management of patient with cheast and lower respiratory tract desorder

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 23
Management of Patients With
Chest and Lower Respiratory
Tract Disorders

Atelectasis
• Collapse or airless condition of alveoli caused by
hypoventilation, obstruction to airways, or compression
• Causes: bronchial obstruction by secretions due to
impaired cough mechanism or conditions that restrict
normal lung expansion on inspiration
• Postoperative patients at high risk
• Symptoms: insidious, include cough, sputum production,
low-grade fever
• Respiratory distress, anxiety, symptoms of hypoxia occur
if large areas of lung are affected

Atelectasis (cont’d)
• Refer to fig. 23-1

Nursing Management
• Prevention
– Frequent turning, early mobilization
– Strategies to improve ventilation: deep breathing
exercises at least every 2 hours, incentive spirometer
– Strategies to remove secretions: coughing exercises,
suctioning, aerosol therapy, chest physiotherapy

Nursing Management (cont’d)
• Treatment
– Strategies to improve ventilation, remove secretions
– Treatments: may include PEEP (positive end-
expiratory pressure), IPPB (intermittent positive-
pressure breathing)
– Bronchoscopy may be used to remove obstruction

Respiratory Infections
• Acute tracheobronchitis
• Pneumonia
– Community-acquired pneumonia
– Hospital-acquired pneumonia
– Pneumonia in immunocompromised host
– Aspiration pneumonia

Diagnostic Tests
• Chest x-ray
• Sputum examination

Medical Treatment of Pneumonia
• Supportive treatment includes fluids, oxygen for hypoxia,
antipyretics, antitussives, decongestants, antihistamines
• Administration of antibiotic therapy determined by gram-
stain results
• If etiologic agent is not identified, utilize empiric
antibiotic therapy
• Antibiotics not indicated for viral infections but are used
for secondary bacterial infection

Nursing Process: Care of the Patient with
Pneumonia - Assessment
• Changes in temperature, pulse
• Secretions
• Cough
• Tachypnea, shortness of breath
• Changes in physical assessment, especially inspection,
auscultation of chest
• Changes in CXR
• Changes in mental status, fatigue, dehydration,
concomitant heart failure, especially in elderly patients

Pneumonia - Diagnoses
• Ineffective airway clearance
• Activity intolerance
• Risk for fluid volume deficient
• Imbalanced nutrition
• Deficient knowledge

Collaborative Problems
• Continuing symptoms after initiation of therapy
• Shock
• Respiratory failure
• Atelectasis
• Pleural effusion
• Confusion
• Superinfection

Pneumonia - Planning
• Improved airway clearance
• Maintenance of proper fluid volume
• Maintenance of adequate nutrition
• Patient understanding of treatment, prevention
• Absence of complications

Improving Airway Clearance
• Encourage hydration; 2 to 3 L a day, unless
contraindicated
• Humidification may be used to loosen secretions
– By face mask or with oxygen
• Coughing techniques
• Chest physiotherapy
• Position changes
• Oxygen therapy administered to meet patient needs

Other Interventions
• Promoting rest
– Encourage rest, avoidance of overexertion
– Positioning to promote rest, breathing (Semi-
Fowler’s)
• Promoting fluid intake
– Encourage fluid intake to at least 2 L a day
• Maintaining nutrition
– Provide nutritionally enriched foods, fluids
• Patient teaching

Aspiration
• Risk factors
• Pathophysiology
• Prevention:
– Elevate HOB
– Turn patient to side when vomiting
– Prevention of stimulation of gag reflex with
suctioning or other procedures
– Assessment, proper administration of tube feeding
– Rehabilitation therapy for swallowing

Pleural Conditions
• Pleurisy: inflammation of both layers of pleurae
– Inflamed surfaces rub together with respirations,
cause sharp pain intensified with inspiration
• Pleural effusion: collection fluid in pleural space usually
secondary to another disease process
– Large effusions impair lung expansion, cause
dyspnea

Pleural Conditions (cont’d)
• Empyema: accumulation of thick, purulent fluid in pleural
space.
– Patient usually acutely ill; fluid, fibrin development,
loculation impair lung expansion
– Resolution is a prolonged process

