Chapter 10: Nursing Management: Patients With Chest and Lower Respiratory Tract Disorders

Atelectasis Pathophysiology Risk factors Manifestations Management: Incentive spirometry Nebulizers Chest physiotherapy (CPT)

Pneumonia Pathophysiology Types: Community-acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Health-care associated pneumonia Risk factors Manifestations and assessment

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? Community-acquired pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Health care–associated pneumonia

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.

Medical and Nursing Management of Pneumonia Antibiotic therapy Supportive care Prevention Gerontological considerations

Oxygen Therapy in the Management of Pneumonia Methods of administration: See Table 10-2 in text

Oxygen Masks

Question Is the following statement true or false? A non-rebreathing mask should fully collapse on full inspiration.

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.

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

Pulmonary Tuberculosis Pathophysiology Risk factors Manifestations and assessment Tuberculin skin test QFT-G test Medication regimen

Question A nurse is administering tuberculin skin tests to a group of employees. What technique will the nurse utilize? Intradermal injection into the workers’ forearms. Intramuscular injection into the vastus lateralis. Subcutaneous injection into the abdominal region. Insertion at a 90-degree angle into the deltoid.

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.

Pulmonary Edema Pathophysiology Risk factors Manifestations and complications Medical management Nursing management

Pleural Conditions Pleurisy Pleural effusion and empyema

Pleural Effusion

Acute Respiratory Failure Pathophysiology Causes include: Decreased respiratory drive Dysfunction of the chest wall Dysfunction of the lung parenchyma Other causes Assessment Management

Acute Respiratory Distress Syndrome (ARDS) Pathophysiology Risk factors Manifestations Management: Positive end-expiratory pressure (PEEP) Pharmacologic treatments Nursing care

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? Preparing to participate in intubation Administering oxygen by nasal cannula Administering bronchodilators by metered dose inhaler Auscultating the patient’s chest

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.

Pulmonary Arterial Hypertension Pathophysiology Risk factors Manifestations Management Nursing care

Pulmonary Embolism Pathophysiology Risk factors Manifestations Assessments: Chest X-ray, ECG, peripheral vascular studies, ABGs, d-dimer, and ventilation–perfusion scan, CT Preventative measures

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

Occupational Lung Diseases Silicosis Asbestosis Coal worker’s pneumoconiosis

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

Lung Cancer (cont.) Risk factors Clinical manifestations Assessment and diagnostic testing Treatment: Surgery Radiation therapy Chemotherapy Complications Nursing care

Chest Trauma Blunt trauma versus penetrating trauma Clinical manifestations and assessment Management includes chest tube placement for pneumothorax

Complication of Chest Trauma: Pneumothorax Types: Simple Traumatic Tension Manifestations Management

Chest Drainage Systems

Chest Trauma (cont.) Complications: Sternal and rib fractures Flail chest Pulmonary contusion Cardiac tamponade

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? Remove excess carbon dioxide from the blood. Monitor the quantity of pleural fluid. To enhance the patient’s expiratory drive. Re-expand the lung and remove excess air and fluid.

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.

Aspiration Pathophysiology Risk factors Preventative measures