1.

History a. Biographical and Demographic data b. Present Health Chief Complaint i. Dyspnea o Onset: Sudden onset indicates pneumothorax, acute respiratory obstruction or ARDS. ii. Cough o Results as a reaction to the irritants of the mucous membrane lining the respiratory tract o Chief protection of the client from the accumulation of secretions in the bronchi and bronchioles o May indicate serious lung disease o Evaluate the type, character and time Dry, irritative cough: URT infection of viral origin. Irritative, high-pitched cough: Laryngotracheitis Brassy cough: Tracheal lesions Severe changing cough: Bronchogenic carcinoma Cough accompanied by pleuristic chest pain: Pleural or chest wall involvement Cough that worsens in supine position: Sinusitis Coughing at night may indicate left-sided heart failure or bronchial asthma. Coughing after food intake may indicate aspiration iii. Sputum Production o Discharge formation which serves as the lungs reaction to recurring irritant or may be associated with nasal discharge o The presence of an infection or disease entity and its causative organism can be determined by its amount, color and consistency. o Great amount of purulent sputum (thick and yellow, green or rust-colored): Bacterial infection o Increase in amount over time: Chronic bronchitis or bronchiectasis o Pink-tinged mucoid sputum: Lung tumor o Profuse, frothy, pink-tinged discharge: Pulmonary edema o Foul-smelling sputum with halitosis: Lung abscess, bronchiectasis or infection iv. Chest pain o Discomfort associated with pulmonary or cardiac disease. o Pain related to pulmonary conditions may be sharp, stabbing, and intermittent, or it may be dull, aching and persistent. o May occur with pneumonia, pulmonary

embolism with lung infarction, and pleurisy o Late symptom of bronchogenic carcinoma v. Wheezing o High-pitched, musical sound heard mainly on expiration o Indicates obstruction or increased resistance of the air passages vi. Clubbing of the fingers o Manifested as sponginess of the nailbed and loss of the nailbed angle o Observed in clients with chronic hypoxic conditions, infections, and malignancies. vii. Hemoptysis o Expectoration of blood from the respiratory tract o Signifies lung or cardiac disorder viii. Cyanosis o A very late indicator of hypoxia o Central cyanosis is typified by bluish discoloration of the lips and tongue o Peripheral cyanosis results from decreased blood flow to distal structures (i.e., nail beds and earlobes) c. Past Health History clients previous hospitalization, illnesses, childhood diseases, medications, and allergies. d. Family Health History previous health history and present health status of every member of the family. 2. Physical Examination a. Upper and Lower Respiratory Structures Use penlight for a routine examination and a nasal speculum for a thorough examination

i.

Nose and Sinuses o Inspect the external nose for lesions, asymmetry, or inflammation. o Examine the internal structures for any signs of swelling, exudates, bleeding or change in color of the nasal mucosa. o Check nasal septum for deviation, perforation, or bleeding. o Inspect the inferior and middle turbinates for presence of polyps. o Palpate the frontal and maxillary sinuses for tenderness. ii. Pharynx and Mouth o Inspect the color, symmetry, and evidence of exudates, ulceration or enlargement. iii. Trachea o Palpate the position and mobility. iv. Thorax

Observe the skin over the thorax for color and turgor and evidence of loss of subcutaneous tissue. o Check for asymmetry. b. Chest Configuration Assess shape and dimensions of the chest o Funnel chest (Pectus excavatum): Depressed lower portion of the sternum with the lower ribs flaring outward o Pigeon chest (Pectus carinatum): Sternum protrudes anteriorly o Barrel chest: Increased anteroposterior diameter of the thorax due to overinflation of the lungs o Kyphoscoliosis: Characterized by elevation of the scapula and S-shaped spine c. Breathing Pattern Observe the rate, regularity, depth and location of respiration. d. Palpation Upper lobe o Place the tips of thumbs at the midsternal line at the sternal notch. o Extend fingers above the clavicles. o Ask client to fully exhale then inhale deeply.

