Management of Patients with Chest and Lower Respiratory Tract Disorders

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Management of Patients with Chest and Lower Respiratory Tract Disorders, Asthma & COPD Atelectasis: • Collapse of alveoli • Acute or chronic • Can be segmental, lobar, or whole lung • Cau... ses? o Decrease in ventilation or blockage that is obstructing the airway o Obstructive → foreign body, tumor o Non-obstructive → neurological or musculoskeletal disease processes (reduced lung volume capacity) o Shallow breathing, hypoventilation, immobility after surgery (with pain → hesitant to cough and deep breath) o Increase pressure on the lung → pneumothorax or pneumonia • Assessment findings o Shortness of air, tachypnea, tachycardia, cough, sputum production, anxiety, orthopnea, low O2 sats o Severe → cyanosis, hypoxemia o When listening to lungs will hear crackles and decreased breath sounds in the involved areas ▪ Crackles in lower lobes ▪ Unequal chest expansion o Chest x-ray will look opaque in area that has atelectasis ▪ Chest x-rays done post-op • Interventions- Prevention is the KEY! Preventative Measures: • TCDB (turning, coughing, deep breathing) • Early mobilization • Incentive spirometry • CPT (chest physiotherapy) • Pain management → comfort, deep breathing, mobility • Monitor opioid use o Respiratory depression Pneumonia: • What is Pneumonia? o Excessive fluid in the lungs due to inflammation of the parenchyma which is lung tissues, caused by an infectious process o Fibrin and edema stiffen the lung, which causes decreased compliance and alveolar collapse ▪ Compliance → the ability of the lung to expand o Segmental, lobar, or diffusely scattered • Types o Bacterial o Mycobacteria (TB) o Fungus o Viral • Community-acquired pneumonia (CAP) o Develops within first 48 hrs. of admission o Do not meet criteria for HCAP o Usually caused by pneumococcus, strep, and h. flu • Health care-associated pneumonia (HCAP) o Multi-drug resistance, immunocompromised, aspiration o Pre-existing lung disease or immunocompromised • Hospital-acquired pneumonia (HAP) • Ventilator-acquired pneumonia (VAP) o Occurs > 48 hrs. after intubation o Prevention is the key Pneumococcal Pneumonia: • Approximately, 18,000 older adults die each year from pneumococcal disease in the United States. • The vaccine should be administered routinely: o Adults 65 years and older o For anyone 2 years or older with certain chronic illnesses Aspiration Pneumonia: • A foreign substance that enters into the lung • Which lung is more likely to be affected? WHY? o Right side more likely (right is straighter angle) • Who is at high risk? o Seizure activity, brain injury, decreased LOC o Flat body position, stroke, swallowing/vocal cord disorder • Prevention is the KEY! o Keep HOB elevated 30-45 degrees at all time o Decrease use of sedatives o Small amount of foods and chew slowly o Assess NG tube placement (x-ray, tube in distal stomach) o Get a swallow study for high risk patients • Signs of aspiration: o Coughing, dyspnea, tachycardia, purulent sputum, diaphoretic, wet sounding voice • Silent aspiration → will not show any of those symptoms o Fever and tachycardia (no coughing) Collaborative Care for Patients with Pneumonia: • Testing/Diagnosis: • History and Physical • High priority - Sputum and blood cultures o Obtain prior to antibiotic therapy – identify the causative organism and determine the appropriate treatment; abx will interfere with culture result • Chest X-ray • CBC • ABG • Bronchoscopy o Look into bronchi → biopsy of lung tissue, remove excess fluid Management: • Specific antibiotic therapy o Started on broad spectrum and then once results come back switch to narrow spectrum (IV then to oral – stable) o Antibiotic stewardship • Oxygenation • Nutritional support o Small, frequent meals o Nutritional supplements • Hydration - IV or PO o Fluid & electrolyte balance • PPD to rule out TB • Analgesics • Antipyretics • Rest • Other respiratory support o Suctioning o Chest PT o Bronchodilators • How to know if patient is i [Show More]

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