Acute respiratory distress syndrome

Acute respiratory distress syndrome, commonly called ARDS, is a sudden failure of the respiratory
system that occurs when fluid builds up in the tiny, elastic air sacs in your lungs. In a short time,
breathing becomes difficult, depriving your organs of the oxygen they need to function.

ARDS usually occurs in people who are already critically ill or who have significant injuries. Severe
shortness of breath — the main symptom of ARDS — usually develops within a few hours to a few
days after the original disease or trauma.

Signs and symptoms

Severe shortness of breath

Labored and unusually rapid breathing

Low blood pressure

Confusion and extreme tiredness

Cough or fever, in some cases

Causes

 Severe viral or bacterial pneumonia

 Infection spreading through your bloodstream (sepsis)

 Heart failure with fluid in your lungs

 Multiple or massive blood transfusions

 A serious head or chest injury

 Fractures of long bones, such as the femur, which can release fat particles that are
carried through your bloodstream to your lungs (fat embolism)

 Prolonged use — from several days to a week — of large volumes of supplemental

oxygen

 Accidental inhalation of vomit or chemicals, such as ammonia or chlorine

 Smoke inhalation

Risk factors

 Have a widespread infection in your bloodstream (sepsis)

 Have chronic liver disease (cirrhosis)

 Use a breathing machine (mechanical ventilator)

 Have had certain types of surgery recently

 Are a heavy drinker

 Are a current or former smoker

Complications

 Pulmonary fibrosis. 

 Collapsed lung (pneumothorax). 

 Bacterial infections. 

 Abnormal lung function. 

 Muscle wasting and weakness. 

 Memory, cognitive and emotional problems. 

Diagnostic tests

 Chest X-ray

 Arterial blood gas analysis

 Computerized tomography (CT) scan

 Blood tests to determine infection

 Heart tests to rule out heart problems that can cause fluid to build up in your lungs.

Interventions

 Identify and treat the cause of the acute respiratory syndrome.

 Administer oxygen as prescribed
 Place the client in high fowler’s position
 Restrict fluid intake as prescribed
 Provide respiratory treatments as prescribed
 Administer diuretics, anticoagulants or corticosteroid as prescribed.
 Prepare the client for intubation and mechanical ventilation using PEEP.

Asthma

 chronic inflammatory disorder of the airways that causes varying degrees of obstruction
in the airways.
 Marked by the airways inflammation and hyperresponsivenes to a variety of stimuli
 Status asthmaticus is a severe life threatening asthma episode that os refractory to
treatment and may result pneumothorax, acute or cor pulmonale or respiratory arrest

Signs and symptoms

 Restlessness
 Wheezing or crackles
 Absent or diminished lung sounds
 Hyperresonance
 Use of accessory muscle for breathing
  Tachypnea with hyperventilation
 Prolonged exhalation
 Tachycardia
 Cyanosis
 Diaphoresis
 Pulsus paradoxus
 Decreased oxygen saturation
 Decreased airflow rates
Causes

 Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites

 Respiratory infections, such as the common cold

 Physical activity (exercise-induced asthma)

 Cold air

 Air pollutants and irritants, such as smoke

 Certain medications, including beta blockers, aspirin and other nonsteroidal anti-
inflammatory drugs

 Strong emotions and stress

Risk factors

 Having a blood relative (such as a parent or sibling) with asthma

 Having an allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)

 Being overweight

 Being a smoker

 Exposure to secondhand smoke

 Having a mother who smoked while pregnant

 Exposure to exhaust fumes or other types of pollution

 Exposure to occupational triggers, such as chemicals used in farming, hairdressing and

manufacturing

 Low birth weight

Complications

 Sick days from work or school during asthma flare-ups

 Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well
you can breathe

 Emergency room visits and hospitalizations for severe asthma attacks

 Side effects from long-term use of some medications used to stabilize severe asthma

Interventions
 Monitor vital signs
 Monitor pulse oximetry
 Monitor peak flow
 Position the client in semi fowler’s position during acute attacks.
 Administer oxygen as prescribed
 Stay with the client to decrease anxiety
 Administer bronchodilators as prescribed
 Record the color, amount, and consistency of the sputum, if any
 Administer corticosteroid as prescribed
 Auscultate lung sounds before, during and after treatment

Atelectasis

 Atelectasis a complete or partial collapse of a lung — is a possible complication of many

respiratory problems. Mucus in the airways after surgery, cystic fibrosis, inhaled foreign
objects, severe asthma and chest injuries are among the common causes of atelectasis.
 Atelectasis can be serious because it impairs the exchange of oxygen and carbon
dioxide in your lungs. Treatment depends on the cause and severity of the collapse.

Symptoms

 Difficulty breathing (dyspnea)

 Rapid, shallow breathing

 Cough

 Low-grade fever (in a child)

Causes

 Mucus plug. .

 Foreign body. 

 Narrowing of major airways from disease. 

 Tumor in a major airway. .

 Blood clot. 

 Injury.

 Pleural effusion. 

 Pneumonia. 

 Pneumothorax. 

 Scarring of lung tissue. 

 Tumor. 

