Management of Patients with Chest & LRT Disorders PDF

Management of Pts w/ Chest & LRT Disorders ATELECTASIS Refers to closure or collapse of alveoli Acute or chronic From microatelectasis to macroatelectasis Acute is the most common (post-op/immobilized) Excess secretions or mucous With a chronic airway obstruction (tumor) Lung Collap...

Management of Pts w/ Chest & LRT Disorders ATELECTASIS Refers to closure or collapse of alveoli Acute or chronic From microatelectasis to macroatelectasis Acute is the most common (post-op/immobilized) Excess secretions or mucous With a chronic airway obstruction (tumor) Lung Collapse Pathophysiology Atelectasis may occur in adults as a result of reduced ventilation or any blockage that obstructs passage of air Portion of the lung becomes airless and the alveoli collapse.  Such pressure can be produced by fluid accumulating within the pleural space (pleural effusion), air in the pleural space (pneumothorax), or blood in the pleural space (hemothorax) Clinical Manifestations Dyspnea, cough, and sputum production. Tachycardia, tachypnea, pleural pain, and central cyanosis (late sign of hypoxemia) Assessment and Diagnostic Findings Chest X-ray Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen (less than 90%) Prevention Frequent turning Early mobilization, Manage secretions DBE Incentive spirometry Suctioning, aerosol nebulizer treatments followed by CPT (postural drainage and chest percussion), and bronchoscopy. Management ABC frequent turning, early ambulation, deep-breathing, incentive spirometry & coughing Suctioning, CPT (chest percussion and postural drainage) Nebulizer treatments with bronchodilator Bronchoscopy (cryotherapy or laser therapy) ET tube  Thoracentesis (removal of the fluid by needle aspiration) Radiation for the tumor Clinical Manifestations Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum Sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise Shortness of breath Purulent (pus-filled) sputum Blood-streaked secretions Medical Management Antibiotic treatment on the symptoms, sputum purulence, and results of the sputum culture. Antihistamines usually are NOT PRESCRIBED, can cause excessive drying Expectorants Increase fluid intake Suctioning and bronchoscopy Pneumonia Inflammation of the lung parenchyma Caused by bacteria, mycobacteria, fungi, and viruses. Classification Community-acquired pneumonia (CAP) Hospital-acquired (nosocomial) pneumonia (HAP) Pneumonia in the immunocompromised host, Aspiration pneumonia Community-Acquired Pneumonia Occurs either in the community setting or within the first 48 hours after hospitalization or institutionalization. Hospitalization for CAP depends on the severity of the pneumonia Hospital-Acquired Pneumonia Onset of pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission. Ventilator-associated pneumonia is considered a type of nosocomial pneumonia Impaired host defenses Prevention of HAP 1. staff education 2. infection and microbiologic surveillance 3. prevention of transmission of microorganisms, 4. modifying host risk for infection. Pneumonia in the Immunocompromised Host “Pneumocystis pneumonia.” Occurs with use of corticosteroids, chemotherapy, nutritional depletion Antimicrobial agents, AIDS, genetic immune disorders, mechanical ventilation Aspiration pneumonia Refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway Most common is bacterial infection from aspiration of bacteria that normally reside in the upper airways Substances other than bacteria may be aspirated into the lung, such as gastric contents, exogenous chemical contents, or irritating gases Distribution of lung involvement in bronchial and lobar pneumonia In bronchopneumonia (left), patchy areas of consolidation occur. In lobar pneumonia (right), an entire lobe is consolidated. Assessment and Diagnostic Findings History (particularly of a recent RTI) Physical examination Chest x-ray Blood culture Sputum examination The sputum sample is obtained by having patients do the following: 1. rinse the mouth with water to minimize contamination by normal oral flora, 2. breathe deeply several times, 3. cough deeply, and 4. expectorate the raised sputum into a sterile container.  