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ADULT HEALTH NURSING

BSc Nursing - 3rd Semester Notes

UNIT 1: INTRODUCTION TO ADULT HEALTH NURSING

Definition (ANA): According to the American Nurses Association (ANA), Adult Health Nursing (AHN) is a specialized area of nursing that focuses on the promotion, maintenance, and restoration of health and prevention of illness in adult patients.

UNIT 2: RESPIRATORY SYSTEM

Definition (WHO): According to WHO, the Respiratory System is an organ system responsible for breathing and gas exchange. It supplies oxygen to the body, removes CO₂, maintains normal body function, and maintains homeostasis.

UNIT 3: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Definition

COPD is a common, preventable and treatable lung disease characterized by persistent respiratory airflow limitation, caused by abnormality of the airway or alveoli.

A. BRONCHITIS

Definition: Bronchitis is the inflammation of bronchi - the major air passages that connect the trachea to the lungs. It is characterized by swelling of the bronchial mucosa, excess mucus secretion, cough, and difficulty in breathing.

Types of Bronchitis:

Type	Description
Acute Bronchitis	Acute inflammation of the bronchi lasting less than 3 weeks
Chronic Bronchitis	Chronic inflammation of the bronchi lasting at least 3 months in each of 2 consecutive years, after excluding other causes. It is one of the major causes of COPD.

Causes of Acute Bronchitis (Viral):

Rhinovirus
Adenovirus
COVID-19

Causes of Acute Bronchitis (Bacterial):

Mycoplasma pneumoniae

Risk Factors / Causes of Chronic Bronchitis:

Smoking (most common)
Air pollution
Dust exposure
Occupational hazard
Chronic lung disease
Weather change
Poor nutrition

Characteristics of Chronic Bronchitis:

Excessive mucus production
Narrowing of airway
Progressive airflow limitation
Persistent cough

Pathophysiology:

Due to causative factors (smoking, pollution, infection)
Inflammation of bronchial mucosa begins
Vasodilation and edema → airway narrowing (contraction)
Excess mucus secretion
Reduced ciliary function
Airflow obstruction

Signs and Symptoms:

Persistent cough
Productive sputum (thick, green-yellow-white colored mucus)
Fever
Fatigue
Weakness
Dyspnea (difficulty in breathing)
Chest tightness
Tachypnea (rapid breathing)
Crackles on auscultation

B. EMPHYSEMA

Definition: Emphysema is a chronic lung disease and a major form of COPD. In emphysema, the tiny air sacs (alveoli) of the lungs become damaged and lose their elasticity. This makes it harder to breathe and trapping of air occurs, reducing the movement of oxygen into the blood stream.

Characteristics:

Enlarged enzyme (protease-antiprotease imbalance)
Morbid air trapping
Progressive breathlessness
Hyperinflated (barrel) chest
Reduced exercise tolerance

Common Symptoms:

Dyspnea
Breathlessness
Chest pain/tightness
Progressive worsening dyspnea
Persistent cough with mucus
Wheezing sound
Fatigue
Weight loss

Nursing/Medical Management of Emphysema:

Cessation of smoking (strongly advised)
Exercise and pulmonary rehabilitation
Medication support
Oxygen intake (supplemental O₂)
Airway management

UNIT 4: DIAGNOSTIC TESTS FOR RESPIRATORY DISORDERS

History Collection:

Take complete patient history

Blood Investigations (CBC):

Hemoglobin (Hb)
WBC (White Blood Cells)
RBC (Red Blood Cells)
Urea
Sodium
Potassium
Creatinine

Sputum Examination:

For culture and sensitivity

Pulmonary Function Tests:

PFT (Pulmonary Function Test)
Pulse Oximetry (SpO₂)
ABG (Arterial Blood Gas)
CT Scan

UNIT 5: MEDICAL MANAGEMENT OF COPD/BRONCHITIS

Pharmacological Management:

