2.

PAP pulmonary arterial pressure

(INCREASED)

3.

(INCREASED)

UP COLLEGE OF NURSING

Measures end-systolic and end-diastolic

pressure
Reveals cardiac status
Swan-ganz (3-balloon tip) cardiac
catheterization
Echocardiograph reveals enlarged heart
chamber depending on the extent of heart
failure/cardiomyopathy
ABG analysis reveals elevated PCO2 and
decreased PO2 (respiratory acidosis)

MEDICAL-SURGICAL NURSING
Cardiology, Respiratory, Gastrointestinal
Lecturer: Mr. Ferdinand B. Valdez
4.
CONGESTIVE HEART FAILURE
Inabilitiy of the heart to pump blood towards systemic
circulation

5.

Tracheostomy for severe respiratory distress and

laryngospasm performed at bedside within 10-15 minutes

Unoxygenated blood will go to SVC&IVC

R atriumTricuspid valveR ventriclePulmonary
arteryLUNGS (oxygenation)Pulmonary vein
L atriumMitral valveL ventricle
L ventricleaortasystemic circulation

I.

Measures pressure in right ventricle

Reveals cardiac status
Swan-ganz cardiac catheterization
PCWP pulmonary capillary wedge pressure

CVP reveals fluid status; Normal = 4-10cm H2o

ALLENS test collateral circulation
II. RIGHT SIDED HEART FAILURE

LEFT-SIDED HEART FAILURE (Pulmonary)

A. PREDISPOSING FACTORS
1. Tricuspid valve stenosis
2. COPD
3. Pulmonary embolism (char by chest pain and
dyspnea)
4. Pulmonic stenosis
5. left sided heart failure

A. PREDISPOSING FACTORS
1. 90% - mitral valve stenosis
RHD (inflammation of the miral valve d/t
invasion of group A beta hemolytic
streptococcus) anti-streptolysis O titer
(ASO) 300 todd units
Penicillin, PASA, steroids
Aging (calcification)
2. MI
3. IHD/ CAD
4. HPN
5. Aortic valve stenosis

B. SIGNS AND SYMPTOMS (Venous congestion)

1. jugular vein distention/NVD
2. pitting edema
3. ascites
4. weight gain
5. hepatosplenomegaly
6. jaundice
7. pruritus/ urticaria
8. esophageal varices
9. anorexia
10. generalized body malaise

B. SIGNS AND SYMPTOMS

1. Pulmonary edema/congestion
Dyspnea, PND, 2-3 pillow orthopnea (high
fowlers to promote maximum lung
expansion)
Productive cough (blood tinged sputum)
Rales/Crackles
Bronchial wheezing
Frothy salivation
2. Pulses alternans (aternate weak & strong pulse)
3. Cyanosis
4. Anorexia and general body malaise (all energy
exerted for breathing)
5. PMI displaced laterally in the axilla d/t
cardiomegaly
6. S3 (ventricular gallop)

C. DIAGNOSTICS
1. CXR cardiomegaly
2. CVP measures pressure in right atrium; N =
4-10cc of H2O
During CVP: place on trendelenburg to
prevent pulmonary embolism and to
promote ventricular filling
Manometer is placed at the right midaxillary line at the level of the right atrium
MAINTAIN STRICT ASEPTIC TECHNIQUE
BY CHANGING DRESSING DAILY (#1
priority)
Flat on bed post CVP

C. DIAGNOSTICS
1. CXR cardiomegaly
1

Hypovolemia (<4cm of H20) fluid

challenge by increasing IVF
Hypervolemia diuretics (loop)
3. Echocardiography reveals enlarged heart
chamber
Muffled heart sounds cardiomyopathy
Cyanotic heart diseases
TOF tet spells cyanosis with
hypoxemia
Tricuspid valve stenosis
Transposition of aorta
Acyanotic
PDA machine-like murmur
DOC: Indomethacin SE:
corneal cloudiness
4. Liver enzymes
SGPT UP
SGOT UP
D. NURSING MANAGEMENT
(Goal: increase myocardial contraction increase CO;
Normal CO is 3-6L/min; N stroke volume is 6070ml/h2o
1. Administer medications as ordered
Cardiac glycosides (increase force of
cardiac contraction)
Digoxin
o Withhold if HR is <60 bpm,
notify physician
o Toxicity: Anorexia, N/V,
confusion, photophobia, Xantopiayellowish spots
Digitoxin given if (+) Hx of ARF;
metabolized in liver and not in
kidneys
Loop diuretics (GIVEN IN AM)
Lasix
o
10-15 minimum effect up to
6 H (maximum effect)
o
SE: uric acid, glucose,
Calcium, Sodium, Potassium
o
Increase Potassium in the
diet
Bronchodilators
Aminophylline (Theophylline)
Tachycardia/Palpitations
CNS hyperactivity
NO COFFEE
Narcotic analgesics
Morphine sulfate induces
vasodilation
Vasodilators
NTG and ISDN
Anti-arrhythmic agents SE: confusion
Lidocain
Bretyllium
YOU DONT GIVE THIAZIDE
DIURETICS TO THESE PATIENTS

2.