Nasotracheal or orotracheal suctioning with a sputum trap or by fiberoptic bronchoscopy to collect sputum Prevention Vaccination against pneumococcal infection is advised for the following: People 65 years of age or older Immunocompetent people People with functional or anatomic asplenia People living in environments or social settings in which the risk of disease is high Immunocompromised people at high risk for infection Nursing Diagnoses Nursing Diagnoses Ineffective airway Activity intolerance Risk for deficient fluid volume Imbalanced nutrition: less than body requirements Deficient knowledge Nursing Interventions Improving Airway Patency Promoting Rest and Conserving Energy Promoting Fluid Intake Maintaining Nutrition  Promoting Patients’ Knowledge Monitoring and Managing Potential Complications Promoting Home and Community-Based Care Aspiration Aspiration of stomach contents into the lungs Can result in tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and finally death. It can occur when the protective airway reflexes are decreased or absent Risk factors for Aspiration Seizure activity Brain injury Decreased level of consciousness from trauma, drug or alcohol, excessive sedation, or general anesthesia Nausea and vomiting in the patient with a decreased level of consciousness  ET tube; tube malposition; high residual volumes Flat body positioning Stroke Swallowing disorders Cardiac arrest Silent aspiration  When a nonfunctioning NGT allows the gastric contents to accumulate in the stomach, a condition known as silent aspiration may result. Silent aspiration often occurs unobserved and may be more common than suspected. If untreated, massive inhalation of gastric contents develops in a period of several hours. Prevention Prevention is the primary goal when caring for patients at risk for aspiration. Several preventive interventions, including positioning, dietary changes, drugs, oral hygiene, and tube feeding. Compensating for Absent Reflexes Identifying Delayed Stomach Emptying  Assessing Feeding Tube Placement Best method for determining tube placement is via x- ray. Observation of the aspirate and testing of its pH are the most reliable Managing Effects of Prolonged Intubation Severe acute respiratory syndrome (SARS) Is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus SARS develops in people who either have close contact with a person who has been diagnosed with the disease or a history of travel or residence in an area with known cases  transmitted via respiratory droplets May also be spread when a person touches a surface contaminated by the droplets and then touches his or her mucous membranes.  Fever (greater than 38), coughing, and difficulty breathing. The incubation period is usually 2 to 7 days Patients develop symptoms within 10 days Older age, Immunosuppressed Currently, no treatment except supportive care is recommended  limit transmission of SARS are a priority. Negative pressure isolation rooms, personal protective equipment, hand hygiene, environmental cleaning and disinfection techniques and source control measures to contain patients’ secretions Tuberculosis (TB) Infectious disease that primarily affects the lung parenchyma It also may be transmitted to the meninges, kidneys, bones, and lymph nodes. Associated with poverty, malnutrition, overcrowding, substandard housing, and inadequate health care Transmission and Risk Factors Spreads from person to person by airborne transmission and droplets through talking, coughing, sneezing, laughing, or singing. Risk Factors Close contact with someone who has active TB. Immunocompromised Substance abuse Any person without adequate health  Preexisting medical conditions or special treatment Immigration from countries with a high prevalence of TB (southeastern Asia, Africa, Latin America, Caribbean) Institutionalization  Living in overcrowded, substandard housing Being a health care worker performing high-risk activities Clinical Manifestations low-grade fever cough night sweats fatigue weight loss nonproductive, or mucopurulent sputum hemoptysis Assessment and Diagnostic Findings A complete history, physical examination, tuberculin skin test, chest x-ray, acid-fast bacillus smear, and sputum culture Tuberculin Skin Test Purified protein derivative (PPD), is injected Tests read after 72 hours tend to underestimate the true size of induration (hardening). A delayed localized reaction indicates that the person is sensitive to tuberculin  into the intradermal layer of the inner aspect of the The Mantoux test forearm, approximately 4 inches below the elbow for tuberculosis The test result is read 48 to 72 hours after injection.  A reaction occurs when both induration and erythema are present Erythema without induration is not considered significant. A reaction of 0 to 4 mm is considered not significant. A reaction of 5 mm or greater may be significant in people who are considered to be at risk  An induration of 10 mm or greater is usually considered significant in people who have normal or mildly impaired immunity. Vaccination with bacille Calmette-Guérin (BCG) is given to produce a greater resistance to development of TB. It is effective in up to 76% of people who receive it  More than 90% of people who are tuberculin- significant reactors do not develop clinical TB Medical Management Pulmonary TB is treated primarily with antituberculosis agents for 6 to 12 months. Prophylactic measures Household family members of patients with active disease Patients with HIV infection who have a PPD test reaction with 5 mm of induration or more  Patients with fibrotic lesions suggestive of old TB detected on a chest x-ray and a PPD reaction with 5 mm of induration or more Patients whose current PPD test results show a change from former test results.  