1. health and fitness
2. disease
3. asthma

Respiratory Module
Lower Respiratory Tract Infections
Lecture 6
Atelectasis
•
Definition
–
Closure or collapse of
alveoli
Atelectasis: Pathophysiology
• Can occur as a result of
i alveolar ventilation
or
• any type of blockage
• that impedes the
passage of air to and
from the alveoli
Atelectasis: Etiology
• #1 post-op
• h secretions or mucus
plug
• Chronic airway
obstruction
– i.e. lung CA
• Excessive pressure on
the lungs
Atelectasis: Risk Factors
•
•
•
•
•
•
•
Altered breathing
patterns
Retained secretions
Pain
i LOC
Immobility
Prolonged supine
position
Post-op
Atelectasis: Clinical Manifestations
• “The development of Atelectasis usually is insidious”
– Cough
– sputum production
– low-grade fever
Atelectasis: Clinical Manifestations
• If Atelectasis involves a large amount of lung tissue S&S
include
– Marked resp. distress
– Dyspnea (orthopnea)
– Pulse?
• Tachycardia
– Respiratory rate?
• Tachypnea
– Pleural pain
– Central cyanosis
Atelectasis: Assessment and Diagnostic
Findings
•
breath sounds
– i
– Crackles
•
Chest X-ray
– patchy infiltrates
– consolidated area
Atelectasis: Assessment and Diagnostic
Findings
• SpO2
– < 90%
• PaO2
– i < 80
• PaCO2
– h > 45
• HCO3– h to compensate
• ABG analysis
– Resp. acidosis
Atelectasis: Prevention
•
•
•
Frequent turning
Early mobilization
Strategies to expand the
lungs
– Deep breathing
– Incentive Spirometry
(IS)
Atelectasis: Prevention
• Strategies to manage
secretions
– Directed cough
– Suctioning
– Nebulizer
– Chest physical
therapy
– h fluids
Atelectasis: Management
• Goal:
–
to h ventilation and i
secretions
• Frequent turning
• Early amb.
• Lung volume expansion
maneuvers
Atelectasis: Management
• Coughing
• PEEP
• Bronchoscope
Atelectasis: Management
•
If due to bronchial
obstruction
– Coughing
– Suctioning
– Chest physiotherapy
– Nebulizers
– Bronchodilators
– Endotracheal
intubation &
mechanical ventilation
Atelectasis: Management
• If due to compression of the
lung tissue
– Decrease the
compression
– Thoracentesis
– Chest tubes
Small Group Questions
1. What can a nurse due to prevent a patient from
acquiring Atelectasis?
2. Which patients are most likely to acquire
Atelectasis?
3. How is Atelectasis treated?
4. Describe the ABG’s of a patient with Atelectasis.
5. Name 4 S&S of Atelectasis.
Acute Tracheobronchitis
AKA
• Bronchitis
• Acute Bronchitis
Acute Tracheobronchitis
Pathophysiology
• Inflammation of the
mucous membranes of
the trachea & bronchial
tree
• Follows URI
Acute Tracheobronchitis
• What pathogen is most
commonly responsible
for tracheobronchitis?
A. Bacteria
B. Virus
C. Fungus
D. Parasite
Acute Tracheobronchitis
Etiology/Contributing
factors
• Infection
• Inhalation of irritants
– Sulfur dioxide
– Nitrogen dioxide
– Air pollutants
•
May be a complication
of bronchial asthma
Acute Tracheobronchitis
Clinical Manifestations
• Usually self limiting
• Durations
– Several days
• Sputum
– Mucopurulent
• Cough
– Dry, irritation, dyspnea
• Pain
– Sternal soreness
• Fever / chills
• Headache / gen. malaise
Acute Tracheobronchitis
Diagnostic findings
• Sputum C&S
• Chest x-ray
• Breath sounds
– Sonorous wheezes
– Stridor
• Symptoms
Acute Tracheobronchitis
Treatment
• Symptomatic
• Bed rest
• Cool vapor
• Steam
• Moist heat to chest
• If bacterial
– Antibiotics
Acute Tracheobronchitis
Nursing interventions
• Enc bronchial hygiene
• Enc TCDB / h fluids
• Position
– HOB h
• Caution against over
exertion  relaps
• Auscultate BS
• Check V/S
Acute Tracheobronchitis
Prevention
• Treat URI
Complications
• Bronchopneumonia
Small group questions???
