Timby's Introductory Medical-Surgical Nursing, 13e, Chapter 21 PDF

Timby’s Introductory Medical- Surgical Nursing, 13e Chapter 21: Caring for Clients With Lower Respiratory Disorders Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Infectious and Inflammatory D...

Timby’s Introductory Medical- Surgical Nursing, 13e Chapter 21: Caring for Clients With Lower Respiratory Disorders Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Infectious and Inflammatory Disorders #1 Acute Bronchitis  Pathophysiology and Etiology: inflammation of mucous membranes o Causes: Haemophilus influenzae, Streptococcus pneumoniae, and Mycoplasma pneumoniae; fungal infections: Aspergillus  Assessment Findings: fever, chills, malaise, headache, dry, irritating, and nonproductive cough; mucopurulent sputum  Medical Management: bed rest, antipyretics, expectorants, antitussives, increased fluids, antibiotics  Nursing Management: lung sounds, VS, cough/deep breathe Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #2 Pneumonia Pathophysiology and Etiology: inflammatory process affecting the bronchioles and alveoli o Categorizes  Radiation, chemical, and aspiration  Bronchopneumonia: lobar pneumonia  CAP and HAP  See Table 21-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #3 Pneumonia—(cont.)  Assessment Findings: fever, chills, productive cough, discomfort in chest wall, malaise, rust-colored sputum  Medical Management: antibiotic therapy, hydration, O2, bed rest, chest PT, postural drainage, bronchodilators, analgesics, antipyretics, and cough expectorants or suppressants  Nursing Management (See Box 21-2) o Respiratory assessment: LS, pulse oximetry, ABGs o Cough and sputum assessments; position: semi-Fowler’s Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #4 Pleurisy Pathophysiology and Etiology: inflammation of the parietal and visceral pleurae Assessment Findings: shallow respirations and excruciating pain, dry cough, fatigues easily, dyspnea; friction rub Medical Management: analgesics and antipyretics, NSAIDs Nursing Management: analgesics, heat/cold, splint chest; emotional support Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #5 Pleural Effusion  Pathophysiology and Etiology: abnormal collection of fluid between visceral and parietal pleurae o Causes: pneumonia, lung cancer, TB, PE, CHF  Assessment Findings: fever, pain, dyspnea, friction rub  Diagnostic Findings: chest radiography, CT, thoracentesis  Medical Management: antibiotics, analgesics, cardiotonic drugs, chest tube  Nursing Management: prep for thoracentesis and chest tube function and drainage Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #6 Lung Abscess/Empyema  Pathophysiology and Etiology: localized pus formation o Causes: aspiration, bacterial pneumonia, or mechanical obstruction  Assessment Findings: chills, fever, weight loss, chest pain, productive cough; sputum: purulent or blood streaked; finger clubbing  Medical Management: postural drainage, antibiotics o Surgical Management: thoracentesis, thoracotomy  Nursing Management: antibiotics, CPT, diet high in protein, emotional support Copyright © 2022 Wolters Kluwer · All Rights Reserved Postural Drainage Lung areas to be drained and the best postural drainage positions Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #7 Influenza  Pathophysiology and Etiology: acute respiratory disease; major strains A, B, and C; subtypes  Assessment Findings: severe headache, muscle aches, anorexia, sore throat, laryngitis, nasal discharge, dry cough See Table 21-2  Medical Management o Preventive: flu vaccination; isolation in hospital setting  Nursing Management: prevention; vaccine administration (IM, FluMist)  See Box 21-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Infectious and Inflammatory Disorders #8 Pulmonary Tuberculosis  Pathophysiology and Etiology: bacterial infectious disease; caused by Mycobacterium tuberculosis  Assessment Findings: onset insidious, fatigue, anorexia, weight loss, slight nonproductive cough o Later: night sweats, cough—productive of mucopurulent and blood-streaked sputum, weakness, wasting, hemoptysis, and dyspnea  Diagnostic Findings: Mantoux tuberculin skin test (TST), chest radiography, CT scan, MRI (See Table 21-3 and Nursing Guidelines 21-1)  Medical Management: drug therapy: isoniazid (INH) (See Drug Therapy Table 21-1), Segmental resection (See Box 21-4) Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 A 17-year-old client’s mother has recently been diagnosed with pulmonary tuberculosis. The nurse would expect the primary provider to order which of the following tests initially? A) The Mantoux test B) Chest radiograph C) A sputum culture D) Gram stain of the sputum Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 A) The Mantoux test Rationale: A Mantoux test may be read in 3 days and will reveal whether the tubercle bacillus has entered the client’s body. Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #1 Bronchiectasis Pathophysiology and Etiology: chronic infection and irreversible dilation of bronchi and bronchioles Assessment Findings: chronic cough expectoration of purulent drainage; fatigue, weight loss, anorexia, and dyspnea Medical Management: antibiotics, bronchodilators, and mucolytics; humidification Nursing Management o Postural drainage techniques; chest percussion, oral hygiene Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #2 Atelectasis  Pathophysiology and Etiology: collapse of alveoli o Causes: aspiration, mucous plug, fluid or air tumors, enlarged heart, aneurysm, prolonged bed rest  Assessment Findings: cyanosis, fever, pain, dyspnea, increased pulse and respiratory rates, increased secretions Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #3 Atelectasis—(cont.) Diagnostic Findings: chest x-ray, ABG, and pulse oximetry results Medical Management: improve ventilation, suctioning, deep breathing, coughing, bronchodilators, and humidification; oxygen Nursing Management o Deep breathing, coughing, incentive spirometer (See Client and Family Teaching 21-1) Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #4 Chronic Bronchitis Pathophysiology and Etiology: hypersecretion of mucus and recurrent or chronic respiratory tract infections o Causes: bronchial asthma, influenza or pneumonia, air pollution, smoking Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #5 Chronic Bronchitis—(cont.)  Assessment Findings: early: chronic cough productive of thick, white mucus; bronchospasm  Medical Management: prevent recurrent irritation and removal of secretions, smoking cessation, bronchodilators, increased fluids, postural drainage, steroid therapy  Nursing Management o Prevention: education, eliminate environmental irritants o MDIs, postural drainage, rest  See Client and Family Teaching 21-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #6 Emphysema Pathophysiology and Etiology: alveoli lose elasticity, trapping air that is normally expired; fibrous scarring; bullae formation (pneumothorax) Assessment Findings o Exertional dyspnea, breathlessness at rest o Chronic productive cough, pursed-lip breathing o Expiration difficult, carbon dioxide narcosis o Use of accessory muscles; barrel-chested Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #7 Emphysema—(cont.)  Diagnostic Findings: chest radiography, fluoroscopy, CT o Pulmonary function studies: decreased vital capacity and forced expiratory volume o ABGs: hypoxemia, respiratory acidosis  Medical Management: bronchodilators, aerosol therapy, O2 therapy, antibiotics, physical therapy  Nursing Management o Monitoring: O2 and PaCO2 levels, breathing exercises, nutrition (See Client and Family Teaching 21-3 and Nutrition Notes 21-1) Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #8 Asthma  Pathophysiology and Etiology: inflammation and bronchoconstriction of airway and hypersensitivity of airway (See Evidence- Based Practice 21-1) o Types: allergic/nonallergic  Triggers: allergen or irritant  Causes: infections, exercise, weather changes, emotions, medication sensitivity Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #9 Asthma—(cont.)  Diagnostic Findings: chest auscultation, pulmonary function studies  Assessment Findings: SOB, wheezing, coughing, production of thick sputum, prolonged expiration  Medical Management: avoidance of allergen; antihistamines, desensitization, pharmacologic (See Drug Therapy Table 21-2 and Nutrition Notes 21-2)  Nursing Management o Medication administration, O2, MDI, peak flow monitoring o See Client and Family Teaching 21-4 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 The nurse is instructing the client with asthma about the importance of measuring peak flow rates. Which of the following statements about the purpose of measuring peak flow rates is correct? A) They help wean the client off their bronchodilator B) They measure the client’s response to bronchodilator therapy C) They eliminate the need for blood test monitoring of thedrug level D) They determine when the client may return to work Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 B) They measure the client’s response to bronchodilator therapy Rationale: Serial measurements of peak flow rate provide objective data of the therapeutics of drug response. Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #10 Cystic Fibrosis Pathophysiology and Etiology: faulty transport of sodium and chloride, production of abnormally thick sticky mucus o Cause: inherited, defective autosomal recessive gene Assessment Findings: frequent respiratory infections, cough, purulent sputum, thick mucus, finger clubbing, hemoptysis, failure to thrive, greasy stools, salty-tasting skin Copyright © 2022 Wolters Kluwer · All Rights Reserved Obstructive Pulmonary Diseases #11 Cystic Fibrosis—(cont.) Medical Management: bronchodilator, respiratory treatments, diet management, pancreatic enzymes o Surgical Management: lung transplant Nursing Management o CPT o Postural drainage o Vigorous percussion and vibration Copyright © 2022 Wolters Kluwer · All Rights Reserved Occupational Lung Diseases Conditions (See Table 21-4) o Pneumoconiosis: inflammation of lungs: dust or gas o Silicosis: inhalation of silica o Coal dust (black lung) o Asbestosis: asbestos inhalation Treatment: prevention: dust control, ventilation, protective masks, hoods, industrial respirators Nursing Management: respiratory treatment, emotional support (See Box 21-6) Copyright © 2022 Wolters Kluwer · All Rights Reserved Pulmonary Circulatory Disorders #1 Pulmonary Hypertension  Pathophysiology and Etiology: resistance to blood flow in the pulmonary circulation causes pulmonary arterial hypertension (See Box 21-7)  Assessment Findings: dyspnea, weakness, chest pain, fatigue, JVD, orthopnea, peripheral edema  Medical Management: vasodilators, anticoagulants; management of underlying cardiac/respiratory disease  Nursing Management o Recognize S/S of respiratory distress, prevent fatigue, assist with ADLs, and administer O2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Pulmonary Circulatory Disorders #2 Pulmonary Embolism  Pathophysiology and Etiology: obstruction of pulmonary arteries or branches; blood clot o Virchow triad  Assessment Findings: immediate onset: pain, tachycardia, and dyspnea; fever; cough; blood-streaked sputum; cyanosis; irregular heart rate; wheezing  Medical Management: IV heparin, IV thrombolytic drug o Surgical Management: embolectomy  Nursing Management: prevention of DVT (See Box 21-8) Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute Respiratory Distress Syndrome  Pathophysiology and Etiology: acute lung injury (See Table 21- 5) o Causes: aspiration r/t near drowning, vomiting, drug ingestion/overdose, hematologic disorders, smoke inhalation, lung infection, trauma  Assessment Findings: increased respiratory rate; shallow, labored respirations; cyanosis; use of accessory muscles; anxiety; mental confusion  Medical Management: humidified O2, mechanical ventilation, artificial airway  Nursing Management o Assess and monitor respiratory status; O2 and ventilation Copyright © 2022 Wolters Kluwer · All Rights Reserved Respiratory Failure  Pathophysiology and Etiology: inability to exchange sufficient amounts of O2 and CO2 for the body’s needs o Causes: acute/ chronic; COPD, neuromuscular disorders  Assessment Findings; apprehension, restlessness, wheezing, cyanosis, dyspnea, hypoxemia, hypercapnia  Medical Management: maintaining patent airway; humidified O2; mechanical ventilation  Nursing Management o Obtain emergency resuscitative equipment o Assess respirations and monitor Vital signs o See Nutrition Notes 21-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Malignant Disorders Lung Cancer  Pathophysiology and Etiology: prolonged exposure to carcinogens; cigarette smoking (See Table 21-6)  Assessment Findings: cough produces mucopurulent or blood-streaked sputum, anorexia, weight loss, dyspnea, chest pain  Diagnostic Findings: chest x-ray, CT, PET scan, MRI, bronchoscopy  Medical Management: chemotherapy and radiation o Surgical Management: lobectomy  Nursing Management: emotional support/post-op Copyright © 2022 Wolters Kluwer · All Rights Reserved Trauma Fractured Ribs  Pathophysiology and Etiology: trauma, flail chest  Assessment Findings: severe pain; inspiration and expiration, respiratory acidosis  Medical Management: elastic bandage, rib belt, analgesics Penetrating Wounds  Assessment Findings: pneumothorax, hemothorax, subcutaneous emphysema, hemorrhage, lung contusion, damage to surrounding tissues, fractured ribs  Medical and Surgical Management: airway management, emergency treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Trauma #2 Blast Injuries  Pathophysiology and Etiology: Compression of the chest by an explosion can seriously damage the lungs by rupturing the alveoli.  Assessment Findings: Subcutaneous emphysema, Crepitation  Diagnosis: symptoms and physical examination, chest radiography and lung scan  Management: complete bed rest and oxygen, may require surgery and the insertion of chest tubes  Nursing care: closely observed for early signs of respiratory distress Copyright © 2022 Wolters Kluwer · All Rights Reserved Thoracic Surgery Thoracotomy Reasons: remove fluid, blood, or air; remove tumors; lung removal; repair structures; repair trauma; biopsy o Preoperative Nursing: lung assessment, history o Postoperative Nursing: chest tube management Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 The client’s left thoracotomy tube is connected to water-seal drainage and suction. The client is to be transported to the x-ray department. How will the nurse transport the client? A) Disconnect the suction and maintain the water-seal drainage system B) Ask if the x-ray department can possibly do its procedure in the client’s room C) Disconnect the chest tube from the water-seal drainage system D) Obtain a portable suction machine from central supply to transport the client Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 A) Disconnect the suction and maintain the water-seal drainage system Rationale: This is the only choice that maintains the water-seal drainage. The client can be off suction for short periods. Copyright © 2022 Wolters Kluwer · All Rights Reserved