Users of IV/injection drugs who have PPD test results with 10 mm of induration or more Patients with high-risk comorbid conditions and a PPD result with 10 mm of induration or more Prophylactic taking daily doses for 6 to 12 months Lung Abscess A lung abscess is necrosis of the pulmonary parenchyma It is generally caused by aspiration of anaerobic bacteria. Risk Factors Impaired cough reflexes swallowing difficulties CNS disorders (eg, seizure, stroke) drug addiction, alcoholism, esophageal disease immunocompromised NGT feedings Altered LOC due to anesthesia Clinical Manifestations mild productive cough to acute illness fever productive cough foul-smelling, bloody sputum. Leukocytosis  Pleurisy or dull chest pain dyspnea weakness anorexia weight loss Assessment and Diagnostic Findings pleural friction rub (grating or rubbing sound) crackles C-XRY Sputum Culture Bronchoscopy CT Scan Prevention Appropriate antibiotic therapy before any dental procedures Dental and oral hygiene Antimicrobial therapy URI Medical Management Drainage of the lung abscess Postural drainage and CPT Percutaneous chest catheter for long-term drainage Bronchoscopy Proper diet Lobectomy Nursing Management Antibiotics and IV treatments DBCT Teaching Patients Self-Care PLEURAL CONDITIONS Disorders that involve the membranes covering the lungs (visceral pleura) and the surface of the chest wall (parietal pleura) or disorders affecting the pleural space. Pleurisy (Pleuritis) Inflammation of both layers of the pleurae (parietal and visceral). May develop with URTI, trauma, PE, CA and after thoracotomy. Clinical Manifestations Pleuritic pain (taking a deep breath, coughing, or sneezing worsens the pain). It usually occurs only on one side. As pleural fluid develops, the pain decreases Assessment and Diagnostic Findings C-XRY Sputum Culture Thoracentesis Pleural biopsy Nursing Management Discover what causes the pleurisy and to relieve the pain Enhance comfort Turning frequently onto the affected side Use the hands or a pillow to splint the rib cage while coughing. Pleural Effusion Collection of fluid in the pleural space Complication of heart failure, TB, pneumonia, RTI, Nephrotic syndrome, PE, and neoplastic tumors. Most common is bronchogenic carcinoma. Clinical Manifestations Caused by the underlying disease. Severity of symptoms is determined by the size of the effusion A large pleural effusion causes dyspnea Assessment and Diagnostic Findings Physical examination Chest x-ray, Chest CT, Thoracentesis confirm the presence of fluid. Medical Management Discover the underlying cause Prevent reaccumulation of fluid Relieve discomfort, dyspnea, and respiratory compromise Thoracentesis CTT Suctioning Nursing Management Positions the patient for thoracentesis Record fluid amount and sent for appropriate laboratory testing. Monitor chest tube drainage and water-seal system Administer analgesics Patient education Empyema Accumulation of thick, purulent fluid within the pleural space Complications of bacterial pneumonia or lung abscess. At first the pleural fluid is thin, with a low leukocyte count but progresses to a fibropurulent stage to loculated empyema Clinical Manifestations Similar to those of RTI If the patient is immunocompromised, the symptoms may be vague. If the patient has received antimicrobial therapy, manifestations may be less obvious. Assessment and Diagnostic Findings Chest auscultation Chest CT Thoracentesis under ultrasound guidance. Medical Management Drain the pleural cavity and achieve complete expansion of the lung The fluid is drained, and appropriate antibiotics Sterilization of the cavity requires 4 to 6 weeks of antibiotics. Drainage of the pleural fluid Empyema – pus Hemothorax – blood Pneumothorax – air Hydrothorax – water Thoracentesis Needle aspiration with a thin percutaneous catheter, if the volume is small and the fluid is not too purulent or too thick Tube thoracostomy chest drainage using a large diameter intercostal tube attached to water-seal drainage instilled through the chest tube in patients with loculated or complicated pleural effusions Thoracotomy Open chest drainage, including rib resection, to remove the thickened pleura, pus, and debris The drainage tube is left in place until the pus-filled space is obliterated completely. Monitored by serial chest x-rays Patient should be informed that treatment may be long term. Patients are discharged from the hospital with a chest tube in place, with instructions to monitor fluid drainage at home. Nursing Management