RESPIRATORY SYSTEM

PART THREE
3- Disorders of Lower Respiratory
System
Disorders of Lower Respiratory System

 Management
 reduction of risks - tobacco smoking cessation or change in environment that
has tobacco smoke
 drugs
 bronchodilators
 corticosteroids
 expectorants
 supplemental oxygen therapy
 pulmonary rehabilitation
 Nursing interventions
 reinforce client and family teaching regarding:
 diaphragmatic breathing
 purse-lip breathing
 inspiratory muscle training
 controlled coughing
 pacing of daily activities
 physical conditioning
 oxygen therapy: do not exceed two liters per minute via nasal cannula
 avoid temperature extremes, air pollution, and high altitudes
 monitor for complications of COPD
 respiratory insufficiency
 respiratory failure
 pulmonary infections
 Asthma

 Definition: a recurrent, reversible airway disease characterized by increased

airway responsiveness to a variety of stimuli that produce airway narrowing and
tenacious, thick, excess, mucous
 Etiology
 extrinsic: when a specific allergy can be related to the attack
 intrinsic: when the attack is seemingly unrelated to a specific allergen
 respiratory infection

 stress

 exercise

 gastroesophageal reflux

 aspiration

 disease waxes and wanes, has remissions and exacerbations

 Findings
 Orthopnea, expiratory wheezing
 Barrel chest, cyanosis, clubbing of fingers
 Distention of neck veins
 Edema of extremities

 Increased PaCO2 and decreased PaO2

 Polycythemia
 accessory muscle use to breathe
 Asthma

 Diagnostics
 acute phase
 physical examination and history

 arterial blood gases

 chest x-ray

 complications in acute or remission phases

 hypoxemia - too little oxygen in arterial blood

 hypercapnia - too much carbon dioxide in blood

 recurrence of other respiratory infections

 Right-sided heart failure (cor pulmonale)

 dysrhythmia

 absence of wheezing may occur and be an indication of

absence of airflow, which is a medical emergency

 Asthma
 Management
 pharmacologic therapy
 long-acting control medications
 corticosteroids
 mast cell stabilizers
 long acting beta agonists
 cholinergic antagonists
 leukotrine modifiers
 quick-relief medications
 short-term beta agonists
 intravenous corticosteroids
 peak flow monitoring
 anti-allergy therapy
 Nursing interventions
 monitor client's respiratory status
(respiratory effort, rate, lung sounds, pulse
oximetry
 observe for subtle evidences of hypoxia
(restlessness, other changes in level of
consciousness)
 administer medications as prescribed
 reinforce client and family teaching
regarding:
 use of medications - expected effects,
side effects, routine, when to notify
health care provider
 avoidance of triggers that cause
asthmatic episodes
 how to respond to emergency
situations
 Interstitial Lung Disorders

 Definition: Irritants such as toxic drugs, radiation, and industrial substances

cause damaging inflammation of the alveoli and interstitial tissue of the lungs.
The lungs become scarred, stiff, and non-compliant.
 Common interstitial lung disorders
 Silicosis
 Asbestos
 Black lung disease - also called pneumoconiousis
 Hypersensitive pneumonitis
 Sarcoidosis
 Findings
 Difficulty inhaling
 Evidences of hypoxia
 Cough - chronic
 Hemoptysis
 Fatigue
 Anorexia
 Weight loss
 Interstitial Lung Disorders

 Diagnostics
 Chest X-rays
 CT scan
 Biopsy of lung
 Management
 Avoidance of irritants
 Oxygen therapy
 Symptom relief with medications (antitussives,
bronchodilators, corticosteroids)
 Nursing interventions
 Prevent infections
 Pace client's activities to reduce oxygen demands and
dyspnea
 Plan for small, frequent meals
 Encourage client to have daily activity within pulmonary
tolerance
 Monitor for depression associated with disease and refer as
indicated
 Refer client to programs for quitting smoking if indicated
 Disorders in which lung tissue
collapses