Administer O2 inhalation at 3-4 L/minute via

NC as ordered high flow
3. High fowlers
4. Restrict Na and fluids
5. Monitor strictly VS and IO and Breath Sounds
6. Weigh pt daily and assess for pitting edema
7. abdominal girth daily and notify MD
8. provide meticulous skin care
9. provide a dietary intake which is low in
saturated fats, Na and caffeine
10. Institute bloodless phlebotomy
ROTATING TOURNIQUET
Rotated every 15 minutes to promote
a decrease in venous return
To decrease venous return
BP cuff3 limb, clockwise
11. Health teaching and discharge planning
Prevent complications
Arrhythmia
Shock
Thrombophlebitis
MI
Cor pulmonale RV hypertrophy
Regular adherence to medications
Diet modifications
Importance of ff. up care
Wear medic alert bracelet

PERIPHERAL VASCULAR DISORDERS

I. Arterial ulcersMORE PAINFUL
A. Thromboangitis obliterans Buergers disease
(feet)
B. Reynauds Phenomenon (hand)
II. Venous Ulcers
A. Varicose veins
B. Thrombophlebitis/DVT
ARTERIAL ULCERS

I. THROMBOANGITIS OBLITERANS acute

inflammatory condition affecting the smaller and
medium sized arteries and veins of the lower extremities
A. PREDISPOSING FACTORS
1. High risk group men 30 years old above
2. Chronic smoking
B. SIGNS AND SYMPTOMS Consistent to all
arterial diseases
1. Intermittent claudication leg pain upon
walking
2. can be relieved by rest
3. cold sensitivity and skin color changes (RUBOR
WITH DEPENDENCY)

white/pallor bluish/cyanosis
red/rubor
(+) especially post smoking
decreased peripheral pulses particularly in
dorsalis pedis and posterior tibial

4.
2

5.
6.
7.

Trophic changes/
nodulesulcerationgangrene formation
ulceration
gangrene formation

C. DIAGNOSTICS
1. oscillometry reveals a decrease in peripheral
pulse volume
2. Doppler utz decrease in blood flow to
affected extremity
3. angiography site and extent of malocclusion
D. NURSING MANAGEMENT
1. encourage slow progressive physical activity
walking 3-4x/day
out of bed 3-4x/day
2. medications as ordered
analgesics
vasodilators
anticoagulants
3. instruct patient to avoid smoking and exposure
to cold environment
4. institute foot care management
avoid barefoot walking
straight toenails
lanolin cream for feet to avoid breakdown
(-) constricting
clothesischemiagangrene
5. Assist in surgery: BKA

I.

2.

ENCOURAGE PT TO WEAR GLOVES WHEN

OPENING A REFRIGERATOR

3.

instruct: avoid smoking and exposure to cold

environment

VARICOSE VEINS abnormal dilation of the veins of

the lower extremities d/t incompetent valves leading to
increased venous pooling and venostasis decreased
venous return; valves of veins promote increased
venous return
A. PREDISPOSING FACTORS
1. Hereditary
2. CONGENITAL WEAKNESS OF VEINS
3. thrombophlebitis
4. cardiac diseases
5. pregnancy
6. obesity (increase in BW by 20%)
7. prolonged immobility prolonged standing
and sitting (dorsiflex foot if sitting for more
than 2H)

episodes of arterial spasms involving the digits of hands

and fingers

B. SIGNS AND SYMPTOMS

1. pain after prolonged standing
2. dilated tortous skin veins which are warm to
touch
3. HEAVINESS IN THE LEGS

A. PREDISPOSING FACTORS
1. high risk group women 40 years old up
2. smoking
3. collagen diseases
SLE (butterfly rash on face, autoimmune)
o 2 common precipitating factors leading
to SLE: INFECTION, EXPOSURE TO SUN
RA (SYSTEMIC, non-gender specific)
4. direct hand trauma
piano playing
EXCESSIVE TYPING
Carpal tunnel syndrome
Operating chainsaw
Writing

C. DIAGNOSTICS
1. Venographycheck for allergy, force fluids to
prevent FVD because dye is considered as an
osmotic diuretic and is nephrotoxic
2. trendelenburgs test elevate legs 10-20
minutes then instruct the patient to stand up
if veins distend quickly < 35 seconds
incompetent valves
D. NURSING MANAGEMENT (consistent to all
venous ulcers)
1. elevate legs above heart level increased
venous return (1-2 pillow elevation)
2. measure circumference of leg to determine
swelling
3. antiembolic stocking, full support panty hose
4. medications as ordered analgesics
5. assist in surgery
vein stripping and ligation
o 2 most common Cx:

B. SIGNS AND SYMPTOMS

Ad minister medications as ordered

Analgesics
Vasodilators (Reserpine/Serpasil)
o Most common SE: major
depressionSUICIDE IDEATION
o Known to lead to the development of
breast cancer
o Nsg priority: SAFETY

VENOUS ULCERS

II. REYNAULDS DISEASE characterized by acute

1.