1.
2.
3.
4.
5.
6.
Describe the pathophysiology of tracheobronchitis?
What is the usual causative agent for tracheobronchitis?
What does self-limiting mean?
What breath sounds are associated with Tracheobronchitis?
Identify a nursing diagnosis for tracheobronchitis?
Name for nursing comfort measures for a pt. with
tracheobronchitis?
Pneumonia
Pathophysiology
• An inflammatory process in which there is
consolidation
– caused by exudates filling the alveolar spaces.
• Gas exchange cannot take place in
consolidated area
Pneumonia
Causative agents
• Viral pneumonia
• Bacterial Pneumonia
– Streptococcus pneumoniae
– Pneumocystis Pneumonia
•
•
•
•
•
Fungal pneumonia
Radiation pneumonia
Chemical pneumonitis
Aspiration pneumonia
Hypostatis pneumonia
Pneumonia
Which of the following
components of respiration
would pneumonia affect?
(there may be more than
one answer)
A. Ventilation
B. Perfusion
C. Diffusion
Pneumonia FYI
• Most common cause of death from infectious
agents
• 66,000 deaths / year
• $$$
Pneumonia
Progression of events
• Inflammation 
• h Exudate 
• i movement of O2 and CO2 
• WBC migrate into the alveoli 
• Fill air-containing spaces
• i ventilation
• PaO2 ?
–i
Pneumonia - Classifications
• Community-acquired pneumonia
– CAP
– Community or < 48 hr after hospitalization
• Hospital-acquired pneumonia
– HAP
– Nosocomial
– (CDC: 15-20% all pt get HAP)
• Immuno-compromised host
– Pneumocystis pneumonia (PCP)
• Aspiration
•
Mrs. Sickly is admitted to Sierra View District Hospital on Wednesday
Morning at 0930 AM for severe back pain and general declining state.
She is 82 years old. On Friday morning at 0600 AM the nurse notes
decreased breath sounds in the left lung, a productive cough and
crackles. The doctor orders a chest x-ray which shows consolidation in
the base of the left lung. She has pneumonia. What type of pneumonia
does she have?
A.
B.
C.
D.
Community acquired pneumonia
Nosocomial pneumonia
Immuno-compromised host
Aspiration
Pneumonia: Risk factors
•
•
•
•
•
•
•
•
Immunosuppressant
Smoking
Prolonged immobility
Depressed cough reflex
NPO
Alcohol intoxication
Gen. anesthetic or opiod
Advanced age
Pneumonia
S&S: bacterial
•
• Onset:
•
– Sudden
• Pain:
–
–
–
–
Severe chest pain
sharp
Guarding
i mobility (affected side)
• Temperature
– High temp (>106)
– Chills
•
•
•
Cough
– Painful
Sputum
– Rust colored
Breathing
– Shallow
– Rapid rate
– Wheezing & crackles
– Decreased BS
Peristaltic activity
– Slows down
PaO2
– i
– Cyanotic
Pneumonia: S&S: viral pneumonia
• Blood cultures:
– Sterile
• Sputum
– Copious
• Temperature
– Seldom chills
• Respirations
– Slow
– Wheezing & crackles
– Diminished BS
• Pulse
– Slow
• PaO2
– i
– Cyanotic
• Viral less severe than
bacterial
• Mortality is low
Pneumonia
S&S Elderly
• General deterioration
• Weakness
• Abd. Symptoms
• Anorexia
• Confusion
• Tachycardia
• Tachypnea
• Do Not C/O
–
–
–
–
Cough
Pain
Fever
Sputum
Pneumonia
Dx
• Sputum C&S
• CBC / WBC
–h
• Bacteria
–i
• Viral
• ABG’s
• Chest x-ray
• What is a normal WBC
count?
– 5,000 – 10,000 mm3
Pneumonia
• What would you expect the
ABG’s of a person with
bacterial pneumonia to
have?
