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Atelectasis Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression Causes: bronchial obstruction by.

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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 Atelectasis Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression Causes: bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration Postoperative patients at high risk Symptoms: insidious, include cough, sputum production, low-grade fever Respiratory 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 spirometer Strategies to remove secretions: coughing exercises, suctioning, aerosol therapy, chest physiotherapy

4 Nursing Management (cont’d)
Treatment Strategies to improve ventilation, remove secretions Treatments: may include PEEP (positive end-expiratory pressure), IPPB (intermittent positive-pressure breathing) Bronchoscopy may be used to remove obstruction

5 Respiratory Infections
Acute tracheobronchitis Pneumonia Community-acquired pneumonia Hospital-acquired pneumonia Pneumonia in immunocompromised host Aspiration pneumonia


7 Risk Factors Cancer, smoking, COPD (produce mucus, or obstruct bronchus Immunocompromised pt Prolonged immobility and shallow breathing Depressed cough reflex, aspiration of foreign material

8 Alcoholism GA, sedative Advance age Respiratory therapy with improperly cleaned equipment Transmission 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 coughing Tachypnea ( 25 – 45b\m) Rapid bounding pulse In sever cases cheeks flushed and the lips with nail beds become cyanosed.

10 Orthopnea Decrease appetite, fatigue Purulent sputum Crackles, increased tactile fermitus, dullness on percussion, bronchial breathing sounds, egophony and whispered pectoriloquy.

11 Diagnostic Tests Chest x-ray Sputum examination


13 Medical Treatment of Pneumonia
Supportive treatment includes fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, antihistamines Administration of antibiotic therapy determined by gram-stain results If etiologic agent is not identified, utilize empiric antibiotic therapy Antibiotics 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, pulse Secretions Cough Tachypnea, shortness of breath Changes in physical assessment, especially inspection, auscultation of chest Changes in CXR Changes in mental status, fatigue, dehydration, concomitant heart failure, especially in elderly patients

15 Nursing Process: Care of the Patient with Pneumonia - Diagnoses
Ineffective airway clearance Activity intolerance Risk for fluid volume deficient Imbalanced nutrition Deficient knowledge

16 Collaborative Problems
Continuing symptoms after initiation of therapy Shock Respiratory failure Atelectasis Pleural effusion Confusion Superinfection

17 Nursing Process: Care of the Patient with Pneumonia - Planning
Improved airway clearance Maintenance of proper fluid volume Maintenance of adequate nutrition Patient understanding of treatment, prevention Absence of complications

18 Improving Airway Clearance
Encourage hydration; 2 to 3 L a day, unless contraindicated Humidification may be used to loosen secretions By face mask or with oxygen Coughing techniques Chest physiotherapy Position changes Oxygen therapy administered to meet patient needs

19 Other Interventions Promoting rest Promoting fluid intake
Encourage rest, avoidance of overexertion Positioning to promote rest, breathing (Semi-Fowler’s) Promoting fluid intake Encourage fluid intake to at least 2 L a day Maintaining nutrition Provide nutritionally enriched foods, fluids Patient teaching

20 Aspiration Risk factors Pathophysiology Prevention: Elevate HOB
Turn patient to side when vomiting Prevention of stimulation of gag reflex with suctioning or other procedures Assessment, proper administration of tube feeding Rehabilitation therapy for swallowing

21 Pleural Conditions Pleurisy: inflammation of both layers of pleurae
Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration Pleural effusion: collection fluid in pleural space usually secondary to another disease process Large 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 expansion Resolution is a prolonged process

23 Pleural Effusion

24 Causative Factors for Pulmonary Disease
Cigarette smoking Air pollution

25 Acute Respiratory Distress Syndrome
Severe form of acute lung injury Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance Symptoms Rapid onset of severe dyspnea Hypoxemia that does not respond to supplemental oxygen

26 Pathophysiology of ARDS

27 Management of ARDS Intubation, mechanical ventilation with PEEP to treat progressive hypoxemia Positioning: frequent position changes, proning Nutritional support General supportive care

28 Pulmonary Emboli Obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombus Most thrombus are blood clots from leg veins Obstructed area has diminished or absent blood flow Although area is ventilated, no gas exchange occurs Inflammatory process causes regional blood vessels, bronchioles to constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, right ventricular workload Ventilation-perfusion imbalance, right ventricular failure, shock occur

29 Risk Factors for Pulmonary Emboli
Venous stasis Hypercoagulabilty Venous endothelial disease Certain disease states: heart disease, trauma, postoperative/postpartum, diabetes mellitus, COPD Other conditions: pregnancy, obesity, oral contraceptive use, constrictive clothing Previous 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 stasis Early ambulation Anticoagulant therapy Sequential compression devices (SCDs) Treatment Measures to improve respiratory, CV status Anticoagulation, thrombolytic therapy

