Mr.

Jayesh Patidar
CHEST X-RAY
 Remove all jewelry and other metal objects from the
chest area

 Assess the client's ability to inhale and hold his or her

breath

 Question women regarding pregnancy

 Help the client get dressed after the procedure

SPUTUM SPECIMEN
 Specimen obtained by expectoration or tracheal
suctioning to assist in the identification of organisms
or abnormal cells

 Obtain an early morning sterile specimen from

suctioning or expectoration

 Instruct the client to rinse the mouth with water

before collection
 Obtain at least 15 mL of sputum

 Instruct client to take several deep breaths and then

cough deeply to obtain sputum

 Always collect the specimen before the client begins

antibiotic therapy

 If a culture of sputum is prescribed, transport the

specimen to the laboratory immediately

 Assist the client with mouth care

PULMONARY ANGIOGRAPHY
 An invasive fluoroscopic procedure in which a catheter
is inserted through the antecubital or femoral vein into
the pulmonary artery or one of its branches

 Involves an injection of iodine or radiopaque contrast

material

 Obtain informed consent

 Assess for allergies to iodine, seafood, or other
radiopaque dyes

 Maintain NPO status of the client for 8 hours before

the procedure

 Monitor vital signs

 Assess results of coagulation studies

 Instruct the client to lie still during the procedure

 Instruct the client that he or she may feel an urge to
cough, flushing, nausea, or a salty taste following
injection of the dye

 Have emergency resuscitation equipment available

 Avoid taking BP for 24 hours in the extremity used for

the injection

 Assess insertion site for bleeding

 Monitor for delayed reaction to the dye

BRONCHOSCOPY
 Direct visual examination of the larynx, trachea, and
bronchi with a fiberoptic bronchoscope

 Obtain informed consent

 Maintain NPO status for the client form midnight

before the procedure

 Obtain vital signs

 Remove dentures or eyeglasses

 Prepare suction equipment

 Establish an IV access as necessary and administer

medication for sedation as prescribed

 Have emergency resuscitation equipment available

 Maintain the client in semi-Fowler’s position after the

procedure
 Assess for the return of gag reflex

 Have an emesis basin readily available for the client to

expectorate sputum

 Monitor for bloody sputum

 Notify the physician if fever, difficulty in breathing, or

other signs of complications occur following the
procedure
THORACENTESIS
 Removal of fluid or air from the pleural space via a
transthoracic aspiration

 Obtain informed consent

 Obtain vital signs

 Prepare the client for ultrasound or chest radiograph,

if prescribed, before the procedure
 Note that the client is positioned sitting upright, with
the arms and shoulders supported by a table at the
bedside during the procedure

 If the client cannot sit up, the client is placed lying in

bed toward the unaffected side, with the head of the
bed elevated

 Instruct the client not to cough, breath deeply, or

move during the procedure

 Apply a pressure dressing, and assess the puncture site

for bleeding
PULMONARY FUNCTION TESTS
 Tests used to evaluate lung mechanics, gas exchange,
and acid-base disturbance through spirometric
measurements, lung volumes, and arterial blood gas
levels

 Consult with the physician regarding holding

bronchodilators before testing

 Instruct the client to void before the procedure and to

wear loose clothing
 Remove dentures

 Instruct the client to refrain from smoking or eating a

heavy meal for 4 to 6 hours before the test

 After the procedure, client may resume normal diet

and any bronchodilators and respiratory treatments
that were held before the procedure
VENTILATION-PERFUSION LUNG
SCAN
 The perfusion scan evaluates blood flow to the lungs

 The ventilation scan determines the patency of the

pulmonary airways and detects abnormalities in
ventilation

 A radionuclide may be injected for the procedure

 Obtain informed consent

 Assess the client for allergies to dye, iodine or seafood

 Remove jewelry around the chest area

 Review breathing methods that may be required

during testing

 Monitor client for reaction to the radionuclide

 Instruct client that the radionuclide clears from the

body in about 8 hours
ARTERIAL BLOOD GASES
 Measurement of the dissolved oxygen and carbon
dioxide in the arterial blood that helps indicate the
acid-base state and how ell oxygen is being carried to
the body

