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TOPIC # 1: Care and Management of Clients with Problems in Oxygenation

Instructor: Mr. Alain Pilar

*irreversible brain damage can occur within 6 mins.

PEDIATRIC
1. EPIGLOTTITIS – medical emergency that may result in death if not treated
quickly
Epiglottis – flap of tissue that sits at the base of the tongue
- keeps food from going into the trachea when swallowing
- when it gets infected or inflamed, it can obstruct or close off the trachea
which may be fatal unless treated promptly

EPIDEMIOLOGY
• more common in children than in adults in the past due to the smaller diameter of
children’s epiglottic opening when compared to adults
• little narrowing of the windpipe can dramatically increase the resistance of an
airway, making breathing more difficult
• epiglottitis caused by HIB (haemophilus influenza B) has a distribution in that it
typically occurs among children aged 2-7 y.o. and has not been reported among
Navajo Indians and Alaskan Eskimos
• epiglottitis occurs in different peaks in both children and adults
o children 2-4 y.o.
o adults 20-40 y.o.
• epiglottitis in the very young (younger than 1 y.o.) is unusual and occurs in only
about 4% of cases

CLINICAL MANIFESTATIONS
• sore throat
• muffling or changing in the voice
• difficulty in speaking
• fever
• difficulty in swallowing
• fast heart rate – tachycardia
• DOB

DIAGNOSTICS
• laryngoscopy – visualize the size of the epiglottis
• x-ray

NURSING/COLLABORATIVE MANAGEMENT
• initial treatment may consist of making the person as comfortable as possible,
including placing an ill child in a dimly lit room with the parent holding the child,
humidified oxygen, and close monitoring. If there are no signs of respiratory
distress, IV fluids may be helpful. It is important to prevent anxiety because it
may lead to an acute airway obstruction especially in children
- if epiglottitis is severe, don’t or only give minimal fluids
- calm approach
• people with possible signs of airway obstruction require laryngoscopy in the
operating room with proper staff and airway intervention equipment. In severe
cases, the doctor may need to perform cricothyrotomy (cutting the neck to insert a
breathing tube directly into the windpipe)
• IV antibiotics may effectively control inflammation and get rid of the infection
from the body. Antibiotics are usually prescribed to treat the most common types
of bacteria. Blood cultures are usually obtained with the premise that any
organism found growing in the blood can be attributed as the cause of epiglottitis.
However, in many cases, if not the actual majority, blood cultures fail to yield this
information.
• Corticosteroids and epinephrine have been used in the past. However, there is no
good proof that these medications are helpful in cases of epiglottitis

2. Laryngotracheobronchitis – inflammation of the mucous membrane of the larynx,


trachea and bronchial tree
- often follows infection of the upper respiratory tract

RISK FACTORS:
• smoking
• exposure to people with respiratory infections
• underlying respiratory infections

CLINICAL MANIFESTATIONS
• (initially) dry, irritating cough with scanty amount of mucoid sputum
• sternal soreness from coughing
• fever with chills
• nigh sweats
• headaches
• general malaise
(late signs)
• DOB
• Noisy inspiration (stridor) and expiration (wheeze)
• Purulent (pus filled) sputum
• Blood streaked secretions

DIAGNOSTICS
• bronchoscopy
• culture and sensitivity of sputum

COMMON CAUSATIVE ORGANISMS


• Streptococcus pneumoniae
• Haemophilus influenza
• Mycoplasma pneumoniae
• Fungal Aspergillus

NURSING/COLLABORATIVE MANAGEMENT
• encourage bronchial hygiene
• increase fluid intake
• effective coughing
• encourage to sit up frequently – every 2 hours
• encourage rests – to heal our body
• mild analgesics
• antipyretics
• ABT (complete course)
• Expectorants
• Cool vapor therapy
• Moist heat to chest

NOTE: Antihistamines not prescribed because it causes excessive drying and may make
secretions more difficult to expectorate

3. BRONCHITIS – generally refers to an acute inflammation of the air passages


within your lungs
- occurs when trachea (windpipe) and large and small bronchi (airways) in
your lungs become inflamed because of infection or other causes

