PNEUMONIA:-Is an inflammation of the lung tissue affecting one or both sides of the chest that often occurs as a result of infection.

Anatomy

Respiratory Emergencies

PATHOPHYSIOLOGY:-Pneumonia is a serious infection or inflammation of lungs. The air sacs in the lungs fill with pus or other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and spreading infection through the body . Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs .

Causes

1-)Bacteria2-)Viruses 3-)Fungal 4-)parasite5-)Idiopathic

Risk factors:-1-)All ages. Most commonly and those at highest risk:-Elderly -Children 2-) weak immune systems 3-)Smoker 4-)chronic illnesses especially lung problems

Classifications:-_By:-1-) CausesA- Bronchiolitis obliterans organizing pneumonia( is caused by inflammation of the small airways of the lungs)B- Eosinophilic pneumonia(often occurs in response to infection with parasite or after exposure to certain types of environmental factors.)C- Chemical pneumonia D- Aspiration pneumoniaE Dust pneumonia F- Necrotizing pneumonia(pneumonias that cause substantial necrosis of lung cells) 2-)location acquired A- Community acquired (CAP ) B- hospital acquired 3-)Area of lung affected-1-Bronchopneumonia 2- lobar pneumonia4-) Clinical (acute or chronic)5-)The patient's immune status

Signs and Symptoms:-The symptoms of pneumonia may differ depending on what is causing it, but some common symptoms may include: • Painful cough •Shaking chills • fever• pleuritic chest pain• tachycardia • tachypnea• U RTI • respiratory distress• fatigue • orthopnea • poor appetite

Diagnosis:-1-) by History.2-) x-ray 3-) Sputum examination4-) blood culture 5-) CBC

Transmission:- is caused by the inhalation of infected microorganisms spread through contact with an infected person. The microorganisms enter the body through the mouth, nose and eyes. If the body's resistance is down, the natural process of fighting off diseases is weakened and the microorganisms are free to spread into the lungs and the lungs' air sacs. The air sacs become filled with fluid and pus from the infectious agent, making it more difficult for the body to get the oxygen it needs, and the person may become sick,

Differential diagnosis: -1.) Pulmonary infarction2. )TB3. )Pulmonary edema4.) Bronchiectasis5.) Pulmonary embolism6.) Lung cancer7. )Acute allergic alveolitis

• Medical management:-

* depends on the severity of symptoms and the type of organism causing the infection by administration of appropriate antibiotic as determined by the results of gram stain and culture

Medical management:-1-) Hydration2-) Analgesic/Antipyretic3-) Oxygen4-) Antibiotics 5-) Physiotherapy .

Nursing managements:-1-)Improving AIRWAY PATENCY by:- -Proper position -Removing secreations -Encourages hydration and humidification-Encourages patient to deep breath and coughing- If the patient is immobile it is imperative that the patient be turned every two hours and encouraged to cough and deep breath -Chest physiotherapy- Administering oxygen as prescribed and monitoring for the effects.-Monitoring vital signs including oxygen level --Monitoring lung sounds watching for edema and patients feeling of shortness of breath.

Nursing managements:-2.) Promoting rest 3.)Promoting fluid intake4.) Maintaining nutrition,5.)Promoting the patients knowledge about his/her disease process .6.) Monitoring and managing potential complications.7.) Promoting home and community-based care by- teaching patients self care ,- continuing care.

Complications 1.) Hypotension. 2.) shock and respiratory failure 3.)Atelectasis and pleural effusion (fluid around the lung)4.) Super infection 5.) Empyema (pus in the pleural cavity), -6.) Hyponatremia (low blood sodium)7.) rarely an abscess in the lung

Preventions of Pneumonia1-)Practice good hygiene. Cough or sneeze on tissue . Use separate drinking glasses. Wash your hands often with warm soapy water or Alcohol

based gel when soap and water not available 2-)Get an influenza shot every year3-)Practice good preventive measures by:- -eating a proper diet -getting regular exercise and plenty of sleep. 4-)Do not smoke5-) Avoid exposure to secondary smoke .

Thanks SIS-FAREEDA MOH’DMGH CETD NURSE20 14

DEFINITIONAsthma :-*Is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm .

Causes:- The cause of asthma is not known, but there is evidence that many factors play a part1-)Genetic factors 2-)Environmental factors: 3-)Dietary changes 4-)Lack of exercise 5-)Occupational exposure

Pathophysiology :-Airway inflammation is the primary problem in asthma. An initial event in asthma appears to be the release of inflammatory mediators triggered. The mediators are released from bronchial mast cells, alveolar macrophages, and epithelial cells. Some mediators directly cause acute bronchoconstriction.” The inflammatory mediators also direct the activation of eosinophils and neutrophils, and their migration to the airways, where they cause injury. called “late-phase asthmatic response” results in epithelial damage, airway edema, mucus hyper secretion and hyper responsiveness of bronchial smooth muscle Varying airflow obstruction leads to recurrent episodes of wheezing, breathlessness, chest tightness and cough

Types of Asthma :-

1.) Child-Onset Asthma2.) Adult-Onset Asthma3.) Exercise-Induced Asthma 4.) Cough-Induced Asthma 5.) Occupational Asthma6.) Nocturnal Asthma7.) Steroid-Resistant Asthma (Severe Asthma)

Diagnosis :- 1-)Peak flow measurements2-)Lung function tests3-)Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin) 4-)Arterial blood gas5-)Chest x-ray