Empyema is a prolonged process. Instruct in lung-expanding breathing exercises Support in the method of drainage of the pleural fluid If discharged home with a CTT, instruct patient and family on care of the drainage, measurement and observation of drainage, s/s of infection, and how and when to contact the health care provider. Pulmonary Edema Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both. Severe, life-threatening condition. Clinical Manifestations Dyspnea, Air hunger, and central cyanosis anxious and often agitated. Foamy, frothy, and often blood-tinged secretions. Acute respiratory distress and may become confused. Assessment and Diagnostic Findings Crackles in the lung bases (especially in the posterior bases) Chest x-ray reveals increased interstitial markings. Pulse oximetry values begin to fall Hypoxemia Medical Management Vasodilators, inotropic medications Contractility medications may be administered. Intra-aortic balloon pump may be indicated if there is no response Diuretics and fluids are restricted. Oxygen Intubation and mechanical ventilation Morphine to reduce anxiety and control pain. Nursing Management Oxygen administration Intubation and mechanical ventilation Monitor patient’s responses. Acute Respiratory Failure Sudden and life-threatening deterioration of the gas exchange function of the lung Failure of the lungs to provide adequate oxygenation for the blood.  Decrease in arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) Increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg(hypercapnia), with an arterial pH of less than 7.35.  It is important to distinguish between acute and chronic respiratory failure. Chronic respiratory failure is deterioration in the gas exchange function that has persisted for a long period after an episode of acute respiratory failure. Develop a tolerance to the gradually worsening hypoxemia and hypercapnia. Clinical Manifestations Early signs (restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased BP) As the hypoxemia progresses confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis, and finally respiratory arrest. Use of accessory muscles Medical Management Correct the underlying cause and to restore adequate gas exchange Intubation and mechanical ventilation Oxygenation Nursing Management Assisting with intubation and maintaining mechanical ventilation Patients are usually managed in ICU Assists in turning schedule, mouth care, skin care, ROM of extremities Initiates some form of communication Acute Respiratory Distress Syndrome(ARDS) Severe form of acute lung injury. Characterized by a sudden and progressive pulmonary edema Increasing bilateral infiltrates on chest x-ray, Hypoxemia unresponsive to oxygen supplementation Etiologic Factors Aspiration Drug ingestion and overdose Hematologic disorders Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances Localized infection  Metabolic disorders (pancreatitis, uremia) Shock Trauma Major surgery Fat or air embolism Systemic sepsis Clinical Manifestations Acute event that typically develops over 4 to 48 hour Severe dyspnea that usually occurs 12 to 48hours Arterial hypoxemia that does not respond to oxygen is characteristic. Chest x-ray are similar to cardiogenic pulmonary edema Severe hypoxemia Assessment and Diagnostic Findings Crackles Plasma brain natriuretic peptide (BNP) level to distinguish from hemodynamic pulmonaryedema Echocardiography, and pulmonaryartery catheterization. Pulmonary artery catheterization Medical Management Identification & treatment of the underlying condition. Circulatory support, adequate fluid volume, and nutritional support Supplemental oxygen Intubation and mechanical ventilation Monitor ABG, pulse oximetry, and bedside pulmonary function testing.  PEEP is a critical part of the treatment of ARDS. PEEP improves oxygenation, but it does not influence the natural history of the syndrome.  Use of PEEP helps increase functional residual capacity and reverse alveolar collapse by keeping the alveoli open, resulting in improved arterial oxygenation Pulmonary artery pressure catheters are used to monitor the patient’s fluid status and the severe and progressive pulmonary hypertension sometimes observed in ARDS.  