Pleural Effusion

Causative Factors for Pulmonary Disease
• Cigarette smoking
• Air pollution

Acute Respiratory Distress Syndrome
• Severe form of acute lung injury
• Syndrome characterized by sudden, progressive
pulmonary edema, increasing bilateral lung infiltrates on
CXR, hypoxemia refractory to oxygen therapy, decreased
lung compliance
• Symptoms
– Rapid onset of severe dyspnea
– Hypoxemia that does not respond to supplemental
oxygen

Pathophysiology of ARDS

Management of ARDS
• Intubation, mechanical ventilation with PEEP to treat
progressive hypoxemia
• Positioning: frequent position changes, proning
• Nutritional support
• General supportive care

Pulmonary Emboli
• Obstruction of pulmonary artery or branch by blood clot,
air, fat, amniotic fluid, or septic thrombus
– Most thrombus are blood clots from leg veins
• Obstructed area has diminished or absent blood flow
– Although area is ventilated, no gas exchange occurs
• Inflammatory process causes regional blood vessels,
bronchioles to constrict, further increasing pulmonary
vascular resistance, pulmonary arterial pressure, right
ventricular workload
• Ventilation-perfusion imbalance, right ventricular failure,
shock occur

Risk Factors for Pulmonary Emboli
• Venous stasis
• Hypercoagulabilty
• Venous endothelial disease
• Certain disease states: heart disease, trauma,
postoperative/postpartum, diabetes mellitus, COPD
• Other conditions: pregnancy, obesity, oral contraceptive
use, constrictive clothing
• Previous history of thrombophlebitis

Prevention and Treatment of Pulmonary
Emboli
• Prevention
– Exercises to avoid venous stasis
– Early ambulation
– Anticoagulant therapy
– Sequential compression devices (SCDs)
• Treatment
– Measures to improve respiratory, CV status
– Anticoagulation, thrombolytic therapy

Umbrella Filter

Question
• Tell whether the following statement is true or false:
• Bradypnea is the most common sign for a possible
pulmonary embolism.

Answer
• False.
• Rationale: Tachypnea, not bradypnea, is the most
common sign for a possible pulmonary embolism.

Pneumoconioses
• Occupational lung diseases
• Cause of death of 124,846 people in United States (1968
to 2000)
• Causative agents
• Role of nurse as employee advocate
• Role of nurse in health education, teaching preventive
measures
• Role of OSHA

Care of the Patient with Lung Cancer
• Prevention, causes
• Classification of lung cancer
• Treatment
– Surgery
– Radiation
– Chemotherapy
• Palliative care

Nursing Care of the Patient with Cancer
• Psychological support
• Pain
• Airway clearance
• Fatigue
• Dyspnea

Question
• Which of the following is the most common surgery for a
small apparently curable tumor of the lung?
A.Lobectomy
B.Pneumonectomy
C.Segmentectomy
D.Sleeve resection

Answer
• A. Lobectomy
• Rationale: The most common surgical procedure for a
small, apparently curable tumor of the lung is a
lobectomy. A pneumonectomy is the removal an entire
lung. Segmentectomy is not recommended as curative
resection of lung cancer and is a removal of a segment of
the lung. A sleeve resection is removal of the cancerous
lobes with a segment of the main bronchus resected.

Chest Trauma
• Blunt trauma
• Sternal, rib fractures
• Flail chest
• Pulmonary contusion
• Penetrating trauma
• Pneumothorax
– Spontaneous or simple
– Traumatic
– Tension pneumothorax

Flail Chest

Open Pneumothorax and Tension
Pneumothorax

Question
• Tell whether the following statement is true or false:
• An initial characteristic symptom of a simple
pneumothorax is a sudden onset of chest pain.

Answer
• True.
• Rationale: An initial characteristic symptom of a simple
pneumonthorax is a sudden onset of chest pain.

management of patient with cheast and lower respiratory tract desorder

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Destacado

Destacado (10)

Similar a management of patient with cheast and lower respiratory tract desorder

Similar a management of patient with cheast and lower respiratory tract desorder (20)

Más de Kalinga Institute of Medical Sciences

Más de Kalinga Institute of Medical Sciences (20)

Último

Último (20)

management of patient with cheast and lower respiratory tract desorder