ETIOLOGY/CAUSE
• cigarette smoking
• heavy air pollution
• recurrent infection
• thin mucus lining of those airways can become irritated and swollen
• the cells that make up this lining may leak fluids in response to the inflammation
• coughing is a reflex that works to clear secretions from your lungs
• both adults and children can get bronchitis

CLINICAL MANIFESTATIONS
• cough
• sputum production
• dyspnea
• elevated temperature
• tachycardia
• tachypnea

DIAGNOSTICS
• chest x-ray
• pulmonary function test
• ABG – best indicator for oxygen saturation
• Culture and sensitivity of sputum

NURSING /COLLABORATIVE
• respiratory hygiene
• oxygen
• ABT (will not work for viral)
• Expectorants
• Bronchodilators

4. BRONCHIOLITIS – common illness of the respiratory tract caused by an


infection that affects the tiny airways called the bronchioles, which lead to the
lungs. As those airways become inflamed, they swell and fill with mucus, making
breathing difficult.
- most often affects infants and young children because their small airways
can become blocked more easily
- peak occurrence: 3-6 months of age
- typically occurs during the first 2 years
- more common in males, children who have not been breastfed, and those
who live in crowded areas

CLINICAL MANIFESTATIONS
• stuffiness
• runny nose
• mild cough
• mild fever
(late signs of severe condition)
• rapid, shallow breathing
• rapid heartbeat
• drawing in of the neck and chest with each breath, known as retractions
• flaring of nostrils
• irritability with difficulty sleeping and signs of fatigue or lethargy

NURSING/COLLABORATIVE MANAGEMENT
• fortunately, most cases of bronchiolitis are mild and require no specific
professional treatment
• antibiotics aren’t useful because bronchiolitis is caused by a viral infection, and
antibiotics are only effective against bacterial infections
• medications may sometimes be given to help open a child’s airways
• infants who have trouble breathing, are dehydrated or appear fatigued should
always be evaluated by a doctor. Those who are moderately or severely ill may
need to be hospitalized, watched closely and given fluids and humidified oxygen.
Rarely, in very severe cases, some babies are placed on respirators to help them
breathed until they start to get better
5. PNEUMONIA – inflammation of the lung parenchyma caused by various
microorganisms including bacteria, mycobacteria, chlamydiae, mycoplasma,
fungi, parasites and viruses
- “pneumonitis” is a more general term that describes an inflammatory
process in the lung tissue that may predispose or place the patient at risk
for microbial invasion

TYPES
• Community Acquired Pneumonia (CAP)
• Hospital Acquired Pneumonia (HAP)/ Nosocomial
• Pneumonia in Immunocompressed Host
o Pneumocystis pneumonia – Pneumocystis jiroveli
o Fungal pneumonia – Aspergillus fumigatus
• Aspiration Pneumonia

RISK FACTORS
• COPD
• Cancer
• Prolonged bed immobility
• Shallow breathing
• Cigarette smoking
• Depressed cough reflex

CLINICAL MANIFESTATIONS
• sudden onset of chills
• rapid rising of fever (38.5 – 40 C)
• pleuritic chest pain
• tachypnea – lungs is now compensating for extra oxygen
• rapid and bounding pulse
• mucoid, purulent sputum – rusty color
• orthopnea – difficulty breathing while lying down
• poor appetite
• generalized weakness

DIAGNOSTICS
• CXR
• Blood culture
• Sputum culture
• Fiber optic bronchoscopy

NURSING/COLLABORATIVE MANAGEMENT
• improving airway clearance – pulmonary toileting or respiratory hygiene
• promoting rest/conserving energy – to recuperate from your illness
• promoting fluid intake – makes secretions less viscous
• maintaining nutrition
• ABT
• USN
• Chest physiotherapy

6. ASTHMA – chronic inflammatory disease of the airways that causes airway


hyperresponsiveness, mucosal edema and mucous production

RISK FACTORS
• allergens
• respiratory infections
• exercise and hyperventilation
• weather changes

