Chapter 10: Nursing Management: Patients With Chest and Lower Respiratory Tract Disorders

1. Chapter 10: Nursing Management: Patients With Chest and Lower Respiratory Tract Disorders

2. Atelectasis • Pathophysiology • Risk factors • Manifestations • Management: • Incentive spirometry • Nebulizers • Chest physiotherapy (CPT)

3. Pneumonia • Pathophysiology • Types: • Community-acquired pneumonia • Hospital-acquired pneumonia • Ventilator-associated pneumonia • Health-care associated pneumonia • Risk factors • Manifestations and assessment

4. 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? • Community-acquired pneumonia • Hospital-acquired pneumonia • Ventilator-associated pneumonia • Health care–associated pneumonia

5. 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.

6. Medical and Nursing Management of Pneumonia • Antibiotic therapy • Supportive care • Prevention • Gerontological considerations

7. Oxygen Therapy in the Management of Pneumonia • Methods of administration: See Table 10-2 in text

8. Oxygen Masks

9. Question • Is the following statement true or false? • A non-rebreathing mask should fully collapse on full inspiration.

10. 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.

11. 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

12. Pulmonary Tuberculosis • Pathophysiology • Risk factors • Manifestations and assessment • Tuberculin skin test • QFT-G test • Medication regimen

13. Question • A nurse is administering tuberculin skin tests to a group of employees. What technique will the nurse utilize? • Intradermal injection into the workers’ forearms. • Intramuscular injection into the vastus lateralis. • Subcutaneous injection into the abdominal region. • Insertion at a 90-degree angle into the deltoid.

14. 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.

15. Pulmonary Edema • Pathophysiology • Risk factors • Manifestations and complications • Medical management • Nursing management

16. Pleural Conditions • Pleurisy • Pleural effusion and empyema

17. Pleural Effusion

18. Acute Respiratory Failure • Pathophysiology • Causes include: • Decreased respiratory drive • Dysfunction of the chest wall • Dysfunction of the lung parenchyma • Other causes • Assessment • Management

19. Acute Respiratory Distress Syndrome (ARDS) • Pathophysiology • Risk factors • Manifestations • Management: • Positive end-expiratory pressure (PEEP) • Pharmacologic treatments • Nursing care

20. 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? • Preparing to participate in intubation • Administering oxygen by nasal cannula • Administering bronchodilators by metered dose inhaler • Auscultating the patient’s chest

21. 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.

22. Pulmonary Arterial Hypertension • Pathophysiology • Risk factors • Manifestations • Management • Nursing care

23. Pulmonary Embolism • Pathophysiology • Risk factors • Manifestations • Assessments: • Chest X-ray, ECG, peripheral vascular studies, ABGs, d-dimer, and ventilation–perfusion scan, CT • Preventative measures

24. 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

25. Occupational Lung Diseases • Silicosis • Asbestosis • Coal worker’s pneumoconiosis

26. 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

27. Lung Cancer (cont.) • Risk factors • Clinical manifestations • Assessment and diagnostic testing • Treatment: • Surgery • Radiation therapy • Chemotherapy • Complications • Nursing care

28. Chest Trauma • Blunt trauma versus penetrating trauma • Clinical manifestations and assessment • Management includes chest tube placement for pneumothorax

29. Complication of Chest Trauma: Pneumothorax • Types: • Simple • Traumatic • Tension • Manifestations • Management

30. Chest Drainage Systems

31. Chest Trauma (cont.) • Complications: • Sternal and rib fractures • Flail chest • Pulmonary contusion • Cardiac tamponade

32. 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? • Remove excess carbon dioxide from the blood. • Monitor the quantity of pleural fluid. • To enhance the patient’s expiratory drive. • Re-expand the lung and remove excess air and fluid.

33. 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.

34. Aspiration • Pathophysiology • Risk factors • Preventative measures