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Respiratory 3
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LRS Disorders: Infectious
- Pneumonia (illustration)
- Definition/etiology
- acute infection of lung parenchyma
- cause: bacterium, virus, protozoan, mycobacterium, mycoplasma, or rickettsia
- pneumonia is the leading cause of death from infectious causes
- may affect only a region of lung: lobar pneumonia, bronchopneumonia
- may be the result of:
- primary infection
- secondary to other lung damage
- aspiration
- Risk factors for pneumonia
- pre-existing pulmonary disease
- abdominal and thoracic surgery
- mechanical ventilation
- advanced age
- decreased ability to protect airway or cough effectively
- artificial airway
- chronic illness and debilitation
- depressed immune function
- cancer
- Diagnostics
- chest radiograph
- sputum culture, sensitivity and microscopic analysis, Gram stain, cytology
- ABG as indicated by clinical condition
- Management
- antimicrobials, depending on pathogen
- antipyretic
- expectorants
- antitussives
- supplemental oxygen, as indicated
- IV fluids to treat dehydration
- Nursing interventions
- monitor finger oximeter if hemoglobin levels within normal limits
- promote hydration to liquify secretions
- teach effective coughing techniques to minimize energy expenditure
- suction if necessary
- teach the need to continue entire course of antimicrobial therapy which is usually seven to ten days
- teach that findings are expected to be less within 48 to 72 hours of initial therapy
- Pulmonary tuberculosis (PTB) (illustration)
- Etiology
- mycobacterium tuberculosis
- bacilli lodge in alveoli
- pulmonary infiltrates
- can spread throughout body via blood
- multi-drug resistant PTB is becoming more prevalent
- PTB incidence is rising with increasing homelessness and AIDS
- Findings
- weakness with fatigue
- anorexia with weight loss
- night sweats
- chest pain
- productive cough
- Diagnostics
- sputum and gastric contents, analysis for the presence of acid-fast bacilli
- chest x-ray for presence of active or calcified lesions, "coin" lesions
- tuberculin testing
- tine, mantoux tests
- checked 48 to 72 hours for induration
- positive if >10 mm induration in healthy persons
- establishes if there is an antibody response to the tubercle bacillus
- if positive, indicates prior exposure to bacillus, not an active disease
- Management
- long-term, six to 24 months, antimicrobial therapy with isoniazid (INH) (Hyzyd) or rifampin (Rifadin), with ethambutol HCL (Etibi) in some cases
- bed rest or chair rest until findings abate
- surgical resection of involved lung if medication is not effective
- high carbohydrate, high protein diet with frequent small meals
- Nursing interventions
- with active infection, client must be isolated with airborne precautions when in the hospital
- teach client
- proper techniques to prevent spread of infection: hand washing, etc.
- to report bloody sputum
- not to use over the counter (OTC) medications without health care provider's approval
- importance of taking medications as prescribed
- adherence to treatment regimen
- return at scheduled times for lab testing of liver enzymes
- an increase in B6 to minimize peripheral neuropathies, a common side effect of drug therap
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Lung abscess
- Localized area of lung infection
- Usually follows pneumonia, TB or aspiration
- Treatment consists of draining and culturing abscess and antimicrobial therapy
- LRS Disorders: Miscellaneous
- Pulmonary embolism
- Definition/etiology
- clot blocks blood from the "bed" of arteries that feed the lung
- client is breathing but gases are not exchanged - ventilation without perfusion
- hypoxemia results
- can be mild or immediately fatal, based on the size and location of clot(s)
- usually clot has traveled from deep veins in the leg or pelvis
- Diagnostics
- ventilation/perfusion (V/P) scan, also called V/Q scan
- ABG
- EKG
- Management
- oxygen via mask
- anticoagulation - heparin in acute and coumadin for chronic risk
- thrombolytics
- filter surgically placed in vena cava for long term care
- Acute respiratory distress syndrome (ARDS)
- Definition/etiology
- alveolar capillary membrane becomes more permeable to fluids
- increased extravascular lung fluid
- pulmonary compliance decreases
- intrapulmonary shunt increases
- refractory hypoxemia
- usually seen after lung injury or massive multi-system organ disease
- Findings
- restlessness, anxiety
- dyspnea
- tachycardia
- cyanosis
- intercostal retractions
- Diagnostics
- clinical presentation and history of findings
- hypoxemiaon ABG despite increasing inspired oxygen level
- chest x-ray shows diffuse infiltrates
- Management
- optimize oxygenation
- mechanical ventilation
- sedation may be required
- paralytic agents may be necessary
- antibiotics, as indicated
- corticosteroids
- Nursing interventions
- plan for frequent rest periods
- monitor trends in oxygenation status, ABGs, respiratory effort
- observe for behavioral changes and vital signs; confusion and hypertension may indicate cerebral hypoxia
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