Chapter 26
Upper Airway Disorder
Tracheotomy- this is temporary and is used for Le Fort III, most extensive fracture,
with airway obstruction and severe bleeding.
Chapter 27
Acute Bronchitis is the inflammation of the mid and large airways of the lung
without evidence of pneumonia. Nurse should administer mild analgesics (NSAID,
Tylenol), encourage fluid intake 2-3 L/day, ambulate, cough, avoid smoking, use
humidifier at night, instruct prevention like hand washing and recognize increase
sputum and SOB.
Asthma is a chronic disorder of airways characterized by airflow obstruction,
bronchial hyperresponsiveness and airway inflammation. Nurse should educate
patient and family about prevention of asthma attacks and provide emotional
support to whom may be frightened about patients dyspnea. Nurse should assess
breath sounds, peak flow, pulse ox and vital signs. Teach proper use and side effects
of medications.
Influenza is a contagious respiratory disease caused by influenza viruses. Nurse
should advise patient to rest, drink plenty of fluids, avoid alcohol and tobacco and to
take aspirin or acetaminophen
*Pneumonia is an acute inflammation of the lungs caused by infection. Nurse
should monitor oxygen sat and should be kept at 93% or patient’s baseline.
Pulmonary Fungal Infections are caused by inhalation of fungal spores. Nurse
should give mild analgesics for chest pain, encourage fluids 3L/day, Assess dyspnea
at (rest, exertion and sleep), administer oxygen, position patient in upright position,
or head up at night, assess ability to perform ADL.
*Pulmonary Tuberculosis is a chronic and contagious bacterial infection caused by
M. tuberculosis inhaled from the air from cough or sneeze and characterized by
granulomas in the infected tissues. Nurse should prevent spread of infection, assist
family to manage environment, monitor prescribed pharmacotherapy, address
patient anxiety related to disease and issues of poor nutrition, pain and fatigue.
Nontuberculosis (atypical) Mycobacterium includes atypical mycobacteria and is
prevalent in soil, natural water sources, foodstuffs and animals. Symptoms include
productive cough, fever, weight loss or hemoptysis. Nursing management same as
pulmonary infection.
*Lung Abscess is a pus filled cavity located in the parenchyma of the lung caused by
fungal and parasitic infections. Nurse should assess medical hx of influenza,
pneumonia, febrile illness, cough and sputum production. A physical assessment:
looking for fatigue, pale. Patient may c/o chest pain. Auscultate for decreased
sounds in involved area, bronchial breath sounds and fine crackles over lesions
Interstitial Lung Disease Cause inflammation or scarring of lung tissue. Nurse
should address issues such as dyspnea, fatigue, and activity tolerance. May require
supplemental oxygen to facilitate maintaining activity levels. Nurse should provide
education of management, initiate discussion of advanced directives and address
emotional issues like depression, anxiety and anger.
Idiopathic Pulmonary Fibrosis is a chronic, progressive, fibrosing interstitial lung
disease of unknown etiology that usually affects age 40. No proven treatment. Nurse
should encourage adequate nutritional intake.
Sarcoidosis of the lung, is caused by inflammatory immune system disorder that
affects any organ but most commonly attacks the lungs. Administer corticosteroids
to prevent granuloma formation and reverse immunologic abnormalities
Pneumoconiosis is a group of interstitial lung diseases associated with
occupational exposures that cause interstitial lung fibrosis.
Silicosis is a fibrosing interstitial lung disease caused by the inhalation of
crystalline free silica dust, most commonly quartz. Miners, foundry workers and
sandblasters are at risk. Nurse needs to manage lung lavage, corticosteroids, and
bronchodilators.
Coal Worker’s Pneumonoconiosis is caused by the inhalation of coal dust
into the lung, which caused inflammatory lesions in bronchioles and may extend in
the alveoli. Nurse should instruct the patient to eliminate exposure, and stop
smoking.
Asbestosis is a pulmonary fibrosis caused by inhalation of asbestos fibers. IT
causes inflammatory response leading to fibrosis and destroys lung architecture and
causes honeycombing making lungs stuff and small. No treatment and management
includes smoking cessation, early detection, removal from exposure and
pneumococcal and influenza vaccinations
Chronic Obstructive Pulmonary Disease is a chronic, recurrent, obstruction in
pulmonary airways. It involves dyspnea, wheezing, accessory muscles, ad decreased
forced expiratory volume. Nurse should assess for dyspnea, muscle fatigue,
increased work of breathing. Teach patient about methods to use inhalants and
demonstrate good coughing techniques to clear mucus. Nurse cautions patient to
avoid extremes of temperature, exposure to crowds, poor air waulity or high pollen
counts.