Risk factors

 Premature birth, if the lungs aren't fully developed

 Any condition that interferes with spontaneous coughing, yawning and sighing

 Lung disease, such as asthma, bronchiectasis or cystic fibrosis

 Confinement to bed, with infrequent change of position

 Abdominal or chest surgery

 Recent general anesthesia

 Shallow breathing — a result of abdominal pain or rib fracture, for example

 Respiratory muscle weakness, due to muscular dystrophy, spinal cord injury or another
neuromuscular condition

 Obesity, which can elevate your diaphragm and hamper your ability to inhale fully

Intervention

Medications :

 Acetylcysteine (Acetadote, Mucomyst), which thins mucus and makes it easier to cough
up.

 Inhaled bronchodilators (Foradil, Maxair, Proventil, Serevent, Ventolin, Xopenex), which

open the bronchial tubes of the lungs, making breathing easier.

 DNase (Dornase Alfa), which is used to clear mucus plugs in children with cystic fibrosis
and is gaining acceptance as a treatment for atelectasis for people without cystic fibrosis.

 Clapping (percussion) on your chest over the collapsed area to loosen mucus

 Performing deep-breathing exercises (incentive spirometry)

 Positioning your body so your head is lower than your chest (called postural drainage),
which allows mucus to drain better

 Supplemental oxygen, which can help relieve shortness of breath (dyspnea)

Bronchitis

Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from
your lungs. Bronchitis may be either acute or chronic.

A common condition, acute bronchitis often develops from a cold or other respiratory infection.
Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining
of the bronchial tubes, often due to smoking.  
 Symptoms

 Cough

 Production of mucus (sputum), either clear or white or yellowish-gray or green in color

 Shortness of breath, made worse by mild exertion

 Wheezing

 Fatigue

 Slight fever and chills

 Chest discomfort

Risk factors

 Cigarette smoke. 

 Low resistance. 

 Gastroesophageal reflux disease (GERD). 

 Exposure to irritants on the job. 

Complications

 Chronic bronchitis

 Asthma

 Other lung disorders

 Rest

 Drinking fluids

 Breathing in warm, moist air

 Taking an over-the-counter (OTC) cough suppressant and acetaminophen (Tylenol,

others) or aspirin (for adults)

Medications
In some circumstances, your doctor may prescribe medications:

 Antibiotics. Bronchitis usually results from a viral infection, so antibiotics aren't

effective. However, your doctor may prescribe an antibiotic if he or she suspects that you have a
bacterial infection. If you have a chronic lung disorder or if you smoke, your doctor may also
prescribe antibiotics to reduce your risk of a serious, secondary infection.

 Cough medicine. It's best not to suppress a cough that brings up mucus, because
coughing helps remove irritants from your lungs and air passages. If your cough keeps you from
sleeping, use enough OTC cough medicine so that you can rest, but not enough to suppress your
 cough completely. If your cough is seriously depriving you of sleep, your doctor may recommend
a prescription cough suppressant.

 Other medications. If you have asthma or chronic obstructive pulmonary disease

(COPD), your doctor may recommend an inhaler and other medications to reduce inflammation
and open narrowed passages in your lungs.

Intervention

 Rest

 Drinking fluids

 Breathing in warm, moist air

 Taking an over-the-counter (OTC) cough suppressant and acetaminophen (Tylenol,

others) or aspirin (for adults)

Medications
Antibiotics and Cough medicine. 

Emphysema

Emphysema is a factor in the progression of chronic obstructive pulmonary disease (COPD), a

condition that limits the flow of air when you breathe out. Emphysema occurs when the air sacs
at the ends of your smallest air passages (bronchioles) are gradually destroyed. Smoking is the
leading cause of emphysema.

As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into
large, irregular pockets with gaping holes in their inner walls. This reduces the number of air
sacs and keeps some of the oxygen entering your lungs from reaching your bloodstream. In
addition, the elastic fibers that hold open the small airways leading to the air sacs are slowly
destroyed, so that they collapse when you breathe out, not letting the air in your lungs escape.

Airway obstruction, another feature of COPD, contributes to emphysema. The combination of

emphysema and obstructed airways makes breathing increasingly difficult. Treatment often
slows, but doesn't reverse, the process.

Symptoms

Emphysema symptoms are mild to begin with but steadily get worse as the disease progresses.
The main emphysema symptoms are:

 Shortness of breath

 Wheezing

 Chest tightness

 Reduced capacity for physical activity

 Chronic coughing, which could also indicate chronic bronchitis

 Loss of appetite and weight

 Fatigue

Causes

 Smoking. 

 Protein deficiency

Risk fators

 Smoking.

 Age. 

 Exposure to secondhand smoke. 

 Occupational exposure to fumes or dust. 

 Exposure to indoor and outdoor pollution. 

 HIV infection. 

 Connective tissue disorders.

Test and diagnosis

 Spirometry and other pulmonary function tests (PFTs). 

 Arterial blood gases analysis. 

 Pulse oximetry. 

 Chest X-ray. 

 Sputum examination. 

 Computerized tomography (CT) scan.  

