Anatomy of the Respiratory Diseases

The respiratory system has many structures and organs with their various functions which help
respiratory activities to be carried out. These include;
1. Nose
2. Pharynx
3. Larynx
4. Two bronchi (one bronchus to each lung)
5. Bronchioles and smaller air passages
6. Two lungs and their coverings, the pleura
The two primary bronchi are formed when the trachea divides at about the level of the 5th
thoracic vertebra. The right bronchus is wider, shorter, and more vertical unlike the left which is
narrower and about 5cm long. The right bronchus is approximately 2.5cm and thus becomes
easily obstructed when a foreign body is inhaled. It branches into three whiles the left branches
into two, one to each lobe. Within each lobe the lung tissue is further divided into lobules which
are supplied with air by the terminal bronchioles. This further divides into respiratory
bronchioles, alveolar ducts and large numbers of alveoli sacs (air sacs), about 150million of them
in an adult lung where gaseous exchange takes place. The alveoli are surrounded by a dense
network of capillaries. Lying between the squamous cells are septal cells that secrete surfactant,
a phospholipid fluid which prevents the alveoli from drying out. It also reduces surface tension
and prevent alveoli walls from collapsing during expiration.

BRONCHIAL ASTHMA
Asthma is a chronic inflammatory disease of the airways, characterized by episodes of airflow
obstruction resulting from oedema, bronchospasm and increased mucus production.

AETIOLOGY/ CAUSES
Asthma has no common cause but there are factors that can predispose factors or allergic
triggers of the individual to the condition. These include:
1. Pollen; Tress, grasses, weeds
2. Allergy to pollens (Examples grass, tree and weed) or to perennial (Examples mold, dust,
roaches) and animal fur.
3. Exercise
4. Stress/Psychological/Emotional upset
5. Rhinos sinusitis with post nasal drip.
6. Certain medications. (Aspirin, Cimetidine)
7. Airway irritant/Physical factors such as air pollution, dust, chemicals (laundry detergents),
smoke, strong odour or perfumes.
8. Cold weather changes or sudden change in temperature and barometric pressure
9. Tobacco Smoke
Allergic triggers usually cause asthma symptoms by demonizing or bridging the high-affinity
immunoglobulin E (IgE) receptors located on the mast cells in the lungs.
PATHOPHYSIOLOGY

The smaller bronchi contain a number of muscular tissues in their walls when contracts cause the
narrowing of the lumen of the bronchial tubes (bronchospasm). In case of inhaled or ingested
allergen, sensitizing antibodies immunoglobulin (IgE) are produced by the B- lymphocytes in large
numbers which attaches themselves to the mast cells found in the lungs.
A re-exposure to allergens causes the mast cells to locally release spasmogens and
vasoconstrictive substance which include histamine, bradykinins, prostaglandins and eosinophil
chemotactic factor of an as Phylaxis (ECFA).
When the vagal nerves are also stimulated through exercise, cold, emotion or smoking, the
parasympathetic system release acetylcholine which causes direct bronchoconstriction as well as
bronchospasm and secretion of viscid mucus in the bronchi.
The narrowing causes difficulty in breathing air in and out of the alveoli. In order to obtain
sufficient ventilation of lungs in the presence of increased resistance to airflow, the respiratory
movements are forced and in addition to these muscles, accessory muscles are brought into
action. The accessory muscles used in respiration result in the individual experiencing more
difficulty in emptying the lungs than filling them.
Therefore, the characteristics of asthma are difficult and prolong expiration which brings about
fatigue. In severe cases the attack may be prolonged for more than 24 hours and may not
respond to treatment. There it is referred to as Status Asthmatics

CLASSIFICATION
The condition can be classified or grouped into four (4) types.
These are;

Intermittent asthma: It is characterized by cough, wheezing, chest tightness, or difficult breathing

less than twice a week, flare-ups are brief, but intensity may vary.
Mild asthma: Will-controlled with as needed reliever medication alone or with low-intensity
controller treatment such as low-dose inhaled corticosteroids (ICS), leukotriene receptor
antagonists, or chromones.
Moderate asthma: Well-controlled with low-dose ICS/long-acting beta2-agonists (LABA).
Severe asthma: Requires high-dose ICS/LABA to prevent it from becoming uncontrolled, or
asthma that remains uncontrolled despite this treatment

