Immobility in Post-operative Care

Immobility and Post-operative Care

• Post-operative patients without movement restrictions should ambulate to encourage lung expansion, especially those with lung diseases.
• Chronic and excruciating pain can disrupt vital signs and hinder lung function by limiting full expansion.
• Patients experiencing trauma or surgical procedures involving the lungs should be encouraged to ambulate and perform range of motion (ROM) exercises.
• For patients with CNS dysfunction or coma, nursing responsibility includes delivering passive ROM exercises.

Pathophysiology of Atelectasis

• General anesthesia can temporarily depress physiological functions, necessitating deep breathing exercises post-surgery.
• Decreased airflow leads to atelectasis, detectable via specific symptoms rather than visually.
• Indicators of active infections include cough with discolored sputum (greenish/yellowish), while a rusty sputum indicates late-stage pneumonia.

Pathophysiology of Pneumonia

• Pneumonia can be caused by infectious agents (like Mycoplasma) and non-infectious agents (foreign matter).
• Inflammatory responses release agents such as histamine and WBCs, resulting in mucus hypersecretion and significant consolidation due to WBC activity.
• Symptoms include fever, chills, shortness of breath, cyanosis, and productive coughs with abnormal sputum colors.

Diagnostic Tests for Pneumonia

• Chest X-ray and sputum examination are critical; sputum exam is the most reliable diagnostic option.
• CBC reveals elevated white blood cell counts, typically above 10,000 cells/cu mm, indicating infection.

Medical Management for Pneumonia

• Pharmacological treatments target symptoms and underlying infections.
• Supportive treatment includes oxygen therapy and mechanical ventilation for severe cases or when alveoli collapse is imminent.

Signs and Symptoms of Pulmonary Tuberculosis

• Common symptoms include low-grade fever, appetite loss, night sweats, dry cough progressing to hemoptysis, chest pain, and weight loss.
• Morning sputum specimens are collected over three days to ensure accurate diagnosis of pulmonary tuberculosis due to overnight secretion buildup in the lungs.
• Chest X-rays provide supportive evidence of PTB, with Ghon tubercle as a key indicator.

Classification of Pulmonary Tuberculosis (PTB)

• Class 0: No exposure; no infection.
• Class 1: Exposed; no infection.
• Class 2: Latent infection; negative symptoms; positive PPD.
• Class 3: Active infection; all tests positive.
• Class 4: Clinically inactive infection; positive tests.
• Class 5: Suspected disease; pending diagnosis.

Medical Management for Pulmonary Edema

• Pulmonary edema results from conditions like congestive heart failure (CHF) and left ventricular failure, leading to fluid accumulation in the lungs.
• Immediate treatment may involve vasodilators and inotropic drugs to enhance cardiac function.
• Symptoms of pulmonary edema include productive cough with frothy sputum, central cyanosis, and altered mental status.

Signs and Symptoms of Acute Respiratory Failure (ARF)

• Common indicators include tachypnea, difficulty breathing, retractions, central cyanosis, and altered consciousness.
• Intubation and mechanical ventilation are primary interventions for managing ARF.

Medical Management of Acute Respiratory Distress Syndrome (ARDS)

• Intubation and mechanical ventilation are critical for maintaining ventilation and oxygenation, coupled with pharmacologic treatments like human recombinant interleukin-1 receptor antagonist and neutrophil inhibitors.