENDER.
NASAL POLYPS
http://en.wikipedia.org/wiki/Polyp_(medicine)http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Allergic_rhinitishttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Paranasal_sinushttp://en.wikipedia.org/wiki/Nosehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Polyp_(medicine)7/28/2019 Respiratory Final Presentation
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NASAL POLYPS
SYMPTOMS NASALBLOCK SINUSITIS ANOSMIAORLOSSOFSMELL
SECONDARYINFECTIONLEADINGTOHEADACHE. CAUSE: UNKNOWNBUTARECOMMONLYTHOUGHTTOBECAUSEDBY ALLERGY ASIGNIFICANTNUMBERAREASSOCIATEDWITHNON-
ALLERGICADULTASTHMAORNORESPIRATORYORALLERGICTRIGGERTHATCANBEDEMONSTRATED.
http://en.wikipedia.org/wiki/Sinusitishttp://en.wikipedia.org/wiki/Anosmiahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Anosmiahttp://en.wikipedia.org/wiki/Sinusitis7/28/2019 Respiratory Final Presentation
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TREATMENT STEROIDSTOPICALOR
ORAL
SURGICAL
METHODS
.
FUNCTIONAL ENDOSCOPIC SINUS SURGERY
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FUNCTIONAL ENDOSCOPIC SINUS SURGERY
PHARYNGITIS
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PHARYNGITIS
PHARYNGITISISANINFLAMMATIONOFTHE
PHARYNX, INCLUDINGPALATE,
TONSILS,ANDPOSTERIORWALL
OFTHEPHARYNX, MOST
COMMONLYCAUSEDBYACUTE
INFECTION, USUALLYTRANSMITTEDTHROUGH
RESPIRATORYSECETIONS.
STREPTOCOCCALPHARYNGITIS
(STREPTHROAT)ANDRHINOVIRUSES (COMMONCOLD)
AREFREQUENTCAUSES.
PHARYNGITIS
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PHARYNGITIS
Acute bacterial pharyngitis is usually caused bygroup A beta-hemolytic streptococci (streptococcalpharyngitis/strep throat).
Peak age group for streptoccocal pharyngitis is 5 to
18, but it may occur in all age groups.
PHARYNGITIS
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PHARYNGITIS
Other bacterial causes includeH. influenzae,,Corynebacterium diphtheriae (diphtheria),
Neisseria gonorrhoeae (gonorrhea), and othergroups of streptococcus.
Transmission ofN. gonorrhoeae is through oralcontact with genital secretions;
More chronic causes are irritation from postnasal
drip of allergic rhinitis and chronic sinusitis,chemical irritation, and systemic diseases
PHARYNGITIS
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PHARYNGITIS
For acute bacterial infections, abrupt onset of sorethroat and fever (usually above 38.2 0C instreptococcal pharyngitis.
Throat pain
Pharynx appears reddened with edema of uvula;pharynx and tonsils may be covered with exudate
Varying degrees of sore throat, nasal congestion,
fatigue, and fever with other bacterial and viralcauses.
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DIAGNOSTICS Throat culture or rapid streptococcal antigen
detection test to rule out streptococci. Rapid streptests provide results within 5 minutes.
TREATMENT
ANTIBIOTICS
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Encourage compliance with full course ofantibiotic therapy, despite feeling better in severaldays, to prevent complications.
Advise lukewarm saline gargles and use
antipyretic/analgesics as directed to promotecomfort.
Encourage bed rest with increased fluid intake
during fever.
SINUSITIS
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SINUSITIS
Sinusitis is aninflammation of
the mucous
membranes of one
or more paranasal
sinuses.
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It is usually precipitated bycongestion from viral upperrespiratory infection and/ornasal allergy.
Obstruction of the sinus
ostia (resulting frommucosal swelling and/ormechanical obstructionleads to retention ofsecretions and is the usualprecursor to sinusitis.