 Perform Allen's test before drawing radial artery

specimens

 Have the client rest for 30 minutes before specimen

collection to ensure accurate measurement of body
oxygenation
 Avoid suctioning before drawing the ABG sample

 Do not turn off oxygen unless the ABG sample is

ordered to be drawn with the client breathing room air

 Place specimen on ice

 Note the client temperature on the lab form

 Note the oxygen and type of ventilation the client is

receiving on the lab form
 Apply pressure to the puncture site for 5 to 10 minutes
or longer if the client is taking anticoagulant therapy
or has a bleeding disorder

 Transport the specimen to the laboratory within 15

minutes
 Apply direct pressure over the client’s ulnar and radial
arteries simultaneously

 While applying pressure, ask the client to open and

close the hand repeatedly; the hand should blanch

 release pressure from the ulnar artery while

compressing the radial artery and assess the color of
the extremity distal to the pressure point

 If pinkness fails to return within 6 seconds, the ulnar

artery is insufficient, indicating that the radial artery
should not be used for obtaining a blood specimen
 pH – 7.35 – 7.45

 PCO2 – 35 – 45 mmHg

 HCO3 – 22 – 27 mEq/L
PULSE OXIMETRY
 Is a noninvasive test that registers the oxygen
saturation of the client’s hemoglobin

 The capillary oxygen saturation is recorded as a

percentage

 The normal value is 96% to 100%

 A pulse oximeter reading can alert the nurse to

hypoxemia before clinical signs occur
 A sensor is placed on the client’s finger, toe, nose, ear
lobe or forehead to measure oxygen saturation, which
then is displayed on a monitor

 Do not select an extremity with an impediment to

blood flow

 Results lower than 91% necessitate immediate

treatment

 If the oxygen saturation is lower than 85%,

oxygenation to body tissues is compromised; if less
than 70% it is life threatening
LUNG BIOPSY
 A percutaneous lung biopsy is performed to obtain
tissue for analysis by culture or cytological
examination

 A needle biopsy is done to identify pulmonary lesions,

changes in lung tissue, and the cause of pleural
effusion
 Obtain informed consent

 Maintain NPO status of the client before the

procedure

 Inform client that a local anesthetic will be used but a

sensation of pressure during needle insertion and
aspiration may be felt

 Apply a dressing to the biopsy site and monitor for

drainage or bleeding
 Monitor for signs of respiratory distress, and notify the
physician if they occur

 Prepare client for chest radiography if prescribed

 Is more commonly known as nosebleed

 Bleeding can either be in the anterior or posterior

region

 Anterior bleeds are more common and originates from

the group of vessels called Kiesselbach Plexus
Etiology
 Most common cause of epistaxis is dry, cracked
mucous membranes

 Other causes include trauma, forceful nose blowing,

nose picking, and hypertension

 Anything that reduces the blood clotting ability can

also trigger epistaxis (hemophilia, anticoagulants,
cocaine use)
Interventions
 Let client sit in a chair and lean forward

 Be sure to wear gloves and standard precautions

 Place pressure on the nares for 5 to 10 minutes to stop

bleeding (not done for clients with nose fracture)

 Apply ice packs or cold compress on the nose area

 Nasal pack with neosenephrine for 3 to 5 days

 Liquid diet progressing to soft diet

 Avoid oral temperature taking

 Instruct client not to blow and pick nose for 2 days

after removal of the nasal pack

 Instruct client not to bend over

 Notify physician if bleeding is recurrent

 Are grapelike clusters of mucosa in the nasal passages

 Usually benign, but can obstruct the nasal passages

 Exact cause is unknown but are related to chronic

inflammation

 Some people with allergies are prone to develop polyps

Interventions
 Control allergy symptoms with oral antihistamines or
nasal corticosteroid sprays

