NURS320 MedSurg1 Exam 1 PDF - Respiratory Assessment

17: Assessment of Respiratory Function Residual Volume (RV): Air left in the lungs after exhaling fully = 1200 mL o ↑ in obstructi...

17: Assessment of Respiratory Function Residual Volume (RV): Air left in the lungs after exhaling fully = 1200 mL o ↑ in obstructive diseases Key words o Hypoxemia: low oxygen in the blood Vital Capacity (VC): Maximum air exhaled after deep inhalation = 4600 mL o Hypoxia: low oxygen in tissues & cells o VC = TV + IRV + ERV o Physiologic dead space: portion of the tracheobronchial tree that does not participate in o ↓ in neuromuscular disease, fatigue, pulmonary edema, COPD, obesity gas exchange Inspiratory Capacity (IC): Total air inhaled after normal exhalation = 3500 mL Respiratory System o IC = TV + IRV o Ventilation: Moving air in & out. o ↓ in restrictive diseases & obesity o Gas Exchange: Oxygen in, Carbon dioxide out. Functional Residual Capacity (FRC): Air remaining in lungs after normal exhalation = o Air Filtration: Nose & cilia trap particles. 2300 mL o Immune Defense: Tonsils, adenoids, alveolar macrophages. o FRC = ERV + RV o Speech Production: Sinuses & larynx o ↑ in COPD; ↓ in ARDS & obesity o Works with the cardiovascular system for perfusion (blood flow to the lungs). Total Lung Capacity (TLC): Total amount of air lungs can hold = 5800 mL Anatomy o TLC = TV + IRV + ERV + RV o Upper Respiratory Tract o ↓ in restrictive diseases (atelectasis, pneumonia); ↑ in COPD § Structures: Nose, paranasal sinuses, pharynx, tonsils, adenoids, larynx, trachea. o Pulmonary Diffusion (Gas Exchange) § Nose: Filters, humidifies, & warms air. § Movement of O₂ & CO₂ btwn the alveoli & capillaries. § Paranasal Sinuses: Resonance in speech; common site of infections § Alveolar capillary membrane is thin & has a large surface area, making gas exchange 4 pairs: Frontal, Ethmoid, Sphenoid, Maxillary. easy. § Pharynx (Throat): Passageway for air & food; connects to larynx o Pulmonary Perfusion (Blood Flow in Lungs) § Tonsils & Adenoids (pharyngeal tonsils): Part of the immune system, protecting § Right ventricle pumps blood → pulmonary artery → lungs. against infections. § Larynx (Voice Box): Connects pharynx to trachea; protects airway & produces sound. § Blood passes through lung capillaries for gas exchange. Epiglottis: Prevents food entry into airway. § Oxygenated blood returns to the left side of the heart via the pulmonary vein. § Not all blood participates in gas exchange (some bypasses alveoli = shunted blood). Vocal cords: Produce sound. § Pulmonary circulation has low pressure, allowing blood flow adjustments. Thyroid cartilage: largest; forms Adam’s apple. In upright position pulmonary artery pressure to not great enough to work Cricoid cartilage: Only complete cartilage ring in the larynx. against gravity to supply blood to apex of lungs § Trachea (Windpipe): Connects larynx to bronchi. o Upper lung: Less blood flow. Made of smooth muscle & C-shaped cartilage rings (prevent collapse). o Middle lung: Moderate blood flow. o Lower Respiratory Tract o Lower lung: Most blood flow (due to gravity). § Includes: Lungs, bronchi, bronchioles, alveoli. Lying on one side = More blood flows to the lung on that side. § Lungs § Pulmonary artery pressure, gravity, & alveolar pressure determine perfusion Right lung:3 lobes; left lung: 2 lobes patterns Surrounded by pleura (visceral & parietal) to reduce friction. o Ventilation-Perfusion (V/Q) Mediastinum: Between lungs § V/Q Ratio (1:1): Balance between airflow (ventilation) & blood flow (perfusion) for o Contains: Heart, thymus, major blood vessels, esophagus. adequate gas exchange § Bronchi: Main airways branching from the trachea into lungs. § Factors affecting balance: § Bronchioles: Smaller airways without cartilage, leading to alveoli. Airway blockages. § Cilia: Tiny hairlike structures that move mucus & foreign particles out of lungs. Changes in lung compliance. § Alveoli: 300 million tiny air sacs in the lungs for gas exchange. Gravity effects on blood flow. Types of alveolar cells: § V/Q Imbalance Types o Type I: 95% of alveolar SA; barrier between air & blood. Normal V/Q: Good ventilation & perfusion. o Type II: Produces type I cells & surfactant (reduces lung surface tension). Low V/Q (Shunt): Poor ventilation, normal blood flow; perfusion < ventilation o Macrophages: Defense cells that remove foreign particles. o E.g. pneumonia, atelectasis, tumor, mucus plug Functions o Blood bypasses lungs, causing low oxygen levels (hypoxia). o Oxygen Transport o Severe hypoxia → When shunting 70 mmHg = Normal Inspiratory wheezing = Bronchitis. § PaO₂ 45–70 mmHg = kinda safe § Hemoptysis (Coughing Up Blood) Common Causes: § PaO₂ 7). § CO₂ moves from cells → blood → lungs → exhaled. o Dark, coffee-ground blood from stomach →Acidic pH (95% § Low (10 days suggests bacterial. early symptomatic phase. o EMERGENCY SYMPTOMS o Inflammation of mucous membrane of nose o Can be acute/chronic, allergic (seasonal/perennial)/nonallergic § Difficulty breathing, stridor (high-pitched breathing sound), drooling →Possible airway o Causes of the Common Cold obstruction § 200+ viruses can cause colds. § Fever >102°F, severe headache, confusion →Possible meningitis/sepsis § Most common virus: Rhinoviruses. § Other viruses: Coronavirus, Adenovirus, Influenza, Parainfluenza, RSV. § Facial swelling, severe ear pain, vision problems →Possible sinus or brain abscess § Cold weather does NOT cause colds, but low humidity in winter allows viruses to o Nursing Management & Treatment survive longer. § Laryngitis Treatment: § No effective vaccine due to many virus strains. Voice rest, avoid smoking, inhaling cool steam. o Symptoms of Viral Rhinitis GERD? proton pump inhibitors (omeprazole). § Low-grade fever. 