NCM112 Prelim Quiz 1 "Health is a state of complete physical, mental, and social well-

being and not merely the absence of disease and infirmity”.

Question #1 (1 Point) This was stated by;
You are fully aware of the fact that some risk factors are WHO
correctable or modifiable and other risk factors are innate and
not modifiable. Which of the following risk factors is the most Question #14 (1 Point)
likely able to be correctable?
The client states, “Heart disease runs in our family. My blood
Lifestyle pressure has been high.” The nurse determines that this is an
example of the client’s:
Question #2 (1 Point)
Risk factors
This is characterized by severe symptoms relatively of short
duration. Question #15 (1 Point)

Acute illness Client assessment provides the nurse with necessary

information for the development of a plan of care. Risk factors
Question #3 (1 Point) are important to identify to assist the client, if possible, to
respond and modify his or her lifestyle. Which one of the
Defined as an alteration in normal function resulting in
following assessment findings indicates a lifestyle risk factor?
reduction of capacities and shortening of life span.
Sunbathing
Disease
Question #16 (1 Point)
Question #4 (1 Point)
Epidemiologists are interested in learning about ___________.
Personal state in which a person feels unhealthy.
All of these
Illness
Question #17 (1 Point)
Question #5 (1 Point)
Diseases that are always present in a community, usually at a
State in which a person’s physical, emotional, intellectual and
low, more or less constant, frequency are classified as having
social development or spiritual functioning is diminished or
an ____________ pattern.
impaired compared with a previous experience.
Endemic
Illness
Question #18 (1 Point)
Question #6 (1 Point)
Diseases that are due mostly to environmental changes,
Refers to conditions that increases vulnerability of individual
increased population densities, and pollution that result from
or group to illness or accident;
modernization in third world nations are referred to as:
Predisposing factors
diseases of development
Question #7 (1 Point)
Question #19 (1 Point)
Refers to the degree of resistance the potential host has
Osteoporosis and degenerative diseases like Osteoarthritis
against a certain pathogen;
belongs to what type of risk factor?
Susceptibility
Age
Question #8 (1 Point)
Question #20 (1 Point)
A group of symptoms that sums up or constitute a disease;
It is otherwise known as the Universal Health Care Act (UHC
Syndrome Law).

Question #9 (1 Point) RA 11223

A woman undergoing radiation therapy developed redness and Question #21 (1 Point)
burning of the skin around the breast. This is best classified as
Diseases that results from changes in the normal structure,
what type of disease?
from recognizable anatomical changes in an organ or body
Iatrogenic tissue is termed as;

Question #10 (1 Point) Organic

Term to describe the reactivation and recurrence of Question #22 (1 Point)

pronounced symptoms of a disease;
Excessive alcohol intake is what type of risk factor?
Exacerbation
Lifestyle
Question #11 (1 Point)
Question #23 (1 Point)
You are the nurse in a long term care facility. One of the major
Which of the following is an example of acute illness/disease
considerations that you apply into your practice is strict
condition?
infection control prevention measures because you are
knowledgeable about the fact that the normal aging process is Myocardial Infarction (MI)
associated with the deterioration of the body’s normal
defenses. Which theory of aging supports your belief that strict Question #24 (1 Point)
infection control prevention measures are necessary?
Which of the following is classified as endemic disease?
The Immunological Theory of Aging
Malaria
Question #12 (1 Point)
Question #25 (1 Point)
The nurse is assessing a postoperative adult patient. Which of
the following should the nurse document as subjective data? Which of the following diseases is caused by a biological
agent?
Patient's description of pain
Dengue Hemorrhagic Fever (DHF)
Question #13 (1 Point)
QUIZ 2 Bronchoscopy

1. A pulse oximeter is attached to a client's finger. The purpose 18. Prophylaxis for pulmonary tuberculosis includes;
is to:
BCG
Detect oxygen saturation of arterial blood before symptoms of
hypoxemia develops 19. Within the alveoli, surface tension is decreased and
inflation is possible because of the presence of which
2. The pulse oximeter alarms indicating the oxygen saturation substance?
is at 86%. What would be the priority action?
Surfactant
Checking the position of the probe
20. The purpose of chest percussion and vibration is to loosen
3. The client was assisted by the nurse to any of the following secretion in the lungs. Which of the following statement is
positions for thoracentesis, EXCEPT: true?