 Removal of polyps when it is obstructs breathing

 Instruct client to avoid using aspirin after surgery

 The septum dividing the nasal passages is slightly
deviated

 May result form nasal trauma but often has no cause

 Clients may complain of chronically stuffy nose

 Other client may have headaches and nosebleeds

Interventions
 Submucous resection (SMR) or nasoseptoplasty
can be done

 Nasal packing is placed postoperatively to reduce

bleeding
 Inflammation of the mucosa of one or more sinuses

 Can either be acute or chronic

 Chronic is present for more than 2 months and are

unresponsive to treatment

 Maxillary and ethmoid sinuses are the most commonly

affected
 Inflammation is often the result of a bacterial
infection

 Because the mucous lining of the nose and sinuses is

continuous, nasal organisms easily travel to the sinuses

 Drainage is blocked when sinuses swell due to

infection

 S. pneuomoniae and H. influenzae

 Other causes are allergies, fungal infection and NGT

Signs and Symptoms
 Pain over the affected sinuses

 Purulent nasal drainage

 Fever in acute infection

 Fatigue

 Foul breath
 Maxillary sinus – pain over the cheek and upper teeth

 Ethmoid sinus – pain between and behind the eyes

 Frnotal sinus – pain in the forehead

Diagnostic Tests
 Uncomplicated sinusitis may be diagnosed based on
symptoms alone

 X-ray, CT scan, or MRI may be done to confirm the

diagnosis and determine the cause

 Culture and sensitivity of the nasal discharge

Interventions
 Aimed at relieving pain and promoting sinus drainage

 Place client in semi-Fowler’s position

 Hot moist packs for 1 to 2 hours twice a day

 Acetaminophen or ibuprofen may be prescribed by the

physician for pain and fever

 Encourage client to increase oral fluid intake unless

contraindicated
 Antihistamines are generally avoided because it dries
and thickens secretions

 Adrenergic nasal sprays such as oxymetazoline for up

to 3 days

 Caldwell-Luc procedure to drain sinus if conservative

treatments cannot relieve symptoms
 Also called as CORYZA

 Inflammation of the nasal mucous membranes

 Occurs as a reaction to allergens or may be caused by

viral or bacterial infection
Signs and Symptoms
 Nasal congestion

 Localized itching

 Sneezing

 Nasal discharge

 Fever and malaise may accompany viral or bacterial

rhinitis
Interventions
 Rest and fluids are the most effective treatment

 Never give antibiotics for a viral infection

 Acetaminophen may be prescribed for generalized

discomfort

 Antihistamines may also be prescribed to control

symptoms
 Inflammation of the pharynx

 Usually related to bacterial or viral infection as well as

trauma

 Beta-hemolytic streptococci

 If strep throat is untreated it can lead to rheumatic

fever or glomerulonephritis
Signs and symptoms
 Most common is sore throat

 Dysphagia

 Throat appears red and swollen, and exudate may be

present

 Fever, chills, headache, and general malaise

Diagnostic test
 Culture and sensitivity – to identify the causative
organism and determine which antibiotic will be
effective
Interventions
 Encourage rest

 Increase fluid intake if not contraindicated

 Saltwater gargles help reduce swelling

 If bacterial, antibiotics may be prescribed

 Acetaminophen may be prescribed to relieve

discomforts
 Inflammation of the mucous membrane lining the
larynx (voice box)

 Caused by irritation from smoking, alcohol, chemical

exposure or infection

 Often follows an upper respiratory infection

Signs and symptoms
 Common symptom is hoarseness

 Cough

 Dysphagia

 Fever
Diagnostic test
 Laryngoscopy may be done if hoarseness persists for
more than 2 weeks to rule out cancer of the larynx
Interventions
 Provide rest

 Encourage fluids unless contraindicated

 Provide humidified oxygen

 Encourage client to avoid talking

 Obtain paper and pen to help client communicate

 Antibiotics may be prescribed for bacterial infection

 Throat lozenges may help increase comfort

 Help client to identify causative factors that need to be

avoided
 Tonsils are masses of lymphoid tissue that lie on each
side of the oropharynx

 Tonsils filter microorganisms to protect the lungs from

infection

 Tonsillitis occurs when the filtering function becomes

overwhelmed with virus or bacteria and infection
results
 Adenoids is a mass of lymphoid tissue at the back of
the nasopharynx

 Tonsillitis is more common in children

 Streptococcus species, S. aureus, H. influenzae, and

pneumococcus species
Signs and symptoms
 Begins suddenly with a sore throat

 May be accompanied by fever, chills, and pain on

swallowing

 Headache, malaise and myalgia

 Tonsils appear red and swollen and may have yellow or

white exudates
 If adenoids are involved client may have complaints of
snoring, nasal obstruction, and a nasal tone to the
voice
Diagnostic tests
 Throat culture and sensitivity