• PaO2?
• PaCO2?
• pH
• HCO3- ? - Why?
• Analysis?
Pneumonia
Treatment
• Antibiotics?
• Rest
• Fluids
–h
– Humidifier
• Antipyretic
• Anti-tussive?
•
•
•
•
•
Analgesics
Anti-histamines
Nasal Decongestants
O2
Mucolytic drug
– Alivaire
– Via – nebulizer
Pneumonia: Nrs. diagnosis
•
•
•
•
•
Ineffective airway clearance: r/t copious secretions
Activity intolerance: r/t impaired resp. function
Risk for deficient fluid volume: r/t fever & dyspnea
Imbalanced nutrition: less than body requirement
Deficit knowledge: about the treatment regimen and
preventive health measures
Pneumonia – Nursing Interventions
• Improve airway patency
– Hydration
• 2-3 L/day
• Humidifier
– TCDB
– Lung expansion maneuvers
• Incentive spirometer
– Chest physiotherapy
– O2
Pneumonia – Nursing Interventions
• Promoting rest & conserving energy
– Position
• Semi-fowler
• Affected side for pain
– Turn frequently
– Moderate activity only
• Promoting fluid intake
– 2 L/day
Pneumonia – Nursing Interventions
• Maintaining nutrition
– Gatorade
– Ensure
• Promoting the patients knowledge
Pneumonia
Prevention
• Vaccine
– Pneumonia
– Flu
• Treat URI
• Avoid irritants
Pneumonia
Complications
• Shock
• Respiratory failure
• Atelectasis
• Pleural effusion
• Superinfection
Pneumonia: Small Group Questions
1. Describe the pathophysiology of pneumonia.
2. What is the difference btw bacterial and viral
pneumonia?
3. What causes pneumocystis carinii?
4. What leads to hypostatis pneumonia?
5. What lab values are associated with bacterial
pneumonia? / viral pneumonia?
Pneumonia: Small Group Questions
6. What is Nosocomial pneumonia
7. Identify 5 risk factors for developing pneumonia
8. What medications might be administered to treat a
pt. with pneumonia?
9. What nursing education would you give to a patient
with pneumonia?
10. What ABG’s are associated with pneumonia?
11. What are the gerontological considerations of
caring for the elderly in regards to pneumonia?
SARS
• Severe Acute
Respiratory Syndrome
• Viral respiratory illness
• Caused by a coronavirus
SARS
• FYI
– First reported in Asia
2003
– 8098 people worldwide
dx with SARS in 2003
– 774 died!
SARS
• Mode of transmission
– Respiratory droplet
• When infected person
coughs or sneezes
• The droplet gets on
another's mucous
membranes or
• On a surface that is touch
by another and then they
touch their own mucous
membranes
SARS
S&S
• Initial
–
–
–
–
–
High fever
H/A
Body aches
Mild resp. symptoms
After 2-7 days
• After 2-7 days
– Dry cough
– Progressive hypoexmia

– Pneumonia
SARS
• Treatment
– Same for viral
pneumonia
• Infection control
– Limit transmission
• Neg pressure rooms
• Protective equipment
• Good cleaning or hands
and room
• Contain secretions
Tuberculosis
• AKA
– TB
– Consumption
Tuberculosis - FYI
• Causes more death than any other disease. 2
billion world wide, 15 million in the US
Tuberculosis - FYI
• When it becomes active it kills 60% of those
not treated. Amounts to about 3 million
deaths each year. In the US about 20,000 TB
cases become active each year.
Tuberculosis - FYI
• When treated, about
90% of those with
active TB survive!
Tuberculosis
• Pathophysiology
– Mycrobacterium
tuberculosis
– Tubercle bacillus
Question?
• TB is caused by a(n)?
A. Bacteria
B. Virus
C. Fungus
D.Parasite
E. Little green bugs!
Tuberculosis
Pathophysiology
• Mode of transmission
– Air-borne
•  alveoli
• Multiplies in alveoli
Tuberculosis
• Immune response phase
– Macrophages attack TB
– TB has waxy cell wall that protects it from
macrophages
– Immune system surrounds the infected
macrophages
– Forms a Lesion
– Called a Tubercle
Tuberculosis
• Dormant /latent phase
– Contagious?
