Presentation on theme: "Atelectasis Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression Causes: bronchial obstruction by."— Presentation transcript:
1 Management of Patients With Chest and Lower Respiratory Tract Disorders
2 AtelectasisCollapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compressionCauses: bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspirationPostoperative patients at high riskSymptoms: insidious, include cough, sputum production, low-grade feverRespiratory distress, anxiety, symptoms of hypoxia occur if large areas of lung are affected
3 Nursing Management Prevention Frequent turning, early mobilization Strategies to improve ventilation: deep breathing exercises at least every 2 hours, incentive spirometerStrategies to remove secretions: coughing exercises, suctioning, aerosol therapy, chest physiotherapy
4 Nursing Management (cont’d) TreatmentStrategies to improve ventilation, remove secretionsTreatments: may include PEEP (positive end-expiratory pressure), IPPB (intermittent positive-pressure breathing)Bronchoscopy may be used to remove obstruction
7 Risk FactorsCancer, smoking, COPD (produce mucus, or obstruct bronchusImmunocompromised ptProlonged immobility and shallow breathingDepressed cough reflex, aspiration of foreign material
8 AlcoholismGA, sedativeAdvance ageRespiratory therapy with improperly cleaned equipmentTransmission of organisms from staff of health care.
9 Clinical Manifestation Sudden onset of chills, rapid raising fever (38.5 – 40.5o)Pleuritic chest pain increase with deep breathing and coughingTachypnea ( 25 – 45b\m)Rapid bounding pulseIn sever cases cheeks flushed and the lips with nail beds become cyanosed.
10 OrthopneaDecrease appetite, fatiguePurulent sputumCrackles, increased tactile fermitus, dullness on percussion, bronchial breathing sounds, egophony and whispered pectoriloquy.
13 Medical Treatment of Pneumonia Supportive treatment includes fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, antihistaminesAdministration of antibiotic therapy determined by gram-stain resultsIf etiologic agent is not identified, utilize empiric antibiotic therapyAntibiotics not indicated for viral infections but are used for secondary bacterial infection
14 Nursing Process: Care of the Patient with Pneumonia - Assessment Changes in temperature, pulseSecretionsCoughTachypnea, shortness of breathChanges in physical assessment, especially inspection, auscultation of chestChanges in CXRChanges in mental status, fatigue, dehydration, concomitant heart failure, especially in elderly patients
15 Nursing Process: Care of the Patient with Pneumonia - Diagnoses Ineffective airway clearanceActivity intoleranceRisk for fluid volume deficientImbalanced nutritionDeficient knowledge
16 Collaborative Problems Continuing symptoms after initiation of therapyShockRespiratory failureAtelectasisPleural effusionConfusionSuperinfection
17 Nursing Process: Care of the Patient with Pneumonia - Planning Improved airway clearanceMaintenance of proper fluid volumeMaintenance of adequate nutritionPatient understanding of treatment, preventionAbsence of complications
18 Improving Airway Clearance Encourage hydration; 2 to 3 L a day, unless contraindicatedHumidification may be used to loosen secretionsBy face mask or with oxygenCoughing techniquesChest physiotherapyPosition changesOxygen therapy administered to meet patient needs
19 Other Interventions Promoting rest Promoting fluid intake Encourage rest, avoidance of overexertionPositioning to promote rest, breathing (Semi-Fowler’s)Promoting fluid intakeEncourage fluid intake to at least 2 L a dayMaintaining nutritionProvide nutritionally enriched foods, fluidsPatient teaching
20 Aspiration Risk factors Pathophysiology Prevention: Elevate HOB Turn patient to side when vomitingPrevention of stimulation of gag reflex with suctioning or other proceduresAssessment, proper administration of tube feedingRehabilitation therapy for swallowing
21 Pleural Conditions Pleurisy: inflammation of both layers of pleurae Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspirationPleural effusion: collection fluid in pleural space usually secondary to another disease processLarge effusions impair lung expansion, cause dyspnea
22 Pleural Conditions (cont’d) Empyema: accumulation of thick, purulent fluid in pleural space.Patient usually acutely ill; fluid, fibrin development, loculation impair lung expansionResolution is a prolonged process
24 Causative Factors for Pulmonary Disease Cigarette smokingAir pollution
25 Acute Respiratory Distress Syndrome Severe form of acute lung injurySyndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung complianceSymptomsRapid onset of severe dyspneaHypoxemia that does not respond to supplemental oxygen
27 Management of ARDSIntubation, mechanical ventilation with PEEP to treat progressive hypoxemiaPositioning: frequent position changes, proningNutritional supportGeneral supportive care
28 Pulmonary EmboliObstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombusMost thrombus are blood clots from leg veinsObstructed area has diminished or absent blood flowAlthough area is ventilated, no gas exchange occursInflammatory process causes regional blood vessels, bronchioles to constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, right ventricular workloadVentilation-perfusion imbalance, right ventricular failure, shock occur
29 Risk Factors for Pulmonary Emboli Venous stasisHypercoagulabiltyVenous endothelial diseaseCertain disease states: heart disease, trauma, postoperative/postpartum, diabetes mellitus, COPDOther conditions: pregnancy, obesity, oral contraceptive use, constrictive clothingPrevious history of thrombophlebitis