SAME WITH BUERGERS DISEASE EXCEPT

DECREASE IN PERIPHERAL PULSES
pain on digits of hands especially AFTER
SMOKING

C. DIAGNOSTICS
1. SAME except OSCILLOMETRY

THROMBOSISEMBOLISM

D. NURSING MANAGEMENT
3

o Encourage to ambulate post-op.

sclerotherapy
for spider-web varicosities
cold solution injected into the vein
SE: thrombosis

B. Parts
1. Nose made up of framework of cartilages;
divided into R and L by the nasal septum
consists of anastomosis of veins known as
KEISSEL-BACK PLEXUS (site of epistaxis)
2. Pharynx muscular passageway for BOTH
FOOD AND AIR

II. THROMBOPHLEBITIS/ DEEP VEIN

THROMBOSIS (DVT)inflammation of the veins of
the extremities with thrombus formation

A. PREDISPOSING FACTORS
1. smoking
2. obesity
3. prolonged use of OCPs
4. CHRONIC ANEMIA
5. diet high in saturated fats
6. DM
7. CHF
8. MI
9. POST-CANNULATION (insertion of various
catheters)
10. post-surgical operation
11. sedentary lifestyle

POST-SUB TOTAL THYROIDECTOMY:

C. DIAGNOSTICS
1. venography
2. Doppler utz
3. arteriography

D. NURSING MANAGEMENT
1. elevate the legs above heart level
2. APPLY WARM MOIST PACK TO RELIEVE

6.

measure circumference of leg muscles to

determine if it is swollen
anti-embolic stockings
administer medications as ordered
analgesics
ANTICOAGULANTS HEPARIN
prevent complications
pulmonary embolismsudden sharp chest
pain and unexplained dyspnea/ shortness
of breath
cerebral embolismheadache, dizziness
RESPIRATORY SYSTEM

I.

made up of framework of :
Hyoid bone u shaped bone in neck
Cricoid cartilage
Thyroid cartilage
Arythenoid cartilage
Functions: speech production and cough
reflex

II. Lower respiratory tract

A. Function: Gas Exchange
B. Parts
1. trachea consists of tracheal rings
passageway of air
site of tracheostomy (4th-6th tracheal ring)
2. Bronchus bifurcates to R and L
3. Lungs
Right 3 lobes, 10 segments
Left 2 lobes, 8 segments
Client post pneumonectomy
affected side to promote lung
expansion/ semi-fowlers position
Post lobectomy unaffected side to
promote venous drainage (done in
bronchiectasisthe only COPD
always subjected to this procedure)
Pleural cavity
Parietal
Fluidto prevent pleural friction rub
Visceral

LYMPHATIC CONGESTION

4.
5.

Difficulty of breathing d/t laryngospasm

secondary to trauma
Hoarseness of voice d/t trauma to larynx
secondary to post sub total thyroidectomy

Earliest sign of complete airway obstruction:

INABILITY TO COUGHAssist in Heimlich
maneuver

B. SIGNS AND SYMPTOMS

1. pain at the affected extremity
2. presence of cyanosis
3. dialted tortous veins
4. (+) HOMANS pain on calf on dorsiflexion

3.

Oropharynx
Nasopharynx
Connected to the middle ear by the
eustacian tube
Laryngopharynx
Glottis opening of larynx--.if
inflamed, need for permanent artificial
airway/tracheostomy
Larynx opens to allow passage of air
and closes to allow passage of food
going to the esophagus
Located below the thyroid gland

Upper Respiratory Tract

A. Functions
1. filtering
2. warming and moistening
3. humidification
4

4.

Alveoli/ Acinar cells

site for gas exchange (via diffusion); basic
living unit
Cells of the alveoli:
Alveolar type II cells secretes
surfactants which are lipoprotein in
nature that decreases surface tension
thereby preventing collapse of the
alveoli
Types of surfactant: Lecithin (2) and
Sphingomyelin (1)indicates lung
maturity (normal LS ratio2:1)

4.