o Ask the client to take a deep breath and identify any painful areas of the chest wall. Position of trachea o Determine whether the trachea is palpable at midline or has shifted to the right or left. e. Thoracic Percussion Used to determine whether underlying tissues are filled with air, fluid, or solid material Estimates the size and location of certain structures within the thorax (heart, liver, diaphragm) Dull and flat sounds: Greater than normal amount of solid matter (tumor, consolidation) is present than air. Hyperresonance: Presence of greater than normal amount of air in the area (emphysema, asthma) f. Auscultation Evaluates the presence of fluid or solid obstruction in the lung structures by listening to the breath sounds with the use of a stethoscope 3. Diagnostic Evaluation a. Tests to Evaluate Respiratory Function i. Pulmonary Function Test: Includes measurements of lung volumes and capacities, ventilatory functions, mechanics of breathing, and diffusion and gas exchange ii. Pulse Oximetry - non-invasive method of monitoring subtle or sudden changes in oxygen saturation of hemoglobin iii. Capnography non-invasive procedure used to measure carbon dioxide concentration exhaled by the client who are receiving mechanical ventilation iv. Arterial Blood Gas Analysis measures the degree of oxygenation of the blood and adequacy of alveolar ventilation v. Ventiliation-Perfusion Lung Scan painless procedure used to measure adequacy of lung ventilation and perfusion b. Tests to Evaluate Anatomic Structure i. Radiography (Chest X-ray) ii. Magnetic Resonance Imaging iii. Ultrasonography iv. Gallium Scan v. Bronchoscopy vi. Laryngoscopy vii. Alveolar Lavage viii. Endoscopic Thoracotomy ix. Pulmonary Angiography c. Specimen Recovery and Analysis i. Sputum Culture - to identify organisms responsible for infection of the respiratory tract ii. Nose and Throat Culture to identify specific pathogenic organisms present in the nose and throat

Middle lobe Place tips of thumbs at the xiphoid process. o Extend fingers laterally around the ribs. o Ask client to breathe in deeply. Lower lobe o Place the tips of thumbs along the clients back at the spinous processes of the lower thoracic level. o Extend fingers around the ribs. o Ask client to breathe in deeply. Depth of excursion o Measure the girth of the chest at three levels (axilla, xiphoid, and subcostal) during inspiration and expiration. Fremitus o Vocal (tactile) fremitus: Vibration felt over the chest wall as the client speaks; used to assess the quality of underlying tissues Place the palms of hands lightly on the chest wall. Ask the client to speak a few words or repeat 99 several times. Chest wall pain

iii. Thoracentesis to remove fluid and air in the pleural cavity iv. Biopsy - examination of cells through excision of small amount of tissues obtained from target structures B. Care of Clients with Upper Respiratory Tract Disorders 1. Upper Respiratory Infections a. Epistaxis also known as nose bleeding; usually associated with infection, trauma, irritation, foreign bodies, and tumor Nursing Interventions Nasal packing maybe inserted to control bleeding. Observe for additional bleeding. Watch out for presence of hypotension, hypertension, and infection. Instruct the client to minimize strenuous activities. Teach client to prevent dryness of the nasal cavity through the use of humidifier or vaporizer. Monitor the vital signs. Suction can remove excess blood and clots. Provide tissues and an emesis basin to allow the patient to expectorate any excess blood. Reassure the patient in a calm, efficient manner that bleeding can be controlled to reduce patient's anxiety. b. Common Colds An afebrile, infectious, acute inflammation of the nasal cavitys mucus membranes Assessment Nasal congestion, malaise Scratchy or sore throat, fever Sneezing, chills Teary / watery eyes Headache and muscle ache Nursing Interventions Encourage increase fluid intake. Provide warm salt-water gargles for sore throat. Instruct patient to cover mouth & nose while sneezing and dispose tissue or solid articles properly. Decongestants, antihistamines, Vitamin C, Aspirin, and expectorants are usually prescribed. b. Sinusitis Inflammation of the sinuses as a result of an URTI or allergic rhinitis Assessment Pressure and pain over the sinus area Purulent nasal secretions Chronic hoarseness, chronic headaches and facial pain Note: Symptoms are most pronounced upon awakening in the morning.

