Chapter 28 Nursing Management Lower Respiratory Problems Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Chapter 28Chapter 28

Nursing ManagementNursing ManagementLower Respiratory ProblemsLower Respiratory Problems

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.


Chapter 28Chapter 28 1. Describe the pathophysiology, types, clinical manifestations, and collaborative care of 1. Describe the pathophysiology, types, clinical manifestations, and collaborative care of

pneumonia. pneumonia. 2. Explain the nursing management of the patient with pneumonia. 2. Explain the nursing management of the patient with pneumonia. 3. Describe the pathogenesis, classification, clinical manifestations, complications, 3. Describe the pathogenesis, classification, clinical manifestations, complications, diagnostic abnormalities, and nursing and collaborative management of tuberculosis. diagnostic abnormalities, and nursing and collaborative management of tuberculosis. 4. Identify the causes, clinical manifestations, and nursing and collaborative management 4. Identify the causes, clinical manifestations, and nursing and collaborative management of pulmonary fungal infections. (PC 1, 2, 3, 5, 6; MC 1, MP 3)of pulmonary fungal infections. (PC 1, 2, 3, 5, 6; MC 1, MP 3) 5. Explain the pathophysiology, clinical manifestations, and nursing and collaborative 5. Explain the pathophysiology, clinical manifestations, and nursing and collaborative management of lung abscesses. management of lung abscesses. 6. Identify the causative factors, clinical features, and management of environmental lung 6. Identify the causative factors, clinical features, and management of environmental lung diseases. diseases. 7. Describe the causes, risk factors, pathogenesis, clinical manifestations, and nursing and 7. Describe the causes, risk factors, pathogenesis, clinical manifestations, and nursing and collaborative management of lung cancer. collaborative management of lung cancer. 8. Identify the mechanisms involved and the clinical manifestations of pneumothorax, 8. Identify the mechanisms involved and the clinical manifestations of pneumothorax, fractured ribs, and flail chest. fractured ribs, and flail chest. 9. Describe the purpose, methods, and nursing responsibilities related to chest tubes. 9. Describe the purpose, methods, and nursing responsibilities related to chest tubes. 10. Explain the types of chest surgery and appropriate preoperative and postoperative care. 10. Explain the types of chest surgery and appropriate preoperative and postoperative care. 11. Compare and contrast extrapulmonary and intrapulmonary restrictive lung disorders in 11. Compare and contrast extrapulmonary and intrapulmonary restrictive lung disorders in terms of causes, clinical manifestations, and collaborative management. terms of causes, clinical manifestations, and collaborative management. 12. Describe the pathophysiology, clinical manifestations, and management of pulmonary 12. Describe the pathophysiology, clinical manifestations, and management of pulmonary embolism, pulmonary hypertension, and cor pulmonale. embolism, pulmonary hypertension, and cor pulmonale.

13. Discuss the use of lung transplantation as a treatment for pulmonary disorders. 13. Discuss the use of lung transplantation as a treatment for pulmonary disorders.


Acute BronchitisAcute Bronchitis

Inflammation of the BronchiInflammation of the Bronchi Most commonly viral infectionsMost commonly viral infections

Can be bacterialCan be bacterial Most commonly bacterial with smokersMost commonly bacterial with smokers

Symptoms include:Symptoms include: Cough, low grade fever, tachypnea, tachycardiaCough, low grade fever, tachypnea, tachycardia Some wheezing or rhonchiSome wheezing or rhonchi

Nursing management:Nursing management: Medications, testing, supportive careMedications, testing, supportive care


PneumoniaPneumonia

EtiologyEtiology Normal defense mechanismsNormal defense mechanisms Factors predisposing to pneumoniaFactors predisposing to pneumonia Acquisition of organismsAcquisition of organisms

Types of pneumoniaTypes of pneumonia Community-acquired pneumoniaCommunity-acquired pneumonia Hospital-acquired, ventilator-associated, and health care–Hospital-acquired, ventilator-associated, and health care–

associated pneumoniaassociated pneumonia Fungal pneumoniaFungal pneumonia Aspiration pneumoniaAspiration pneumonia Opportunistic pneumoniaOpportunistic pneumonia


Pneumonia (cont'd)Pneumonia (cont'd)

