Respiratory Disorders and Nursing Interventions

Atelectasis

Partial or complete collapse of the lung or a section of the lung.

Pulmonary Infections

Infections affecting the lungs, characterized by causes, clinical manifestations, nursing management, complications, and prevention.

Pleurisy

Inflammation of both the visceral and parietal pleurae, causing severe, sharp pain intensified by breathing.

Pleurisy Clinical Manifestations

Pain worsens with deep breaths, coughing, or sneezing, localized or radiates to the shoulder or abdomen.

Pleurisy Assessment and Diagnostic Methods

Includes auscultation for pleural friction rub, chest x-rays, sputum culture, and thoracentesis for pleural fluid examination.

Pleurisy Medical Management

Involves monitoring for signs of pleural effusion, providing analgesics, heat or cold applications, and intercostal nerve block for severe pain.

Pleurisy Nursing Management

Focuses on enhancing patient comfort by turning frequently and teaching rib cage splinting during coughing.

Pleural Effusion

Accumulation of fluid in the pleural space, often secondary to other diseases, with symptoms varying based on underlying conditions.

Pleural Effusion Assessment and Diagnostic Methods

Include physical examination, chest x-rays, chest CT scan, thoracentesis, pleural fluid analysis, and pleural biopsy.

Pleural Effusion Medical Management

Aims to discover the underlying cause, prevent reaccumulation of fluid, and relieve discomfort through treatments like thoracentesis and chemical pleurodesis.

Pleural Effusion Nursing Management

Involves implementing medical regimen, monitoring chest tube drainage, administering care related to the cause, assisting in pain relief, and educating patients on catheter care.

Thoracentesis

Removal of excess air and fluid from the pleural cavity to prevent infection using sterile technique and specific patient positioning.

Pulmonary Edema

Abnormal accumulation of fluid in the interstitial spaces of the lungs leading to flash pulmonary edema, often resulting from left ventricular failure.

Clinical Manifestations of Pulmonary Edema

Symptoms include restlessness, anxiety, cold and moist hands, cyanotic nail beds, ashen skin, weak and rapid pulse, distended neck veins, coughing with foamy sputum, and decreased oxygen saturation.

Assessment and Diagnostic Methods for Pulmonary Edema

Diagnosis involves evaluating clinical manifestations, abrupt signs of left-sided heart failure, increased interstitial markings on chest x-ray, and pulse oximetry for ABG levels.

Medical Management Goals

Reduce volume overload, improve ventricular function, and enhance respiratory exchange using oxygen and medication therapies.

Oxygenation in Pulmonary Edema

Involves providing adequate oxygen concentrations, intermittent or continuous positive pressure, endotracheal intubation if necessary, and monitoring pulse oximetry and ABGs.

Pharmacologic Therapy for Pulmonary Edema

Includes intravenous morphine for anxiety and dyspnea, diuretics for rapid diuresis, and vasodilators like nitroglycerin for symptom relief.

Nursing Management in Pulmonary Edema

Involves assisting with oxygen administration, positioning for circulation, providing psychological support, monitoring medication effects, and maintaining necessary interventions.

Pulmonary Embolism

Obstruction of the pulmonary artery by a thrombus, often originating in the venous system or right side of the heart, leading to impaired gas exchange and potentially life-threatening complications.

Clinical Manifestations of Pulmonary Embolism

Symptoms vary based on thrombus size and location, commonly including dyspnea, chest pain, anxiety, tachycardia, cough, hemoptysis, and potential shock or sudden death.

Assessment and Diagnostic Methods for Pulmonary Embolism

Diagnostic workup includes chest x-ray, ECG, ABG analysis, ventilation-perfusion scan, pulmonary angiography, spiral CT scan, D-dimer assay, and pulmonary arteriogram.

Ambulation or leg exercises

Physical activities performed by patients on bed rest to prevent complications.

Sequential compression devices

Devices used to prevent deep vein thrombosis by promoting blood circulation in the legs.

Anticoagulant therapy

Treatment with medications like heparin or warfarin to prevent blood clot formation.

Nasal oxygen

Administration of oxygen through the nose to relieve hypoxemia and respiratory distress.

Perfusion scan

Imaging test to assess blood flow through the lungs.

Dobutamine or dopamine infusion

Slow infusion of medications to treat hypotension by dilating pulmonary vessels and bronchi.

ECG monitoring

Continuous monitoring of the electrocardiogram for dysrhythmias and right ventricular failure.

Thrombolytic therapy

Treatment using medications like urokinase or alteplase to dissolve blood clots.

Surgical embolectomy

Surgical removal of a pulmonary embolism in cases of hemodynamic instability.

Transvenous catheter embolectomy

Surgical procedure involving catheter insertion to remove a pulmonary embolism.

Nursing care for PE prevention

Actions taken by nurses to minimize the risk of pulmonary embolism in patients.

Encouraging early ambulation

Advising patients to walk early to prevent blood clots.

Monitoring anticoagulant therapy

Supervising patients on anticoagulants, checking vital signs and clotting parameters.

Minimizing chest pain

Methods to reduce chest pain in patients with pulmonary embolism.

Managing oxygen therapy

Care provided to patients receiving oxygen, including monitoring and assistance with breathing exercises.

Alleviating anxiety

Techniques to reduce anxiety in patients, such as encouraging expression of feelings.

