EPISTAXIS- bleeding from the nose (most common)

ETIOLOGY (CAUSE)

Most causes of nasal bleeding can be identified readily through a directed history and physical examination.
The patient should be asked about the initial presentation of the bleeding, previous bleeding episodes, and
their treatment, comorbid conditions, and current medications, including over the counter medicines and herbal
and home remedies. Although the differential diagnosis should include both local and systemic causes,
environmental factors such as humidity and allergens also must be considered. Often no cause for the
bleeding is identified.

Common Cause of Epistaxis

Local causes

 Nasal trauma (nose picking, foreign bodies, forceful nose blowing)

 Allergic, Chronic or infectious rhinitis
 Chemical irritants
 Medication
 Drying of the nasal mucosa from low humidity
 Deviation of the nasal septum or septal perforation
 Bleeding polyp of the septum or lateral nasal wall (inverted papilloma)
 Neoplasm of the nose or sinuses
 Tumors of the nasopharynx especially Nasopharyngeal
 Angiofibroma
 Vascular malformation
Systemic causes

 Hemophilia
 Hypertension
 Leukemia
 Liver disease ex.cirrhosis)
 Medication ex.aspirin,anticoagulants, anti-inflammatory drugs)
 Platelet dysfunction
 Thrombocytopenia

PATHOPHYSIOLOGY
Bleeding typically occurs when the mucosa is eroded and vessels become exposed and subsequently
break. More than 90% of bleeds occur anteriorly and arise from Little’s area, where the Kiesselbach plexus
forms on the septum. The Kiesselbach plexus is where vessels from both the ICA (anterior and posterior
ethmoidal arteries) and the ECA (sphenopalatine and branches of the internal maxillary arteries) converge.
These capillary or venous bleeds provide a constant ooze, rather than the profuse pumping of blood observed
from an arterial origin. Anterior bleeding may also originate anterior to the inferior turbinate.
Posterior bleeds arise further back in the nasal cavity, are usually more profuse, and are often of
arterial origin (eg, from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx). A
posterior source presents a greater risk of airway compromise, aspiration of blood, and greater difficulty
controlling bleeding.

CLINICAL MANIFESTATION (S/SX)

Bleeding usually starts from one nostril. In case of heavy bleeding, it may fill up both the nostrils and overflow
the nasopharynx. In certain cases, blood may drip back from the nose through the throat to stomach. A person
is likely to vomit in such a condition. The common signs of excessive nosebleed are:
 Excess blood loss may cause dizziness and fainting, confusion, loss of alertness and light-headedness.
However, the condition is rare.
 Bleeding from other body parts like teeth, gums, nostrils, etc. indicate inability of blood to clot.
 Additional bleeding from other parts of the body, such as bleeding gums when brushing teeth, blood in
urine or bowel movements, or easy bruising also indicate an inability of the blood to clot.
DIAGNOSIS
To diagnose epistaxis, routine laboratory testing is not required. Patients with symptoms or signs of a
bleeding disorder and those with severe or recurrent epistaxis should have CBC, PT, and PTT. CT may be
done if a foreign body, a tumor, or sinusitis is suspected.

TREATMENT /SURGICAL / MODALITIES & MEDICAL

Treatments depend on the cause and could include:

 Nasal packing. Gauze, special nasal sponges or foam or an inflatable latex balloon is inserted into
your nose to create pressure at the site of the bleed. The material is often left in place for 24 to 48
hours before being removed by a healthcare professional.
 Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy
(electrocautery) to seal the bleeding blood vessel. A local anesthetic is sprayed in the nostril first to
numb the inside of your nose.
 Medication adjustments/new prescriptions. Reducing or stopping the amount of blood thinning
medications can be helpful. In addition, medications for controlling blood pressure may be
necessary. Tranexamic (Lystedaâ), a medication to help blood clot, may be prescribed.
 Foreign body removal if this is the cause of the nose bleed.
 Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the
nosebleed.
 Ligation. In this procedure, the culprit blood vessel is tied off to stop the bleeding.

NSG. CARE/ MANAGEMENT

The client with epistaxis usually arrives at the emergency room following unsuccessful attempts to stop the
bleeding—signs of airway obstruction. The goals of treatment are to maintain the airway, stop bleeding identify
the cause, and prevent a recurrence.
Initial Treatment

 Tilt head forward to prevent posterior blood drainage

 Apply continuous pressure by pinching nares together for 5-10 minutes
 Pressure applied between the upper lip and gum may help in some difficult cases.
 If no improvement, pack the nose with vasoconstrictor-soaked gauze and a heavy coat of petroleum
jelly for 10 minutes
 In severe cases a nasostat is inserted, a foley catheter device that provides direct compression to
the site via a balloon.
 Resuscitation with IV fluids or possibly blood transfusion may be necessary for severe blood loss to
prevent hypovolemic shock.

Nursing management

 Monitor for patient vital signs assists in the control of bleeding.

 Provides tissues and emesis basin to allow the patient to expectorate any excess blood.
 Administer humidified oxygen by facemask to a patient with posterior packing.
 Assuring the patient in a calm, efficient manner that bleeding can be controlled can help
reduce anxiety.

SINUSITIS

ETIOLOGY
Sinusitis can stem from various factors, but it always results from fluid becoming trapped in the sinuses. This
fuel the growth of germs.

 Viruses: In adults, 90 percent cases of sinusitis result from a virus

 Bacteria: In adults, 1 case in 10 is caused by bacteria
 Pollutants: Chemicals or irritants in the air can trigger a buildup of mucus
 Fungi: The sinuses either react to fungi in the air, as in allergic fungal sinusitis (AFS), or they are
invaded by fungi, as in chronic indolent sinusitis. This is rare in the U.S.
PATHOPHYSIOLOGY

The most common cause of acute sinusitis is an upper respiratory tract infection (URTI) of viral origin. The viral
infection can lead to inflammation of the sinuses that usually resolves without treatment in less than 14 days. If
symptoms worsen after 3 to 5 days or persist for longer than 10 days and are more severe than normally
experienced with a viral infection, a secondary bacterial infection is diagnosed. The inflammation can
predispose to the development of acute sinusitis by causing sinus ostial blockage. Although inflammation in
any of the sinuses can lead to blockade of the sinus ostia, the most commonly involved sinuses in both acute
and chronic sinusitis are the maxillary and the anterior ethmoid sinuses. The anterior ethmoid, frontal, and
maxillary sinuses drain into the middle meatus, creating an anatomic area known as the osteomata complex .

The nasal mucosa responds to the virus by producing mucus and recruiting mediators of inflammation, such as
white blood cells, to the lining of the nose, which cause congestion and swelling of the nasal passages. The
resultant sinus cavity hypoxia and mucus retention cause the cilia—which move mucus and debris from the
nose—to function less efficiently, creating an environment for bacterial growth.

CLINCAL MANIFESTATIONS
Symptoms vary, depending on the length and severity of the infection. If the patient has two or more of the
following symptoms and thick, green or yellow nasal discharge, they may be diagnosed with acute sinusitis.

 facial pain and pressure

 blocked nose
 nasal discharge
 congestion
 cough

In more advanced cases, the following symptoms may also be present:

 fever
 halitosis, or foul-smelling breath
 tiredness
 toothache
 headache

DIAGNOSIS
Your doctor will feel for tenderness in your nose and face and look inside your nose, and can usually make the
diagnosis based on the physical exam.

Other methods that might be used to diagnose acute sinusitis and rule out other
conditions include:

 Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic

light inserted through your nose allows your doctor to visually inspect
the inside of your sinuses.

 xse A CT scan shows details of your sinuses and nasal area. It's not
usually recommended for uncomplicated acute sinusitis, but imaging studies might help find
abnormalities or suspected complications.

 Nasal and sinus samples. Laboratory tests aren't generally necessary for diagnosing acute
sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue
samples (cultures) from your nose or sinuses might help find the cause, such as a bacterial
infection.
  Allergy testing. If your doctor suspects that allergies have
triggered your acute sinusitis, he or she will recommend an
allergy skin test. A skin test is safe and quick, and can help
pinpoint the allergen that's causing your nasal flare-ups.

TREATMENT / MODALITIES & MEDICAL

 Saline nasal spray, which you spray into your nose several times a
day to rinse your nasal passages.
 Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. ...
 Decongestants. ...
 OTC pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or
aspirin.

SURGICAL
Structural issues, such as a deviated septum, may need surgery. Surgery may also be advised if there are
polyps, or if the sinusitis has resisted all other treatments. Functional endoscopic sinus surgery (FESS) is the
main procedure used for treatment, but other surgeries may be required as other parts of the nose are often
affected. If a deviated septum is causing recurrent infections, for example, a septoplasty will be used to
straighten out this bone and cartilage. Treatment may still be required following surgery to prevent the return of
sinusitis. Surgery should always be the last resort on sinusitis in children, and obtaining a second
opinion is recommended before proceeding. Insurers may require patients to provide in-depth evidence to
ensure that the surgery is for sinusitis and not for cosmetic surgery, to improve the appearance of the nose.

