Lung Cancer, Pulmonary Edema, Pulmonary Embolism, ARDS, COPD, Emphysema, Chronic Bronchitis & Asthma

Lung Cancer

• Cancer in the lung.
• Smoking is a primary cause.
• Can originate in the lung or metastasize from elsewhere (colon and kidney).
• Risk factors:
  • Cigarette smoking (primary cause).
  • Asbestos and chemicals.
  • Secondhand smoke.
  • Age (older than 50 years).
• Signs and Symptoms:
  • Dyspnea (shortness of breath).
  • Chills.
  • Hemoptysis (bleeding in the sputum).
  • Chronic cough.
  • Fatigue.
  • Weight loss.
  • Frothy sputum with streaks of blood.
  • Wheezing (on the affected side).
• Diagnosis:
  • Chest X-ray.
  • CT scan.
  • MRI.
  • Biopsy (via incision or bronchoscopy).
• Treatment:
  • Depends on type and stage.
  • Surgery (if operable).
  • Lung transplant (less likely for smokers).
  • Radiation.
  • Chemotherapy.
  • Palliative care (hospice).
• Emotional support and mental health care are important.

Pulmonary Edema

• Accumulation of fluid in the interstitial lung tissue and alveoli.
• Causes:
  • Coronary artery disease.
  • Rapid administration of IV fluids (including blood products).
  • Opioid overdose.
  • Cardiomyopathy.
  • Pulmonary embolism.
  • Asthma.
  • Sleep apnea.
• Flash pulmonary edema can occur with rapid infusion of fluids.
• Signs and Symptoms:
  • Frothy sputum.
  • Orthopnea.
  • Agitation.
  • Restlessness.
  • Respiratory failure.
  • Wheezing.
• Diagnosis:
  • Chest X-ray.
  • ABG (arterial blood gas).
• Treatment:
  • Oxygen.
  • Diuretics (monitor for hypotension and dehydration, risk versus benefit).
• Morphine (to suppress respiratory rate).
  • Vasodilators.
  • Intubation (if necessary).
• Monitor electrolytes.

Pulmonary Embolism (PE)

• Obstruction of blood supply to the lungs often by a blood clot, but can also be caused by: fat, air, tissue from a tumor, or amniotic fluid.
• Can be partial or complete.
• Risk Factors:
  • Birth control pills.
  • Recent surgery.
  • Immobility.
  • History of congestive heart failure.
  • Obesity.
  • Recent childbirth.
  • Femur fracture (high risk).
• Signs and Symptoms:
  • Chest pain.
  • Shortness of breath.
  • Hemoptysis.
  • Elevated temperature.
  • Elevated white blood cell count.
  • Low blood pressure.
  • High heart rate.
  • Diaphoresis.
• Diagnosis:
  • D-dimer (blood draw, usually high).
  • ABG.
  • VQ scan (ventilation vs. perfusion).
  • CT scan.
  • Pulmonary angiography.
• Treatment:
  • Anticoagulant therapy (Heparin IV followed by Warfarin/Coumadin).
• Monitor PT/INR to check coagulation.
  • Thrombolytics.
  • IVC filter (to catch clots).
• Preventative Measures:
  • Anti-embolism stockings (TED hose).
  • SCDs (Sequential Compression Devices).
  • Oxygen.

Acute Respiratory Distress Syndrome (ARDS)

• A complication of a disease, not a disease itself.
• Fluid leaks into interstitial spaces, leading to pulmonary edema and respiratory distress; alveolar collapse.
• Causes:
  • Sepsis.
  • COPD.
  • Drug overdose.
  • Pneumonia.
  • Aspiration.
  • Inhalation of smoke.
  • Chest trauma.
  • Drowning/near drowning.
  • Pancreatitis
  • Neuromuscular diseases
• Signs and Symptoms:
  • Hypotension.
  • Decreased urinary output (kidney involvement).
  • Increased CO_2 levels.
  • Agitation.
  • Crackles and/or wheezing.
• Symptoms usually appear 24 hours after the initial event.
• Diagnosis:
  • Pulmonary function test.
  • ABGs.
  • Chest X-ray (white-out lungs).
• Treatment:
  • Corticosteroids.
  • Antibiotics (to prevent infection).
  • Morphine.
  • Diuretics (treat pulmonary edema).
  • Bronchodilators.
  • Mucolytics.
• Nursing interventions includes prone positioning to improve lung expansion.
• Monitor oxygen saturation and ABGs for improvement.

Chronic Obstructive Pulmonary Disease (COPD)

• Chronic lung condition primarily found in smokers.
• Irreversible; damage is permanent.
• Umbrella term that includes emphysema and chronic bronchitis.

Emphysema

• Alveoli enlarge and lose elasticity, impairing gas exchange.
• Often seen with COPD in chronic smokers.
• Alveoli can rupture and turn into non-functional scar tissue.
• Oxygen decreases, and carbon dioxide increases.
• Causes:
  • Cigarette smoking.
  • Inhaled irritants.
  • Secondhand smoke.
• Signs and Symptoms:
  • Shortness of breath.
  • Coughing.
  • Wheezing.
  • Barrel chest.
  • Clubbing (clubfinger) of the fingers.
• Treatment:
  • Bronchodilators.
  • Steroids (use cautiously due to side effects; risk vs. benefit).
  • Long-term oxygen (low and slow).
• COPD patients breathe better when oxygen levels are lower due to CO2 retention.
• BIPAP machine to blow off CO2.
• Diet:
  • High protein, high calorie.
  • Small, frequent meals.
  • Limit fluid intake to 2-3 liters per day.
• Pursed-lip breathing techniques help.

Chronic Bronchitis

• Excessive mucus in the airways obstructs airflow.
• Lining of bronchial tubes becomes inflamed and scars.
• Airways become resistant and can create bronchospasms.
• Gas exchange is impaired.
• Most common cause is smoking.
• Signs and Symptoms:
  • Frequent cough (productive) for a minimum of 3 months out of the year for at least 2 years.
  • Shortness of breath.
  • Wheezing.
  • Cyanosis.
• Diagnosis:
  • Chest X-ray.
  • ABGs.
  • Pulmonary function tests (PFTs).
  • Pulse oximetry.
• Treatment:
  • Steroids (Long term).
  • Bronchodilators (Long term).
  • Low-flow oxygen (if needed).
• Usually irreversible.

Asthma

• Widespread narrowing of the airways.
• Can develop in childhood or adulthood; may be exercise-induced.
• Triggers:
  • Extrinsic: pollen, dust, feathers, animal dander, certain foods.
  • Intrinsic: respiratory tract infections; stress
• Attack can be fatal.
• Signs and Symptoms:
  • Tightness of the chest.
  • Chest pain.
  • Dyspnea.
  • Nasal flaring.
  • Rapid heart rate.
  • Increased respiratory rate.
  • Wheezing.
• Diagnosis:
  • Pulmonary Function Tests (PFTs).
  • Elevated eosinophils (during an attack).
• Treatment:
  • Bronchodilators (rescue inhaler).
  • Maintenance therapy (steroids).
  • Oxygen (if needed).
• Nursing interventions include avoid triggers, teach effective breathing techniques and relaxation techniques.
• Educate patients regarding when and how to use their medications.
• Education of family and caregivers is critical, especially for children with asthma.