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Acute Sinusitis Pain stabbing or aching, over the infected sinus
and referred to face and head
Nasal congestion and discharge; may or maynot be present
Anosmia (lack of smell): inspired or expired aircannot reach the olfactory groove
Red and edematous nasal mucosa May have fever
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Chronic Sinusitis Persistent nasal obstruction; chronic nasal discharge
clear or purulent when infected
Cough produced by constant dripping of dischargeback into nasopharynx
Feeling of facial fullness/pressure
Headache may be vague or in same pattern as
acute sinusitis, more noticeable in the morning;fatigue
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Topical decongestant sprayor drops orsystemic decongestants for mucosal shrinkage toencourage drainage from sinus.
Topical nasal corticosteroids are frequentlyused in chronic sinusitis, and may be used in acutecases.
Analgesics pain may be significant
Warm compresses; cool vapor humidity for comfort and topromote drainage
LEGIONNAIRES DISEASE
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LEGIONNAIRE S DISEASE
Causes The bacteria that cause
Legionnaire's disease have beenfound in water delivery systems.They can survive in thewarm,moist, air conditioning systems
of large buildings, includinghospitals. Spread of the bacteria from
person to person has not beenproven.
Most infections occur in middle-
aged or older people, although theyhave been reported in children.Typically, the disease is less severein children.
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Symptoms tend to get worseduring the first 4 - 6 days.They typically improve inanother 4 - 5 days.
Chest pain Coughing up blood Fever Gastrointestinal symptoms,
such as diarrhea, nausea,vomiting, and abdominalpain
General discomfort,uneasiness, or ill feeling(malaise)
Headache Joint pain
Loss of energy
Muscle aches andstiffness
Nonproductive cough
Shaking chills
Shortness of breath
DIAGNOSTICS
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G OS CS
Tests that may be done include: Arterial blood gases
Chest x-ray
Complete blood count (CBC), includingwhite bloodcell count
Erythrocyte sedimentation rate
Liver function tests
Sputum culture for theLegionella bacteria
INTERVENTIONS
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Antibiotics are used to fight the infection. Treatmentis started as soon as Legionnaire's disease issuspected, without waiting for confirmation by labtest.
Antibiotics commonly used to treat this conditioninclude:
Quinolones (ciprofloxacin, levofloxacin,
moxifloxacin, or gatifloxacin) Macrolides (azithromycin, clarithromycin, or
erythromycin)
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CHEST INJURIES
RIB FRACTURES
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Rib fracture results fromdirect blunt chesttrauma and causes apotential forintrathoracic injury,
such as pneumothorax orpulmonary contusion.
Pain with movementand chest splinting result
in impaired ventilation andinadequate clearance ofsecretions.
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Pain on inspiration,coughing
Voluntary splinting,rapid and shallow
breathing, inhibitedcough, diminished
breath sounds over area
Palpable crepitus overarea, bruising
INTERVENTIONS
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Note that ribs usually unite spontaneously. Position the client in high Fowler's position.
Administer pain medication as prescribed tomaintain adequate ventilatory status.
Monitor for increased respiratory distress.
Instruct the client to self-splint with hands and arms.
Managed at home
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FLAILCHEST
Flail chest is blunt chest trauma associated with accidents,
which may result in hemothorax and rib fractures. The loose segment of the chest wall becomes paradoxical to
the expansion and contraction of the rest of the chest wall.
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Pain and dyspnea oninspiration
Paradoxic chestmovement
Palpable crepitus
Diminished breathsounds
> high Fowler's position.
>humidified oxygen asprescribed.>Encourage coughing anddeep breathing.>Administer painmedication as prescribed.
>Maintain bed rest and limitactivity to reduce oxygendemands.>Prepare for intubationwith mechanicalventilation, with PEEP for
severe flail chest associatedwith respiratory failure andshock.