DIETETICS

FOODS FOR SINUSITIS

The below foods carry anti-bacterial/fungal/inflammatory properties that all assist in reducing sinus congestion:

 Foods containing Omega-3 fatty acids, such as cold-water fish (Salmon, Sardines, Mackerel,
Anchovies), Fish and Linseed oils, Avocado, nuts, seeds and eggs. These essential fatty acids act as a
natural anti-inflammatory, reducing sinus swelling and congestion.
 Garlic, which may boost immunity levels enabling you to more easily fight off a Sinus infection.
 Foods containing high amounts of Vitamin C, such as Citrus fruits, tomatoes, strawberries, broccoli and
blueberries. The Vitamin C reduces inflammation; boost overall immunity levels and acts as a natural
anti-histamine.
 Pineapple, which contains the bromelain enzyme known for its anti-inflammatory and decongestive
properties.
 Apple Cider Vinegar, which is rich in the Potassium that functions to break down mucous production.
 Water, which should be consumed in large amounts to prevent the mucous membranes from drying out
and a consequent congestion taking place.
 Foods that eliminate Candida yeast from the gut (which has linked to Sinusitis), such as cold pressed
oils (such as Olive oil) and most fresh vegetables.

FOODS TO AVOID WITH SINUSITIS

Certain foods are renown for causing Sinusitis and Sinus headaches. Foods that should be avoided include:

 Dairy products, which have been associated with the production of phlegm and mucous. These may be
replaced Rice products as Soy may also occasionally cause mucous to thicken.
 Spicy foods, which may trigger acid reflux that can trigger an episode of Sinusitis.
 Alcohol, which dehydrates the body thus hardens mucous and inflames sinus and nasal membranes. It
may also trigger acid reflux that may aggravate the condition.
 Caffeine, a diuretic that dehydrates the nasal membranes. Coffee should especially be avoided as it is
acidic as well and may cause acid reflux from the stomach.

It is also worth avoiding eating meals late at night as this may cause acid reflux in the stomach that may trigger
a Sinusitis attack.
INFLUENZA
Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs.
Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea
and vomiting.

For most people, the flu resolves on its own. But sometimes, influenza and its complications can be
deadly. People at higher risk of developing flu complications include:

 Young children under age 5, and especially those under 6 months

 Adults older than age 65

 Residents of nursing homes and other long-term care facilities

 Pregnant women and women up to two weeks after giving birth

 People with weakened immune systems

 Native Americans

 People who have chronic illnesses, such as asthma, heart disease, kidney disease, liver
disease and diabetes

 People who are very obese, with a body mass index (BMI) of 40 or higher

ETIOLOGY
Influenza results from infection with 1 of 3 basic types of influenza virus: A, B, or C.

 Direct contact. Transmission of influenza from poultry or pigs to humans appears to occur

predominantly as a result of direct contact with infected animals.

 Unhygienic food preparation. The risk is especially high during slaughter and preparation for
consumption; eating properly cooked meat poses nor risk.

 Aerosol transmission. Influenza viruses spread from human to human via aerosols created when
an infected individual coughs or sneezes; infection occurs after an immunologically susceptible
person inhales the aerosol; if not neutralized by secretory antibodies, the virus invades airway and
respiratory tract cells.

 Contact with contaminated objects. Contact with excrement from infected birds or contaminated
surfaces or water are also considered mechanisms of infection.

PATHOPHYSIOLOGY
Influenza viruses are enveloped, negative-sense, single-stranded RNA viruses of the family Orthomyxoviridae.

 The core nucleoproteins are used to distinguish the 3 types of influenza viruses: influenza A, B, and
C (IAV, IBV, and ICV).

 Hemagglutinin and neuraminidase are critical for virulence, and they are major targets for the
neutralizing antibodies of acquired immunity to influenza.

 Hemagglutinin binds to respiratory epithelial cells, allowing cellular infection.

 Neuraminidase cleaves the bond that holds newly replicated virions to the cell surface, permitting
the infection to spread.

 The species specificity of influenza strains is partly due to the ability of a given hemagglutinin to bind
to different sialic acid receptors on respiratory tract epithelial cells.
CLINICAL MANIFESTATIONS
The presentation of influenza virus infection varies; however, it usually includes many of the symptoms
described below.

 Cough. Cough and other respiratory symptoms may be initially minimal but frequently progress as
the infection evolves; patient may report nonproductive cough, cough-related pleuritic chest pain,
and dyspnea.

 Fever. Fever may vary widely among patients, with some having low fevers and other developing
fevers as high as 1040F; some patients report feeling feverish and feeling chills.

 Sore throat. Sore throat may be severe and may last 3-5 days; the sore throat may be a significant
reason why patients seek medical attention.

 Myalgia. Myalgias are common and range from mild to severe.

 Weakness. Weakness and severe fatigue may prevent patients from performing their normal

activities or work; patients report needing additional sleep; in some cases, patients with influenza
may be bedridden.

DIAGNOSIS
Rapid diagnostic tests for influenza are available and are becoming more widely used.

 Rapid diagnostic tests. The US FDA waived federal Clinical Laboratories Improvement Act (CLIA)
requirements and cleared for marketing 7 rapid influenza diagnostic tests that directly detect
influenza A or B virus-associated antigens or enzyme in throat swabs, nasal swabs, or nasal
washes; these tests can produce results within 30 minutes; some these include QuickVue Influenza
A+B test (Quidel), ZstatFlu (ZymeTx), and QuickVue Influenza test (Quidel).

 Viral culture. Culture may require 3-7 days, yielding results long after the patient has left the clinic,
office, or emergency department and well past the time when drug therapy could be efficacious.

 Polymerase chain reaction testing. RT-PCR testing of nasopharyngeal throat secretions is the

criterion standard for confirming influenza virus infection; it is the only in vitro diagnostic test for
influenza that is cleared by the FDA for use with lower respiratory tract specimens.
 Direct immunofluorescent tests. Some laboratories offer direct immunofluorescent tests on fresh
specimens, but these tests are labor– and personnel-intensive and are less sensitive than culture
methods.

 Serologic testing. In order to overcome the expensive and time-consuming obstacle of culturing,
several serologic tests have become available; in reality, many of these are not bedside tests;
generally, 30-60 minutes are required to perform the test’s multiple steps.; test sensitivities generally
range from 60-70%.

 Testing for Avian influenza. A rapid test from nasopharyngeal swab specific to H5N1 influenza
(Arbor Vita Corporation) was approved by the FDA in 2009.

 Chest radiography. In elderly or high-risk patients with pulmonary symptoms, chest radiography is

indicated to exclude pneumonia; with avian influenza, pulmonary infiltrates are seen in almost all
patients; the widely varied radiographic characteristics range from diffuse or patchy infiltrates to
lobar multilobar consolidation.

TREATMENT
Usually, you'll need nothing more than rest and plenty of fluids to treat the flu. But if you have a severe
infection or are at higher risk for complications, your doctor may prescribe an antiviral drug to treat the flu.
These drugs can include oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) or baloxavir (Xofluza).
These drugs may shorten your illness by a day or so and help prevent serious complications.

Oseltamivir is an oral medication. Zanamivir is inhaled through a device similar to an asthma inhaler and
shouldn't be used by anyone with certain chronic respiratory problems, such as asthma and lung disease.
Antiviral medication side effects may include nausea and vomiting. These side effects may be lessened if the
drug is taken with food.

Most circulating strains of influenza have become resistant to amantadine and rimantadine (Flumadine), which
are older antiviral drugs that are no longer recommended.

DIETETICS

Foods to eat

Food is what gives your body the energy and nutrients it needs to function. Such effects are equally vital when
you have the flu. Still, it’s all about eating the right foods for your condition.

Consider eating the following foods when you have the flu.

1.Broth

Whether you prefer chicken, beef, or vegetable, broth is one of the best things you can eat when you have the
flu. You can eat it as soon as your symptoms begin and until you have fully recovered.

Broth helps prevent dehydration, and the warm elements can help soothe a sore throat and relieve congestion.

2. Chicken soup

Chicken soup combines the benefits of broth along with additional ingredients. Cut-up chicken provides your
body with iron and protein, and you’ll also gain nutrients from carrots, herbs, and celery.

You can eat chicken soup throughout the duration of the flu to help keep you hydrated and satiated; just be
sure to watch the salt content.

3. Garlic

While you might think of garlic as a food-flavoring agent, it’s actually been used in alternative medicine for a
variety of ailments for centuries. One study Trusted Source of garlic supplements in adults with the flu found
enhanced immunity and reduced symptom severity.

You don’t necessarily have to take supplements, though. Eating raw garlic may also be beneficial. Due to the
immune-enhancing effects, consider eating garlic at the first signs of the flu.

4. Yogurt

Yogurt with live cultures not only can help soothe a sore throat but can also boost your immune system,
according to a study of mice reported in the journal International Immunopharmacology Trusted Source. Yogurt
also contains protein.

You can eat yogurt while your throat is sore, but just be sure to choose whole yogurts without any added
sugars.

5. Vitamin C–containing fruits

Vitamin C is an important nutrient to help boost  your immune system, which is especially important when
you’re sick. While supplements can help, your body can absorb nutrients like vitamin C more effectively from
the foods you eat.
Consider snacking on vitamin C–rich fruits while you have the flu. Some fruits high in vitamin C include
strawberries, tomatoes, and citrus fruits.

6. Leafy greens

Spinach, kale, and other leafy greens can also help boost your immune system when you have the flu. They
have both vitamin C and vitamin E, another immune-enhancing nutrient.
Consider combining leafy greens with fruit in a smoothie, or eat them raw with a drizzle of lemon and olive oil.
It’s best to eat these immune-boosting foods throughout the duration of your illness.

7. Broccoli

Broccoli is a nutrient powerhouse that can benefit your body when you have the flu. Eating just one serving will
provide immune-boosting vitamins C and E, along with calcium and fiber.

Consider eating broccoli when your appetite returns toward the middle or end of the flu. You can also eat
broccoli soup; just remember to check the sodium content.

