74

Respiratory system

Respiratory refresher (continued)

LUNG CANCER (CONTINUED)
Antineoplastics: cyclophosphamide, doxorubicin (Doxil),
cisplatin (Platinol), vincristine
Key interventions
Assess the clients pain level and administer analgesics, as
prescribed.
Provide suctioning and assist with turning, coughing, and deep
breathing.
Track laboratory values, and monitor for bleeding, infection,
and electrolyte imbalance due to effects of chemotherapy.
PLEURAL EFFUSION AND EMPYEMA
Key signs and symptoms
Decreased breath sounds
Dyspnea
Fever
Pleuritic chest pain
Key test results
Chest X-ray shows radiopaque fluid in dependent regions.
Thoracentesis shows lactate dehydrogenase (LD) levels less
than 200 international units and protein levels less than 3 g/dl (in
transudative effusions); ratio of protein in pleural fluid to serum
greater than or equal to 0.5, LD in pleural fluid greater than or
equal to 200 international units, and ratio of LD in pleural fluid
to LD in serum greater than 0.6 (in exudative effusions); and
acute inflammatory white blood cells and microorganisms
(in empyema).
Key treatments
Thoracentesis (to remove fluid) with chest tube insertion if
necessary
Thoracotomy if thoracentesis isnt effective
Antibiotics for empyema: according to sensitivity of causative
organism
Key interventions
Administer O2.
Administer antibiotics.
Provide meticulous chest tube care, and use sterile technique
for changing dressings around the tube insertion site.
Ensure chest tube patency by watching for bubbles in the
underwater seal chamber.
Record the amount, color, and consistency of chest tube
drainage.
PLEURISY
Key signs and symptoms
Pleural friction rub (a coarse, creaky sound heard during late
inspiration and early expiration)
Sharp, stabbing pain that increases with respiration

313419NCLEX-RN_Chap04.indd 74

Key test results

Although diagnosis generally rests on the clients history and
the nurses respiratory assessment, diagnostic tests help rule
out other causes and pinpoint the underlying disorder.
Key treatments
Bed rest
Analgesic: acetaminophen with oxycodone (Percocet)
Anti-inflammatories: indomethacin (Indocin), ibuprofen
(Motrin)
Key interventions
Stress the importance of bed rest and plan your care to allow
the client as much uninterrupted rest as possible.
Administer antitussives and pain medication as necessary.
Encourage the client to cough and deep breathe. Teach
him to apply firm pressure at the pain site during coughing
exercises.
PNEUMOCYSTIS PNEUMONIA
Key signs and symptoms
Generalized fatigue
Low-grade, intermittent fever
Nonproductive cough
Shortness of breath
Weight loss
Key test results
Chest X-ray may show slowly progressing, fluffy infiltrates and
occasionally nodular lesions or a spontaneous pneumothorax,
but these findings must be differentiated from findings in other
types of pneumonia or acute respiratory distress syndrome.
Histologic studies confirm P. jiroveci. In clients with human
immunodeficiency virus (HIV) infection, initial examination
of a first morning sputum specimen (induced by inhaling an
ultrasonically dispersed saline mist) may be sufficient; however, this technique is usually ineffective in clients without HIV
infection.
Key treatments
O2 therapy, which may include endotracheal intubation and
mechanical ventilation
Antibiotics: co-trimoxazole (Bactrim), pentamidine (Pentam)
Antipyretic: acetaminophen (Tylenol)
Key interventions
Assess the clients respiratory status, and monitor ABG levels.
Administer O2 therapy as necessary. Encourage ambulation,
deep-breathing exercises, and use of incentive spirometry.
Administer antipyretics, as required.

4/8/2010 6:46:14 PM