CLINICAL MANIFESTATIONS
• cough
• dyspnea
• wheezing
(late signs) – STATUS ASTHMATICUS
• diaphoresis
• tachypnea
• widening pulse pressure

DIAGNOSTICS
• pulmonary function test – spirometer
• pulse oximetry – peak flow meter
• ABG
• CXR
• Sputum analysis

NURSING/COLLABORATIVE MANAGEMENT
• calm approach
• patient education
• breathing exercise especially for pediatric patients
• nutritional therapy
• reduce bronchial secretions – DBE, coughing, USN
• improving sleep pattern
• increasing activity tolerance
• controlling infection

PHARMACOLOGICAL AGENTS
• quick relief (quicker fast acting medicines)
o short acting bronchodilators
(2-4 puffs)
o nebulizers – up to 3 treatments at 20-minute intervals
o IV bronchodilators
• Long term
o Prenisone, Salmetrol, Montelukast, Theophylline

Kinds of puff:
• DPI – dry powder inhaler
• MDI – metered dose inhaler

7. CYSTIC FIBROSIS – most common fatal autosomal recessive disease among the
Caucasian population
- person must inherit a copy of the CF gene (one from each parent) in order
to have CF
- multisystemic genetic disease, respiratory systems are frequently major
manifestations

EPIDEMIOLOGY
• 1:3 americans have CF
• less frequent among Asians, Hispanic and African Americans
• 37% of those affected are 18 y.o. and above

CLINICAL MANIFESTATIONS
• productive cough
• wheezing
• hyperinflation of the lung
• non-pulmonary: GI (pancreatic insufficiency, vitamin insufficiency, biliary
cirrhosis, recurrent pancreatitis, recurrent abdominal pain, weight loss, CF r/t
diabetes

DIAGNOSTICS
• elevated sweat chloride concentration (>60 meq/L) (quantitative pilocarpine
iontophoresis sweat test)
pilocarpine – induce sweating

NURSING/COLLABORATIVE MANAGEMENT
• chest physiotherapy (postural drainage, chest percussion, vibration, breathing
exercise)
• education (avoid exposure to crowd/people with infection)
• adequate fluid and dietary intake
• ABT for acute exacerbations (oral, IV or aerosolized)
• Bronchodilators
• Inhaled mucolytics (mucomyst)
• Anti-inflammatory agents (corticosteroids/ibuprofen)
• Gene therapy
• Double lung transplantation
8. SIDS (SUDDEN INFANT DEATH SYNDROME) – syndrome marked by the
symptoms of sudden and unexplained death of an apparently healthy infant aged
one month to one year
- the term cot death is often used in the United Kingdom, Australia and New
Zealand, while crib death is used in North America

RISK FACTORS
Prenatal
• inadequate prenatal care
• inadequate prenatal nutrition
• tobacco smoking
• use of heroin
• subsequent births less than one year apart
• alcohol abuse
• being overweight
• smoking and taking other drugs while pregnant

Post-natal
• LBW (especially less than 1.5 kg – 3.3 lbs)
• Exposure to tobacco smoke
• Laying an infant to sleep on his or her stomach
• Failure to breastfeed
• Excess clothing and overheating
• Excess bedding, soft sleep surface and stuffed animals
• Gender (61 % of SIDS cases occurs in males)
• Age (incidence rises from zero at birth, is highest from two to four months and
declines towards zero at one year)
• Premature birth (increase risk of SIDS death by 50 times)

ADULT
I. Chest Injuries
1. Pneumothorax – parietal or visceral pleura is breached
- pleural space is exposed to the positive atmospheric pressure, normally the
pressure in the pleural space is negative or sub atmospheric. This negative
pressure is required to maintain lung expansion, when either pleura is
breached, air enters the pleural space and the lung or a portion of it
collapses

TYPES
• simple – rupture of a bleb or a bronchopleural fistula, may enter through a breach
of either parietal or visceral pleura
- may be associated with diffuse intestinal lung disease and sever
emphysema
• traumatic – occurs when air escapes from a laceration in the lung itself and enters
the pleural space (unusually accompanied by hemothorax)
 open pneumothorax – when wound in the chest wall is large
enough to allow air to pass freely in and out of the thoracic cavity
(sucking chest wound)
• tension pneumothorax – small wound in the chest, air is trapped (like a one way
valve) with subsequent pressure build-up