8. Oatmeal

When you’re sick, a hot bowl of oatmeal can be a soothing, nutritious food choice. Oatmeal, like other whole
grains, is also a natural source of immune-boosting vitamin E. It also contains polyphenol antioxidants as well
as immune-strengthening beta-glucan fiber.

Choose whole oats for the most benefits.

9. Spices

Toward the end of the flu, you might have increased sinus and chest congestion. Certain spices, such as
pepper and horseradish, can help break up congestion so you can breathe better. However, avoid spicy foods
when you have a sore throat.

Staying hydrated

It’s easy to get dehydrated with the flu. Not only do you eat and drink less and have an overall reduced water
intake, but you also lose water with sweat when you have a fever.

Not only are fluids important for your body functions in general, but they can also help break up congestion and
stave off infections.

When it comes to hydrating beverages, water still ranks number one. It also acts as a natural detox for your
body. If you aren’t a fan of water or are looking for something with more flavor, you can also drink:

 broth
 ginger tea
 herbal tea with honey
 honey and lemon tea (mix equal parts with hot water)
 100 percent juices (look for products without added sugars)

Low-sugar sports drinks or other electrolyte-containing beverages, such as Pedialyte, may be used if you’re
dehydrated only.

Although they’re not typical of the seasonal flu, vomiting and diarrhea are symptoms that could warrant the use
of electrolytes.
What to avoid

Knowing what to avoid eating with the flu is perhaps just as important as what you should eat. When you’re
sick with the flu, avoid the following items:

 Alcohol. This lowers your immune system and causes dehydration.

 Caffeinated beverages. Items such as coffee, black tea, and soda can make you more dehydrated.
Plus, many of these beverages may contain sugar.
 Hard or jagged foods. Crunchy crackers, chips, and foods with similar textures can aggravate a cough
and sore throat.
 Processed foods. Whether these are from a fast food joint or made from a box, the more processed a
food is, the fewer nutrients you’ll get. With the flu, your body is trying to heal itself, so it’s important to
support the process with whole, nutritious foods.

NSG. CARE / MNGT.

Prevention is the most effective management strategy for influenza.

 Vaccines. To prevent seasonal flu, the Advisory Committee on Immunization Practices (ACIP) of
the US Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics
(AAP) recommend routine annual influenza vaccination for all persons aged 6 months or older,
preferably before the onset of influenza activity in the community.

 Surveillance. Enhanced surveillance with daily temperature taking and prompt reporting with
isolation through home medical leave and segregation of smaller subgroups decrease the spread of
influenza.

 Bed rest. Patients with influenza generally benefit from bed rest; most patients with influenza
recover in 3 days; however, malaise may persist for weeks.

 Hospitalization. Patients most often require hospitalization when influenza exacerbates underlying

chronic diseases; some patients, especially elderly individuals, may be too weak to care for
themselves alone at home; on occasion, the direct pathologic effects of influenza may necessitate
hospitalization.
 Prehospital care. Prehospital care is predominantly supportive; supplemental oxygenation to
manage respiratory symptoms or objective hypoxia may be needed; ventilatory support with a bag-
valve-mask device or with field intubation may be required if the patient is in respiratory failure;
intravenous access should be obtained, and a bolus of a crystalloid can be administered to support
hemodynamic stability.

 Consultations. Consultation with an infectious disease specialist is prudent in some cases of

seasonal influenza; for management of severe disease, intensive care specialists must be involved.

CANCER OF THE LARYNX (Laryngeal Cancer)

ETIOLOGY

Throat cancer typically occurs when healthy cells sustain damage and begin to overgrow. These cells can turn
into tumors. Laryngeal cancers are tumors that originate in your voice box.

The mutations that damage cells in your larynx are often due to smoking. They can also be the result of:

 heavy alcohol use

 poor nutrition
 human papillomavirus exposure
 immune system problems
 workplace exposure to toxins, such as asbestos
 certain genetic diseases, such as Fanconi anemia

PATHOPHYSIOLOGY
Occurs predominantly in men older than age 60. Most patients have a history of smoking; those with
Supraglottis laryngeal cancer frequently have a history of smoking and a high alcohol intake. Other risk factors
include vocal straining, chronic laryngitis, industrial exposure, nutritional deficiency, and family predisposition.
About two-thirds of carcinomas of the larynx arise in the glottis, almost one-third arise in the Supraglottis
region, and about 3% arise in the subglottic region of the larynx. When limited to the vocal cords (intrinsic),
spread is slow because of lessened blood supply. When cancer involves the epiglottis (extrinsic), cancer
spreads more rapidly because of abundant supply of blood and lymph and soon involves the lymph nodes of
the neck. A malignant growth may occur in three different areas of the larynx: the glottis area (vocal cords),
Supraglottis area (area above the glottis or vocal cords, including epiglottis and false cords), and sub glottis
(area below the glottis or vocal cords to the cricoid). Two thirds of laryngeal cancers are in the glottis area.
Supraglottis cancers account for approximately one third of the cases, subglottic tumors for less than 1%.
Glottic tumors seldom spread if found early because of the limited lymph vessels found in the vocal. Clinical
manifestations

CLINICAL MANIFESTATIONS

Some of the following may be symptoms of laryngeal cancer, or they could be symptoms of other conditions:

 A sore throat or cough that does not go away

 A change in your voice, such as hoarseness, that does not get better after two weeks
 Any pain or other trouble when you swallow
 Ear pain
 A lump in the neck or throat
 Dysphonia (problems producing voice sounds)

If you have any of the following symptoms, see your doctor right away:

 Dyspnea (trouble breathing)

 Stridor (breathing that is high-pitched and noisy)
 Globus sensation (a feeling like there is something in the throat)
 Hemoptysis (coughing up blood)

DIAGNOSIS

These tests and procedures may be used to help diagnose laryngeal cancer:

 Physical exam: A physician will examine the throat and neck.

 Laryngoscopy: The doctor examines the larynx with a mirror or a thin, lighted tube called a flexible
endoscope.
 Biopsy: The doctor removes a small piece of the larynx so that it can be examined under a
microscope.
 CT or CAT scan (also called computed tomography, computerized tomography, or computerized
axial tomography): Computed tomography uses X-rays and computers to produce images of a cross-
section of the body.
 MRI (also called magnetic resonance imaging): Magnetic resonance imaging uses a large magnet,
radio waves, and a computer to produce clear pictures, or images, of the human body.
 PET scan: A very small dose of a radioactive chemical, called a radiotracer, is injected into a vein in
the arm. The tracer travels through the body and is absorbed by the organs and tissues being studied.
A machine called a PET scanner creates three- dimensional pictures from the energy given off by the
tracer substance.

TREATMENT / MODALITIES & MEDICAL

Laryngeal cancer is treated with radiation therapy, chemotherapy, or surgery. Sometimes, it is treated with a
combination of these methods.

Radiation therapy- Radiation therapy delivers high energy x-rays to the tumor to kill cancer cells. By focusing
the radiation on the cancer cells, the damage to normal structures can be minimized.
Chemotherapy- Chemotherapy is the use of medications to kill or to slow the growth of rapidly multiplying
cancer cells. These medications are often given intravenously (through a needle into a blood vessel) and can
have major side effects.

Surgery- Surgery for early laryngeal cancer is done to allow the patient to keep the major functions of the
larynx, including speaking and swallowing. The goal is to take out the cancer without having to remove the
entire larynx. In cases of advanced laryngeal cancer, a laryngectomy (complete removal of the larynx) is often
performed.

SURGICAL

The goals of surgery for early larynx cancer are to cure the cancer while still keeping the normal functions of
the larynx. The surgeries that are performed for early laryngeal cancers are:

 Cordectomy: removal of a vocal cord.

 Vertical partial laryngectomy: removal of part of the larynx and a vocal cord.
 Frontolateral hemilaryngectomy: removal of part of the front of the larynx.
 Supracricoid laryngectomy: removal of most of the larynx, while saving the voice.
 Supraglottic laryngectomy: removal of the supraglottis.

DIETETICS
A balanced diet is a diet that provides the correct nutrients at the right time. In health we need:

 Carbohydrates: bread, potato, rice, pasta are filler foods and together with sugars are required to
provide energy for our muscles and for our brain.
 Protein: fish, other sea food, meat, poultry, dairy and vegetable protein from pea’s beans and pulses.
These provide amino acids the building blocks for skin, muscle, hair, nails hormones and many other
biological, neurological and healing processes.
 Fats and oils: These often get bad press but we need a good compliment of all kinds of fats and oils in
our diet. We need them for our immune system, brain and many other organs. Some are better for us
than others. A balanced diet requires small amounts of saturated and unsaturated fats and oils.  All
meats will contain saturated fat, trim off any visible fats and grill or bake. Some oils come from
vegetable sources. Oil from fish is good for the heart and it’s recommended that we eat oily fish once or
twice per week.
 Fruits and Vegetables: These provide us with fiber, vitamins, minerals, antioxidants and fluids. Most
fruits and vegetables are fairly low in calories that’s why people otherwise in good health who need to
lose weight are often asked to increase their fruit and vegetable intake, and decrease their fat and
carbohydrate intake.
 Dairy: milk, cheese, eggs, butter, yoghurt. A mixture of fat protein and carbohydrates. Often high in
calories and saturated fats, but also available with reduced saturated fat and sugar content
 Fluids: foods contain a surprising amount of fluid but we also need to drink through the day, water,
tea, coffee, juices etc. Our requirements change from day to day depending on our environment and
degree of activity. If you feel thirsty you are already dehydrated!
All of the above constitute the makings of a balanced diet when taken at the right time, in the right amounts, at
the right frequency. Even the most balanced diets can result in weight gain if eaten in excess, or weight loss, if
sparsely consumed.