Lying prone with the head of the bed "Percussion delivers cushioned blows to the client with
cupped palms while secretions while gently shakes secretion
4. You noted from the lab exams in the chart of a client that she loose on the exhalation cycle."
has reduced oxygen in the blood.
QUIZ 3
This condition is called:
1. A client returned to his room an hour ago following a
Hypoxemia bronchoscopy. He is requesting for some water. The nurse
must:
5. The client has difficulty breathing when on her back and
must sit upright in bed to breathe effectively and comfortably. Check the gag and swallowing reflex
The nurse documents this condition as:
2. A client with COPD complains of difficulty of breathing.
Orthopnea thick mucus secretion, and rales and Crackles upon
auscultation. The nurse expects referral of patient to which
6. Chest x-ray was ordered after thoracentesis. Your patient provider?
then asked, "What is the reason for another chest x-ray?" How
will you explain? Respiratory therapist

It was ordered to rule out the possibility of pneumothorax 3. The nurse instructs the person with Chronic Obstructive
Pulmonary Disease (COPD) to breathe:
7. To obtain a specimen for sputum culture and sensitivity,
which of the following instruction is best? While pursing lips during expiration

Obtain the specimen upon waking up, cough deeply and 4. Your patient has just been intubated in preparation for
expectorate into container mechanical ventilation. In evaluating the effectiveness of
this intervention, your first action will be to
Instruct the client to cough after pursed lip D Obtain the
specimen after respiratory Auscultate lung sounds

8. Common opening between the respiratory and digestive 5. aminophylline is prescribed to the patient with respiratory
system is: problems. This medication acts as

Pharynx Bronchodilator

9. The nurse is assisting in a thoracentesis. She is aware that 6. Which of the following are strategies that would be used
the needle will be inserted into the: to relieve symptoms of upper respiratory infection?

Pleural space Gargling with warm salt water

7. In upper respiratory infection, which of the following
10. Cheyne-Stokes breathing is: nursing interventions would address problems such as;
fever, diaphoresis, and increase secretions
Slow, shallow respirations which result to inadequate alveolar
ventilation Encouraging fluid intake

Marked rhythmic waxing and waning of respirations from very 8. When there is an accumulation of secretions resulting in
deep to very shallow breathing and temporary apnea collapsed portions of the lung, it is documented as:

11. The best position to promote maximum lung expansion is: Pleural effusion

Semi-Fowlers 9. The nurse is teaching the emphysema patient pursed-lip

breathing. She explains the purpose for this is to:
12. Which of the following risk factors presents the greatest
threat for respiratory diseases? Promote C02 elimination

Smoking 10. To prevent hospital-acquired pneumonia, the nurse must

learn to manage resources and environment. Which of the
13. The characteristic manifestation of airway obstruction is: following actions may help?

Noisy breathing Adherence to 1 suction cannula per 1 patient

14. Where are the respiratory centers located in the brain? 11. the patient undergoing MDT for DOTS does not strictly and
continuously followed the SCC. what would happen?
Medulla and pons
Multidrug resistance
15. The following are appropriate nursing diagnoses for clients 12. A newly diagnosed patient asks what asthma is. Which of
with oxygenation problems: the following explanations by the nurse is correct?
D. All of these "Your airways are inflamed spastic"
16. A patient has been exposed to tuberculosis. He has a 13. How many liters per minute of 02 should he administered
Mantoux test. The nurse reads the test 72 hours later. Which of to the patient with emphysema?
the following responses is interpreted as being positive?
6 L/min
10 mm induration
14. which of the following is the best explanation of
17. A patient is being prepared for a diagnostic procedure. The emphysema for newly diagnosed patient?
nurse explains, "This test allows the doctor to view your
“You have inflamed bronchioles, which elasticity, and air
trachea and bronchi. He will insert an instrument down your
gets trapped"
throat." The nurse has partially explained a:
15. The nurse is caring for a client with COPD who has Virulence Relative power or the degree of pathogenicity of the
shortness of breath, RR = 28 bpm, and an 02 sat of 92%. invading microorganism, the ability to produce poisons that repel or
Which intervention is contraindicated in this client? destroy phagocytes
bronchodilators
Etiology Is the causation of the disease. Etiologic description
Putting the client in supine recumbent includes identification of all factors that act together to bring a
16. the nurse is teaching a client with COP about the purpose disease condition.
of using bronchodilator. Which explanation should the
Risk Factors
nurse include?