• No
– Symptomatic?
• No
– PPD?
• positive
– chest x-ray?
• Negative
Tuberculosis
• Active phase
– If an infected person has a weakened immune
system, 
– the TB escapes and infects the body
Tuberculosis
• 5-10% become active
• Only contagious when
active
• Primarily affect lungs
but…
–
–
–
–
Kidneys
Liver
Brain
Bone
Tuberculosis
Etiology
• Assoc. w/
–
–
–
–
–
Poverty
Malnutrition
Overcrowding
Substandard housing
Inadequate health care
• Elderly
• HIV
• Prison
Tuberculosis
S&S (active phase)
• NOC sweats
• Low grade fever
• Wt loss
• Chronic productive cough
– Rust colored sputum
– Thick
• Hemoptysis
• SOB
Tuberculosis
Diagnostic exams
• PPD
–
–
–
–
Mantoux skin test
> 10mm in diameter
induration
Indicates:
• Latent TB
– Read
• 48-72 after
– Intradermal: 15-degrees
– Do not rub
Tuberculosis
• Diagnostic tests
– X-ray
• Cavities or lesions
– Symptoms
– Acid Fast Bacillus
Tuberculosis
Treatment
• INH
– isonicotinyl hydrazine
– Isoniazid
– Toxic to the liver
• Rifampin
– Turns urine red
• Streptomycin
– Causes 8th cranial nerve damage
– Acoustic nerve
Tuberculosis: treatment
• Rx toxic to liver and
CNS
• Must take >6months
• Usually take > one at a
time
• Not contagious after
2wks of treatment
• INH - TUBERCULOSIS MEDICATION
Your positive skin test reaction shows that you
have been exposed to tuberculosis at some
time in the past. The tuberculosis germ is still
present in your body. If your chest x-ray is
normal, you do NOT have active TB disease.
• TB germs can live in your body without making you
sick. This is called TB infection, and this is what you
have. Your immune system has trapped the TB
germs. However, if your immune system or body
defenses go down, as can happen with stress, longterm illnesses, old age, or other stressors such as
alcohol abuse, the TB germs may multiply and
develop into active TB disease. TB germs can affect
other organs besides the lungs.
• We recommend that you take preventive medicine
now, before your TB infection becomes active TB
disease. This medicine, taken every day for six or
nine months, will kill the TB germs in your body so
that you will not develop active TB disease. The
medicine you will be taking is Isoniazid - also called
“INH.” This medicine may deplete your body’s stores
of vitamin B6, so you will also be given additional
vitamin B6, to counteract possible side effects from a
lack of this vitamin.
Tuberculosis
Nursing Dx
• Impaired gas exchange
• Ineffective airway
clearance
• Anxiety
• Knowledge deficit
• Alt. nutrition
Tuberculosis
Preventative measures
• Clean well ventilated living areas
• Resp. isolation
– Negative pressure room
• Vaccine?
– BCG
– Does not prevent TB
– Causes a + PPD
• If exposed take
– INH
Tuberculosis
Complications
• Malnutrition
• S/E of medication
treatment
• Multi-drug resistance
• Spread of TB infection
Small Group Questions
1.
2.
3.
4.
5.
What type of pathogen is TB?
What is the mode of transmission?
What are the classic S&S of TB ?
How to administer and read a PPD?
If a pt is PPD +, what does that mean?
Small Group Questions
6. What is the standard screening method of
TB?
7. That medications are used to treat TB, what
are their side effects?
8. Where in the US is TB most prevalent?
Why?
Lung Abscess
Pathophysiology
• Localized necrotic lesion of the lung
parenchyma containing purulent material 
• Lesion collapses and forms a cavity
Lung Abscess
Etiology / contributing
factors
• Aspiration
• Obstruction of the
bronchi
Risk Factors:
• Any one at risk for
aspiration is at risk for
lung abscess!
–
–
–
–
–
Impaired cough reflex
CNS disorders
NGT
Alcoholism
i LOC
Lung Abscess
S&S
• Most often Rt or left
side?