PULMONARY CONTUSION
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a. Often results from abruptchest compression: ruptureof alveoli and pulmonaryarterioles with hemorrhage
and interstitial and bronchialedema
b. May result in airwayobstruction, atelectasis,
impaired gas diffusionimpacting ability to clearsecretions and breathe
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Manifestations: Appear 12 -24 hours
after injury
Increasing shortness ofbreath, restlessness,chest pain
Copious sputum,
possibly blood tinged May lead to ARDS,
death
Significant pulmonarycontusion can result inlong-term insufficiencyrequiring home healthreferral Client and familyeducation regarding
care of chronicrespiratory problem
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PNEUMOTHORAX
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a. Pneumothorax is the accumulation of atmospheric air inthe pleural space, which results in a rise in intrathoracic
pressure and reduced vital capacity.b. The loss of negative intrapleural pressure results in
collapse of the lung.c. A spontaneous pneumothorax occurs with the rupture
of a bleb.d. open pneumothorax/secondary pneumothorax
occurs when an opening through the chest wall allows
the entrance of positive atmospheric pressure into thepleural space
e. TENSION PNEUMOTHORAX
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HEMOTHORAX
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Blood in pleural spaceresulting from chesttrauma, surgery,diagnostic procedures
Blood collection results in
impaired ventilation andgas exchange, risk ofshock
Manifestations are
similar to pneumothorax;diminished lung soundsand dull percussion tone
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Diagnosis is made by chest xray Treatment includes insertion of chest tube; blood
replacement if significant loss (may be replaced byautotransfusion in which blood collected in chest
tube and then reinfused within 4 hours as withplanned thoracic surgery)
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Dependent upon severity of problem 1. Small ones: may involve serial xrays to monitor
resolution without intervention 2. Symptomatic requires insertion of chest tubes
(thoracostomy)
Thoracostomy: placement of closed-chest catheter toallow lungs to re-expand
Pleurodesis - Creation of adhesions between parietaland visceral pleura to prevent recurrent pneumothorax
---Instillation of chemical agent (bleomycin, tetracycline,povidone iodine, doxycycline) to cause inflammation andscarring
Di f th R i t
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Diseases of the Respiratory
System
OBSTRUCTIVEAIRWAY DISEASES
Asthma
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Increased responsiveness of lower airways tomultiple stimuli.
Episodic and with reversible obstruction.
May range in severity from mild withoutlimitation of patients activity, to severe andlife-threatening.
Men and women are equally affected.Afflicts children more commonly than adults.
ASTHMA
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Asthma is a chronicrespiratory disorder
Bronchi andbronchioles are
affected bronchiolemuscles tighten,mucus is produced
breathing is difficult
Asthma
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Airway narrowing
results from: Smooth muscle
spasm
Airway edema and
inflammation
Mucus plugging
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Variants: Exercise-induced asthma
Triad asthma nasal polyps, asthma, aspirin intolerance
Cardiac asthma - An asthmatic attack due to
bronchoconstriction caused by pulmonary congestionand failure of the left ventricle.
Asthmatic bronchitis
Drug-induced asthma Aspirin/NSAIDs
ASTHMA - causes
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Generally it isthought that asthmais somewhatinherited
TRIGGERS includepollen, dust, smoke,pets, exercise,exercise, drugs,infectioin
ASTHMA - symptoms
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Chest tightness
Wheezing
Night-time cough
Restricted breathing
Labored breathing;flaring nares
Cough; increasedsecretions
Distended neck veins Pulsus paradoxus
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INTERVENTIONS
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Assess airway patency.
Continuously monitorrespiratory status, pulseoximetry, and color; bealert to decreased
wheezing or a silentchest, which may signalthe inability to move air.
Prepare the child for achest radiograph.
Initiate an intravenousline, and prepare tocorrect dehydration,acidosis, or electrolyteimbalances.
Administer humidifiedoxygen by nasal prongsor face mask.
Administer quick-relief (rescue)medications.
