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Lower Respiratory Tract Disorders: Bronchiectasis, Pneumonia, Tuberculosis, Pleurisy, Pleural Effusion

This chapter covers the pathophysiology, signs and symptoms, diagnosis, and therapeutic interventions for bronchiectasis, pneumonia, tuberculosis, pleurisy, and pleural effusion.

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Lower Respiratory Tract Disorders: Bronchiectasis, Pneumonia, Tuberculosis, Pleurisy, Pleural Effusion

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  1. Chapter 31 Nursing Care of PatientswithLower Respiratory Tract Disorders

  2. Bronchiectasis • Pathyphysiology • ChronicInfection • Dilation ofOneorMore Large Bronchi • AirwayObstruction • Etiology • Secondary to CF, Asthma, TB

  3. Signs and Symptoms • Dyspnea • Cough • Large Amounts of Sputum • Anorexia • Recurrent Infection • Clubbing • Crackles and Wheezes

  4. Diagnosis • X-Ray • CT Scan • Sputum Culture • Tests to Find Underlying Cause

  5. Therapeutic Interventions • Antibiotics • Mucolytics, Expectorants • Bronchodilators • Chest Physiotherapy • Oxygen • Surgical Resection

  6. Pneumonia • Pathophysiology • Acute Lung Infection • Inflammation and Alveolar Damage • Alveoli Filled with Exudate • Reduced Surface Area for Gas Exchange

  7. Etiology • Bacteria, Usually Streptococcus pneumoniae • Virus • Fungus- PCP • Aspiration • Artificial Ventilation (VAP)- patients that are intubated and mechanically ventillated • Hypostasis- hypo-ventilate due to bed rest, immobility • Chemical- due to toxic chemical

  8. At Risk • Very Young • Elderly • Hospitalized • Intubated • Immunocompromised

  9. Prevention • Pneumococcal Vaccine • Flu Vaccine • Coughing and Deep Breathing • Hand Washing • Frequent Mouth Care, Continuous Suction for VAP

  10. Signs and Symptoms • Chest Pain • Fever, Chills • Cough, Dyspnea • Yellow, Rusty, or Blood-tinged Sputum • Crackles, Wheezes • Malaise

  11. Signs and Symptoms in Elderly • New Onset • Confusion • Lethargy • Fever • Dyspnea

  12. Complications • Pleurisy (Inflammation of the pleura) • Pleural Effusion (excess fluid in the pleural space • Atelectasis (collapsed aveoli) • Spread of Infection

  13. Diagnosis • Chest X-Ray • Sputum Culture • Blood Cultures

  14. Therapeutic Interventions • Antibiotics – PO or IV • Antiviral Medication (Zovirax) • Bronchodilators • Expectorants • Oxygen • Fluids

  15. Tuberculosis • Pathophysiology • AFB Implant on Bronchioles or Alveoli • Tubercle Formed • Immune System Keeps in Check • 5% to 10% Infected Become Ill • May Activate with Impaired Immunity

  16. At Risk • Elderly • Alcoholics • Those Living in Crowded Conditions • New Immigrants • Those with HIV

  17. Signs and Symptoms • Cough • Blood-tinged Sputum • Night Sweats • Anorexia and Weight Loss • Low-grade Fever • Dyspnea, Chest Pain (Late)

  18. Diagnostic Tests • PPD Skin Test • Chest X-Ray • Sputum Cultures • QuatifFERON-TB Gold

  19. Therapeutic Interventions • Combination of Drugs for 6 to 24 Months • INH • Rifampin • Streptomycin • Ethambutol • Occasional Surgical Removal • Isolation

  20. Nursing Diagnoses: Lower Respiratory Disorders • Impaired Gas Exchange • Ineffective Airway Clearance • Ineffective Breathing Pattern • Activity Intolerance

  21. Impaired Gas Exchange • Monitor • LungSounds,Respiratory RateAndEffort • Dsypnea • MentalStatus • SpO2, ABGs • Position • Fowler’s • GoodLung Down • Administer Oxygen • Teach Breathing Exercises • Discourage Smoking

  22. Ineffective Airway Clearance • Monitor • LungSounds • Sputum • Encourage • Fluids • DeepBreathing • Coughing • Administer Expectorants • Turn Every 2 Hours Daily or Ambulate • Suction PRN • Consider CPT or Mucus Clearance Device

