Interventions for Clients with Interventions for Clients with Noninfectious Problems of the Noninfectious Problems of the Upper and Lower Respiratory Upper and Lower Respiratory

TractTract

Fracture of the NoseFracture of the Nose

Displacement of either the bone or cartilage Displacement of either the bone or cartilage of the nose can cause airway obstruction or of the nose can cause airway obstruction or cosmetic deformity and is a potential source cosmetic deformity and is a potential source of infection.of infection.

Cerebrospinal fluid could indicate skull Cerebrospinal fluid could indicate skull fracture.fracture.

Interventions:Interventions:– RhinoplastyRhinoplasty– NasoseptoplastyNasoseptoplasty

Immediate postoperative appearance of a client who has undergone rhinoplasty. Note the splint and gauze drip pad (moustache dressing).

EpistaxisEpistaxis

Nosebleed is a common problem.Nosebleed is a common problem. Interventions if nosebleed does Interventions if nosebleed does

not respond to emergency care:not respond to emergency care:– Affected capillaries are cauterized Affected capillaries are cauterized

with silver nitrate or electrocautery with silver nitrate or electrocautery and the nose is packed.and the nose is packed.

– Posterior nasal bleeding is an Posterior nasal bleeding is an emergency.emergency.

(Continued)(Continued)

EpistaxisEpistaxis (Continued) (Continued)

– Assess for respiratory distress and for Assess for respiratory distress and for tolerance of packing or tubes.tolerance of packing or tubes.

– Administer humidification, oxygen, Administer humidification, oxygen, bedrest, antibiotics, pain medications.bedrest, antibiotics, pain medications.

Client with balloon stents in place to control a posterior nasal bleed.

Nasal PolypsNasal Polyps

Benign, grapelike clusters of Benign, grapelike clusters of mucous membranes and mucous membranes and connective tissueconnective tissue

May obstruct nasal breathing, May obstruct nasal breathing, change character of nasal change character of nasal discharge, and change speech discharge, and change speech qualityquality

Surgery: treatment of choiceSurgery: treatment of choice

Cancer of the Nose and Cancer of the Nose and SinusesSinuses

Cancer of the nose and sinuses is Cancer of the nose and sinuses is rare and can be benign or rare and can be benign or malignant.malignant.

Onset is slow and manifestations Onset is slow and manifestations resemble sinusitis.resemble sinusitis.

Local lymph enlargement often Local lymph enlargement often occurs on the side with tumor mass.occurs on the side with tumor mass.

Radiation therapy is the main Radiation therapy is the main treatment; surgery is also used.treatment; surgery is also used.

Facial TraumaFacial Trauma

Le Fort I nasoethmoid complex Le Fort I nasoethmoid complex fracturefracture

Le Fort II maxillary and Le Fort II maxillary and nasoethmoid complex fracturenasoethmoid complex fracture

Le Fort III combination of I and II Le Fort III combination of I and II plus an orbital-zygoma fracture, plus an orbital-zygoma fracture, often called often called craniofacial craniofacial disjunctiondisjunction

First assessment: airwayFirst assessment: airway

Facial Trauma Facial Trauma InterventionsInterventions

Anticipate the need for Anticipate the need for emergency intubation, emergency intubation, tracheotomy, and tracheotomy, and cricothyroidotomy.cricothyroidotomy.

Control hemorrhage.Control hemorrhage. Assess for extent of injury.Assess for extent of injury. Treat shock.Treat shock. Stabilize the fracture segment.Stabilize the fracture segment.

Obstructive Sleep ApneaObstructive Sleep Apnea

Breathing disruption during sleep that lasts Breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum at least 10 seconds and occurs a minimum of five times in an hourof five times in an hour

Excessive daytime sleepiness, inability to Excessive daytime sleepiness, inability to concentrate, and irritabilityconcentrate, and irritability

Nonsurgical managementNonsurgical management– noninvasive positive-pressure ventilation (NPPV) noninvasive positive-pressure ventilation (NPPV)

to hold open the upper airways. Essentially, a to hold open the upper airways. Essentially, a nasal mask or full-face mask delivery system nasal mask or full-face mask delivery system allows mechanical delivery of either Bi-level allows mechanical delivery of either Bi-level positive airway pressure (BiPAP) or nasal positive airway pressure (BiPAP) or nasal continuous positive airway pressurecontinuous positive airway pressure

– change of sleep positionchange of sleep position Surgical management: Surgical management:

uvulopalatopharyngoplastyuvulopalatopharyngoplasty

Disorders of the LarynxDisorders of the Larynx

Vocal cord paralysisVocal cord paralysis Vocal cord nodules and polypsVocal cord nodules and polyps Laryngeal traumaLaryngeal trauma

Bilateral vocal cord nodules caused by contact and voice abuse, often seen after viral illnesses

A hemorrhagic vocal cord polyp

Upper Airway ObstructionUpper Airway Obstruction

Life-threatening emergency in Life-threatening emergency in which an interruption in airflow which an interruption in airflow through the nose, mouth, through the nose, mouth, pharynx, or larynx occurs.pharynx, or larynx occurs.

