NUR252: UNIT III

INFLAMMATORY
DISORDERS OF THE
RESPIRATORY SYSTEM
 PNEUMONIA: DESCRIPTION
 Pneumonia is an inflammation of
the lung (Bronchioles, Alveoli,
Interstitial tissues and on occasion
the pleura) usually caused by an
infection (Viral, Bacterial, Fungal).
 Lobar pneumonia is an infection
that only involves a single lobe, or
section, of a lung
PNEUMONIA 2: DESCRIPTION
 Bronchial pneumonia is when the
pneumonia spreads to several
patches in one or both lungs.
Bronchial pneumonia is most
prevalent in infants, young children
and aged adults.
 PNEUMONIA 3: DIAGNOSTIC
TESTS
 Chest X-RAY
 C.B.C

 Blood cultures
 Sputum Analysis

 Pulse oximetry

 Arterial Blood Gas

 Thoracentesis
 PNEUMONIA 4: ETIOLOGY
 Inhalation of infectious particles
 Aspiration of oropharyngeal or
gastric contents
 Hematogenous deposition

 Invasion from infection in contiguous

structures
 Direct inoculation

 Reactivation
 PNEUMONIA 5: ETIOLOGY
 Community-acquired pneumonia
 Hospital-acquired pneumonia

 Aspiration pneumonia

 Pneumonia caused by opportunistic

pathogens
 Emerging pathogens
 PNEUMONIA 6:
PATHOPHYSIOLOGY
Bacteria from the upper airways or,
less commonly, from hematogenous
spread, find their way to the lung
parenchyma
 Antigen-antibody response release
endotoxins
 Engorgement of the alveoli with fluid,
blood, and exudate
 PNEUMONIA 7:
PATHOPHYSIOLOGY
 Cellular infiltration and massive
congestion due to infiltration of
lymphocytes, neutrophils,
erythrocytes and fibrin
 Alveoli becomes airless due to
exudation and perfusion
 Consolidation of lung tissue
 PNEUMONIA 8:
SIGNS AND SYMPTOMS
 Cough that brings up a greenish or
yellowish mucus; sometimes
hemoptysis occurs
 Fever and chills; elevated WBC
 Stabbing or sharp chest pains that
worsen during deep respiration
 Rapid, shallow breathing
 Shortness of breath
 Crackles or rales
 PNEUMONIA 9:
SIGNS AND SYMPTOMS
Sometimes the following signs and
symptoms of pneumonia are also
experienced:
 Headache
 Excessive sweating and skin that is
clammy to the touch
 Loss of appetite
 Severe Fatigue
 Older adults sometimes may experience
confusion
 PNEUMONIA 9:
TREATMENT
 Antibiotics

 Antiviral

 Antifungal

 Antipyretics

 Analgesics
 PNEUMONIA 10: PROCEDURES
 Bronchoscopy is a surgical
technique for viewing the interior of
the airways.
 Using sophisticated flexible fiber
optic instruments, surgeons are able
to explore the trachea, main stem
bronchi, and some of the small
bronchi.
 PNEUMONIA 11: PROCEDURES
 In children, this procedure may be
used to remove foreign objects that
have been inhaled.
 In adults, the procedure is most
often used to take samples of
(biopsy) suspicious lesions and for
culturing specific areas in the lung.
 PNEUMONIA 12: PROCEDURES
A bronchoscope is a tube with a
tiny camera on the end which is
inserted through the nose (or mouth)
into the lungs.
 During a bronchoscopy procedure, a
scope will be inserted through the
nostril until it passes through the
throat into the trachea and bronchi.
PNEUMONIA 13: PROCEDURES
A bronchoscope is used to provide a
view of the airways of the lung
(tracheobronchial tree). The scope
also allows the doctor to collect lung
secretions and lung tissue for biopsy
for tissue specimens.
 PNEUMONIA 14: PROCEDURES
 Thoracentesis is a procedure to
remove fluid from the space between
the lining of the outside of the lungs
(pleura) and the wall of the chest.
 http://note3.blogspot.com/2004
/02/thoracentesis-procedure-
guide.html
 PNEUMONIA 15: PROCEDURES
 A small area of skin on the chest or back
is cleaned
 Local anesthetic is injected in this area

 A needle is then placed through the skin

of the chest wall into the pleural space
 Fluid is withdrawn and collected and may
be sent to a laboratory for analysis
(pleural fluid analysis).
 PNEUMONIA 16:
NURSING MANAGEMENT
 ASSESSMENT