Monitoring for complications

Being watchful for potential complications like cardiogenic shock in PE patients.

Postoperative nursing care

Care provided after surgery, including monitoring vital signs and encouraging activity.

Pneumonia

An infection of the lungs caused by various microorganisms, leading to respiratory symptoms.

Types of pneumonia

Classifications including acute, chronic, community-acquired, hospital-acquired, aspiration, and others.

Acute pneumonia

Develops rapidly, lasts 2-3 weeks, and spreads easily causing quick symptoms.

Chronic pneumonia

Develops gradually over weeks to months and does not spread easily.

Community-acquired pneumonia

Common in people with underlying conditions, often caused by Streptococcus.

Hospital-acquired pneumonia

Infection acquired during hospital stay, not present at admission.

Aspiration pneumonia

Inflammation of lungs due to inhaling foreign material like food or vomit.

Severe Acute Respiratory Syndrome (SARS)

Highly contagious pneumonia caused by coronavirus, first seen in 2002.

Chemical pneumonia

Inflammation of lungs due to inhaling chemical toxins like pesticides.

Causative organisms of pneumonia

Microorganisms including viruses (adenoviruses, flu), bacteria (Streptococcus), fungi, and parasites.

Bacteria

Microorganisms entering lungs through airborne droplets or bloodstream.

Fungi

Organisms causing pneumonia in immunocompromised individuals.

Parasites

Organisms affecting lungs after entering through skin or ingestion.

Inflammation of Lung Parenchyma

Infection caused by bacteria like Strep. Pneumoniae, leading to symptoms like rusty sputum.

Pulmonary Tuberculosis

Infectious disease primarily affecting lung parenchyma, caused by Mycobacterium tuberculosis.

TB Transmission

Spread through inhalation of droplets from active pulmonary disease.

TB Risk Factors

Includes close contact, immunocompromised status, and living conditions.

TB Clinical Manifestations

Symptoms like fever, cough, night sweats, and weight loss.

TB Assessment Methods

Includes TB skin test, chest x-ray, acid-fast bacillus smear, and sputum culture.

Gerontologic Considerations for TB

Elderly may show atypical symptoms; TB skin test may produce no reaction.

Pharmacologic Therapy for TB

Treatment with antituberculosis agents for 6 to 12 months.

Promoting Airway Clearance

Encouraging increased fluid intake and drainage facilitation.

Advocating Adherence to Treatment

Emphasizing medication importance, schedule, side effects, and resistance risk.

Promoting Activity and Nutrition

Planning activity schedule, ensuring adequate nutrition, and identifying resources.

Preventing TB Infection Spread

Instructing hygiene measures, reporting cases, and monitoring for dissemination.

Pneumothorax

Accumulation of air in pleural space causing pressure rise.

Types of Pneumothorax

Includes simple (pleura breach) and tension (lung laceration) types.

Pneumothorax Symptoms

Manifestations like dyspnea and decreased breath sounds on affected side.

Chest Expansion

Tracheal deviation to the unaffected side (CXR); exclusive for TENSION pneumothorax

Chest Tubes and Drainage System

Aims to restore negative pressure of the pleural cavity and drain collected fluid/blood; components include suction control chamber, water seal chamber, closed collection chamber

Assessment of the Site

Done at least every 4 hours for excessive or abnormal drainage; listen for cracking sound upon palpation for subcutaneous emphysema

Repositioning

Every 2 hours if lying on the affected side; place a rolled towel beside the tubing

Oscillations or Fluctuations on Water Seal

Normal; Absence indicates re-expansion of the lungs or obstruction; management includes notifying the MD for CXR and avoiding milking and stripping for obstruction

Presence of Bubbling

Drainage Bottle: No bubbling; Water Seal Bottle: Intermittent bubbling; Suction Control Bottle: Continuous gentle bubbling

Abnormal Bubbling

Water Seal Bottle: Continuous bubbling; Suction Control Bottle: Vigorous bubbling; alert for leakage

Management of Abnormal Bubbling

Clamp the tube and tape the leak for short periods; prolonged clamping can cause tension pneumothorax

Absence of Bubbling

May indicate lung re-expansion or obstruction; management remains the same

Tube Pulled from the Site

Cover with dry sterile dressing; if air is leaking, ensure the dressing is not occlusive; use vaselinized or petrolatum gauze if needed

Tube Disconnected or Water Seal Bottle Breaks

Submerge the end in 1 inch of sterile saline or water; reconnect

Rib Fracture

Results from direct blunt chest trauma; characterized by pain at the site increasing with respiration; management involves spontaneous union and high fowler's position

Flail Chest

Results from fracture of 3 or more ribs due to blunt chest trauma; characterized by paradoxical breathing; management includes oxygen, watching for respiratory distress, and maintaining high fowler's position

Acute Lung Injury

Umbrella term for hypoxemic respiratory failure; acute respiratory distress syndrome is a severe form of acute lung injury

Empyema

Accumulation of purulent material in the pleural space

Hemoptysis

Coughing up of blood from the lower respiratory tract

Hemothorax

Partial or complete lung collapse due to blood accumulating in the pleural space; may occur after surgery or trauma

Restrictive Lung Disease

Disease causing a decrease in lung volumes

Tension Pneumothorax

Characterized by increasing positive pressure in the pleural space with each breath; requires immediate decompression