Lower Respiratory Tract disorder

Pneumothorax
 Is the presence of atmospheric air in the pleural space,
causing atelectasis.
 It can occur when external puncture wounds allow air to
enter the chest
Signs and symptoms:
 Absent or decreased breath sounds
 Shift of apical pulse (mediastinal shift) away from the site
of the pneumothorax
 Chest xray- darkened area of the air-filled pleural space
management
 Need oxygen
 Thoracotomy catheter or needle may be placed through the
chest wall into the pleural space to remove accumulated air
 If air in the pleural space is from a puncture wound such as stab
wound, cover the chest wound immediately with an impressive
materials such as petrolatum gauze to prevent further air from
entering and to decrease the risk of atelectasis
The extent of symptoms and the outcome will depend on the cause
of entry of air into the pleural space and its removal.
 Bronchopulmonary dysplasia
 Is a chronic lung condition that can occur in infants
 Frequently found in preterm infants who received mechanical
ventilation for respiratory distress syndrome at birth is thought
to occur from a combination of surfactant deficiency,
barotrauma, oxygen toxicity and inflammation.
 Infants may develop tachypnea, retractions, nasal flaring,
tachycardia, and oxygen dependence.
 Auscultation (decreased air movement)
 Chest xray- overinflation, inflammation, and atelectasis
(fibrotic scarring)
 The clinical course ranges form a mild need for increased
oxygen, which gradually resolves over a few months, to severe
disease requiring chronic tracheotomy and mechanical
ventilation during the first few years of life
 Administration of a corticosteroids to reduce inflammation and
a bronchodilator by nebulizer can improve respiratory
function. Infants need to be monitored carefully for nutrition
and fluid intake, especially if they are ventilator-dependent.
Cystic fibrosis
 Is an inherited disease of the secretory glands. The
disease is characterized by a thick mucus secretions,
particularly in the pancreas and the lungs, as well as
electrolyte abnormalities in sweat gland secretions.
 Abnormality of the long arm of chromosome 7 results in
the inability to transport small molecules across cell
membranes, leading to dehydration of epithelial cells in
the airway and pancreas.
 CF is inherited from an autosomal recessive trait.
 1 in 2500 live births and is most found in White children
 Chorionic villi sampling or amniocentesis can be
performed during pregnancy for early detection.
 Affected males may be unable to reproduce secondary to
persistent plugging and blocking of the vas deferens by
tenacious seminal fluid. Affected females may have thick
cervical secretions that limit sperm motility. Alternative
insemination and vitro fertilization are options for
patients who desire to become pregnant.
 Absence of pancreatic enzymes in the duodenum results in
an inability to digest fat, protein and some sugars
Signs and symptoms
 Bowel movements become large, bulky and greasy
(steatorrhea)
 Increased bulk of feces often leads to a
protuberant abdomen.
 Malnutrition
 Fat soluble vitamin A,D,E cannot be absorbed in
the absence of fat absorption resulting in vitamin
deficiency.
 AP diameter of the chest becomes enlarged
 Thickened mucus in the bronchioles
 Clubbed fingers (inadequate peripheral tissue
perfusion)
 Respiratory infections develop around 4-6 months
of age and wheezing and rhonchi are often heard
on chest auscultation.
 The level of chloride to sodium in perspiration is
increased 2-5 times above normal resulting in
“salty” perspiration
Sweat testing
 Detects abnormal salt concentration
 Normal sodium chloride in sweat is 20mEq/L;
more than 60mEq/L of sodium chloride is
diagnostic of CF
Duodenal analysis
 Detect pancreatic enzymes and reveal the extent of pancreatic
involvement.
 This is done by passing a NGT into the duodenum, secretions
are then aspirated for analysis. The tube placement can be
determined by pH levels. Secretions from the duodenum are
sent to the laboratory for analysis of trypsin content, the
easiest pancreatic enzymes to assay.
Stool analysis
 Stool may be collected and analyzed for fat content and lack
of trypsin of the stool
Pulmonary testing
 Chest xray generally confirms the extent of pulmonary
involvement. Pulmonary function may be tested to determine
the extent of atelectasis and emphysema