RISK FACTORS
• smoking
• trauma
• underlying respiratory disease

CLINICAL MANIFESTATIONS
• sudden pleuritic pain
• tachypnea
• dyspnea
• anxiety
• cyanosis
• hypotension
• tachycardia

SIMPLE TENSION
Trachea midline shifted away from the
affected side

Chest Expansion decreased decreased or fixed in a


hyper expansion state

Breath Sounds diminished diminished or absent

Percussion normal sound/ affected side is hyper


resonant
hyper resonant

DIAGNOSTICS
• CXR
• ABG
• Pulse oximetry

NURSING/COLLABORATIVE MANAGEMENT
• main goal: evacuate the air or blood from the pleural space
• small chest tube (28 french) inserted into the 2nd intercostals space for removal of
air
• large chest tube (32 French) inserted into the 4th or 5th intercostals space – drain
blood
• emergency – anything large enough to fill the chest wall may be used
• ABT
• High concentration oxygen for severe hypoxia

2. FLAIL CHEST – complication of blunt chest trauma


- usually occurs when 3 or more adjacent ribs are fractured at 2 or more
sites resulting in a free floating segment, as a result, the chest wall loses
stability causing respiratory impairment

CLINICAL MANIFESTATIONS
• hypoxemia
• respiratory acidosis

DIAGNOSTICS
• serial CXR
• ABG
• Pulse oximetry

NURSING/COLLABORATIVE MANAGEMENT
• clearing secretions from the lungs
• (small segment) positioning, coughing, deep breathing coughing, deep breathing
suctioning
• (mild to moderate flail chest) monitor fluid intake, appropriate fluid replacement,
pulmonary physiotherapy
• (severe flail chest) intubation and mechanical ventilator
• pain management:
o patient controlled analgesia
o intercostals nerve blocks
o epidural analgesia
o intrapleural administration of opioids
3. PULMONARY CONTUSION – thoracic injury and is frequently associated with
flail chest
Contusion – no break in the skin but there is a bruise
- damage to the tissues resulting in hemorrhage and localized edema
- may not be evident initially on examination but develops in the post
traumatic period
- it may involve a small portion of one long, a massive section o f a lung,
one entire lung, or both lungs
- dependent on the impact

CLINICAL MANIFESTATIONS
• decreased breath sounds – not known initially
- thickening of lung tissues (gabungol ang sound)
• tachypnea – lungs compensate
• tachycardia – compensatory mechanism
• chest pain
• hypoxemia – lung’s vital capacity is decreased because it is now swollen
• blood tinged secretions – when coughing
- not to be confused as having pulmonary tuberculosis
- only due to injury
• changes in sensorium/eratic mood – baseline: px. is cooperative/friendly
- brain is affected because of decreased oxygenation
• agitation, combative irrational behavior

DIAGNOSTICS
• pulse oximetry
• ABG
• CXR (changes usually shows 1-2 days post injury) – due to delayed lung
contusion

NURSING MANAGEMENT
• pulmonary toileting – secretions/drainage due to “hubag”
• supplemental oxygen
non-rebreather oxygenation – to hyperoxygenate
• pain control – due to rubbing and friction between pleural walls
• intubation and mechanical ventilation/respirator – depending on the degree

4. RESPIRATORY FAILURE – sudden life threatening deterioration of the gas


exchange function of the lung
- it exists when the exchange of oxygen for carbon dioxide in the lungs
cannot keep up with the rate of oxygen consumption and carbon dioxide
production by the cells of the body
- can be caused by excessive energy expenditure
TYPES:
• ARF (acute respiratory failure)
- decreased PAO2 <50 mm hg (hypoxemia)
- increased PACO2 >50 mm hg (hypercapnia)
• CRF (chronic respi failure) – deterioration in the gas exchange function of the
lungs that has developed insidiously or has persisted for along period after an
episode of ARF