BRONCHITIS
ETIOLOGY
Respiratory viruses are the most common causes of acute bronchitis, and cigarette smoking is indisputably the
predominant cause of chronic bronchitis.
Viral and Bacterial Infections in Acute Bronchitis
The most common viruses include influenza A and B, parainfluenza, respiratory syncytial virus, and
coronavirus, although an etiologic agent is identified only in a minority of cases. 
Acute bronchitis is usually caused by infections, such as those caused by Mycoplasma species, Chlamydia
pneumoniae, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae, and by viruses,
such as influenza, parainfluenza, adenovirus, rhinovirus, and respiratory syncytial virus. Exposure to irritants,
such as pollution, chemicals, and tobacco smoke, may also cause acute bronchial irritation.
Bordetella pertussis should be considered in children who are incompletely vaccinated, though studies
increasingly report this bacterium as the causative agent in adults as well.

Smoking and Other causes of Chronic Bronchitis

Cigarette smoking is indisputably the predominant cause of chronic bronchitis. Common risk factors for acute
exacerbations of chronic bronchitis are advanced age and low forced expiratory volume in 1 second
(FEV1).  Most (70-80%) acute exacerbations of chronic bronchitis are estimated to be due to respiratory
infections. 
Estimates suggest that cigarette smoking accounts for 85-90% of chronic bronchitis and chronic obstructive
pulmonary disease. Studies indicate that smoking pipes, cigars, and marijuana causes similar damage.
Smoking impairs ciliary movement, inhibits the function of alveolar macrophages, and leads to hypertrophy and
hyperplasia of mucus-secreting glands.
Smoking can also increase airway resistance via vagally mediated smooth muscle constriction. Unless some
other factor can be isolated as the irritant that produces the symptoms, the first step in dealing with chronic
bronchitis is for the patient to stop smoking.
Air pollution levels have been associated with increased respiratory health problems among people living in
affected areas. The Air Pollution and Respiratory Health Branch of the National Center for Environmental
Health directs the fight of the US Centers for Disease Control and Prevention against respiratory illness
associated with air pollution.

PATHOPHYSIOLOGY
During an episode of acute bronchitis, the cells of the bronchial-lining tissue are irritated and the mucous
membrane becomes hyperemic and edematous, diminishing bronchial mu cociliary function. Consequently,
the air passages become clogged by debris and irritation increases. In response, copious secretion of mucus
develops, which causes the characteristic cough of bronchitis.
In the case of mycoplasmal pneumonia, bronchial irritation results from the attachment of the organism
(Mycoplasma pneumoniae) to the respiratory mucosa, with eventual sloughing of affected cells. Acute
bronchitis usually lasts approximately 10 days. If the inflammation extends downward to the ends of the
bronchial tree, into the small bronchi (bronchioles), and then into the air sacs, bronchopneumonia results.
Chronic bronchitis is associated with excessive tracheobronchial mucus production sufficient to cause cough
with expectoration for 3 or more months a year for at least 2 consecutive years. The alveolar epithelium is both
the target and the initiator of inflammation in chronic bronchitis.
A predominance of neutrophils and the peri bronchial distribution of fibrotic changes result from the action of
interleukin 8, colony-stimulating factors, and other chemotactic and proinflammatory cytokines. Airway
epithelial cells release these inflammatory mediators in response to toxic, infectious, and inflammatory stimuli,
in addition to decreased release of regulatory products such as angiotensin-converting enzyme or neutral
endopeptidase.
Chronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent bronchitis, or chronic
bronchitis with obstruction. Mucoid sputum production characterizes simple chronic bronchitis. Persistent or
recurrent purulent sputum production in the absence of localized suppurative disease, such as bronchiectasis,
characterizes chronic mucopurulent bronchitis.
Chronic bronchitis with obstruction must be distinguished from chronic infective asthma. The differentiation is
based mainly on the history of the clinical illness: patients who have chronic bronchitis with obstruction present
with a long history of productive cough and a late onset of wheezing, whereas patients who have asthma with
chronic obstruction have a long history of wheezing with a late onset of productive cough.

Chronic bronchitis may result from a series of attacks of acute bronchitis, or it may evolve gradually because of
heavy smoking or inhalation of air contaminated with other pollutants in the environment. When so-called
smoker's cough is continual rather than occasional, the mucus-producing layer of the bronchial lining has
probably thickened, narrowing the airways to the point where breathing becomes increasingly difficult. With
immobilization of the cilia that sweep the air clean of foreign irritants, the bronchial passages become more
vulnerable to further infection and the spread of tissue damage.

CLINICAL MANIFESTATION
A complete history must be obtained, including information on exposure to toxic substances and smoking.
Symptoms of bronchitis include the following:
 Cough (the most commonly observed symptom)
  Sputum production (clear, yellow, green, or even blood-tinged)
 Fever (relatively unusual; in conjunction with cough, suggestive of influenza or pneumonia)
 Nausea, vomiting, and diarrhea (rare)
 General malaise and chest pain (in severe cases)
 Dyspnea and cyanosis (only seen with underlying chronic obstructive pulmonary disease [COPD]
or another condition that impairs lung function)
 Sore throat
 Runny or stuffy nose
 Headache
 Muscle aches
 Extreme fatigue
Physical examination findings in acute bronchitis are variable and may include the following:
 Diffuse wheezes, high-pitched continuous sounds, and the use of accessory muscles (in severe
cases)
 Diffuse diminution of air intake or inspiratory stridor (indicative of bronchial or tracheal obstruction)
 Sustained heave along the left sternal border (indicative of right ventricular hypertrophy secondary
to chronic bronchitis)
 Clubbing on the digits and peripheral cyanosis (indicative of cystic fibrosis)
 Bullous myringitis (suggestive of mycoplasmal pneumonia)
 Conjunctivitis, adenopathy, and rhinorrhea (suggestive of adenoviral infection)

DIAGNOSIS
Bronchitis may be suspected in patients with an acute respiratory infection with cough; yet, because many
more serious diseases of the lower respiratory tract cause cough, bronchitis must be considered a diagnosis of
exclusion.
Studies that may be helpful include the following:
 Complete blood count (CBC) with differential
 Procalcitonin levels (to distinguish bacterial from nonbacterial infections)
 Sputum cytology (if the cough is persistent)
 Blood culture (if bacterial superinfection is suspected)
 Chest radiography (if the patient is elderly or physical findings suggest pneumonia)
 Bronchoscopy (to exclude foreign body aspiration, tuberculosis, tumors, and other chronic
diseases)
 Influenza tests
 Spirometry
 Laryngoscopy (to exclude epiglottitis)

TREATMENT / SURGICAL

 Bronchodilator Medications Inhaled as aerosol sprays or taken orally, bronchodilator medications

may help to relieve symptoms of chronic bronchitis by relaxing and opening the air passages in the
lungs.
 Steroids Inhaled as an aerosol spray, steroids can help relieve symptoms of chronic bronchitis.
Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood
pressure, diabetes and cataracts. It is important to discuss these side effects with your doctor before
using steroids.
 Antibiotics Antibiotics may be used to help fight respiratory infections common in people with
chronic bronchitis.
 Vaccines Patients with chronic bronchitis should receive a flu shot annually and pneumonia shot
every five to seven years to prevent infections.
 Oxygen Therapy As a patient's disease progresses, they may find it increasingly difficult to breathe
on their own and may require supplemental oxygen. Oxygen comes in various forms and may be
delivered with different devices, including those you can use at home.
 Surgery Lung volume reduction surgery, during which small wedges of damaged lung tissue are
removed, may be recommended for some patients with chronic bronchitis.
 Pulmonary Rehabilitation An important part of chronic bronchitis treatment is pulmonary
rehabilitation, which includes education, nutrition counseling, learning special breathing techniques,
help with quitting smoking and starting an exercise regimen. Because people with chronic bronchitis
 are often physically limited, they may avoid any kind of physical activity. However, regular physical
activity can actually improve a patient's health and wellbeing.