Drug Class	Purpose
Bronchodilators	Dilate airways; relieve bronchospasm
Corticosteroids	Reduce airway inflammation
Antibiotics	Treat bacterial infection
Antitussives	Suppress cough
Expectorants & Mucolytics	Loosen and thin mucus secretions
Bone protectors	Protect from steroid-induced bone loss

UNIT 6: CAUSE OF COPD (ADDITIONAL FACTORS)

Alpha-1 Antitrypsin Deficiency (AATD)

A real inherited condition (Alpha-1 Antitrypsin Deficiency)
It is an inherited genetic disorder in which the body produces reduced amounts of a protein called alpha-1 antitrypsin (AAT)
AAT is a protein that protects the lungs and is produced mainly in the liver
Deficiency of AAT leads to progressive lung damage

Diagnostic Tests for AATD:

History collection
Blood investigation
PFT

Medical Treatment:

Bronchodilators
Antibiotics

UNIT 7: BARREL CHEST

Definition: It is a chest that appears round and enlarged, giving it the shape of a barrel. The posture forms from front to back (anteroposterior diameter increases), giving the barrel shape.

Clinical Note: Barrel chest is commonly seen in patients with long-standing emphysema due to chronic air trapping and lung hyperinflation.

UNIT 8: PLEURAL EFFUSION

Definition

A collection of excess fluid in the pleural space. Normally, the pleural space contains only 10-20 mL of fluid. Any accumulation more than 20 mL is considered pleural effusion.

Pleural effusion is secondary to many other diseases.

Classification

1. Transudative Pleural Effusion

Also known as hydrothorosis/nephrotic effusion
Occurs in:
- Non-inflammatory condition
- Congestive heart failure
- Nephrotic syndrome
It is an accumulation of low-protein, no-cell-count flow
Results from imbalance in hydrostatic and oncotic pressures

2. Exudative Pleural Effusion

Occurs in areas of inflammation
Inflammation is an accumulation of increased protein content
Results from increased capillary permeability
Seen in: Pneumonia, TB, Pulmonary embolism

Etiology:

Pneumonia
Pleural pulmonary infections
Nephrotic syndrome
Heart failure
Cirrhosis
Peritoneal dialysis

Pathophysiology of Pleural Effusion

Hydrostatic pressure increases
Oncotic pressure decreases
Unable to maintain fluid in intravascular space
Transfer to intrastial (interstitial) space and infusion into pleural cavity

Key Terms:

Oncotic pressure (Colloidal osmotic pressure): Pressure exerted by protein in blood that keeps fluid in blood vessels
Intrastial pressure: The pressure of fluid present outside blood vessels

UNIT 9: LUNG ABSCESS

Definition

A lung abscess is a localized collection of pus within the lung tissue, caused by:

Destruction and necrosis of lung tissue
Infection due to bacteria
It commonly produces a cavity containing pus that communicates with the bronchus

Causes / Risk Factors

Anaerobic bacterial infection
Aspiration of oropharyngeal contents
Pneumonia (complications)

Additional Causes:

Septic (septicemia)
Poor dental hygiene
Immunosuppression
Staphylococcal pneumonia
Gram-negative organisms

Pathophysiology (Flow Chart):

Aspiration (due to causes above)
        ↓
Bacterial Infection begins
        ↓
Inflammation of lung tissue
        ↓
Tissue destruction and necrosis
        ↓
Pus formation
        ↓
Cavity develops in lung tissue
        ↓
Cavity may rupture into bronchus
        ↓
Productive cough with foul-smelling sputum

Signs and Symptoms:

Acute Lung Abscess:

Sudden onset
Difficulty in self-care
Usually present with fever, cough

Chronic Lung Abscess:

Productive cough with foul-smelling sputum
Prolonged course

QUICK REVISION TABLE

Condition	Key Feature	Major Cause
Acute Bronchitis	< 3 weeks	Viral (Rhinovirus, COVID)
Chronic Bronchitis	≥ 3 months × 2 years	Smoking
Emphysema	Alveolar destruction	Smoking, AATD
Pleural Effusion	Fluid in pleural space	Pneumonia, Heart failure
Lung Abscess	Pus in lung tissue	Aspiration, Anaerobes
Barrel Chest	Increased AP diameter	Emphysema

