Management of Respiratory Disorders Chapter 23

Atelectasis

• Can be classified as acute or chronic.
• Nonobstructive atelectasis occurs without airway blockage, while obstructive involves gas reabsorption or compression.
• Common causes include foreign bodies, tumors, altered breathing patterns, retained secretions, pain, prolonged supine positioning, and specific surgical procedures.
• Clinical signs include increasing dyspnea, cough, sputum production, tachycardia, tachypnea, pleural pain, and central cyanosis.
• Chronic atelectasis may lead to pulmonary infections.
• Assessment includes physical examination showing increased work of breathing, hypoxemia, decreased breath sounds, and chest X-ray confirmation.
• Prevention strategies involve frequent turning, early mobilization, lung expansion techniques, and effective secretion management.
• Treatment goals include improving ventilation and removing secretions, utilizing incentives like incentive spirometry and deep breathing exercises.
• Advanced measures may include PEEP, CPAP, bronchoscopy, or thoracentesis if initial treatments fail.

Pneumonia

• An inflammation of lung parenchyma caused by bacteria, mycobacteria, fungi, or viruses.
• Types include Community-Acquired, Health Care-Associated, Hospital-Acquired, Ventilator-Associated, pneumonia in immunocompromised hosts, and aspiration pneumonia.
• Common causative pathogens vary by pneumonia type, with S. pneumoniae prevalent in community settings.
• Risk factors for drug-resistant infections include age, alcoholism, recent antibiotic therapy, and underlying health conditions.
• Assessment involves physical examination, chest X-ray, and sputum cultures; deep cough is required for sputum sampling.
• Medical management includes appropriate antibiotic therapy, clinical stability criteria, and supportive treatments for viral pneumonia.
• Complications can lead to septic shock, respiratory failure, pleural effusion, and empyema.
• Nursing diagnoses may include ineffective airway clearance, risk for deficient fluid volume, fatigue, and imbalanced nutrition.

Pulmonary Tuberculosis

• Primarily affects lung parenchyma and is caused by Mycobacterium tuberculosis.
• Transmission is airborne, with various risk factors impacting susceptibility.
• Diagnosis involves positive skin tests, blood tests, sputum cultures, history of exposure, and chest X-rays.
• The Mantoux test indicates previous TB exposure; induration size determines significance.
• Medical management includes anti-TB agents for 6 to 12 months, with a focus on preventing drug-resistant strains.
• Nursing care focuses on promoting airway clearance, adhering to treatment regimens, enhancing activity and nutrition, and preventing disease transmission.

Management of Pleural Effusion

• Management involves clinical assessment to determine the underlying cause.
• Interventions may include thoracentesis to drain excess fluid and relieve symptoms.
• Understanding the difference between transudative and exudative effusions is critical for effective treatment.

General Nursing Interventions

• Education on disease prevention and management is vital for patients at risk for respiratory disorders.
• Emphasis on the nursing process in caring for patients with respiratory issues, ensuring comprehensive assessment and response to patient needs.