MANAGEMENT OF PATIENTS

WITH CHEST AND LOWER

RESPIRATORY TRACT DISORDERS
ATELECTASIS
• Refers to the closure or collapse or airless condition of
of alveoli
• Often is described in relation to chest x-ray findings
and/or clinical signs and symptoms.
ATELECTASIS
• Acute or chronic
• Micro or macro

• Nonobstructive—reduced ventilation
• Obstructive—any blockage that obstructs passage of
air to and from the alveoli
ATELECTASIS
CAUSES
• intrabronchial obstruction
• tumors, bronchospasm
• foreign bodies
• extrabronchial compression (tumors, enlarged lymph
nodes); or
• endobronchial disease (bronchogenic carcinoma,
inflammatory structures)
ATELECTASIS
Such pressure may be produced by:
PLEURAL EFFUSION
fluid accumulating within the pleural space
PNEUMOTHORAX
air in the pleural space
HEMOTHORAX
blood in the pleural space
ATELECTASIS
Assessment findings
• dyspnea
• decreased breath sounds on affected side,
• decreased respiratory excursion
• dullness to flatness upon percussion over affected
area
ATELECTASIS
Assessment findings
• Cyanosis
• Tachycardia
• Tachypnea
• elevated temperature
• Weakness
• pain over affected area
ATELECTASIS
Diagnostic tests
a. Bronchoscopy: may or may not reveal an obstruction
b. Chest x-ray shows diminished size of affected lung
and lack of radiance over atelectatic area
c. PaO2 decreased
ATELECTASIS
Prevention
• Change patient’s position frequently to prevent
secretions from accumulation.
• Encourage early mobilization
• Encourage appropriate deep breathing and coughing to
mobilize secretions and prevent them from
accumulating.
• Teach/reinforce appropriate technique for incentive
spirometry.
ATELECTASIS
Prevention
• Administer prescribed opioids and sedatives
CAREFULLY to prevent respiratory depression.
• Perform postural drainage and chest percussion, if
indicated.
• Institute suctioning to remove tracheobronchial
secretions, if indicated.
ATELECTASIS
TREATMENT
• incentive spirometry
• chest percussion
• postural drainage
• coughing and deep-breathing exercises
ATELECTASIS
The goal in treating the patient with atelectasis is to:

improve ventilation
remove secretions
ATELECTASIS
TREATMENT
If these measures fail:
• bronchoscopy may help remove secretions.
• Humidity and bronchodilators
*Atelectasis secondary to an obstructing neoplasm may
require surgery or radiation therapy.
ATELECTASIS
MANAGEMENT
• keep the patient’s airways clear and relieve hypoxia.
• encourage the patient to cough, turn, and breathe
deeply every 1 to 2 hours as ordered.
• splinting when coughing
• walk as soon as possible
ATELECTASIS
MANAGEMENT
• adequate analgesics to control pain
• humidify inspired air and encourage adequate fluid
intake to mobilize secretions
• loosen and clear secretions with postural drainage
and chest percussion.
ACUTE TRACHEOBRONCHITIS
an acute inflammation of the mucous membranes of
the trachea and the bronchial tree
often follows infection of the upper respiratory tract.
ACUTE TRACHEOBRONCHITIS
CLINICAL MANIFESTATIONS
• dry, irritating cough and expectorates a scanty amount
of mucoid sputum.
• sternal soreness from coughing and has fever or chills
and night sweats, headache, and general malaise.
• noisy inspiration and expiration (inspiratory stridor
and expiratory wheeze)
ACUTE TRACHEOBRONCHITIS
CLINICAL MANIFESTATIONS
Severe:
purulent (pus-filled) sputum
blood-streaked secretions
ACUTE TRACHEOBRONCHITIS
Management
• Antibiotic therapy
• No to antihistamine--dryness
• Increased OFI
• Suctioning may be needed
ACUTE TRACHEOBRONCHITIS
NURSING MANAGEMENT
• Encourage bronchial hygiene—increased OFI and
directed coughing to remove secretions
• rest
PNEUMONIA
• Inflammation of the lung parenchyma caused by
various microorganisms, including bacteria,
mycobacteria, fungi and viruses.