Pharmacologic Therapy There is no specific pharmacologic treatment for ARDS exceptsupportive care Nutritional Therapy Patients with ARDS require 35 to 45 kcal/kg/day tomeet caloric requirements. Enteral feeding is the first consideration Parenteral nutrition also may be required. Pulmonary Arterial Hypertension Exists when the mean pulmonary artery pressure exceeds 25 mm Hg with a pulmonary capillary wedge pressure of less than 15 mm Hg Unlike systemic blood pressure, these pressures cannot be measured indirectly Must be measured directly during right-sided heart catheterization. Not clinically evident until late in its progression. Two types idiopathic (or primary) pulmonary arterial hypertension pulmonary arterial hypertension due to a known cause It occurs most often in women 20-40 years of age Fatal within 5 years of diagnosis. Causes Idiopathic (Primary) Arterial Hypertension and Pulmonary Arterial Hypertension Due to a Known Cause Collagen vascular diseases Congenital systemic-to-pulmonary shunts Portal hypertension Altered immune mechanisms (HIV infection)  Diseases associated with significant venous or capillary involvement Chronic thrombotic or embolic disease Pulmonary venous hypertension Pulmonary vasoconstriction due to hypoxemia COPD  Normally, the pulmonary vascular bed can handle the blood volume delivered by the right ventricle. If the pulmonary vascular bed is destroyed or obstructed: pulmonary hypertension Increased pulmonary artery pressure Increased pulmonary vascular resistance hypoxemia or hypercapnia right ventricular hypertrophy Clinical Manifestations Dyspnea, the main symptom of pulmonary hypertension, occurs at first with exertion and eventually at rest. Substernal chest pain Weakness, fatigue, syncope, occasional hemoptysis right-sided heart failure (peripheral edema, ascites, distended neck veins, liver engorgement), crackles, heart murmur. Anorexia and abdominal pain in the RUQ Assessment and Diagnostic Findings History PE Chest x-ray Pulmonary function studies ECG Echocardiogram, Ventilation–perfusion scan  Medical Management Manage the underlying condition Anticoagulation supplemental oxygen with exercise Diuretics and oxygen should be added as needed Lung transplantation Atrial septostomy Nursing Management Identify patients at high risk for pulmonary arterial hypertension Instruct patient and family about the use of home oxygen therapy. Emotional and psychosocial Support groups  Pulmonary Heart Disease (Cor Pulmonale) Condition in which the right ventricle of the heart enlarges Type of pulmonary arterial hypertension due to a known cause. m  Any disease affecting the lungs and accompanied by hypoxemia may result in cor pulmonale. Most frequent cause is severe COPD Hypoxemia or acidosis (eg, deformities of the thoracic cage, massive obesity) Primary idiopathic pulmonary arterial hypertension, pulmonary embolus Disorders of the CNS, respiratory muscles, chest wall, and pulmonary arterial tree Clinical Manifestations Symptoms of cor pulmonale are usually related to the lung disease, such as COPD. Edema of the feet and legs, distended neck veins, Enlarged palpable liver, pleural effusion, ascites, and heart murmurs. Headache, confusion, and somnolence (hypercapnia). Shortness of breath, wheezing, cough, and fatigue. Medical Management Improve ventilation treat both the underlying lung disease and the manifestations of heart disease. 24-hour oxygen therapy in patients with severe hypoxemia reportedly leads to better survival rates Pulse oximetry and ABG DBCT  CPT In respiratory failure, ET tube and mechanical ventilation Bed rest, sodium restriction, and diuretic Digitalis may be prescribed to relieve pulmonary HPN ECG Nursing Management Intubation and mechanical ventilation Administer medications close self-monitoring (fluid retention, weight gain, edema) & 24-hour use of oxygen. It is Promoting Home and Community-Based Care Teaching Patients Self-Care Care and monitoring of patients by families at home Supplemental oxygen Nutrition counseling is warranted Sodium-restricted diet or taking diuretics. Stop smoking  Refers to the obstruction of the pulmonary artery or one of its branches by a thrombus Pulmonary Venous thromboembolism (VTE) is a term that includes both DVT and PE. Embolism Associated with trauma, surgery, pregnancy, heart failure, older than 50 years, hypercoagulable states, and prolonged immobility. Risk Factors Prolonged immobilization Prolonged periods of sitting/traveling Varicose veins Spinal cord injury Injury Tumor Increased platelet count  Thrombophlebitis Vascular disease Foreign bodies (IV/central venous catheters) Heart disease (especially heart failure) Diabetes mellitus COPD Other Predisposing Conditions Advanced age Obesity Pregnancy Oral contraceptive use History of previous thrombophlebitis, PE Constrictive clothing Clinical Manifestations Depend on the size of the thrombus Dyspnea is the most frequent symptom Chest pain is common and is usually sudden and pleuritic in origin. It may be substernal and may mimic angina pectoris or MI Anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. Assessment and Diagnostic Findings Death from PE commonly occurs within 1 hour after the onset of symptoms Early recognition and diagnosis are priorities. Chest x-ray ECG, ABG  Pulmonary angiography is considered the best method to diagnose PE (fluroscopy) Pulmonary angiogram allows for direct visualization arterial obstruction V/Q scan - minimally invasive, involving the IV administration of a contrast agent. CT Scan Prevention Prevent DVT Active leg exercises Use of anti-embolism stockings Sequential compression devices (SCDs) Medical Management PE is often a medical emergency, emergency management is of primary concern. Dissolve (lyse) the existing emboli Emergency Management Massive PE is a life-threatening emergency. Stabilize the cardiopulmonary system. Nasal oxygen is administered immediately to relieve hypoxemia, respiratory distress, and central cyanosis.  