Chapter 10

Nursing Management: Patients

With Chest and Lower
Respiratory Tract Disorders

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Atelectasis
Pathophysiology
Risk factors
Manifestations
Management:
Incentive spirometry
Nebulizers
Chest physiotherapy (CPT)

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Pneumonia
Pathophysiology
Types:
Community-acquired pneumonia
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Health-care associated pneumonia
Risk factors
Manifestations and assessment

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Question
A nurse is reviewing the epidemiology of pneumonia. The
nurse should be aware of a seasonal pattern of incidence
and prevalence in what type of pneumonia?
A.Community-acquired pneumonia
B.Hospital-acquired pneumonia
C.Ventilator-associated pneumonia
D.Health careassociated pneumonia

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Answer
A. Community-acquired pneumonia
Rationale: Most cases of CAP occur in the winter and
early spring. The etiology of the other three major types
of pneumonia does not include seasonal patterns of
incidence and prevalence.

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Medical and Nursing Management of

Pneumonia
Antibiotic therapy
Supportive care
Prevention
Gerontological considerations

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Oxygen Therapy in the Management of

Pneumonia
Methods of administration: See Table 10-2 in text

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Oxygen Masks

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Question
Is the following statement true or false?
A non-rebreathing mask should fully collapse on full
inspiration

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Answer
False
Rationale: It is important to adjust the oxygen flow of a
non-rebreathing mask so that the reservoir bag does not
completely collapse on inspiration

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Nursing Care of the Patient With

Pneumonia
Assessments
Diagnoses: Functional and respiratory
Goals and interventions address:
Improved airway patency
Conserving energy
Maintenance of proper fluid volume
Maintenance of adequate nutrition
Understanding of treatment and preventive measures
Absence of complications

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Pulmonary Tuberculosis
Pathophysiology
Risk factors
Manifestations and assessment
Tuberculin skin test
QFT-G test
Medication regimen

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Question
A nurse is administering tuberculin skin tests to a group
of employees. What technique will the nurse utilize?
Intradermal injection into the workers forearms
Intramuscular injection into the vastus lateralis
Subcutaneous injection into the abdominal region
Insertion at a 90-degree angle into the deltoid

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Answer
A. Intradermal injection into the workers forearms
Rationale: During the tuberculin skin test, tubercle
bacillus extract is injected into the intradermal layer of
the inner aspect of the forearm

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Pulmonary Edema
Pathophysiology
Risk factors
Manifestations and complications
Medical management
Nursing management

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Pleural Conditions
Pleurisy
Pleural effusion and empyema

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Pleural Effusion

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Acute Respiratory Failure

Pathophysiology
Causes include:
Decreased respiratory drive
Dysfunction of the chest wall
Dysfunction of the lung parenchyma
Other causes
Assessment
Management

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Acute Respiratory Distress Syndrome

(ARDS)
Pathophysiology
Risk factors
Manifestations
Management:
Positive end-expiratory pressure (PEEP)
Pharmacologic treatments
Nursing care

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Question
A patient has been admitted to the emergency
department with signs and symptoms that are suggestive
of ARDS. What action should the ED nurse prioritize?
A.Preparing to participate in intubation
B.Administering oxygen by nasal cannula
C.Administering bronchodilators by metered dose inhaler
D.Auscultating the patients chest

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Answer
A. Preparing to participate in intubation
Rationale: In order to facilitate the priorities of airway
and breathing, prompt intubation is imperative in the
treatment of a patient with ARDS. This is a priority over
other assessments and interventions.

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Pulmonary Arterial Hypertension

Pathophysiology
Risk factors
Manifestations
Management
Nursing care

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Pulmonary Embolism
Pathophysiology
Risk factors
Manifestations
Assessments:
Chest X-ray, ECG, peripheral vascular studies, ABGs,
d-dimer, and ventilationperfusion scan, CT
Preventative measures

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Treatment of Pulmonary Embolism

Emergency measures
Anticoagulants, thrombolytics
Nursing care includes:
Prevention
Monitoring thrombolytic and anticoagulant therapy
Managing pain and anxiety
Managing oxygen therapy
Monitoring for complications

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Occupational Lung Diseases

Silicosis
Asbestosis
Coal workers pneumoconiosis

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Lung Cancer
The leading cancer killer among men and women in the United
States
In 2005, 196,687 people in the United States were diagnosed
with lung cancer, and 159,217 people died of it
Types:
Small cell lung cancer
Nonsmall cell lung cancer
Squamous cell carcinoma
Large cell carcinoma
Adenocarcinoma

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Lung Cancer (contd)

Risk factors
Clinical manifestations
Assessment and diagnostic testing
Treatment:
Surgery
Radiation therapy
Chemotherapy
Complications
Nursing care

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Chest Trauma
Blunt trauma vs. penetrating trauma
Clinical manifestations and assessment
Management includes chest tube placement for
pneumothorax

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Complication of Chest Trauma:

Pneumothorax
Types:
Simple
Traumatic
Tension
Manifestations
Management

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Chest Drainage Systems

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Chest Trauma (contd)

Complications:
Sternal and rib fractures
Flail chest
Pulmonary contusion
Cardiac tamponade

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Question
A patient returns to the unit after thoracic surgery with a
water-sealed chest drainage system. What should the
nurse instruct the patient and the family about the main
purpose of this system?
A.Remove excess carbon dioxide from the blood
B.Monitor the quantity of pleural fluid
C.To enhance the patients expiratory drive
D.Re-expand the lung and remove excess air and fluid

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
D. Re-expand the lung and remove excess air and fluid
Rationale: The main purpose of chest tubes and closed
drainage systems are to re-expand the lung involved and
to remove excess air, fluid, and blood. They are not used
to remove carbon dioxide, to enhance the respiratory
drive, or to monitor the quantity of pleural fluid.

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Aspiration
Pathophysiology
Risk factors
Preventative measures

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