Improves airflow and reduces air trapping • Genetic and Physiological

• Age
17. A diagnosis of pneumonia is typically achieved by which • Environment
diagnostic test: • Lifestyle

Sputum culture and sensitivity Etiologic Factors

18. the nurse is conducting a class for family members of • Hereditary

clients diagnosed with TB. Which of the following should • Congenital
the nurse teach family members regarding transmission of • Metabolic
the disease? • Deficiency
• Traumatic
It is transmitted through contaminated an infected person
• Allergic
19. To evaluate effectiveness of suctioning, the nurse should • Neoplastic
primarily: • Idiopathic
• Degenerative
Auscultate for clear breath sounds • Iatrogenic
20. A client has tested positive for tuberculosis and is started Disease Characteristics
on isoniazid (INH) for 6 months. What information would
the nurse plan to include in the client's teaching plan? • Remission
• Exacerbation
Alcohol consumption is contraindicated • Organic
CONCEPTS IN THE CARE OF AT-RISK AND SICK ADULT • Functional
CLIENTS • Occupational
• Familial
HEALTH CARE SITUATIONS • Venereal
• Epidemic
Concept of Illness • Endemic
• Pandemic
• Illness is a personal state in which the person feels unhealthy • Sporadic
or ill.
• Illness may or may not be related to disease.
• Illness is a state in which a person’s physical, emotional,
intellectual, social, developmental or spiritual functioning is Common Causes of Disease:
diminished or impairment compared with previous experience
1. Biologic Agents
Acute Illness
2. Inherited Generic Defects
• Usually has a short duration and severe.
• The signs and symptoms appear abruptly, are intense and 3. Physical Agents
often subside after a relatively short period. 4. Chemical Agents
• Following an acute illness a person may return to normal level
of wellness 5. Tissue response to irritation/injury (fever, inflammation)
Chronic Illness 6. Faulty chemical or metabolic process
• Slow onset. Persists, usually longer than 6 months and can 7. Emotional or physical reaction to stress
also affect functioning in any dimension.
• Chronically ill person has long term disease process Symptomatology. Study of symptoms.
• The client fluctuates between maximal functioning and serious
relapses that may be life threatening Symptom. Any disorder of appearance, sensation or function
experienced by the patient indicative of a certain phase of a disease.
Key Terms Manifestation of perceptible changes in the body which indicate the
presence of a disease or disorder.
Disease
Sign. An objective symptom or objective evidence or physical
• Disturbance of structure or of function of the body or its manifestation made apparent by special methods of examination or
constituent parts. use of sense.
• Lack of or inadequate adaptation of the organism to his
environment. Syndrome. A set of symptom, the sum of which constituents a
• Failure of the adaptive mechanism to adequately counteract disease.
the stimuli or stresses to which it is subject resulting in
disturbances in function and structure of any part, organ or • A group of symptoms which commonly occurs together
system of the body
• A group of signs and symptoms which when considered together
Morbidity. Condition of being diseased. characterize a disease.

Morbidity Rate. The proportion of disease to health in a community Pathology. The branch of medicine which deals with the cause,
nature, treatment and resultant structural and functional changes of
Mortality. Condition or quality of being subject to death. disease.