MODALITIES & MEDICAL

Drug classes that may be used to treat chronic bronchitis/COPD include:

 Antibiotics to treat worsening coughs, breathlessness, and mucus production caused by infections.
 Anti-inflammatory drugs, such as corticosteroids (also called steroids), to reduce swelling and mucus
output. Steroids can have many different types of side effects, including swelling in feet and hands,
mood changes, increased appetite and weight gain, trouble sleeping, and more serious ones such
as diabetes, higher risk of infections, osteoporosis, and cataracts.
 Bronchodilators to keep muscles around the airways relaxed so that airways stay open. There are long-
acting and short-acting bronchodilators. Short-acting products are often called rescue drugs because
they act quickly, but wear off in a couple of hours.
 Combination drugs that contain a mix of steroids and long- or short-acting bronchodilators

DIETETICS
Avoid dairy products like milk, butter, cheese because these will increase mucus secretion in the respiratory
system.
. Avoid hot spicy and highly seasoned food.
. Avoid cold food, cold drinks, ice, ice-creams and aerated drinks.
. Drink luke warm water.
. Boil a mixture of Bishops weed (Ajwain), tea leaves and water and inhale the steam, helps to decongest. Do
this at least 2-3 times a day.
. Gargle with warm water, a pinch of salt and turmeric to sooth your throat.
. Have only fruits for 4-5 days later can have raw salads, vegetables and sweet fruits for next 5-6 days.
. Have hot vegetable soups.
. Have bland and boiled food.
. Include turmeric, garlic, ginger and onions in your diet but avoid if you are on homeopathic medication.
. Consume lots of vitamin C: foods of animal origin are poor in vitamin C.
- Fresh citrus fruits, green vegetables.
. Increase consumption of vitamin B:
- Milk and milk products, eggs, shrimps, crabs and lobsters.
- Lean meat especially pork, fish, dairy products, poultry, egg yolk, Liver, kidney, pancreas, yeast (Brewer's
yeast).
- Carrots, bananas, avocado, raspberries, artichoke, cauliflower, soy flour, barley, cereals pasta, whole grains,
barn like unpolished rice and wheat germ, dried beans, peas and soybeans.
- Green leafy vegetables, legumes, nuts, whole grain.
. Consume lots of vitamin A; it maintains the integrity of the respiratory mucosa: Liver oils of fish like cod,
shark, and halibut are richest source of vitamin A.
- Animal sources: egg, milk and milk products, meat, fish, kidney and liver.
- Yellow orange colored fruits and vegetables, dark green leafy vegetables.
. Have ginger powder or fresh ginger juice in honey before retiring to bed.
. Every morning, drink boiled mixture of - half cup water, little ginger, 2-3 leaves of sweet basil (tulsi) and mint
leaves, or you can eat the raw leaves, this will boost up your immunity.

NSG. CARE / MNGT.

Therapy is generally focused on alleviation of symptoms. Care for acute bronchitis is primarily supportive. Care
for chronic bronchitis includes avoidance of environmental irritants.
Agents employed for symptomatic treatment include the following:
 Central cough suppressants (eg, codeine and dextromethorphan) – Short-term symptomatic relief of
coughing in acute and chronic bronchitis
 Bronchodilators (eg, ipratropium bromide and theophylline) – Control of bronchospasm, dyspnea, and
chronic cough in stable patients with chronic bronchitis; a long-acting beta-agonist plus an inhaled
corticosteroid can also be offered to control chronic cough
  Nonsteroidal anti-inflammatory drugs (NSAIDs) – Treatment of constitutional symptoms of acute
bronchitis, including mild-to-moderate pain
 Antitussives/expectorants (eg, guaifenesin) – Treatment of cough, dyspnea, and wheezing
 Mucolytics – Management of moderate-to-severe COPD, especially in winter
Among otherwise healthy individuals, antibiotics have not demonstrated any consistent benefit in acute
bronchitis. The following recommendations have been made with respect to treatment of acute bronchitis with
antibiotics:
 Acute bronchitis should not be treated with antibiotics unless comorbid conditions pose a risk of serious
complications
 Antibiotic therapy is recommended in elderly (>65 years) patients with acute cough if they have had a
hospitalization in the past year, have diabetes mellitus or congestive heart failure, or are receiving
steroids
 Antibiotic therapy is recommended in patients with acute exacerbations of chronic bronchitis
In stable patients with chronic bronchitis, long-term prophylactic therapy with antibiotics is not indicated.
Influenza vaccination may reduce the incidence of upper respiratory tract infections and, subsequently, reduce
the incidence of acute bacterial bronchitis. It may be less effective in preventing illness than in preventing
serious complications and death.

ASTHMA

ETIOLOGY

No single cause has been identified for asthma. Instead, researchers believe that the breathing condition is
caused by a variety of factors. These factors include:

 Genetics. If a parent or sibling has asthma, you’re more likely to develop it.
 History of viral infections. People with a history of severe viral infections during childhood (e.g. RSV)
may be more likely to develop the condition.
 Hygiene hypothesis. This theory explains that when babies aren’t exposed to enough bacteria in their
early months and years, their immune systems don’t become strong enough to fight off asthma and
other allergic conditions.

PATHOPHYSIOLOGY

Airflow limitation in asthma is recurrent and caused by a variety of changes in the airway. These include:

 Bronchoconstriction. In asthma, the dominant physiological event leading to clinical symptoms is

airway narrowing and a subsequent interference with airflow. In acute exacerbations of asthma,
bronchial smooth muscle contraction (bronchoconstriction) occurs quickly to narrow the airways in
response to exposure to a variety of stimuli including allergens or irritants. 

 Airway edema. As the disease becomes more persistent and inflammation more progressive, other
factors further limit airflow. These include edema, inflammation, mucus hypersecretion and the
formation of inspissated mucus plugs, as well as structural changes including hypertrophy and
hyperplasia of the airway smooth muscle. These latter changes may not respond to usual treatment.

 Airway hyperresponsiveness. Airway hyperresponsiveness—an exaggerated bronchoconstrictor

response to a wide variety of stimuli—is a major, but not necessarily unique, feature of asthma. The
degree to which airway hyperresponsiveness can be defined by contractile responses to challenges
with methacholine correlates with the clinical severity of asthma. The mechanisms influencing airway
hyperresponsiveness are multiple and include inflammation, dysfunctional neuro regulation, and
structural changes; inflammation appears to be a major factor in determining the degree of airway
hyperresponsiveness. Treatment directed toward reducing inflammation can reduce airway
hyperresponsiveness and improve asthma control.

 Airway remodeling. In some persons who have asthma, airflow limitation may be only partially
reversible. Permanent structural changes can occur in the airway; these are associated with a
 progressive loss of lung function that is not prevented by or fully reversible by current therapy. Airway
remodeling involves an activation of many of the structural cells, with consequent permanent changes
in the airway that increase airflow obstruction and airway responsiveness and render the patient less
responsive to therapy

CLINICAL MANIFESTATION

The most common symptom of asthma is wheezing, a squealing or whistling sound made when you
breathe. Other asthma symptoms may include:

 Coughing, especially at night, when laughing, or during exercise

 Tightness in the chest
 Shortness of breath
 Difficulty talking
 Anxiousness or panic
 Fatigue

The type of asthma that you have can determine which symptoms you experience. Not everyone with
asthma will experience these particular symptoms. The first indication that you have asthma may not be an
actual asthma attack.

DIAGNOSIS

There’s no single test or exam that will determine if you or your child has asthma. Instead, your doctor
will use a variety of criteria to determine if the symptoms are the result of asthma. The following can help
diagnose asthma:

 Health history. If you have family members with the breathing disorder, your risk is higher. Alert your
doctor to this genetic connection.
 Physical exam. Your doctor will listen to your breathing with a stethoscope. You may also be given a
skin test to look for signs of an allergic reaction, such as hives or eczema. Allergies increase your risk
for asthma.
 Breathing tests. Pulmonary function tests (PFTs) measure airflow into and out of your lungs. For the
most common test, spirometry, you blow into a device that measures the speed of the air.

Doctors don’t typically perform breathing tests in children under 5 years of age because it’s difficult to
get an accurate reading. Instead, they may prescribe asthma medications to your child and wait to see if
symptoms improve. If they do, your child likely has asthma. For adults, your doctor may prescribe a
bronchodilator or other asthma medication if test results indicate asthma. If symptoms improve with the use of
this medication, your doctor will continue to treat your condition as asthma.

TREATMENT / MODALITIES & MEDICAL

Treatments for asthma fall into three primary categories:
Breathing exercises- These exercises can help you get more air into and out of your lungs. Over time, this
may help increase lung capacity and cut down on severe asthma symptoms. Your doctor or an occupational
therapist can help you learn these breathing exercises for asthma

Quick-acting treatments:
Bronchodilators- Bronchodilators work within minutes to relax the tightened muscles around your airwaves.
They can be taken as an inhaler (rescue) or nebulizer.
First-aid Asthma Treatment- If you think that someone you know is having an asthma attack, tell them to sit
them upright and assist them in using their rescue inhaler or nebulizer. Two to six puffs of medication should
help ease their symptoms.
Long-term asthma control medications:

 Anti-inflammatories. Taken with an inhaler, corticosteroids and other anti-inflammatory medications

help reduce swelling and mucus production in your airwaves, making it easier to breathe.
 Anticholinergics.  These helps stop your muscles from tightening around your airwaves. They’re
usually taken daily in combination with anti-inflammatories.
 Long-acting bronchodilators. These should only be used in combination with anti-inflammatory
asthma medications.
 Biologic therapy drugs. These new, injectable medications may help people with severe asthma.
SURGICAL
Bronchial thermoplasty is a treatment for severe asthma. It's a way to open your airways. The procedure uses
gentle heat to shrink the smooth muscles in your lungs -- the ones that tighten during asthma attacks and
make it hard to breathe.

You'll go to a hospital to get bronchial thermoplasty. It's given in three separate sessions, with about 3 weeks
between each. Each treatment lasts less than an hour, and a different part of your lungs gets treated each
time.

Bronchial thermoplasty doesn't cure asthma. But it may make you feel and breathe better.

DIETETICS

Vitamin D- Getting enough vitamin D may help reduce the number of asthma attacks in children ages 6 to 15,
according to the Vitamin D Council. Sources of vitamin D include:

 salmon
 milk and fortified milk
 fortified orange juice
 eggs

If you know you have allergies to milk or eggs, you may want to avoid them as a source of vitamin D. Allergic
symptoms from a food source can manifest as asthma.

Vitamin A- children with asthma typically had lower levels of vitamin A in their blood than children without
asthma. In children with asthma, higher levels of vitamin A also corresponded to better lung function. Good
sources of vitamin A are:

 carrots
 cantaloupe
 sweet potatoes
 leafy greens, such as romaine lettuce, kale, and spinach
 broccoli

Apples- An apple a day may keep asthma away. According to a research review article in Nutrition Journal,
apples were associated with a lower risk of asthma and increased lung function.