• Inflammation of the alveolar spaces of the lung,

resulting in consolidation of lung tissue as the alveoli
fill with exudates
PNEUMONIA
PNEUMONITIS
more general term that described the inflammatory
process in the lung tissue that may predispose or place
the patient at risk for microbial infection
PNEUMONIA
CLASSIFICATIONS:
1. Community-Acquired Pneumonia (CAP)
2. Health-Care Acquired Pneumonia (HCAP)
3. Hospital-Acquired Pneumonia (HAP)
4. Ventilator-Acquired Pneumonia (VAP)
PNEUMONIA
1. Community-Acquired Pneumonia (CAP)
Pneumonia occurring in the community
PNEUMONIA
2. Health-Care Acquired Pneumonia (HCAP)
Pneumonia occurring in the non hospitalized patient
with extensive health care contact with one or more
of the following:
PNEUMONIA
Hospitalization for >2 days in an acute care facility within
90 days of infection
Residence in a nursing home or long-term care facility
Antibiotic therapy, chemotherapy, or wound care within
30 days of current infection
Hemodialysis treatment at a hospital or clinic
Home infusion therapy or home wound care
Family member with infection due to multi-drug resistant
bacteria
PNEUMONIA
3. Hospital-Acquired Pneumonia (HAP)
Pneumonia occurring >48 hours after hospital
admission that did not appear to be incubation at the
time of admission
PNEUMONIA
4. Ventilator-Acquired Pneumonia (VAP)
A type of HAP that develops >48 hours after
endotracheal tube intubation
PNEUMONIA
*Aspiration Pneumonia
Refers to the pulmonary consequences resulting from
entry of endogenous and exogenous substances into
the lower airway.
PNEUMONIA
AT RISK FOR ASPIRATION PNEUMONIA
• Geriatric clients.
• Clients with decreased level of consciousness (LOC).
• Post operative clients.
• Clients with a poor gag reflex.
• Weak clients.
• Clients receiving tube feedings.
PNEUMONIA
Bronchopneumonia
Lobar pneumonia
PNEUMONIA
CAUSES
Decreased cough
Aspiration
Antibiotic use
Smoking
Client illness: diabetes, AIDS, chronic lung disease
Near-drowning
PNEUMONIA
CAUSES
Inhaling noxious gases
Steroid therapy
Malnutrition
Alcoholism
Clients who are NPO
Clients who’ve undergone abdominal or thorax surgery
PNEUMONIA
SPUTUM RAINBOW
The colors of sputum and their corresponding bacteria
Rust Streptococcus pneumoniae
 Pink Staphylococcus aureus
 Green with odor Pseudomonas aeruginosa
PNEUMONIA
PATHOPHYSIOLOGIC FINDINGS ARE:
1. HYPERTROPHY OF MUCOUS MEMBRANE
Increased sputum production
Wheezing
Dyspnea
Rales
Ronchi
PNEUMONIA
PATHOPHYSIOLOGIC FINDINGS ARE:
2. INCREASED CAPILLARY PERMEABILITY
Increased Fluid Exudation
Consolidation-tissue that solidifies as a result of
collapsed alveoli
Hypoxemia
PNEUMONIA
PATHOPHYSIOLOGIC FINDINGS ARE:
3. INFLAMMATION OF THE PLEURA
Chest pain
Pleural effusion
Dullness
Decreased Breath sounds
Increased tactile fremitus
PNEUMONIA
DIAGNOSTIC EXAM
• Chest x-ray: patchy or lobular infiltrates.
• CBC: leukocytosis.
• Blood culture: positive for causative organism.
• ABGs: hypoxemia.
PNEUMONIA
DIAGNOSTIC EXAM
• Fungal/acid-fast bacilli cultures: identify etiologic
agent.
• Sputum culture: positive for infecting organism.
• Bronchoscopy
PNEUMONIA
MANAGEMENT
1. Facilitate adequate ventilation.