Intravenous infusion lines are inserted to establish routes for medications or fluids that will be needed. A perfusion scan, hemodynamic measurements, and ABG determinations are performed.  Hypotension is treated by a slow infusion of dobutamine The ECG is monitored continuously for dysrhythmias Digitalis glycosides, IV diuretics, and antiarrhythmic agents are Blood is drawn for serum electrolytes, CBC, and hematocrit. Intubation and mechanical ventilator.  If the patient has suffered massive embolism and is hypotensive, an indwelling urinary catheter is inserted to monitor urinary output. Small doses of IV morphine or sedatives are administered to relieve patient anxiety General Management Oxygen therapy to correct the hypoxemia Use of antiembolism stockings or intermittent pneumatic leg compression devices reduces venous stasis. Anticoagulation Therapy Anticoagulant therapy (heparin, warfarin sodium [Coumadin]) Heparin is generally recommended Because the half-life of heparin is dose dependent, it is difficult and time-consuming to adjust and maintain the IV drip infusion at a therapeutic level; frequent laboratory testing is necessary.  With long-term heparin use, there is also the risk of antibody formation and bleeding. Therapy may be changed to an oral regimen, such as warfarin, as soon as the patient is able to take oral medications All patients must continue to take anticoagulation for at least 3 to 6 months after the embolic event. Thrombolytic Therapy Used in treating PE, particularly in patients who are severely compromised Resolves the thrombi or emboli quickly Bleeding is a significant side effect Contraindications to CVA within the past 2 months Active bleeding, surgery within 10 days of the thrombotic event, recent labor and delivery, trauma, or severe hypertension A surgical embolectomy involves removal of the actual clot on cardiopulmonary bypass. very risky Transvenous catheter embolectomy -is a technique in which a vacuum-cupped catheter is introduced transvenously -Suction is applied to the end of the embolus, and the embolus is aspirated into the cup. -Catheters are available that pulverize the clot with high-velocity jets of normal saline solution. Greenfield filter Inserted through the internal jugular vein or common femoral vein The perforated umbrella permits the passage of blood but prevents the passage of large thrombi. Nursing Management Encourages ambulation and leg exercises Do not to sit or lie in bed for prolonged periods Do not wear constrictive clothing. Legs should not be dangled Feet should rest on the floor or on a chair. IV catheters should not be left in place for prolonged periods. Sarcoidosis Multisystem, granulomatous disease of unknown etiology. May involve almost any organ or tissue but most commonly involves the lungs, lymph nodes, liver, spleen, CNS, skin, eyes, fingers, and parotid glands. More common in women (young and middle-aged adults). Hypersensitivity response to one or more exogenous agents (bacteria, fungi, virus, chemicals) Clinical Manifestations The lung is most commonly involved -dyspnea, cough, hemoptysis, and congestion. Generalized symptoms include anorexia, fatigue, and weight loss. Other signs include uveitis, joint pain, fever, and granulomatous lesions of the skin, liver, spleen, kidney, and CNS. Assessment and Diagnostic Findings Chest x-rays and CT Mediastinoscopy or transbronchial biopsy Open lung biopsy Hypoxemia and hypercapnia Medical Management Many patients undergo remission without specific treatment. Corticosteroids for anti-inflammatory effects Multiple tests are used to monitor involved systems. OCCUPATIONAL LUNG DISEASES: PNEUMOCONIOSES Refers to a nonneoplastic alteration of the lung resulting from inhalation of mineral or inorganic dust Caused by inhalation and deposition of mineral dusts in the lungs Asymptomatic, but advanced disease often is accompanied by disability and premature death. Not treatable once they develop, but they are preventable (face masks, hoods, industrial respirators)  Exposure to an agent known to cause an occupational disorder Length of time from exposure of agent to onset of symptoms Lack of other more likely explanations of the signs and symptoms Supportive therapy is aimed at preventing infections and managing complications. END