Lower Respiratory Study Sheet

7/29/2019 Lower Respiratory Study Sheet

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N143 UNIT I LOWER RESPIRATORY

LOWER RESPIRATORY TRACT INFECTIONS

ACUTE BRONCHITIS: Inflammation of the bronchi that usually occurs with a viral upper respiratory

infection or in conjunction with chronic obstructive pulmonary disease (COPD).

Cough most common symptom may last 10-20 days

Self-limiting condition; treatment is supportive:

o Rest, fluids, anti-inflammatory agents

o Cough suppressant; If cough severe/persistent,

o Bronchodilators PRN; Wheezing

o Broad spectrum Abx; COPD

o Intivirals; Influenza

PERTUSSIS

Highly contagious infection of the lower respiratory tract spread by droplets: Gram-negative bacillus,Bordella pertussis Immunization available, rates rising due to waning immunity.

Pertussis cough has a whooping sound. More frequent at night and may last 6-10 weeks

Thick tenacious secretions

Treatment consists of antibiotics and supportive care:

o Rest, fluids, anti-inflammatory agentso Cough suppressant

o Bronchodilators PRN; Wheezing

o Broad spectrum Abx; COPD

PNEUMONIA: Acute inflammation of the lung parenchyma (essential functional elements of organ) including

interstitial spaces, alveoli, and bronchioles.

Classified according to the causative microorganism, such as bacteria, viruses,Mycoplasma, fungi,

parasites, and chemicals.

Organisms can reach the lung by three methods: aspiration, inhalation, and homogenous spread from aninfection elsewhere in the body.

A clinically effective way to classify pneumonia because causative agents can be predicted and empirictreatment (observation and experience) can be implemented:

o Community-acquired pneumonia CAP: is a lower respiratory tract infection of the lung

parenchyma with onset in the community or during the first 2 days of hospitalization.

Mycoplasma pneumoniae, S. aureus

o Hospital-acquired pneumonia HAP: is pneumonia occurring 48 hours or longer after hospital

admission and not incubating at the time of hospitalization.

E.coli, Pseudomonas aeruginosa, Streptococcus pneumoniae

Aspiration pneumoniarefers to the sequelae (morbid condition as a result of another condition)occurring

from abnormal entry of secretions or substances into the lower airway.

o

CVA-dysphagia Opportunistic pneumonia occurs in certain patients with altered immune responses who are highly

susceptible to respiratory infections. Additional risk of fungal pneumonia, Pneumoncystis jiroveci, andcytomegalovirus (CMV)

o HIV, radiation, chemotherapy, corticosteroids

o Onset slow and subtle: Fever, tachycardia, tachypnea, dyspnea, nonproductive cough and

hypoxemia.

o IV/oral Bactrim, Septra

Fungal pneumonia, Pneumoncystis jiroveci, and cytomegalovirus (CMV)1


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o Antivirals

Four characteristic stages of pneumonia:

o Congestion: Inflammatory response to bacterial endotoxins results in serous fluid in alveoli;

organisms multiply and spread to adjacent alveoli. This edema stiffens lungs, decreases

compliance and vital capacity. This causes hypoxemia due to gas exchange effected.

o Red hepatization: Dilation of capillaries; alveoli fill with organisms, leukocytes, RBCs, and

fibrin giving lungs red granular appearance.

o Gray hepatization: Blood flow decreases, leukocytes and fibrin consolidate.

o Resolution: Resolution and healing; exudate lysed and processed by macrophages. Gas exchange

returns to normal.

Complications frequent chronic conditions:

o Pleural effusion: Transudate in pleura may require aspiration via thoracentisis.

o Abscess: PNA caused by S. aureus and gram-negative organisms.

o Pericarditis: Spread of infecting organism to pericardium.

Pneumonia Severity Index-PSI; Helps determine treatment category and further treatment will be

tailored to most likely infecting organism. Therapy will then be further modified according to:

o C+S results

o Clinical response: Fever, sputum purulence, leukocytosis, oxygenation, CXR.Patents who continue to deteriorate will be assessed for other infectious etiologies, complications,coexisting infections, drug-resistance organisms.