a. Administer oxygen as needed and assess its

effectiveness.
b. Place client in Fowler’s position.
c. Turn and reposition frequently clients who are
immobilized/obtunded.
PNEUMONIA
MANAGEMENT
1. Facilitate adequate ventilation.

d. Administer analgesics as ordered to relieve pain

associated with breathing
e. Auscultate breath sounds every 2—4 hours.
f. Monitor ABGs.
PNEUMONIA
MANAGEMENT
2. Facilitate removal of secretions
• general hydration
• deep breathing and coughing
• Suctioning
• Expectorants
• chest physical therapy
PNEUMONIA
MANAGEMENT
3. Observe color, characteristics of sputum and report
any changes; encourage client to perform good oral
hygiene after expectoration.
PNEUMONIA
MANAGEMENT
4. Provide adequate rest and relief/control of pain.
a. Provide bed rest with limited physical activity.
b. Limit visits and minimize conversations.
c. Plan for uninterrupted rest periods.
d. Institute nursing care in blocks to ensure periods of rest.
e. Maintain pleasant and restful environment
PNEUMONIA
MANAGEMENT
5. Administer antibiotics as ordered. Monitor effects
and possible toxicity.
6. Prevent transmission (respiratory isolation may be
required for clients with staphylococcal pneumonia).
7. Control fever and chills: monitor temperature and
administer
• antipyretics as ordered, maintain increased fluid intake,
provide frequent clothing and linen changes.
PNEUMONIA
MANAGEMENT
8. Provide client teaching and discharge planning
concerning prevention of recurrence.
a. Medication regimen/antibiotic therapy
b. Need for adequate rest,
c. Need to continue deep breathing and coughing
exercises
 PNEUMONIA
MANAGEMENT
8. Provide client teaching and discharge planning concerning
prevention of recurrence.
d. Availability of vaccines
e. Techniques that prevent transmission
f. Avoidance of persons with known respiratory infections
g. Need to report signs and symptoms of respiratory
infection
PNEUMONIA
COMPLICATIONS
Shock and respiratory failure
Pleural effusion
Empyema
ASPIRATION
• Inhalation of foreign material (oropharyngeal or
stomach contents) into the lungs.