Epidemiology Study of the patterns of health and disease, its Diagnosis. Art or act of determining the nature of a disease,
occurrence and distribution in man, for the purpose of control and recognition of a diseased state.
prevention of disease.
Complication. A condition that occurs during or after the course of
Susceptibility Study of the patterns of health and disease, its an illness.
occurrence and distribution in man, for the purpose of control and
prevention of disease. Prognosis. Prediction of the course and of a disease, medical
opinion as to the outcome of a disease process.
Etiologic Agent One that possesses the potential for producing
injury or disease. (e.g. Streptococcus, Staphylococcus) Recovery. Implies that the person has no observable or known after
effects from his illness; there is apparent restoration to the pre-
illness state
Good prognosis means that there is great possibility to recover from Failing to adhere to a treatment plan or to do so consistently
the disease and poor prognosis means that there is great risk for increases the risks of developing complications and accelerating the
morbidity or mortality. disease process includes learning to live with symptoms or
disabilities and coming to terms with identity changes resulting from
CHRONIC ILLNESS having a chronic condition.
• Are often defined as medical conditions or health problems with It also consists of carrying out the lifestyle changes and regimens
associated symptoms or disabilities that require long- term designed to control symptoms and to prevent complications.
management (3 months or longer).
• Illnesses or diseases that have a prolonged course, that do not The Challenges of Living with Chronic Conditions Include the
resolve spontaneously, and for which complete cures are rare. Need to Accomplish the Following:
• The specific condition may be a result of illness, genetic
factors, or injury; it maybe a consequence of conditions or • Alleviate and manage symptoms
unhealthy behaviors that began during childhood and young • Psychologically adjust to and physically accommodate
adulthood. disabilities
• Prevent and manage crises and complications
affect people of all ages, the very young, the middle- aged, and the • Carry out regimens as prescribed
very old. are found in all ethnic, cultural, and racial groups, although • Validate individual self-worth and family functioning
some disorders occur more frequently in some groups than in others • Manage threats to identity
(Centers for Disease Control and Prevention [CDC], 2004 • Normalize personal and family life as much as possible
• Live with altered time, social isolation, and loneliness
account for 7 of the 10 leading causes of death in the United States, • Establish the networks of support and resources that can
including the three most frequently occurring diseases that result enhance quality of life
from preventable causes (tobacco use, improper diet and physical • Return to a satisfactory way of life after an acute debilitating
inactivity, and alcohol use). episode (eg, another myocardial infarction or stroke) or
reactivation of a chronic condition
occurs in all socioeconomic groups, but people who have low
• Die with dignity and comfort
incomes and disadvantaged backgrounds aremore likely to report
poor health (RWJF, 2001) APPLYING THE NURSING PROCESS USING THE PHASES OF
THE CHRONIC ILLNESS SYSTEM
• Factors such as poverty and inadequate health insurance
decrease the likelihood that people with chronic illness or Evidence Based Practice
disability receive health care and health screening measures
such as mammography, cholesterol testing, and routine • an approach that enables nurses to provide the
checkups (United States Department of Health and Human highest quality care based on the best evidence
Services[USDHHS],2005). available

• How people react to and cope with chronic illness is usually Nursing Process
similar to how they react to other events in their lives, de-
pending, in part, on their understanding of the condition and • a deliberate problem-solving approach for meeting
their perceptions of its potential impact on their own and their people's health care and nursing needs.
family’s lives.
P I C O T Format
Management of Chronic Conditions
✓ Patient/Population problem
• includes learning to live with symptoms or disabilities and ✓ Intervention
coming to terms with identity changes resulting from having a ✓ Comparison
chronic condition. ✓ Outcome
• It also consists of carrying out the lifestyle changes and ✓ Time frame
regimens designed to control symptoms and to prevent
complications Nursing Process
• Although some people assume what might be called a
‘sickrole´ identity, most people with chronic conditions do not ✓ Assessment
consider themselves to be sick or ill and try to live as normal a
life as possible. Only when complications develop or symptoms Organize, analyze, synthesize, and summarize the data
interfere with activities of daily living (ADLs) do most people
with chronic health conditions think of themselves as being sick ✓ Diagnosis
or disabled (Nijhof,1998) clinical judgment about individual, family, or community responses
Causes of the Increasing Number of People with Chronic to actual or potential health processes that can be managed by
Conditions Include the Following: independent nursing intervention.

• A decrease in mortality from infectious diseases, such as ✓ Planning

smallpox, diphtheria, and other serious conditions
• Longer life spans because of advances in technology and ✓ Intervention
pharmacology, improved nutrition, safer working conditions,
Involves carrying out the proposed plan of nursing care
and greater access (for some people) to health care
• Improved screening and diagnostic procedures, enabling early ✓ Evaluation
detection and treatment of diseases
• Prompt and aggressive management of acute conditions, such Compare the patient's actual outcome with the expected outcome
as myocardial infarction and acquired immuno-deficiency and data collection
syndrome (AIDS) + related infections
• The tendency to develop chronic illnesses with advancing age Step 1. Identifying Specific Problems and the Trajectory Phase
• Lifestyle factors, such as smoking, chronic stress, and
sedentary lifestyle, that increase the risk for chronic health The first step is assessment of the patient to determine the
problems such as respiratory disease, hypertension, specific problems identified by the patient, family, nurse, and
cardiovascular disease, and obesity other health care providers.