32 Umbrella Filter

33 Pneumoconioses Occupational lung diseases
Cause of death of 124,846 people in United States (1968 to 2000) Causative agents Role of nurse as employee advocate Role of nurse in health education, teaching preventive measures Role of OSHA

34 Care of the Patient with Lung Cancer
Prevention, causes Classification of lung cancer Treatment Surgery Radiation Chemotherapy Palliative care

35 Nursing Care of the Patient with Cancer
Psychological support Pain Airway clearance Fatigue Dyspnea

36 Chest Trauma Blunt trauma Sternal, rib fractures Flail chest
Pulmonary contusion Penetrating trauma Pneumothorax Spontaneous or simple Traumatic Tension pneumothorax

37 Flail Chest

38 Open Pneumothorax and Tension Pneumothorax

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 COPD Figure 39–2 The pathogenesis of chronic obstructive pulmonary disease.

43 Chronic Obstructive Pulmonary Disease
Risk Factors Cigarette smoking Air pollution Occupational exposures Airway infection Familial and genetic factors

44 Chronic Bronchitis The 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.

45 Pathophysiology of Chronic Bronchitis

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).

47 Changes in Alveolar Structure with Emphysema


49 Normal Chest Wall and Chest Wall Changes with Emphysema

50 Emphysema Figure 39–3 Typical appearance of a client with emphysema. Note the client’s anxious expression and assumption of the tripod position, leaning forward with the hands on the knees.

51 Typical Posture of a Person with COPD

52 Chronic Hypoxemia Figure 39–5 Clubbing of fingers caused by chronic hypoxemia.


54 Risk Factors for COPD Tobacco smoke causes 80-90% of COPD cases!
Passive smoking Occupational exposure Ambient air pollution Genetic abnormalities Alpha1-antitrypsin

55 Nursing Process: The Care of Patients with COPD- Assessment
Health history Inspection and examination findings Review of diagnostic tests

56 Nursing Process: The Care of Patients with COPD- Diagnoses
Impaired gas exchange Impaired airway clearance Ineffective breathing pattern Activity intolerance Deficient knowledge Ineffective coping

57 Collaborative Problems
Respiratory insufficiency or failure Atelectasis Pulmonary infection Pneumonia Pneumothorax Pulmonary hypertension

58 Nursing Process: The Care of Patients with COPD- Planning
Smoking cessation Improved activity tolerance Maximal self-management Improved coping ability Adherence to therapeutic regimen and home care Absence of complications

59 Improving Gas Exchange
Proper administration of bronchodilators and corticosteroids Reduction of pulmonary irritants Directed coughing, “huff” coughing Chest physiotherapy Breathing exercises to reduce air trapping diaphragmatic breathing pursed lip breathing Use of supplemental oxygen

60 Improving Activity Tolerance
Focus on rehabilitation activities to improve ADLs and promote independence. Pacing of activities Exercise training Walking aides Utilization of a collaborative approach

61 Other Interventions Set realistic goals Avoid extreme temperatures
Enhancement of coping strategies Monitor for and management of potential complications

62 Patient Teaching Disease process Medications Procedures
When and how to seek help Prevention of infections Avoidance of irritants; indoor and outdoor pollution, and occupational exposure Lifestyle changes, including cessation of smoking

63 Bronchiectasis Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Caused by: Airway obstruction Diffuse airway injury Pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections Genetic disorders such as cystic fibrosis Abnormal host defense (eg, ciliary dyskinesia or humoral immunodeficiency) Idiopathic causes

64 Bronchiectais: Clinical Manifestations
Chronic cough Purulent sputum in copious amounts Clubbing of the fingers

65 Bronchiectasis: Medical Management
Postural drainage Chest physiotherapy Smoking cessation Antimicrobial therapy

66 Bronchiectasis: Nursing Management
Focuses on alleviating symptoms and clearing pulmonary secretions Patient teaching

67 Asthma A 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 Asthma Figure 39–1 The pathogenesis of an acute episode of asthma.


70 Asthma Incidence Risk Factors
Prevalence of asthma currently relatively stable Hospitalizations and deaths due to asthma decreasing Risk Factors Allergies Family history Air pollution Occupational exposures Respiratory viruses Exercise in cold air Emotional stress

71 Medications Used for Asthma
Quick-relief medications Beta2-adrenergic agonists Anticholinergics Long-acting medications Corticosteroids Long acting beta2-adrenergic agonists Leukotriene modifiers

72 Examples of Metered Dose Inhalers, and Spacers A Metered Dose Inhaler and Spacer in Use

73 Patient Teaching The nature of asthma as a chronic inflammatory disease Definition of inflammation and bronchoconstriction Purpose and action for each medication Identification of triggers and how to avoid them Proper inhalation techniques How to perform peak flow monitoring How to implement an action plan When and how to seek assistance

74 Using a Peak Flow Meter

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