For selected acute respiratory disorders, describe:
- Pathophysiology
- Signs and Symptoms
- Complications
- Diagnostic Measures
- Medical Treatment
Assist in developing a nursing care plan for patients with acute respiratory disorders.
Acute Bronchitis
Cause and Risk Factors
Viral: Caused by cold or flu viruses.
Bacterial: Common bacterial offenders include:
- S.pneumoniae
- H.influenzae
Noninfectious: Inhalation of toxins.
Signs and Symptoms
Cough
Sputum production
Fatigue
Dyspnea on exertion
Wheezing or rhonchi
Fever
Chest pain
Symptoms similar to upper respiratory infections (e.g., nasal congestion, runny nose, sore throat).
Medical Diagnosis
Diagnosis based on health history and clinical presentation.
Medical Treatment
Antitussives: e.g., Dextromethorphan
Expectorants: e.g., Guaifenesin
Beta-2 Agonists: e.g., Albuterol.
Nursing Care
Humidification to help with symptoms.
Eliminate environmental triggers.
Precautions as necessary.
Influenza
Complications
Possible complications include:
- Bronchitis
- Viral or bacterial pneumonia
- Sinus or ear infections.
- Acute respiratory failure secondary to the flu.
- Multiple organ dysfunction syndrome (MODS).
- Cardiac complications: EKG abnormalities, acute myocardial infarction, myocarditis, pericarditis.
- CNS complications: Encephalitis, aseptic meningitis, encephalopathy, Guillain-Barré syndrome.
Signs and Symptoms
Abrupt onset of:
- High fever (102°F–104°F; 38°C–40°C lasting 3-4 days).
- Cough and sore throat.
- Headache.
- General body aches and pains.
- Exhaustion and fatigue.
- Older adults may experience altered mental status without fever.
Medical Diagnosis
Rapid influenza diagnostic tests (RIDTs).
Rapid molecular assays via nasal/throat/ nasopharyngeal swab.
Medical Treatment
Antipyretics: Analgesics (not echinacea).
Antivirals to prevent or treat within 48H of symptom onset:
- Oral Oseltamivir (Tamiflu)
- Baloxavir (Xofluza)
- Inhaled Zanamivir (Relenza)
- Intravenous Peramivir (Rapivab).
Yearly Vaccine: Recommended for everyone aged >6 months.
Nursing Care
Most susceptible groups:
- Young children, older adults, pregnant and postpartum women.
- Extremely obese individuals.
- People in institutional settings.
- Individuals with chronic illnesses.
- Immunosuppressed people, Native Americans, Alaska Natives, healthcare personnel who contact high-risk patients.
Pneumonia
Cause and Risk Factors
Inflammation of lung areas such as alveoli and bronchioles.
Infectious Agents:
- Bacteria: S.pneumoniae
- Fungi: Pneumocystisjirovecii
- Viruses: Influenza, RSV.
- Health care-associated infection (HAI): Non-intubated patients within 48 hours of admission.
- Community-acquired infection (CAI): Patients living in the community within the previous 14 days.
- Ventilator-associated pneumonia (VAP).
Fluid accumulation in the lungs due to pathogen invasion.
Hepatization: Activation leads to capillary dilation, infiltration by neutrophils, RBCs, and fibrin filling the alveoli, making the lung appear red and granular.
Eventually, blood flow decreases and the area consolidates through WBC and fibrin infiltration.
Resolution: Consolidated materials dissolve, and macrophages remove debris.
Characterized by abrupt and severe unilateral pain.
Treatment
Address underlying conditions; provide pain relief.
Nursing Care
Pain Management
Use of analgesics, splinting the affected side during coughing.
Administer anti-inflammatory agents (acetaminophen, NSAIDs), antitussives, antimicrobials as needed.
Provide local heat therapy for comfort.
Inadequate Oxygenation Management
Encourage turning, deep breaths, coughing, ambulation, and elevating HOB.
Monitor for signs of pleural effusion: progressive dyspnea, decreased or absent breath sounds, decreased chest wall movement on affected side; consider thoracentesis as necessary.