4  § Nasal congestion & rhinorrhea Facial pain, pressure, or fullness (esp. forehead, cheeks). § Sneezing, watery eyes. Purulent (thick, yellow/green) nasal drainage. § Sore or scratchy throat. Nasal congestion & postnasal drip. § Muscle aches & headache Localized/diffuse headache § Chills, fatigue, & general malaise. Headache, ear pain, & cough. § Cough (appears later in illness). § May trigger herpes simplex (cold sores). Fever (esp. in bacterial cases): ≥39°C/102°F § Symptoms last 12 weeks. Symptoms lasting more than 10 days = likely bacterial. o Treatment § Symptoms of AVRS § Rest & hydration (prevents dehydration & supports immune system). Similar to ABRS but less intense § NSAIDs: Relieves fever & muscle aches. No high fever § Warm saltwater gargles to soothes sore throat Symptoms last 102°F or 39°C). o Aerobic bacteria: Alpha-hemolytic streptococci, Microaerophilic streptococci, If difficulty breathing or severe sinus pain develops. Staphylococcus aureus Rhinosinusitis (Sinusitis) o Anaerobic bacteria: Gram-negative bacilli, Pepto-streptococcus, o Inflammation of the paranasal sinuses & nasal cavity. Fusobacterium o Types of Rhinosinusitis Fungal Infections & Immunodeficiency Risk § Acute (< 4 weeks) § Subacute (4–12 weeks) o Aspergillus → Severe invasive rhinosinusitis in immunocompromised patients. § Chronic (> 12 weeks) o Fungus ball (mycetoma): o Causes & Risk Factors § Dense fungal accumulation, usually in the maxillary sinus. § Viral or bacterial infections § Noninvasive but can become dangerous in immunosuppressed patients § Allergic rhinitis, deviated septum, → Risk of encephalopathy. nasal polyps, enlarged adenoids. § Common symptoms: § Environmental hazards (e.g., Persistent congestion & postnasal drip. chemicals, smoke, pollution). Nasal obstruction; mucopurulent drainage § Underlying conditions (asthma, ↓ sense of smell (hyposmia) & taste. cystic fibrosis, GERD, immunodeficiency). Facial pain/pressure that worsens in the morning. Fatigue & headaches. Mouth breathing, snoring, sore throat. § May be linked to fungal infections in immunocompromised patients. o Complications of Untreated Rhinosinusitis § Osteomyelitis (bone infection). § Meningitis, brain abscess, or encephalitis. § Orbital cellulitis (eye infection) → Can lead to vision loss. § Cavernous sinus thrombosis (blood clot in brain). § Neurologic symptoms (confusion, seizures) → Brain infection risk. § Mucocele (cyst of paranasal sinuses) & ischemic brain infarction o Diagnosis § Sinus palpation for tenderness. § Nasal discharge & inflammation. § Transillumination (light test for sinus blockage): decreased light transmission ~ infection § Imaging (if needed): CT scan, MRI, nasal endoscopy to detect severe inflammation, bone destruction, anatomical issues § Confirming diagnosis Sinus aspirates/cultures to know the pathogen o Acute Rhinosinusitis Flexible endoscopic culture techniques & sinus swabs § Usually follows a viral URI, unresolved infection (viral/bacterial), or allergic rhinitis o Treatment exacerbation. § Acute Bacterial Rhinosinusitis (ABRS) § Sinuses normally drain freely, resolving infections quickly. Antibiotics (Amoxicillin clavulanate, Doxycycline, Levofloxacin) for 5-7 days Obstruction leads to infection Intranasal saline lavage (flushes sinuses). Blocked sinus drainage due to: Intranasal corticosteroids (only if allergic rhinitis present). o Deviated septum, nasal polyps, hypertrophied turbinates, tumors NO antihistamines or decongestants (not recommended). o Enlarged adenoids, trauma, foreign objects § Viral Rhinosinusitis (AVRS) o Swimming/diving, tooth infections NO antibiotics (since it's viral). o Inflammation & nasal congestion from a URI traps fluid, creating a medium Nasal saline sprays & decongestants (Guaifenesin, Pseudoephedrine). for bacterial growth. § Risk Factors: Intranasal corticosteroids or OTC antihistamines if allergies present. § Chronic Rhinosinusitis (CRS) Environmental hazards (paint, sawdust, chemicals) → chronic nasal inflammation. Longer antibiotic courses (2–4 weeks). Immunosuppression increases risk of fungal infections. Corticosteroid nasal sprays (Fluticasone, Beclomethasone). § Common Bacterial Causes (60% of cases): Leukotriene inhibitors (Montelukast) if asthma is present. Streptococcus pneumoniae & Haemophilus influenzae § Surgery (if medication fails) Less common: Staphylococcus aureus, Moraxella catarrhalis Functional Endoscopic Sinus Surgery (FESS) § Biofilms & Resistance: Removes blockages (e.g., nasal polyps, deviated septum). Bacteria form biofilms → 10-1000x more resistant to antibiotics. 85–91% success rate. Biofilms protect bacteria from complete eradication, allowing regrowth after § Fungal sinusitis →Surgical removal + antifungal treatment. treatment stops. o Nursing Diagnosis § Other Organisms: § Ineffective Airway Clearance Occasionally isolated: Chlamydia pneumoniae, Streptococcus pyogenes, viruses, § Acute Pain fungi (Aspergillus fumigatus). § Impaired Verbal Communication § Health care-associated (nosocomial) infections: Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species (60% of cases). § Fluid Volume Deficit § Symptoms of ABRS 5  § Knowledge Deficit related to prevention, treatment, surgical procedure, § Treatment: postoperative care Avoid irritants (smoke, pollution, alcohol, caffeine). o Nursing Management & Patient Education Use humidifiers, saline gargles, lozenges. § ↑ fluids & use humidifiers. Short-term nasal sprays if congestion is present. § Apply warm compresses to relieve sinus pressure. Tonsillectomy may be considered if severe. § Elevate head while sleeping (reduces congestion). o Nursing Management & Patient Education § Avoid swimming, diving, & air travel during acute infection. § For Acute Pharyngitis Pharyngitis (Sore throat) Rest & fluids (2–3L/day). o Inflammation of the pharynx (back of the throat, including tonsils). Change toothbrush after 24 hours of antibiotics (to prevent reinfection). o Peak seasons: Winter & early spring. Delay school/work until 24 hours after starting antibiotics. o Causes § Monitor for Emergency Symptoms § Viral (most common, no antibiotics needed) Difficulty breathing or swallowing. Adenovirus, Influenza virus, Epstein Barr virus (Mono), Herpes simplex virus Drooling or inability to open mouth. § Bacterial (requires antibiotics) High fever that doesn’t improve. Group A Streptococcus (GAS) → "Strep throat". Severe swelling of throat/neck. Neisseria gonorrhoeae, Mycoplasma pneumoniae, C. pneumoniae (less common). Tonsilitis & Adenoiditis § Other Causes o Can be viral or bacterial Irritants (smoke, pollution, allergies). o Common in children but can occur in adults. Chronic cough, acid reflux (GERD), excessive voice use. o Viral (most common) o Symptoms of Acute Pharyngitis § Epstein Barr virus (Mono), Cytomegalovirus, herpes simplex, adenovirus, influenza, § Viral: other viruses causing colds Sore throat (mild to moderate). o Bacterial (requires antibiotics) Red throat but no pus. § Group A Strep (GAS) → Most common cause of bacterial tonsillitis Runny nose, cough, hoarseness. o Tonsillitis Symptoms Low fever (101°F (38.3°C). o Adenoiditis Symptoms Swollen lymph nodes. § Mouth breathing (due to nasal obstruction) Bad breath. § Ear pain or frequent ear infections No cough. § Runny nose, chronic nasal congestion Sometimes: nausea, vomiting, rash (scarlet feverlike rash). § Muffled voice, speech changes o Chronic Pharyngitis § Snoring, sleep apnea § Persistent inflammation common in adults who work in dusty surroundings, use their o Complications voice to excess, suffer from chronic cough, or