*Aspiration pneumonia
ASPIRATION
Pulmonary Aspiration Syndromes
• Aspiration of inert materials:
• May cause asphyxia if amount aspirated is massive.
• Aspiration of toxic materials:
• Results in clinically evident pneumonia.
• Treatment is supportive
ASPIRATION
Pulmonary Aspiration Syndromes
• “Café coronary”
• Acute obstruction of upper airways by food that
occurs in intoxicated individuals.
• Heimlich maneuver may be life-saving.
ASPIRATION
Prevention
Compensating for absent reflex
Assessing tube feeding placement
Identifying delayed stomach emptying
Managing effects of prolonged intubation
ASPIRATION
Clinical practice to prevent aspiration
• Maintain head-of-bed elevation at an angle of 30-45
degrees unless contraindicated -- SF
• Use sedative as sparingly as possible
• Before initiating enteral tube feedings, assess placement
of the feeding tube.
• For patients receiving tube feedings, avoid bolus feedings
in those with high risk aspiration
PULMONARY TUBERCULOSIS
• Infectious disease that primarily affects the lung
parenchyma.
• Also may be transmitted to other parts of the body—
meninges, kidneys, bones and lymph nodes
• Mycobacterium tuberculosis
• An acid-fast aerobic rod that grows slowly and is
insensitive to heat and ultraviolet light.
PULMONARY TUBERCULOSIS
Transmission and risk factors:
• TB spreads from person to person by AIRBORNE
transmission.
• An infected person releases droplet nuclei (usually
particles 1 to 5 mcm in diameter) through talking,
coughing, sneezing, laughing or singing.
PULMONARY TUBERCULOSIS
Transmission and risk factors:
• Larger droplets settle
• Smaller droplets remain suspended in the air and are
inhaled by a susceptible person.
PULMONARY TUBERCULOSIS
Transmission and risk factors:
• Transmitted thru droplet nuclei --- 3 ft or 1 meter
away
• Transmitted airborne--- beyond 3 feet or 1 meter.
PULMONARY TUBERCULOSIS
RISK FACTORS
Close contact with someone who has active TB.
Immunocompromised status
Substance abuse
Pre-existing medical conditions or special treatment
Immigration from countries with a high prevalence of
TB
PULMONARY TUBERCULOSIS
RISK FACTORS
Institutionalization (long-term care facilities,
psychiatric institutions, prisons)
Living in overcrowded, substandard housing
Being a health care worker performing high-risk
activities
PULMONARY TUBERCULOSIS
Areas with high resistance rates:
• National Capital Region, including Laguna
• Cebu
• Davao
• Zamboanga
• Cavite
• Pampanga
Areas with low resistance rates:
• Palawan
• Mountain Province and Benguet
PULMONARY TUBERCULOSIS
Clinical manifestations
Low grade fever
Cough
Night sweats
Fatigue
Weight loss
Hemoptysis
PULMONARY TUBERCULOSIS
Diagnostic Tools
Direct Sputum Smear Microscopy
Sputum AFB
Chest X-ray
Cavitation
PPD
PULMONARY TUBERCULOSIS
Common medication given
Rifampicin
Isoniazid (INH)
Pyrazinamide
Ethambutol
Streptomycin
PULMONARY TUBERCULOSIS
• Rifampicin—red to red orange urine/secretions
• INH-increased tingling sensation/numbness-peripheral
neuritis
• Pyranizinamide- purine accumulation/ increased uric acid
• Ethambutol-eyes or ocular neuritis (visual alteration) not
given for less than 12 years old
• Streptomycin-ototoxicity

ALL CAN CAUSE HEPATOTOXICITY!

PULMONARY TUBERCULOSIS
• Rifampicin- increased fluid intake
• INH- Vit B6 (Pyridoxine)
• Pyranizinamide- increased fluid intake/allupurinol
• Ethambutol- eye examination/ refer to MD
• Streptomycin- refer to MD
ALL CAN CAUSE HEPATOTOXICITY! Check AST and ALT
Jaundice- STOP drugs!
PULMONARY TUBERCULOSIS
TREATMENT
• A private room with negative airflow ventilated
to the outside is necessary.
• Drug therapy must be continued for 6-12 months
• Client is generally considered noninfectious after
1-2 weeks of continuous drug therapy.
PULMONARY TUBERCULOSIS
TREATMENT
• Drugs taken for 6-12 months--Rifampicin, INH,
Streptomycin and Ethambutol
• Non-compliance can lead to drug-resistant PTB.
PULMONARY TUBERCULOSIS
PREVENTIVE THERAPY
• Isoniazid preventive therapy for 6 to 12 months
(prophylaxis)
• Vaccine:
• BCG administration
PULMONARY TUBERCULOSIS
NURSING MANAGEMENT
Teach the isolated patient to cough and sneeze into
tissues and to dispose of secretions properly.
Instruct the patient to wear a mask when he leaves
his room. Visitors and personnel should wear high-
efficiency particulate air respirator masks when in his
room. (N95 MASK)
rest
PULMONARY TUBERCULOSIS
NURSING MANAGEMENT
eat balanced meals. Record weight weekly.
Teach him the signs of adverse medication effects;
warn him to report them immediately.
Emphasize the importance of regular follow-up
examinations to watch for recurring tuberculosis.
LUNG ABSCESS
• Localized collection of pus caused by microbial
infection
• Generally caused by aspiration of anaerobic bacteria
LUNG ABSCESS
Clinical Manifestations
• Fever
• A productive cough with moderate to copious amount
of foul-smelling bloody sputum
• Leukocytosis
• Pleurisy
LUNG ABSCESS
Clinical Manifestations
• Pleurisy
• Dyspnea
• Weakness
• Anorexia
• Weight loss
LUNG ABSCESS
Assessment and Diagnostic Findings
• Adventitious breath sound
• Pleural friction rub
• Crackles may be present

