Transcript LWW PPT Slide Template Master

Chapter 10
Nursing Management: Patients
With Chest and Lower
Respiratory Tract Disorders
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Atelectasis
• Pathophysiology
• Risk factors
• Manifestations
• Management:
– Incentive spirometry
– Nebulizers
– Chest physiotherapy (CPT)
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Pneumonia
• Pathophysiology
• Types:
– Community-acquired pneumonia
– Hospital-acquired pneumonia
– Ventilator-associated pneumonia
– Health-care associated pneumonia
• Risk factors
• Manifestations and assessment
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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?
A. Community-acquired pneumonia
B. Hospital-acquired pneumonia
C. Ventilator-associated pneumonia
D. Health care–associated pneumonia
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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.
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Medical and Nursing Management of
Pneumonia
• Antibiotic therapy
• Supportive care
• Prevention
• Gerontological considerations
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Oxygen Therapy in the Management of
Pneumonia
• Methods of administration: See Table 10-2 in text
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Oxygen Masks
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Question
• Is the following statement true or false?
• A non-rebreathing mask should fully collapse on full
inspiration
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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
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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
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Pulmonary Tuberculosis
• Pathophysiology
• Risk factors
• Manifestations and assessment
– Tuberculin skin test
– QFT-G test
• Medication regimen
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Question
• A nurse is administering tuberculin skin tests to a group
of employees. What technique will the nurse utilize?
A. Intradermal injection into the workers’ forearms
B. Intramuscular injection into the vastus lateralis
C. Subcutaneous injection into the abdominal region
D. Insertion at a 90-degree angle into the deltoid
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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
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Pulmonary Edema
• Pathophysiology
• Risk factors
• Manifestations and complications
• Medical management
• Nursing management
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Pleural Conditions
• Pleurisy
• Pleural effusion and empyema
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Pleural Effusion
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Acute Respiratory Failure
• Pathophysiology
• Causes include:
– Decreased respiratory drive
– Dysfunction of the chest wall
– Dysfunction of the lung parenchyma
– Other causes
• Assessment
• Management
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Acute Respiratory Distress Syndrome
(ARDS)
• Pathophysiology
• Risk factors
• Manifestations
• Management:
– Positive end-expiratory pressure (PEEP)
– Pharmacologic treatments
• Nursing care
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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?
A. Preparing to participate in intubation
B. Administering oxygen by nasal cannula
C. Administering bronchodilators by metered dose inhaler
D. Auscultating the patient’s chest
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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.
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Pulmonary Arterial Hypertension
• Pathophysiology
• Risk factors
• Manifestations
• Management
• Nursing care
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Pulmonary Embolism
• Pathophysiology
• Risk factors
• Manifestations
• Assessments:
– Chest X-ray, ECG, peripheral vascular studies, ABGs,
d-dimer, and ventilation–perfusion scan, CT
• Preventative measures
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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
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Occupational Lung Diseases
• Silicosis
• Asbestosis
• Coal worker’s pneumoconiosis
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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
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Lung Cancer (cont’d)
• Risk factors
• Clinical manifestations
• Assessment and diagnostic testing
• Treatment:
– Surgery
– Radiation therapy
– Chemotherapy
• Complications
• Nursing care
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Chest Trauma
• Blunt trauma vs. penetrating trauma
• Clinical manifestations and assessment
• Management includes chest tube placement for
pneumothorax
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Complication of Chest Trauma:
Pneumothorax
• Types:
– Simple
– Traumatic
– Tension
• Manifestations
• Management
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Chest Drainage Systems
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Chest Trauma (cont’d)
• Complications:
– Sternal and rib fractures
– Flail chest
– Pulmonary contusion
– Cardiac tamponade
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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?
A. Remove excess carbon dioxide from the blood
B. Monitor the quantity of pleural fluid
C. To enhance the patient’s expiratory drive
D. Re-expand the lung and remove excess air and fluid
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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.
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Aspiration
• Pathophysiology
• Risk factors
• Preventative measures
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