RESTRICTIVE LUNG

DISORDERS
 LEARNING OBJECTIVES
1. Compare the various pulmonary infections with regard to
causes, clinical manifestations, nursing management,
complications, and prevention.
2. Use the nursing process as a framework for care of the
patient with pneumonia.
3. Describe risk factors and measures appropriate for
prevention and management of pulmonary embolism.
4. Describe the complications of chest trauma and their
clinical manifestations and nursing management.
 PLEURISY
 PLEURISY (Pleuritis)  Pulmonary infarction
refers to inflammation of  Pulmonary edema
both layers of the pleurae.  Cancer
 Contributing factors:  Thoracotomy
 Pulmonary infection
 Chest trauma
 TB
 PLEURISY
 Clinical Manifestations:
 Severe, sharp, knife-like  Fluid progression
pain in relation to  Pain decreases
respiratory movement
 Little fluid accumulation
 Friction rub (auscultation)
 PLEURISY
 Management:
 Manage the underlying
condition
 Instruct the patient to splint
the chest (pillows or hands)
 Position on the affected side
 PLEURAL EFFUSION
 Collection of fluid in the  Clear fluid effusions
pleural space  Transudates
 Effusion is caused by other factors
 Contributing factors:
 Filtrate of plasma moves across intact
 Heart failure
capillary walls
 Infectious disease of the lungs
 Exudates
 Kidney disease
 Effusion is caused by tumors or
 Neoplasms infections involving the pleura itself
 Extravasation or leakage of fluid into
tissues and cavity
 PLEURAL EFFUSION
 Manifestations:
 Large pleural effusions
 Dyspnea (shortness of breath)
 Decreased or absent lung sound
 Small to moderate pleural
effusions
 Minimal or no dyspnea
 Management:
 Treat the underlying cause
 High fowlers position
 Thoracentesis
 remove fluid
 obtain a specimen for analysis
 relieve dyspnea
 manage respiratory compromise
 Chest tube insertion / water-seal
drainage system
THORACENTESIS
✓Removal of excess air
and fluid from the pleural
cavity

✓Sterile technique
 THORACENTESIS
✓Depending on the
MD’s assessment

✓Chest X-ray: best

method to pinpoint
the site
 THORACENTESIS
✓Sitting on the edge of the bed
with feet supported and arms
on a padded over-bed table

✓Straddling a chair with

arms and head resting on
the back of the chair
 THORACENTESIS
If the patient cannot sit:
✓Lying on the unaffected side
with the head of the bed
elevated 30-450

✓Kozier: sitting with arms

above the head
 THORACENTESIS
✓Obtained by: MD

✓Secured by: RN

✓Given by: patient

 THORACENTESIS
✓Exhale and hold

✓Respiratory distress
✓Hypotension
 THORACENTESIS
✓Do not remove >1000
mL for the first 30 mins

✓Apply vaselinized or
petrolatum gauze
 THORACENTESIS
✓Side-lying on the unaffected
side

✓If the client expectorate blood (may

mean accidental puncture of the
lungs) NOTIFY the MD!

✓Rule-out pneumothorax: Chest X-Ray

 PULMONARY EDEMA

 Abnormal accumulation of fluid in lung tissue, the

alveolar space, or both that commonly occurs as a
result of increased microvascular pressure from
abnormal cardiac function.
 PULMONARY EDEMA

 Manifestations:
 Increasing respiratory distress
 Pink-frothy sputum – classic symptom
 Crackles (base of the lungs that progresses to the
apices)
 Hypoxemia
 PULMONARY EDEMA

 Management:
 Cardiac origin (improve left ventricular function)
 Vasodilators
 Inotropic medications
 Fluid overload
 Diuretics
PULMONARY EMBOLISM
 Obstruction of the pulmonary artery or  RV exceeds workload capacity
one of its branches by a thrombus or  RV failure, decreased CO, decreased
thrombi systemic BP, shock

 Thrombus → detached → lodges in  Risk factors:

branch of pulmonary artery →  Risk of DVT
EMBOLISM → Pulmonary Infarction  Trauma
 Pathophysiology  Surgery
 Clot obstructs pulmonary artery  HF
 Increased alveolar dead spaces  > 50 yo
 Regional blood vessels and bronchioles  Hypercoagulable states
constricts
 Prolonged immobilization
 Increased PVR
 Increase in pulmonary artery pressure
PULMONARY EMBOLISM
 S/Sx:  Mngt: filter
 Blood-tinged  Bed rest
sputum  O2
 Tachypnea  High fowler’s
 Tachycardia position
 Chest pain  Anticoagulants
 Cyanosis  Inferior vena cava
 PNEUMONIA
 Inflammation of LUNG passes underventilated lung  H. influenza
PARENCHYMA areas  E.coli
 Pathophysiology  Blood going back to the  Klebsiella
left-side of the heart is
 Inflammatory rxns of POORLY OXYGENATED  S/Sx:
alveoli  Arterial hypoxemia  RUSTY/PRUNE JUICE-
 Production of exudates – colored sputum (pathognomonic
secretions  4 types sign)
 WBCs migrates into the  Community –acquired pneumonia  Dyspnea
alveoli (CAP)
 Fever
 Health –care associated
 Partial occlusion of pneumonia (HCAP)  Pleuritic chest pain
bronchi/alveoli
 Hospital –acquired pneumonia  Crackles
 Inadequate lung ventilation (HAP)
 Decrease alveolar O2  Ventilator –associated pneumonia
tension (VAP)
 Hypoventilation  Etiology:
 Returning venous blood  Strep. Pneumoniae
 PNEUMONIA
 Dx:  Mngt:
 CXR  ANTIBIOTICS
 Blood culture and gram staining  Oxygen
 Sputum examination  Pulse oximetry
 CBC (leukocytosis)  ABG analysis
 Force fluids
 CPT
 Humidification / Nebulization
 Effective coughing technique
 Semi-fowler’s position
 PNEUMOTHORAX
 Accumulation of atmospheric air in  Open pneumothorax
pleural space which results in rise in  Sucking chest wounds
intra-throracic pressure  Mediastinal flutter
 TYPES:
 TENSION pneumothorax
 SIMPLE pneumothorax  Laceration or hole in the lungs
 Breach in the visceral or parietal  Air is trapped
pleura
 Tension is increased (positive
 Rupture of a bleb pressure)
 TRAUMATIC pneumothorax
 Air escapes from a laceration in the
lung itself or from a wound in the
chest wall
 PNEUMOTHORAX
 S/Sx:  Mngt:
 Dyspnea  Chest tube
 Dec. or Absent breath sound on  Thoracentesis
the affected side
 Dec. chest expansion
 Tracheal deviation to the
unaffected side (CXR)
 Exclusive for TENSION
pneumothorax
CHEST INJURIES
 RIB FRACTURE
 Fracture resulting from direct blunt chest trauma
 S/Sx:
 Pain at the site (increases with respiration)
 Mngt:
 Unite spontaneously
 High fowler’s position
 FLAIL CHEST
 Fracture or 3 or more ribs resulting from direct blunt chest
trauma
 S/Sx:
 PARADOXICAL BREATHING
 Mngt:
 Oxygen
 WOF respiratory distress
 High fowler’s position