Penetrating: Gunshot or stabbing injuries (e.g., result in pneumothorax or severe vessel tears).
Effects
Leads to changes in pressure relationships between air inside and outside the body.
May interfere with normal breathing, leading to inflammation, swelling, pain, risk of air entry into the pleural space, increased secretions, hemorrhage, and collection of abnormal fluid in the lungs.
Immediate care goals include:
- Stabilization
- Prevention of further injury.
Use vented dressings and position the patient appropriately (e.g., semi-Fowler position or on the injured side).
Pneumothorax
Description
Accumulation of air in the pleural cavity leading to lung collapse.
Causes
Chest injury leading to:
- Holes in the chest wall.
- Tears in bronchus/bronchioles/alveoli.
- Spontaneous rupture of air sacs.
Types of Pneumothorax
Open Pneumothorax: Mediastinal flutter; allows air movement in and out, causing lung collapse and mediastinal shift.
Tension Pneumothorax: Life-threatening condition where trapped air cannot escape, raising pressure and compromising heart blood return.
Signs and Symptoms
Air heard/moved through a wound indicates a sucking chest wound.
Other symptoms include dyspnea, tachypnea, tachycardia, restlessness, chest pain, anxiety, reduced movement of the affected chest wall, asymmetric motion, diminished breath sounds on affected side, progressive cyanosis.
Medical Treatment
Includes needle aspiration, chest tube placement, or surgery to repair tears in lung or bronchus.
Nursing Care
Inadequate Oxygenation Management
Recognize signs of respiratory distress efficiently and protect the chest tube.
Appropriate positioning: Fowler or semi-Fowler, avoid lying on the affected side.
Encourage deep breathing and coughing every 2 hours while awake.
Other Interventions
Administer oxygen and monitor for potential complications such as infection:
- Check for fever, increased heart rate, redness/swelling, foul drainage from insertion site, elevated WBC count.
Hemothorax
Description
Blood accumulation between chest wall and lung, often associated with pneumothorax.
Causes
May result from lacerated vessels or lung tissue, malignancies, or pulmonary embolism.
Management
Treat similarly to pneumothorax; surgical intervention may be necessary to control bleeding.
Rib Fractures
Description
Result from blunt trauma, commonly ribs 4-10; usually heals in about 6 weeks.
Signs and Symptoms
Pain at the injury site (exacerbated by inspiration), possible bruising or surface markings, swelling, respiratory patterns may include protective chest holding.
Medical Treatment
Inpatient care may be required for fractures of >3 ribs:
- Intercostal nerve blocks for anesthesia
- Analgesics, mild sedatives
- Possible surgical stabilization.
Nursing Care
Assessment
Watch for signs of pneumothorax.
Goals
Improve oxygenation and manage pain adequately.
Interventions
Breathing exercises and the use of incentive spirometry while supporting fractured ribs.
Flail Chest
Description
Caused typically by multiple rib fractures leading to paradoxical movement of the chest wall.
Signs and Symptoms
Dyspnea, cyanosis, tachypnea, and paradoxical chest movement.
Medical Diagnosis
History, clinical presentation, chest radiographs, arterial blood gas (ABG) tests.
Medical Treatment
May require intubation and mechanical ventilation; surgical stabilization for fractured ribs.
Nursing Care
Refer to fractured rib care guidelines.
Pulmonary Embolus
Risk Factors
Recent surgery on pelvis or lower limbs, immobility, obesity, estrogen therapy, clotting abnormalities.
Cause
An embolus occludes a portion of a pulmonary blood vessel, potentially causing V-P mismatch and hypoxemia.
Large vessel obstruction leads to alveoli collapse, reduced cardiac output, and constricted bronchi.
Signs and Symptoms
Rapid onset of dyspnea, chest pain, anxiety, diaphoresis, cough with hemoptysis, orthopnea, unilateral leg pain.
Medical Diagnosis
Based on history/presentation, imaging (CTPA, ventilation-perfusion scanning), lower extremity ultrasound, ABGs, D-dimer, ECG.