*Chronic bronchitis is the inflammation, vasodilation, congestion, mucosal edema
and bronchospasm. Airway enargment and production of large amouts of thick
mucus.
*Emphysema is the hyperinflation of lungs, loss of elastic recoil, increased airway
resistance due to compromise alveolar walls, bullae and air trapping.
*Ineffective Breathing Pattern Nurse should position to help alleviate dyspnea,
breathing techniques and energy conservation.
*Improve oxygenation: Nurse should encourage diaphragmatic breathing, pursed
lip breathing, relaxation techniques and positioning.
*Ineffective Airway Clearance Nurse should do suctioning, positioning, hydration,
respiratory treatments –flutter valve and tracheostomy.
* Imbalanced Nutrition dietary consultation to prevent protein calorie
malnutrition. Monitor sweight, skin condition and serum prealbumin levels,
dyspnea management and food selection to prevent weight loss.
*Activity Intolerance Nurse should encourage patient to pace activities and
promote self-care. Do not rush through morning activity, gradually increase activity.
Use supplemental oxygen therapy
*Anxiety Teach patient to understand that anxiety will worse symptoms and play
ways to deal with anxiety by family support.
*Pneumonia or other Respiratory Infections risk greater in older patients. Nurse
should teach patient to avoid large crowds, pneumonia vaccination and to get a
yearly influenza vaccine.
*Chest tube to remove excess air or fluid from pleural space. Nurse should do a
respiratory assessment, chest tube site assessment and to keep the chest tube
drainage system upright below level of chest, patent, water levels correct. Look for
air leaks, drainage and check if tubing is kinked.
Polycythemia vera condition that occurs when the hematocrit becomes elevated
beyond the normal range as compensatory mechanism of hypoxemia and
development of cor pulmonale.
Lung Transplantation alternative for patients with advanced end stage pulmonary
disease. High dose corticosteroids are the first-line treatment for rejection.
GENETIC DISORDERS
Cystic Fibrosis autosomal recessive hereditary disease that affects respiratory and
GI. Nurse should administer meds, provide oxygen therapy, and instruct pt and
family on nutrition and exercise. Home care: postural drainage, aerosol nebulization
therapy, and breathing retraining. Teach controlled cough techniques, deep
breathing exercises and progressive exercise conditioning. Psychosocial support.
Pulmonary Embolism is the obstruction of the pulmonary artery or one of its
branches by material that originated elsewhere in body. Can produce pulmonary
vasoconstriction, impair ventilation and perfusion and life threating hypoxemia.
Nurse should assess pulmonary status every hour, administer oxygen to prevent
hypoxia, head of bed 40-35 degrees to promote respiratory excursion and reduce
cardiopulmonary workload. Assess patient for bleeding.
Atelectasis collapses alveoli. Cough and deep breathing.
Pleural Disorders
Pulmonary Hypertension increased pressures in pulmonary artery and
subsequent right ventricular overload and failure developed from vessels being
hypertrophied. Nurse should provide supplemental oxygen to reduce hypoxemia
related pulmonary vasoconstriction, administer diuretics to reduce right heart
volume and workload and educate patient to manage symptoms. Instruct how to
manage activity and fatigue levels like frequent rest intervals.
Cor Pulmonale alteration in the structure and function of the right ventricle due to
pulmonary hypertension caused by a disease that affects lungs. Nurse should
instruct about managing stress and how anxiety influences SOB. Maintain calm nonrushed approach.
Pleural Effusion the abnormal accumulation of fluid in the space between the
parietal pleura which covers the surface of the chest well and visceral pleura, which
voers surface of the lungs. Nurse should assess for signs and symptoms that indicate
deterioration of ventilation and ozygen: dyspnea, accessory muscles, tachypnea,
abnormal breath sounds crackles, decreasing saturations and elevated CO2. Monitor
vital signs, respiratory pattern and lab values.
Near Drowning aka submersion injury defined as patients survival after suffocation
associated with submersion in liquid medium. Nurse should maintain an open
airway and assist ventilation with a bag valve mask device and maintain cervical
spine immobilization. Provide oxygen to maintain saturations > 90%.
Carbon Monoxide Poisoning Signs are nausea, headache, dizziness, difficulty
concentrating weakness, dyspnea, chest pain confusion, syncope, seizure,
obtundation (decreased LOC), hypotension, coma, respiratory failure and death.
Nurse should provide 100% oxygen via nonrebreather mask at 15 liters.
Lung Cancer Nurse should administer pain medications regularly. Oxygen should
maintain oxygen sat and 90%. Nurse should instruct the patient on deep breathing,
coughing and splinting to assist with mobilization of secretions.