Nursing role: Identifying the patient at risk and taking measures to prevent the development of

pneumonia.

o Essential components of nursing care monitoring:

Physical assessment parameters

Facilitating laboratory and diagnostic tests

Providing treatment

Monitoring the patients response to treatment.

o Clinical Manifestations:

Sudden onset: Fever, shaking, chills, SOB, cough productive of purulent sputum,

pleuritic chest pain

Physical exam: Pulmonary consolidation, bronchial breath sounds, crackles, rhonci andwheezes, dullness to percussion, increased fremitus, accessory muscles for breathing

Elderly/debilitated: Confusion/stupor

o Diagnostics:

H&P, Physical exam, CXR, C+S BEFORE Abx!!!!!!

o Collaborative Care:

Prevent with Pneumococcal vaccine, every 5 yrs for at risk populations

Chronic CV, Pulmonary, or DM

>65 SNF

Prompt treatment with appropriate Abx

IV hydration

Pain management!!!!

o Nursing Assessment:

Lung sound, location of alteration for baseline

Multisystem, co-morbidities

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VS, fatigue, MS

ADL

NDx: Impaired gas exchange, Ineffective breathing pattern, Acute pain

o Nursing Interventions:

02 , monitor respirations, cyanosis, cold/clammy skin

Nutrition/hydration to 3/L day

Activity to improve diaphragm movement and chest expansion, mobilize secretions,prevent venous stasis, and improve immune function.

HOB 30*-Prevent Aspiration, Fowlers

Asepsis: Hands, suction, nebulizer

Good lung down: gravity assist drainage of congestion

I/S, TCDB

Bronchial Hygiene: >30ml sputum

Chest physiotherapy

Postural drainage

Percussion

Drainage

Vibration

o Nursing Evaluation:

VS improvement, Lungs clear auscultation/cxr, T100, RR24, HR100, Sp02 90%

Medications:

o Macrolides: erythomcin, Zithromax (shorter cycle of compliance 5 days) , Biaxin

Highly effective

o Respiratory fluorqinolones: Tequin, Levaquin

o Amoxicillin

Oral, IVo Piperacillin/tazobactam (Zoysyn)

Combination drug, very common, want to save for acucte cases and not over use it

TUBERCULOSIS

Tuberculosis (TB) is gram-positive, acid-fast bacillusMycobacterium tuberculosis thatis spread viaairborne droplets. Transmission factors:

o Number of organisms expelled

o Concentration of organisms (small spaces)

o Length of time of exposure

o Immune status of exposed purpose

Resurgence of TB in those with human immunodeficiency virus (HIV) infection and an emergence of

multidrug resistant strains ofM. tuberculosis due to poor compliance

Clinical Manifestations:

o LTBI: Positive skin test; asymptomatic

o Active TB:

Fatigue, malaise, anorexia, weight loss, low grade fever, night sweats

Cough-mucoid-mucopurulent productive, pleuritic pain

Late stage: Hemoptysis

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TB can present with a number of complications:

o Miliary TB: Spread of the disease with involvement of many organs simultaneously

o Pleural effusion: Can result from active or latent TB, protein rich exudate

o Empyema: Large concentration of organism in pleural space

o PNA: Large numbers of bacilli discharge into lungs or lymph nodes

o Organs: Various organs such as CNS/meninges, bone, kidney, joints, adrenal glands, lymph

nodes, genital tract.

Diagnostics:

o Skin test: Purified protein derivative (PPD) Tuberculin skin test (TST); 0.1 ml ID injection.

Induration + for exposure and development of antibodies. Best way to screen!!

o CXR: Infiltrates, cavitary infiltrates, lymph node involvement

o Culture: Acid fast smear X3.

o QuantiFERON-TB test: Blood responds to antigens RAPID!!! Few hours!!!

Medication:

o Active TB: Four drugs are used for a 6-month regimen for maximum effectiveness!!

INH- Isoniazid, rifampin, pyrazinamide, ethambutol

After 2-3 weeks of treatment risk of transmission is reduced

LTBI: To prevent disease in a TB-infected person with latent TB infection (LTBI), isoniazid (INH) isused alone.

Isoniazid for 6-9mo

Rifampin for 4mo; resistant to Isoniazid

Rifampin/pyrainamide- combination drug- severe live injuries and deaths

Nursing Assessment:

o Cough; productive, night sweats, pm T , weight loss, pleuritic chest pain, crackles over lung

apices

Nursing Dx: Ineffective breathing pattern-capacity, Imbalanced nutrition, Noncompliance, Activity

intolerance

Nursing Planning:o Comply with regimen

o No recurrence

o Normal pulmonary function

o Prevent spread

Nursing Implementation:

o Health promotion:

Screening

F/U screen

Public Health Department

o Intervention:

Airborne Isolation-3 negative smears needed to be clinically cleared!!!