– Right
• Varied
–
–
–
–
Dyspnea
Weakness
Fever
Malodorous sputum
– Blood sputum
– Pleurisy
– Anorexia
Lung Abscess
Dx
• Absent / decreased BS
• Chest x-ray
• Sputum culture
• Bronchoscopy
Lung Abscess
Tx
• IV antimicrobial
– Lg amounts
• Chest drainage
– Chest physiotherapy
– TCDB
• Diet
– Protein
• ↑
– Calories
• ↑
– Catabolic state
• Bronchoscopy
– Drain lesion
• Long recovery
Lung Abscess
Prevention
• Antibiotics with dental
work
• Tx pneumonia
• HOB h w/ NGT
Lung Abscess
Complications
• Broncho-pleural fistula
Small Group Questions
1.
2.
3.
4.
5.
Describe the pathophysiology of a lung abscess in
your own words?
What is the most common etiology of a lung
abscess?
How is a lung abscess treated? – nonpharmaceutical.
What nursing education can a nurse give to patient
at risk of developing a lung abscess?
What diet is usually prescribed to a patient with a
lung abscess?
Pleurisy
Pathophysiology
• Pleural membranes
become inflamed
• ‘catch” or rub on I
• The parietal pleura has
nerve endings
• The visceral pleura does
not have nerve endings
Pleurisy
Etiology/Contributing factors
• Usually related to
another underlying
respiratory
problem/disease
–
–
–
–
Pneumonia
TB
Tumor/cancer
Trauma
Pleurisy
S&S
• #1 pain
– with respiration
– movement
– deep breath, cough,
sneeze
– localized (usually one
side or the other)
– Sharp pain on inspiration
– i when hold their breath
– i as fluid develops
• Shallow-rapid breathing
Pleurisy
•
Dx exams/procedures
–
–
S&S
Auscultation ?
•
•
–
–
pleural friction rub
lower, lateral, anterior
X-ray
Thoracentesis
Pleurisy
Tx
• Underlying cause
• Control pain
– Analgesics
– Topical application or
heat or cold
– Indomethacin (Indocin)
(NSAID)
– Narcotics
• Nerve block
• Antibiotics
Pleurisy
Nursing intervention
• Rest
• Pain sympathy
• Lay on ______ side
–
•
Affected
Splint side when DB and
cough
–
–
Pillows
Hands
•
Complications
–
–
–
Pleural effusion
Atelectasis
Empyema
Pleural Effusion: AKA - Hydrothorax
Pathophysiology
• Excess fluid collects in
the pleural space
• h fluid 
• to compression of the
lung tissue 
• atelectasis
• Effusion can be
– clear fluid
– bloody
– purulent
Pleural Effusion
• Pleural Fluid circulated
by lymphatic system.
• Can be cause be a break
in either system
– Respiratory
– Lymphatic
Pleural Effusion
Etiology
• Symptom rather than a
disease
• Generally caused by
another disorder
–
–
–
–
–
Heart failure
TB
Pneumonia
Pulmonary embolism
Tumors / Carcinoma
Pleural Effusion
S&S
• i or absent BS
• SOB
• Percussion
– dull
• Lg amts 
mediastinum to shift
towards…
– unaffected side.
• Tracheal deviation
away from…
– affected side
S&S assoc. w/ the
underlying cause.
• i.e. pneumonia:
– fever, chills, dyspnea,
cough etc.
Pleural Effusion
DX exams/procedures
• Thoracentesis
– C&S fluid
– Gram stain, acid-fast
bacillus stain
•
TB
– Cytologic analysis
•
• X-ray
malignant cells
Pleural Effusion: treatment
•
•
•
•
•
•
Thoracentesis
Chest tube
Prevent re-accumulation of
fluid
Relieve comfort, dyspnea
and respiratory
compromise
pursed lip and
diaphragmatic breathing
Remove fluids Rx.