Bananas- A survey published in the European Respiratory Journal found that bananas might

decrease wheezing in children with asthma. This may be due to the fruit’s antioxidant and potassium content,
which may improve lung function.
Magnesium- A study in the American Journal of Epidemiology found that children ages 11 to 19 who had low
magnesium levels also had low lung flow and volume. Kids can improve their magnesium levels by
eating magnesium-rich foods such as:

 spinach
 pumpkin seeds
 Swiss chard
 dark chocolate
 salmon

Inhaling magnesium (through a nebulizer) is another good way to treat asthma attacks.

NSG. CARE / MNGT.

The immediate care of patients with asthma depend on the severity of the symptoms.

Nursing Assessment

Assessment of a patient with asthma includes the following:

 Assess the patient’s respiratory status by monitoring the severity of the symptoms.

 Assess for breath sounds.

 Assess the patient’s peak flow.

 Assess the level of oxygen saturation through the pulse oximeter.

 Monitor the patient’s vital signs.

. EMOHYSEMA

Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the
lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture -creating larger air
spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of
oxygen that reaches your bloodstream.
 When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for
fresh, oxygen-rich air to enter.

Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that
carry air to your lungs (bronchial tubes), which leads to a persistent cough.

Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease
(COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can't
reverse the damage.

 ETIOLOGY

Smoking is the number one factor. Because of this, emphysema is one of the most preventable types of
respiratory diseases. Air pollutants in the home and workplace, genetic (inherited) factors (alpha-1 antitrypsin
deficiency), and respiratory infections can also play a role in causing emphysema.

Cigarette smoking not only destroys lung tissue, it also irritates the airways. This causes inflammation and
damage to cilia that line the bronchial tubes. This results in swollen airways, mucus production, and difficulty
clearing the airways. All of these changes can lead to shortness of breath.

 PATHOPYSIOLOGY

Emphysema is a pathologic diagnosis defined by permanent enlargement of airspaces distal to the terminal
bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange.
Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms.

First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation.

Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.

 CLINICAL MANIFESTATION

Symptoms of emphysema may include coughing, wheezing, shortness of breath, chest tightness, and an
increased production of mucus. Often times, symptoms may not be noticed until 50 percent or more of the lung
tissue has been destroyed. Until then, the only symptoms may be a gradual development of shortness of
breath and tiredness (fatigue), which can be mistaken for other illnesses. People who develop emphysema
have an increased risk of pneumonia, bronchitis, and other lung infections. See your doctor if any of these
symptoms arise:

 Shortness of breath, especially during light exercise or climbing steps

 On-going feeling of not being able to get enough air
 Long-term cough or “smoker’s cough”
 Wheezing
 Long-term mucus production
 On-going fatigue

 DIAGNOSIS

In making a diagnosis of emphysema, your doctor will start by conducting a thorough medical examination,
recording your medical history and asking about any symptoms you are experiencing.

The following tests may then be conducted to make a definite diagnosis:

 Pulmonary Function Testing (PFT) This test involves a series of breathing maneuvers that

measure the airflow and volume of air in your lungs. This allows your doctor to objectively assess the
function of your lungs.
 High Resolution Computed Tomography (HRCT) This is a special type of CT scan that provides
your doctor with high-resolution images of your lungs. Having a HRCT is no different than having a regular
CT scan; they both are performed on an open-air table and take only a few minutes.
 Chest X-Ray Chest X-rays can help confirm a diagnosis of emphysema and rule out other lung
conditions.
 Arterial Blood Gases Analysis These blood tests measure how well your lungs transfer oxygen to
your bloodstream and remove carbon dioxide.
 Sputum Examination Analysis of cells in your sputum can help determine the cause of some lung
problems.

 TREATMENT

The goal of therapy for emphysema is to provide relief of symptoms, prevent complications and slow the
progression of the disease. Quitting smoking is also essential for patients with emphysema, since
continuing to use tobacco will only further damage the lungs. Our Tobacco Education Center offers classes
as well as individual consultations with doctors trained in treating tobacco addiction. We help smokers
maximize the likelihood of success in their efforts to quit.

Medications

Bronchodilator Medications

Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve symptoms of
emphysema by relaxing and opening the air passages in the lungs.

Steroids Inhaled as an aerosol spray, steroids can help relieve symptoms of emphysema associated with
asthma and bronchitis. Over time, however, inhaled steroids can cause side effects, such as weakened
bones, high blood pressure, diabetes and cataracts. It is important to discuss these side effects with your
doctor before using steroids.

Antibiotics

Antibiotics may be used to help fight respiratory infections common in people with emphysema, such as
acute bronchitis, pneumonia and the flu.

Vaccines

Patients with emphysema should receive a flu shot annually and pneumonia shot every five to seven years
to prevent infections.

Oxygen Therapy

As a patient's disease progresses, they may find it increasingly difficult to breathe on their own and may
require supplemental oxygen. Oxygen comes in various forms and may be delivered with different devices,
including those you can use at home.

Surgery or Lung Transplant

Lung transplantation may be an option for some patients with emphysema. For others, lung volume
reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended.

Protein Therapy

Patients with emphysema caused by an alpha-1 antitrypsin (AAT) deficiency may be given infusions of AAT
to help slow the progression of lung damage.

Pulmonary Rehabilitation

An important part of emphysema treatment is pulmonary rehabilitation, which includes education, nutrition
counseling, learning special breathing techniques, help with quitting smoking and starting an exercise
 regimen. Because people with emphysema are often physically limited, they may avoid any kind of physical
activity. However, regular physical activity can actually improve a patient's health and wellbeing.

 Approach Considerations
The goal of therapy is to relieve symptoms, prevent disease progression, improve exercise tolerance and
health status, prevent and treat complications and exacerbations, and reduce mortality.  Treatments should be
added in a stepwise fashion to reach these goals.
Smoking cessation is the single most effective therapy for most COPD patients. Studies have shown that a
less than 10-minute discussion by a physician can motivate a patient to quit smoking.

 SURGICAL

Surgery may be an option for you if: You have COPD symptoms like emphysema(shortness of breath) or

chronic bronchitis (severe cough). Your symptoms haveaffected your quality of life. You have flare-ups more
often than in the past, and you have to go into the hospital because of COPD flares.

 Dietetics

foods are good for emphysema?

A diet higher in fat, lower in carbs may be best

 Protein-rich foods. Eat high-protein, high quality foods, such as grass-fed meat, pastured poultry
and eggs, and fish — particularly oily fish such as salmon, mackerel, and sardines.
 Complex carbohydrates. ...
 Fresh produce. ...
 Potassium-rich foods. ...
 Healthy fats.

 foods to avoid if you have emphysema?

Here are some foods that should be consumed in small quantities or generally avoided by patients of
COPD.

 Fried foods. ...

 Aerated drinks. ...
 Excess salt. ...
 Dairy produce. ...
 Cruciferous vegetables. ...
 Cold cuts and cured meats. ...
 References: ...
 Further Reading.

 Emphysema Nursing Care Plan

Subjective Data:
 Chronic cough
 Difficulty in breathing
 May notice they are avoiding certain activities that they used to participate in and now cannot due to
breathing difficulties… “I used to play with the grandkids, now I can’t.”
 Chest tightness/pain
Objective Data:
 Wheezing
 Shortness of Breath- especially upon exertion
 Oxygen saturation
 Blue/Gray lips/fingernails- especially upon exertion
  Inability to speak full sentences (have to stop to breath)
 Swelling/edema
 Tachycardia
 Barrel chest

 Emphysema Management

 Bronchodilators. These drugs can help relieve coughing, shortness of breath and breathing problems
by relaxing constricted airways.
 Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help
relieve shortness of breath.
 Antibiotics.

9. ATELECTASIS

Your airways are branching tubes that run throughout each of your lungs. When you breathe, air moves from
the main airway in your throat, sometimes called your windpipe, to your lungs. The airways continue branching
and get progressively smaller until they end in little sacs called alveoli.

Your alveoli help to exchange the oxygen in the air for carbon dioxide, a waste product from your tissues and
organs. In order to do this, your alveoli must fill with air.

When some of your alveoli don’t fill with air, it’s called “atelectasis.”Depending on the underlying cause,
atelectasis can involve either small or large portions of your lung. Atelectasis is different from a collapsed lung
(also called pneumothorax). A collapsed lung happens when air gets stuck in the space between the outside of
your lung and your inner chest wall. This causes your lung to shrink or, eventually, to collapse.While the two
conditions are different, pneumothorax can lead to atelectasis because your alveoli will deflate as your lung
gets smaller.

 DIAGNOSIS

diagnose atelectasis, your doctor starts by reviewing your medical history. They look for any previous lung
conditions you’ve had or any recent surgeries.

they try to get a better idea of how well your lungs are working. To do this, they might:

 check your blood oxygen levelwith an oximeter, a small device that fits on the end of your finger
 take blood from an artery, usually in your wrist, and check its oxygen, carbon dioxide levels, and
blood chemistry with a blood gas test
 order a chest X-ray
 order a CT scan to check for infections or blockages, such as a tumor in your lung or airway
 perform a bronchoscopy, which involves inserting a camera, located on the end of a thin, flexible
tube, through your nose or mouth and into your lungs

 TREATMENT

How is it treated?

Treating atelectasis depends on the underlying cause and how severe your symptoms are.