MINUTES

5.

aspiration of food (aspiration pneumonia)

E. SIGNS AND SYMPTOMS

1. productive cough, greenish to rusty
2. dyspnea with PROLONG EXPIRATORY GRUNT
3. fever, chills, anorexia, general body malaise
4. cyanosis
5. pleuritic friction rub
6. rales/crackles on auscultation
7. abdominal distention paralytic ileus (#1
CAUSE OF GI TRAUMA & #1 COMPLICATION OF
ALL TYPES OF ABDOMINAL SURGERY)

DIAPHRAGM primary muscle for respiration

INTERCOSTAL MUSCLES secondary muscle for
respiration
VENTILATION movement of air in and out of the
lungs
RESPIRATION lungs to cells
Internal
External
RETROLENTAL FIBROPLASIA/ blindness/ROP &
COLLAPSE sub-retinal hemorrhage in premature
infant d/t toxicity from high O2 flow (more than 40%)

F. DIAGNOSTICS
1. Sputum gs/cs confirmatory; type and
sensitivity; (+) to cultured microorganism
2. CXR (+) pulmonary consolidation
3. CBC

elevated ESR (rate of erythropoeisis) N =

0.5-1.5%; compensate for hypoxia which
is its major stimulus

elevated WBC(+) to infection

4. ABG PO2 decreased PCO2 increased
respiratory acidosis
G. NURSING MANAGEMENT
1. enforce CBR
2. Administer medications as ordered

Broad spectrum antibiotics

Penicillin pneumococcal infections
Tetracyclinemost common SE:

RESPIRATORY DISORDERS
I.

prolonged immobility (hypostatic pneumonia)

elderly q H, ON THE AFFECTED SIDE Q 30

PNEUMONIA inflammation of the lung parenchyma

leading to pulmonary consolidation because alveoli is
filled with exudates

Given if allergic
to Penicillin

A. ETIOLOGIC AGENTS
1. Streptococcus pneumoniae (pneumococcal
pneumonia)
2. Hemophilus pneumoniae (bronchopneumonia)
3. Klebsiella pneumoniae
4. Diplococcus pneumoniae
5. Escherichia coli
6. Pseudomonas Aeruginosa

PHOTOSENSITIVITY

Macrolides
Azithromycin (OD, 3days)
1. too costly
2. not much SE
3. only SE: ototoxicity
transient hearing loss

Anti-pyretics

Mucolytics/expectorants
3. Administer O2 inhalation as ordered
4. force fluids to liquefy secretions
5. institute pulmonary toilet to promote
expectoration of secretions

DBE

Coughing exercises

CPTbronchial capping, vibration

Turning and repositioning

6. nebulize and suction PRN (10-15 seconds)
7. place client of semi fowlers to high fowlers to
promote lung re-expansion
8. provide a comfortable and humid environment
9. provide a dietary intake high in CHO, CHON,
Calories and Vit C
10. Assist in postural drainageplaced on various
positions to drain secretions by gravity

Nursing management:

B. MODE OF TRANSMISSION
Via droplet
C. HIGH RISK GROUPS
1. children less than 5 yo
2. elderly *VACCINE EVERY 5 YEARS
D. PREDISPOSING FACTORS
1. Smoking
2. air pollution
3. immunocompromised

(+) AIDS

bronchogenic CA (EARLIEST SIGN:

NONPRODUCTIVE COUGH, NON-INVASIVE
DX: CXR)

 Monitor VS and BS strictly

Best performed before
meals/breakfast or 2-3 hours p.c. to
prevent gastroesophageal reflux or
vomiting
Encourage DBE
ADMINISTER BRONCHODILATORS 15-

8-10 mm (DOH)
10-14 mm (WHO)
indicates previous exposure to
tubercle bacilli
INDURATION IS THE MOST
IMPORTANT GAGE IN MANTOUX TEST

2.
3.

30 MINUTES BEFORE PROCEDURE

Stop if pt. cant tolerate the procedure

Provide oral care after procedure as it
may affect taste sensitivity
CONTRAINDICATIONS:
UNSTABLE VS
HEMOPTYSIS
INCREASED ICP (0-15 mmHg)
INCREASED IOP (12-21 mmHg)
(glaucomatunnel vision)
11. provide pt health teaching and d/c planning

avoidance of precipitating factors

prevention of complications
atelectasis
MENINGITIS

regular compliance to medications

importance of ffup care

II. PULMONARY TUBERCULOSIS (KOCHS
DISEASE) infection of the lung parenchyma caused
by invasion of mycobacterium tuberculosis or tubercle
bacilli (gram negative, acid fast, motile, aerobic, easily
destroyed by heat/sunlight); COMMON AMONG SUBURBAN COMMUNITIES IN AMERICA

A. PRECIPITATING FACTORS
1. malnutrition
2. overcrowding
3. alcoholism

depletes Vit B1 (thiamin) alcoholic

beriberi malnutrition
4. physical and emotional stress/overfatigue
5. ingestion of infected cattle with
mycobacterium bovis
6. virulence (degree of pathogenecity)

4.

