Respiratory Disorders

Atelectasis

A condition characterized by the collapse of lung tissue, leading to reduced gas exchange and potential hypoxemia.

Atelectasis, Pneumothorax, and Pleural Effusion

Diagnosis include X-ray or CT scan shows tracheal deviation or placement away from the affected side.

Primary Atelectasis

Lung tissue remains uninflated due to insufficient surfactant production, typically present at birth in premature or at-risk infants.

Secondary Atelectasis

Increased risk after surgery; caused by airway obstruction, lung compression, or increased recoil due to diminished surfactants.

Surfactants

Substances that reduce surface tension in the lungs, facilitating gas exchange by keeping alveoli open.

Exudates

infected fluids, cells, or substances released from blood vessels or wounds.

Ineffective cough reflex

Results in decreased tidal volume, poor alveolar expansion due to inability to clear secretions.

• Dyspnea and Tachycardia

• Diminished breath sounds from poor air entry causing Hypoxemia

• Hyperresonance in percussion

• Tracheal deviation - asymmetry of chest wall (from rib fractures) or shifting of mediastinal structures to unaffected side of unaffected chest

• Pleuritic pain (sharp pain occurring during inhalation) and Increased RR

• Crackles and gurgles

Symptoms of Atelectasis

Antibiotics, IS, CPT, IPPB, and oxygen if necessary.

Nursing Interventions for Atelectasis (AICIO)

Pneumothorax

Accumulation of air in the pleural space resulting in partial or complete lung collapse.

Tension Pneumothorax

Air enters but cannot leave pleural space (one-way valve), often causing sudden and painful symptoms.

Symptoms of Pneumothorax

Similar to atelectasis but include signs of shock

heart

In tension pneumothorax, onset is sudden and painful (can also affect the _____)

• No shortness of breath, no treatment

• Monitor V/S, signs of shock, and respiration (changing pattern may indicate worsening situation)

• Semi-Fowler’s position

• Analgesics as ordered

• Chest tube - escape route for air given in worse situation like tension or spontaneous

  • Maintain sterile dressing at chest tube insertion site

  • Maintain patency and integrity of closed chest drainage system

  • Evaluate amount of fluid and breath sounds.

• Oxygen if necessary

Nursing Interventions for Pneumothorax (NMSACO)

Pleural Effusion

Abnormal accumulation of fluid in the pleural cavity, which can be transudate, exudate, blood, or chyle.

Chyle

Milky fluid found in lymph from the GI tract.

hydrothorax, empyema, hemothorax, and chylothorax.

Etiologies of Pleural Effusion (HEHC)

Hydrothorax (Transudative)

results from CHF; other causes are RF, nephrosis and liver failure

Empyema (Exudative)

results from infections, malignancies, SLE. May also be caused by direct spread of bacterial pneumonia or trauma-related infections

Hemothorax (Blood)

results from chest injuries, chest surgery complications, malignancies, blood vessel rupture

Chylothorax (Lymphatic)

chyle buildup coming from lymphatic system trauma, inflammation or malignant infiltration

• Increase in capillary pressure – failure to shift the blood back towards the heart

• Increase in capillary permeability - such as in inflammation

• Decrease COP

• Increase in intrapleural negative pressure

• Impairment in lymphatic drainage of the pleura

5 mechanisms of Pleural Effusion

Symptoms of Pleural Effusion

Dyspnea and pleuritic pain

Minimal (300-500cc)

Hemothorax volume that resolves in 10-14 days as small amounts of blood are naturally absorbed from the pleural space.

Moderate (500-1000cc)

Hemothorax volume fills about 1/3 of the pleural cavity lung compression and signs of hypovolemia

Large (1000cc or more)

Hemothorax volume fills half or more of the chest and requires immediate drainage.

Nursing Interventions for Pleural Effusion (SAF)

• Signs of shock

• Analgesics as required

• For moderate to large:

  • Maintain Fluid replacement as ordered and assist with insertion of chest tubes are ordered (maintain patency of tubes)

Diuretics & sodium restriction

Small effusion from CHF requirements

draining tube

Large effusion from cancer requirement

surgery

Loculated pleural effusion (tb or pneumonia) requirement

Adult Respiratory Distress Syndrome (ARDS)

A sequel of several diseases in which the lungs fill with water, making gas exchange impossible (aka lung failure). Results from unknown cause.

• Pneumonia

• Near drowning

• Reaction to drugs and inhaled gases or Allergic reactions (pulmonary)

• Shock infection

• Trauma and Burns

• Diabetic ketoacidosis

Predisposing factors of ARDS (PNRSTD)

Include crackles, hypoxemia, mass consolidation on x-ray, and respiratory acidosis.

Symptoms of ARDS

Nursing Interventions for ARDS (PMS)

• PEEP - Positive End-Expiratory Pressure to improve oxygenation and prevent alveolar collapse

• Mechanical ventilator

• Steroids as ordered - reduce inflammation

• Assess for complication like pneumothorax

• Monitor fluid intake

Pneumonia

An acute infection of the lung parenchyma varying in severity.

Etiology of Pneumonia

Can include bacteria, viruses, fungi, and protozoa.

partial infection

lobar pneumonia

diffused infection

bronchopneumonia

Organisms enter the respiratory tract; the body's defense fails in overwhelming infections.