 WBC count

 Chest x-ray
Interventions
 Promote rest

 Increase fluid intake if not contraindicated

 Warm saline gargle

 Analgesics as ordered

 Antibiotics as ordered (penicillin)

 Surgery: TONSILLECTOMY/ADENOIDECTOMY
 TONSILLECTOMY/
ADENOIDECTOMY
 Indicated if tonsillitis recurs 5 to 6 times a year or
unresponsive to antibiotic therapy

 If breathing or swallowing is affected

 If it causes obstruction and obstructive sleep apnea

 If client will have repeated attacks of purulent otitis media

Preoperative care
 Assess for URTI. Coughing and sneezing may cause
bleeding in the postoperative period

 Check prothrombin time

Postoperative care
 Position client prone with head turned to side or
lateral position

 Semi-Fowler’s if client is already awake

 Provide oral airway until swallowing reflex returns

 Monitor for hemorrhage (frequent swallowing/bright

red vomitus)
 Apply ice collar

 Avoid administration of ASA

 Offer ice cold fluids if client is able to eat

 Bland diet

 Instruct client to avoid clearing of throat

 Inform client to avoid coughing, sneezing, blowing
nose for 1 to 2 weeks

 Encourage client to take 2 to 3 liters of fluid a day until

mouth odor disappears

 Educate client to avoid hard/scratchy foods until

throat is healed

 Inform client that throat discomfort between the 4th

and 8th postoperative day is expected
 Inform client that his/her stools will be black/dark for
few days

 Encourage client to take rest for 2 weeks

 Instruct client to avoid colds and overcrowded places

 Commonly refereed to as the flu

 A viral infection of the respiratory tract

 New strains appear each year

 Easily transmitted via droplets from coughs and sneezes of

infected individuals

 May also be transmitted by physical contact with an

infected person or object

 Incubation period is 1 to 3 days

Signs and symptoms
 Abrupt onset of fever

 Chills

 Myalgia

 Sore throat and cough

 General malaise with headache

Diagnostic test
 Viral culture
Interventions
 Treatment is primarily symptomatic

 Encourage rest and fluids

 Acetaminophen may be prescribed for

fever, headache, and myalgia

 Oseltamivir (Tamiflu) may be prescribed to reduce

severity and duration of symptoms
 Visceral and parietal pleurae becomes inflamed and
does not slide easily

 Usually related to another underlying respiratory

disorder

 The irritation causes an increase in the formation of

pleural fluid, which in turn reduces friction and
decreases pain
Signs and symptoms
 Sharp pain in the chest on inspiration

 Pain during coughing or sneezing

 Shallow and rapid breathing

 Fever, chills and elevated WBC

 Pleural friction rub upon auscultation

Diagnostic tests
 Auscultation

 Chest x-ray examination

 Excess fluid collects in the pleural space

 With increase in fluid production and inadequate

reabsorption

 Normal amount of pleural fluid for each lung is 1 to

15mL

 Effusion can be transudative or exudative

 Generally caused by another lung disorder

Signs and symptoms
 May or may not experience pleuritic pain

 Shortness of breath

 Cough and tachypnea

 Dull sound upon percussion of the affected area

 Lung sounds can be decreased or absent over the

effusion
Diagnostic tests
 Chest x-ray

 Thoracentesis
Interventions
 Encourage bedrest

 Therapeutic thoracentesis

 Treatment of underlying cause

 Collapse of the alveoli

 Commonly occurs in postsurgical clients who do not

cough and deep breathe effectively

 Areas of the lungs that are not well aerated become

plugged with mucus, which prevents inflation of
alveoli
 Instruct client to perform coughing and deep
breathing exercises

 Encourage frequent position changes and ambulation

 Occurs when a thrombus forms (deep vein) detaches,
travels to the right side of the heart, and then lodges in
a branch of the pulmonary artery

 At risk are those with deep vein thrombosis including

those with prolonged immobilization, surgery, obesity,
pregnancy, congestive heart failure, advanced age, or a
history of thromboembolism

