1 / 125

Lower Respiratory Tract Disorders: Bronchiectasis, Pneumonia, Tuberculosis

This chapter discusses the pathophysiology, signs and symptoms, diagnosis, and therapeutic interventions for lower respiratory tract disorders such as bronchiectasis, pneumonia, and tuberculosis. It also includes nursing diagnoses and interventions for these conditions.

jbridget
Download Presentation

Lower Respiratory Tract Disorders: Bronchiectasis, Pneumonia, Tuberculosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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 • Aspiration • Artificial Ventilation (VAP) • Hypostasis • 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 • Pleural Effusion • Atelectasis • 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. Diagnostic Tests • Chest X-Ray • CBC • FVC, FEV1 • Tests to Determine Cause

  31. Therapeutic Interventions • Pain Management • Treat Underlying Cause

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

  33. Etiology • Transudative • Heart Failure • Liver or Kidney Disease • Exudative • Pneumonia • TB • CA

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

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

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

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

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

  39. Diagnosis • Chest X-Ray • CT Scan • Bronchoscopy • Lung Biopsy • ANA Titre

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

  41. Atelectasis • Pathophysiology • Collapse of Alveoli • Etiology • Hypoventilation

  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

More Related