Management of Patients with Chest and Lower Respiratory Tract Disorders, Asthma & COPD
Atelectasis:
• Collapse of alveoli
• Acute or chronic
•
... [Show More] Can be segmental, lobar, or whole lung
• Causes?
o Decrease in ventilation or blockage that is obstructing the airway
o Obstructive → foreign body, tumor
o Non-obstructive → neurological or musculoskeletal disease processes (reduced lung volume
capacity)
o Shallow breathing, hypoventilation, immobility after surgery (with pain → hesitant to cough and
deep breath)
o Increase pressure on the lung → pneumothorax or pneumonia
• Assessment findings
o Shortness of air, tachypnea, tachycardia, cough, sputum production, anxiety, orthopnea, low O2
sats
o Severe → cyanosis, hypoxemia
o When listening to lungs will hear crackles and decreased breath sounds in the involved areas
▪ Crackles in lower lobes
▪ Unequal chest expansion
o Chest x-ray will look opaque in area that has atelectasis
▪ Chest x-rays done post-op
• Interventions- Prevention is the KEY!
Preventative Measures:
• TCDB (turning, coughing, deep breathing)
• Early mobilization
• Incentive spirometry
• CPT (chest physiotherapy)
• Pain management → comfort, deep breathing, mobility
• Monitor opioid use
o Respiratory depression
Pneumonia:
• What is Pneumonia?
o Excessive fluid in the lungs due to inflammation of the parenchyma which is lung tissues, caused
by an infectious process
o Fibrin and edema stiffen the lung, which causes decreased compliance and alveolar collapse
▪ Compliance → the ability of the lung to expand
o Segmental, lobar, or diffusely scattered
• Types
o Bacterial
o Mycobacteria (TB)
o Fungus
o Viral
• Community-acquired pneumonia (CAP)
o Develops within first 48 hrs. of admission
o Do not meet criteria for HCAP
o Usually caused by pneumococcus, strep, and h. flu
• Health care-associated pneumonia (HCAP)
o Multi-drug resistance, immunocompromised, aspiration
o Pre-existing lung disease or immunocompromised
• Hospital-acquired pneumonia (HAP)
• Ventilator-acquired pneumonia (VAP)
o Occurs > 48 hrs. after intubation
o Prevention is the key
Pneumococcal Pneumonia:
• Approximately, 18,000 older adults die each year from pneumococcal disease in the United States.
• The vaccine should be administered routinely:
o Adults 65 years and older
o For anyone 2 years or older with certain chronic illnesses
Aspiration Pneumonia:
• A foreign substance that enters into the lung
• Which lung is more likely to be affected? WHY?
o Right side more likely (right is straighter angle)
• Who is at high risk?
o Seizure activity, brain injury, decreased LOC
o Flat body position, stroke, swallowing/vocal cord disorder
• Prevention is the KEY!
o Keep HOB elevated 30-45 degrees at all time
o Decrease use of sedatives
o Small amount of foods and chew slowly
o Assess NG tube placement (x-ray, tube in distal stomach)
o Get a swallow study for high risk patients
• Signs of aspiration:
o Coughing, dyspnea, tachycardia, purulent sputum, diaphoretic, wet sounding voice
• Silent aspiration → will not show any of those symptoms
o Fever and tachycardia (no coughing)
Collaborative Care for Patients with Pneumonia:
• Testing/Diagnosis:
• History and Physical
• High priority - Sputum and blood cultures
o Obtain prior to antibiotic therapy – identify the causative organism and determine the appropriate
treatment; abx will interfere with culture result
• Chest X-ray
• CBC
• ABG
• Bronchoscopy
o Look into bronchi → biopsy of lung tissue, remove excess fluid
Management:
• Specific antibiotic therapy
o Started on broad spectrum and then once results come back switch to narrow spectrum (IV then
to oral – stable)
o Antibiotic stewardship
• Oxygenation
• Nutritional support
o Small, frequent meals
o Nutritional supplements
• Hydration - IV or PO
o Fluid & electrolyte balance
• PPD to rule out TB
• Analgesics
• Antipyretics
• Rest
• Other respiratory support
o Suctioning
o Chest PT
o Bronchodilators
• How to know if patient is i [Show Less]