 Fate emboli can occur as a complication following

fracture of a long bone
Signs and symptoms
 Blood-tinged sputum

 Chest pain

 Cough

 Cyanosis

 Distended neck veins

 Dyspnea accompanied by anginal and pleuritic pain,
exacerbated by inspiration

 Hypotension

 Shallow respirations

 Tachypnea and tachycardia

 Wheezes on auscultation
Diagnostic tests
 CT scan – can diagnose PE quickly

 Ventilation-perfusion scan

 Pulmonary angiogram

 Chest x-ray, ECG, ABG analysis, MRI

 D-dimer – a blood test to help rule out PE

Interventions
 Administer oxygen as prescribed

 Place client in high fowler’s position

 Monitor lung sounds

 Maintain bed rest and active and passive ROM

exercises

 Encourage use of incentive spirometry

 Monitor pulse oximetry

 Prepare for intubation and mechanical ventilation for

severe hypoxemia

 Administer anticoagulation therapy intravenously or

orally as prescribed

 Monitor coagulation studies closely

 Prepare the client for embolectomy or vein ligation

 Is a chronic multisystem disorder characterized by
exocrine gland dysfunction

 Autosomal recessive trait disorder

 The mucus produced by the exocrine glands is

abnormally thick, tenacious, and copious, causing
obstruction of the small passageways of the affected
organs, particularly in the respiratory, GI, and
reproductive systems
 The most common symptoms are pancreatic enzyme
deficiency caused by duct blockage, progressive
chronic lung disease associated with infection, and
sweat gland dysfunction resulting in increased sodium
and chloride sweat concentrations

 Is a fatal genetic disorder and respiratory failure is the

most common cause of death
Signs and symptoms
 Thick tenacious or purulent sputum

 Cough

 Chronic sinusitis

 Finger clubbing

 Hemoptysis
 Frequent bouts of infection

 Foul-smelling stools

 Poor appetite

 Malnutrition

 Bowel obstruction

 Delayed sexual maturation and infertility

Diagnostic test
 Sweat chloride test – most reliable
 Production of sweat is stimulated with pilocarpine
iontophoresis

 Sweat is collected and the sweat electrolytes are

measured (minimum of 50mg of sweat)

 Normal sweat chloride concentration is 40mEq/L

 Between 40-60 requires repeat testing; above 60 is

positive
Interventions
 Chest physiotherapy (percussion and postural
drainage) on awakening and the evening

 Administer bronchodilators as prescribed

 Instructsignificant others not to give cough

suppressants such as guaifenesin (Robitussin)

 Teach client on forced expiratory technique to

mobilize secretions
 Administer antibiotics as prescribed

 Administer oxygen as prescribed

 Monitor for hemoptysis; more than 300mL in 24 hours

for older children needs to be treated immediately

 Promote bed rest in case of hemoptysis

 Pancreatic insufficiency should be replaced with

pancreatic enzymes
 Administer pancreatic enzymes (Pancrease, Viokase)
with all meals and snacks

 Enteric-coated pancreatic enzymes should not be

crushed or chewed

 Pancreatic enzymes should not be given if the child is

NPO

 Encourage a well-balanced, high-protein, high-calorie

diet
 Assess for weight and monitor for failure to thrive

 Monitor for constipation and intestinal obstruction

 Ensure adequate fluid and salt intake

 Promote adequate hydration

 Encourage regular exercise

 Recommend use of hot shower occasionally

 Inform client to use breathing and coughing exercises

 Unexpected death of an apparently healthy infant
younger than 1 year for whom a thorough autopsy fails
to demonstrate and adequate cause of death

 Unknown cause that may be related to a brain stem

abnormality in the neurological regulation of
cardiorespiratory control

 Most frequently occurs during winter months

 Death usually occurs during sleep periods, but not

necessarily at night
 Most frequently affects infants from 2 months to 4
months of age

 Incidence is higher in males

 Incidence is higher in Native Americans, African

Americans, Hispanics
Signs and symptoms
 Child is apneic, blue, and lifeless

 Frothy blood-tinged fluid in the nose and mouth

 Typically found in disheveled bed, with blankets over

the head, and huddled in a corner

 Child may appear to have been clutching bedding

 Diaper may be wet and full of stool

Prevention
 Place infant in supine position when sleeping

 Soft moldable mattresses and bedding, such as pillows,

should not be used for bedding

 Stuffed animals should be removed from the crib while

the infant is sleeping

 Discourage bed sharing

 Avoid overheating during sleep

 Chronic inflammatory disorder of the airways that
causes varying degrees of obstruction in the airways