Pathophysiology of Pneumonia

• Fever and Malaise

• Chills and Cough

• Rales and Rhonchi - Pleuritic pain

• Dyspnea

Symptoms of Pneumonia (FCRD)

• Administer Antibiotics/Antiviral/Antifungi specific for the causative organism, as ordered

• Control fever (paracetamol)

• Encourage adequate fluid intake

• Chest physiotherapy

• Provide bronchial Hygiene

• Oxygen, as ordered

Nursing Interventions for Pneumonia (ACECHO)

Chronic Obstructive Pulmonary Disease (COPD)

Includes emphysema and chronic bronchitis, characterized by obstructed airflow.

• Sputum production

• Crackles and wheezes

• Adventitious BS (abnormal breath sounds)

• Pursed lip appearance

• Alteration in LOC

• Alteration in skin color

• Voice changes

• Barrel chest

• Clubbing of fingers

• Cyanosis

• Polycythemia (blood cancer)

• Decreased metabolism

Assessment of COPD (SWAPLSCVBCCPM)

• Decreased spo2 (normal: 95-100)

• ABG - increase in PACo2 and decreased PAo2

• PFT

• CXR

Diagnosis of COPD

• Rest

• Increased oral fluids, 3 liters per day

• Good oral care

• Diet: calorie, CHON, CHO

• O2 therapy not > 3LPM

• Avoid smoking, pollutants

• CPT, Deep breathing

• Bronchial hygiene measures – steam, aerosol, medimist inhalation

• Facilitate removal of secretions, Suction as needed

Collaborative Management of COPD

• Bronchodilators

  • Aminophylline, ventolin, bricanyl, alupent

• Antihistamines

  • diphenhydramine

• Steroids

  • antimicrobial

• Expectorants/Mucolytic

  • mucosolvan

COPD Pharmacotherapy (BASE)

Bronchial Asthma

Bronchial obstruction due to bronchoconstriction, mucus hypersecretion, and inflammation.

Non allergenic

• Viral respiratory infection

• Weather changes

• Fumes, strong odors

• Smoking

• Exercise

• Drugs-aspirin, NSAIDS

Allergens

• Dust mites

• Pollens

• Food allergens

Management Goals for Asthma (RVIMT)

• Relieve bronchoconstriction

• Maintain alveolar ventilation

• Reduce airway inflammation/hyperreactivity

• Mobilize secretions

• Avoid drug toxicity

Pharmacotherapy for Asthma (ACA)

adrenergic B2-agonists, corticosteroids, and anticholinergics.

• O2 inhalation

• Hydration

• Serial monitoring of ABG’s

• Psychosocial support

Supportive care for asthma

irreversible

Asthma is reversible COPD is ________

Pulmonary Emphysema

Lung disease involving damage to alveoli, leading to hyperinflation and inadequate oxygen supply. The air sacs are unable to completely deflate (hyperinflation) and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body, aka “pink puffer”.

Bronchiectasis

Permanent dilatation of bronchi caused by infection or other factors.

Chronic Bronchitis

Excessive mucus production in bronchi, leading to cough and respiratory issues, aka “blue bloater”. Caused by the same factors that cause emphysema.

Pulmonary Tuberculosis (TB)

Infectious disease caused by Mycobacterium tuberculosis, transmitted by droplets.

• Class I: no exposure

• Class II: exposure no infection

• Class III: disease, clinically active

• Class IV: treated, disease not clinically active

• Class V: suspect

TB Classification

Client Education for TB

• TB is infectious, can be cured with antimicrobial

• Transmitted by droplet

• Cover mouth, nose when coughing, sneezing or laughing

• Wash hands

• Wear masks when advised

• Take medication religiously as prescribed

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, and Streptomycin.

Primary Anti-TB Drugs (RIPES)

• Observe for bleeding

• Use soft toothbrush, electric razor

• Evaluate use of contraceptives

DO’S for patient teaching in TB

• Take ASA with coumadin

• Restrictive clothing on legs

• Prolonged sitting/standing

• Smoking

DON’TS for patient teaching in tb

• Fat embolism

• Multiple trauma

• PVC’s

• Abdominal surgery

• Immobility

• Hypercoagulability

Causes of TB

Nursing Interventions for TB

Involve oxygen therapy, early ambulation post-op, and monitoring for complications.

• Restlessness (hallmark)

• Dyspnea

• Stabbing chest pain

• Cyanosis

• Signs of shock

Assessment for TB (RDSCS)

Histoplasmosis

A fungal infection from pigeon and chicken manure commonly seen in rural areas, with symptoms like cough, malaise, and joint pain. Not spread from human to human.

CXR and histoplasmin skin test.

Diagnosis of Histoplasmosis

• Amphotericin B

  • Toxicity: anorexia, chills, fever, nephrotoxicity, headache, adrenal failure

• Teach farmers to wet chicken manure before shoveling so that dust does not become airborne

Management for histoplasmosis

Pneumoconiosis

Occupation-related respiratory disorder caused by inhalation of industrial dust.

Types of Pneumoconiosis

Asbestosis (asbestos), silicosis (silicon), bagossis (hay dust), and coal worker's pneumoconiosis (black lung)

Lung Cancer

Malignant tumor growth within lung tissue, with various types and poor prognosis related to exposure.

Include cough, wheezing, shortness of breath, chest pain, and weight loss.

Symptoms of Lung Cancer

Squamous cell

35 – 50% of all lung cancers

Adenocarcinoma

15 – 35% of all lung cancers

Small cell (oat cell)

20-25% of all lung cancers

Large cell

10-15% of all lung cancers

Nursing Interventions for Lung Cancer (SCAN-O)

• Prepare the patient for Surgery if tumor is small enough to be removed

• Prepare patient for planned treatments - Chemotherapy / radiation therapy

• Analgesics as ordered to control pain

• Maintain Nutritional status

• Adequate Oxygenation through oxygen therapy or planned activity-rest