LOWER RESPIRATORY

DISORDER
ATELECTASIS

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 Refers to collapse of previously expanded lung tissue
 A shrunken airless state of the alveoli.

 Can be primary or secondary.

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Etiology
 Primary
1. Lung tissue remains uninflated as a result of insufficient surfactant
production.
2. Present at birth typically on premature and at-risk infants.

 Secondary – caused by airway

obstruction, lung compression and
increased recoil due to diminished
surfactants
 Airway obstruction may be due to mucus
plugs, tumors or exudates.
 Its risk increases after surgery

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Pathophysiologic Processes and
Manifestations:
1. Surfactant must be constantly replenished.
2. Ineffective cough reflex  decreased tidal volume and
decreases sigh mechanism  poor alveolar expansion
3. Increased viscosity of sputum pooling of secretions
4. Complete airway obstruction  absorption of oxygen from
dependent alveoli and collapse of that portion of lung.

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 Symptoms may include:
1. Crackles and gurgles
2. Diminished breath sounds from
poor air entry
3. Dyspnea and tachycardia
4. Hypoxemia

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Overview of Nursing Interventions:
1. Encourage deep breathing and coughing
2. Encourage the performance of incentive spirometry
3. Administer antibiotics as ordered
4. Administer oxygen if necessary

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PNEUMOTHORAX
 It is the accumulation of air in the pleural space, which results in
partial or complete lung collapse.

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 Types are:

1. Tension – air enters but can’t leave

pleural space
2. Secondary – air enters the pleural space
as a result of injury to the chest wall,
respiratory structures or esophagus
3. Spontaneous – air enters the pleural
space when air-filled blebs (blisters) on
the lung surface rupture.

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Etiology
 Tension pneumothorax - unknown causes

 Secondary pneumothorax – injury to the chest wall from

trauma

 Spontaneous – ruptured bleb (common to smokers).

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Pathophysiologic Processes and
Manifestations

 Severity of symptoms depends on the size

of injury and the amount of tissue left
intact.
Symptoms can include:
1. Pleuritic pain (sharp pain occurring during inhalation)
2. Increased RR
3. Dyspnea
4. Asymmetry of chest wall (from rib fractures)
5. Decreased breath sounds over the area of pneumothorax
6. Trachea deviating to the injury site
7. Shifting of mediastinal structures to unaffected side of
unaffected chest
8. Signs of shock (due to large pneumothorax)

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Overview of Nursing Interventions:
 Monitor V/S, signs of shock
 Observe respirations; changing pattern may indicate
worsening situation
 Semi-Fowler’s position
 Administer oxygen if necessary
 Analgesics as ordered

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 Chest tube:
1. Maintain sterile dressing at chest tube insertion site
2. Maintain patency and integrity of closed chest drainage system
3. Evaluate amount of fluid and breath sounds.

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PLEURAL EFFUSION
Description
 Refers to an abnormal accumulation of fluid in the pleural
cavity.
 Fluid may be transudate (hydrothorax), exudates (empyema),
blood (hemothorax) or chyle (chylothorax) – chyle is a milky
fluid found in lymph fluid from GI tract.

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Etiology
Hydrothorax – results from CHF; other causes
are RF, nephrosis and liver failure
Empyema – from infections, malignancies,
SLE. May also be caused by direct spread of
bacterial pneumonia or trauma-related
infections
Hemothorax – chest injuries, chest surgery
complications, malignancies, blood vessel
rupture
Chylothorax – trauma, inflammation or
malignant infiltration

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Pathophysiologic Processes and
Manifestations
1. 5 mechanisms:

a. Increase in capillary pressure – failure to shift

the blood back towards the heart
b. Increase in capillary permeability - such as in
inflammation
c. Decrease COP
d. Increase in intrapleural negative pressure
e. Impairment in lymphatic drainage of the pleura

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2. Pleural effusion results in decreased lung volume on the
affected side and a mediastinal shift on the other side 
decreased lung volume on the other side as well

3. Characteristic signs: diminished breath sounds and

flatness and dullness to percussion.

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1. Other symptoms are:
a. Dyspnea
b. Pleuritic pain
c. Constant discomfort
2. Severity of hemothorax is determined by
volume of fluid:
a. Minimal (300-500cc) – resolves in 10-14 days as
small amounts of blood are naturally absorbed
from the pleural space.
b. Moderate (500-1000 cc) – fills about 1/3 of the
pleural cavity  lung compression and signs of
hypovolemia
c. Large (1000 cc or more) – fills half or more of
the chest and requires immediate drainage.

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Overview of Nursing Interventions:
1. Observe patient for signs of shock
2. Administer analgesics as required
3. For moderate to large:
a. Maintain fluid replacement as ordered.
b. Assist with insertion of chest tubes are ordered.
c. Maintain patency of tubes.
d. Prepare for surgery if bleeding doesn’t stop.

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ACUTE
RESPIRATORY
DISTRESS
SYNDROME
(ARDS)

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Description
 A sequela of several diseases in which the lungs fill with water,
making gas exchange impossible

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Etiology
 Results from unknown cause.
 Predisposing factors
Pneumonia
Near drowning
Reaction to drugs and inhaled gases
Allergic reactions (pulmonary)
Shock Infection
Diabetic ketoacidosis
Trauma
Burns

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Pathophysiology

Increased permeability of alveolar-

capillary membrane  penetration
of protein and fluid from the IV
compartment into the pulmonary
interstitium and alveoli 
noncardiac pulmonary edema
Plasma protein inactivates
surfactant  injury to the alveolar
cells  surface tension
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Increased pressure from excessive
fluid and increased surface tension 
alveolar collapse  stiffening of the
lungs  difficulty in inflation

Decreased lung compliance and

increased work of breathing

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Symptoms include:
Crackles and gurgles
Hypoxemia due to poor diffusion
Respiratory distress
X-ray result – mass consolidation
ABG Analysis: Respiratory acidosis

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Nursing Interventions
 Monitor fluid intake
 Administer steroids as ordered  reduce inflammation
 Assess for complication like pneumothorax
 Institute PEEP as ordered
 Provide care necessary for a mechanical ventilator
 Protect the airway from injury
 Relieve anxiety

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ACUTE
RESPIRATORY
FAILURE

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Description
 Is a disease sequela which occurs when the lungs are unable
to adequately oxygenate the blood (hypoxemia)
 pO2 is less than 50 mmHg and CO2 is more than 50 mmHg

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Etiology

Infections like pneumonia

COPD exacerbations

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Pathophysiology

Loss of ventilation / perfusion at

the alveolar-capillary level  non-
elimination of CO2 and non-
absorption of O2  altered gas
exchange  hypoxia and
hypercapnia.
Hypoxia  stupor, coma,
bradycardia and hypotension

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 Hypercapnia
Vasodilation  shock
Sedation of CNS
Respiratory acidosis
 Other symptoms
Tachycardia
Diaphoresis
Restlessness
Agitation
Cool skin

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Nursing Interventions
 Mechanical ventilator with O2 as ordered – maintain airway,
nutrition and hydration
 Assess for complications of pneumothorax
 Administer antibiotics as ordered (if infection is present)
 Administer bronchodilators as prescribed

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