  23. Ineffective Breathing Pattern • Monitor • RespiratoryRate,Depth,Effort • ABGs, SpO2 • Determine/Treat Cause • Position • Teach Diaphragmatic Breathing

  24. Activity Intolerance • Monitor Response to Activity • VitalSigns • SpO2 • Use Portable O2 for Ambulation • Allow Rest Between Activities • Obtain Bedside Commode • Increase Activity Slowly • Refer to Pulmonary Rehabilitation

  25. Additional Diagnoses for TB • Risk for Ineffective Self Health Management • Teach Patient and Family • Consider Visiting Nurse/DOT • Risk For Infection Transmission • Teach Patient and Family • Maintain Isolation Precautions

  26. Prevention of TB Spread • Clean, Well-ventilated Living Areas • Isolation of Patients Who Have Active TB • High-efficiency Filtration Masks • Gowns, Gloves, Goggles if Contact with Sputum Likely

  27. Restrictive Disorders • Reduced Compliance • Limited Chest Wall Expansion

  28. Pleurisy • Pathophysiology • Inflammation of Visceral and Parietal Pleurae • Friction Between Pleurae on Inspiration • Etiology • Secondary to Pneumonia, TB, CA, PE

  29. Signs and Symptoms • Sharp Pain on Inspiration • Shallow Breathing • Fever, Elevated WBC • Friction Rub

  30. Therapeutic Interventions • Pain Management • Treat Underlying Cause

  31. Pleural Effusion • Pathophysiology • Excess Fluid Between Visceral and Parietal Pleurae • Pleural Fluid Not Reabsorbed • May Collapse Lung

  32. Etiology • Transudative Pleural effusions can result from: • Heart Failure • Liver or Kidney Disease • Exudative can result from: • Pneumonia • TB • CA

  33. Signs and Symptoms • Dyspnea • Pain • Cough • Tachypnea • Diminished Lung Sounds

  34. Diagnostic Tests • Chest X-Ray • Thoracentesis • Tests to Determine Cause

  35. Therapeutic Interventions • Treat Underlyng Cause • Analgesics • Thoracentesis/Chest Tube

  36. Pulmonary Fibrosis • Pathophysiology • Injury toAlveoli • Scarring,Fibrosis • ImpairedGas Exchange • Etiology • Heredity • Virus • Environmental/Occupational Exposure • ImmuneDysfunction • Idiopathic

  37. Pulmonary Fibrosis • Pathophysiology • Formation of scar tissue in lung tissue after inflammation or irritation • Cigarette smoking, frequent aspiration, or exposure to environmental or occupational substances • Complications • Pulmonary hypertension, cor pulmonale, and ventilatory failure-which is end-stage disease

  38. Signs and Symptoms • Progressive Dyspnea • Crackles • Chronic Cough • Fatigue • Clubbing

  39. Diagnosis • Chest X-Ray • CT Scan • Bronchoscopy • Lung Biopsy • ANA Titer- autoimmune disorder

  40. Therapeutic Interventions • Glucocorticoids • Immune Suppressants • Smoking Cessation • Oxygen • Flu/Pneumonia Vaccines • Pulmonary Rehabilitation • Lung Transplant

  41. Atelectasis • Pathophysiology • Collapse of Alveoli • Etiology • Hypoventilation • Most commonly occurs in post surgical patients who do not cough and deep breath effectively

  42. Signs and Symptoms • Fine Crackles • Diminished Breath Sounds • Dyspnea

  43. Therapeutic Interventions • Prevention • Cough and Deep Breathe • Incentive Spirometer • Turn • Ambulate

  44. Nursing Diagnoses: Restrictive Disorders • Impaired Gas Exchange • Ineffective Breathing Pattern • Acute Pain

  45. Obstructive Disorders • Airway Obstruction • Difficult Exhalation

  46. COPD • Combination of • ChronicBronchitis • Emphysema • (Asthma) • Chronic Airflow Limitation

  47. COPD (cont’d)

  48. Pathophysiology • Chronic Bronchitis • Chronic Inflammation • Low-grade Infection • Hypertrophied Mucous Glands in Bronchi • Impaired Ciliary Function • Ineffective Airway Clearance • Diagnosed After Ill 3 Months of Year for 2 Consecutive Years

  49. Pathophysiology (cont’d) • Emphysema • Destruction of Alveolar Walls • Loss of Elastic Recoil • Damage to Pulmonary Capillaries • Air Trapping • Impaired Gas Exchange

  50. Types of Emphysema

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