Exam Tips for BSc Nursing 3rd Sem:

Always define first, then classify, then give pathophysiology as a flow chart

Know the difference between Transudate vs Exudate (protein content is the key differentiator)

PFT, ABG, Pulse Oximetry are the most important investigations to remember

Chronic bronchitis = 3 months × 2 years - memorize this definition

Emphysema = alveolar wall destruction + air trapping = barrel chest

It’s only one unit

Got it! Here are your notes reorganized as a single unit:

ADULT HEALTH NURSING

BSc Nursing - 3rd Semester

UNIT: RESPIRATORY SYSTEM DISORDERS

ADULT HEALTH NURSING - INTRODUCTION

RESPIRATORY SYSTEM

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Definition: COPD is a common, preventable and treatable lung disease characterized by persistent respiratory airflow limitation, caused by abnormality of the airway or alveoli (obstructive airway).

1. BRONCHITIS

Definition: Bronchitis is the inflammation of the bronchi - the major air passages that connect the trachea to the lungs. It is characterized by swelling of the bronchial mucosa, excess mucus secretion, cough, and difficulty in breathing.

Types of Bronchitis

a) Acute Bronchitis Acute inflammation of the bronchi lasting less than 3 weeks.

Causative Organisms:

Viral: Rhinovirus, Adenovirus, COVID-19
Bacterial: Mycoplasma pneumoniae

b) Chronic Bronchitis Chronic inflammation of the bronchi lasting at least 3 months in each of 2 consecutive years, after excluding other causes. It is one of the major causes of COPD.

Characteristics of Chronic Bronchitis:

Excessive mucus production
Narrowing of airway (decrease in airflow)
Progressive airflow limitation
Persistent cough

Risk Factors / Causes

Smoking (most common cause)
Air pollution
Dust exposure
Occupational hazard
Chronic lung disease
Weather change
Poor nutrition

Pathophysiology

Due to causative factors → Inflammation of bronchial mucosa
Vasodilation and edema → Airway contraction (narrowing)
Excess mucus secretion
Reduced ciliary function
Airflow obstruction

Signs and Symptoms

Persistent cough
Productive sputum (thick, green/yellow/white mucus)
Fever
Fatigue and weakness
Dyspnea (difficulty breathing)
Chest tightness
Tachypnea (rapid breathing)
Crackles on auscultation

2. EMPHYSEMA

Definition: Emphysema is a chronic lung disease and a major form of COPD. The tiny air sacs (alveoli) become damaged and lose their elasticity. This makes it harder to breathe by trapping air in the lungs and reducing the movement of oxygen into the blood stream.

Characteristics

Enlarged enzyme activity (protease-antiprotease imbalance)
Morbid air trapping
Progressive breathlessness
Hyperinflated barrel chest

Signs and Symptoms

Dyspnea
Breathlessness
Chest pain/tightness
Persistent cough with mucus
Wheezing sound
Fatigue
Weight loss

Management of Emphysema

Cessation of smoking (essential)
Exercise and pulmonary rehabilitation
Medication support
Supplemental Oxygen intake
Airway management support

CAUSE: ALPHA-1 ANTITRYPSIN DEFICIENCY (AATD)

A real inherited condition (Alpha-1 Antitrypsin Deficiency)
It is an inherited genetic disorder in which the body produces reduced amounts of alpha-1 antitrypsin (AAT)
AAT is a protein that protects the lungs and is produced mainly in the liver
Deficiency leads to progressive lung damage (a known cause of COPD)

BARREL CHEST

Definition: It is a chest that appears round and enlarged, giving it the shape of a barrel. The anteroposterior (front to back) diameter increases, giving the barrel shape. It is commonly seen in long-standing emphysema due to chronic air trapping.