 DIAGNOSIS

 PLANNING

 INTERVENTIONS

 EVALUATION
 IN CLASS GROUP ACTIVITY
 A 26 year old male patient was admitted
to hospital with a chief complaint of rapid
shallow breathing, shortness of breath,
stabbing chest pains, fever and chills for 2
days. On admission patient had a
persistent hacking cough that is mostly
non-productive. Moist rales/crackles were
heard in both lungs. The patient is weak
and is unable to stand on his own, and
appears very fatigued.
IN CLASS GROUP ACTIVITY 2
The patient said to the nurse that he is
not feeling to eat anything. His vital signs
were T39, P140, R38 and BP90/55. Whilst
taking his vital signs the nurse observed
that the patient’s skin and mucus
membranes were dry. The patient got
married recently and lives in an extended
family setting. He wonders aloud who
would look after his young bride when he
is away. He was later diagnosed as having
bilateral bronchial pneumonia.
IN CLASS GROUP ACTIVITY 3
 Identify nursing diagnoses relevant
to this patient
 Discuss the management of this
patient in relation to
(a) breathing and oxygenation
(b) fluid and electrolyte balance
© safety and comfort needs a
(d) psychosocial needs
TUBERCULOSIS: DESCRIPTION
 Tuberculosis (TB) is a bacterial infection
caused by a germ called Mycobacterium
tuberculosis. The bacteria usually attack
the lungs, but they can also damage other
parts of the body.
 Two types:

Primary infection- first time exposure

Secondary infection- reactivation of
dormant bacilli
 TUBERCULOSIS 2:
DIAGNOSTIC TEST
 Mantoux test
 CXR

 Culture (sputum)
 TUBERCULOSIS 3:
ETIOLOGY
 Direct inhalation of infective droplet
nuclei
 Transdermal and gastrointestinal
(GI) transmission also have been
reported
 Infected patients living in crowded or
closed environments pose a
particular risk for noninfected
persons.
 TUBERCULOSIS 4:
PATHOPHYSIOLOGY
 Organisms enter the lungs (airborne
droplets)
 Organisms multiply in the alveoli

 Organisms enter lymphatic system and

bloodstream
 Cell mediated response is triggered

 Formation of tubercles as macrophages

attempt to isolate organism
 Scar tissue formation
 TUBERCULOSIS 5:
SIGNS AND SYMPTOMS
 Cough (productive in active stage,
dry in initial stage)
 Fever (afternoon or night)

 Malaise

 Weight loss

 Anorexia
 TUBERCULOSIS 6:
SIGNS AND SYMPTOMS
 Chest pain (with breathing or
coughing)
 Hemoptysis

 Dyspnea

 Crackles

 Enlarged painful lymph nodes

 TUBERCULOSIS 7:
TREATMENT
 Drug therapy
 TUBERCULOSIS 7:NURSING
MANAGEMENT
 ASSESSMENT

 DIAGNOSIS

 PLANNING

 INTERVENTIONS

 EVALUATION
 LUNG CANCER
 Lung cancer is a disease
characterized by uncontrolled cell
growth in tissues of the lung
 It is termed brochiogenic carcinoma
because the tumor usually stems
from the bronchial mucosa
 It is defined as cancer of the
epithelial lining of the lung
 LUNG CANCER 2:
DIAGNOSTIC TESTS
 CXR

 CT-SCAN
 BRONCHOSCOPY
 LUNG CANCER 3:
ETIOLOGY
 Smoking

 Second hand smoke

 Exposure to radioactive substances

 Exposure to asbestos

 Viruses
 LUNG CANCER 4:
PATHOPHYSIOLOGY
 Activation of oncogenes
 Inactivation of tumor suppressor
genes
 Proto-oncogenes are believed to turn
into oncogenes when exposed to
particular carcinogens
 LUNG CANCER 5:
SIGNS AND SYMPTOMS
 A persistent cough that gets worse over
time
 Constant chest pain
 Coughing up blood (hemoptysis)
 Shortness of breath, wheezing, or
hoarseness
 Recurrent pneumonia or bronchitis
 Swelling of the neck and face
 Loss of appetite or weight loss
 Fatigue
 LUNG CANCER 6:
TREATMENT
 Radiotherapy

 Chemotherapy

 Surgery

 Diet
 LUNG CANCER 8:
TREATMENT
 ASSESSMENT

 DIAGNOSIS

 PLANNING

 INTERVENTIONS

 EVALUATION