If you’re having trouble breathing or feel like you’re not getting enough air, seek immediate medical treatment.
You may need the assistance of a breathing machine until your lungs can recover and the cause is treated.

Nonsurgical treatment

Most cases of atelectasis don’t require surgery. Depending on the underlying cause, your doctor might suggest
one or a combination of these treatments:

 Chest physiotherapy. This involves moving your body into different positions and using tapping
motions, vibrations, or wearing a vibrating vest to help loosen and drain mucus. It’s generally used for
obstructive or postsurgical atelectasis. This treatment is commonly used in people with cystic fibrosis as
well.
 Bronchoscopy. Your doctor can insert a small tube through your nose or mouth into your lungs to
remove a foreign object or clear a mucus plug. This can also be used to remove a tissue sample from a
mass so that your doctor can figure out what is causing the problem.
 Breathing exercises. Exercises or devices, such as an incentive spirometer, that force you to breathe
in deeply and help to open up your alveoli. This is especially useful for postsurgical atelectasis.
 Drainage. If your atelectasis is due to pneumothorax or pleural effusion, your doctor may need to drain
air or fluid from your chest. To remove fluid, they’ll likely insert a needle through your back, between
your ribs, and into the pocket of fluid. To remove air, they may need to insert a plastic tube, called
a chest tube, to remove extra air or fluid. The chest tube may need to be left in for several days in more
severe cases.

 Surgical treatment

In very rare cases, you may need to have a small area or lobe of your lung removed. This is usually only done
after trying all other options or in cases involving permanently scarred lungs.

 symptoms

The symptoms of atelectasis range from nonexistent to very serious, depending on how much of your lung is
affected and how fast it develops. If only a few alveoli are involved or it happens slowly, you might not have
any symptoms.

When atelectasis involves a lot of alveoli or comes on quickly, it’s hard to get enough oxygen to your blood.
Having low blood oxygen can lead to:

 trouble breathing
 sharp chest pain, especially when taking a deep breath or coughing
 rapid breathing
 increased heart rate
 blue-colored skin, lips, fingernails, or toenails

Sometimes, pneumonia develops in the affected part of your lung. When this happens, you can have the
typical symptoms of pneumonia, such as a productive cough, fever, and chest pain.
  Couse/ etiology
 Injury. Chest trauma — from a fall or car accident, for example — can cause you to avoid taking deep
breaths (due to the pain), which can result in compression of your lungs.
 Pleural effusion. ...
 Pneumonia. ...
 Pneumothorax. ...
 Scarring of lung tissue. ...
 Tumor.

10. COPD

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes
obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production
and wheezing.

Diagnosis
 Spirometer
Open pop-up dialog box

COPD is commonly misdiagnosed. Many people who have COPD may not be diagnosed until the disease is
advanced.

To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical
history, and discuss any exposure you've had to lung irritants — especially cigarette smoke. Your doctor may
order several tests to diagnose your condition.

Tests may include:

 Lung (pulmonary) function tests. These tests measure the amount of air you can inhale and exhale,
and whether your lungs deliver enough oxygen to your blood. During the most common test, called
spirometry, you blow into a large tube connected to a small machine to measure how much air your lungs
can hold and how fast you can blow the air out of your lungs. Other tests include measurement of lung
volumes and diffusing capacity, six-minute walk test, and pulse oximetry.

 Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can
also rule out other lung problems or heart failure.

 CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit
from surgery for COPD. CT scans can also be used to screen for lung cancer.

 Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into
your blood and removing carbon dioxide.

 Laboratory tests. Lab tests aren't used to diagnose COPD, but they may be used to determine the
cause of your symptoms or rule out other conditions. For example, lab tests may be used to determine if
you have the genetic disorder alpha-1-antitrypsin deficiency, which may be the cause of COPD in some
people. This test may be done if you have a family history of COPD and develop COPD at a young age.

 Treatment
Many people with COPD have mild forms of the disease for which little therapy is needed other than
smoking cessation. Even for more advanced stages of disease, effective therapy is available that can
control symptoms, slow progression, reduce your risk of complications and exacerbations, and improve
your ability to lead an active life.
 The most essential step in any treatment plan for COPD is to quit all smoking. Stopping
smoking can keep COPD from getting worse and reducing your ability to breathe. But quitting
smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have
been unsuccessful.

Medications
Several kinds of medications are used to treat the symptoms and complications of COPD. You may take some
medications on a regular basis and others as needed.

Bronchodilators

Bronchodilators are medications that usually come in inhalers — they relax the muscles around your airways.
This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity
of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that
you use every day or both.

Examples of short-acting bronchodilators include:

 Albuterol (ProAir HFA, Ventolin HFA, others)

 Ipratropium (Atrovent HFA)

 Levalbuterol (Xopenex)

 Surgecal

Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by
medications alone. Surgical options include:

 Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged
lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining
healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this
surgery can improve quality of life and prolong survival.

Endoscopic lung volume reduction ― a minimally invasive procedure ― has recently been approved by
the U.S. Food and Drug Administration to treat people with COPD. A tiny one-way endobronchial valve is
placed in the lung, allowing the most damaged lobe to shrink so that the healthier part of the lung has
more space to expand and function.

 Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria.
Transplantation can improve your ability to breathe and to be active. However, it's a major operation that
has significant risks, such as organ rejection, and youꞌll need to take lifelong immune-suppressing
medications.

 Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs (alveoli) are
destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors
remove bullae from the lungs to help improve air flow.

 Lifestyle and home remedies (dietetics)

If you have COPD, you can take steps to feel better and slow the damage to your lungs:

 Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing
more efficiently throughout the day. Also be sure to discuss breathing positions, energy conservation
techniques and relaxation techniques that you can use when you're short of breath.

 Clear your airways. With COPD, mucus tends to collect in your air passages and can be difficult to
clear. Controlled coughing, drinking plenty of water and using a humidifier may help.

 Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular
exercise can improve your overall strength and endurance and strengthen your respiratory muscles.
Discuss with your doctor which activities are appropriate for you.
  Eat healthy foods. A healthy diet can help you maintain your strength. If you're underweight, your
doctor may recommend nutritional supplements. If you're overweight, losing weight can significantly help
your breathing, especially during times of exertion.

 Avoid smoke and air pollution. In addition to quitting smoking, it's important to avoid places where
others smoke. Secondhand smoke may contribute to further lung damage. Other types of air pollution
also can irritate your lungs, so check daily air quality forecasts before going out.

 See your doctor regularly. Stick to your appointment schedule, even if you're feeling fine. It's
important to regularly monitor your lung function. And be sure to get your annual flu vaccine in the fall to
help prevent infections that can worsen your COPD. Ask your doctor when you need the pneumococcal
vaccine. Let your doctor know if you have worsening symptoms or you notice signs of infection.

Pathogenesis

Inflammation is present in the lungs, particularly the small airways, of all people who smoke. This normal
protective response to the inhaled toxins is amplified in COPD, leading to tissue destruction, impairment of the
defence mechanisms that limit such destruction, and disruption of the repair mechanisms. In general, the
inflammatory and structural changes in the airways increase with disease severity and persist even after
smoking cessation. Besides inflammation, two other processes are involved in the pathogenesis of COPD—an
imbalance between proteases and antiproteases and an imbalance between oxidants and antioxidants
(oxidative stress) in the lungs.

 Pathophysiology
A chronic airway obstruction that limits airflow into and out of the alveoli – this restricts O2 from entering AND
traps CO2 from escaping.

 Etiology
There are two types of COPD: Chronic Bronchitis and Emphysema. The most common cause of COPD is
smoking of any form: cigarette, pipe, cigar, second hand. Any lung irritant can cause COPD and also
exacerbate it.

Desired Outcome
Clear, even, non-labored breathing while maintaining optimal oxygenation for patients.

 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan

Subjective Data:
 Difficulty Breathing
 Chest tightness
 “I can’t breathe”
Objective Data:
 Wheezing
 ↓ Oxygen saturation
 ↓ pH and ↑ pCO2 on ABG
 Blue/Gray lips/fingernails
 Inability to speak full sentences (have to stop to breathe)
 Swelling/edema
o Caused by Cor Pulmonale (right-sided heart failure due to increased pressures within the
lungs).
 Tachycardia
 Barrel Chest
 Congestion on X-ray

Nursing Interventions and Rationales

 Avoid irritants:
o Quit smoking or being around secondhand smoke
o Be mindful of the weather (very cold weather can aggravate the bronchi)
o Allergens like dust or pollen
  The key to avoiding a flare-up of COPD is to avoid things that make it worse. If the patient is smoking still this
is a priority, they need to quit smoking. Provide education on smoking with COPD and the benefits of quitting.  
 If the patient has been working very hard to breathe for a long period and is getting worse, be prepared
with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient!
  Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway.
Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis long
before their physical airway becomes compromised…  
 Breathing Treatments and medications**Bronchodilators BEFORE corticosteroids
 
 Beta-Agonists: Such as albuterol work as bronchodilators
 Anticholinergics: Such as Ipratropium work to relax bronchospasms
 Corticosteroids: Such as Fluticasone work as an anti-inflammatory

 
 Monitor Oxygen saturation. Do NOT give > 2 pm NC without orders from a provider.
  This is subjective as you need to make sure to understand the patient’s baseline. Plan oxygen monitoring with
the physician. Give oxygen as ordered and needed. Be careful about turning their drive to breathe off by giving
too much O2. As a general rule, COPD patients should be kept around 88%-92%.  
 Obtain an ECG
  The lungs and the heart are in the same general area if someone is having problems breathing, make sure
their heart is ok. Sometimes people having a heart attack can feel like they can’t breathe due to the pressure or
pain on their chest. Also, COPD is stressful on the heart, so even if the main problem is breathing, monitoring
the heart, especially during an episode/exacerbation is important.  
 Encourage a healthy weight can be either overweight or underweight
  Having access to weight on the patient decreases the space for the lungs to expand. Plus, generally, those
who lose weight are also moving more to lose the weight, double win. Some patients (especially those with
emphysema) can be very thin (barrel-chested) and it is important to make sure they are getting the proper
nutrition so their body is at the optimal performance (for that patient).  
 Encourage small, frequent meals
  Patients find it hard to eat large meals or food that needs to be chewed extensively – it is difficult to eat and
breathe at the same time. Encouraging them to eat smaller, more frequent meals will help to ensure they get
adequate nutritional intake.  
 Encourage movement/activity
  Sedentary lifestyle causes increased shortness of breath and less tolerance for movement. Helping the
patient move more often helps improve breathing abilities.  
 Assess for/Administer influenza vaccine and pneumococcal vaccine
   Preventing complications such as influenza or pneumonia is important because the lungs are already working
harder to keep the body balanced with oxygen and CO2. An increased risk of infection only complicates the
patient’s ability to breathe.