3. PLEURAL EFFUSION

Definition: A collection of abnormal amount of fluid in the pleural space. Normally, the pleural space contains 10-20 mL of fluid. Any accumulation more than 20 mL is considered pleural effusion. It is usually secondary to another disease.

Classification

a) Transudative Pleural Effusion

Also known as hydrothorosis
Occurs in non-inflammatory conditions
Low protein, no cell count
Caused by: Congestive heart failure, Nephrotic syndrome, Cirrhosis

b) Exudative Pleural Effusion

Occurs in areas of inflammation
High protein content, increased cell count
Caused by: Pneumonia, TB, Pulmonary embolism
Results from increased capillary permeability

Key Terms

Oncotic Pressure (Colloidal osmotic pressure): Pressure exerted by protein in blood that keeps fluid within blood vessels
Intravascular Pressure: The pressure of fluid present outside blood vessels

Etiology

Pneumonia / Pleural pulmonary infections
Nephrotic syndrome
Heart failure
Cirrhosis
Peritoneal dialysis

Pathophysiology

Hydrostatic pressure increases AND oncotic pressure decreases
Fluid unable to remain in the intravascular space
Fluid transfers to interstitial space
Fluid infuses into the pleural cavity

4. LUNG ABSCESS

Definition: A lung abscess is a localized collection of pus within the lung tissue, caused by necrosis and destruction of lung tissue. It commonly produces a cavity containing pus that communicates with the bronchus.

Causes / Risk Factors

Anaerobic bacterial infection
Aspiration of oropharyngeal contents
Septic emboli
Poor dental hygiene
Immunosuppression
Staphylococcal pneumonia
Gram-negative organisms

Pathophysiology

Aspiration (due to above causes)
           ↓
  Bacterial Infection
           ↓
  Inflammation of lung tissue
           ↓
  Tissue destruction & necrosis
           ↓
      Pus formation
           ↓
  Cavity develops in lung tissue
           ↓
  Cavity may rupture into bronchus
           ↓
  Productive cough with foul-smelling sputum

Signs and Symptoms

Acute Lung Abscess	Chronic Lung Abscess
Sudden onset	Productive cough
Difficulty in self-care	Foul-smelling sputum
Usually with fever	Prolonged course

DIAGNOSTIC TESTS (for all Respiratory Disorders)

1. History Collection

2. Blood Investigations (CBC):

Hemoglobin (Hb)
WBC (White Blood Cells)
RBC (Red Blood Cells)
Urea
Sodium
Potassium
Creatinine

3. Sputum Examination - for culture and sensitivity

4. Pulmonary Function Test (PFT)

5. Pulse Oximetry (SpO₂)

6. Arterial Blood Gas (ABG)

7. CT Scan

MEDICAL MANAGEMENT

Drug Class	Purpose
Bronchodilators	Dilate airways; relieve bronchospasm
Corticosteroids	Reduce airway inflammation
Antibiotics	Treat bacterial infection
Antitussives	Suppress cough
Expectorants & Mucolytics	Loosen and thin mucus secretions
Bone Protectors	Prevent steroid-induced bone loss

QUICK REVISION

Condition	Key Definition Point	Major Cause
Acute Bronchitis	< 3 weeks duration	Viral (Rhinovirus, COVID)
Chronic Bronchitis	≥ 3 months × 2 consecutive years	Smoking
Emphysema	Alveolar wall destruction + air trapping	Smoking, AATD
Pleural Effusion	Fluid > 20 mL in pleural space	Pneumonia, Heart failure
Lung Abscess	Pus-filled cavity in lung	Aspiration, Anaerobes
Barrel Chest	Increased anteroposterior diameter	Emphysema

Key Exam Points:

Transudative = low protein | Exudative = high protein

Chronic bronchitis: 3 months × 2 years (must memorize)

Emphysema: alveoli lose elasticity → air trapping → barrel chest

Main investigations: PFT, ABG, Pulse Oximetry, CT Scan, CBC

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