CLINICAL MANIFESTATIONS
• Restlessness – because you have that feeling of impending doom
• Fatigue – “waras” ‘coz you need more energy
• headache
• dyspnea – difficulty of breathing
• air hunger
• tachypnea
• increased BP
(late signs)
• confusion
• lethargy
• central cyanosis – palanggit-om
• diaphoresis - palamugnaw
• respiratory arrest

DIAGNOSTICS
• ABG
• Pulse Oximetry
• CXR

NURSING/COLLABORATIVE MANAGEMENT
• assisting in intubation/mechanical ventilation
• monitor level of responsiveness – if patient is a respi patient, make rounds as
often as possible
• turning (to sides every 2 hours to prevent complication), mouth care, skin care
(prevent decubitus ulcer) , ROM (always allow them to move at their maximum
potentials)
• medical management objective is to correct the underlying cause and to restore
adequate gas exchange in the lung (intubation and mechanical ventilation)

RSI – rapid sequence intubation


- done with the aid of tranquilizers

5. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) – previously called


adult respiratory distress syndrome
- severe form of acute lung injury
- characterized by a sudden and progressive pulmonary edema, increasing
bilateral infiltrates on chest x-ray, hypoxemia refractory to oxygen
supplementation, and reduced lung compliance. These signs occur in the
absence of left sided heart failure.

3 HALLMARK FEATURES:
• bilateral patchy infiltrates on CXR
• no signs of heart failure
• no improvement in PaO2 despite increasing O2 delivery

RISK FACTORS
• aspiration
• drug ingestion and overdose
• hematologic disorders – blood dyscrasias, leukemia, sickle cell anemia
• prolonged inhalation of high concentration oxygen, smoke or corrosive substances
• localized infection – there are pus inside the lungs
• metabolic disorders – extreme cases of hypo/hyperglycemia
• shock – any type of shock (e.g. hypovolemic shock, neurogenic shock)
• trauma – due to blood loss or extreme pain
• major surgery
• fat or air embolism
• systemic sepsis – septicemia
• disseminated vascular coagulation
• massive blood transfusion – BT is supposed to have a time interval so as not to
have massive blood transfusion
• burns
• pancreatitis
• near drowning

CLINICAL MANIFESTATIONS
Stage 1
• dyspnea upon exertion
• respiratory rate are normal or increased
• cardiac rate are normal or increased
• diminished breath sounds
Stage 2
• increased respiratory rate
• usage of accessory muscle
• restless, apprehensive, mentally sluggish or agitated
• present dry cough or frothy sputum
• increased cardiac rate
• cool, clammy skin
• crackles – a type of adventitious breath sound
Stage 3 (intubation is ordered)
• severe tachypnea
• decreased mental acuity
• tachycardia with arrhythmias (irregularities)
• labile blood pressure
• skin is pale and cyanotic
• diminished breath sounds
• crackles
• ronchi
Stage 4
• decreased respi rate
• decreased cardiac rate
• loss of consciousness
• skin is cool and cyanotic
• breath sounds are severely diminished or absent

DIAGNOSTICS
• ABG
• CXR
• Pulmonary Artery Catheterization – measurement of pulmonary artery
- used for cardiac functions
- check effectivity of medications to the heart
- used to rule out cardiac cause of difficulty of breathing
- results indicates COPD, emphysema, and other respiratory illnesses
- measures difference blood pressure once inside the left ventricle of the
blood
- Central line catheter or Swan-ganz catheter

NURSING/COLLABORATIVE MANAGEMENT
• assess the patient’s respiratory status every 2 hours, more often f indicated (note
rate, rhythm and depth)
• auscultate lungs bilaterally for adventitious or diminished breath sounds
• monitor VS and institute cardiac monitoring
• monitor level of consciousness
• ABT(suspect involvement of infectious process) and steroids (great anti-
inflammatories)
• Diuretics may be needed
• Respiratory support (humidified air, ET intubation and mechanical ventilation,
PEEP – positive end expiratory pressure, suctioning)
• Place patient in prone position
6. COPD (Chronic Obstructive Pulmonary Disease)
- disease characterized by airflow limitation that is not fully reversible
- includes emphysema and chronic bronchitis
- (CF, bronchiectasis, and asthma are now classified as chronic pulmonary
disorders)

