NUR 324 Lecture 5: Management of Patients with

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9 Feb 2017
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Management of Patients with Chest and Lower Respiratory Track Disorders
Glossary
Acute lung injury acute sever hypoxia
Acute Respiratory Distress Syndrome (ARDS)
Asbestosis mesothelioma is related
Aspiration chocking
Atelectasis partial or complete collapse of the lung
Central cyanosis will see in mouth Hemoptysis coughing up blood
Consolidation region of lung tissue that has filled with liquid
Hemothorax type of pleural effusion in which blood accumulates in the pleural cavity
Cor pulmonale an alteration in the structure and function of the right ventricle of the heart
caused by a primary disorder of the respiratory system
Induration tissue firmness
Empyema collection of puss in a cavity of the body (especially the plural cavity)
Open lung biopsy portion of lung tissue removed
Fine-needle aspiration type of biopsy
Orthopnea cannot lay flat
Pleural effusion excess fluid that accumulates in the pleural cavity
Pulmonary embolism lung blood clot
Pleural friction rub
Purulent infected
Pleural space
Restrictive lung disease lung diseases that restrict lung expansion
Space between outer part of lung and inner chest
Pneumothorax collapsed lung
Tension pneumothorax progressive buildup of air in the pleural cavity
Pulmonary edema excess fluid in the lungs
Respiratory Infections
Acute tracheobronchitis
Pneumonia
Aspiration
Severe Acute Respiratory Syndrome
Pulmonary Tuberculosis
Lung Abscess
Atelectasis
Pathophysiology
- Collapse or airless condition of alveoli caused by hypoventilation (perioperative issues),
obstruction to airways, or compression
- Causes:
Bronchial obstruction by secretions due to impaired cough mechanism
Can assess for strong cough if they can take a deep breath and cough
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Conditions that restrict normal lung expansion on inspiration
At Risk Populations (Acute)
- Postoperative patients:
Anesthesia
Analgesics pain killers
Supine positioning patient should be getting up and moving not remaining supine for
long periods
Splinting of chest wall because of pain need pressure of the pillows to have a
productive cough
Abdominal distention liver failure can have fluid accumulation and put pressure on the
diaphragm
Impaired cough
Retention of secretions fluid buries the alveoli
At Risk Populations (Chronic)
- Impaired cough mechanisms
- Debilitation/immobility
- Excessive pressure on lung tissue:
Pleural effusion
Pneumothorax
Hemothorax
Pericardial effusion abnormal accumulation of fluid around the heart
Tumor growth within thorax
Elevated diaphragm
Clinical Manifestations
- Initial symptoms: insidious, include cough, dyspnea (difficulty breathing), sputum
production, low-grade fever
- Respiratory distress, anxiety (normal first symptom), symptoms of hypoxia occur if large
areas of lung are affected
- Progressive symptoms: tachycardia, tachypnea (increased breathing rate), pleural pain,
central cyanosis (around the lips)
Assessment/Diagnostic Findings
- Increased work of breathing
- Hypoxemia
breath sounds over affected area
- Chest x-ray abnormalities
- Alert: tachypnea, dyspnea, hypoxemia
Prevention
- Chage patiet’s positio – especially to upright position
- Mobilization: bed to chair to ambulation
- Deep breathing, coughing, incentive spirometry
- Judicious use of opioids, sedatives
- Postural drainage, chest percussion (loosens up the secretions), suctioning as needed
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Medical Management
- Strategies for prevention are first line measures to treat atelectasis (incentive spirometry +
deep breathing)
- Positive end-expiratory pressure (PEEP)
Put pressure while patient is expiration
- Continuous positive pressure breathing (CPPB)
- Bronchoscopy go down with to scope to identify problem
- Acute Tracheobronchitis
Pathophysiology
- Infection most often
- Irritants
- Intubation
- Inflammation of mucous membranes tracheal, bronchial tree
- May be bacterial or fungal infections (fungal takes longer, not many drugs)
- May also be physical (allergen) or chemical irritants
- People with smoke inhalation
Clinical Manifestations
- Dry cough that may progress to purulent sputum
- Fever, night sweats (temperature fluctuation), headache, malaise
- Abnormal breath sounds, sternal soreness (coughing)
Medical Management
- Antibiotic or antifungal therapy based on sputum culture
- Fluid intake to mobilize secretions
- Suctioning if secretions cannot be cleared by coughing
- Vapor therapy for symptom management
Nursing Management
- Acute tracheobronchitis is primarily treated in the home
- Fluid intake; steps to induce, improve cough, removal of secretions (cough and spit)
- Adherence to any antimicrobial therapy
- Rest
- Pneumonia
- Inflammation of lung tissue caused by:
Bacteria most common
Mycobacteria
Fungi more with immune suppression
Viruses
- Pneumonia and influenza most common cause of death from infectious disease in United
States
8th leading cause of death in United States in 2010
Vulnerable populations should get the flu shot
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