Negative pressure room

HEPA N95 mask, fit teste

Medical workup: CXR, smear, culture,

Drug therapy

Teach respiratory etiquette

Screen close contacts/family members

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o Home Care

Teach compliance!!!

PH Notification!

Directly Observed Therapy DOT:

Important for compliance issues!!!

Relapse teaching:

Recognize symptoms Seek medical attention

Reactivation factors:

o Immunosupressive, malignancy, prolonged illness

F/U CXR, smear in 12 months

Nursing Evaluation:

o Resolution

o Normal pulmonary function

o Absence of complications

o No transmission of TB

ATYPICAL MYCOBACTERIA

Atypical mycobacteria cause disease that resembles TB, both in manifestations and treatment.

Disease typically occurs in those who are immunosuppressed or have chronic pulmonary disease.

PULMONARY FUNGAL INFECTIONS

Infections are found frequently in seriously ill patients being treated with corticosteroids; antineoplastic,immunosuppressive drugs; or multiple antibiotics. They are also found in patients with acquired

immunodeficiency syndrome (AIDS) and cystic fibrosis.

Skin tests, serology and biopsy help identify the infecting organism.

Since these infections are not transmitted from person to person, the patient does not have to be placed

in isolation. Antifungal medications are the mainstay of treatment.

NURSING AND COLLABORATIVE MANAGEMENT: LUNG ABSCESS

A lung abscess is a pus-containing lesion of the lung.

The causes and pathogenesis of lung abscess are similar to those of pneumonia.

o Mainly aspiration of bacteria, malignancy, TB, fungal, parasitic.

The onset of a lung abscess is usually insidious, especially if anaerobic organisms are the primary cause.A more acute onset occurs with aerobic organisms.

o Manifestations:

Cough producing purulent sputum; dark brown foul smelling/tasting

Hemoptysis; common

Fever, chills, prostration, pleurtic pain, dyspnea, weight loss Physical exam:

Lungs: Dull to percussion over affected area

Decreased breath sounds

Bronchial sounds transmitted to periphery; Bronchus patent with drainage

Crackles as abscess drains

o Complications:

Chronic abscess, bronchopleural fistula, bronchiectasis, empyema, brain abscess.

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Antibiotics given for a prolonged period (up to 2-4 months) are usually the primary method of treatment.

Diagnostics: CXR, CT, Cultures: Sputum, blood, pleural fluid.

Nursing Implementation:

o Teach importance of compliance

o Teach SE to report

o Importance of F/U C+S

Teach Bronchial Hygiene:

Postural drainage

Percussion

Drainage

Vibration

o Rest, nutrition, fluids, dental hygiene

ENVIRONMENTAL LUNG DISEASES

Environmental or occupational lung diseases are caused or aggravated by workplace or environmentalexposure and are preventable.

Pneumoconiosis is a general term for a group of lung diseases caused by inhalation and retention of dust

particles.

The best approach to management of environmental lung diseases is to try to prevent or decreaseenvironmental and occupational risks.

LUNG CANCER

Cigarette smoking is the most important risk factor in the development of lung cancer. Smoking is

responsible for approximately 80% to 90% of all lung cancers.

Primary lung cancers are often categorized into two broad subtypes: nonsmall cell lung cancer (80%)and small cell lung cancer (20%).

CT scanning is the single most effective noninvasive technique for evaluating lung cancer. Biopsy is

necessary for a definitive diagnosis.

Staging of nonsmall cell lung cancer is performed according to the TNM staging system. Staging of

small cell lung cancer by TNM has not been useful because the cancer is very aggressive and always

considered systemic.

o Tumor: Size, location, degree of invasion

o N: Node involvement

o M: Metastases

Treatment options are dependent upon the stage of disease.

o Surgical resection is the treatment of choice in nonsmall cell lung cancer stages I and II,

because the disease is potentially curable with resection.

o Radiation therapy may be used as adjuvant therapy after resection or with the intent to cure if the

patient is unable to tolerate surgical resection caused by co-morbidities.

Stereotactic: Beams concentrated from different directionso Chemotherapy and targeted therapy may be used in the treatment of nonresectable tumors or as

adjuvant therapy to surgery in nonsmall cell lung cancer.

o Prophylactic cranial radiation: Prevent cerebral metastases

o Bronchioscopic laser therapy: Laser accessible bronchial lesions that may be causing obstruction

o Photodynamic: Photofrin injected into tumor; 48 hrs later laser light destroys tumor cells.

o Stenting: Relief of dyspnea, cough or respiratory insufficiency, supports airway against collapse

or outside compression keeping lumen open

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o Cryotherapy: Freezing polyoid lesions

The overall goals of nursing management of a patient with lung cancer will include effective breathing

patterns, adequate airway clearance, adequate oxygenation of tissues, minimal to no pain, and a

realistic attitude toward treatment and prognosis.