• Chest Xray
• CT SCAN
LUNG ABSCESS
The following measures will reduce the risk of lung
abscess:
Appropriate antibiotic therapy
Adequate dental and oral hygiene
Appropriate antimicrobial therapy for patients with
pneumonia
LUNG ABSCESS
PHARMACOLOGIC THERAPY
• Intravenous antimicrobial therapy
• Long-term therapy with oral antibiotics
PLEURAL CONDITIONS
PLEURISY
• PLEURITIS
• Inflammation of both layers of the pleurae (parietal
and visceral)

When inflamed pleural membranes rub together

during respiration result in severe, sharp, knife-like
pain.
PLEURAL CONDITIONS
PLEURAL EFFUSION
Collection of fluid in the pleural space
Usually secondary to other diseases

Normal: 5-15 mL of pleural fluid

PLEURAL CONDITIONS
PLEURAL EFFUSION
Transudate– transudative
Exudate – exudative
PLEURAL CONDITIONS
Transudate
Filtrate of plasma that moves across intact capillary
walls
Occurs when factors influencing the formation and
reabsorption of pleural fluid are altered, usually by
imbalances in hydrostatic and oncotic pressure.
Implies that the pleural membranes are nor diseased.
PLEURAL CONDITIONS
Transudative pleural effusion can stem from:
heart failure
hepatic disease with ascites
peritoneal dialysis
hypoalbuminemia
disorders resulting in overexpanded intravascular
volume
PLEURAL CONDITIONS
Exudate
Extravasation of fluid into tissues or a cavity
Usually results from inflammation by bacterial
products or tumors involving the pleural surfaces
PLEURAL CONDITIONS
Exudative pleural effusion can stem from:
PTB
subphrenic abscess
esophageal rupture
pancreatitis
bacterial or fungal pneumonitis or empyema
cancer
pulmonary embolism with or without infarction
myxedema
chest trauma
PLEURAL EFFUSION
Signs and symptoms
dyspnea,
dry cough
possible pleuritic pain that worsens with coughing or
deep breathing
dullness on percussion
tachycardia, tachypnea
decreased chest motion and breath sounds
PLEURAL EFFUSION
Medical management
Discover the underlying cause
Thoracentesis
Pleurectomy- insertion of small catheter attached
to a drainage bottle for out patient management
PLEURAL EFFUSION
MANAGEMENT
Administer oxygen as ordered
Record the amount, color, and consistency of tube
drainage.
EMPYEMA
• Accumulation of thick, purulent fluid within the
pleural space, often with fibrin development and a
loculated area where the infection is located.
EMPYEMA
• Occurs in complication of bacterial pneumonia or lung
abscess
• From penetrating chest trauma, hematogenous
infection of the pleural space, non bacterial infections
and iatrogenic causes.
EMPYEMA
Medical management
• Needle aspiration
• Tube thoracostomy
• Open chest drainage
PULMONARY EDEMA
• abnormal accumulation of fluid in the lung tissue
and/or alveolar space.
• occurs when capillary fluid leaks into the alveoli.
*Since the alveoli are filled with fluid, they don’t
oxygenate the blood very well and the patient will be in
respiratory distress
PULMONARY EDEMA
1. Cardiogenic
2. Non-cardiogenic