habitually use alcohol and tobacco. § Peritonsillar abscess (pus near tonsils, can block airway) § There are three types of chronic pharyngitis: § Obstructive sleep apnea (OSA) Hypertrophic: characterized by general thickening & congestion of the § Chronic infections → May need tonsillectomy pharyngeal mucous membrane § Sepsis, pneumonia Atrophic: probably a late stage of the first type (the membrane is thin, whitish, o Adenoiditis Complications glistening, and at times wrinkled) § Frequent ear infections → Hearing loss Chronic granular: characterized by numerous swollen lymph follicles on the pharyngeal wall § Chronic nasal congestion → Breathing difficulty § S+S § Middle ear infections (otitis media) → Ruptured eardrum Constant sense of irritation of fullness in the throat o Diagnosis Cough (postnasal drip) § RADT for Strep Difficulty swallowing § Throat culture (if RADT is negative) o Complications of Untreated Strep Throat § Physical exam (swollen tonsils, redness, white patches, enlarged lymph nodes) § Rhinosinusitis, otitis media (ear infection). § Audiometric hearing test (if ear infections are frequent due to adenoiditis) § Peritonsillar abscess (pus near tonsils). o Treatment § Meningitis, pneumonia, or sepsis. § Viral Tonsillitis & Adenoiditis § Rheumatic fever (affects heart & joints, can lead to heart disease). Fluids, rest, warm saltwater gargles. § Glomerulonephritis (kidney inflammation). NSAIDs or acetaminophen for pain/fever. o Diagnosis Lozenges, throat sprays, soft foods. § Rapid Antigen Detection Test (RADT) → 90–95% accuracy. § Bacterial Tonsillitis (Strep Throat) Penicillin or Cephalosporins (cefdinir), azithromycin, or clarithromycin. § Throat culture → Confirms negative RADT results, takes 24 hours. § Tonsillectomy & Adenoidectomy o Treatment Indications for Surgery: § Viral Pharyngitis o Recurrent tonsillitis (chronic infections) despite antibiotics. Rest & hydration. o Enlarged tonsils causing breathing/swallowing problems (OSA). Saltwater gargles (warm, 105°–110°F). o Recurrent ear infections due to adenoids → Hearing loss risk. Lozenges & throat sprays (benzocaine, honey, menthol). o Peritonsillar abscess blocking airway. NSAIDs or acetaminophen for pain/fever. o Suspected cancer (persistent tonsil asymmetry). Cool beverages, popsicles, or warm tea. Postoperative Care § Bacterial Pharyngitis (Strep Throat) → Requires Antibiotics o Position patient prone with head turned to drain secretions. 1st: Penicillin V potassium (10day course) o Monitor for bleeding (bright red blood, frequent swallowing, vomiting dark o Penicillin allergy? → Cephalosporins, Azithromycin, or Clarithromycin. blood). o Apply an ice collar to the neck for swelling & pain relief. Complete the full course to prevent complications. o Provide water/ice chips as soon as tolerated. o Chronic Pharyngitis o Signs of Post-op Bleeding § Smoking, alcohol, air pollution, GERD, excessive voice use. § Frequent swallowing (swallowing blood). § Chronic cough, postnasal drip, allergies. § Bright red bleeding from mouth/nose. § Types: § Vomiting large amounts of dark or bright-red blood. Hypertrophic → Thickened, swollen pharynx. § ↑ HR, fever, restlessness. Atrophic → Thin, shiny, dry pharynx. § Call the surgeon immediately! § Pain Management Granular → Swollen lymph tissue in throat. Liquid acetaminophen (with or without codeine) for 3–5 days. § Symptoms: § Diet & Fluids Constant throat irritation & mucus buildup. Start with soft foods Sore throat & difficulty swallowing. Avoid spicy, hot, acidic, or rough foods (chips, toast). Intermittent postnasal drip. Avoid milk/dairy if it causes thick mucus. 6  Drink plenty of fluids to stay hydrated. Loss of voice with difficulty swallowing saliva § Activity Restrictions Hemoptysis (coughing up blood) No strenuous activity, heavy lifting, or exercise for 10 days. Noisy breathing (stridor) Avoid smoking, secondhand smoke, & dry air (use a humidifier). Hoarseness lasting >5 days (possible malignancy) § Good Oral Care o Treatment Gentle mouthwashes (alkaline or warm saline) help with mucus buildup. § Acute Laryngitis Treatment: Avoid vigorous brushing or gargling to prevent bleeding. Rest the voice (avoid whispering as it strains vocal cords) Peritonsillar Abscess Hydration (2–3L/day to thin secretions) o A collection of pus between the tonsil & surrounding soft tissue. Steam inhalation/humidifier o Often a complication of untreated tonsillitis or pharyngitis. Avoid irritants (smoking, pollutants) o Can cause airway obstruction → Medical emergency! Expectorants if secretions present o Most common in adults (20–40 years old). If bacterial →Antibiotics (penicillin, cephalosporins) o Causes If severe or recurrent → corticosteroids (beclomethasone) § Bacterial Infections (Most Common Pathogens) Streptococcus pyogenes (GAS) § Reflux Laryngitis Treatment: Staphylococcus aureus Proton pump inhibitors (PPIs) (e.g., omeprazole) Neisseria species Lifestyle changes (avoid acidic/spicy foods, eat smaller meals, elevate head when sleeping) Corynebacterium species Epistaxis (Nosebleed) § Can spread to the neck, chest, brain → Life-threatening complications. o Most commonly from the anterior septum (Kiesselbach's plexus). o Symptoms o Can be anterior (more common, less severe) or posterior (less common, more severe & § Severe sore throat (usually one-sided). harder to control). § Fever, chills. o Causes: § Trismus (difficulty opening the mouth). § Trauma (nose picking, blunt injury, nasal fracture) § Drooling (due to pain/swelling). § Dry air (winter, indoor heating) § Muffled "hot potato" voice. § Nasal infections (rhinitis, rhinosinusitis) § Severe difficulty swallowing (odynophagia, dysphagia). § Nasal sprays overuse (corticosteroids, decongestants) § Ear pain on the affected side (otalgia). § Inhaled irritants (cocaine, smoke, chemicals) § Foul-smelling breath (halitosis). o Systemic Causes: § Swollen, red tonsil pushing the uvula to the opposite side. § Hypertension (high BP ↑ bleeding risk) § Tender, swollen lymph nodes in the neck. § Blood disorders (thrombocytopenia, clotting disorders) § Emergency Symptoms § Liver disease (affects clotting factors) Difficulty breathing (airway obstruction). § Use of blood thinners (aspirin, warfarin) Stridor (high-pitched breathing sound). § Arteriosclerosis Severe swelling in the neck. § Hereditary conditions (Rendu–Osler–Weber syndrome) Altered mental status (due to sepsis). o Clinical Manifestations o Diagnosis § Anterior Epistaxis (Most Common): § Clinical Exam: Swollen, pus-filled tonsil, uvula deviation. Bright red bleeding from one nostril. § Throat Culture & Rapid Strep Test (RADT): Identify bacterial infection. Typically mild & stops with