Nursing Interventions Give information about adverse effects of nasal decongestant sprays and about rebound congestion Instruct patient to increase fluid intake antibiotics, decongestants, and corticosteroids are usually prescribed prevent nasal crusting c. Rhinitis Inflammation of the mucous membranes of the nose Classified as infectious, allergic, and non-allergic Assessment Increased nasal drainage Nasal congestion sneezing Nursing Management Provide detailed instruction on proper use of saline nasal or aerosol sprays. Supplemental humidification may be necessary Increase fluid intake Decongestants and analgesic is usually prescribed e. Pharyngitis A febrile inflammation of the throat usually caused by Group A streptoccocus (strep throat) Assessment Fiery-red pharyngeal membrane and tonsils Swollen and exudative lymphoid follicles Enlarged and tender cervical lymph nodes Fever, malaise, sore throat, hoarseness, cough, rhinitis Nursing Interventions Implement bed rest during febrile stage and measures to prevent spread of infection. Use ice collar to relieve severe sore throat. f. Acute and Chronic Tonsillitis and Adenoiditis Inflammation of the tonsils and adenoid tissues caused by group A streptococci Signs and Symptoms Sore throat, fever S noring, dysphagia E nlarged adenoids may cause mouth breathing, earache, draining ears, frequent colds, voice impairment and noisy respiration and nasal obstruction. Medical and/or Surgical Management Tonsillectomy or adenoidectomy: Indicated for recurrent tonsilitis when

conservative or symptomatic therapy is unsuccessful Antibiotic therapy Nursing Interventions Report to surgeon If patient vomits large amounts of bright-red blood at frequent intervals, becomes restlessness, and the pulse rate and temperature increase. After surgery, the most comfortable position for the patient is prone with the head turned to the side to allow drainage from the mouth and pharynx. If no bleeding occurs, give water and ice chips as soon as desired. Instruct patient to refrain from talking and coughing to prevent throat pain. f. Peritonsillar Abscess (Quinsy) A form of infection that usually accompanies tonsillitis; Pus formation occurs in the fascial space. Assessment Dysphag ia Drooling Muffled voice Pain on one side of the throat and ear Nursing Interventions Saline or alkaline mouth wash Ice collars Soft foods as tolerated by the client Sips of cool fluids g. Laryngitis Inflam mation of the larynx as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutants May also occur with an URTI Assessment Hoarseness or aphonia (complete loss of voice) Persistent hoarseness. Nursing Interventions Instruct the patient to rest the voice, avoid irritants and to maintain a well-humidified environment. Medical management: topical corticosteroids and antibiotics.

ii.

iii.

iv.

v.

2. Nursing Process for Clients with Upper Respiratory Tract Infection a. Obstruction and Trauma of the Upper Respiratory tract i. Acute Laryngeal Edema often associated with allergic reaction, injury, and inflammation. Assessment Hoarseness Acute onset of shortness of breath

b.

Nursin g Interventions Maintain patent airway. Administer subcutaneous epinephrine and corticosteroid if edema is caused by allergic reaction. Emergency tracheostomy maybe performed if endotracheal intubation is not successful. Chronic Laryngeal Edema develops when there is an obstruction in the lymph drainage artificial airway maybe necessary Laryngospasm Spasm of the laryngeal muscles resulting from traumatic accident in the larynx, response to some inhaled chemicals, industrial fumes, and hypocalcemia. Medical management: supplemental oxygen, creation of artificial airway, and administration of succinylcholine to subside the spasm. Laryngeal Paralysis Most common complication of thyroidectomy secondary to laryngeal nerve trauma resulting to breathy quality of the clients voice. Usually affects one vocal cord so the airway is not affected. Management is directed to prevent aspiration Signs of aspiration: o Coughing upon swallowing o Ineffective cough o Diminished breath sounds o Presence of wheezes, ronchi, or wheezes Laryngeal Injury Occurs most often during a vehicular accident that results to damage of the drivers neck. Observe the client for increasing dyspnea, use of accessory muscles during respiration, swelling of the neck, dysphagia, stridor, inability to speak, and other changes in clients respiratory patterns. Artificial airway is necessary if obstruction occurs. Nasal Obstruction Most common form of nasal obstruction: nasal polyps, more frequently at the mucous membrane that lines the nose. Surgery is usually performed to remove the obstruction in order to restore the normal nasal breathing. Nursing Interventions after Surgery

c.

