Management of Patients with Chest and Lower Respiratory Tract Disorders: Focuses on various conditions affecting the respiratory system, their management, and nursing interventions.
Definition: Closure or collapse of alveoli.
Types: Acute (most common in postoperative settings) and chronic.
Symptoms:
Acute: Insidious onset, increasing dyspnea, tachycardia, tachypnea, pleural pain, central cyanosis in severe cases.
Chronic: Similar to acute; may include pulmonary infection.
Causes:
Foreign body, tumor/growth, altered breathing patterns, retained secretions, pain, prolonged supine position, increased abdominal pressure, decreased lung volume (due to musculoskeletal or neurological disorders), restrictive defects, surgical procedures.
Characterized by:
Increased work of breathing.
Hypoxemia (low oxygen levels).
Physical examination findings: Decreased breath sounds and crackles over affected areas.
Diagnostic tools: Chest x-ray can suggest diagnosis before symptoms appear; Pulse oximetry may show SpO2 < 90%.
Prevention Strategies:
Frequent turning of patients.
Early mobilization.
Strategies for lung expansion: Incentive spirometer, voluntary deep breathing, and secretion management.
Use of pressurized metered-dose inhalers.
Goals: Improve ventilation and remove secretions.
Key Interventions:
Frequent turning.
Early ambulation.
Lung volume expansion maneuvers.
Multidisciplinary approaches: ICOUGH protocol, PEEP, CPAB, bronchoscopy, CPT, endotracheal intubation, mechanical ventilation, thoracentesis for compression relief.
Definition: Inflammation of the trachea's mucous membranes; often follows a viral infection.
Symptoms: Dry cough initially progressing to mucoid sputum, dyspnea, stridor, wheezes, purulent sputum.
Management:
Medical: Antibiotics, analgesics, increased hydration, cool vapor therapy, suctioning.
Nursing: Bronchial hygiene, rest, adherence to medication.
Definition: Inflammation of lung parenchyma caused by microorganisms (bacteria, fungi, viruses).
Classification:
Community-acquired (CAP)
Health care-associated (HCAP)
Hospital-acquired (HAP)
Ventilator-associated pneumonia (VAP).
Types of Pneumonia:
Community-acquired: Caused mainly by S. Pneumoniae; viral in children.
Health care-associated: Caused by multidrug-resistant organisms; requires early diagnosis.
Hospital-acquired: Occurs > 48 hours post-hospitalization; high mortality rate.
Ventilator-associated: Develops after 48 hours of mechanical ventilation; prevention is critical.
Underlying disorders: Heart failure, diabetes, COPD, HIV/AIDS, cystic fibrosis, influenza.
Varies by type and causative organism:
Streptococcal: chills, fever, pleuritic chest pain, tachypnea.
Viral: relative bradycardia, headache, low-grade fever.
Tools: History, physical exam, chest x-ray, blood cultures, sputum examination, bronchoscopy for severe cases.
Vaccination: Vaccines reduce pneumonia incidence; recommended for at-risk populations (older adults, immunocompromised).
Appropriate antibiotic therapy based on culture results.
Supportive treatments: fluids, oxygen therapy, antipyretics, antitussives.
Potential for asymptomatic to severe pneumonia.
Treatments involve conservative outpatient management; hospitalization required for severe cases.
Monitor vital signs, secretions, cough, respiratory status, and mental status changes.
Possible issues: Sepsis, respiratory failure, atelectasis, pleural effusion, delirium.
Emphasis on improving airway patency, maintaining fluid balance, nutrition, understanding treatment protocols, and preventing complications.
Oxygen therapy, effective coughing techniques, chest physiotherapy, hydration, nutrition, patient education.
Improvement in airway patency, knowledge about management strategies, and absence of complications.
Inhalation of foreign material into lungs; can lead to pneumonia.
Prevention: Swallowing screenings, maintaining head elevation during feeding, careful tube feeding practices.
Caused by Mycobacterium tuberculosis.
Symptoms include cough (nonproductive, mucopurulent), night sweats, fatigue, and weight loss.
Mantoux test, sputum cultures, blood tests.
Treatment course of 6 to 12 months; concerns about drug resistance.
Focus on airway clearance, adherence to treatment, activity encouragement, and preventing transmission.
Complication of pneumonia; symptoms include productive cough with foul sputum, dyspnea, and weakness.
Includes chest x-ray, sputum culture, and CT scans.
Key strategies involve adequate drainage and antimicrobial therapy.
Administer intravenous antibiotics, encourage deep breathing and coughing exercises, and provide nutritional support.
Characterized by multi-system granulomatous inflammation.
Symptoms range from respiratory complications to systemic issues (fatigue, weight loss).
Includes imaging and biopsies for diagnosis.
Combination of corticosteroids and supportive care; education for patients on their condition.
Involve disorders affecting pleural membranes (pleuritis, pleural effusion, empyema).
Pleurisy: Inflammation with associated pain during respiration.
Accumulation of purulent fluid in pleural space; requires drainage and antibiotic treatment.
Characterized by hypoxemia and CO2 retention; prompt recognition and intervention are essential.
Intubation and mechanical ventilation, addressing underlying causes, emotional support, prevention of complications.
Employed to secure the airway, requires proper cuff management and monitoring.
Surgical creation of an opening in the trachea; involves long-term airway management practices.
Employed in severe respiratory conditions; requires close monitoring and intervention.
Includes conditions like pulmonary hypertension and embolism; management focuses on stabilization and prevention.
Includes pneumoconiosis; preventable through health education and safety in the workplace.
Leading cause of cancer deaths, mainly linked to smoking; management includes palliative care and symptom management.
Appropriate preoperative and postoperative management for thoracotomy and chest trauma; focus on patient education and monitoring.