 Marked by airway inflammation and

hyperresponsiveness to a variety of stimuli or triggers

 Causes recurrent episodes of wheezing,

breathlessness, chest tightness, and coughing
associated with airflow obstruction that may resolve
spontaneously; it is often reversible with treatment
Classification
 Severe Persistent
 Symptoms are continuous

 Physical activity requires limitation

 Frequent exacerbations occur

 Nocturnal symptoms occur frequently

 Moderate Persistent
 Daily symptoms occur

 Daily use of inhaled short acting beta agonist is needed

 Exacerbations affect activity

 Exacerbations occur at least twice a week and may last

for days

 Nocturnal symptoms occur more frequently than once

weekly
 Mild Persistent
 Symptoms occur more frequently than twice weekly but
less often than once daily

 Exacerbations may affect activity

 Nocturnal symptoms occur more frequently than twice a

month
 Mild Intermittent
 Symptoms occur twice weekly or less

 Client is asymptomatic between exacerbations

 Exacerbations are brief (hours to days)

 Intensity of exacerbations vary

 Nocturnal symptoms occur twice a month or less

Signs and symptoms
 Restlessness

 Wheezing or crackles upon auscultation

 Absent or diminished lung sounds

 Hyperresonance

 Use of accessory muscles for brething

 Tachypnea

 Prolonged exhalation

 Tachycardia

 Pulsus paradoxus

 Diaphoresis

 Cyanosis

 Decreased oxygen saturation

Interventions
 Position client in a high Fowler’s position or sitting to
aid in breathing

 Administer oxygen as prescribed

 Stay with the client to decrease anxiety

 Administer bronchodilators as prescribed

 Record the color, amount and consistency of sputum, if any

 Administer corticosteroids as prescribed

 Auscultate lung sounds before, during, and after

treatments

 Monitor vital signs

 Monitor pulse oximetry

 Instruct client to avoid triggers

 Also known as chronic obstructive lunge disease and
chronic airflow limitation

 Is a disease state characterized by airflow obstruction

caused by emphysema or chronic bronchitis

 Progressive airflow limitation occurs, associated with

an abnormal inflammatory response of the lungs that
is not completely reversible

 Can lead to pulmonary insufficiency or pulmonary

hypertension
Diagnostic tests
 Chest x-ray

 Ultrasound

 ABG

 CBC

 Sputum analysis
Signs and Symptoms
 Cough

 Exertional dyspnea

 Wheezing and crackles

 Sputum production

 Weight loss
 Barrel chest (emphysema)

 Use of accessory muscles for breathing

 Prolonged expiration

 Orthopnea

 Congestion and hyperinflation seen on chest x-ray

 Respiratory acidosis
Interventions
 Monitor vital signs

 Administer low concentration of oxygen as prescribed

 Monitor pulse oximetry

 Provide chest physiotherapy

 Instruct client to do breathing techniques

 Record the color, amount, and consistency of sputum

 Monitor weight

 Encourage small frequent meals to maintain nutrition

and prevent dyspnea

 Provide a high caloric, high protein diet with

supplements

 Encourage fluid intake up to 3L per day

 Place client in high Fowler’s position

 Allow activity as tolerated

 Administer bronchodilators as prescribed

 Administer corticosteroids as prescribed

 Administer mucolytics as prescribed

 Administer antibiotics for infection if prescribed

Client education
 Adhere to activity limitations, alternating rest periods
with activity

 Avoid eating gas producing foods, spicy foods, and

extremely hot or cold beverages

 Avoid crowds

 Avoid extremes in temperature

 Avoid fireplaces, pets, feather pillows and other
environmental allergens

 Avoid powerful odors

 Receive immunization as recommended

 Stop smoking

 Recognize signs of infection

 Use medications and inhalers as prescribed

 Use oxygen therapy as prescribed

 Use breathing techniques

 When dusting, use a wet cloth

 Infection of the pulmonary tissue, including the
interstitial spaces, the alveoli, and the bronchioles

