chap. 30 - lower respiratory problems

lower respiratory tract infections

• acute bronchitis

• pertussis

• pneumonia

• tuberculosis

restrictive respiratory disorders

• atelectasis

• pleural effusion

thoracic injury

pneumothorax

vascular lung disorders

• pulmonary edema

• pulmonary embolism

• pulmonary hypertension

acute bronchitis

inflammation of the bronchi

• main symptom = persistent cough (last up to 3 weeks - worse/frequent at night)

• usually viral

• nursing focus → respiratory assessment, symptom management

acute bronchitis treatment

• relieve symptoms (cough, discomfort, fever)

• support recovery w/ fluids, rest, appropriate symptom management

• maintain airway function (ease breathing when wheezing present)

• monitor for complications → pneumonia, worsening respiratory distress

pertussis

“whooping” cough — highly contagious respiratory infection caused by gram-negative bacterium

• main symptom = paroxysmal cough → rapid inspiration → whoop

• whooping cough absent in adolescents + adults

• spread through respiratory droplets

• macrolide antibiotics

• nursing focus → infection control, respiratory assessment

pertussis vaccines

• DTap → for infants + children younger than 7 years

  • higher amounts of diphtheria, pertussis components

• Tdap → for adolescents + adults

  • reduced amounts of diphtheria, pertussis components

  • pregnant patients should receive Tdap at 27-36 weeks

pneumonia

acute infection of lung parenchyma + impaired oxygenation

• CAP → pneumonia acquired in community, outside healthcare setting

• HAP → pneumonia that develops > 48 hours after hospital admission and was not present at admission

• VAP → pneumonia that develops > 48 hours after endotracheal intubation

• diagnosis → chest x-ray + sputum culture

• antibiotics for bacterial pneumonia

• nursing focus → oxygenation, respiratory status, complications

VAP bundle

• HOB elevation at 30-45 degrees

• assess readiness for extubation

• regular oral care

• maintain appropriate ETT cuff pressure

• strict hand hygiene

• proper secretion management

tuberculosis (TB)

infectious disease caused by mycobacterium […] (acid-fast bacillus)

• airborne transmission through coughing, speaking, sneezing

• latent vs active

• multidrug therapy

• airborne precautions

• nursing focus → infection control, medication adherence

latent TB

TB bacteria are present but INACTIVE

• patient has no symptoms and cannot spread TB

active TB

TB bacteria are ACTIVELY multiplying

• causing symptoms and pulmonary/laryngeal TB can spread to others

active pulmonary TB symptoms

• persistent cough with or w/o hemoptysis

• fever

• night sweats

• weight loss/decreased appetite

• fatigue

TB treatment

active TB requires combination anti-tubercular therapy for several months

• isoniazid (INH)

• rifampin (RIF)

• pyrazinamide (PZA)

• ethambutol (EMB)

pneumothorax

air enters pleural space

• lung may partially or completely collapse

• s/s:

  • sudden dyspnea

  • pleuritic chest pain

  • decreased/absent breath sounds on AFFECTED side

types of pneumothorax

• spontaneous pneumothorax → occurs w/o an obvious traumatic injury

• traumatic pneumothorax → results from chest trauma

• tension pneumothorax → HIGH PRIORITY

tension pneumothorax

air enters pleural space and cannot escape → pressure rapidly builds up

watch for:

• severe respiratory distress

• hypoxemia

• hypotension

• tracheal deviation may occur

• distended neck veins may occur

pleural effusion

abnormal collection of fluid in the pleural space — OUTSIDE

• usually sign of underlying condition, rather than a disease by itself

• s/s:

  • dyspnea

  • decreased breath sounds

  • possible pleuritic discomfort

  • may impair lung expansion

• nursing priorities:

  • asses respiratory status

  • monitor oxygenation

  • position for comfort

  • prepare/monitor for thoracentesis if ordered

types of pleural effusion

• transudative effusion → caused by changes in fluid pressure

  • low in protein + cells

• exudative effusion → caused by inflammation, infection, malignancy

  • high in protein + cells

• emphysema → pleural effusion that contains pus, usually due to bacterial infection

atelectasis

alveolar collapse

• common after surgery/immobility

• decreased ventilation → impaired oxygenation

• risk factors:

  • shallow breathing

  • pain

  • immobility

• nursing priorities:

  • incentive spirometry

  • cough/deep breathing

  • early ambulation

  • pain management

  • monitor SpO2

  • expand lung wall

  • get patient moving

pulmonary edema

fluid INSIDE lungs (alveoli + interstitial spaces) — gas exchange impaired

• common cause = left-sided HF

  • left-sided HF → increased pulmonary pressure → fluid moves into lungs → pulmonary edema

• s/s:

  • dyspnea

  • crackles

  • hypoxemia

  • pink + frothy sputum

• often associated w/ cardiac dysfunction

• nursing priority:

  • oxygenations

  • rapid assessment/intervention

pulmonary embolism (PE)

a clot obstructs pulmonary blood flow

• blood clot travels to pulmonary arteries and blocks blood flow to part of the lung

• s/s:

  • sudden dyspnea

  • pleuritic chest pain

  • tachycardia

  • tachypnea

  • hypoxemia

  • anxiety/restlessness

• risk factors:

  • immobility

  • recent surgery

  • previous VTE

  • prolonged travel

  • hyper-coagulable states

• nursing priority → recognize sudden change + escalate care

pulmonary hypertension

increased pressure in pulmonary circulation

• carries blood from right side of the heart to the lungs

• increased pressure makes it harder for the right side of heart to pump blood through lungs

• s/s:

  • dyspnea

  • fatigue

  • exercise intolerance

  • chest discomfort

  • syncope in more severe disease

  • signs of right-sided HF

• nursing focus → monitor respiratory/cardiac status, asses activity tolerance, monitor oxygenation, manage underlying cause