Ice pack is recommended to minimize bleeding. Place patient in semi-fowlers position to reduce dema. Increase fluid intake and frequent mouth care to prevent dryness and oropharyngeal discomfort. Nasal Fracture Most common form: deviated nasal septum due to a traumatic accident affecting the clients nose Causes airway obstruction resulting to changes in the velocity of air, dryness, crusting, and bleeding of the nasal membrane Management: application of ice to fractured site to reduce edema and bleeding. Reconstructive surgery maybe necessary to restore normal nasal breathing. Postoperative management is directed to reduction of edema and hemorrhage, and control of pain.

C.

Care of Clients with Chest and Lower Respiratory Tract Disorders 1. Atelectasis Incomplete expansion or collapse of parts of or a whole lung May be secondary to surgery, immobility, metastasis and chronic obstruction of airway Signs and Symptoms Productive cough, low-grade fever Dyspnea, tachycardia, tachypnea pleural pain, central cyanosis Dyspnea in supine position Decreased breath sounds and crackles X-ray reveals patchy or consolidated areas Nursing Interventions Administration of supplemental oxygen Maintain airway patency Perform postural drainage, chest physiotherapy, and endotracheal suctioning Preventive measures: o Deep breathing and coughing exercises o Frequent position change o Early ambulation after surgery 2. Respiratory Infections a. Care of Patients with Tuberculosis

b.

Low -grade fever, cough, night sweats Fatigue, weight loss, nonproductive cough or mucopurulent sputum He moptysis CX R reveals lesions in the upper lobes Acid -fast bacillus smear is (+) for mycobacterium Medical Management INH, rifampicin, pyrazinamide, and streptomycin and ethambutol for 6-12 months Vita min B6 Nursing Interventions Pre vent transmission of infection. Instr uct patient to take the medications with empty stomach or 1 hour before meals an to take the medications religiously Pati ents taking INH should avoid foods rich in tyramine and histamine. This drug-food interaction may cause headache, flushing, hypotension, light-headedness, palpitations and diaphoresis Info rm the patient that rifampicin may discolor contact lenses. Advi ce the client to wear personal protective equipment (particulate respirator mask) Care of Client With Pneumonia An inflammation of the lung parenchyma commonly associated with an increase in interstitial and alveolar fluid. Causative factors: bacterial, viral, mycoplasmal, fungal invasion, inhalation of toxic chemicals, smoke, or gases, or aspiration of food, fluids or vomitus

Pseudomonas aeruginosa - most common causative organism of hospitalacquired gram-negative pneumonia Streptoccocus pneumonia most common causative organism of communityacquired pneumonia Signs and Symptoms Fever, chills, sweats, pleuritic chest pain. Orthopnea, dyspnea Productive cough Headache or fatigue Crackling breath sounds Increased tactile fremitus over areas of pneumonia

Communicable disease caused by Mycobacterium tuberculosis Transmitted through inhalation of air-borne droplets Signs and Symptoms

3.

CXR reveals diffuse consolidation Medical and/or Surgical Management Antibiotic therapy Antipyretics, antihistamines and decongestans may be given Warm, moist inhalations may be indicated. Nursing Interventions Increase fluid intake. Teach patient how to splint the chest to promote comfort during coughing. Elevate the head of the bed to facilitate breathing. Assess respiratory rate frequently. Monitor ABG and observe for signs and symptoms of hypoxia or hypercapnia. Assess for signs of complications (shock, respiratory failure, atelectasis and superinfection). Pleural Conditions a. Pleurisy (Pleuritis) Inflammation of the pleura secondary to infection, injury, or malignancy May be dry pleurisy (pleural fluid remains unchanged despite presence of the disease), or wet pleurisy (the fluid increases abnormally) Assessment Pleuritic pain that worsens in deep breathing, coughing or sneezing. This pain occurs only on one side and may be absent when the breath is held and may radiate to the shoulder or abdomen Fever and chills, tachypnea Dyspnea Nursing Interventions Manage pain Monitor for signs of pleural effusion Medical management includes administration of analgesics and antibiotics Pleural Effusion Accumulation of fluid in the pleural space between the visceral and parietal pleura. Signs and Symptoms Dyspnea on exertion Decreased or absent tactile fremitus Dull or flat percussion Cough, fever, chills, pleuritic chest pain CXR reveals presence of fluid Nursing Interventions Prioritize pain management Assist in finding the most comfortable position Encourage ambulation Monitor respiratory status any signs or symptoms of returning pleural effusion

