Chapter 28: Lower Respiratory Problems
Is an acute inflammation of the lung parenchyma.
Is caused by a microbial organism.
More likely to result when defense mechanisms become incompetent or are overwhelmed by
the virulence or quantity of infectious agents.
Pneumonia can be classified according to the causative organism, such as bacteria, viruses,
Mycoplasma, fungi, parasites, and chemicals.
A clinically effective way to classify pneumonia is as follows:
o Community-acquired pneumonia is defined as a lower respiratory tract infection of the
lung parenchyma with onset in the community or during the first 2 days of
o Hospital-acquired pneumonia is pneumonia occurring 48 hours or longer after hospital
admission and not incubating at the time of hospitalization.
Aspiration pneumonia refers to the sequelae occurring from abnormal entry of secretions or
substances into the lower airway.
Opportunistic pneumonia presents in certain patients with altered immune responses who are
highly susceptible to respiratory infections.
There are four characteristic stages of pneumonia: congestion, red hepatization, gray
hepatization, and resolution.
o In the hospital, the nursing role involves identifying the patient at risk and taking
measures to prevent the development of pneumonia.
o The essential components of nursing care for patients with pneumonia include
monitoring physical assessment parameters, facilitating laboratory and diagnostic tests,
providing treatment, and monitoring the patient’s response to treatment.
TUBERCULOSIS (TB) Is an infectious disease caused by Mycobacterium tuberculosis, a gram-positive, acid-fast bacillus
that is usually spread from person to person via airborne droplets.
Despite the decline in TB nationwide, rates have increased in certain states and high rates
continue to be reported in certain populations.
The major factors that have contributed to the resurgence of TB have been (1) high rates of TB
among patients with HIV infection and (2) the emergence of multidrug resistant strains of M.
Can present with a number of complications: the spread of the disease with involvement of
many organs simultaneously (miliary TB), pleural effusion, emphysema, and pneumonia.
The tuberculin skin test (Mantoux test) using purified protein derivative (PPD) is the best way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis disease requires
demonstration of tubercle bacilli bacteriologically.
Most TB patients are treated on an outpatient basis. The mainstay of TB treatment is drug
therapy. Drug therapy is used to treat an individual with active disease and to prevent disease in
a TB-infected person.
Patients strongly suspected of having TB should (1) be placed on airborne isolation, (2) receive
appropriate drug therapy, and (3) receive an immediate medical workup, including chest x-ray,
sputum smear, and culture.
PULMONARY FUNGAL INFECTIONS
Are found frequently in seriously ill patients being treated with corticosteroids, antineoplastic
and immunosuppressive drugs, or multiple antibiotics.
Are also found in patients with AIDS and cystic fibrosis.
Community-acquired pulmonary lung infections include aspergillosis, cryptococcosis, and
candidiasis. These infections are not transmitted from person to person, and the patient does
not have to be placed in isolation.
Is a pus-containing lesion of the lung parenchyma that gives rise to a cavity. In many cases the causes and pathogenesis of lung abscess are similar to those of pneumonia.
The onset of a lung abscess is usually insidious, especially if anaerobic organisms are the primary
cause. A more acute onset occurs with aerobic organisms.
Antibiotics given for a prolonged period (up to 2 to 4 months) are usually the primary method of
ENVIRONMENTAL LUNG DISEASES
Environmental or occupational lung diseases are caused or aggravated by workplace or
environmental exposure and are preventable.
Pneumoconiosis is a general term for a group of lung diseases caused by inhalation and retention
of dust particles.
The best approach to management of environmental lung diseases is to try to prevent or decrease
environmental and occupational risks.
Cigarette smoking is the most important risk factor in the development of lung cancer. Smoking
is responsible for approximately 80% to 90% of all lung cancers.
Primary lung cancers are often categorized into two broad subtypes: non–small cell lung cancer
(80%) and small cell lung cancer (20%).
CT scanning is the single most effective noninvasive technique for evaluating lung cancer. Biopsy
is necessary for a definitive diagnosis.
Staging of non–small cell lung cancer is performed according to the TNM staging system. Staging
of small cell lung cancer by TNM has not been useful because the cancer is very aggressive and
always considered systemic.
Treatment options for lung cancer include:
o Surgical resection is the treatment of choice in non–small cell lung cancer Stages I and II,
because the disease is potentially curable with resection. o Radiation therapy used with the intent to cure may be moderated in the individual who
is unable to tolerate surgical resection due to comorbidities. It may also be used as
adjuvant therapy after resection of the tumor.
o Chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant
therapy to surgery in non–small cell lung cancer.
The overall goals of nursing management of a patient with lung cancer will include (1) effective
breathing patterns, (2) adequate airway clearance, (3) adequate oxygenation of tissues, (4)
minimal to no pain, and (5) a realistic attitude toward treatment and prognosis.
Refers to air in the pleural space. As a result of the air in the pleural space, there is partial or
complete collapse of the lung.
Types of pneumothorax include:
o Closed pneumothorax has no associated external wound. The most common form is a
spontaneous pneumothorax, which is accumulation of air in the pleural space without
an apparent antecedent event.
o Open pneumothorax occurs when air enters the pleural space through an opening in
the chest wall. Examples include stab or gunshot wounds and surgical thoracotomy.
o Tension pneumothorax is a pneumothorax with rapid accumulation of air in the pleural
space causing severely high intrapleural pressures with resultant tension on the heart
and great vessels. It may result from either an open or a closed pneumothorax.
o Hemothorax is an accumulation of blood in the intrapleural space. It is frequently found
in association with open pneumothorax and is