direct pressure. § Ultrasound (intraoral or transcutaneous): Confirms fluid collection. § Posterior Epistaxis (Less Common, More Severe): § CT scan (if airway compromise is suspected). Profuse bleeding from deeper nasal structures. o Treatment May flow down throat, causing coughing & nausea. § Antibiotics (IV or oral, depending on severity) Often requires medical intervention. § Corticosteroids (to reduce swelling). o Severe Cases → Risk of Hypovolemia & Airway Compromise! § Pain management: NSAIDs, acetaminophen, or opioids if severe. § Fluids (IV or oral to prevent dehydration). o Monitor for dizziness, hypotension, tachycardia, pallor. o First Aid for Mild Epistaxis: § If Abscess is Severe → Requires Drainage! § Sit upright & lean forward to prevent blood aspiration. Needle Aspiration (Preferred, less painful). Avoid tilting the head backward. Incision & Drainage (I&D) (More painful but effective). § Pinch the soft outer portion of the nose for5-10 minutes. Tonsillectomy (for recurrent abscesses or high risk). Breathe through the mouth. § If airway obstruction occurs → Emergency § Apply ice packs to constrict vessels. Intubation (breathing tube). § Use phenylephrine (12 sprays) for vasoconstriction. o If Bleeding Persists: Cricothyroidotomy or tracheostomy (if severe). § Identify Bleeding Site (Nasal speculum & suction) o Nursing Care § Chemical or Electrical Cauterization: § Monitor for Complications Silver nitrate or electrocautery for visible bleeding sites. Sepsis (fever, tachycardia, confusion). § Nasal Packing: Mediastinitis (infection spreading to the chest). Anterior Packing (gauze with petroleum jelly or Gelfoam) Brain abscess (severe headache, neurological symptoms). Posterior Packing (balloon catheter or nasal sponge) § Post-Drainage Care Packing remains for 3-4 days (with possible antibiotics to prevent infection). Upright position (to prevent aspiration of pus). § IV Fluids & Monitoring (For severe bleeding cases). Encourage gentle gargling every 12 hours for 24–36 hours. o Post-Treatment Care & Patient Education: Avoid spicy, rough, or acidic foods. § No vigorous exercise for several days. Laryngitis § No hot/spicy foods (↑ vasodilation). o Common Causes: § No smoking or vaping (ENDS use). § Viral infections (most common) § No forceful nose blowing, straining, or picking. § Bacterial infections (secondary) § Use humidifiers to prevent nasal dryness. § Voice overuse or strain o When to Seek Medical Help: § Environmental irritants (dust, smoke, chemicals) § If bleeding lasts >15 minutes despite pressure. § Gastroesophageal reflux disease (GERD) → reflux laryngitis § If frequent recurrent episodes occur. § Sudden temperature changes, malnutrition, or immunosuppression § If signs of severe blood loss appear (dizziness, pallor, tachycardia). o Signs & Symptoms § Acute Laryngitis: 19: Chest & Lower Respiratory Disorders Hoarseness or aphonia (loss of voice) Key words Dry, sore throat (worse in the evening) o Acute lung injury: an umbrella term for hypoxemic respiratory failure; equivalent to ARDS Persistent, dry cough o Bilevel positive airway pressure (BiPAP): noninvasive spontaneous mechanical ventilation Tickling sensation in throat given via a mask to deliver different pressures for breathing in & out Worsens with cold air or cold liquids o Consolidation: lung tissue becoming solid in due to collapse of alveoli or infectious process If allergies present → swollen uvula (pneumonia) § Chronic Laryngitis: o Continuous mandatory (volume or pressure) ventilation (CMV): also referred to as assist–control (A/C) ventilation; mode of mechanical ventilation in which the patient’s Persistent hoarseness breathing pattern may trigger the ventilator to deliver a preset tidal volume or set Continuous irritation in the throat pressure; in the absence of spontaneous breathing, the machine delivers a controlled Coughing with thick mucus breath at a preset minimum rate & tidal volume or set pressure § Severe Symptoms Requiring Immediate Care: 7  o Continuous positive airway pressure (CPAP): positive pressure applied throughout the o Dry, hacking cough, little sputum respiratory cycle to a spontaneously breathing patient to promote alveolar & airway o Soreness in the chest from coughing stability & increase functional residual capacity; may be given with endotracheal or o Mild fever, chills, night sweats, headache, fatigue tracheostomy tube or by mask Progression: o Fraction of inspired oxygen (Fio2): concentration of oxygen delivered (e.g., 1.0 = 100% o Noisy breathing (inspiratory stridor, expiratory wheezing), SOB oxygen) o Thick, puslike sputum (may be blood-streaked in severe cases) o Induration: an abnormally hard lesion or reaction, as in a positive tuberculin skin test § Treatment o Restrictive lung disease: disease of the lung that causes a decrease in lung volumes Antibiotics based on symptoms, sputum purulence & culture + sensitivity o Thoracotomy: surgical opening into the chest cavity NO antihistamines: can dry out secretions = harder to clear o Tracheotomy: surgical opening into the trachea Fluids: Helps thin mucus for easier removal o Transbronchial: through the bronchial wall, as in a transbronchial lung biopsy Coughing & Suctioning: Clears airways Inflammatory & Infectious Pulmonary Disorders Steam therapy or humidified air: Eases throat irritation o Atelectasis Pain relievers: For chest discomfort § Collapse of alveoli due to blockage or poor airflow. Bronchoscopy: May be needed for severe cases to remove mucus § Common after surgery or in people who are immobile & taking shallow breaths. Intubation: Rare, only in cases of respiratory failure § Types of Atelectasis § Most cases are mild & managed at home Obstructive Atelectasis: Caused by a blockage (e.g., mucus, tumor) preventing air Monitor for worsening symptoms such as increased difficulty breathing, from entering the alveoli. persistent fever, or worsening fatigue. Non-Obstructive Atelectasis: Caused by low ventilation (e.g., shallow breathing, o Pneumonia pain, lung compression). § Infection that inflames the alveoli, caused by bacteria, viruses, fungi, or mycobacteria. Compressive Atelectasis: from pleural effusion (fluid in pleural space), § Can make breathing difficult & reduce oxygen exchange in the lungs. pneumothorax (air in pleural space), hemothorax (blood in pleural space), § Can be mild to life-threatening, especially in older adults & ppl with chronic illnesses. pericardial effusion, tumors, diaphragm elevation § Types of Pneumonia Community-Acquired Pneumonia (CAP): most common o From community or ≤48 after hospital admission; not HCAP o S. pneumoniae (pneumococcus) most common bacteria Health Care-Associated