Administer analgesics and assess its effectivity. Maintain closed tube drainage when appropriate Medical management may include thoracocenthesis and chest drainage, and diuretic therapy c. Empyema (Suppurative Pleuritis) Localized collection of pus in the pleural cavity May result in thickening of the pleura and restriction of movement in the underlying lung Assessment Signs and symptoms are the same as those of an acute respiratory infection or pneumonia Medical and/or Surgical Management Thoracentesis Thoracostomy Open chest drainage with possible rib resection Large doses of antibiotics based on the causative organism Nursing Interventions Encourage lung expansion breathing exercises. Provide care and manage the drainage system. Educate the patient and family about care of the drainage system. Encourage breathing exercises to restore respiratory function. Monitor for signs of infection. 4. Chronic Obstructive Pulmonary Disease a. Chronic Bronchitis Inflammation of the bronchi Characterized by chronic cough and increased mucus production secondary to increased in number of goblet cells and submucous glands Assessment Persistent productive cough that is worst in the morning and evening; lasts 3 months for 2 consecutive years Reduced chest expansion, wheezing Fever, dyspnea, Diminished exercise tolerance Nursing Interventions Increase fluid intake. Provide comfort measures. Assess respiratory status. Perform chest physiotherapy and postural drainage. Medical management: corticosteroids and bronchodilators b. Bronchiectasis Permanent and abnormal dilation of the bronchial tree with impaired drainage of bronchial secretions. Assessment Cough Purulent sputum production Fever and chills Hemoptysis Nasal stiffiness Fatigue and weakness Clubbing of fingers

b.

 Nursing Interventions Perform chest physiotherapy Encourage fluid intake Medical management may include administration of bronchodilators, supplemental oxygen, and antibiotics. c. Emphysema Abnormal enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls Assessment Dyspnea, cough, wheezing, occasional fever Tachypnea with prolonged expiration, and uses accessory muscles for expiration. Barrel chest deformity and increased expiratory effort Anorexia, weakness and activity intolerance Pursed-lip breathing Hyperresonance and decreased fremitus in all lung fields Jugular vein distention and right ventricular throbbing Hypercapnia and hypoxemia Increase total lung capacity, functional residual capacity and residual volume Medical Management Bronchodilator s, antimicrobials, costicosteroids. Oxygen therapy Lung transplant Nursing Interventions Provide comfort measures. Provide psychological support. Assist in pulmonary rehabilitation Smoking cessation Promote exercise Minimize exposure to allergens Maintain adequate nutrition Watch out for sings of respiratory distress Watch out for presence of productive cough, pain with coughing, fever, and the consistency and color of sputum. d. Asthma A chronic, relapsing inflammatory disorder of the bronchial airway characterized by periods of bronchospasms with accompanying edema Triad of symptoms: wheezing, coughing, and dyspnea. Assessment Sy mptoms are commonly worse at night, accompanied by dyspnea and marked respiratory effort Clie nt prefers to sit upright or lean forward, using accessory muscles of respiration Insp iratory and expiratory wheezing, non-productive coughing, prolonged

expiration, tachycardia, and tachypnea are evident

Medical Management

5.

Anti -inflammatory medications, betaadrenergic agonists, bronchodilators, anticholinergics Pea k flow monitoring Nursing Interventions Assess breathing pattern and noting the use of accessory muscles during respiration Place client in high fowlers position Administer oxygen as ordered Assess consistency and color of the sputum Assess client to cough effectively Increase oral fluid intake Perform chest physiotherapy and postural drainage Offer frequent oral care Acute Respiratory Failure