Intervention

 A target date to quit

 Relapse prevention

 Advice for healthy lifestyle changes

 Social support systems

 Lie on your back with your head and knees supported by pillows. 

 Place your fingertips on your abdomen, just below the base of your rib cage. 

 Practice pushing your abdomen against your hand as your chest becomes filled with air. 

 Pursed-lip breathing

 Deep-breathing exercise.

 Stop smoking. 

 Avoid other respiratory irritants. 

 Exercise regularly. 

 Clear your airways. 

 Protect yourself from cold air. 

 Avoid respiratory infections. 

 Maintain good nutrition. 

 Other medications

 Bronchodilators. 

 Inhaled steroids. 

 Supplemental oxygen

 Pulmonary rehabilitation program. 

 Antibiotics. 

 Inoculations against influenza and pneumonia. 

Pulmonary fibrosis

Pulmonary fibrosis is a serious disease that causes progressive scarring of your lung tissue.

The current thinking is that pulmonary fibrosis begins with repeated injury to the tissue within
and between the tiny air sacs (alveoli) in your lungs. The damage eventually leads to scarring
 (fibrosis), which stiffens your lungs and makes breathing difficult. The most common symptoms
are shortness of breath and a dry cough.

signs and symptoms

 Shortness of breath (dyspnea)

 A dry cough

 Fatigue

 Unexplained weight loss

 Aching muscles and joints

Causes

 Occupational and environmental factors

 Radiation.

Risk factors

 Age. 

 Your sex. In general, men are more likely to have pulmonary fibrosis than women are.

 Occupational and environmental toxins. 

 Radiation and chemotherapy. 

Complications

 Low blood-oxygen levels (hypoxemia

 High blood pressure in your lungs (pulmonary hypertension). 

 Right-sided heart failure (cor pulmonale). 

 Respiratory failure. 

Diagnostic tests

 Chest X-ray. 

 High-resolution computerized tomography (HRCT) scan. 

 Pulmonary function tests. 

 Oximetry. 
 Exercise stress test. 

Intervention

 The lung scarring that occurs in pulmonary fibrosis can't be reversed, and no current
treatment has proved effective in stopping the ultimate progression of the disease. Some
treatments, though, may improve symptoms temporarily or slow the disease's progress.
Others help improve quality of life.
 Stop smoking
 Exercise regularly. 
 Eat well. 
 Get plenty of rest

Pneumonia

Pneumonia is an inflammation of your lungs, usually caused by infection. Bacteria, viruses, fungi
or parasites can cause pneumonia. Pneumonia is a particular concern if you're older than 65 or
have a chronic illness or impaired immune system. It can also occur in young, healthy people.

Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a

complication of another condition, such as the flu. Antibiotics can treat most common forms of
bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach
is to try to prevent infection.

Signs

 Fever

 Cough

 Shortness of breath

 Sweating

 Shaking chills

 Chest pain that fluctuates with breathing (pleurisy)

 Headache

 Muscle pain

 Fatigue

Causes

 Community acquired Pneumonia

 Hospital-acquired (nosocomial) pneumonia.

 Aspiration pneumonia. 
 Pneumonia caused by opportunistic organisms. 

Risk factors

 Age. 

 Certain diseases. 

 Smoking, alcohol abuse

 Hospitalization in an intensive care unit. 

 Having COPD and using inhaled corticosteroids for more than 24 weeks. 

 Exposure to certain chemicals or pollutants. 

 Surgery or traumatic injury. 

 Ethnicity. 

Complications

 Bacteria in your bloodstream. .

 Fluid accumulation and infection around your lungs

 Lung abscess. 

 Acute respiratory distress syndrome (ARDS). 

Diagnostic tests

 Physical exam. 

 Chest X-rays. 

 Blood and mucus tests. 

Intervention

 Get plenty of rest

 Stay home from school or work until after your temperature returns to normal and you stop
coughing up mucus. 

 Drink plenty of fluids, especially water. 

 Take the entire course of any prescribed medications

 Keep all of your follow-up appointments. 

 Give prescribed medication

 Pneumothorax
 A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between your
lungs and chest wall, creating pressure against the lung. Depending on the cause of the
pneumothorax, your lung may only partially collapse, or it may collapse completely.

A pneumothorax can be caused by a chest injury, certain medical procedures involving your
lung, lung disease, or it may occur for no obvious reason.

Signs

 Sudden, sharp chest pain on the same side as the affected lung — this pain doesn't occur
in the center of your chest under the breast bone

 Shortness of breath, which may be more or less severe, depending on how much of your
lung is collapsed

 A feeling of tightness in your chest

 A rapid heart rate

Risk factors

 Your sex. In general, men are far more likely to have a pneumothorax than women

 Smoking. 

 Age. 

 Lung disease. 

 A history of pneumothorax. 

 Complication

 Persistent air leak. 

 Low blood oxygen levels (hypoxemia). 

 Cardiac arrest. 

 Respiratory failure. 

 Shock. 

 Diagnostic tests

 Computerized tomography (CT) scan. 

 Blood tests. 

Intervention

Needle or chest tube insertion

Frequent observation .