Lower Respiratory Spring 10

Management of Chest and Lower Respiratory Tract Disorders : 

Management of Chest and Lower Respiratory Tract Disorders Chapter 23

Pneumonia : 

Pneumonia Inflammatory process Multiple causes Types Community-acquired Nosocomial or hospital-acquired Aspiration

Pneumonia : 

Pneumonia Interventions include: Help client to cough and deep breathe at least every 2 hours. Administer incentive spirometer—chest physiotherapy if complicated. Oxygen therapy (see table 25-1)

Pneumonia : 

Pneumonia Antibiotics Prevent dehydration. Monitor intake and output of fluids. Use bronchodilators, especially beta2 agonists. Positioning

Pneumonia Complications : 

Pneumonia Complications Shock Respiratory failure May need hemodynamic and ventilatory support. Atelectasis Pleural effusion.

Pulmonary Tuberculosis : 

Pulmonary Tuberculosis Highly communicable disease caused by Mycobacterium tuberculosis Most common bacterial infection Transmitted via airborne route Initial infection multiplies freely in bronchi or alveoli Increase related to the onset of HIV

Assessment : 

Assessment Diagnosis considered: based on symptoms and result of PPD Bacillus Calmette-Guerin vaccine: Produces positive PPD skin test if received within 10 years Complicates interpretation of TB test CXT+/or screening is the recommendation for know BCG vaccination

PPD Skin Test Procedure : 

PPD Skin Test Procedure Intradermal administration of PPD forearm Must be “read” between 48 and 72 hours To accurately “read” Visual inspection for erythema Tactile inspection to monitor size of induration 10 mm or > area of induration 5mm or > in immunocompromised Consider positive and must be referred

PPD Placement : 

PPD Placement

Confirmation of Disease : 

Confirmation of Disease Positive reaction does not necessarily mean active disease. May indicate exposure to TB or dormant disease Diagnosis confirmed by: Chest X-ray Positive smear for AFB and Sputum culture of Mycobacterium tuberculosis

Interventions : 

Interventions Combination drug therapy Isoniazid Rifampin Pyrazinamide Ethambutol or streptomycin Education Must follow exact drug regimen Proper nutrition Reverse weight loss and lethargy About disease

Pulmonary Emboli : 

Pulmonary Emboli The obstruction of a pulmonary artery or branch by blood clot (thrombus). Most thrombi are blood clots from the veins of the legs. The obstructed area has diminished or absent blood flow. Although this area is ventilated, no gas exchange takes place. Manifestations: Dyspnea, chest pain, tachypnea, tachycardia, anxiety, cough, diaphoresis

Risk Factors for Pulmonary Emboli : 

Risk Factors for Pulmonary Emboli See Chart 23-7 Venous stasis Thrombophebitis Oral contraceptives Constrictive clothing Trauma Foreign bodies

Diagnostics : 

Diagnostics Low to moderate index of suspicion CXR ECG ABGs V/Q scan Peripheral vascular studies High index of suspicion D-dimer Spiral CT Pulmonary angiography

Prevention and Treatment of Pulmonary Emboli : 

Prevention and Treatment of Pulmonary Emboli PreventionSee Chart 23-8 Exercises to avoid venous stasis Early ambulation Anticoagulant therapy Sequential compression devices (SCDs) Treatment Measures to improve respiratory and CV status Anticoagulation and thrombolytic therapy

Umbrella Filter : 

Umbrella Filter

Lung Cancer : 

Lung Cancer A leading cause of cancer deaths worldwide Metastasizes at late-stage diagnosis Staged to assess size and extent of disease Etiology and genetic risk Incidence and prevalence make lung cancer a major health problem. Health promotion and illness prevention is primarily through education strategies and reduced tobacco smoking.

Manifestations of Lung Cancer : 

Manifestations of Lung Cancer Often nonspecific, appearing late in the disease process Chills, fever, and cough Dyspnea Blood-tinged sputum

Treatment : 

Treatment Surgery Lobectomy Pneumonectomy Chemotherapy Radiation

Chest Trauma : 

Chest Trauma Blunt Sternal and Rib fractures Flail chest Pulmonary contusion Penetrating GSW and Stabbing Pneumothorax Cardiac tamponade Subcutaneous emphysema

Chest Drainage : 

Chest Drainage Used to treat spontaneous and traumatic pneumothorax Used postop to re-expand the lung & remove excess air, fluid, blood Types of drainage systems Management: See Chart 25-18 Prevention of cardiopulmonary complications: See Chart 25-19