• Non cardiogenic PE occurs due to damage of the

pulmonary capillary lining.
• May be due to direct injury to the lung,
hematogenous injury to the lungs.
ACUTE RESPIRATORY FAILURE
• Respiratory failure is a sudden and life-threatening
deterioration of the gas exchange function of the
lung and indicates failure of the lungs to provide
adequate oxygenation or ventilation for the blood.
• Occurs when the lungs no longer meet the body’s
metabolic needs
ACUTE RESPIRATORY FAILURE
Defined clinically as:
1. PaO2 of less than 60 mmHg
2. PaCO2 of greater than 50 mmHg
3. Arterial pH of less than 7.35
ACUTE RESPIRATORY FAILURE
CAUSES
• CNS depression- head trauma, sedatives
• CVS diseases- MI, CHF, pulmonary emboli
• Airway irritants- smoke, fumes
• Endocrine and metabolic disorders- myxedema,
metabolic alkalosis
• Thoracic abnormalities- chest trauma, pneumothorax
ACUTE RESPIRATORY FAILURE
CLINICAL MANIFESTATIONS
Early sign associated with impaired oxygenation:
• Restlessness, fatigue, headache, dyspnea, air hunger,
tachycardia and increased blood pressure
ACUTE RESPIRATORY FAILURE
CLINICAL MANIFESTATIONS
Late sign as hypoxemia progresses:
• Confusion, lethargy, tachypnea, central cyanosis,
diaphoresis and respiratory arrest
ACUTE RESPIRATORY FAILURE
MEDICAL MANAGEMENT
• Correct underlying cause
• ET intubation and mechanical ventilator
• Antibiotics
• Steroids
• Bronchodilators
ACUTE RESPIRATORY FAILURE
NURSING INTERVENTIONS
1. Maintain patent airway
2. Administer O2 to maintain PaO2 at more than 60 mmHg
3. Suction airways as required
4. Monitor serum electrolyte levels
5. Administer care of patient on mechanical ventilation
ACUTE RESPIRATORY DISTRESS SYNDROME
• Characterized by severe inflammatory process
causing diffuse alveolar damage that results in
sudden and progressive pulmonary edema,
increasing bilateral infiltrates on chest x-ray and
hypoxemia.
• sudden inability of the body to sufficiently oxygenate
the blood, and usually occurs in critically ill patients
ACUTE RESPIRATORY DISTRESS SYNDROME
Other names for ARDS are:
• shock lung, stiff lung, wet lung, or white lung
ACUTE RESPIRATORY DISTRESS SYNDROME
CAUSES • Near drowning.
• Anaphylaxis. • Inhalation of toxic gases.
• Aspiration. • Massive blood
• Burns. transfusions.
• Drug overdose. • Pneumonia.
• Embolus. • Sepsis.
• Heart surgery. • Shock.
• Injury to the chest.
ACUTE RESPIRATORY DISTRESS SYNDROME
SIGNS AND SYMPTOMS
• Shortness of breath • Low O2 level in blood
• Tachycardia • Retractions
• Confusion • Metabolic acidosis
• Lethargy • Respiratory acidosis
• Mottled skin or cyanosis • Multiple organ system failure
• Restlessness, apprehension • Pneumonia
• Crackles, wheezing • Cyanosis
ACUTE RESPIRATORY DISTRESS SYNDROME
TESTS
• ABG analysis
• Chest x-ray
ACUTE RESPIRATORY DISTRESS SYNDROME