7. PLEURAL EFFUSION
- presence of excessive fluid in the pleural space

TYPES
• transudative effusion (watery fluid)
• exudative effusion (less watery, contains high concentration WBC and
plasma protein)
empyema – presence of pus in the pleural space
hemothorax – presence of blood
chylothorax – presence of chyle (a milky fluid containing lymph
fat droplets and digestive enzymes)

CLINICAL MANIFESTATIONS
• fever with chills
• pleuritic chest pain
• dyspnea
• orthopnea
• cough

DIAGNOSTICS
• CXR
• Chest CT
• Thoracentesis – invasive procedure done to release fluid
- a.k.a pleural fluid effusion/aspiration
- done to relieve discomfort caused by pain and other symptoms of
respi problems
- px. may feel pressure like pain upon insertion
• Pleural fluid culture
• Pleural biopsy

Blood tinged drainage – malignant pleural effusion

NURSING/COLLABORATIVE MANAGEMENT
• pulmonary toileting
• assisting in thoracentesis – a minor surgery
• pain control

EMPYEMA - an accumulation of thick, purulent fluid within the pleural space, often
with fibrin development and loculated (walled-off) area where infection is located
CLINICAL MANIFESTATIONS
• fever
• night sweats
• pleural pain
• cough
• dyspnea
• anorexia
• weight loss
(symptoms are similar to that of pneumonia)

DIAGNOSTICS
• chest CT
• ultrasound guided diagnostic thoracentesis
• C & S of pleural fluid

NURSING/COLLABORATIE MANAGEMENT
• lung expanding breathing exercise
• pleural drainage
• pulmonary toileting
• thoracentesis
• tube thoracostomy
• open chest drainage via thoracotomy (rib resection)

PLEURISY – inflammation of the pleura

CLINICAL MANIFESTATION
• pleuritic pain, or pleuritic (movement related, once breath is held pain is
absent)
• dry cough – because pleura is just inflamed
• fever
• assymetrical chest expansion – depending on the location of pleurisy
• tachypnea
• diminished breath

DIAGNOSTICS
• CXR

NURSING/COLLABORATIVE MANAGEMENT
• assess respiratory status, percuss and auscultate lung sound
• v/s, noting fever and respiratory rate
• encourage bed rest
• instruct to splint chest wall when coughing
• ABT
• Antitussive at night time
• NSAIDS
PULMONARY EMBOLISM (PE) – refers to the obstruction of the pulmonary artery or
one of its braches by a thrombus (or thrombi) that

RISK FACTORS
• trauma
• surgery
• pregnancy
• heart failure
• age older than 50
• hypercoagulable states
• prolonged immobility

CLINICAL MANIFESTATIONS
• dyspnea – sudden blockage of the lungs
• tachycardia – compensation from dyspnea
• chest pain (pleuritc, may mimic angina pectoris or MI)
• anxiety, apprehension – because of the sudden feeling of impending doom
• fever
• cough
• diaphoresis
• hemoptysis
• syncope

DIAGNOSTICS
• CXR
• ECG – for differential diagnosis
• Peripheral vascular studies – ultrasound (UTZ)
• ABG
• Ventilation–perfusion scan (V/Q) scan – a scan of the lungs
- differentiate ventilatory problem or vascular abnormalities of the lungs
- two different tests done synchronously
- gamma camera visualize image made by the radioactive material
- ventilation scan – reflects patency of pulmonary airway
- ventilation scan – wash in and wash is normal
- pulmonary embolism – normal ventilation and abnormal perfusion ; there
is low O2 saturation
- medical imaging to evaluate circulation of air and blood in the lungs
- perfusion evaluates how well blood circulates within the lungs
- abnormal result due to airway obstruction, COPD, pneumonia, embolus
- requires injection of radioactive material
- test pulmonary emboli, evaluate pulmonary function

(# of sticks/cigarette /day) x (# years smoking)


