Chapter19 (2) 2

Chapter Overview

  • Management of Patients with Chest and Lower Respiratory Tract Disorders: Focuses on various conditions affecting the respiratory system, their management, and nursing interventions.

Atelectasis

  • 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.

Assessment and Diagnosis for Atelectasis

  • 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%.

Nursing Interventions for Atelectasis

  • 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.

Management of Atelectasis

  • 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.

Acute Tracheobronchitis

  • 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.

Pneumonia

  • 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.

Risk Factors for Pneumonia

  • Underlying disorders: Heart failure, diabetes, COPD, HIV/AIDS, cystic fibrosis, influenza.

Clinical Manifestations of Pneumonia

  • Varies by type and causative organism:

    • Streptococcal: chills, fever, pleuritic chest pain, tachypnea.

    • Viral: relative bradycardia, headache, low-grade fever.

Assessment and Diagnosis of Pneumonia

  • Tools: History, physical exam, chest x-ray, blood cultures, sputum examination, bronchoscopy for severe cases.

Pneumonia Prevention

  • Vaccination: Vaccines reduce pneumonia incidence; recommended for at-risk populations (older adults, immunocompromised).

Medical Management of Pneumonia

  • Appropriate antibiotic therapy based on culture results.

  • Supportive treatments: fluids, oxygen therapy, antipyretics, antitussives.

COVID-19 Considerations

  • Potential for asymptomatic to severe pneumonia.

  • Treatments involve conservative outpatient management; hospitalization required for severe cases.

Assessment for Bacterial Pneumonia

  • Monitor vital signs, secretions, cough, respiratory status, and mental status changes.

Complications of Bacterial Pneumonia

  • Possible issues: Sepsis, respiratory failure, atelectasis, pleural effusion, delirium.

Planning and Goals for Bacterial Pneumonia

  • Emphasis on improving airway patency, maintaining fluid balance, nutrition, understanding treatment protocols, and preventing complications.

Nursing Interventions for Bacterial Pneumonia

  • Oxygen therapy, effective coughing techniques, chest physiotherapy, hydration, nutrition, patient education.

Expected Outcomes for Bacterial Pneumonia

  • Improvement in airway patency, knowledge about management strategies, and absence of complications.

Aspiration

  • Inhalation of foreign material into lungs; can lead to pneumonia.

  • Prevention: Swallowing screenings, maintaining head elevation during feeding, careful tube feeding practices.

Pulmonary Tuberculosis

  • Caused by Mycobacterium tuberculosis.

  • Symptoms include cough (nonproductive, mucopurulent), night sweats, fatigue, and weight loss.

Assessment and Diagnostic Findings for TB

  • Mantoux test, sputum cultures, blood tests.

Medical Management of Tuberculosis

  • Treatment course of 6 to 12 months; concerns about drug resistance.

Nursing Management of TB

  • Focus on airway clearance, adherence to treatment, activity encouragement, and preventing transmission.

Lung Abscess

  • Complication of pneumonia; symptoms include productive cough with foul sputum, dyspnea, and weakness.

Assessment and Diagnostic Findings for Lung Abscess

  • Includes chest x-ray, sputum culture, and CT scans.

Medical Management of Lung Abscess

  • Key strategies involve adequate drainage and antimicrobial therapy.

Nursing Management of Lung Abscess

  • Administer intravenous antibiotics, encourage deep breathing and coughing exercises, and provide nutritional support.

Sarcoidosis

  • Characterized by multi-system granulomatous inflammation.

  • Symptoms range from respiratory complications to systemic issues (fatigue, weight loss).

Assessment and Diagnostic Findings for Sarcoidosis

  • Includes imaging and biopsies for diagnosis.

Management of Sarcoidosis

  • Combination of corticosteroids and supportive care; education for patients on their condition.

Pleural Conditions

  • Involve disorders affecting pleural membranes (pleuritis, pleural effusion, empyema).

  • Pleurisy: Inflammation with associated pain during respiration.

Empyema

  • Accumulation of purulent fluid in pleural space; requires drainage and antibiotic treatment.

Acute Respiratory Failure (ARF)

  • Characterized by hypoxemia and CO2 retention; prompt recognition and intervention are essential.

Medical and Nursing Management of ARF

  • Intubation and mechanical ventilation, addressing underlying causes, emotional support, prevention of complications.

Endotracheal Intubation

  • Employed to secure the airway, requires proper cuff management and monitoring.

Tracheotomy

  • Surgical creation of an opening in the trachea; involves long-term airway management practices.

Mechanical Ventilation

  • Employed in severe respiratory conditions; requires close monitoring and intervention.

Pulmonary Vascular Disorders

  • Includes conditions like pulmonary hypertension and embolism; management focuses on stabilization and prevention.

Occupational Lung Disease

  • Includes pneumoconiosis; preventable through health education and safety in the workplace.

Lung Cancer

  • Leading cause of cancer deaths, mainly linked to smoking; management includes palliative care and symptom management.

Surgical Considerations

  • Appropriate preoperative and postoperative management for thoracotomy and chest trauma; focus on patient education and monitoring.