E. NURSING MANAGEMENT
1. enforce CBR
2. institute strict respiratory isolation
3. administer O2 inhalation
4. forced fluids
5. encourage DBE and coughing

NO CLAPPING in chronic PTB d/t

hemoptysis may lead to hemorrhage
6. nebulize and suction PRN
7. provide comfortable and humid environment
8. institute short course chemotherapy

Intensive phase
INH
MOST COMMON
SE: peripheral neuritis (increase
SE:
vit B6 or pyridoxine
HEPATITS/HEPA
Taken for 4 months, before meals
TOTOXIC
Rifampicin/Rivactine
SE: red orange color of bodily
secretions
Taken for 4 months, before meals
PZACAN BE REPLACED BY
ETHAMBUTOL (SE: OPTIC NEURITIS)

SE: allergic reactions;

hepatotoxicity and nephrotoxicity
Taken for 2 months, after meals
INH and Rifampicin is given for 4
months, a.c. to facilitate absorption
These 3 drugs are given
simultaneously to prevent
development of resistance

Standard Regimen
Aminoglycosides
STREPTOMYCIN injection
(aminoglycoside)
NEOMYCIN
Amikacin
GENTAMYCIN
1. common SE: 8th CN damage
tinnitus, vertigo
hearing loss ototoxicity
2. nephrotoxicity
a. BUN (N = 10-20)
b. CREA (N = 8-10)
MOST IMPORTANT;
indicates renal clearance
Health teaching and d/c planning

B. MODE OF TRANSMISSION: Airborne

droplet infection
C. SIGNS AND SYMPTOMS
1. productive cough (yellowish)
2. LOW GRADE AFTERNOON FEVER, NIGHT
SWEATS

3.
4.
5.

sputum AFB (+) tubercle bacilli

CXR (+) pulmo infiltrated/granuloma due to
caseous necrosis *2 other types of necrosis
coagulative, liquifactive
CBC elevated WBC

anorexia, malaise, WEIGHT LOSS

chest/back pain
hemoptysis

D. DIAGNOSTICS
1. Skin testing

Mantoux test injection of PPD

Induration width (within 48-72 h)

9.
6

Avoidance of precipitating factors

Prevention of complications
Atelectasis
Military TBspread of TB to
adjacent organs; most feared
Strict compliance to medications
Diet modifications
Importance of ffup care

1.
2.
3.
4.
5.
6.
7.

III. HISTOPLASMOSIS acute fungal infection caused

by inhalation of contaminated dust with histoplasma
capsulatum from birds manure

SIGNS AND SYMPTOMS

Productive cough

Fever, chills, anorexia, generalized body

malaise

Cyanosis

Chest and JOINT PAINS

Dyspnea

Hemoptysis

3.

DIAGNOSTICS

Histoplasmin skin test is (+)

ABG analysis reveals pO2 low

4.

NURSING MANAGEMENT

Enforce CBG

Administer meds as ordered

Antifungal agents
Amphotericin B (Fungizone) SE:
nephrotoxicity and hypokalemia
Corticosteroids
Anti-pyretics
Mucolytics/expectorants

Administer oxygen inhalation as ordered

Forced fluids

Prevent complications
Bronchiectasis

Prevention of spread
Spraying of breeding places
Kill bird and owner! Hehe!

prolonged expiratory grunt

anorexia and generalized body malaise
cyanosis
scattered rales/rhonchi
PULMONARY HYPERTENSION

PERIPHERAL EDEMA

COR PULMONALE/ R VENTRICULAR

HYPERTROPHY

D. NURSING MANAGEMENT
1. enforce CBR
2. administer medications as ordered

bronchodilators

antimicrobials

corticosteroids

mucolytics/expectorants
3. low inflow O2 admin; high inflow will cause
respiratory arrest
4. force fluids
5. nebulize and suction client as needed
6. provide comfortable and humid environment
7. health teaching and d/c planning

avoidance of smoking

prevent complications
CO2 narcosis coma
Cor pulmonale
Pleural effusion
Pneumothorax

Regular adherence to meds

Importance of ffup care

II. BRONCHIAL ASTHMA reversible inflammatory
lung condition caused by hypersensitivity to allergens
leading to narrowing of smaller airways
A. PREDISPOSING FACTORS
1. Extrinsic (Atopic/Allergic Asthma)

Pollens, dust, fumes, smoke, fur, dander,

lints20% only
2. Intrinsic (Non-Atopic/Non-Allergic)

Drugs (ASPIRIN, penicillin, B-blockers)

Foods (seafoods, eggs, chicken, chocolate,

milk)

Food additives (nitrates, nitrites)

Sudden change in temperature, humidity

and air pressure

Genetics, hereditary

Physical and emotional stress

3. Mixed type combination of both

COPD
I.