CHARACTERISTICS OF CHRONIC CONDITIONS Assessment enables the nurse to identify the specific medical,
social, and psycho-logical problems likely to be encountered
• Managing chronic illness involves more than managing medical in a phase.
problems. Associated psychological and social problems must
also be addressed Step 2. Establishing and Prioritizing Goals
• Chronic conditions usually involve many different phases over • Once the phase of illness has been identified for a
the course of a person’s lifetime. There can be acute periods, specific patient, along with the specific medical
stable and unstable periods, flare- ups, and remissions. problems and related social and psychological
• Each phase brings its own set of physical, psycho- logical, and problems, the nurse helps prioritize problems and
social problems, and each requires its own regimens and types establish the goals of care.
of management.
• Identification of goals must be a collaborative effort,
Keeping chronic conditions under control requires persistent with the patient, family
adherence to therapeutic regimens.
Step 3. Defining the Plan of Action to Achieve Desired Outcomes

• Once goals have been established, it is necessary to Assess for General Appearance
identify a realistic and mutually agreed-on plan for
achieving them including specific criteria that will be To gather SUBJECTIVE/OBJECTIVE data:
used to assess the patient’s progress.
 Dyspnea
• The identification of the person responsible for each  Cyanosis
task in the action plan is also essential.  Character of cough
 Sputum
• In addition, identification of the environmental, social,  Stridor
and psychological factors that might interfere with or  Hoarseness
facilitate achieving the desired outcome is an
important part of planning Auscultate for

Step 4. Implementing the Plan and Interventions Abnormal Cause of Description Associated
(Adventitious Sound Disorders
• This step addresses implementation of the plan.
) Sound
Possible nursing interventions include providing
direct care, serving as an advocate for the patient,
Coarse Fluid in Moist Pulmonary
teaching, counseling, making referrals, and case-
crackles airways bubbling edema,
managing (eg, arranging for resources).
(rales) sound, bronchitis,
• The nurse works with each patient and family to heard on pneumonia
identify the best ways to integrate treatment regimens inspiration
into their ADLs to accomplish two tasks: or
expiration
(1) adhering to regimens to control symptoms and
keep the illness stable, and Fine crackles Alveoli Velcro Heart failure,
(rales) popping being torn atelectasis
(2) dealing with the psychosocial issues that can open on apart,
hinder illness management and affect quality of life. inspiration heard at
end of
Step 5. Following Up and Evaluating Outcomes inspiration
• The final step involves following up to determine if the
Wheezes Narrowed Fine high- Asthma
problem is resolving or being managed and if the
airways pitched
patient and family are adhering to the plan. This
violins
follow-up may uncover the existence of new problems
mostly on
resulting from the intervention, problems that
expiration
interfere with the ability of the patient and family to
carry out the plan, or previously un- expected Stridor Airway Loud Obstruction
problems. Maintaining the stability of the chronic obstructio crowing from tumor or
condition while preserving the patient’s control over n noise heard foreign body
his or her life and the patient’s sense of identity and without
accomplishment is a primary goal. Based on the stethoscop
follow-up and evaluation, consideration of alternative e
strategies or revision of the initial plan may be
warranted. Pleural Pleura Sound of Pleurisy, lung
friction rub rubbing leather cancer,
Oxygenation
together rubbing pneumonia,
Assessment of respiratory status/ Diagnostic tests/ Nursing together, pleural irritation
Diagnosis grating

Health History Diminished Decreased Faint lung Emphysema,

air sounds hypoventilation,
To gather SUBJECTIVE data: movement obesity,
muscular chest
 Demographic Data wall
 Personal and Family History
 Current Health Problem Absent No air No sounds Pneumothorax,
 Smoking History movement heard pneumonectom
 History of Medication Used y
 History of Allergies
 Occupational and Socioeconomic Status
 Environment
DIAGNOSTIC TESTS
 Immunization Status
 Vital Signs Diagnostic Tests/Laboratory Tests
Abnormal Patterns of Breathing To confirm or rule out the diagnosis:

 Mantoux Test
 Chest X-ray
 Bronchoscopy
 Sputum Exam
 Pulmonary Function Test
 ABG Studies
 Pulse Oximetry
 Thoracentesis

NURSING DIAGNOSIS

 Impaired gas exchange

 Ineffective airway clearance
 Ineffective breathing pattern
 Impaired verbal communication
 Activity intolerance
 Anxiety
 Altered nutrition: less than body requirements
 Risk for infection
RESPIRATORY CARE MODALITIES

Oxygen Therapy

GOAL:

to provide adequate transport of oxygen in the blood while

decreasing the work of breathing and reducing stress on the
myocardium.