Pneumonia (HCAP): o In non-hospitalized pt w/ extensive healthcare exposure o High risk for MDROs o Risk factors § Hospitalized for ≥2 days in the past 90 days. § Resides in a nursing home or long-term care facility. § Recent antibiotic therapy, chemo, or wound care (w/in 30 days) § Hemodialysis treatment at a hospital or clinic. § Home infusion therapy or home wound care. § Family member with an MDR bacterial infection. § Causes Hospital-Acquired Pneumonia (HAP): Develops 48+ hours after hospital admission Post-surgery effects (pain, anesthesia). o Common in critically ill & immunocompromised pts; high mortality rate Mucus buildup blocking airways. o Risk factors: Lung compression from pleural fluid, tumors, or enlarged heart. § Severe acute or chronic illness § Comorbid conditions (diabetes, lung disease, malnutrition) Immobility, preventing deep breaths. § Aspiration, prolonged supine positioning, coma § Symptoms § Prolonged hospitalization Key signs: gradual onset w/ SOB, productive cough, tachypnea, mild-to-moderate § Ventilation support (ET tube, mechanical ventilation) Acute (lobar): respiratory distress, tachycardia, tachypnea, pleural pain, central § Use of nasogastric tubes, sedatives, or prolonged antibiotic use cyanosis (late hypoxemia); dyspnea in supine position & anxiety o Common bacteria: Severe cases: acute S+S; risk for infection distal to obstruction = signs of § Pseudomonas aeruginosa pulmonary infection § Staphylococcus aureus (including MRSA) § Diagnosis § Klebsiella pneumoniae, E. coli, Acinetobacter species CXR shows lung collapse; ~patchy infiltrates or consolidation § Enterobacter species, Haemophilus influenzae Decreased oxygen levels on pulse oximetry (96 hours after intubation): § U: understanding (pt & staff education) § Often caused by multidrug-resistant organisms (MDROs) § G: getting out of bed 3x/day o Bundled interventions (VAP prevention protocol). § H: head of bed elevation Pneumonia in the immunocompromised host 2 line: for non-responsive pts nd o Common agents include pneumocystis, fungi, and tuberculosis o Positive airway pressure therapy (CPAP/PEEP) keeps airways open. o Receiving immunosuppressive agents, history of immunosuppressive o Coughing & suctioning clears mucus & opens airways. condition o Chest physiotherapy & nebulizers loosens & removes mucus. o Subtle onset with progressive dyspnea, fever, and nonproductive cough o Bronchoscopy clears blockages if other treatments fail. § Causes of Pneumonia Thoracentesis or chest tube removes fluid if lung compression is the cause. Bacteria Severe cases may require mechanical ventilation if breathing worsens. o Streptococcus pneumoniae Chronic atelectasis due to tumors may need surgery, radiation, or airway stents. o H. influenzae (older adults, COPD, diabetes, alcoholism), Pulmonary Infections o Mycoplasma pneumonia (spread thru resp. droplets, affects bronchioles) o Acute Tracheobronchitis o Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa) § Inflammation of the trachea & bronchial tubes, often following a viral URI Viruses (Influenza, COVID19, RSV, adenovirus, herpes simplex, cytomegalovirus) § Can lead to a secondary bacterial infection, especially in people with weakened o Common in children; can cause alveolar inflammation & exudation immune systems. Fungi (Pneumocystis jiroveci in immunocompromised patients) § Causes Aspiration (inhalation of food, liquids, or stomach acid into the lungs) Infections: § Aspiration Pneumonia o Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma Foreign substances enter the lower airway, leading to lung infection and pneumoniae inflammation. o Fungal: Aspergillus (rare) Can occur in both community and hospital settings. o Viral: Often precedes bacterial infection Clinical picture: tachycardia, dyspnea, central cyanosis, hypertension, hypotension, Irritants: Exposure to smoke, chemicals, or pollutants and potential death § Symptoms Common Causes & Pathogens: Early signs: o Bacterial aspiration (most common): 8  § Anaerobes, Staphylococcus aureus, Streptococcus species, Gram- Adults (19+) with weakened immune systems (HIV, organ negative bacilli transplant, leukemia, lymphoma, chronic kidney disease, asplenia, o Non-bacterial aspiration: CSF leaks, cochlear implants). § Gastric contents (acidic fluids can damage lung tissue). o PPSV23 (Pneumococcal Polysaccharide Vaccine – protects against 23 § Exogenous chemicals or irritating gases (can trigger lung inflammation). strains): Pathophysiology: § Recommended for: o Normal airway defenses prevent foreign material from reaching the lungs. All adults ≥65 years old. o Aspiration allows bacteria or other substances to enter the lower respiratory tract. Adults (19–64 years) who smoke or have chronic heart, lung, o Inflammatory reaction in the alveoli leads to fluid (exudate) buildup, impairing liver disease, or alcoholism. oxygen-carbon dioxide exchange. Adults who previously received PCV13 should get PPSV23 (at o Mucosal edema & secretion buildup cause airway obstruction, leading to least1 year later for immunocompetent adults). decreased ventilation. o PCV13 & PPSV23 should NOT be given together. o Ventilation-perfusion (V/Q) mismatch occurs, leading to hypoxemia Smoking cessation (reduces lung inflammation & infection risk). § Types of Pneumonia Based on Distribution: Hand hygiene & infection control (prevents respiratory infections). Lobar pneumonia: Affects an entire lobe. Flu vaccination (reduces pneumonia risk from influenza complications). Bronchopneumonia: Patchy distribution starting in the bronchi, spreading to lung Proper dental care (reduces aspiration pneumonia risk). tissue (more common). Pulmonary hygiene (deep breathing, coughing, incentive spirometry for high-risk § Risk Factors patients). Weakened immune system (AIDS, chemotherapy, chronic illness). § Medical Management of Pneumonia Chronic diseases (heart failure, diabetes, COPD, alcoholism). Antibiotics for bacterial pneumonia (based on causative pathogen & severity): Post-viral infections (e.g., staphylococcal pneumonia after flu). penicillin, macrolides, fluoroquinolone Aspiration risk (e.g., dysphagia, stroke, altered consciousness). Rest & hydration Cystic fibrosis (linked to Pseudomonas & Staphylococcus infections). Oxygen therapy (if hypoxia is present). Hospitalization (increased risk of multidrug-resistant pathogens like S. aureus & Monitor & manage complications (e.g., sepsis, respiratory failure) gram-negative bacilli). Antiviral drugs: remdesivir for COVID19 Living in long-term care facilities. Pain relievers & fever reducers Recent travel or environmental exposure to specific pathogens. Nebulizers or inhalers § Clinical manifestation § Nursing Process: Diagnoses Symptoms vary based on pneumonia type, causal organism, and underlying Ineffective Airway Clearance conditions. Fatigue and Activity Intolerance Cannot diagnose pneumonia type based on symptoms alone. Risk for Fluid Volume Deficit Typical Symptoms (Bacterial Pneumonia - e.g., Streptococcus pneumoniae) Imbalanced Nutrition o Sudden onset of chills & high fever (38.5°–40.5°C / 101°–105°F). Knowledge Deficit o Pleuritic chest pain (worse with deep breathing & coughing). § Complications o Severe illness with respiratory distress: Sepsis: Infection spreads to the bloodstream o Tachypnea (25–45 breaths/min). Respiratory failure: Severe cases may require a ventilator o Shortness of breath (dyspnea) & accessory muscle use. Pleural effusion: Fluid buildup around the lungs Relative bradycardia (pulse lower than expected for fever) Lung abscess: Pus-filled pocket in the lung o May indicate viral, mycoplasma, or Legionella infection. § COVID19 & Pneumonia Atypical or Gradual Onset Symptoms Causes severe viral pneumonia o Nasal congestion, sore throat, headache, low-grade fever, myalgia, rash, Symptoms: Fever, cough, shortness of breath, loss of taste/smell pharyngitis. Treatment: Oxygen therapy, antivirals (remdesivir), steroids, supportive care o Mucopurulent sputum (may be delayed by a few days). Prevention: Vaccination, masks, hand hygiene Severe cases: Flushed cheeks, central cyanosis (lips & nails, late sign of hypoxia). o Aspiration Orthopnea: Patients prefer sitting up (orthopneic position). § When foreign material enters the lungs instead of the stomach. Fatigue, poor appetite, excessive sweating (diaphoresis). § Causes of Aspiration § Sputum Characteristics & Associations Impaired swallowing (dysphagia, stroke, neurological disorders) Purulent sputum: Common in bacterial pneumonia. Decreased consciousness (sedation, anesthesia, intoxication) Rusty, blood-tinged sputum: Seen in pneumococcal, staphylococcal, and Klebsiella GERD (acid reflux entering the lungs) pneumonia. Prolonged intubation or tracheostomy (weakens protective airway reflexes) § Pneumonia Symptoms in High-Risk Patients Vomiting (especially when lying flat) Immunocompromised patients (cancer, transplant, steroids, etc.) may have: Tube feeding complications (misplacement, delayed stomach emptying) o Fever, crackles, and lung consolidation signs: § Signs & Symptoms o Increased tactile fremitus (vibrations felt on palpation). Coughing or choking after eating or drinking o Dullness on percussion. Wheezing or shortness of breath o Bronchial breath sounds, egophony ("E" sounds like "A"). Cyanosis. tachycardia, Fever o Whispered pectoriloquy (whispered sounds clearly heard on auscultation). § Complications COPD patients: May show worsening respiratory symptoms or purulent sputum Aspiration Pneumonia: Infection in the lungs from inhaled bacteria or food as the only sign. particles Difficult to differentiate between pneumonia & COPD exacerbation. Airway Obstruction: Blockage due to solid food or thick secretions § Assessment & Diagnosis Lung Damage: Acid from the stomach can cause severe inflammation History: Recent respiratory infection, underlying diseases, exposure risk factors. Respiratory Failure: Severe cases may require a ventilator Physical Examination: Fever, tachypnea, crackles, consolidation signs (↑ § Prevention Strategies fremitus, dullness, bronchial sounds). Keep patients upright (30–45° angle) when eating or tube feeding Key Diagnostic Tests: Screen patients with difficulty swallowing (stroke, dementia) o Chest X-ray: Identifies lung infiltrates, lobar consolidation. Speech therapy to helps patients with swallowing difficulties o Blood cultures: Detect bacteremia (infection in bloodstream). Ensure feeding tubes are correctly placed o Sputum sample: Regular mouth cleaning reduces bacteria that can be aspirated § Patient instructed to rinse mouth, take deep breaths, cough deeply, Suction to clear excess saliva or secretions in at-risk patients and expectorate into a sterile container. Avoid straws because can increase the risk of aspiration § Avoids contamination with normal oral flora. Monitor stomach emptying, delayed emptying increases aspiration risk o Invasive Specimen Collection (For Severe or Atypical Cases): § Management if Aspiration Occurs § Nasotracheal/orotracheal suctioning with sputum trap. Suction the airway immediately if secretions are present § Fiberoptic bronchoscopy (for chronic, severe, or immunocompromised Administer oxygen if breathing is affected patients). Monitor for pneumonia (fever, cough, breathing difficulty) § Bronchoalveolar lavage (BAL) or protected brush specimen. Adjust feeding methods if aspiration risk remains high § Prevention Speech therapy consultation for long-term swallowing difficulties Pneumococcal vaccination significantly reduces pneumonia cases, hospitalizations, o Pulmonary Tuberculosis and mortality, especially in older adults. § Infectious disease primarily affecting the lungs, but can spread toother organs (brain, Pneumococcal Vaccines: kidneys, bones). o PCV13 (Pneumococcal Conjugate Vaccine – protects against 13 strains): § Caused by Mycobacterium tuberculosis bacillus (slow-growing bacteria). § Recommended for: § Spreads through airborne droplets (coughing, sneezing, talking). All adults ≥65 years old. A weakened immune system increases risk. § Patho 9  Inhaled bacterial travel to alveoli → multiply & spread via lymphatic system & o IV antibiotics (e.g., clindamycin, ampicillin-sulbactam, or a carbapenem) are given in high doses for at least 3 weeks. blood stream o Once improvement is seen (normal temperature, lower WBC count, & Phagocytes & TB-specific lymphocytes attack bacteria & surrounding tissue improved x-ray findings), switch to oral antibiotics for an additional 4-12 Exudate buildup in alveoli → bronchopneumonia weeks to ensure complete resolution. Infection develops 2-10 weeks after exposure Drainage Techniques: § High-risk groups include: o Postural drainage & chest physiotherapy (CPT) help clear secretions. People with HIV/AIDS; Healthcare workers; Elderly o In some cases, a percutaneous chest catheter is inserted for prolonged People in close-contact settings (prisons, shelters, nursing homes) drainage. Ppl with poor nutrition or chronic diseases o Bronchoscopy is rarely used for drainage. Those traveling from TB-prevalent countries Nutritional Support: § Signs & Symptoms (insidious) o A high-protein, high-calorie diet is necessary to combat the catabolic state Early symptoms are mild & develop slowly associated with chronic infection. Persistent cough (> 3 weeks): nonproductive or mucopurulent; hemoptysis Surgical Intervention: Chest