 The edema associated with inflammation stiffens the

lung, decreases lung compliance and vital capacity,
and causes hypoxemia

 Can be community-acquired or hospital acquired

 Chest x-ray shows lobar or segmental consolidation,

pulmonary infiltrates, or pleural effusions
 A sputum culture identifies the organism

 The white blood cell count and the erythrocyte

sedimentation rate are elevated
Signs and symptoms
 Chills

 Elevated temperature

 Pleuritic pain

 Tachypnea

 Rhonchi and wheezes

 Use of accessory muscles for breathing

 Mental status changes

 Sputum production
Interventions
 Administer oxygen as prescribed

 Monitor respiratory status

 Monitor for labored respirations, cyanosis, and cold

and clammy skin

 Encourage coughing and deep breathing and use of

the incentive spirometer
 Place the client in a semi-Fowler’s position to facilitate
breathing and lung expansion

 Change the client’s position frequently and ambulate

as tolerated to mobilize secretions

 Provide CPT

 Perform nasotracheal suctioning if the client is unable

to clear secretions
 Monitor pulse oximetry

 Monitor and record color, consistency, and amount of

sputum

 Provide a high-calorie, high-protein diet with small

frequent meals

 Encourage fluids, up to 3 liters/day, to thin secretions

unless contraindicated

 Provide a balance of rest and activity, increasing activity

gradually
 Administer antibiotics as prescribed

 Administer antipyretics, bronchodilators, cough

suppressants, mucolytic agents, and expectorants as
prescribed

 Prevent the spread of infection by hand washing and

the proper disposal of secretions
 Highly communicable disease caused by
Mycobacterium tuberculosis

 An aerobic bacterium that primarily affects the

pulmonary system, especially the higher lobes, where
the oxygen content is highest

 TB has an insidious onset, and many client are not

aware of symptoms until the disease is well-advanced

 Improper or noncompliant use of treatment programs

may cause the development of multidrug-resistant
strain of TB
 Transmission is via the airborne route by droplet
infection

 Droplets enter the lungs, and the bacteria form a

tubercle lesion
Risk Factors
 Child younger than 5 years of age

 Drinking unpasteurized milk

 Homeless individuals or those from low

socioeconomic status

 Individuals in constant, frequent contact with an

untreated or undiagnosed individual
 Individuals living in crowded areas

 Older client

 Individuals with malnutrition, infection, immune

dysfunction or HIV infection, or immunosuppressed
Signs and Symptoms
 Fatigue

 Lethargy

 Anorexia

 Weight loss

 Low-grade fever
 Chills

 Night sweats

 Persistent cough and the production of mucoid and

mucopurulent sputum, which is occasionally streaked
with blood

 Chest tightness and a dull, aching chest pain may

accompany the cough
 Chest x-ray reveals multinodular infiltrates with
calcification in the upper lobes

 Sputum cultures reveal presence of causative agent

 Mantoux test
Interventions
 Place client in respiratory isolation precautions in a
negative-pressure room

 Provide the client and family with information about

TB

 Instruct client to follow the medication regimen

exactly as prescribed
 Inform client to resume activities gradualy

 Instruct client to increase intake of foods rich in iron,

protein, and vitamin C

 Instruct client to cover nose and mouth when coughing or

sneezing

 Encourage handwashing

 Inform client that when the results of three sputum

cultures are negative he/she is no longer considered
infectious
 Advise client to avoid excessive exposure to silicone or
dust

 Instruct client regarding the importance of compliance

with treatment, follow-up care, and sputum cultures,
as prescribed
Bronchodilators
 Sympathomimetic bronchodilators dilate the airways
of the respiratory tree and relax the smooth muscle of
the bronchi (Albuterol)

 Methylxanthine bronchodilators stimulate the CNS

and respiration, dilate coronary and pulmonary
vessels, cause diuresis, and relax smooth muscle
(theophylline)
Side effects
 Palpitations and tachycardia

 Dysrhythmias

 Hyperglycemia

 Restlessness, nervousness, tremors

 Anorexia, nausea, and vomiting

 Headaches and dizziness

 Mouth dryness and throat irritation

Interventions
 Assess vital signs

 Monitor for cardiac dysrhythmias

 Assess for cough, wheezing, decreased breath sounds, and

sputum production

 Monitor for restlessness and confusion

 Provide adequate hydration administer oral medications

with or after meals
 Instruct the client to stop smoking

 Monitor for a therapeutic serum theophylline level of

10 to 20mcg/mL
Antihistamines
 Are called histamine antagonists or H1 blockers; these
medications compeet with histamine for receptor sites