INDICATIONS INCLUDE:
To drain the middle and lower portions of lungs, position
arterial hypoxemia, COPD, ARDS, tissue and cellular hypoxia should be chest above the head.
LOW FLOW SYSTEM

Nasal Cannula PATHOPHYSIOLOGIC BASIS OXYGENATION – VENTILATION

24 – 40% FiO2 RESPIRATORY TRACT INFECTIONS
Standard Mask UPPER RESPIRATORY TRACT INFECTION
40 – 65% FiO2 Disorders of the upper respiratory tract include problems occurring
in the nose, sinuses, pharynx, larynx, and trachea
Rebreather Mask
VIRAL RHINITIS (COMMON COLD)
80 – 100% FiO2
The term “common cold” often is used when referring to an upper
HIGH FLOW SYSTEM
respiratory tract infection that is self-limited and caused by a virus
Venturi Mask (viral rhinitis).

100% FiO2 The release of histamine and other substances causes vasodilation
and edema, which result in symptoms.

S/Sx: Nasal congestion, rhinorrhea, sneezing, sore throat, and

CHEST TUBE DRAINAGE general malaise

Medical Mgt.

• No specific treatment, symptomatic treatment

• Adequate rest, Increase oral fluid intake
• Increase Vitamin C intake
• Expectorants as needed
• Warm salt-water gargle for sore throat
• Antihistamines - to relieve sneezing, rhinorrhea, and nasal
congestion
• Topical (nasal) decongestant agent

URTI

Nursing Mgt.
• insertion of a tube into the intrapleural space to • Teach patient how to break chain of infection
maintain negative pressure when air/fluid have • Proper Hand Hygiene
accumulated • Cough etiquette
• chest tube is attached to underwater drainage to allow
for the escape of air/fluid and to prevent reflux of air PNEUMONIA
into the chest
An acute inflammatory process involving the lung parenchyma
PRINCIPLES: GRAVITY and WATER SEAL
TYPES OF PNEUMONIA:
CHEST PHYSIOTHERAPY (Postural Drainage, Percussion,
Vibration)  Community acquired pneumonia (cap)
 Hospital acquired pneumonia (hap)
 Opportunistic pneumonia
 Aspiration pneumonia
 Hypostatic pneumonia

Etiologic Agent

• Streptococcus pneumoniae
• Hemophylus influenzae
• Diplococcus pneumoniae
• Klebsiella pneumoniae
• Escherechia pneumoniae
used for individuals with increased production of secretions,
• Pseudomonas
or thick, sticky secretions, for clients with impaired removal of
secretions or with ineffective cough. Predisposing Factors

• Smoking
• Air pollution
• Immunocompro-mised
• Related to prolonged immobility
• Aspiration

Signs and Symptoms

• Productive cough
• Dyspnea
• Fever, chills, anorexia and general body malaise
• Weight loss
• Rales/ crackles
• Bronchial wheezing
• Cyanosis
• Pleuritic friction rub
• Chest pain
• Abdominal distention

Diagnostic Procedures

• Sputum GS CS
• Chest x-ray
• ABG analysis
• CBC

Nursing Mgt.

• Enforce CBR
• Institute strict respiratory isolation
• Administer O2 inhalation
• Force fluids
• Place client on semi-fowler’s position
• Encourage deep breathing and coughing exercise
• Nebulize and suction when needed
• Comfortable and humid environment
• Institute short course chemotherapy
• Provide increase carbohydrates, protein, vitamin C and
Nursing Mgt.
calories
• Enforce CBR • Provide client health teaching and discharge planning
• Administer O2 inhalation low inflow • Avoidance of precipitating factors
• Administer medication as ordered • Prevent complications
• Force fluid
Medical Mgt.
• Place on semi-fowler’s position
• Institute pulmonary toilet • Simultaneous administration of 3 or more drugs
• Nebulize and suction as needed (increases the therapeutic effects of medication and
• Assist in postural drainage decreases the development of resistant bacteria
• Provide increase carbohydrates, calories, protein and Vit.
C • Course of treatment: average 6 – 12 mos.
• Health teaching and discharge planning
• DOTS (DIRECTLY OBSERVED TREATMENT SHORT
TUBERCULOSIS COURSE)

Is an infectious disease caused by bacteria (Mycobacterium • Is the name for a comprehensive strategy which primary
tuberculosis) that are usually spread from person to person health care services around the world are using to detect
through the air. and cure TB.