DYSPNEA ON EXERTION

C. DIAGNOSTICS
1. ABG analysis: decreased PO2, increased
PCO2, respiratory acidosis; hypoxemia
cyanosis

A. PREDISPOSING FACTORS

Inhalation of contaminated dust

2.

productive cough

CHRONIC BRONCHITIS (Blue Bloaters)

Inflammation of the bronchi due to hypertrophy or
hyperplasia of goblet mucous producing cells leading to
narrowing of smaller airways
A. PREDISPOSING FACTORS
1. Smoking--#1 cause of all COPD
2. air pollution

B. SIGNS AND SYMPTOMS

1. nonproductive to productive cough

B. SIGNS AND SYMPTOMS

7

2.
3.
4.
5.
6.
7.

dyspnea
wheezing on expiration
tachycardia, palpitations d/t compensation
diaphoresis
mild apprehension, restlessness/anxiety
cyanosis

2.

C. DIAGNOSTICS
1. PFT decreased vital lung capacity
2. ABG analysis PO2 decreased
D. NURSING MANAGEMENT
1. enforce CBR
2. administer medications as ordered

bronchodilators ADMINISTER FIRST 5-10

GROSS BLEEDING

MINUTES TO FACILITATE ABSORPTION OF

CORTICOSTEROIDS

3.
4.
5.
6.

Bronchoscopy direct visualization of bronchi

lining using a fibroscope inserted on the mouth

Pre-bronchoscopy
Secure consent
Explain procedure
Maintain on NPO for 4-6H
Monitor VS and breath sounds strictly

Post-bronchoscopy
Feeding initiated upon return of gag
reflex
Instruct client to avoid talking,
coughing and smoking immediately
after as it may irritate respiratory tract
MONITOR FOR S/SX OF FRANK OR

Monitor for signs of laryngeal spasm

DOB and SOB
D. TREATMENT
1. Segmental wedge lobectomya segment of
the lung is removed
Most common feared Cx:

inhalation
MDI/pump

Corticosteroids

Mucolytics/expectorants

Mucomyst/Acetylcistinesuction

Antihistamine
administer oxygen inhalation as ordered
forced fluids
nebulize and suction patient as necessary
health teaching and d/c planning

avoidance of precipitating factors

prevention of complications
status asthmaticus
epinephrine & bronchodilators
aminophylline drip
EMPHYSEMAMOST FEARED CX

regular adherence to medications

importance of ffup care

PNEUMOTHORAX

place on unaffected side to promote

drainage
Pneumonectomyaffected
Lobectomyunaffected

2.
3.

E. NURSING MANAGEMENT
1. enforce CBR
2. administer medications as ordered

bronchodilators

antimicrobials

corticosteroids

mucolytics/expectorants
3. low inflow O2 admin; high inflow will cause
respiratory arrest
4. force fluids
5. nebulize and suction client as needed
6. provide comfortable and humid environment
7. health teaching and d/c planning

avoidance of smoking

prevent complications
CO2 narcosis coma
Cor pulmonale
Pleural effusion
Pneumothorax

Regular adherence to meds

Importance of ffup care

III. BRONCHIECTASIS PERMANENT DILATION of the

bronchus due to destruction of muscular and elastic
tissue of the alveolar walls seen through bronchoscopy
can lead to narrowing of smaller airways
A. PREDISPOSING FACTORS
1. recurrent lower respiratory tract infection
2. histoplasmosis
3. congenital disease
4. presence of tumor
5. chest trauma
B. SIGNS AND SYMPTOMS
1. consistent productive cough
2. dyspnea
3. anorexia
4. general body malaise
5. presence of cyanosis
6. rales and crackles
7. HEMOPTYSIS

IV. PULMONARY EMPHYSEMA terminal and

irreversible stage of COPD characterized by :
Inelasticity of alveoli
Air trapping
Maldistribution of gasses
Overdistention of thoracic cavity (Barrel chest)
A. PREDISPOSING FACTORS
1. smoking

C. DIAGNOSTICS
1. ABG analysis reveals low PO2
8

2.
3.

4.
5.

air pollution
hereditary: involves LOSS OF ALPHA-1
ANTITRYPSIN no elastase production
cannor stretchno recoil, inelastictraps
gasmaldistribution of gassescompensate
by overdistention of thoracic cavity
allergy
high risk group elderly degenerative
decreased vital lung capacity and thinning of
alveolar lobes

V. PNEUMOTHORAX partial or complete collapse of

the lungs due to accumulation of air in pleural space
A. TYPES
1. Spontaneous air enters pleural space without
an obvious cause

Ruptured blebs (alveoli fluid-filled sacs)

inflammatory lung conditions
2. Open air enters pleural space through an
opening in pleural wall

Gun shot wounds

Multiple stab wounds

3. Tension air enters pleural space during
inspiration and cannot escape leading to
overdistention of the thoracic cavity
mediastinal shift to the affected side (IE. FLAIL

B. SIGNS AND SYMPTOMS

1. productive cough
2. DYSPNEA AT REST
3. PROLONGED EXPIRATORY GRUNT
4. resonance to hyperresonance
5. decreased tactile fremitus
6. DECREASED BREATH SOUNDS ( IF (-) BS LUNG
COLLAPSE/ATELECTASISCONFIRMED
THOUGH CXR

7.
8.
9.
10.
11.

