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Chapter 23 - Management of Patients With Chest and Lower Respiratory Tract Disorders
Chapter 23 - Management of Patients With Chest and Lower Respiratory Tract Disorders
Chapter 23 - Management of Patients With Chest and Lower Respiratory Tract Disorders
Disorders
Prep-U
A shallow, monotonous respiratory pattern coupled with immobility
places the patient
at an increased risk of developing atelectasis. These specific factors are less
likely to
result in pulmonary embolism or aspiration. ARDS involves an exaggerated
inflammatory response and does not normally result from factors such as
immobility
and shallow breathing.
The nurse should encourage hydration because adequate hydration thins
and loosens
pulmonary secretions. Oral suctioning is not sufficiently deep to remove
tracheobronchial secretions. The patient should have the head of the bed
raised, and rest
should be promoted to avoid exacerbation of symptoms.
The purified protein derivative (PPD) is always injected into the
intradermal layer of
the inner aspect of the forearm. The subcutaneous and intramuscular routes
are not
utilized.
The key characteristic of pleuritic pain is its relationship to respiratory
movement.
Taking a deep breath, coughing, or sneezing worsens the pain. The patient's
ABGs
would most likely be abnormal and shortness of breath would be expected.
In addition to irritating the mucous cells of the bronchi and inhibiting the
function of
alveolar macrophage (scavenger) cells, smoking damages the ciliary
cleansing
mechanism of the respiratory tract. Smoking also increases the amount of
mucus
production and distends the alveoli in the lungs. It reduces the oxygencarrying capacity
of hemoglobin, but not by directly competing for binding sites.
A patient who has ARDS usually requires intubation and mechanical
ventilation.
Oxygen by nasal cannula would likely be insufficient. Deep suctioning and
nebulizers
may be indicated, but the priority is to secure the airway.
Early signs of acute respiratory failure are those associated with impaired
oxygenation
and may include restlessness, fatigue, headache, dyspnea, air hunger,
tachycardia, and
increased blood pressure. As the hypoxemia progresses, more obvious signs
may be
present, including confusion, lethargy, tachycardia, tachypnea, central
The nurse should use strict hand hygiene to help minimize the client's
exposure to infection, which could lead to pneumonia. The head of the
bed should be kept at a minimum of 30 degrees. The client should be
turned and repositioned at least every 2 hours to help promote secretion
drainage. Oral hygiene should be performed every 4 hours to help
decrease the number of organisms in the client's mouth that could lead
to pneumonia.
For a patient with a lung abscess the nurse encourages a diet that is high
in protein and calories to ensure proper nutritional intake. A
carbohydrate-dense diet or diets with limited fats are not advisable for a
patient with a lung abscess.
The client has developed a pneumothorax, and the best action is to
prevent further deflation of the affected lung by placing an airtight
dressing over the wound. A vented dressing would be used in a tension
pneumothorax, but because air is heard moving in and out, a tension
pneumothorax is not indicated. Applying direct pressure is required if
active bleeding is noted.
The client demonstrates understanding of how to prevent relapse when
A tension pneumothorax causes the lung to collapse and the heart, the
great vessels, and the trachea to shift toward the unaffected side of the
chest (mediastinal shift). A traumatic pneumothorax occurs when air
escapes from a laceration in the lung itself and enters the pleural space
or enters the pleural space through a wound in the chest wall. A simple
pneumothorax most commonly occurs as air enters the pleural space
through the rupture of a bleb or a bronchopleural fistula. Cardiac
tamponade is compression of the heart resulting from fluid or blood
within the pericardial sac.
Chemical irritation from noxious fumes, gases, and air contaminants can
induce acute tracheobronchitis. Aspiration related to near drowning or
vomiting, drug ingestion or overdose, and direct damage to the lungs are
factors associated with the development of acute respiratory distress
syndrome.
Because lung cancer produces few early symptoms, its mortality rate is
high. Lung cancer has increased in incidence due to increase in number
of women smokers, growing aging population, and exposure to pollutants
but not indicative of mortality rates.
Ineffective airway clearance is the priority nursing diagnosis for this
client. Pneumonia involves excess secretions in the respiratory tract and
inhibits air flow to the capillary bed. A client with pneumonia may not
have an Ineffective breathing pattern, such as tachypnea, bradypnea, or
Cheyne-Stokes respirations. Risk for falls and Impaired tissue integrity
aren't priority diagnoses for this client.