 CLINICAL MANIFESTATION

Common signs and symptoms of COPD include:

 An ongoing cough or a cough that produces a lot of mucus; this is often called smoker's cough.

 Shortness of breath, especially with physical activity.
 Wheezing or a whistling or squeaky sound when you breathe.
 Chest tightness.

11. Bronchiectasis

Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to
a build-up of excess mucus that can make the lungs more vulnerable to infection.

 The most common symptom of bronchiectasis is a persistent cough that brings up a

large amount of phlegm on a daily basis.

The phlegm can be clear, pale yellow or yellow-greenish in colour. Other people may only occasionally cough
up small amounts of phlegm, or none at all.

Other symptoms may include:

 shortness of breath
 wheezing
 coughing up blood or blood stained phlegm
 chest pain
 joint pain
 clubbing of the fingertips – the tissue beneath the nail thickens and the fingertips become rounded and
bulbous

Pathophysiology

As bronchiectasis is an acquired disorder, its pathophysiology is commonly described as distinct phases of

infection and chronic inflammation. The interaction between these phases establishes a vicious circle (Fig. 1)
in which the end result is the destruction of the bronchi and the accompanying clinical symptoms.
 Fig 1. Vicious circle of bronchiectasis

 CLINICAL MANIFESTATION

The most common signs and symptoms of bronchiectasis are:

 A daily cough that occurs over months or years.

 Daily production of large amounts of sputum (spit). ...
 Shortness of breath and wheezing (a whistling sound when you breathe)
 Chest pain.
 Clubbing (the flesh under your fingernails and toenails gets thicker)

 Modalities and medical

Antibiotics Antibiotics may be used to help fight respiratory infections caused by bronchiectasis. Mucus
Thinners and Expectorants Mucus thinners and expectorants help loosen and clear mucus from lungs.
Respiratory Therapy People with bronchiectasis must clear mucus from their lungs on a daily basis.

Antibiotics are the most common treatment for lung infections, which can be common in people with
bronchiectasis. Some people take continuous antibiotics because they get a lot of infections. Antibiotics may
be taken orally, or in case of more difficult to treat infections, they may be given intravenously.

 SUGICAL

 Surgical treatment of bronchiectasis usually uses pulmonary resection, or the removal of part of the lung.
Oftentimes, partial resection of the lung is completed with minimal morbidity and mortality. 

 DIETETICS

Eat a healthy balanced diet with less processed foods and more whole foods. Avoid excessive salt, sugar

and saturated fat and eat plenty of fiber in the form of fruit, vegetables, and whole grains.

 Nursing Care Planning & Goals

The goals for a patient with bronchiectasis include:

 Improvement in gas exchange.

  Achievement of airway clearance.

 Improvement in breathing pattern.

 Improvement in activity tolerance.

Nursing Interventions

Nursing interventions focus on the following:

 Smoking cessation. Patient teaching targets smoking and other factors that increase the
production of mucus and hamper its removal.

 Bronchodilators. Administer bronchodilators as prescribed.

 Postural drainage. Perform postural drainage with percussion and vibration in the morning and at
night as prescribed.

 Antibiotics. Administer antibiotics as prescribed.

 Activities. Encourage alternating activity with rest periods.

12. PNEUMONIA

Pneumonia and your lung

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus
(purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of
organisms, including bacteria, viruses and fungi, can cause pneumonia.

 Clinical manifestation/ Symptoms

The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of
germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to
those of a cold or flu, but they last longer.

 Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)

 Cough, which may produce phlegm

 Fatigue
  Fever, sweating and shaking chills

 Lower than normal body temperature (in adults older than age 65 and people with weak immune
systems)

 Nausea, vomiting or diarrhea

 Shortness of breath

 (ETIOLOGY)Causes

Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your
body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your
immune system, even if your health is generally good.

Pneumonia is classified according to the types of germs that cause it and where you got the infection.

PATHOGENESIS. Pneumonia indicates an inflammatory process of the lung parenchyma caused by a

microbial agent. The most common pathway for the microbial agent to reach the alveoli is by microaspiration of
oropharyngeal secretions.

Pneumonia, inflammation and consolidation of the lung tissue as a result of infection, inhalation of foreign
particles, or irradiation. Many organisms, including viruses and fungi, can cause pneumonia, but the most
common causes are bacteria, in particular species of Streptococcus and Mycoplasma.

 Diagnosis

Chest X-ray showing pneumoniaOpen pop-up dialog box

Your doctor will start by asking about your medical history and doing a physical exam, including listening to
your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that suggest pneumonia.

If pneumonia is suspected, your doctor may recommend the following tests:

 Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism
causing the infection. However, precise identification isn't always possible.

 Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the
infection. However, it can't tell your doctor what kind of germ is causing the pneumonia.
  Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs
from moving enough oxygen into your bloodstream.

 Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to
help pinpoint the cause of the infection.

 Treatment

Treatment for pneumonia involves curing the infection and preventing complications. People who have
community-acquired pneumonia usually can be treated at home with medication. Although most symptoms
ease in a few days or weeks, the feeling of tiredness can persist for a month or more.

Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. The
options include:

 Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the
type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms
don't improve, your doctor may recommend a different antibiotic.

 Cough medicine. This medicine may be used to calm your cough so that you can rest. Because
coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough
completely. In addition, you should know that very few studies have looked at whether over-the-counter
cough medicines lessen coughing caused by pneumonia. If you want to try a cough suppressant, use the
lowest dose that helps you rest.

 Fever reducers/pain relievers. You may take these as needed for fever and discomfort. These include
drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).

 Lifestyle and home remedies

These tips can help you recover more quickly and decrease your risk of complications:

 Get plenty of rest. Don't go back to school or work until after your temperature returns to normal and
you stop coughing up mucus. Even when you start to feel better, be careful not to overdo it. Because
pneumonia can recur, it's better not to jump back into your routine until you are fully recovered. Ask your
doctor if you're not sure.

 Stay hydrated. Drink plenty of fluids, especially water, to help loosen mucus in your lungs.

 Take your medicine as prescribed. Take the entire course of any medications your doctor prescribed
for you. If you stop taking medication too soon, your lungs may continue to harbor bacteria that can
multiply and cause your pneumonia to recur.

13. PUMONARY TUBERCULOSIS

Pulmonary tuberculosis is defined as an active infection of the lungs (latin pulmo = lung). It is the most
important TB infection, because an infection of the lungs is highly contagious due to the mode of
droplet transmission. It can be life-threatingly dangerous to the patient: if left untreated, more than 50% of
patients with pulmonary tuberculosis die. Worldwide, 87% of all tuberculosis cases that were reported in 2004
were either only pulmonary TB or included pulmonary TB. 
 X-ray showing pulmonary TB infection

Most cases of pulmonary TB are post-primary TB infections. This means that after the initial, primary infection
has healed, the granuloma (the mass of immune cells surrounding the TB infection preventing it from doing
further damage) that was formed during that process still contains TB bacteria, which can survive for years
(see How TB infects the body).
If the immune system of the person with a TB granuloma deteriorates, these bacteria can be reactivated and
TB may break out again.

 Causes/etiology

Pulmonary TB is caused by the bacterium Mycobacterium tuberculosis (M tuberculosis). TB is contagious. This

means the bacteria is easily spread from an infected person to someone else. You can get TB by breathing in
air droplets from a cough or sneeze of an infected person. The resulting lung infection is called primary TB.
Most people recover from primary TB infection without further evidence of the disease. The infection may stay
inactive (dormant) for years. In some people, it becomes active again (reactivates).

Most people who develop symptoms of a TB infection first became infected in the past. In some cases, the
disease becomes active within weeks after the primary infection.

The following people are at higher risk of active TB or reactivation of TB:

 Older adults

 Infants

 People with weakened immune systems, for example due to HIV/AIDS, chemotherapy, diabetes, or
medicines that weaken the immune system
Your risk of catching TB increases if you:

 Are around people who have TB

 Live in crowded or unclean living conditions

 Have poor nutrition

The following factors can increase the rate of TB infection in a population:

 Increase in HIV infections

 Increase in number of homeless people (poor environment and nutrition)

 Presence of drug-resistant strains of TB

Pathophysiology . Although, usually a lung infection, tuberculosis is a multi-system disease with protean

manifestation. The principal mode of spread is through inhalation of infected aerosolized droplets