Asthma triggers:-A trigger is any thing or condition that causes inflammation in the airways, which then leads to asthma symptoms*Infections such as colds, flu, or pneumonia*Allergens such as food, pollen, mold, dust and pet dander*Exercise

Asthma triggers:- *Air pollution and toxins*Weather, especially extreme changes in temperature*Drugs (such as aspirin,)*Emotional stress and anxiety*Singing, laughing, or crying*Smoking, perfumes, or sprays

Risk factors for asthma :- 1-)Genetics 2-)Allergies3-)Medical Conditions-Respiratory infections in childhood-Low birth weight-Obesity-Congestive heart failure-Pulmonary embolism

4-)Gender5-) Ethnic Background 6-) Medications

Clinical manifestations :-1-)Coughing, especially at night 2-)Wheezing 3-)Shortness of breath 4-)Chest tightness, pain, or pressure

Early warning signs:-* Frequent cough, especially at night *Losing your breath easily or shortness of breath *Feeling very tired or weak when exercising *Wheezing or coughing after exercise *Feeling tired, easily upset*Decreases or changes in a peak expiratory flow *Signs of a cold, *upper respiratory infection, or allergies (sneezing, runny nose, cough, congestion, sore throat, and headache) *Trouble sleeping

Symptoms of worsening asthma:-

*Cough that won’t go away (day and night) *Wheezing *Tightness in the chest *Shortness of breath *Poor response to medicines (bronchodilators)

Late, severe symptoms:-* Severe wheezing (both when breathing in and out) *Coughing that won’t stop *Very rapid breathing *Inability to catch your breath *Chest pain or pressure *Tightened neck and chest muscles *Difficulty talking *Inability to fully exhale *Feelings of anxiety or panic *Pale, sweaty face *Blue lips or fingernails

Managements:- cannot be cured, but appropriate management can control the disorder and enable people to enjoy a good quality of life1.) The first step in asthma management is environmental control by* Clean the house at least once a week and wear a mask while doing it *Avoid pets with fur or feathers *Wash the bedding (sheets, pillow cases, mattress pads) weekly in hot water *Encase the mattress, pillows and in dust-proof covers *Replace bedding made of down, foam rubber *Consider replacing carpeting with hardwood floors *Use the air conditioner *Keep the humidity in the house low

Managements:- 2.) The second step is to monitor lung function. *Asthmatics use a peak flow meter to gauge their lung function* listen to breath sounds *pulse oxymetry ,and vital signs3.) The third step in managing asthma involves the use of medications. There are two major groups of medications used in controlling asthma - Anti inflammatory (corticosteroids) and bronchodilators. -immunotherapy may help those there are not control symptoms or used medications.

Nursing managements:-*The goal of nursing care in a patient’s having an asthma attack is to make sure there is adequate oxygen intake.1-) Evaluate respiratory rate/depth and breath sounds2-). Assist client to maintain a comfortable position 3-)Encourage/instruct in deep-breathing and directed coughing exercises4-)Obtain history of recent medication use, particularly theophylline preparations, steroids and inhalers. 5-)Obtain baseline data on respiratory function, using a peak flow meter, listen to breath sounds

*Nursing managements:-6-) the nurse must following physician order to:--Administer inhaled rapid acting bronchodilators to open up the airways.-Administer corticosteroids such as prednisone to reduce inflammation in the airways.-Administer low flow humidified oxygen to prevent hypoxemia.-Administer intravenous fluids to prevent dehydration and oral intake looses secretions in the airways.7-)-the nurse has to ensure that long term asthma medications like inhaled corticosteroids long acting bronchodilators are administered as prescribed by the physician.

*Nursing management:-8-)Check results of diagnostic procedures . 9-)Assess vital signs every 15 to 30 minutes in initial treatment period; retake temperature at least once; 10-)observe for changes in level of consciousness (e.g., depression due to hypoxemia or excitation due to aminophylline and/ or epinephrine11-)Removing any potential allergen or trigger from environment like flowers or perfumes12-)Maintaining a quite calm environment to reduce anxiety and promote normal respiratory rate13-)Monitoring the side effects of administered medications14-)Monitoring the arterial blood gases as an indication of improvement or deterioration-15-)Prepare for mechanical ventilation if patient cannot breathe on his own

*Patient Teaching :-*Providing information that will help prevent asthmatic episodes and teaching patients skills required to administer asthmatic medications properly. These skills and information are as follows1-)The need to identify and eliminate any actual or potential allergen, substance or condition that could precipitate an asthma attack.2-)The need to permit no smoking around3-)The need to report frequent use of rapid acting bronchodilators.The need to take long term medication as prescribed even when there are no asthma attacks.4-)How to use an inhaler and a spacer.5-)How to use a peak flow meter and the significance of the readings.6-(Assisting the patient to create an asthma management and emergency plan.7-)When to contact a healthcare provider or seek emergency services

complications of asthma:-: 1-)Decreased ability to exercise and take part in other activities 2-)Lack of sleep due to nighttime symptoms 3-)Permanent changes in the function of the lungs 4-)Persistent cough5-)Trouble breathing that requires breathing assistance (ventilator6-) Pneumothorax7-) Respiratory failure8-)Death

Preventions :-*You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.*Eliminate tobacco smoke from the home. (Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair

Peak Flow Meter - YouTube_2.flv

How to use an Inhaler - YouTube.flv

How to use a puffer with a spacer - YouTube.flv

How to Use a Metered Dose Inhaler - Demonstration - YouTube.flv

Thanks SIS-FAREEDA MOH’D MGH CETD NURSE2012