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1. Quick-Relief (RescueMedications)Short-acting B2-agonists
Anticholinergics (for relief ofacute bronchospasm)Systemic corticosteroids (for its
antiinflammatory action to treatreversible airflow obstruction)
ASTHMA - treatments
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IMMEDIATEbronchodilators give immediate reliefto tightened
bronchioles
Inhalers can bemetered - ie medicineis forced out by achemical propellant
powdered - nopropellant
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2. Long-term control (preventer medications): to achieve
and maintain control of inflammation
Leukotriene modifiers to prevent bronchospasm and
inflammatory cell infiltration
3. Nebulizer, metered-dose inhaler or peak expiratory flow
meters
4. Chest physiotherapy
5. Allergen control
Prevention and reduction of exposure to airborne and
environmental allergens
Chronic Obstructuve Pulmonary Disease
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FACTORS:
Cigarette smoking
Air pollution
Occupational exposure todusts and gases
Airway infection
Genetic and familialfactors
The Philippine Burden of
Lung Disease studyindicated that 12 percentor one in eightindividuals 40 years andabove living in MetroManila suffers fromCOPD
Top eight mortality causein RP
Affects middle-aged andolder adults
BRONCHITIS
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An infection of thebronchi
2 types:
1. Acute caused by abacteria
- treated withantibiotics
CHRONIC BRONCHITIS
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Bronchial Inflamation mucus ciliar.acidosis
Causes:
Smoking
Pollution
Allergens
CHRONIC BRONCHITIS
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Assessment:
1. Chronic Cough
2. Blue Bloater: cyanotic edema
chronic cough exertional dyspnea,RR
hypoxia polycythemia- RBC
hypercapnia cor pulmonale-RVH &
resp. acidosis dilatation
incidence in heavy cigarette smokers
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EMPHYSEMA
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A chronic respiratorydisorder
The alveolar wallsbreak down & lose
their elasticity Surface area is
greatly reduced breathing is difficult
EMPHYSEMA
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Destruction and Overdistension of the Alveoli
Air Trapping
Respi. Acidosis
Cigarette smokingHeredity, Bronchial asthma Aging process
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Disequilibrium betweenELASTASE & ANTIELASTASE (alpha-1-antitrypsin)
Destruction of distal airways and alveoli Overdistention of ALVEOLI
Hyper-inflated and pale lungs
Air trapping, decreased gas exchange and Retention of CO2
Hypoxia Respiratory acidosis
EMPHYSEMA
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CAUSES:
1. Smoking, Pollution and Allergens
2. alpha-antitrypsin causes expansion of the
alveoli
- strengthens the walls of the
alveoli(blebs)
EMPHYSEMA
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Assessment:
pink puffer:
mucus speaks in short & jerky sentence
coughing anxious
orthopneic pos. Frequently develop URTI
barrelled chest Prolonged expiratory time
SOB digital clubbing
wheezing
EMPHYSEMA
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ASSESSMENT:
1. Exertional Dyspnea
2. Barrelled chest
3. Hyperesonance
4. Spontaneous pneumothorax
EMPHYSEMA - treatments
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Low-flow oxygen tank delivers a higheroxygen concentration
Lung volumereduction surgery(LVR) removal ofdamaged tissue to lethealthy tissue workmore efficiently
INTERVENTIONS
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Monitor vital signs.
Administer a lowconcentration of oxygen (1to 2 L/min) al) prescribed;the stimulus to breathe is alow aeterial P02 instead of
an increased Pao2 Provide respiratory
treatments and CPT.
Instruct the client indiaphragmatic orabdominal and pursed lip
breathing techniques.
Suction fluids from the
client's lungs, if necessary,to clear the airway andprevent infection.
Monitor weight.
Encourage small, frequentmeals to prevent dyspnea.
Provide a high-calorie,high-protein diet withsupplements.
INTERVENTIONS
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Encourage fluid intake up
to 3000 mL/day to keepsecretions thin, unlesscontraindicated.
Position client in highFowler's position and
leaning forward to aid inbreathing.
Allow activity as tolerated.
Administer
bronchodilators asprescribed, and instruct theclient in the use of oral andinhalant medications.
Administer corticosteroids
as prescribed to reduceinflammation.
Administer mucolytics asprescribed to thinsecretions.
Administer antibiotics forinfection if prescribed.
OCCUPATIONAL LUNG DISEASES
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Asbestosis is a diffuse
interstitial fibrosis of thelung caused by inhalationof asbestos dust andparticles.