Treatments:
• Monitor respiratory status.
• Assess lung sounds
• Monitor ABGs.
• Administer sedatives or neuromuscular blocking
agents to paralyze the respiratory muscles and
improve ventilation.
• Treat blood gas imbalances.
PULMONARY HYPERTENSION
• Characterized by elevated pulmonary arterial pressure
and secondary to right ventricular heart failure.
PULMONARY HYPERTENSION
Clinical manifestations
• DYSPNEA
• Substernal chest pain
PULMONARY HYPERTENSION
Assessment and Diagnostic Findings
• History
• PE
• CXR
• PFT
• ECG
• Echocardiogram
PULMONARY HEART DISEASE
• COR PULMONALE
• Condition that results from PH, which causes the right
side of the heart to enlarged because of he increased
work required to pump blood against high resistance
through the pulmonary vascular system.
• Causes right sided heart failure
PULMONARY EMBOLISM
This refers to the obstruction of the pulmonary artery
or one of its branches by a blood clot (thrombus)
that originates somewhere in the venous system or
in the right side of the heart.
Most commonly, pulmonary embolism is due to a clot
or thrombus from the deep veins of the lower legs.
PULMONARY EMBOLISM
• Thrombus dislodges from moves into the lungs, the
legs or pelvis
• Thrombus dislodges from clot forms on heart valve
and breaks loose; heart valve smaller growths break
off and form embolus
• Atrial fibrillation--Atrial quiver causing turbulent blood
flow; could cause clot that travels to lungs
PULMONARY EMBOLISM
• Central venous catheters-Clot could form on foreign
body (catheter tip) and dislodge
• Fractures-Especially in long bones, fat emboli could
travel to the lungs
• Immobility Increases risk of DVTs
• Dehydration; Blood is thick, which leads to clot
formation
• polycythemia vera
PULMONARY EMBOLISM
• Pregnancy
• Vein disorders: varicose veins
• Sickle cell disease
• Thrombophlebitis
• Birth control pills/hormone
• Smoking
• Cancer
• Amniotic fluid Ruptured
PULMONARY EMBOLISM
Signs and symptoms
• Shortness of breath/restless—first sign
• Chest pain: sharp, substernal
• Cough (hemoptysis)
• Restlessness
• Tachycardia
PULMONARY EMBOLISM
Signs and symptoms
• Low-grade fever Inflammation
• Cyanosis
• Crackles; pleural rub-heard at embolism site due to
inflammation
• Pulmonary hypertension
PULMONARY EMBOLISM
DIAGNOSTIC EXAM
• ABGs: hypoxemia.
• D-dimer test positive: increases with PE; increases if
clot is present in the body.
• Chest x-ray: small infiltrate or effusion.
• Lung perfusion scan: ventilation–perfusion mismatch.
PULMONARY EMBOLISM
Patient Teaching for prevention of Pulmonary Embolism
Active leg exercises to avoid venous stasis
Early ambulation
Use of elastic compression stockings
Avoidance of leg-crossing and sitting for prolonged
periods
Drink fluids
CHEST TRAUMA
• Blunt thoracic injuries

