Chapter19

Management of Patients with Chest and Lower Respiratory Tract Disorders

Atelectasis

  • Closure or collapse of alveoli

  • Types: Acute (most common in postoperative settings) and Chronic

  • Symptoms:

    • Acute: dyspnea, cough, tachycardia, tachypnea, pleural pain, cyanosis

    • Chronic: similar to acute; may include pulmonary infection

Assessment and Diagnosis

  • Increased work of breathing and hypoxemia

  • Signs: decreased breath sounds, crackles

  • Diagnostics: chest x-ray, pulse oximetry (SpO2 < 90%)

Nursing Interventions

  • Prevention strategies: frequent turning, early mobilization

  • Techniques: incentive spirometer, deep breathing exercises, secretion management

Management

  • Improve ventilation, remove secretions

  • First-line measures: frequent turning, early ambulation

  • Multidisciplinary approaches: PEEP, bronchoscopy, etc.

Acute Tracheobronchitis

  • Inflammation after viral infection

  • Symptoms: dry cough, dyspnea, wheezing, purulent sputum

Management

  • Medical: antibiotics, analgesics, hydration

  • Nursing: bronchial hygiene, rest, medication adherence

Pneumonia

  • Inflammation caused by various microorganisms

  • Types:

    • Community-acquired (most common: S. Pneumoniae)

    • Health care-associated

    • Hospital-acquired

    • Ventilator-associated

Risk Factors and Clinical Manifestations

  • Related to underlying disorders (e.g., heart failure, diabetes)

  • Symptoms vary: chills, cough, pleuritic chest pain, tachycardia

Assessment and Diagnosis

  • Tools: history, physical exam, chest x-ray, blood cultures, sputum analysis

Prevention

  • Vaccinations for pneumococcal pneumonia recommended for older adults

Medical Management

  • Administration of antibiotics, supportive treatment

  • Longer treatment and special considerations for older adults

COVID-19 Considerations

  • Symptoms may range from mild to severe

  • Conservative outpatient management for mild cases; hospitalization for severe cases

Bacterial Pneumonia Assessment

  • Monitor vital signs, secretions, and cough

  • Assess for changes in mental status and signs of dehydration

Complications

  • Possible sepsis, respiratory failure, atelectasis, pleural effusion

Goals for Management

  • Improved airway patency, increased activity, proper nutrition

  • Education on treatment protocols, prevention of complications

Nursing Interventions for Bacterial Pneumonia

  • Oxygen therapy, chest physiotherapy, nutrition supports

  • Emphasize patient education and self-care

Aspiration

  • Inhalation of foreign materials may lead to pneumonia

  • Risk factors include loss of consciousness

Pulmonary Tuberculosis (TB)

  • Caused by Mycobacterium tuberculosis

  • Spread through airborne droplets; may affect multiple organs

Assessment and Management of TB

  • Involves skin tests, sputum cultures

  • Treatment typically lasts 6-12 months with multiple medications

Lung Abscess

  • Complication of bacterial pneumonia

  • Symptoms: productive cough, leukocytosis

Management of Lung Abscess

  • Focus on adequate drainage, chest physiotherapy, and nutritional support

Sarcoidosis

  • Often affects younger adults, especially African American women

  • Clinical manifestations depend on the systems affected

Management of Sarcoidosis

  • Corticosteroids, patient education on management

Pleural Conditions

  • Involve disorders of pleural membranes

  • Types: Pleurisy, pleural effusion, empyema

Acute Respiratory Failure (ARF)

  • Notable signs include hypoxemia and confusion

  • Management includes identifying the underlying cause and ventilation support

Endotracheal Intubation and Tracheostomy

  • Procedures for airway management and mechanical ventilation support

Mechanical Ventilation

  • Indications and care for patients receiving mechanical ventilation

Acute Respiratory Distress Syndrome (ARDS)

  • Characterized by rapid onset of severe dyspnea

  • Management focuses on treating the underlying cause and providing ventilatory support

Occupational Lung Disease

  • Includes pneumoconiosis from inhalation of dust; preventable through education and protective gear

Lung Cancer

  • Leading cause of cancer deaths; predominantly caused by smoking

  • Management includes various treatment modalities and symptom management.