MODE OF TRANSMISSION: Preventive Measures

 airborne • BCG IMMUNIZATION

 droplet; coughing, sneezing, talking
• IMPROVED SOCIAL CONDITIONS
Etiologic Agent
DRUG SIDE EFFECTS
• Mycobacterium tuberculosis/Tubercle bacilli/Koch’s
bacilli ISONIAZID (INH) Bactericidal PERIPHERAL
NEURITIS
Predisposing Factors
RIFAMPIN Bactericidal Body secretions may
• Malnutrition turn to orange (urine,
• Overcrowded places tears, perspiration,)
• Alcoholism
• Over fatigue ETHAMBUTOL Bacteriostatic OPTIC NEURITIS
• Ingestion of infected cattle with mycobacterium bovis (decreased red-green
• Virulence of microorganism color discrimination,
decreased visual
Signs and Symptoms
acuity)
• No symptoms at first (primary infection)
• Low grade afternoon fever, night sweats PYRAZINAMIDE Bactericidal Hyperuricemia,
• Productive cough (yellowish sputum) Hepatotoxicity
• Anorexia, generalized body malaise
• Weight loss STREPTOMYCIN Bactericidal OTOTOXICTY,
• Dyspnea NEPHROTOXICITY
• Chest pain
• Hemoptysis (chronic)

Diagnostic Procedures

• Mantoux test, PPD (Tuberculin Skin test)

• Sputum Exam
• Chest X-ray
• CBC
INFLUENZA • If client has a tension pneumothorax, the initial treatment
of choice is to insert a large-bore needle into the second
Influenza, commonly referred to as the flu, is a viral infection of intercostal space midclavicular line to relieve pressure.
the respiratory tract. Next, a chest tube system is placed
MODE OF TRANSMISSION: Nursing Mgt.
 via droplets from coughs and sneezes of infected • Bed rest to decrease need for oxygen.
individuals, direct contact • Monitor vital signs.
 The INCUBATION PERIOD from time of exposure to onset • Elevate the head of the bed: promotes maximum lung
of symptoms is 1 to 3 days. expansion, decreases work of breathing.
Etiologic Agent ATELECTASIS
• AH1N1 Collapse of lung tissue at any structural level
• MERS-COV
• BIRD FLU/AVIAN FLU TYPES:
• SARS
• NCOV/COVID PRIMARY – due to decreases surfactant factor

Predisposing Factors SECONDARY – due to airway obstruction and lung

compression
• Immunocompro-missed
• Comorbidity RISK – post surgery, elderly, obese, bedridden, history of
• History of exposure smoking
• Virulence of microorganism
CAUSES – reduction in lung distention forces (pneumothorax,
Signs and Symptoms pleural effusion, ascites, obesity) Localized airway obstruction
(FBAO, mucus plug)
• Nonproductive cough
• Fever over 101F , Chills and sweats Insufficient pulmonary surfactant (RDS, inhalation anesthesia,
• Fatigue and malaise Aspiration of Gastric contents)
• Headache
Signs and Symptoms
• Muscle aches (myalgia)
• Watery, nasal discharge • Initially detected on CXR
• Sore throat • Some are asymptomatic
• IF significant hypoxemia occurs = dyspnea, tachypnea,
Diagnostic Procedures
tachycardia, and cyanosis
• viral culture, serology, • Diminished breath sounds and crackles over involved area
• rapid antigen testing, • Fever: less than 101F (common)
• reverse transcription polymerase chain reaction (RT-PCR)
Management
Medical Mgt.
• Treatment is directed toward the cause
• Treatment is primarily symptomatic. • Change position frequently
• Acetaminophen is given for fever, headache, and myalgia. • Early ambulation
Aspirin is avoided in children because it increases the risk • Deep breathing and coughing exercise
for Reye’s syndrome. • Chest physiotherapy
• Rest and fluids. • Oxygen therapy if with hypoxia
• Antibiotics are used only if a secondary bacterial infection • Check VS and breath sounds
is present.
COPD
• Antiviral drugs such as amantadine (Symmetrel),
zanamivir (Relenza) and oseltamivir (Tamiflu) may be Chronic Obstructive Pulmonary Disorders
helpful for high-risk patients if given within 48 hours of
exposure TYPES:

