lower restriction

Lower Respiratory Disorders and Lung Cancer

Objectives

• The student will:
  • Understand and discuss common restrictive disorders of the lower respiratory tract.
  • Understand and discuss the clinical manifestations of restrictive disorders.
  • Understand treatment and nursing care associated with restrictive disorders.
  • Understand and verbalize common medications and treatments associated with restrictive disorders.

Pleurisy

• Definition: Inflammation of the pleura.
• Clinical Manifestations:
  • Sharp pain that worsens with inspiration.
  • Pleural friction rub.
  • Shallow breathing.
• Treatment:
  • Administration of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) to reduce inflammation.
  • Splinting to provide comfort.
  • Laying on the affected side to relieve pain by reducing strain on the pleura.
  • Description: Patients report that "breathing hurts", so they may hold a pillow against their body for comfort.

Atelectasis

• Definition: A condition characterized by collapsed and airless alveoli.
• Causes:
  • The most common cause is obstruction of the small airways typically due to mucus plugs or foreign bodies.
  • Frequently observed in patients on mechanical ventilation (MV) and in almost all postoperative patients.
• Clinical Manifestations:
  • Decreased breath sounds.
  • Shortness of air (dyspnea).
  • Decreased oxygenation levels.
• Treatment:
  • TCDB (Turn, Cough, Deep Breath) exercises.
  • Encouragement of mobility to facilitate lung expansion.
  • Incentive spirometry (I/S) for encouraging deep breathing.
  • Instructions include:
    • Clear secretions post-operatively.
    • Monitor oxygen saturation (O2 Stat) every 2 hours, especially post-surgery.
    • Emphasize adequate pain management during inhalation, typically every 30-45 minutes to encourage long, slow inhalations.

Pleural Disorders

Pleural Effusion

• Definition: A buildup of fluid in the pleural space.
• Causes:
  • Congestive heart failure (CHF).
  • Liver disease.
  • Kidney disease.
  • Lung infections.
  • Malignancies.

Empyema

• Definition: A buildup of purulent fluid in the pleural space (infected fluid).
• Causes:
  • Pneumonia.
  • Malignancy.
  • Lung abscess.
• Note: Potential for diminished or absent breath sounds.

Assessment of Pleural Effusion and Empyema

• Common Signs and Symptoms:
  • Shortness of air (SOA) and decreased oxygen saturation (O2).
  • Dry cough and chest pain that is non-radiating.
  • Chest pain may worsen upon inhalation.
  • Decreased or absent breath sounds upon auscultation.
  • Increased respiratory rate (RR) and effort.
  • Decreased chest expansion.
  • Fever may indicate empyema.

Diagnostics and Interventions

Diagnostics

• Chest x-ray to visualize fluid presence.
• Thoracentesis for fluid sample collection.

Interventions and Treatment

• Administration of antibiotics for infection control.
• Insertion of a chest tube for drainage.
• Performing thoracentesis.
• Possible chemical pleurodesis to adhere the pleura and prevent further effusion.

Thoracentesis Procedure Care

Pre-Procedure:

• Obtain consent and confirm patient identification (ID).
• Provide patient education regarding the procedure.

Procedure:

• Proper positioning:
  • Upright with arms resting on a table, or
  • Side-lying with the affected lung up.
• Patient should refrain from talking or coughing during the procedure.
• Monitor vital signs and respiratory pattern throughout.
• Send labeled specimens to the lab for analysis.

Post-Procedure:

• Monitor for complications such as:
  • Pneumothorax (collapsed lung): Listen for lung sounds.
  • Hypovolemia: Watch for hypotension and tachycardia.
  • Observe for serous fluid leaking from the site, which may indicate infection or bleeding.

Lung Cancer

Risk Factors and Epidemiology

• Major risk factors include:
  • Smoking (primary causative factor).
  • Environmental exposures (e.g., asbestos).
  • Genetic predisposition.
  • Advanced age.
  • Metastasis potential to other areas, such as: Bone, Blood and lymph, Brain, and Adrenal glands.