Chapter19 (2) 2
Management of Patients with Chest and Lower Respiratory Tract Disorders: Focuses on various conditions affecting the respiratory system, their management, and nursing interventions.
Definition: Closure or collapse of alveoli.
Types: Acute (most common in postoperative settings) and chronic.
Symptoms:
Acute: Insidious onset, increasing dyspnea, tachycardia, tachypnea, pleural pain, central cyanosis in severe cases.
Chronic: Similar to acute; may include pulmonary infection.
Causes:
Foreign body, tumor/growth, altered breathing patterns, retained secretions, pain, prolonged supine position, increased abdominal pressure, decreased lung volume (due to musculoskeletal or neurological disorders), restrictive defects, surgical procedures.
Characterized by:
Increased work of breathing.
Hypoxemia (low oxygen levels).
Physical examination findings: Decreased breath sounds and crackles over affected areas.
Diagnostic tools: Chest x-ray can suggest diagnosis before symptoms appear; Pulse oximetry may show SpO2 < 90%.
Prevention Strategies:
Frequent turning of patients.
Early mobilization.
Strategies for lung expansion: Incentive spirometer, voluntary deep breathing, and secretion management.
Use of pressurized metered-dose inhalers.
Goals: Improve ventilation and remove secretions.
Key Interventions:
Frequent turning.
Early ambulation.
Lung volume expansion maneuvers.
Multidisciplinary approaches: ICOUGH protocol, PEEP, CPAB, bronchoscopy, CPT, endotracheal intubation, mechanical ventilation, thoracentesis for compression relief.
Definition: Inflammation of the trachea's mucous membranes; often follows a viral infection.
Symptoms: Dry cough initially progressing to mucoid sputum, dyspnea, stridor, wheezes, purulent sputum.
Management:
Medical: Antibiotics, analgesics, increased hydration, cool vapor therapy, suctioning.
Nursing: Bronchial hygiene, rest, adherence to medication.
Definition: Inflammation of lung parenchyma caused by microorganisms (bacteria, fungi, viruses).
Classification:
Community-acquired (CAP)
Health care-associated (HCAP)
Hospital-acquired (HAP)
Ventilator-associated pneumonia (VAP).
Types of Pneumonia:
Community-acquired: Caused mainly by S. Pneumoniae; viral in children.
Health care-associated: Caused by multidrug-resistant organisms; requires early diagnosis.
Hospital-acquired: Occurs > 48 hours post-hospitalization; high mortality rate.
Ventilator-associated: Develops after 48 hours of mechanical ventilation; prevention is critical.
Underlying disorders: Heart failure, diabetes, COPD, HIV/AIDS, cystic fibrosis, influenza.
Varies by type and causative organism:
Streptococcal: chills, fever, pleuritic chest pain, tachypnea.
Viral: relative bradycardia, headache, low-grade fever.
Tools: History, physical exam, chest x-ray, blood cultures, sputum examination, bronchoscopy for severe cases.
Vaccination: Vaccines reduce pneumonia incidence; recommended for at-risk populations (older adults, immunocompromised).
Appropriate antibiotic therapy based on culture results.
Supportive treatments: fluids, oxygen therapy, antipyretics, antitussives.
Potential for asymptomatic to severe pneumonia.
Treatments involve conservative outpatient management; hospitalization required for severe cases.
Monitor vital signs, secretions, cough, respiratory status, and mental status changes.
Possible issues: Sepsis, respiratory failure, atelectasis, pleural effusion, delirium.
Emphasis on improving airway patency, maintaining fluid balance, nutrition, understanding treatment protocols, and preventing complications.
Oxygen therapy, effective coughing techniques, chest physiotherapy, hydration, nutrition, patient education.
Improvement in airway patency, knowledge about management strategies, and absence of complications.
Inhalation of foreign material into lungs; can lead to pneumonia.
Prevention: Swallowing screenings, maintaining head elevation during feeding, careful tube feeding practices.
Caused by Mycobacterium tuberculosis.
Symptoms include cough (nonproductive, mucopurulent), night sweats, fatigue, and weight loss.
Mantoux test, sputum cultures, blood tests.
Treatment course of 6 to 12 months; concerns about drug resistance.
Focus on airway clearance, adherence to treatment, activity encouragement, and preventing transmission.
Complication of pneumonia; symptoms include productive cough with foul sputum, dyspnea, and weakness.
Includes chest x-ray, sputum culture, and CT scans.
Key strategies involve adequate drainage and antimicrobial therapy.
Administer intravenous antibiotics, encourage deep breathing and coughing exercises, and provide nutritional support.
Characterized by multi-system granulomatous inflammation.
Symptoms range from respiratory complications to systemic issues (fatigue, weight loss).
Includes imaging and biopsies for diagnosis.
Combination of corticosteroids and supportive care; education for patients on their condition.
Involve disorders affecting pleural membranes (pleuritis, pleural effusion, empyema).
Pleurisy: Inflammation with associated pain during respiration.
Accumulation of purulent fluid in pleural space; requires drainage and antibiotic treatment.
Characterized by hypoxemia and CO2 retention; prompt recognition and intervention are essential.
Intubation and mechanical ventilation, addressing underlying causes, emotional support, prevention of complications.
Employed to secure the airway, requires proper cuff management and monitoring.
Surgical creation of an opening in the trachea; involves long-term airway management practices.
Employed in severe respiratory conditions; requires close monitoring and intervention.
Includes conditions like pulmonary hypertension and embolism; management focuses on stabilization and prevention.
Includes pneumoconiosis; preventable through health education and safety in the workplace.
Leading cause of cancer deaths, mainly linked to smoking; management includes palliative care and symptom management.
Appropriate preoperative and postoperative management for thoracotomy and chest trauma; focus on patient education and monitoring.