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

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Presentation on theme: "Chapter 10: Nursing Management: Patients With Chest and Lower Respiratory Tract Disorders."— Presentation transcript:

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

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

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

4 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

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

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

8 Oxygen Masks

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

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

13 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.

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

16 Pleural Conditions Pleurisy Pleural effusion and empyema

17 Pleural Effusion

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

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

20 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

21 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 Pulmonary Arterial Hypertension
Pathophysiology Risk factors Manifestations Management Nursing care

23 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 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 Occupational Lung Diseases
Silicosis Asbestosis Coal worker’s pneumoconiosis

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

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

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

30 Chest Drainage Systems

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

32 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.

33 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 Aspiration Pathophysiology Risk factors Preventative measures


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