Lung Cancer Screening

• Screening is recommended for specific high-risk groups:
  • Individuals aged 50-80 with a history of smoking.
  • Smokers who have a 20 pack-year history.
  • Current smokers or those who quit within the last 15 years.
• Recommended screening: Low dose CT scans.
• Understanding risk: Calculated as the number of cigarettes per day multiplied by years smoked compared to a nonsmoker's risk.

Clinical Manifestations and Diagnostics

Clinical Manifestations

• Persistent cough.
• Wheezing and shortness of air (SOA).
• Pleuritic chest pain.
• Anorexia and significant weight loss.
• Hemoptysis (coughing up blood).

Diagnostics

• Diagnostic imaging and procedures:
  • Chest x-ray.
  • CT scan.
  • Bronchoscopy with biopsy.
  • PET scan for assessing metabolic activity of tumors.
• Notable point: Smokers may experience a specific cough, and questions about the intent of blood-tinged sputum should be asked.

CT Scan Computed Tomography Scan

• May use contrast dye for enhanced imaging; requires:
  • Assessment of allergies to iodine and shellfish prior to use.
  • Ensuring the patient is appropriately hydrated and has IV access for dye administration.
• Monitoring renal function is critical, particularly for those on medications such as metformin.
• Important: Elevated creatinine (Cr), Blood Urea Nitrogen (BUN), and decreased Glomerular Filtration Rate (GFR) could suggest potential kidney impairment, especially when interacting with iodine contrast.
• Encourage intake of fluids to flush out the contrast.

PET Scan

Pre-Procedure Preparation

1. 24 hours before the test: Follow a low-carb, no-sugar diet; avoid strenuous exercise.
2. 6 hours before the test: No eating allowed.
3. On the day of the test: A blood sample is taken to check glucose levels.

What to Expect During a PET Scan

1. The patient lies on a scanning bed inside the PET chamber for about 20-45 minutes.
2. IV delivers a radioactive tracer.
3. A waiting period of 60 minutes follows for the tracer to circulate throughout the body.

Bronchoscopy and Biopsy

Pre-Procedure

• Patient must be NPO (nothing by mouth).
• Hold any blood thinners to minimize bleeding risks.
• Sedation is administered for comfort.
• Topical anesthetic may be applied to throat.

Post-Procedure

• Patient remains NPO until gag reflex returns.
• Monitor for:
  • Sedation effects.
  • Signs of bleeding.
  • Respiratory difficulty: stridor, wheezing, oxygen saturation (O2), and respiratory rate (RR).

Surgical Treatment of Lung Cancer

• Criteria: If resections are possible, a whole lung or a portion of the lung (chunk) may be removed surgically.

Post-Operative Nursing Care

1. Respiratory assessment is critical.
2. Positioning: High Fowler's position to optimize lung function.
3. Chest tube management for drainage and monitoring.
4. Pain management: Understanding pain implications for mobility and rehabilitation.
5. Activity encouragement: Early ambulation and pulmonary hygiene practices.
6. Infection risk awareness: Recognizing it as a significant concern post-surgery, especially with chest tubes in place.

Math for Medication Dosing

Problem 1: Morphine Sulfate

• A client is ordered to receive morphine sulfate at 6 mg/hour. The medication comes as 50 mg/100 ml NS.

• Calculation of the rate (ml/hr) to be set on the IV pump:

  
  ext{Rate} ext{(ml/hr)} = rac{6 ext{ mg/hr}}{rac{50 ext{ mg}}{100 ext{ ml}}} imes (100) = 12 ext{ ml/hr}
  

Problem 2: Azithromycin Dosing

• A client is ordered to receive azithromycin 10 mg/kg/day in 3 divided doses. The client weighs 140 lbs.
• Weight conversion from lbs to kg:
  
  ext{Weight in kg} = rac{140 ext{ lbs}}{2.2} = 63.64 ext{ kg}
  
• Total daily dose calculation:
  
  63.64 ext{ kg} imes 10 ext{ mg/kg} = 636.4 ext{ mg/day}
  
• Dose per administration for divided doses:
  
  rac{636.4 ext{ mg}}{3} = 212.13 ext{ mg/dose} ext{ (approx. 212 mg per dose)}