CLINICAL FEATURES

1. Swelling or inflammation, specifically in the airway linings.

2. Production of large amounts of mucus that is thicker than normal.
3. Narrowing because of muscle contractions surrounding the airways.
4. Feeling short of breath.
5. Frequent coughing, especially at night
6. Wheezing (a whistling noise during breathing)
7. Difficult breathing
8. Chest tightness
9. Chest tightness
10. Tachycardia and increase pulse rate pressure may be present.
11. Hypoxemia and central cyanosis may set in as a late sign of poor oxygen
12. Nocturnal symptoms may be present
13. Choking sensation during exercise
14. Anxiety and apprehension
15. Diaphoresis

DIAGNOSTIC INVESTIGATIONS
1. Physical examination: Is done to look for signs of asthma or other related conditions. Like the
ears, nose, throat, skin, and listen to your chest and lungs. Listen to your chest and lungs.
2. Signs and symptoms and physical examination may help in the diagnosis of the disease.
3. Arterial blood gas analysis and pulse oximetry reveal hypoxemia during acute stage.
4. Skin test to identify allergen.
5. Full blood count test may disclose elevated eosinophils.
6. Pulmonary function studies may reveal diminished maximum breathing capacity, tidal
volume and forced expiratory volume.
7. Chest x-ray

NURSING DIAGNOSIS

1. Ineffective Breathing Pattern related to bronchospasm, airway inflammation, and

increased airway resistance
2.Ineffective airway clearance related to production of mucus and bronchospasm.
3. Acute pain (chest pain) related to lung inflammation
4. anxiety related to unknown outcome of disease .
5. Ineffective sleep pattern related to pain.

DIFFERENTIAL DIAGNOSIS

There is specific diagnosis done to confirm the condition since other conditions mimic the same
signs and symptoms. Occasionally, asthma may resemble;
1. Foreign body in the throat
2. 2. Pertussis
3. Pneumonia
4. Hyperventilation

MEDICAL TREATMENT
1. Give Humidified oxygen by nasal cannula at 2L/minute to ease breathing and also increase
arterial oxygen saturation.
2. Intubation and mechanical ventilation are instituted if the client fails to respond to
oxygenation.
3. Bronchodilators such as theophylline can be given to relax bronchial smooth muscle thus
dilating the airway.
4. Corticosteroids such as Hydrocortisone Sodium Succinate can also be given for their anti-
inflammatory properties and to reduce oedema that is they decrease inflammation.
5. Antibiotics such as Erythromycin can be given to fight against any infection. Example
respiratory infections.
6. Metered Dose inhaler like salbutamol (Ventolin) may also be given as a fast-acting
bronchodilator to act directly on the airways in mild-moderate asthma.
7. Analgesic such as Paracetamol can be given to help control pyrexia and relieve pain.
8. Steroids such as prednisolone to control inflammation.

NURSING MANAGEMENT
Psychological Care
1. Patient and family are reassured to gain their cooperation and lessen their anxiety level about
the condition.
2. The nurse then assures them of competent staff that will help with the management of the
condition.
3. Provide divisional therapy in the form of jokes, watching of kid’s programs on television,
listening to soft music. All these aimed at diverting child’s attention from the pain and worries.

Rest and Sleep

1.Patient is encouraged to rest to conserve energy.

2.Remind patient to be in bed to avoid over exertion and possible exacerbation of symptoms.
3.Ensure noise-free environment and proper ventilation.
4.Coordinate all nursing activities to avoid disturbing child’s sleep, to relieve respiratory distress
and help in maximum lung expansion, place child in fowler’s position with the head end of the
bed raised.