Regular adherence to meds

Importance of ffup care

CHEST) PARADOXICAL BREATHING

Barrel chest
anorexia and generalized body malaise
rales or crackles
alar flaring

B. PREDISPOSING FACTORS
1. Chest trauma d/t accidents & wrong CPR
2. Inflammatory lung condition
3. tumors (poor exchangelung collapse)

PURSED-LIP BREATHING (TO ELIMINATE

EXCESS CO2)

C. SIGNS AND SYMPTOMS

1. sudden sharp chest pain, unexplained dyspnea
2. cyanosis
3. diminished breath sounds
4. cool, moist skin1st sign of shock
5. mild restlessness and apprehension
6. resonance to hyperresonance
7. decreased tactile fremitus

C. DIAGNOSTICS
1. ABG analysis reveal

Panlobular/centrilobular emphysema-PO2 decreased and PCO2 increased

respiratory acidosis (blue bloaters/chronic)

Panacinar/centriacinar PCO2 depression

and PO2 elevation (pink puffers
hyperaxemia)
2. Pulmonary function test decreased vital lung
capacity

D. DIAGNOSTICS
1. ABG analysis: PO2 decreased
2. CXR confirms collapse of lungs

D. NURSING MANAGEMENT
1. enforce CBR
2. administer medications as ordered

bronchodilators

antimicrobials

corticosteroids

mucolytics/expectorants
3. low inflow O2 admin; high inflow will cause
respiratory arrest
4. force fluids
5. nebulize and suction client as needed
6. provide comfortable and humid environment
7. Institute PEEP which allows for maximum
alveolar diffusion and prevent lung collapse
8. health teaching and d/c planning

avoidance of smoking

prevent complications
CO2 NARCOSIS COMA
COR PULMONALE
PLEURAL EFFUSION
PNEUMOTHORAX

E. NURSING MANAGEMENT
1. Assist in endotracheal intubation (WRONG
PLACEMENT(-) BILATERAL BREATH SOUNDS)

2.

Assist in thoracentesisaspiration of fluid and

blood from the pleural space
3. Administer meds as ordered

Narcotic analgesics Morphine sulfate

Antibiotics/Anti-microbial
4. Assist in CTT to H20 sealed drainage to reestablish (-) pressure in the lungs and to
remove air
*Atmospheric pressure-(+) 760 mmHg, Lung
pressure:-6 to -12 mmHg
WATER SEALED DRAINAGE
I.

OBJECTIVES
A. To restore (-) pressure in lungs
B. Promote re-expansion of lungs
C. To drain blood, fluid, and air

D. Prevent reflux of blood, fluid and air

C. descending colon
D. sigmoid colon
E. rectum
F. FUNCTION: ELIMINATION
IV. ACCESSORY ORGANS
A. Salivary glands produces 1.2-1.5 L of saliva per
day for mechanical digestion
1. Parotid below and infront of the ear
2. Sublingual
3. Submaxillary
B. Vermiform appendixRLQ
C. Liverlargest gland (R hypochondriac region)
D. Gall bladder
E. Pancreaslocated behind the stomach

II. NURSING MANAGEMENT

A. Maintain strict asepsis
B. Monitor VS, IO, BS
C. Encourage DBE
D. Administer medications as ordered
1. Narcotic analgesics Morphine sulfate
2. antimicrobials
E. Prepare: clamp for air leakage, extra bottle for
accidental breakage, petroleum gauze for accidental
removal
F. Monitor/assess oscillation, bubbles or fluctuations
1. If (+) continuous intermittent bubbling
normal/intact
H2O goes up with each inspiration
H2O goes down with each expiration
2. If (+) continuous, remittent, bubbling
Check for air leakage
Clamp towards the chest tube
Notify physician
3. If (-) fluctuations
Check for loops/kinks/clots
Milk towards H2O seal if (+) clots
Full re-expansion of lungs
(-) fluctuations
3 parameters to
warrant removal
(+) breath sounds
of CTT
CXR full re-expansion

Tears: lacrimal gland lacrimal duct lacrimal sac

punctae nasolacrimal gland
I.