pain or difficulty breathing o Rarely required; pulmonary resection (lobectomy) is considered if there is Low-grade fever; Night sweats; Fatigue & weakness massive hemoptysis or if medical treatment fails. Unexplained weight loss o Sarcoidosis § A multisystem inflammatory disease that primarily affects the lungs but can involve Loss of appetite other organs (skin, liver, spleen, kidneys, eyes, & nervous system). In elderly or immunocompromised individuals, symptoms may be vague (confusion, § It leads to the formation of noncaseating granulomas (clusters of immune cells) that loss of appetite, mild fever). may cause fibrosis (scarring) & organ dysfunction. § Diagnosis of TB § Most common in African Americans, affecting women slightly more than men, & Tuberculin Skin Test (Mantoux Test) typically appears between ages 20-40. o A small amount of TB protein is injected under the skin. § Pathophysiology o Read in 48–72 hours for a reaction (swelling at the site). Thought to be a hypersensitivity reaction to unknown triggers (bacteria, viruses, o Positive result = Possible TB exposure, but does not confirm active TB. chemicals). TB Blood Tests (IGRA QuantiFERON-TB Gold® Plus, TSPOT®) The immune system forms granulomas in response to these triggers. o Used for people who had the BCG vaccine or can’t return for a skin test In the lungs, granulomas can cause stiffness, reduced lung capacity, & impaired reading. oxygen exchange. CXR: Checks for TB lung damage (white spots or cavities). § Clinical Manifestations (insidious) Sputum Culture: Confirms active TB by detecting TB bacteria in mucus. Dyspnea, chronic cough, hemoptysis, chest congestion § Types of TB Infection Eye inflammation (uveitis); Joint pain & fever; Skin lesions Latent TB (Inactive, Not Contagious) Fatigue, weight loss, loss of appetite o Positive TB test but no symptoms. Granulomas may disappear on their own or lead to permanent scarring (fibrosis). o Bacteria is dormant (not active). o Requires preventive treatment to avoid future activation. § Assessment & Diagnosis Active TB (Contagious & Needs Treatment) CXR/CT scan → Looks for hilar adenopathy (swollen lymph nodes in the chest) o Symptoms develop & TB bacteria spreads to others. & lung granulomas. o Needs immediate treatment. Lung biopsy → Confirms noncaseating granulomas (the hallmark of sarcoidosis). § Treatment of TB Lasts 6–12 months with multiple antibiotics to prevent resistance. Pulmonary function tests (PFTs) → Detect lung restriction (decreased lung Firstline TB Medications: capacity). o Isoniazid (INH): Can cause liver damage; avoid alcohol. ABGs → May show hypoxemia or hypercapnia o Rifampin (RIF): Turns body fluids orange; interacts with many drugs. § Medical Management o Pyrazinamide (PZA): Can cause joint pain, liver issues. May resolve without treatment in some cases. o Ethambutol (EMB): May cause vision problems. Corticosteroids (e.g., prednisone) are the 1st line treatment to reduce After 23 weeks of treatment, patients are usually no longer contagious. inflammation. Stopping medication early can cause drug-resistant TB (MDRTB). o Usually continued for12 months & tapered gradually. § Drug-resistant TB o Used for lung, eye, skin, liver, & heart involvement. Multidrug resistant TB (MDRTB): Resistant to isoniazid & rifampin. Immune suppressants (e.g., methotrexate, azathioprine, leflunomide) may be Extensively drug-resistant TB (XDRTB): Resistant to multiple TB drugs. added if steroids don’t work or cause side effects. MDR & XDRTB require longer treatment (18+ months) with stronger medications. Regular follow-ups (every 36 months) are needed to monitor disease § Nursing Management of TB progression. Promoting airway clearance Pleural Disorders Advocating adherence to the treatment regimen o Pleurisy (Pleuritis) Promoting activity and nutrition § Inflammation of the pleurae (the two layers surrounding the lungs). Preventing transmission § Often linked to pneumonia, TB, PE, cancer, chest trauma, heart failure o Lung Abscess § Clinical Manifestations § A localized collection of pus in the lung Sharp chest pain that worsens with deep breaths, coughing, or sneezing. § Pathophysiology Pain is usually on one side & may radiate to the shoulder or abdomen. Often develops after a bacterial pneumonia or when oral secretions are Holding the breath reduces pain. aspirated. Pleural friction rub (grating sound) may be heard with a stethoscope in early The infection causes lung tissue to die, forming a cavity that fills with pus. stages. A cavity of at least2 cm in diameter on a chest x-ray confirms the diagnosis. Fever, chills, pleuritic pain, dyspnea § Risk factors: Decreased or absent breath sounds; decreased fremitus; and a dull, flat sound Impaired cough or swallowing reflexes, CNS disorders (e.g., stroke, seizures), on percussion substance abuse, esophageal disease, immunosuppression, poor dentition, & NG May have tracheal deviation away from affected side tube feedings. § Assessment & Diagnosis § Clinical Manifestations CXR. Fever & productive cough with copious, foul-smelling sputum (sometimes blood- Sputum analysis tinged). Thoracentesis (removes & tests pleural fluid) Chest pain, often dull & associated with pleurisy. Pleural biopsy (rare) Shortness of breath (dyspnea); leukocytosis § Medical Management Weakness, anorexia, & weight loss over time. Treat the underlying cause (e.g., antibiotics for infection). § Assessment & Diagnosis Pain relief: Physical Exam: dullness on percussion & reduced or absent breath sounds in the o NSAIDs (e.g., ibuprofen) help reduce pain & inflammation. affected area; ~crackles or a ~pleural friction rub can o Heat or cold therapy for additional relief. CXR: Shows an infiltrate with an air-fluid level in a cavity. o Intercostal nerve block for severe pain. CT scan & sputum culture. § Nursing Management § Prevention Encourage the patient to lie on the affected side to reduce pleural stretching & Maintain good dental & oral hygiene to reduce anaerobic bacteria in the mouth. pain. Use appropriate antibiotics when treating pneumonia to prevent complications. Teach the patient to hold a pillow against the chest while coughing for support. Careful management during dental procedures in at-risk patients. Monitor for pleural effusion § Medical Management o Pleural Effusion Antibiotic Therapy: § The accumulation of excess fluid in the pleural space (normally contains 515 mL of lubricating fluid). 