 Decrease nasopharyngeal, GI, and bronchial

secretions by blocking the H1 receptor

 Diphenhydramine (Benadryl), Loratadine (Claritin),

Cetirizine hydrochloride (Zyrtec)
Side effects
 Drowsiness and fatigue

 Dizziness

 Urinary retention

 Blurred vision

 Wheezing
 Constipation

 Dry mouth

 GI irritation

 Hypotension

 Confusion
Interventions
 Monitor vital signs

 Administer with food or milk

 Instruct client to avoid hazardous activities, alcohol,

and other CNS depressants

 Instruct the client to suck on hard candy or ice chips

for dry mouth
Expectorants and Mucolytic Agents
 Expectorants loosen bronchial secretions so that they
can be eliminated with coughing; they are used for dry,
unproductive cough and to stimulate bronchial
secretions

 Mucolytic agents thin mucous secretions to help make

the cough more productive

 Acetylcysteine (Mucomyst), Dornase alfa

(Pulmozyme)
Side effects
 GI irritation

 Skin rash

 Oropharyngeal irritation
Interventions
 Take medication with full glass of water to loosen
mucus

 Maintain adequate fluid intake

 Encourage client to cough and deep breathe

 Monitor for side effects

Isoniazid
 Inhibits the synthesis of mycolic acids and acts to kill
actively growing organisms in the extracellular
environment

 Active only during cell division and is used in

combination with other anti TB drugs
Side effects
 Hypersensitivity reactions

 Peripheral neuritis

 Hepatotoxicity

 Pyridoxine (vitamin B6) deficiency

 Nausea and vomiting

 Dry mouth
Interventions
 Assess for hypersensitivity

 Assess for hepatic dysfunction

 Monitor for tingling, numbness, or burning of the

extremities

 Administer 1 hour before or 2 hours after meals

 Administer pyridoxine as prescribed

 Instruct client to avoid alcohol

 Instruct the client not to skip doses

Rifampin (Rifadin)
 Inhibits bacterial RNA synthesis

 Binds to DNA-dependent RNA polymerase and blocks

RNA transcription
Side effects
 Hypersensitivity reaction

 Heartburn

 Nausea and vomiting

 Red-orange-colored body secretions

 Hepatotoxicity
Interventions
 Asses for hypersensitivity

 Evaluate CBC, uric acid, and liver function test results

 Monitor mental status

 Instruct client not to skip doses

 Instruct client to avoid alcohol

Ethambutol
 Interferes with cell metabolism and multiplication by
inhibiting one or more metabolites in susceptible
organisms

 Inhibits bacterial RNA synthesis

Side effects
 Hypersensitivity reactions

 Nausea and vomiting

 Dizziness

 Malaise

 Mental confusion

 Optic neuritis

 Increased uric acid levels

Interventions
 Assess the client for hypersensitivity

 Evaluate the results of CBC, uric acid, and renal and

liver function tests

 Obtain baseline visual acuity and color discrimination,

especially to green

 Monitor for visual changes

 Monitor intake and output

 Asses mental status

 Instruct client not to skip doses

Pyrazinamide
 Exact mechanism of action is unknown
Side effects
 Increases liver function tests and uric acid levels

 Myalgia

 Photosensitivity

 Hepatotoxicity

 Thrombocytopenia
Interventions
 Assess for hypersensitivity

 Evaluate CBC, liver function test results, and uric acid

levels

 Assess for painful or swollen joints

 Take with food

 Avoid sunlight or UV light

 Instruct client not to skip doses

Streptomycin
 An aminoglycoside antibiotic used with at least one
other antitubercular medication

 Interferes with protein synthesis

Side effects
 Hypersensitivity

 Visual changes

 Increased liver and renal function studies

 Peripheral neuritis
Interventions
 Assess for hypersensitivity

 Monitor liver and renal function test results

 Perform baseline audiometric testing and repeat every

1 to 2 months because the medication impairs the
eighth cranial nerve

 Monitor for visual changes

 Monitor intake and output

 Instruct the client not to skip doses