Observation
1. Observe the severity of the attack and degree of respiratory distress. Examples are
rapid/shallow respiration and dyspnoea.
2. Check and monitor vital signs such as temperature, pulse, respiration and blood pressure and
SpO2 were recorded accurately. Tepid sponge if temperature is above normal.
3. Observe breathing pattern for expiratory dyspnoea noting whether the child uses her
accessory muscles.
4. The level of patient’s anxiety should be noted.
5. The patient should be observed for cyanosis and signs of air hunger.
6. Patient is observed for signs of dehydration like weight loss, loss of skin turgor, oliguria.
7. Monitor intake and output chart if intravenous fluids are in situ to avoid fluid overload.
Observe the site for swelling and also patency as well as flow rate. Sputum is observed for blood
stain, amount and colour.

Nutrition

1. Encourage intake of fluids daily. This is important because when respiratory rate increases,
there is an increase fluid loss during exhalation which can lead to dehydration.
2. Normal diet can also be given if patient can tolerate.
3. Fluids also help to liquefy the secretions.

Elimination
1. Child is encouraged to void and empty bowel when the need arises.
2. Encourage intake of fluids, roughages and fibre to promote easy bowel movement.
3. Regular passive exercise and changing position is also encouraged to promote peristalsis and
prevent pressure sore.

Exercise
1.Exercise improves circulation; prevent oedema, hypostatic pneumonia and others.
2.Proper breathing pattern such as abdominal breathing, side expansion breathing, forward
breathing and elbow arching can be done in the form of exercise.
3.Passive exercise such as raising child’s limbs, assisting child to sit up in bed is encouraged.

Personal Hygiene
1. Because there may be poor appetite, patient oral toileting or mouth care is done before and
after meals.
2. Mouth care is done on regular basis to avoid dryness and cracking that might result from
dehydration.
3. Patient may need to be bed bathed if she cannot walk to the bathroom.

Health Education and Home Care

1.The patient needs advice to develop a healthy habit. She should be provided balanced diet such
as food rich in protein, carbohydrate and vitamins.
2.Advice patient on respiratory irritant or allergens such as flowers, tobacco smoke, strong
perfumes, odour of agents.
3.Encourage family to protect as much the patient from cold and if possible emotional upset
should be prevented.
4.Educate patient and family on medication, purpose and action of the drug and advise them to
report any adverse effect.
5.There is the need to brief the patient and family on the knowledge of the condition and triggers
to avoid.
6.Advise them on early sign and symptoms and the need for early treatment.
7.Regular follow up is important in the management of asthma therefore the need to stress on.

Medication
1. Serve prescribes medication as ordered.
2. Observe the rules of drug administration such as the right patient, right drug, right time, right
dose, right route, right to know and refuse drug.
3. Monitor desired effect and side effect of drugs. Document and report any adverse effect for
immediate action.

Prevention

1. Patients with recurrent asthma should undergo tests to identify the substances that precipitate
the symptoms.
2. Possible causes are dust, dust mites, roaches, and certain types of cloth, pets, horses,
detergents, soaps, certain foods, mold’s, and pollens.
3. If the attacks are seasonal, pollens can be strongly suspected, patients are instructed to avoid
the causative agents whenever possible

COMPLICATIONS OF ASTHMA

1. Respiratory failure

2. Atelectasis

3. Pneumothorax

4. Pneumonia

5. Bronchiectasis

6. Pulmonary hypertension

7. Status asthmatics

8. Fracture of the rib

GROUP MEMBERS

NAME INDEX NUMBER

ABOAGYEWAA LYDIA 682022001
ABOAGYEWAAH FRANCISCA 682022002
ABRAHAM LINCOLN 682022003
ABUBAKAR LAURATU 682022004
ACHEAMPONG DORIS 682022005
ACHEAMPONG GLENDORFF 682022006
ACHEAMPONG LORETTA 682022007
ACHEAMPONG STELLA 682022008
ACKOM BERNICE YAA 682022010
ADAMS JEMIMAH OPOKU 682022011
ADANSI JOHN 682022012
ADDAI ELLEN SERWAA 682022013
ADJEI ALBERTA SARFO 682022014
ADJEI JESSICA 682022015
WIREDU ROSEMOND 682022211