OTHER TYPES OF LUNG TUMORS

Secondary lung tumors are rare, accounting for only 5% of lung masses. They include chondromas,

hamartomas, leiomyomas, and mesotheliomas.

The lungs are a common site for secondary metastases for a number of cancers.

CHEST TRAUMA AND THORACIC INJURIES

PNEUMOTHORAX

Pneumothorax is air in the pleural space resulting in a rise in intrthoracic pressure and reduced vitalcapacity. Loss of negative pressure results in partial or complete collapse of the lung, There are several

types:

o Closed pneumothoraxhas no associated external wound. The most common form is a

spontaneous pneumothorax, which is accumulation of air in the pleural space without anapparent antecedent event possibly due to rupture of a pulmonary bleb.

o Open pneumothoraxoccurs when an opening in the chest wall allows positive atmospheric air to

enter the pleural space. Examples include stab or gunshot wounds and surgical thoracotomy.

o A tension pneumothorax may be open or closed; thereis a rapid accumulation of air in the

pleural space causing severely high intrapleural pressures with resultant tension on the heart and

great vessels.

o Hemothorax is an accumulation of blood in the intrapleural space. Chylothorax is lymphatic fluid

in the pleural space caused by a leak in the thoracic duct. Causes of both include trauma, surgical

procedures, and malignancy.

o Spontaneous pneumothorax:

Clinical Manifestatons:

o Absent breath sounds on effected side

o Decreased expansion unilaterallyo Dypsnea, cyanosis, tachypnea

o Hypotension

o Tachycardia, sharp chest pain

o Sucking sound, open wound

o Tracheal deviation to unaffected side in tension pneumothorax

o Crepitus on palpation SQ emphysema

Nursing Interventions:

o Occlusive dressing over wound

o 02

o Fowlers

o Prep for Chest tube

o Monitor chest tube drainage system

o Monitor for crepitus, SQ emphysema

Treatment depends on the severity of the pneumothorax and the nature of the underlying disease.

FRACTURED RIBS

Rib fractures are the most common type of chest injury resulting from blunt trauma.

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Clinical manifestations include pain at the site, especially with inspiration and coughing.

The main treatment goal is to decrease pain to promote effective breathing. Patients also need to be

taught deep breathing, coughing, and use of incentive spirometry.

FLAIL CHEST

Flail chest results from multiple rib fractures, causing an unstable chest wall. The diagnosis of flail chest is

made on the basis of fracture of two or more ribs, in two or more separate locations, causing an unstable

segment.

Nursing assessment:

o Paradoxical respirations

o Severe chest pain

o Dypsnea, cyanosis, tachypnea, shallow respirations

o Tachycardia, hypotension

o Diminished breath sounds

Nursing Interventions:

o Fowlers

o Humidified 02

o Monitor for increased respiratory distresso Encourage cough deep breathe

o Pain medication

o Bed rest and limit activity to limit 02 demands

o Prep for intubation, vent with positive end-expiratory pressure (PEEP) for severe flail chest with

shock and respiratory failure

Initial therapy consists of airway management, adequate ventilation, supplemental oxygen therapy, careful

administration of intravenous (IV) solutions, and pain control.

The definitive therapy is to reexpand the lung and ensure adequate oxygenation.

CHEST TUBES AND PLEURAL DRAINAGE

The purpose of chest tubes and pleural drainage is to remove the air and fluid from the pleural space and to

restore negative intrapleural pressure so that the lungs can reexpand.

Drainage collection chamber: Chest tube connects here, calibrated columns

Chest tube malposition is the most common complication.

Routine monitoring is done by the nurse to evaluate if the chest drainage is successful by observing for

tidaling in the water-seal chamber, listening for breath sounds over the lung fields, and measuring theamount of fluid drainage.