30 Thromboembolism P. Vessel Figure 39–6 A thromboembolism lodged in a pulmonary vessel.
31 Prevention and Treatment of Pulmonary Emboli Exercises to avoid venous stasisEarly ambulationAnticoagulant therapySequential compression devices (SCDs)TreatmentMeasures to improve respiratory, CV statusAnticoagulation, thrombolytic therapy
33 Pneumoconioses Occupational lung diseases Cause of death of 124,846 people in United States (1968 to 2000)Causative agentsRole of nurse as employee advocateRole of nurse in health education, teaching preventive measuresRole of OSHA
34 Care of the Patient with Lung Cancer Prevention, causesClassification of lung cancerTreatmentSurgeryRadiationChemotherapyPalliative care
35 Nursing Care of the Patient with Cancer Psychological supportPainAirway clearanceFatigueDyspnea
39 Management of Patients With Chronic Pulmonary Disease
40 COPD: Chronic Obstructive Pulmonary Disease A disease state characterized by airflow limitation that is not full reversible (GOLD).COPD is the currently is 4th leading cause of death and the 12th leading cause of disability.COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders.Asthma is now considered a separate disorder but can coexist with COPD.
41 Pathophysiology of COPD Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious agents.Inflammatory response occurs throughout the airways, lung parenchyma, and pulmonary vasculature.Scar tissue and narrowing occurs in airways.Substances activated by chronic inflammation damage the parenchyma.Inflammatory response causes changes in pulmonary vasculature.
42 COPDFigure 39–2 The pathogenesis of chronic obstructive pulmonary disease.
44 Chronic BronchitisThe presence of a cough and sputum production for at least 3 months in each of 2 consecutive years.Irritation of airways results in inflammation and hypersecretion of mucous.Mucous-secreting glands and goblet cells increase in number.Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways.Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes.The patient is more susceptible to respiratory infections.
46 Emphysema:Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli.Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion.Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.Hypoxemia result of these pathologic changes.Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale).
54 Risk Factors for COPD Tobacco smoke causes 80-90% of COPD cases! Passive smokingOccupational exposureAmbient air pollutionGenetic abnormalitiesAlpha1-antitrypsin
55 Nursing Process: The Care of Patients with COPD- Assessment Health historyInspection and examination findingsReview of diagnostic tests
56 Nursing Process: The Care of Patients with COPD- Diagnoses Impaired gas exchangeImpaired airway clearanceIneffective breathing patternActivity intoleranceDeficient knowledgeIneffective coping
57 Collaborative Problems Respiratory insufficiency or failureAtelectasisPulmonary infectionPneumoniaPneumothoraxPulmonary hypertension
58 Nursing Process: The Care of Patients with COPD- Planning Smoking cessationImproved activity toleranceMaximal self-managementImproved coping abilityAdherence to therapeutic regimen and home careAbsence of complications
59 Improving Gas Exchange Proper administration of bronchodilators and corticosteroidsReduction of pulmonary irritantsDirected coughing, “huff” coughingChest physiotherapyBreathing exercises to reduce air trappingdiaphragmatic breathingpursed lip breathingUse of supplemental oxygen
60 Improving Activity Tolerance Focus on rehabilitation activities to improve ADLs and promote independence.Pacing of activitiesExercise trainingWalking aidesUtilization of a collaborative approach
61 Other Interventions Set realistic goals Avoid extreme temperatures Enhancement of coping strategiesMonitor for and management of potential complications
62 Patient Teaching Disease process Medications Procedures When and how to seek helpPrevention of infectionsAvoidance of irritants; indoor and outdoor pollution, and occupational exposureLifestyle changes, including cessation of smoking
63 BronchiectasisBronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles.Caused by:Airway obstructionDiffuse airway injuryPulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infectionsGenetic disorders such as cystic fibrosisAbnormal host defense (eg, ciliary dyskinesia or humoral immunodeficiency)Idiopathic causes
64 Bronchiectais: Clinical Manifestations Chronic coughPurulent sputum in copious amountsClubbing of the fingers
65 Bronchiectasis: Medical Management Postural drainageChest physiotherapySmoking cessationAntimicrobial therapy
66 Bronchiectasis: Nursing Management Focuses on alleviating symptoms and clearing pulmonary secretionsPatient teaching
67 AsthmaA chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production.Inflammation leads to cough, chest tightness, wheezing, and dyspnea.The most common chronic disease of childhood.Can occur at any age.Allergy is the strongest predisposing factor.
68 AsthmaFigure 39–1 The pathogenesis of an acute episode of asthma.
70 Asthma Incidence Risk Factors Prevalence of asthma currently relatively stableHospitalizations and deaths due to asthma decreasingRisk FactorsAllergiesFamily historyAir pollutionOccupational exposuresRespiratory virusesExercise in cold airEmotional stress
71 Medications Used for Asthma Quick-relief medications Beta2-adrenergic agonistsAnticholinergicsLong-acting medications CorticosteroidsLong acting beta2-adrenergic agonistsLeukotriene modifiers
72 Examples of Metered Dose Inhalers, and Spacers A Metered Dose Inhaler and Spacer in Use
73 Patient TeachingThe nature of asthma as a chronic inflammatory diseaseDefinition of inflammation and bronchoconstrictionPurpose and action for each medicationIdentification of triggers and how to avoid themProper inhalation techniquesHow to perform peak flow monitoringHow to implement an action planWhen and how to seek assistance