Found in workers involved inmanufacture, cutting and
demolition of asbestos-containing materials,
Asbestos mining andmanufacturing, construction,roofing, demolition work,brake linings, floor tiles,paints, plastics, shipyards,insulation
Fibrous pleural thickening
and pleural plaqueformation producerestrictive lung disease,decrease in lung volume,diminished gas transfer, andhypoxemia with subsequent
development of corpulmonale.
OCCUPATIONAL LUNG DISEASES
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SILICOSIS is a chronic
pulmonary fibrosis causedby inhalation of silica dust.
Exposure to silica dust isencountered in almost anyform of mining because the
earths crust is composed ofsilica and silicates (gold,coal, tin, copper mining);also stone cutting,quarrying, manufacture of
abrasives, ceramics,pottery, and foundry work.
When silica particles
(which have fibrogenicproperties) are inhaled,nodular lesions areproduced througout thelungs. These nodules
undergo fibrosis, enlarge,and fuse.
OCCUPATIONAL LUNG DISEASES COAL WORKERS
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COAL WORKERSPNEUMOCONIOSIS
(CWP; black lung) is a variety
of respiratory disease found in coalworkers in which there is anaccumulation of coal dust in thelungs, causing a tissue reaction inits presence.
Dusts (coal, kaolin, mica,silica) are inhaled and deposited
in the alveoli and respiratorybronchioles.
When normal clearancemechanisms no longer can handlethe excessive dust load, therespiratory bronchioles and alveolibecome cloged with coal dust,
dying macrophages, andfibroblasts, which lead to theformation of the coal macule, theprimary lesion of CWP.
ASSESSMENT
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Chronic cough; productive
in silicosis and CWP Dyspnea on exertion;
progressive and irreversiblein asbestosis and CWP
Susceptibility to lowerrespiratory tract infections
Bibasilar crackles inasbestosis.
Expectoration of varyingamounts of black fluid andCWP.
INTERVENTIONS
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There is no specific treatment; exposure is eliminated,
and the patient is treated symptomatically. Give prophylactic isoniazid (INH) to patient with positive
tuberculin test, because silocosis is associated with high risk ofTB
Persuade people who have been exposed to asbestos fibers tostop smoking to decrease risk of lung cancer.
Keep asbestosis worker under cancer surveillance; watch forchanging cough, hemoptysis, weight loss, melena, and so
forth. Bronchodilators may be of some benefit if any degree airway
obstruction is present
PNEUMONIA
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The alveoli become
inflamed and fill withliquid
Gas exchange isimpaired and the
body becomesstarved for oxygen
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X-RAY OF PNEUMONIA
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Patient haspneumonia inthe right lung(note white
mass = fluid)
Lungs shouldappear black onan x-ray
Lobular pneumonia
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Lobularpneumoniaaffects a lobeof the lungs(see x-ray),andbronchialpneumoniacan affectpatches
throughoutboth lungs.
TYPES OF PNEUMONIA
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LOBULAR BRONCHIAL
TREATMENT
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BACTERIAL
Caused by thebacterium
Streptococcuspneumoniae
Treated withantibiotics
Can be somewhatprevented with thepneumococcal
vaccine
VIRAL
Caused by a virus
Can be treated with
anti-viral medication They are usually less
severe however asecondary bacterial
infection can followwhich is then treatedwith antibiotics
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ASSESSMENT INTERVENTIONS
Chills
Elevated temperature
Pleuritic pain Rhonchi and wheezes
Use of accessory musclesfor breathing
Cyanosis Mental status changes
Sputum production
Administer oxygen as prescribed. Monitor respiratory status. Monitor for labored respirations,
cyanosis, and cold and clammy skin. Encourage coughing and deep
breathing and use of incentivespirometer.
Position client in semi-Fowlerposition to facilitate breathing andlung expansion.
Change client's position frequently
and ambulate as tolerated tomobilize secretions.
Provide CPT. Perform nasotracheal suctioning if
the client is unable to clear secretions
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END
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