10  § Usually secondary to another disease, like TB, PE, cancer, heart failure, pneumonia, or Hematogenous (Bloodborne) Injury: kidney disease. o Sepsis: Causes inflammatory capillary damage § Pathophysiology o Pancreatitis: Release of inflammatory mediators Fluid can be clear, bloody, or puslike. o Multiple blood transfusions (TRALI transfusion-related acute lung injury) § Types of Pleural Effusion: o Cardiopulmonary bypass surgery Transudative effusion → Clear fluid caused by fluid imbalance (e.g., heart failure, Injury + Elevated Hydrostatic Pressure: o Neurogenic pulmonary edema (after head trauma or seizure) liver disease). o High-altitude pulmonary edema (HAPE) Exudative effusion → Fluid with protein & inflammatory cells caused by § Pathophysiology infection, cancer, or inflammation. Capillary Damage & Increased Permeability § Clinical Manifestations o Inflammatory mediators (cytokines, histamines) →Leaky capillaries Dyspnea (worse with large effusions). o Fluid moves from blood vessels into alveoli Difficulty lying flat. Alveolar Flooding Cough (depends on the underlying cause). o Alveoli fill with protein-rich fluid, impairing gas exchange Symptoms vary based on the underlying disease: o Surfactant is diluted → Alveoli collapse (atelectasis) o Pneumonia → Fever, chills, chest pain. Severe Hypoxemia o Cancer-related effusion → Progressive shortness of breath. o Shunting: Blood bypasses ventilated alveoli → Oxygen does not improve § Assessment & Diagnosis hypoxemia Decreased/absent breath sounds over the affected lung. Dullness on percussion. o Lung compliance decreases → Stiff lungs Tracheal deviation (in severe cases). Respiratory Failure CXR & CT scan → Confirm fluid accumulation. o ARDS may develop o If untreated →Multi-Organ Failure (MOF), death Thoracentesis → Needle procedure to remove & analyze pleural fluid. § Clinical Manifestations § Medical Management Acute, rapid onset symptoms Treat the underlying cause (e.g., heart failure, pneumonia, cancer). Severe dyspnea; Tachypnea; Cyanosis; Crackles Thoracentesis Cough with frothy, blood-tinged sputum o May need repeated procedures if fluid reaccumulates. Profound hypoxemia despite O2 therapy Chest tube drainage: Use of accessory muscles o sed for continuous removal of fluid. Confusion, agitation (signs of hypoxia) Pleurodesis (for recurrent effusions): Unlike cardiogenic pulmonary edema, NCPE does NOT cause: o A chemical (e.g., talc) is instilled into the pleural space to create adhesions & o JVD, peripheral edema, S3 heart sound prevent further fluid buildup. § Diagnosis of Noncardiogenic Pulmonary Edema Other procedures: ABGs: Severe hypoxemia, respiratory alkalosis early, acidosis late o Surgical pleurectomy → Removes part of the pleura. Chest X-ray: Diffuse bilateral infiltrates (white-out pattern) o Pleural catheter (PleurX®) → Allows at-home fluid drainage. Echocardiogram: Normal left ventricular function (rules out heart failure) BNP Levels: Normal BNP rules out cardiogenic cause o Pleuroperitoneal shunt → Moves fluid from the pleura to the abdomen Pulmonary Artery Catheterization (Swan-Ganz Catheter) using a pump. PCWP < 18 mmHg (low in NCPE, high in cardiogenic edema) o Empyema § Medical Management § A collection of thick, pus-filled fluid in the pleural space, often forming walled-off NO cure: Supportive treatment is key! (loculated) pockets of infection. Oxygen Therapy (high-flow O2 or non-rebreather mask) § Commonly from bacterial pneumonia or lung abscess but can also be caused by chest o Noninvasive ventilation (BiPAP, CPAP) trauma, surgery, or bloodstream infections. o Mechanical ventilation with PEEP (if severe hypoxemia) § Pathophysiology o Prone positioning (if refractory hypoxemia) Early Stage: Pleural fluid is thin with a low white blood cell count. Fluid Management Fibro-purulent Stage: Fluid thickens, & fibrin forms pockets (loculations). o Careful IV fluid balance (prevent fluid overload) Chronic Stage: The lung becomes trapped by a thick exudative membrane, o Diuretics (Furosemide, if hypervolemic) preventing normal lung expansion. Medications § Clinical Manifestations o Corticosteroids (if inflammatory cause) Fever, night sweats, & pleuritic chest pain. o Nitric Oxide (select cases, improves oxygenation) Cough, dyspnea (shortness of breath), & weight loss. o Vasopressors/Inotropes (if hypotensive) Decreased breath sounds & dullness on percussion over the affected lung. o Antibiotics (if sepsis suspected) Symptoms may be vague in immunocompromised patients or those on antibiotics. § Nursing Management § Diagnosis Monitor respiratory status closely! Chest CT scan (best method for this) o SpO2, ABGs, breath sounds, work of breathing Thoracentesis (needle drainage) → Identifies the type of fluid (infected, thick, o Signs of worsening hypoxia (confusion, agitation, cyanosis) or puslike). Positioning § Medical Management o High Fowler’s (upright position) Goals: Drain the pleural cavity, treat the infection, & fully expand the lung. o Prone position (if ARDS develops) Treatment Options: Reduce Oxygen Demand o Thoracentesis for small, thin fluid collections. o Cluster nursing care (to avoid exhaustion) o Tube thoracostomy (chest tube) for thicker or loculated fluid collections. o Sedation (if anxious, struggling to breathe) § Thrombolytics (clot-busting drugs) may be used to break up thick fluid Strict Fluid Monitoring pockets. o Daily weights, I&O monitoring o Surgical drainage (thoracotomy or decortication) severe cases where the o Monitor for signs of fluid overload lung is trapped by thick exudate. o Pulmonary Embolism (PE) § When a blood clot (thrombus) obstructs the pulmonary artery or one of its branches, o IV Antibiotics (4-6 weeks) → Based on culture results to sterilize the impairing blood flow to the lungs. pleural space. § Originates venous circulation or right side of heart o Long-term drainage may be needed, & some patients are discharged home § A life-threatening emergency requiring immediate intervention. with a chest tube. § Related Condition: Pulmonary Vascular Disorder Deep Vein Thrombosis (DVT): Most common source of PE o Pulmonary Edema Venous Thromboembolism (VTE): Includes both DVT & PE § Abnormal fluid accumulation in lung tissue & alveoli § Pathophysiology of PE § Noncardiogenic Pulmonary Edema (NCPE) occurs due to damage to the pulmonary Thrombus formation → Typically in deep veins of the legs (DVT) capillary lining rather than heart failure (cardiogenic cause). § Severe, life-threatening condition! Clot dislodges & travels to the lungs via venous circulation Impairs gas exchange Pulmonary artery obstruction → Blocks blood flow to lung tissues Leads to severe hypoxemia V/Q mismatch → Impaired gas exchange Can progress to acute respiratory failure § Causes of Noncardiogenic Pulmonary Edema Right ventricular strain → Can lead to cor pulmonale & shock Direct Lung Injury: § Risk Factors for PE (Virchow’s Triad) o Aspiration; chest trauma; smoke inh