– Lasix
• Anti-inflammatory +
analgesics
– Toradol
– NSAIDS
– Corticosteroids
• Treat underlying cause
• Chemical pleurodesis
Pleural Effusion
Nursing intervention
• Implement medical
regime
• Pain management
• Monitor chest tubes
• Assist with
thoracentesis
Empyema
Pathophysiology
•
Collection of pus in the
pleural space
Etiology
•
Usually secondary to
pneumonia, TB or lung
abscess
Clinical manifestations and
treatment
•
Same as pleural effusion
•
Elevated WBC
Hemothorax
Pathophysiology
• Do you want to take a
stab at it?
• Blood in the pleural space
Etiology
• Trauma
– #1
• Lung CA
• Pulm. emboli
Symptoms:
• Same as pneumothorax
Treatment
• Chest tube
• Treat underlying issue
Nursing Management
• Monitor chest tube
• Monitor resp. status
Small Group Questions
1. Describe the difference between pleurisy, pleural
effusion, hemothorax and empyema.
2. What is the etiology for each of the above
disorders?
3. Describe the medical treatment for the above.
4. What is the Rx treatment for each of the above?
Pneumothorax
Pathophysiology:
• “Accumulation of air
or gas in the pleural
cavity”
•
Left-sided pneumothorax (on the
right side of the image) on CT scan of
the chest with chest tube in place.
Pneumothorax
Anatomy Review- Pleural
cavity
• Visceral pleura
•
•
–
Encases lungs
Pleural space/cavity
–
–
–
–
Area between pleura
Contains fluid (4ml)
Fluid prevents friction
Fluid circulated by…
•
lymph system
Parietal pleura
–
Lines chest wall
Pneumothorax
Anatomy review - Breathing
• Diaphragm i & accessory
muscles move outward 
• Negative pressure in the
thoracic cavity 
• Negative pressure pulls air
into the lungs via the nose
and mouth
• Diaphragm & accessory
muscle relax (h) 
• air exhaled
Pneumothorax
•
If the visceral pleural is
perforated or the chest
wall & parietal pleural
are perforated
– air enters the pleural
space 
– negative pressure is
lost 
– Lung on the affected
side collapses
Pneumothorax
Classifications of
pneumothorax
• Spontaneous
pneumothorax
–
–
–
with out injury
Air enters the pleural
cavity via the airway
Farther classified as:
•
•
Primary
Secondary
Pneumothorax
Spontaneous (Primary)
Pneumothorax
• Pt. with no known lung
disease.
• D/T a rupture of a bulla
in the lung.
• Most often tall, thin
men between 20 and
40 years old.
Pneumothorax
Spontaneous Secondary
Pneumothorax
• occurs in pt. with known lung
disease
•
•
–
most often COPD
Other lung diseases
commonly assoc. with
–
–
–
–
–
Tuberculosis
Pneumonia
Asthma
cystic fibrosis
lung cancer
Often severe & life
threatening
Pneumothorax
•
Traumatic
Pneumothorax
– D/T injury to the chest
wall
– Further classified as
Open or closed
Pneumothorax
Open Pneumothorax
• Air enters pleural cavity via
outside
• A free communication
between the exterior and
the pleural space as through
an open wound
– blowing wound
– sucking wound
• may be caused by a
penetrating injury
– stab wound,
– gunshot wound
– impaled object
Pneumothorax
Closed pneumothorax
• Air enters the pleural
cavity via lungs
• D/t/ blunt chest
trauma
– Car crash
– Fall
– Crushing chest injury
Pneumothorax
Iatrogenic pneumothorax
• D/T procedure /
treatment
Pneumothorax
Tension Peumothorax
• air accumulates in the
pleural space with each
breath.
• The remorseless increase
in intrathoracic pressure

• massive shifts of the
mediastinum away from
the affected lung 
• compressing intrathoracic
vessels 
• cardiovascular collapse
Pneumothorax
Tension Pneumonthorax
• a piece of tissue forms
a one-way valve that
allows air to enter the
pleural cavity but not to
escape, overpressure
can build up with every
breath
Pneumothorax
Etiology / Contributing factors
•
Spontaneous
–
–
•
Lung disease - COPD
Tall, thin men
Traumatic
–
–
A penetrating chest wound
Barotrauma
•
•
scuba divers
Iatrogenic Pneumothorax
–
–
–
–
* insertion of a central line
* thoracic surgery
* thoracentesis
* pleural or transbronchial
biopsy.