Early recognition is essential to Early recognition is essential to prevent further complications, prevent further complications, including respiratory arrest.including respiratory arrest.

Upper Airway Obstruction Upper Airway Obstruction InverventionsInverventions

Interventions include:Interventions include:– Assessment for cause of the obstructionAssessment for cause of the obstruction– Maintenance of patent airway and ventilationMaintenance of patent airway and ventilation

CricothyroidotomyCricothyroidotomy Endotracheal intubationEndotracheal intubation TracheostomyTracheostomy

Neck TraumaNeck Trauma

Neck trauma may be caused by a knife, Neck trauma may be caused by a knife, gunshot, or traumatic accident.gunshot, or traumatic accident.

Assess for other injuries including Assess for other injuries including cardiovascular, respiratory, intestinal, cardiovascular, respiratory, intestinal, and neurologic damage.and neurologic damage.

Assess for patent airway.Assess for patent airway. Assess carotid artery and esophagus.Assess carotid artery and esophagus. Assess for cervical spine injuries and Assess for cervical spine injuries and

prevent excess neck movement.prevent excess neck movement.

Head and Neck CancerHead and Neck Cancer

Head and neck cancers can Head and neck cancers can disrupt breathing, eating, facial disrupt breathing, eating, facial appearance, self-image, speech, appearance, self-image, speech, and communication.and communication.

In laryngeal cancer, hoarseness In laryngeal cancer, hoarseness may occur because of tumor bulk may occur because of tumor bulk and inability of the vocal cords and inability of the vocal cords to come together for normal to come together for normal phonation.phonation.

Ineffective Breathing Ineffective Breathing PatternPattern

Interventions include:Interventions include:– Treatment goal: to remove or Treatment goal: to remove or

eradicate the cancer while eradicate the cancer while preserving as much normal function preserving as much normal function as possibleas possible

– Nonsurgical managementNonsurgical management– Radiation therapyRadiation therapy– Chemotherapy Chemotherapy

Surgical ManagementSurgical Management

Laryngectomy (total and partial)Laryngectomy (total and partial) TracheostomyTracheostomy Oropharyngeal cancer resectionsOropharyngeal cancer resections Cordal strippingCordal stripping Cordectomy Cordectomy

Preoperative CarePreoperative Care

Client and family teaching about Client and family teaching about the tumorthe tumor

Self-care of airwaySelf-care of airway Methods of communicationMethods of communication Suctioning Suctioning Pain control methodsPain control methods Critical care environmentCritical care environment Nutritional supportNutritional support Goals for dischargeGoals for discharge

Postoperative CarePostoperative Care

Monitor airway patency, vital Monitor airway patency, vital signs, hemodynamic status, signs, hemodynamic status, comfort level.comfort level.

Monitor for hemorrhage.Monitor for hemorrhage. Assess for complications:Assess for complications:

– Airway obstructionAirway obstruction– HemorrhageHemorrhage– Wound breakdownWound breakdown– Tumor recurrenceTumor recurrence

Airway Maintenance and Airway Maintenance and VentilationVentilation

Ventilatory assistance and weaningVentilatory assistance and weaning Total laryngectomy appliance to Total laryngectomy appliance to

prevent scar tissueprevent scar tissue Coughing and deep breathingCoughing and deep breathing Saline instillationsSaline instillations Oral secretionsOral secretions Stoma care – a combination of Stoma care – a combination of

wound care and airway carewound care and airway care

Wound, Flap, and Wound, Flap, and Reconstructive Tissue CareReconstructive Tissue Care

Pectoralis major myocutaneous flapsPectoralis major myocutaneous flaps Island flapsIsland flaps Rotation flapsRotation flaps Trapezius flapsTrapezius flaps Split-thickness skin graftsSplit-thickness skin grafts Free flaps with microvascular Free flaps with microvascular

anastomosisanastomosis Critical stage: first 24 hr after surgeryCritical stage: first 24 hr after surgery

Hemorrhage Hemorrhage

Uncommon with laryngectomyUncommon with laryngectomy Often surgical drain placed by Often surgical drain placed by

surgeon in the neck area to surgeon in the neck area to collect blood collect blood and drainage for approximately 72 hours postoperatively

Wound BreakdownWound Breakdown

Common complication caused by Common complication caused by poor nutrition, alcohol use, poor nutrition, alcohol use, wound contamination, and wound contamination, and previous radiation therapyprevious radiation therapy