PaO2 drops to less than 50 mm Hg, with subsequent elevation of PaCO2 to greater than 50 mm Hg; arterial pH is <7.35 Impaired ventilation/perfusion mechanism Common Causes Decreased Respiratory Drive Dysfunction of the Chest Wall Dysfunction of the Lung Parenchyma Other Factors (i.e. anesthetic agents, analgesics, and sedatives.) Assessment Restlessness, confusion, lethargy Tachycardia, fatigue, headache Dyspnea, tachypnea Air hunger, increased BP Diaphoresis, central cyanosis Use of accessory muscles and decreased breath sounds Nursing Interventions May require intubation and mechanical ventilation. Assist with intubation and maintenance of mechanical ventilation. Assess respiratory status: monitor patients level of response, ABG analysis, pulse oximetry, and vital signs. Implement measures to prevent development of complications. 6. Respiratory Distress Syndrome Diffuse alveolar capillary damage, leading to severe pulmonary edema, respiratory failure, and arterial hypoxemia a. Assessment Acute Stage Lungs are diffusely red, firm, boggy and heavy with diffuse alveolar damage.

Proliferative Stage Rapid onset of dyspnea, occurring 12-48 hours after an initiating event Labored breathing and tachypnea Intercostal retractions and crackles are evident on physical examination. Medical Management Use of PEEP (positive end-expiratory pressure) Use of inotropic agents to improve cardiac output and to increase systemic BP Antibiotic therapy to prevent infection Nursing Interventions Same as management for patients with pneumonia, pulmonary edema, and other disorders of gas exchange 7. Pulmonary Hypertension Systolic pulmonary artery pressure exceeds 30 mm Hg; mean pulmonary artery pressure exceeds 25 mm Hg. Forms a. Primary or Idiopathic Generally progresses to severe respiratory insufficiency, cor pulmonale, or even death within 5 years after diagnosis b. Secondary Results from existing cardiac or pulmonary disorder Assessment Dyspnea (main symptom) Substernal chest pain, fatigue, syncope Signs of right-sided heart failure Elevated pulmonary arterial pressure ECG reveals peaked T and R waves, or ST-segment depression and T-wave depression Right ventricular hypertrophy Nursing Interventions Oxygen therapy to reduce hypoxemia Vasodilators 8. Pulmonary Heart Disease A serious cardiac condition requiring emergency intervention Arise from a sudden dilatation of the right ventricle as a result of lung disorders that affects its function and vasculature Assessment Same as to those of congestive heart failure Headache, confusion, and somnolence may occur due to hypercapnia Medical Management Supplemental oxygen and bronchodilators to improve gas exchange; reduce pulmonary arterial pressure and pulmonary vascular resistance

b.

Intubation and mechanical ventilation Diuretics, antibiotics and digitalis Nursing Interventions Assess respiratory and cardiac status. Provide bed rest and sodium restriction. Provide chest physiotherapy and bronchial hygiene maneuvers. Encourage adherence to treatment regimen by providing instructions on its importance. 9. Pulmonary Embolism Occlusion of a portion of the pulmonary artery by an embolus that originates from a distant site Assessment Sudden chest pain of pleuritic type and occasionally substernal. Dyspnea, tachypnea Cough, hemoptysis, crackles Split second heart sound, tachycardia Fever, diaphoresis, syncope Signs of shock CXR reveals infiltrates, atelectasis, elevation of the diaphragm, or pleural effusion ECG reveals depression of PRinterval, T-wave changes Medical Management Morphine and dobutamine is given during emergencies. Anticoagulants and thrombolytic medications. Surgical interventions to prevent the embolus from travelling to the heart. Nursing Interventions Examine for a positive Homans sign. Monitor patients under thrombolytic or anticoagulation therapy for signs of bleeding. Closely monitor patients for any signs of possible complications of cardiogenic shock or right ventricular failure 10. Sarcoidosis Multi-system, granulomatous disease of unknown etiology but may be due to hypersensitivity to agents, which release cytokines and cause fibroblasts formation. Signs and Symptoms Dyspnea Cough Hempotysis Congestion May present as peripheral lymphadenopathy or hepatomegaly onset of respiratory difficulties fever, night sweats, weight loss CXR reveals hilar adenopathy and disseminated miliary and nodular lesions in the lungs Nursing Management assess for signs of improvement such as increased exercise tolerance assess for improvement in the pulmonary function and oxygenation of the client