Pneumothorax
Clinical Manifestations (all
types)
•
•
•
•
•
Sudden sharp chest pain
Asymmetrical chest
expansion
dyspnea
Cyanosis
Percussion
–
Hyper resonance or
tympany
• Breath sounds
– diminished
– Absent
Pneumothorax
Clinical Manifestations (all
types)
• Respiratory distress
• O2 Sats
– decreased
• Tachypnea
• Tachycardia
• Restlessness/ Anxiety
Pneumothorax
S&S of open
pneumothorax
•
Cripitus
– (subcutaneous
emphysema)
•
Sucking chest wound”
Pneumothorax
S&S Tension pneumothorax
• i cardiac output
• Hypotension
• Tachycardia (compensatory)
• Tachypnea
• Mediastinal shift and
tracheal deviation
–
•
•
To the unaffected side
Cardiac arrest
Distended neck veins
Pneumothorax
Dx exam and tests
• HX & PE
• Chest x-ray
• ABG’s
–
Initial PaCO2
•
•
–
Decreased
respiratory alkalosis
Later ABG’s
•
•
•
Hypoxemia
Hypercapnia
Acidosis
Pneumothorax
Treatment - First aid:
Open pneumothorax
• Cover immediately
with an occulsive
dressing, made airtight with petroleum
jelly or clean plastic
sheeting.
Pneumothorax
Tx: Small pneumothorax
• Spontaneous recovery
– Bed rest
– resolve on its own in 1
to 2 weeks
•
Remove with small
bore needle inserted
into the pleural space
Pneumothorax
Tx: Larger pneumothorax
• Chest tube
• Surgery repair
• Pleurodesis
–
–
–
•
•
“glue”
Very painful
Prep with analgesic
O2
Surgery
Pneumothorax
Nursing interventions
• Closely monitor resp status
• Frequent assess
•
•
•
•
•
–
–
–
–
–
LOC
Color
VS
Chest pain?
Restlessness?
Chest Tube
Rest/Activity Balance
Sedation
Provide a means for
communicate
Educate patient & family
• Notify MD for:
– SpO2 < 90% or Change
Greater Than 5%
– Extubation
– Respiratory Distress
– Inadequate Sedation
– h Peak Airway Pressure
(Especially with Pressure
Control Mode)
Pneumothorax
Complications
• Recurrent
pneumothorax
– D/C
•
•
•
•
•
smoking
high altitudes
scuba diving
flying in unpressurized
aircrafts
Cardiac damage
Question?
A client who has been on a ventilator for two
days experiences acute respiratory distress
accompanied by distended neck veins. The
best action of the nurse is to:
A. hand ventilate the client.
B. prepare for chest tube insertion.
C. call the physician immediately.
D. perform emergency chest decompression.
• The question is asking what the nurse should do when a client
on a ventilator has these symptoms. When acute respiratory
distress occurs along with neck vein distension, cyanosis and
tracheal shift are evident, a tension pneumothorax has
probably occurred. The client should be removed from the
machine and ventilated by hand. Then the physician should
be notified (option c). Equipment for chest tube insertion
should be gathered (option b) so it will be ready for
immediate use by the physician. Emergency chest
decompression (option d) should only be attempted after
specific training and if the physician will be delayed.
•
A patient is being treated with chest tubes because
of a pneumothorax. The nurse recognizes that
chest tubes may be used to:
–
–
–
–
–
Prevent pleural irritation
Regain positive intra-pleural pressure
Remove air from the intra-pleural space
All of the above
None of the above
Small Group Questions
1.
2.
3.
4.
5.
What is the pathophysiology of a pneumothorax?
Describe the anatomy of the pleural membrane
(including nerves endings)
What is a spontaneous pneumothorax?
What are some examples of an iatrogenic
pneumothorax?
Define an open and closed pneumothorax.
Small Group Questions
6. Describe the mediastial shift in an pneumothorax.
7. 7. What is the first aid treatment of a traumatic
pneumothorax (include assessment)
8. What is Pleurodesis?
9. What ABG’s would you expect to see late in a
patient with a pneumothorax?