PAROTITIS (Endemic mumps) inflammation of the

parotid gland
A. ETIOLOGIC AGENT
1. paramyxovirus virus
B. SIGNS AND SYMPTOMS
1. swollen parotid gland
2. earache / otalgia
3. dysphagia
4. fever, chills, anorexia, generalized body
malaise
5. lymphadenopathy

III. NURSING MANAGEMENT UPON CTT

REMOVAL
A. Encourage DBE
B. Instruct pt to perform valsalva maneuver to prevent
entry of air in pleural space and to facilitate easy
removal of CTT
C. APPLY VASELINATED AIR OCCLUSIVE DRESSING
D. Maintain dressing dry, clean and intact

C. NURSING MANAGEMENT
1. Enforce strict isolation
2. Meds as ordered
Antipyretics
Antibiotics to prevent secondary
infection
GENTIAN VIOLET HAS NO
COOLING EFFECT! Cooling effect
may be caused by vinegar!
Better to have mumps at an early
stage, preferably before puberty
may lead to sterility
3. Provide a general liquid to soft diet
4. Apply cold compress or ice pack at affected
site
5. Prevent complications
Cervicitis, oophoritis, vaginitis
Meningitis
Orchitis sterility if it occurs during/after
puberty

OVERVIEW OF THE STRUCTURE AND FUNCTION

OF THE GASTROINTESTINAL TRACT
I.

UPPER ALIMENTARY CANAL (Digestion)

A. Mouth
B. Pharynx
C. Esophagusmuscular hollow tube capable of
peristalsis
D. Stomachwidest section of the alimentary canal
E. First half of duodenum
F. FUNCTION: DIGESTION
II. MIDDLE ALIMENTARY CANAL (Absorption)
A. 2nd half of duodenum
B. jejunum
C. ileum
D. 1st half of ascending colon
E. FUNCTION: ABSORPTION
III. LOWER ALIMENTARY CANAL (Elimination)
A. 2nd half of ascending colon
B. transverse colon

II. APPENDECITIS Inflammation of the vermiform

appendix (located at the R. iliac region, produces WBC
during fetal life) *Embryogenesis: yolk sac, liver,
thymus, spleen, appendix
A. PREDISPOSING FACTORS
10

1.
2.
3.

Microbial invasion
FECALITHS undigested food particles
(tomato, guava seeds)
intestinal obstruction

10 LEADING CAUSES OF MORTALITY IN AMERICA:

1CANCER
2ACCIDENT
3CVD
4SUICIDE
5DM
6DIARRHEAL DISEASE
7AIDS
8PNEUMONIA
9STROKE
10PTB

B. SIGNS AND SYMPTOMS

1. (+) rebound tendernessflex R knee & apply
direct pressure
2. low grade fever, anorexia, nausea and vomiting
3. pain at R iliac region
4. diarrhea/constipation
5. tachycardia d/t painLate sign

ACID-BASE IMBALANCE

C. DIAGNOSTICS
1. CBC mild leukocytosis
2. PE (+) rebound tenderness
3. URINALYSIS (+) ACETONE

METABOLIC ACIDOSIS

ILEOSTOMY

CHRONIC DIARRHEA

DM

D. TREATMENT
1. Appendectomy within 24-48 H
MC BURNEYS POINT incision site for
appendectomy
Most feared complications

METABOLIC ALKASLOSIS

CUSHINGS

PYLORIC STENOSIS

PROJECTILE VOMITTING
RESPIRATORY ACIDOSIS

PNEUMONIA

BRONCHITIS

EMPHYSEMA

HYPERVENTILATION

PERITONITIS
SEPTICEMIA

E. NURSING MANAGEMENT PRE-OP

1. secure informed consent
2. routinary nursing care
NPO
Skin preparation
AVOID ENEMA MAY LEAD TO RUPTURE
3. administer medications as ordered
antipyretics
antibiotics
NO ANALGESICS! MAY MASK PAIN WHICH
INDICATES IMPENDING RUPTURE

4.
5.

monitor IO VS and Bowel sounds

AVOID HEAT APPLICATION RUPTURE

F. NURSING MANAGEMENT POST-OP

1. If (+) penrose drain (indicates rupture) place
patient on affected site
2. If (-), based on pt. comfort/ semi-fowlers
3. Administer medications as ordered
Analgesics PRN
Antibiotics
Antipyretics PRN
4. maintain patent IV line
5. monitor VS, IO and bowel sounds
(N=borborygmi)
POINTS ON LUNG DISEASES:
CAN LEAD TO:
a.) COR PULMONALEEMPHYSEMA & BRONCHITIS
b.) PNEUMOTHORAXEMPHYSEMA
c.) CO2 NARCOSISEMPHYSEMA
EXHIBIT SIGNS AS:
a.) ALAR FLARINGEMPHYSEMA
b.) DYSPNEA AT RESTEMPHYSEMA
c.) DYSPNEA ON EXERTIONBRONCHITIS

11