Chapter023 LR

Management of Patients With Chest and Lower Respiratory Tract Disorders

Objectives

  • Identify various lower respiratory tract disorders.

  • Outline the pathophysiology of each disorder.

  • Outline necessary nursing care for affected patients.

  • Integrate patient teaching into the care plan for patients with lower respiratory tract disorders.

Atelectasis

Definition

  • Collapse of parts of the lung, impacting ventilation.

Types

  • Nonobstructive Atelectasis: Often due to connective tissue or fibrosis.

  • Obstructive Atelectasis: Blockage hinders airflow to/from the alveoli.

Causes

  • Surgery, foreign body, excess pressure on the chest, cancer or tumors, altered breathing patterns, retained secretions, pain, prolonged supine positioning.

Specifics

  • Right lower lobe atelectasis can be caused by blockage in the airway or external compression from a tumor/injury.

Nursing Management of Atelectasis

Prevention Strategies

  • Frequent patient repositioning, particularly from supine to upright.

  • Early mobilization and deep breathing exercises every 2 hours.

  • Use of incentive spirometry to promote lung expansion.

Treatment Strategies

  • Techniques to improve ventilation and remove secretions, e.g., coughing exercises, suctioning, aerosol therapy, and chest physiotherapy.

  • May require PEEP and IPPB for lung expansion and oxygenation.

  • Bronchoscopy may be utilized for obstruction removal.

Respiratory Infections

Types of Infections

  • Acute Tracheobronchitis: Inflammation following upper respiratory infection.

  • Pneumonia: Infection of the lungs and air sacs.

    • Community-acquired Pneumonia: Infectious agents from school or work environments.

    • Hospital-acquired Pneumonia: Generally caused by bacteria in hospital settings.

    • Aspiration Pneumonia: Resulting from inhalation of foreign materials.

Symptoms of Pneumonia

  • Cough with sputum, fever (over 100.4 F), tachypnea, chest pain, fatigue/muscle pain.

Medical Treatment

  • Supportive care with fluids, oxygen, antipyretics, anti-tussives, decongestants, and antiviral medication as needed.

  • Antibiotic therapy based on infection type and gram-stain results.

Nursing Process for Pneumonia

Assessment

  • Monitor changes in temperature, pulse, secretions, cough, and respiratory status (tachypnea).

  • Observe for changes in physical assessment (auscultation).

Nursing Diagnosis

  • Ineffective airway clearance, activity intolerance, risk for fluid volume deficit, imbalanced nutrition, deficient knowledge.

Planning

  • Focus on improved airway clearance and adequate fluid/nutrition balance.

Collaborative Problems

  • Monitoring for persistent symptoms and risks of complications such as shock, respiratory failure, hemothorax.

Pleural Conditions

Pleurisy

  • Inflammation causing sharp pain intensified with inhalation.

Pleural Effusion

  • Fluid accumulation, often secondary to other diseases, leading to impaired lung expansion and dyspnea.

Types of Effusions

  • Transudative: Fluid from normal pleurae, commonly due to heart failure.

  • Exudative: Fluid from damaged vessels, containing proteins and inflammatory cells.

Acute Respiratory Distress Syndrome (ARDS)

Definition

  • Life-threatening lung injury characterized by pulmonary edema and refractory hypoxemia.

Pathophysiology

  • Inflammatory response impairs pulmonary vascular permeability, leading to hypoxemia and pulmonary hypertension.

Management

  • Requires intubation, mechanical ventilation with PEEP, and frequent repositioning.

Pulmonary Emboli

Definition

  • Obstruction in pulmonary artery by a clot or other substances affecting blood flow and gas exchange.

Risk Factors

  • Include venous stasis, hypercoagulability, and certain medical conditions.

Prevention and Treatment

  • Emphasize early ambulation and anticoagulation therapies.

Tuberculosis (TB)

Background

  • Infectious disease primarily affecting lungs, transmitted via airborne particles.

Risk Factors

  • Immunocompromised status, overcrowding, poor nutrition, and close contact with active TB patients.

Clinical Manifestations

  • Symptoms include cough, fever, night sweats, and potential hemoptysis.

Treatment

  • Managed primarily with anti-TB agents over 6 to 12 months; challenges include drug resistance.

Nursing Management for TB

  • Focus on promoting airway clearance and adherence to treatment while preventing disease transmission.

Review Questions

  1. What type of condition is pneumonia? (A. Respiratory)

  2. True or False: Community acquired and hospital-acquired pneumonia are types of pneumonia. (True)

  3. Why are hospital patients more prone to pneumonia? (All the above)

  4. Which population is most at risk for pneumonia? (D. Elderly)

  5. What is the common treatment for pneumonia? (B. Antibiotic)