------------------------------------------------------- = pack years
20
NURSING/COLLABORATIVE MANAGEMENT
Main goal: to dissolve (lyse) the existing emboli and prevent new ones from forming –
use thrombolytics
• general measures to improve respiratory and vascular status
• anticoagulant therapy
• thrombolytic therapy – to prevent new clots from forming or prevent clots
from getting bigger and bigger
• surgical intervention – only indicated if indi na madala sa thrombolytic

CARBON MONOXIDE POISONING – occurs after the inhalation of carbon monoxide


gas
- following poisoning, long term sequelae often occur

Carbon monoxide (CO) – product of combustion of organic matter under


conditions of restricted oxygen supply, which prevents complete oxidation to
carbon dioxide (CO2)
- colorless, odorless, tasteless, and non-irritating, making it difficult for
people to detect
- significantly toxic gas with poisoning being the most common type of
fatal poisoning in many countries symptoms of mild poisoning include
headaches and flu-like effects
- larger exposures can lead to significant toxicity of the central nervous
system and heart
- can also have severe effects on the fetus of a pregnant woman

CLINICAL MANIFESTATIONS
• flu-like symptoms
• depression
• chronic fatigue syndrome
• migraine headache
• tachycardia
• headache
• dizziness
• confusion
• convulsion

DIAGNOSTICS
• carboxyhemoglobin – carbon monoxide has 200x affinity to the blood

NURSING/COLLABORATIVE MANAGEMENT
• (first aid) remove victim from exposure immediately without endangering
oneself
• 100% oxygen by tight fitting oxygen mask
HISTOPLASMOSIS – a.k.a. Darling’s disease
- caused by the fungus Histoplasma capsulatum
- symptoms very greatly
- primarily affects the lungs
- if other organs are affected – this form of the disease is called
disseminated histoplasmosis, and it can be fatal if untreated

CLINICAL MANIFESTATIONS
Symptoms will manifest 2 to 27 days after exposure
• cough
• flu like
• may resemble tuberculosis

DIAGNOSTICS
• chest x-ray
• C & S of sputum

NURSING/COLLABORATIVE MANAGEMENT
• Antifungal medications are used to treat severe cases of acute
histoplasmosis and all cases of chronic and disseminated disease.
• Typical treatment of severe disease first involves treatment with
amphotrecin B, followed by oral itroconazole. In many milder cases,
simply itraconazole is sufficient.
• Asymptomatic disease is typically not treated.
• Past infection results in partial protection against ill effects if reinfected.
• Educate to avoid areas that may harbor fungus (bird and bat droppings) for
prevention.

Cranberry juice – drink to make your urine acidic

SARCOIDOSIS – multisystem, granulomatous disease of unknown etiology


- may involve any organ or tissue but most commonly involves the lungs

CLINICAL MANIFESTATIONS
Hallmark of sarcoidosis are it its insidious onset and lack of prominent clinical
signs or symptoms
• dyspnea
• cough
• hemoptysis
• congestion
• anorexia
• fatigue
• weight loss

DIAGNOSTICS
• CXR
• CT Scan
• Transbronchial biopsy
• Open lung biopsy

NURSING/COLLABORATIVE MANAGEMENT
• corticosteroids
• pulmonary support and toileting
• assisting in diagnostics

SILICOSIS – a chronic fibrotic pulmonary disease caused by inhalation of silica dust

(Pneumoltramicroscopicsilicovolcanoconeosis)

RISK FACTORS
• miners
• quarrying
• tunneling operations
• glass manufacturing
• stone cutting

CLINICLA MANIFESTATIONS
• dyspnea
• fever
• cough
• weight loss
(late signs in progression of the disease)
• hypoxemia
• severe air flow obstruction
• right sided heart failure
• edema

DIAGNOSTICS
• CXR
• Biopsy

NURSING/COLLABORATIVE MANAGEMENT
• There is no specific treatment for silicosis, because the fibrotic process in
the lung is irreversible. Supportive therapy is directed at managing
complications and preventing infections.
• Oxygen therapy
• Inhaled beta-adrenergic agonist
• Anticholinergics
• Bronchodilators
• Education about protective materials (e.g. mask)