ADVANCED-MS (lower respiratory disorders) (on EXAM 2)

week 5

Hypercapnic respiratory failure is characterized by the PaC02 over _________ mmHg

45

Hypoxemic respiratory failure is characterized by PaO2 under ______ mmHg

55

Atelectasis

WHAT: collapse/closure of alveoli (can be acute or chronic)

*most common with post-op patients due to immobility

S/S: insidious/increasing dyspnea, cough, sputum production, tachypnea/cardia, pleural pain, and cyanosis

ASSESS: labored breathing, decreased breath sounds/crackles, or a low O2 sat (under 90%)

INTERVENTIONS/PREVENTION: frequent turning, early ambulation, incentive spirometry, deep breathing, suctioning, CPT, and PEEP/CPAB

Lung abscess

WHAT: a localized collection of pus formed by the destruction of lung tissue (most common from bacterial pneumonia)

S/S: (varies) mild cough --> pleural friction rub (grating sound)

INTERVENTIONS: IV antibiotics (3 weeks or more), then oral ABX's for 4-12 weeks, postural drainage, CPT, and encourage deep breathing/increased protein

Pulmonary tuberculosis

WHAT: disease caused by the presence of Mycobacterium tuberculosis in the lungs

S/S: night sweats, fatigue, weight loss, low-grade fever, non-productive cough w/ insidious onset

INTERVENTIONS: rifampin/INH (6-12 months) NO ALC., promote airway clearance, prevent transmission, and promote activity/nutrition

Pneumonia

WHAT: inflammation of the lungs due to various microorganisms

RISKS: HF, diabetes, alcoholism, COPD, AIDs/flu, and CF

S/S: bacterial--> chills/fever, pleuritic chest pain, tachypnea, respiratory distress, rash, orthopnea, purulent sputum, and crackles

INTERVENTIONS: ABX'S if bacterial, oxygen for hypoxia, antipyretics, decongestants, increase fluids, and prevention through vaccination

aspiration

WHAT: Breathing fluid, food, vomitus, or an object into the lungs (can be a complication of pneumonia)

S/S: tachycardia, dyspnea, cyanosis, HTN, and hypotension

INTERVENTIONS: HOB above 30 degrees or more, thickened liquids for swallowing problems, and avoiding stimulation of the gag reflex

Pleurisy

WHAT: inflammation of both layers of the pleura

SIGNS: pleuritic pain/pleural friction rub

DIAGNOSTICS: chest x-ray, sputum analysis, and thoracentesis

pleural effusion

WHAT: abnormal accumulation of fluid in the pleural space

S/S: fever, chills, pleuritic pain, dyspnea, decreased breath sounds, and dull/flat breath sounds

Empyema

WHAT: accumulation of pus in the pleural cavity

(complication of bacterial pneumonia or lung abscess)

INTEREVNTIONS: ABX's and draining the fluid

acute respiratory distress syndrome (ARDS)

WHAT: respiratory failure as a result of disease or injury (sudden/progressive edema)

S/S: agitation, restlessness, confusion, rapid onset of severe dyspnea, hypoxemia that does NOT respond to oxygen therapy, and tachypnea/retractions

INTERVENTIONS: immediate mechanical ventilation/intubation (PEEP) to keep alveoli open, pulmonary toileting, reduce anxiety, fluid/electrolyte management, hemodynamic monitoring, and PRONE positioning

lung cancer

WHAT: malignant tumor arising from the lungs and bronchi (leading cause of death in the U.S)

*85% due to cigarette smoking

S/S: N/A, extreme fatigue, persistent cough (often first sign), and unexplained weight loss

TREATMENT: surgery, radiation, and chemotherapy