5Aspiration pneumoniaIs an inflammatory condition of the lungs and bronchi caused by the inhalation of food/fluid or vomitusThe affects of this type will depend onThe substance inhaledThe amountThe resulting inflammation and/or destruction of lung tissue
6Infective pneumoniaThe body’s defences fail to prevent inhaled or airborne microbes reaching and colonising in the lungsThis can be achieved byInhalation of infective organismsAspiration of infective organisms fromThe upper respiratory tractFrom gastric contentsHaematogenous – common in bacteraemia or secondary to UTI
7Causes Lowered resistance URTI Depression of CNS (head injuries, drugs)Alcohol abuseCardiac failureDebilitating illnessSuper-infection in hospitalised patientsExposure to intense cold, dampnessAny bronchial obstructionProlonged immobilisationPulmonary oedema and congestionImpaired coughingalcohol suppresses macrophage function and white cell mobilisation
9Prevention Natural resistance should be maintained Avoid contact with people with URTIsObliteration of cough reflex and aspiration should be avoidedHighly susceptible people should be immunisedImmobilised patients should be turned every two hours and encouraged to deep breath and cough
10Complications Pleuritis – may lead to pneumothorax, empyema Pleural fibrosisAbscess formationChronic lung disease – leading to interstitial fibrosisBronchiectasis (bronchial dilation)
12Exemplified by chronic bronchitis and obstructive emphysema and asthma Patients may have a history of:SmokingDyspnoea, where labored breathing occurs and gets progressively worseCoughing and frequent pulmonary infectionsPeople with COPD may develop respiratory failure accompanied by hypoxaemia, carbon dioxide retention, and respiratory acidosis
14AsthmaCharacterized by shortness of breath, wheezing, and chest tightnessActive inflammation of the airways precedes bronchospasmAirway inflammation is an immune response caused by release of IL-4 and IL-5, which stimulate antibodies and recruit inflammatory cellsAirways thickened with inflammatory mucus magnify the effect of bronchospasm
16Other Respiratory Diseases TuberculosisInfectious disease caused by the bacterium Mycobacterium tuberculosisSymptoms include fever, night sweats, weight loss, a racking cough, and splitting headacheTreatment entails a 12-month course of antibiotics
18Other Respiratory Diseases Lung CancerSquamous cell carcinoma (20-40% of cases) arises in bronchial epitheliumAdenocarcinoma (25-35% of cases) originates in peripheral lung areaSmall cell carcinoma (20-25% of cases) contains lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize
19Incidence and mortality rates: national Lung cancer is the fifth most common registerable cancer in Australia.Around 8,200 Australians are diagnosed with lung cancer each year.More than 7,000 Australians die from lung cancer each year.One in 33 Australians will develop lung cancer by the age of 75.
20Risk factors/Prevention Smoking is a major cause of lung cancer.Smokers and workers exposed to industrial substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons and chloromethyl ether have a significantly higher risk of developing lung cancer.Research has also demonstrated a link between passive smoking and lung cancer.
21SymptomsLung cancer is very difficult to detect at an early stage, some symptoms may include:A new or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion.Recurring episodes of lung infection, weight loss and swelling of the face or arms are also common symptoms.
22TreatmentThere are a few different types of treatment for lung cancer (with different aims):Surgery - This is used to remove all the cancer in the hope of a cure.Chemotherapy - This is a course of drugs given to kill or control the cancer cells.Radiotherapy - This is a course of x-rays given to kill or control the cancer.Laser treatment - This is used to control the cancer cells. It is used to unblock airways full of tumour, but it does not cure the cancer.
24PneumothoraxIs the accumulation of air or gas in the pleural cavity, resulting in the collapse of the lung on the affected sideHaemothorax – blood in pleural cavityHaemopneumothorax – blood and air in the pleural cavity
27Causes Spontaneous Chest trauma Surgery Central line insertion Positive pressure ventilation
28Spontaneous pneumothorax May occur in healthy individuals and is often due to a rupture of a sub pleural bleb (often affects tall, thin men between yrs)May be a complication of underlying pulmonary disease such as COAD, asthma, cystic fibrosis, TB, pertussis
29Clinical manifestations Sudden sharp chest pain - made worse by deep breath or coughDyspnoea – sudden onsetChest tightnessEasily fatiguedTachycardiaCyanosisUnilateral pleuritic painTachypnoeaSubcutaneous emphysemaPallorDiaphoresisReduced movement on affected sideOpen pneumothorax may reveal obvious haemorrhage or foreign body in chest wall
30Treatment If small then it may require no intervention More extensive Insertion of an intercostal catheter (ICC)Connection to underwater seal drainage (UWSD) systemNon resolution or reoccurrences may need surgical intervention
31Thoracic drainageThis system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural spaceAirFluids such as blood, pus, chyle, serous fluid, gastric juicesSolids such as blood clots
32Thoracic drainageThis system uses gravity and possibly suction to restore negative pressure and remove any material that collects in the pleural spaceAirFluids such as blood, pus, chyle, serous fluid, gastric juicesSolids such as blood clots
34Thoracic drainage Tube placement Is placed in the 2nd, 3rd, or 4th intercostal space.The tube is sutured in and has an occlusive dressing applied to prevent air leaksDetermined by the substance to be drainedSmaller gauge tubes for airLarger gauge tubes for fluidsPneumothorax – usually one tubeHaemothorax – usually two tubes
35Under water seal drainage This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to reenter.
36Under water seal drainage system This drainage system allows the removal of accumulated air, fluids or solids from the pleural cavity without allowing air to re-enter.A chamber containing waterA chamber for collection of fluids or solidsMay be connected to suction
37Nursing care Patient may be nursed in semi Fowlers position Oxygen and analgesia may be neededAllay anxietyEncourage deep breathing and coughingPatient to splint the affected side when coughingCheck respirations – noting chest movementReport increase in respiratory rate or distress, increase in pain or abnormally large increase in drainage to RN Div 1Check dressing daily – maintain asepsis
38Nursing careTubingClamping – to be achieved with two clamps (rubber clipped forceps) above the connection to the UWSD whenIt is necessary to lift system above the level of the bedChanging the systemObserve forKinksDependent loopsFlatteningLoosening of connectionsBlockageTube dislodgement
39Nursing care Drainage system Check the character, consistency and quality of drainageMark the drainage level – noting time and date (usually done each shift)Check for oscillation (swinging of the fluid in rhythm with the patient’s breathing) may be as much as 5-10cmCheck for intermittent bubbling of air (pneumothorax)Ensure suction is maintained at ordered pressure