• form of injury to the chest including the ribs, heart

and lungs, great vessels, trachea and esophagus
BLUNT TRAUMA
• Traumatic injuries to the chest contribute to 75% of all
traumatic deaths.
• Thoracic injuries range from simple rib fractures to
complex life-threatening rupture of organs.
• The mechanisms of injuries causing chest trauma are
separated into two categories: blunt trauma and
penetrating trauma.
BLUNT INJURY
CAUSES
• Motor vehicle accident
• Pedestrian accident
• Fall
• Sports injury
• Crush injury
• Explosion
PENETRATING INJURY CAUSES:
• Knife
• Gunshot
• Stick
• Arrow
• Occupational injury
BLUNT TRAUMA
Rib Fracture:
• Most common chest injury.
• May interfere with ventilation and may lacerate
underlying lung.
BLUNT TRAUMA
Clinical manifestations
• Anterior chest pain
• Overlying tenderness
• Ecchymosis
• Crepitus
• Swelling
BLUNT TRAUMA
• To reduce pain, the patient splints the chest by
breathing in a shallow manner and avoids sighs, deep
breaths, coughing and movement
BLUNT TRAUMA
Rib Fracture:
• Give analgesics to assist in effective coughing and
deep breathing.
• Encourage deep breathing with strong inspiration;
give local support to injured area by splinting with
hands.
PNEUMOTHORAX
• occurs when the parietal or visceral pleura is breached
and the pleural space is exposed to positive
atmospheric pressure.
• Pneumothorax is when the lung collapses due to air
accumulating in the pleural space
PNEUMOTHORAX
PNEUMOTHORAX
• Types of pneumothorax include:
1. simple,
2. traumatic, and
3. tension pneumothorax
PNEUMOTHORAX
1. SIMPLE PNEUMOTHORAX
• occurs when air enters the pleural space through a
breach of either the parietal or visceral pleura.
• occurs as air enters the pleural space through the
rupture of a bleb or a bronchopleural fistula.
PNEUMOTHORAX
2. 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.
• occur with blunt trauma or penetrating chest trauma.
PNEUMOTHORAX
3. TENSION PNEUMOTHORAX
air enters the pleural space with each inspiration but
cannot escape;
causes increased intrathoracic pressure and shifting of
the mediastinal contents to the unaffected side
(mediastinal shift)
PNEUMOTHORAX
Assessment findings
1. Sudden sharp pain in the chest, dyspnea, diminished
or absent breath sounds on affected side, tracheal shift
to the opposite side (tension pneumothorax
accompanied by mediastinal shift)
2. Weak, rapid pulse; anxiety; diaphoresis
PNEUMOTHORAX
Assessment findings
3. Diagnostic tests
a. Chest x-ray reveals area and degree of
pneumothorax
b. PCO2 elevated
c. pH decreased
PNEUMOTHORAX
Nursing interventions
1. Provide nursing care for the client with an
endotracheal tube: suction secretions, vomitus, blood
from nose, mouth, throat, or via endotracheal tube;
monitor mechanical ventilation.
PNEUMOTHORAX
Nursing interventions
2. Restore/promote adequate respiratory function.
a. Assist with thoracentesis and provide appropriate
nursing care.
b. Assist with insertion of a chest tube to water- seal
drainage and provide appropriate nursing care.
c. Continuously evaluate respiratory patterns and
report any changes.
PNEUMOTHORAX
Nursing interventions
3. Provide relief/control of pain.
a. Administer narcotics/analgesics/sedatives as ordered
and monitor effects.
HEMOTHORAX
• Blood in pleural space as a result of penetrating or
blunt chest trauma.
• Accompanies a high percentage of chest injuries.
• Can result in hidden blood loss.
HEMOTHORAX
• Assist with thoracentesis to aspirate blood from pleural
space, if being done before a chest tube insertion.
• Assist with chest tube insertion and set up drainage system
for complete and continuous removal of blood and air.
• Auscultate lungs and monitor for relief of dyspnea.
• Monitor amount of blood loss in drainage.
• Replace volume with I.V. fluids or blood products.
FLAIL CHEST
• Loss of stability of chest wall as a result of multiple
rib fractures, or combined rib and sternum fractures.
• When this occurs, one portion of the chest has lost its
bony connection to the rest of the rib cage.
FLAIL CHEST
• During respiration, the detached part of the chest will
be pulled in on inspiration and blown out on
expiration (PARADOXICAL MOVEMENT)
• Normal mechanics of breathing are impaired to a
degree that seriously jeopardizes ventilation, causing
dyspnea and cyanosis.
FLAIL CHEST
FLAIL CHEST
• Stabilize the flail portion of the chest with hands;
apply a pressure dressing and turn the patient on
injured side
• Thoracic epidural analgesia may be used for some
patients to relieve pain and improve ventilation
FLAIL CHEST
Medical management
• Supportive
• Ventilatory support
• Clearing secretion from the lungs
• Controlling pain
PULMONARY CONTUSION
• Bruise of the lung parenchyma those results in
leakage of blood and edema fluid into the alveolar
and interstitial spaces of the lung.
• Defined as damage to the lung tissues resulting in
hemorrhage and localized edema.
• May not be fully developed for 24 to 72 hours.
PULMONARY CONTUSION
MEDICAL MANAGEMENT
• Immediate management is to restore and maintain
cardiopulmonary function.
• Ensure adequate airway
• Examine for shock and intrathoracic and
intraabdominal injuries is necessary
PULMONARY CONTUSION
MEDICAL MANAGEMENT
• Diagnostic workup
• Hemorrhagic shock
• Chest tube
CARDIAC TAMPONADE
• Compression of the heart as a result of accumulation
of fluid within the pericardial space.
• Caused by penetrating injuries, metastasis, and other
disorders.
CARDIAC TAMPONADE
• pericardiocentesis
end