1. Nursing Management Lower Respiratory Problems
Chapter 28
Nursing Management Lower Respiratory Problems
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

2. Chapter 28
1.     Describe the pathophysiology, types, clinical manifestations, and collaborative care of pneumonia.
2.     Explain the nursing management of the patient with pneumonia.       
3.  Describe the pathogenesis, classification, clinical manifestations, complications,
            diagnostic abnormalities, and nursing and collaborative management of tuberculosis.       
4.  Identify the causes, clinical manifestations, and nursing and collaborative management
            of pulmonary fungal infections. (PC 1, 2, 3, 5, 6; MC 1, MP 3)
5.  Explain the pathophysiology, clinical manifestations, and nursing and collaborative
            management of lung abscesses.
 6. Identify the causative factors, clinical features, and management of environmental lung
           diseases.
7.   Describe the causes, risk factors, pathogenesis, clinical manifestations, and nursing and
             collaborative management of lung cancer.
8.  Identify the mechanisms involved and the clinical manifestations of pneumothorax,                     
             fractured ribs, and flail chest.
9.     Describe the purpose, methods, and nursing responsibilities related to chest tubes.
10.     Explain the types of chest surgery and appropriate preoperative and postoperative care.
11. Compare and contrast extrapulmonary and intrapulmonary restrictive lung disorders in
             terms of causes, clinical manifestations, and collaborative management.
12. Describe the pathophysiology, clinical manifestations, and management of pulmonary
             embolism, pulmonary hypertension, and cor pulmonale.
13. Discuss the use of lung transplantation as a treatment for pulmonary disorders.

3. Acute Bronchitis Inflammation of the Bronchi
Most commonly viral infections
Can be bacterial
Most commonly bacterial with smokers
Symptoms include:
Cough, low grade fever, tachypnea, tachycardia
Some wheezing or rhonchi
Nursing management:
Medications, testing, supportive care

4. Pneumonia Etiology Types of pneumonia Normal defense mechanisms
Factors predisposing to pneumonia
Acquisition of organisms
Types of pneumonia
Community-acquired pneumonia
Hospital-acquired, ventilator-associated, and health care–associated pneumonia
Fungal pneumonia
Aspiration pneumonia
Opportunistic pneumonia

5. Pneumonia (cont'd) Pathophysiology Clinical manifestations
Pulmonary congestion- bacterial invasion
Immune response
Resolution
Clinical manifestations
Often rapid onset
Fever, chills, shaking
Shortness of breath, cough, chest pain
Breath sounds

6. Fig. 28-1

7. Pneumonia (cont'd) Complications Diagnostic studies Collaborative care
Pleurisy, pleural effusion, atalectasis, lung abscess, empyema
Bacteremia, pericarditis, meningitis, endocarditis
Diagnostic studies
CXR, Sputum culture, Blood cultures
Collaborative care
Pneumococcal vaccine- high risk should receive every 5 years
Drug therapy- Must initiate antibiotic therapy within 4 hours of arrival to the hospital, oxygen, bronchodilators
Nutritional therapy- Increase fluid intake, small frequent meals

8. Nursing Management Pneumonia
Nursing assessment-color, resp. rate, work of breathing, lung sounds
Nursing diagnoses- see figure 28-1 (pg 568)
Planning
Nursing implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation

9. Tuberculosis People @ risk
Infectious disease caused by Mycobacterium Tuberculosis
2 million die worldwide annually (14,000 cases in the U.S. diagnosed)
Lungs most common infection site but also may infect:
Nervous system
Kidneys
Adrenals
Lymph nodes
Genital tract
risk
Poor
Homeless
Foreign born
Institutionalized
Immunosuppressed
HIV

10. Tuberculosis (cont'd) Diagnostic studies Collaborative care
TB skin test
Chest x-ray
Bacteriologic and other studies
Collaborative care
Drug therapy
Active disease
Latent tuberculosis infection
Vaccine

11. Nursing Management Tuberculosis
Nursing assessment
Nursing diagnoses
Planning
Nursing implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation

12. Atypical Mycobacteria
Similar to TB in clinical presentation
Only differentiated by Culture
Treatment with similar drugs

13. Pulmonary Fungal Infections
immunocompromised patients
Cultures/biopsy to identify
s/sx similar to bacterial pneumonia
Antifungal medications: monitor for side effects including renal/hepatic toxicity

14. Lung Abscess Most commonly associated with aspiration Cavity is formed
Diagnosed with CXR or CT
Requires long term antibiotic therapy
May require surgery or chest tube drainage

15. Environmental Lung Diseases
Pneumoconiosis, chemical pneumonitis, hypersensitivity pneumonitis
Clinical manifestations
Symptoms may not develop for >10 years
Fibrosis
Collaborative care

16. Lung Cancer Smoking Clinical Manifestations 80-90% of all cancers
Risk declines gradually after cessation
2nd Hand smoke increases risk by 35%
Pipe and cigar smoke still increase risk
Tumor may grow for 8-10 years before visible on CXR (1cm mass is smallest that is seen on CXR)
Persistent cough, hoarseness
May have fever chills
Weight loss, fatigue, nausea, vomiting

17. Fig. 28-2

18. Fig. 28-3

19. Lung Cancer (cont'd) Collaborative care
Surgical therapy- treatment of choice for stage I & II
Radiation therapy- curative as well as adjunct therapy, palliative care
Chemotherapy- usually adjunct therapy
Biologic and targeted therapy

20. Lung Cancer (cont'd) Collaborative care (cont'd) Other therapies
Prophylactic cranial radiation
Bronchoscopic laser therapy
Photodynamic therapy
Airway stenting
Cryotherapy

21. Nursing Management Lung Cancer
Nursing assessment (pg. 583)
Nursing diagnoses (pg. 583)
Planning
Nursing implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation

22. Chest Trauma and Thoracic Injuries

23. Pneumothorax Types of pneumothorax Closed pneumothorax
Open pneumothorax
Tension pneumothorax
Hemothorax
Chylothorax

24. Fig. 28-4

25. Fig. 28-5

26. Fractured Ribs and Flail Chest

27. Fig. 28-6

28. Chest Tubes and Pleural Drainage
Chest tube insertion
Pleural drainage
Heimlich valves
Small chest tubes

29. Fig. 28-7

30. Fig. 28-8

31. Fig. 28-9

32. Nursing Management Chest Drainage
Complications
Chest tube removal

33. Chest Surgery Preoperative care Surgical therapy Postoperative care
Video-assisted thoracic surgery (VATS)
Postoperative care

34. Restrictive Respiratory Disorders
Pleural effusion
Pleurisy
Atelectasis
Interstitial Lung Disease
Idiopathic Pulmonary Fibrosis
Sarcoidosis

35. Vascular Lung Disorders
Pulmonary Edema
Pulmonary Embolism
Pulmonary Hypertension
Cor Pulmonale

36. Fig

37. Fig

38. Fig

39. Lung Transplantation
Patient must pass extensive evaluation including psychological evaluation
Lifelong immunosuppressive therapy
High risk for infections
Acute rejection usually occurs 5-7 days after transplant