medical management may include administration of corticosteroids. 11. Pneumoconioses Disorders caused by inhalation of any aerosol Health effects of inhaled dusts depend on the following: Concentration of the substance Duration of exposure Ability to initiate an immune response Individuals response or susceptibility to the irritant Most Common Types Silicosis Inhalation of silica dust produces a chronic, nodular, dense pulmonary fibrosis Asbestosis Characterized by diffuse pulmonary fibrosis secondary to inhalation of asbestos dust Coal Workers Pneumoconiosis (Black Lung Disease) Includes a variety of respiratory diseases found in coal workers exposed to coal dust for years May lead to the development of cor pulmonale and respiratory failure. Nursing Interventions Educate the patient about the prevention of the disease. Ensure that the work environment is well ventilated. Promote measures to minimize the exposure to harmful products 12. Chest Tumor Include neurogenic tumors, tumors of the thymus, lymph, germ cell, and mesenchyme Assessment Cough, wheezes, dyspnea Anterior chest or neck pain Bulging of the chest wall Heart palpitations and angina Dysphagia and weight loss CXR reveals tumors or cysts Nursing Interventions Monitor injury to the phrenic or recurrent laryngeal nerve. Medical management includes radiation and chemotherapy, and thoracotomy 13. Chest Trauma Caused by sudden compression or positive pressure on the chest wall May be secondary to falls, blows to the chest, or by deceleration injuries in motor vehicular accidents, rib fractures,

flail chest or pulmonary contusion or gunshot or stab wounds Assessment Signs of hypoxemia, hypovolemia, cardiac & respiratory failure Nursing Management Maintain a patent airway. Control hemorrhage. Immobilize spinal column. Stabilize fractured site. Monitor ABG values. Monitor for signs and symptoms of shock. D. Respiratory Care Modalities 1. Non-invasive Respiratory Therapies a. Oxygen therapy Administration of oxygen at a concentration greater than that found in the Environmental atmosphere Indicated to patients who have changes in respiratory rate or pattern resulting from hypoxemia or hypoxia b. Nebulizer therapy Disperses a moisturizing agent or medication, such as bronchodilator or mucolytic agent, into microscopic particles and delivers it to the lungs as the patient inhales. Indicated to patients who have difficulty in raising respiratory secretions; ineffective deep breathing and coughing c. Postural drainage Uses specific positions that allow the force of gravity to assist in the removal of bronchial secretions. Indications: o Elderly patients who have ineffective cough and those with COPD d. Breathing retraining Consist of exercises and breathing practices designed to achieve more efficient and controlled ventilation and to decrease the work of breathing Indicated to patients with COPD and dyspnea 2. Airway management a. Endotracheal intubation Involves passing an endotracheal tube through the mouth or nose into the trachea to facilitate breathing. Indicated in patients who cannot maintain an adequate airway on their own (e.g., comatose patients or patients with upper airway obstruction) b. Tracheostomy A surgical procedure performed to create an opening into the trachea. it is considered as the best route for long-term airway maintenance. Indications:

o Relief of upper airway obstruction o As an access for continuous mechanical ventilation o Prevention of aspiration pneumonia o Prolonged used of ET tube resulting to pain or erosion. o Bilateral vocal cord paralysis 3. Mechanical ventilation To control the patients respiration during surgery and during treatment of severe head injury To oxygenate the blood when the patients ventilatory efforts are inadequate To rest the respiratory muscles Indications: Con tinuous decrease in oxygenation (PaO2) o Incr ease in arterial carbon dioxide levels (PaCO2) o Per sistent acidosis (a decreased pH) Patients Undergoing Thoracic Surgery Thoracic Surgeries a. Pneumonectomy Removal of the entire lung Indicated for cancer when the lesion cannot be removed by a less extensive procedure b. Segmentectomy (Segmental Resection): Indicated when lesions are located in only one segment of the lung c. Lobectomy: Removal of one lobe of the lungs. d. Wedge Resection: Removal of small necrotic tissues near the surface of the lungs. Nursing Interventions After Thoracic Surgery Monitor for signs of respiratory failure. Monitor chest tube drainage system.

Maintain adequate hydration. Monitor for pain. Position client to unaffected side.

5.

Monitor for signs of pulmonary embolism and pulmonary edema. Monitor I & O. Assess dressing and incision site. Watch out for signs of hypovolemic shock. Monitor for thrombophlebitis. Advice client to perform regular leg exercise. Encourage deep breathing exercises. Assess clients respiratory status.