PathophysiologyPathophysiology Pulmonary congestion- bacterial Pulmonary congestion- bacterial

invasioninvasion Immune responseImmune response ResolutionResolution

Clinical manifestationsClinical manifestations Often rapid onsetOften rapid onset Fever, chills, shakingFever, chills, shaking Shortness of breath, cough, chest painShortness of breath, cough, chest pain Breath soundsBreath sounds


Fig. 28-1


Pneumonia (cont'd)Pneumonia (cont'd) ComplicationsComplications

Pleurisy, pleural effusion, atalectasis, lung abscess, Pleurisy, pleural effusion, atalectasis, lung abscess, empyemaempyema

Bacteremia, pericarditis, meningitis, endocarditisBacteremia, pericarditis, meningitis, endocarditis Diagnostic studiesDiagnostic studies

CXR, Sputum culture, Blood culturesCXR, Sputum culture, Blood cultures Collaborative careCollaborative care

Pneumococcal vaccine- high risk should receive every 5 Pneumococcal vaccine- high risk should receive every 5 yearsyears

Drug therapy- Must initiate antibiotic therapy within 4 hours Drug therapy- Must initiate antibiotic therapy within 4 hours of arrival to the hospital, oxygen, bronchodilatorsof arrival to the hospital, oxygen, bronchodilators

Nutritional therapy- Increase fluid intake, small frequent Nutritional therapy- Increase fluid intake, small frequent mealsmeals


Nursing Management PneumoniaNursing Management Pneumonia

Nursing assessment-color, resp. Nursing assessment-color, resp. rate, work of breathing, lung rate, work of breathing, lung soundssounds

Nursing diagnoses- see figure 28-Nursing diagnoses- see figure 28-1 (pg 568)1 (pg 568)

PlanningPlanning

Nursing implementationNursing implementation

Health promotionHealth promotion

Acute interventionAcute intervention

Ambulatory and home careAmbulatory and home care

EvaluationEvaluation


TuberculosisTuberculosis Infectious disease caused by Infectious disease caused by

Mycobacterium TuberculosisMycobacterium Tuberculosis 2 million die worldwide annually (14,000 2 million die worldwide annually (14,000

cases in the U.S. diagnosed)cases in the U.S. diagnosed) Lungs most common infection site but also Lungs most common infection site but also

may infect:may infect: Nervous systemNervous system KidneysKidneys AdrenalsAdrenals Lymph nodesLymph nodes Genital tractGenital tract

People @ riskPeople @ risk PoorPoor HomelessHomeless Foreign bornForeign born InstitutionalizedInstitutionalized ImmunosuppressedImmunosuppressed HIVHIV


Tuberculosis (cont'd)Tuberculosis (cont'd)

Diagnostic studiesDiagnostic studies TB skin testTB skin test Chest x-rayChest x-ray Bacteriologic and other studiesBacteriologic and other studies

Collaborative careCollaborative care Drug therapyDrug therapy

• Active diseaseActive disease• Latent tuberculosis infectionLatent tuberculosis infection• VaccineVaccine


Nursing ManagementNursing ManagementTuberculosisTuberculosis

Nursing assessmentNursing assessment

Nursing diagnosesNursing diagnoses

PlanningPlanning







Atypical MycobacteriaAtypical Mycobacteria

Similar to TB in clinical presentationSimilar to TB in clinical presentation

Only differentiated by CultureOnly differentiated by Culture

Treatment with similar drugsTreatment with similar drugs


Pulmonary Fungal InfectionsPulmonary Fungal Infections

immunocompromised patientsimmunocompromised patients

Cultures/biopsy to identify Cultures/biopsy to identify

s/sx similar to bacterial pneumonias/sx similar to bacterial pneumonia

Antifungal medications: monitor for Antifungal medications: monitor for side effects including renal/hepatic side effects including renal/hepatic

toxicitytoxicity


Lung AbscessLung Abscess

Most commonly associated with aspirationMost commonly associated with aspiration

Cavity is formedCavity is formed

Diagnosed with CXR or CTDiagnosed with CXR or CT

Requires long term antibiotic therapyRequires long term antibiotic therapy

May require surgery or chest tube drainageMay require surgery or chest tube drainage


Environmental Lung DiseasesEnvironmental Lung Diseases

Pneumoconiosis, chemical Pneumoconiosis, chemical pneumonitis, pneumonitis, hypersensitivity hypersensitivity pneumonitispneumonitis