 Definition: There are a number of disorders

in which the pleural space is abnormally
occupied by air or fluid. The result is
pressure on lung tissue reducing lung
capacity.
 pneumothorax: air between the pleurae
 open pneumothorax: hole in the
chest wall, communicating with
lung
 closed pneumothorax: hole in
lung, chest wall intact
 tension pneumothorax - a
medical emergency
 closed pneumothorax
 air is forced into pleural
space, pressure builds up
 shifts mediastinum and
trachea away from affected
side and compresses heart
 treated with chest tube
insertion
 Disorders in which lung tissue
collapses
 pleural effusion - fluid (transudate or exudate) in the pleural
space; treated with thoracentesis or chest tube
 hemothorax - blood in pleural space; treated with thoracentesis
or chest tube
 empyema - purulent drainage in pleural space; usually after a
pleural effusion
 may be a chronic condition associated with lung cancers
 treated with chest tube insertion
 chylothorax
 lymphatic fluid in pleural space
 treated with thoracentesis or chest tube
 drainage is whitish in color
 Disorders in which lung tissue
collapses

 Etiology
 trauma: gunshot wounds, blunt trauma, rib fracture, stab wound
 infection: pneumonia, pancreatitis, pleurisy
 tumors
 heart failure
 antineoplastic medications
 Findings
 asymmetrical chest movement
 dyspnea
 diminished lung sounds on affected side
 subnormal hemoglobin saturation levels
 fatigue and activity intolerance
 tachycardia
 Disorders in which lung tissue
collapses
 Diagnostics - X-ray and cultures that support diagnosis
 Management
 removal of cause
 placement of chest drainage device
 thoracentesis in pleural effusion or hemothorax
 Nursing interventions
 position client for comfort and improved oxygenation
 maintain / monitor chest tube and closed chest drainage system
 monitor respiratory status and effort
 nursing care of a client with a chest tube drainage system
 ensure that the chest tube drainage system is closed, has no
leaks, connections are taped with adhesive tape
 keep the collection device below chest level or insertion site at
all times
 check tubes frequently for kinks or loops
Musculoskeletal diseases that hinder
breathing
 Guillain-Barre syndrome - an idiopathic peripheral
polyneuritis; occurs one to three weeks after mild episode of
fever associated with a viral infection
 "ascending" paralysis that may affect muscles of
respiration
 muscles so weak that client cannot breathe deeply if
high involvement
 may progress to respiratory failure
 may require intubation and mechanical ventilation
during recovery period
 recovery may take months to years
 no specific treatment; only supportive care
 Myasthenia gravis
 sporadic, progressive weakness of skeletal (voluntary)
muscles
 cause: lack of acetylcholine
 often cannot swallow well, may aspirate and lose
protective airway reflexes
 medication requires adherence to schedule
Musculoskeletal diseases that hinder
breathing
 Poliomyelitis
 viral infection
 asymptomatic, mild and paralytic forms
 if disease strikes respiratory muscles, can lead to respiratory
failure
 Amyotrophic lateral sclerosis (ALS; Lou Gehrig's Disease)
 affects motor neurons; autonomic, sensory & mental function
unchanged
 chronic, progressive disease - usually causes death in two to
five years
 disease usually begins in distal ends of upper extremities
 will eventually lead to respiratory failure
 ethical issue is whether clients want mechanical ventilation,
tube feedings, etc., or if they would rather die when disease
becomes this severe
 as disease progresses, cannot swallow well; may aspirate & lose
protective airway reflexes, i.e. cough reflex
Musculoskeletal diseases that hinder
breathing
 Nursing interventions common to musculoskeletal disorders
 monitor carefully for changes in condition
 regularly check swallowing and client's ability to protect
upper airway
 discuss chances of mechanical ventilation: does client wish
it?
 assist with coughing and secretion clearance as indicated
 prevent infection
 monitor for depression associated with disease, assist with
needed referrals
 administer medications specific to medical condition -
strict adherence to schedule
 assist/provide physical therapy as indicated
 maintain/promote adequate nutrition