1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Nursing Management: Patients With Chest and Lower Respiratory Tract Disorders

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Atelectasis Pathophysiology Risk factors Manifestations Management: –Incentive spirometry –Nebulizers –Chest physiotherapy (CPT)

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pneumonia Pathophysiology Types: –Community-acquired pneumonia –Hospital-acquired pneumonia –Ventilator-associated pneumonia –Health-care associated pneumonia Risk factors Manifestations and assessment

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A nurse is reviewing the epidemiology of pneumonia. The nurse should be aware of a seasonal pattern of incidence and prevalence in what type of pneumonia? A.Community-acquired pneumonia B.Hospital-acquired pneumonia C.Ventilator-associated pneumonia D.Health care–associated pneumonia

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Community-acquired pneumonia Rationale: Most cases of CAP occur in the winter and early spring. The etiology of the other three major types of pneumonia does not include seasonal patterns of incidence and prevalence.

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical and Nursing Management of Pneumonia Antibiotic therapy Supportive care Prevention Gerontological considerations

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy in the Management of Pneumonia Methods of administration: See Table 10-2 in text

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Masks

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A non-rebreathing mask should fully collapse on full inspiration

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: It is important to adjust the oxygen flow of a non-rebreathing mask so that the reservoir bag does not completely collapse on inspiration

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care of the Patient With Pneumonia Assessments Diagnoses: Functional and respiratory Goals and interventions address: –Improved airway patency –Conserving energy –Maintenance of proper fluid volume –Maintenance of adequate nutrition –Understanding of treatment and preventive measures –Absence of complications

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Tuberculosis Pathophysiology Risk factors Manifestations and assessment –Tuberculin skin test –QFT-G test Medication regimen

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A nurse is administering tuberculin skin tests to a group of employees. What technique will the nurse utilize? A.Intradermal injection into the workers’ forearms B.Intramuscular injection into the vastus lateralis C.Subcutaneous injection into the abdominal region D.Insertion at a 90-degree angle into the deltoid

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Intradermal injection into the workers’ forearms Rationale: During the tuberculin skin test, tubercle bacillus extract is injected into the intradermal layer of the inner aspect of the forearm

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Edema Pathophysiology Risk factors Manifestations and complications Medical management Nursing management

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pleural Conditions Pleurisy Pleural effusion and empyema

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pleural Effusion

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acute Respiratory Failure Pathophysiology Causes include: –Decreased respiratory drive –Dysfunction of the chest wall –Dysfunction of the lung parenchyma –Other causes Assessment Management

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acute Respiratory Distress Syndrome (ARDS) Pathophysiology Risk factors Manifestations Management: –Positive end-expiratory pressure (PEEP) –Pharmacologic treatments Nursing care

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A patient has been admitted to the emergency department with signs and symptoms that are suggestive of ARDS. What action should the ED nurse prioritize? A.Preparing to participate in intubation B.Administering oxygen by nasal cannula C.Administering bronchodilators by metered dose inhaler D.Auscultating the patient’s chest

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Preparing to participate in intubation Rationale: In order to facilitate the priorities of airway and breathing, prompt intubation is imperative in the treatment of a patient with ARDS. This is a priority over other assessments and interventions.

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Arterial Hypertension Pathophysiology Risk factors Manifestations Management Nursing care

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Embolism Pathophysiology Risk factors Manifestations Assessments: –Chest X-ray, ECG, peripheral vascular studies, ABGs, d-dimer, and ventilation–perfusion scan, CT Preventative measures

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Pulmonary Embolism Emergency measures Anticoagulants, thrombolytics Nursing care includes: –Prevention –Monitoring thrombolytic and anticoagulant therapy –Managing pain and anxiety –Managing oxygen therapy –Monitoring for complications

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Occupational Lung Diseases Silicosis Asbestosis Coal worker’s pneumoconiosis

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Lung Cancer The leading cancer killer among men and women in the United States In 2005, 196,687 people in the United States were diagnosed with lung cancer, and 159,217 people died of it Types: –Small cell lung cancer –Non–small cell lung cancer Squamous cell carcinoma Large cell carcinoma Adenocarcinoma

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Lung Cancer (cont’d) Risk factors Clinical manifestations Assessment and diagnostic testing Treatment: –Surgery –Radiation therapy –Chemotherapy Complications Nursing care

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chest Trauma Blunt trauma vs. penetrating trauma Clinical manifestations and assessment Management includes chest tube placement for pneumothorax

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Complication of Chest Trauma: Pneumothorax Types: –Simple –Traumatic –Tension Manifestations Management

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chest Drainage Systems

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chest Trauma (cont’d) Complications: –Sternal and rib fractures –Flail chest –Pulmonary contusion –Cardiac tamponade

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A patient returns to the unit after thoracic surgery with a water-sealed chest drainage system. What should the nurse instruct the patient and the family about the main purpose of this system? A.Remove excess carbon dioxide from the blood B.Monitor the quantity of pleural fluid C.To enhance the patient’s expiratory drive D.Re-expand the lung and remove excess air and fluid

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Re-expand the lung and remove excess air and fluid Rationale: The main purpose of chest tubes and closed drainage systems are to re-expand the lung involved and to remove excess air, fluid, and blood. They are not used to remove carbon dioxide, to enhance the respiratory drive, or to monitor the quantity of pleural fluid.

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aspiration Pathophysiology Risk factors Preventative measures