Water-Seal chamber:

o Tip of tube under water, prevents air backflow

o Water moves up/down as client inhales/exhales

o Excessive bubbling indicated air leak in system Suction-Control Chamber:

o Suction can be controlled to provide negative pressure

o Various levels of water control amount of suction

o Gentle bubbling indicates that there is suction

Dry suction system:

o Dry suction = No bubbling in suction chamber

o Dial control for suction amount, floater valve in window indicates amount of suction provided

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Portable system: Flutter and Heimlich Valve

o Flutter valve prevents backflow

Intervention:

o Collection chamber:

Monitor drainage; Notify MD: >70-100ml/hr, bright red, sudden increase

Mark drainage at 1-4 hr intervals, use tape

o

Water seal chamber: Monitor fluctuation of fluid level

NO FLUCTUATION: Tube obstructed, dependent loop, suction not working, lung

reexpanded

Pneumothorax: Intermittent bubbling expected, continuous bubbling = leak

Notify MD for continuous bubbling

o Suction control chamber:

Gentle bubbling should be noted

o Occlusive sterile dressing maintained at insertion site

Always keep a sterile clamp and sterile occlusive dressing at bedside!!!

o CXR to assess position of Chest tube and lung reexpansion

o Assess respiratory status and lung sounds

o Monitor for signs of extended pneumothorax and hemothorax

o Keep drainage below level of chest and tubes free of kinks, dependent loops, and obstructions

o Ensure connections secure

o Encourage CDB

o Change position frequently to promote drainage and ventilation

o Do not strip/milk chest tube unless MD order

o Never clamp chest tube without written MD order.

o Drainage system breaks insert tube in sterile water and replace system

o Chest tube emoval:

Client hold deep breath Tube removed

Dressing applied:

Dry sterile, petroleum gauze, Teflon

Per MD client Valsalva maneuver when removed:

Deep breath, exhale, bear down

CHEST SURGERY

A thoracotomy, or the surgical opening into the thoracic cavity, is considered major surgery because the

incision is large, cutting into bone, muscle, and cartilage. The two types of thoracic incisions are median

sternotomy, performed by splitting the sternum, and lateral thoracotomy.

Video-assisted thoracic surgery (VATS) is a minimally invasive thoracoscopic surgical procedure that in

many cases can avoid the impact of a full thoracotomy.

RESTRICTIVE RESPIRATORY DISORDERS

PLEURAL EFFUSION

Pleural effusion is a collection of fluid in the pleural space. It is not a disease but rather an indication of

another disease.

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Pleural effusion is frequently classified as transudative or exudative according to whether the protein

content of the effusion is low or high, respectively.

o A transudateoccurs primarily in noninflammatory conditions and is an accumulation of protein-

poor, cell-poor fluid.

o An exudative effusionis an accumulation of fluid and cells in an area of inflammation.

o An empyema is a pleural effusion that contains pus.

The type of pleural effusion can be determined by a sample of pleural fluid obtained via thoracentesis (a

procedure done to remove fluid from the pleural space).

The main goal of management of pleural effusions is to treat the underlying cause.

Assessment:

o Pleuritic sharp pain increases with inspiration

o Progressive dypsnea and decreased movement on affected side

o Dry non productive cough due to bronchial irritation or mediastinal shift

o Tachycardia

o T

o Breath sounds over affected area

o CXR shows pleural effusion and mediastinal shift away from effected side if fluid >250 ml

Interventions:o Indentify/treat underlying cause

o Monitor breath sounds

o Fowler position

o Encourage CDB

o Prepare for thoracentisis

o Recurrent effusion: Prepare for pleurectomy or pleurodesis

Pleurectomy: Surgically stripping parietal pleura from visceral pleura

Produce inflammatory reaction that promotes adhesions

Pleurodesis: Instilling sclerosing substance via thoracotomy tube

Inflammatory response scleroses tissue together

PLEURISY

Pleurisy, or pleuritis, is an inflammation of the pleura. The most common causes are pneumonia, TB,

chest trauma, pulmonary infarctions, and neoplasms.

Usually occurs on one side of chest in lower lateral portions of chest wall.

Treatment of pleurisy is aimed at treating the underlying disease and providing pain relief.

Assessment:

o Knife like pain aggrevated by breathing/coughing

o Dyspnea

o Pleural friction rub on auscultation

o Apprehension

Interventions:

o Identify/treat cause

o Monitor lung sounds

o Analgesics

o Hot/cold as prescribed

o Encourage CDB

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o Line on affected side and splint chest

ATELECTASIS

Atelectasis is a condition of the lungs characterized by collapsed, airless alveoli.

The most common cause of atelectasis is airway obstruction that results from retained exudates andsecretions. This is frequently observed in the postoperative patient.

INTERSTITIAL LUNG DISEASES

IDIOPATHIC PULMONARY FIBROSIS

Idiopathic pulmonary fibrosisis characterized by scar tissue in the connective tissue of the lungs as a

sequela to inflammation or irritation.