FLU • CHRONIC BRONCHITIS

• ASTHMA
Nursing Mgt. • BRONCHIECTASIS
• EMPHYSEMA
• Administer medications as ordered.
• Administer fluids and electrolytes as ordered. CHRONIC BRONCHITIS
• Monitor respiratory status for rate, effort, use of accessory
muscles, skin color, and breath sounds. Inflammation of bronchus resulting to hypertrophy or
hyperplasia of goblet mucous producing cells leading to
PNEUMOTHORAX/ narrowing of smaller airways.
HEMOTHORAX/ Problem with the airway characterized by excessive mucus
production, impaired ciliary function which decreases mucus
HYDROTHORAX
clearance.
Partial or complete collapse of the lungs due to accumulation
Predisposing Factors
of air or fluid in the pleural space.
• Smoking
ASSESSMENT FINDINGS:
• Air pollution
• sudden sharp pain in the chest, dyspnea, diminished or
Signs and Symptoms
absent breath sounds on affected side, hyperresonance
on percussion, decreased vocal fremitus, tracheal • Productive cough
deviation to opposite side (tension pneumothorax with • Dyspnea on exertion
mediastinal shift) • Prolonged expiratory grunt
• weak, rapid pulse, anxiety, diaphoresis • Anorexia and generalized body malaise
• Scattered rales/ronchi
Medical Mgt.
• Cyanosis
• Oxygen therapy. • Pulmonary hypertension
• Chest tube placement: removes air or blood from the
pleural space so the lung can re-expand.
• Possible surgery: thoracotomy
• Pain medications: monitor respirations
• If chest trauma, the doctor may place an epidural catheter
to manage pain.
• Administer anxiolytics and teach relaxation techniques
  Semi-fowler’s position
 Nebulize and suction when needed
 Provide client health teachings and discharge planning

BRONCHIECTASIS

Abnormal permanent dilation of bronchus leading to

destruction of muscular and elastic tissues of alveoli.

PREDISPOSING FACTORS:

• Recurrent lower respiratory tract infections

• Chest trauma
• Congenital defects
• Related to presence of tumor

Signs and Symptoms

• Productive cough
• Dyspnea
• Cyanosis
BRONCHIAL ASTHMA • Anorexia and generalized body malaise
• Hemoptysis (only COPD with sign)
Reversible inflammatory lung condition due to hypersensitivity
to allergens leading to narrowing of smaller airways. Dx Procedure

Chronic inflammatory process that produces mucosal edema, • ABG – PO2 decrease
mucus secretion and airway inflammation. • Bronchoscopy

Etiologic Agent Treatment

1. Extrinsic Asthma (Atopic / Allergic) • Surgery

• Segmental wedge lobectomy
• Pollen
• Dust EMPHYSEMA
• Fumes Problem with the alveoli that is characterized by a loss of
• Smoke alveolar elasticity, over distention and destruction; with severe
• Gases gas exchange impairment
• Danders
• Furs IRREVERSIBLE TERMINAL STAGE OF COPD
• Lints CHARACTERIZED BY:

Predisposing Factors  Inelasticity of alveoli

 Air trapping
2. Intrinsic Asthma (Non-Atopic / Non-Allergic)
 Maldistribution of gases
• Hereditary  Over distention of thoracic cavity
• Drugs
• Foods
• Food additives
• Sudden change in temperature, air pressure and
humidity
• Physical and emotional stress

Signs and Symptoms

• Cough that is non-productive

• Dyspnea
• Wheezing on expiration
• Cyanosis
• Mild stress/ apprehension
• Tachycardia, palpitations
• Diaphoresis
Predisposing Factors
Diagnostic Procedures
1. Smoking
• Pulmonary Function Test - Incentive spirometer reveals 2. Air pollution
decrease lung capacity 3. Allergy
• ABG analysis - PO2 decrease 4. High risk: elderly
5. Hereditary

Nursing Management

• Enforce CBR
• Administer O2 via low-flow
• Administer medication as ordered
• High fowler’s position
• Force fluids
• Institute pulmonary toilet
• Nebulize and suction when needed
• Provide comfortable and humid environment
• Provide high carbohydrates, protein, calories, vitamins
and minerals
• Health teachings and discharge planning

Signs and Symptoms

Nursing Mgt. • Productive cough

• Dyspnea at rest
 Enforce CBR • Prolong expiratory grunt
 O2 inhalation with low inflow • Anorexia and generalized body malaise
 Administer medication as ordered • Resonance to hyperresonance
 Force fluids • Decrease tactile fremitus
• Decrease or diminished breath sounds
• Rales or ronchi
• Bronchial wheezing
• Barrel chest
• Flaring alai nares
• Purse lip breathing

Diagnostic Procedures

• Pulmonary Function Test

• ABG analysis