Clinical manifestationsClinical manifestations Symptoms may not develop Symptoms may not develop

for >10 yearsfor >10 years FibrosisFibrosis

Collaborative careCollaborative care


Lung CancerLung Cancer

SmokingSmoking 80-90% of all cancers80-90% of all cancers Risk declines gradually Risk declines gradually

after cessationafter cessation 22ndnd Hand smoke Hand smoke

increases risk by 35%increases risk by 35% Pipe and cigar smoke still Pipe and cigar smoke still

increase riskincrease risk

Clinical ManifestationsClinical Manifestations Tumor may grow for 8-10 Tumor may grow for 8-10

years before visible on years before visible on CXR (1cm mass is CXR (1cm mass is smallest that is seen on smallest that is seen on CXR)CXR)

Persistent cough, Persistent cough, hoarsenesshoarseness

May have fever chillsMay have fever chills Weight loss, fatigue, Weight loss, fatigue,

nausea, vomiting nausea, vomiting


Fig. 28-2


Fig. 28-3


Lung Cancer (cont'd)Lung Cancer (cont'd)

Collaborative careCollaborative care Surgical therapy- treatment of Surgical therapy- treatment of

choice for stage I & IIchoice for stage I & II Radiation therapy- curative as Radiation therapy- curative as

well as adjunct therapy, palliative well as adjunct therapy, palliative carecare

Chemotherapy- usually adjunct Chemotherapy- usually adjunct therapytherapy

Biologic and targeted therapyBiologic and targeted therapy


Lung Cancer (cont'd)Lung Cancer (cont'd)

Collaborative care (cont'd)Collaborative care (cont'd) Other therapiesOther therapies

• Prophylactic cranial radiationProphylactic cranial radiation

• Bronchoscopic laser therapyBronchoscopic laser therapy

• Photodynamic therapyPhotodynamic therapy

• Airway stentingAirway stenting

• CryotherapyCryotherapy


Nursing Management Nursing Management Lung CancerLung Cancer

Nursing assessment (pg. 583)Nursing assessment (pg. 583)

Nursing diagnoses (pg. 583)Nursing diagnoses (pg. 583)

PlanningPlanning







Chest Trauma Chest Trauma and Thoracic Injuriesand Thoracic Injuries


PneumothoraxPneumothorax

Types of pneumothoraxTypes of pneumothorax Closed pneumothoraxClosed pneumothorax Open pneumothoraxOpen pneumothorax Tension pneumothoraxTension pneumothorax HemothoraxHemothorax ChylothoraxChylothorax


Fig. 28-4


Fig. 28-5


Fractured RibsFractured Ribsand Flail Chestand Flail Chest


Fig. 28-6


Chest Tubes and Pleural DrainageChest Tubes and Pleural Drainage

Chest tube insertionChest tube insertion

Pleural drainagePleural drainage Heimlich valvesHeimlich valves Small chest tubesSmall chest tubes


Fig. 28-7


Fig. 28-8


Fig. 28-9


Nursing Management Chest DrainageNursing Management Chest Drainage

ComplicationsComplications

Chest tube removalChest tube removal


Chest SurgeryChest Surgery

Preoperative carePreoperative care Surgical therapySurgical therapy

Video-assisted thoracic surgery (VATS)Video-assisted thoracic surgery (VATS) Postoperative carePostoperative care


Restrictive Respiratory DisordersRestrictive Respiratory Disorders

Pleural effusionPleural effusion PleurisyPleurisy AtelectasisAtelectasis Interstitial Lung DiseaseInterstitial Lung Disease Idiopathic Pulmonary FibrosisIdiopathic Pulmonary Fibrosis SarcoidosisSarcoidosis


Vascular Lung DisordersVascular Lung Disorders

Pulmonary EdemaPulmonary Edema Pulmonary EmbolismPulmonary Embolism Pulmonary HypertensionPulmonary Hypertension Cor PulmonaleCor Pulmonale


Fig. 28-10


Fig. 28-11


Fig. 28-12


Lung TransplantationLung Transplantation

Patient must pass extensive evaluation Patient must pass extensive evaluation including psychological evaluationincluding psychological evaluation

Lifelong immunosuppressive therapyLifelong immunosuppressive therapy High risk for infectionsHigh risk for infections Acute rejection usually occurs 5-7 days after Acute rejection usually occurs 5-7 days after

transplanttransplant

Chapter 28 Nursing Management Lower Respiratory Problems Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

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