The clinical course is variable and the prognosis poor, with a 5-year survival rate of 30% to 50% afterdiagnosis.

Although corticosteroids, cytotoxic agents, and antifibrotic agents are used in treating the disease, thereis no evidence that their use is effective.

SARCOIDOSIS

Sarcoidosisis a chronic, multisystem granulomatous disease of unknown cause that primarily affects thelungs.The disease may also involve the skin, eyes, liver, kidney, heart, and lymph nodes.

The disease is often acute or subacute and self-limiting, but in others it is chronic with remissions and

exacerbations.

Treatment is supportive and aimed at suppressing the inflammatory response.

o Assessment:

Night sweats

Fever

Weight loss Cough/dyspnea

Skin nodules

Polyarthritis

Kveim test: Positive nodular lesion in response to antigen

o Interventions:

Corticosteroids

Monitor T

Fluid intake

Rest periods

Small nutritious meals

VASCULAR LUNG DISORDERS

PULMONARY EDEMA

Pulmonary edema is an abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs.

It is considered a medical emergency and may be life-threatening.

The most common cause of pulmonary edema is left-sided heart failure.

PULMONARY EMBOLISM

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Pulmonary embolismis the blockage of pulmonary arteries by a thrombus, fat, or air emboli, or tumor

tissue.

Most pulmonary embolisms arise from thrombi in the deep veins of the legs.

The most common risk factors for pulmonary embolism are immobilization, surgery within the last 3

months, stroke, history of deep vein thrombosis, obesity, CHF, advanced age, and malignancy.

Pulmonary infarction (death of lung tissue) and pulmonary hypertension are common complications of

pulmonary embolism.

It may be diagnosed by spiral CT scan, V/Q scan, and/or pulmonary angiography.

The objectives of treatment are to prevent further growth or multiplication of thrombi in the lower

extremities, prevent embolization from the upper or lower extremities to the pulmonary vascular system,and provide cardiopulmonary support if indicated.

o Assessment:

Apprehension and restlessness

Blood tinged sputum

Chest pain

Cough

Crackle/wheezes

Cyanosis Distended neck veins

Dypsnea with anginal/pleuritic chest pain worse with inspiration

Feeling of impending doom

Hypotension

Petechiae over chest and axilla

Tachpenea and tachycardia

o Interventions:

RRT!!

Reassure client

High fowlers 02

VS and lung sounds

ABG

Prepare to administer heparin, embolectomey, or vena cava filter

Document event, interventions, client response

PULMONARY HYPERTENSION

Pulmonary hypertension can occur as a primary disease (primary pulmonary hypertension) or as a

secondary complication of a respiratory, cardiac, autoimmune, hepatic, or connective tissue disorder(secondary pulmonary hypertension [SPH]).

Primary pulmonary hypertensionis a severe and progressive disease. It is characterized by mean

pulmonary arterial pressure greater than 25 mm Hg at rest (normal 12-16 mm Hg) or greater than 30 mmHg with exercise in the absence of a demonstrable cause.

Primary pulmonary hypertension is a diagnosis of exclusion. All other conditions must be ruled out.

Although there is no cure for primary pulmonary, treatment can relieve symptoms, increase quality oflife, and prolong life.

SPH occurs when a primary disease causes a chronic increase in pulmonary artery pressures. Secondary

pulmonary hypertension can develop as a result of parenchymal lung disease, left ventricular

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dysfunction, intracardiac shunts, chronic pulmonary thromboembolism, or systemic connective tissuedisease.

COR PULMONALE

Cor pulmonale is enlargement of the right ventricle resulting from diseases of the lung, thorax, or

pulmonary circulation. Pulmonary hypertension is usually a preexisting condition in the individual with

cor pulmonale. The most common cause of cor pulmonale is COPD.

The primary management of cor pulmonale is directed at treating the underlying pulmonary problemthat precipitated the heart problem.

LUNG TRANSPLANTATION

There are four types of transplant procedures available: single lung transplant, bilateral lung transplant,heart-lung transplant, and transplant of lobes from living related donor.

Lung transplant recipients are at high risk for bacterial, viral, fungal, and protozoal infections. Infectionsare the leading cause of death in the early period after the transplant.

Immunosuppressive therapy usually includes a three-drug regimen of cyclosporine or tacrolimus,

azathioprine (Imuran) or mycophenolate mofetil (CellCept), and prednisone.

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Lower Respiratory Study Sheet