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management of patient with cheast and lower respiratory tract desorder
1.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 23 Management of Patients With Chest and Lower Respiratory Tract Disorders
2.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Atelectasis (cont’d) • Refer to fig. 23-1
4.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
5.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
6.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory Infections • Acute tracheobronchitis • Pneumonia – Community-acquired pneumonia – Hospital-acquired pneumonia – Pneumonia in immunocompromised host – Aspiration pneumonia
7.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Tests • Chest x-ray • Sputum examination
8.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
9.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
10.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Care of the Patient with Pneumonia - Diagnoses • Ineffective airway clearance • Activity intolerance • Risk for fluid volume deficient • Imbalanced nutrition • Deficient knowledge
11.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Collaborative Problems • Continuing symptoms after initiation of therapy • Shock • Respiratory failure • Atelectasis • Pleural effusion • Confusion • Superinfection
12.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
13.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
14.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Other Interventions • Promoting rest – 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
15.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
16.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
17.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
18.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Pleural Effusion
19.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Causative Factors for Pulmonary Disease • Cigarette smoking • Air pollution
20.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins 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
21.
Copyright © 2010
Wolters Kluwer Health | Lippincott Williams & Wilkins Pathophysiology of ARDS
22.
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Wolters Kluwer Health | Lippincott Williams & Wilkins Management of ARDS • Intubation, mechanical ventilation with PEEP to treat progressive hypoxemia • Positioning: frequent position changes, proning • Nutritional support • General supportive care
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Wolters Kluwer Health | Lippincott Williams & Wilkins 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
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Wolters Kluwer Health | Lippincott Williams & Wilkins 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
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Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention and Treatment of Pulmonary Emboli • Prevention – Exercises to avoid venous stasis – Early ambulation – Anticoagulant therapy – Sequential compression devices (SCDs) • Treatment – Measures to improve respiratory, CV status – Anticoagulation, thrombolytic therapy
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Wolters Kluwer Health | Lippincott Williams & Wilkins Umbrella Filter
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Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Tell whether the following statement is true or false: • Bradypnea is the most common sign for a possible pulmonary embolism.
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Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • False. • Rationale: Tachypnea, not bradypnea, is the most common sign for a possible pulmonary embolism.
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Wolters Kluwer Health | Lippincott Williams & Wilkins 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
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Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Patient with Lung Cancer • Prevention, causes • Classification of lung cancer • Treatment – Surgery – Radiation – Chemotherapy • Palliative care
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Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care of the Patient with Cancer • Psychological support • Pain • Airway clearance • Fatigue • Dyspnea
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Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Which of the following is the most common surgery for a small apparently curable tumor of the lung? A.Lobectomy B.Pneumonectomy C.Segmentectomy D.Sleeve resection
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Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • A. Lobectomy • Rationale: The most common surgical procedure for a small, apparently curable tumor of the lung is a lobectomy. A pneumonectomy is the removal an entire lung. Segmentectomy is not recommended as curative resection of lung cancer and is a removal of a segment of the lung. A sleeve resection is removal of the cancerous lobes with a segment of the main bronchus resected.
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Wolters Kluwer Health | Lippincott Williams & Wilkins Chest Trauma • Blunt trauma • Sternal, rib fractures • Flail chest • Pulmonary contusion • Penetrating trauma • Pneumothorax – Spontaneous or simple – Traumatic – Tension pneumothorax
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Wolters Kluwer Health | Lippincott Williams & Wilkins Flail Chest
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Wolters Kluwer Health | Lippincott Williams & Wilkins Open Pneumothorax and Tension Pneumothorax
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Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Tell whether the following statement is true or false: • An initial characteristic symptom of a simple pneumothorax is a sudden onset of chest pain.
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Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • True. • Rationale: An initial characteristic symptom of a simple pneumonthorax is a sudden onset of chest pain.