Packing and local care as Packing and local care as prescribed to keep wound clean prescribed to keep wound clean and to stimulate growth of and to stimulate growth of healthy granulation tissuehealthy granulation tissue

Risk of carotid artery ruptureRisk of carotid artery rupture

Pain ManagementPain Management

MorphineMorphine Acetaminophen with codeineAcetaminophen with codeine Acetaminophen aloneAcetaminophen alone Nonsteroidal anti-inflammatory Nonsteroidal anti-inflammatory

drugsdrugs

NutritionNutrition

NasogastricNasogastric GastrostomyGastrostomy JejunostomyJejunostomy Parenteral nutrition until the Parenteral nutrition until the

gastrointestinal tract recovers gastrointestinal tract recovers from the effects of anesthesiafrom the effects of anesthesia

No aspiration after total No aspiration after total laryngectomy because the laryngectomy because the airway and esophagus are airway and esophagus are completely separatedcompletely separated

Speech RehabilitationSpeech Rehabilitation

Writing or using a picture boardWriting or using a picture board Artificial larynxArtificial larynx Esophageal speech: sound produced Esophageal speech: sound produced

by “burping” the air swallowed or by “burping” the air swallowed or injected into the esophageal pharynx injected into the esophageal pharynx and shaping the words in the mouthand shaping the words in the mouth

Mechanical devices (electrolarynges)Mechanical devices (electrolarynges) Tracheoesophageal fistulaTracheoesophageal fistula

Risk for AspirationRisk for Aspiration

Interventions include:Interventions include:– Dynamic swallow studyDynamic swallow study– Enteral feedingsEnteral feedings– Routine reflux precautionsRoutine reflux precautions

Elevation of the head of bedElevation of the head of bed Strict adherence to tube feeding Strict adherence to tube feeding

regimenregimen No bolus feeding at nightNo bolus feeding at night Checking residual feedingChecking residual feeding

Anxiety InterventionsAnxiety Interventions

Interventions include:Interventions include:– Team conferenceTeam conference– Explore reason for anxietyExplore reason for anxiety– TeachingTeaching– Antianxiety drugs such as diazepam Antianxiety drugs such as diazepam

administered with caution because administered with caution because of the possibility of respiratory of the possibility of respiratory depressiondepression

– Lorazepam Lorazepam

Disturbed Body ImageDisturbed Body Image

Interventions include:Interventions include:– Helping client and family set Helping client and family set

realistic goalsrealistic goals– Involving client in self-careInvolving client in self-care– Teaching alternate communication Teaching alternate communication

methodsmethods– Easing client into a more normal Easing client into a more normal

social environment after the social environment after the hospitalizationhospitalization

(Continued)(Continued)

Disturbed Body ImageDisturbed Body Image (Continued)(Continued)

– Advising loose-fitting, high-collar Advising loose-fitting, high-collar shirts or sweaters, scarves, jewelry, shirts or sweaters, scarves, jewelry, or cosmetics to be worn to cover or cosmetics to be worn to cover the laryngectomy stomathe laryngectomy stoma

Stoma CareStoma Care

Apply shield over the Apply shield over the tracheostomy tube or tracheostomy tube or laryngectomy stoma when laryngectomy stoma when bathing to prevent water from bathing to prevent water from entering the airway. entering the airway.

Apply protective stoma cover or Apply protective stoma cover or guard to protect the stoma during guard to protect the stoma during the day.the day.

Instruct client how to increase Instruct client how to increase humidity in the home.humidity in the home.

Interventions for Interventions for Clients with Clients with

Noninfectious Problems Noninfectious Problems of the Lower of the Lower

Respiratory TractRespiratory Tract

Chronic Airflow LimitationChronic Airflow Limitation

Chronic lung diseases of chronic Chronic lung diseases of chronic airflow limitation include:airflow limitation include:– AsthmaAsthma– Chronic bronchitisChronic bronchitis– Pulmonary emphysemaPulmonary emphysema

Chronic obstructive pulmonary Chronic obstructive pulmonary disease includes emphysema and disease includes emphysema and chronic bronchitis characterized chronic bronchitis characterized by bronchospasm and dyspnea.by bronchospasm and dyspnea.

Asthma Asthma

Intermittent and reversible Intermittent and reversible airflow obstruction affects only airflow obstruction affects only the airways, not the alveoli.the airways, not the alveoli.

Airway obstruction occurs due to Airway obstruction occurs due to inflammation and airway inflammation and airway hyperresponsiveness.hyperresponsiveness.

Aspirin and Other Aspirin and Other NonsteroidalNonsteroidal

Anti-Inflammatory DrugsAnti-Inflammatory Drugs Incidence of asthma symptoms after Incidence of asthma symptoms after

taking aspirin and other nonsteroidal taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)anti-inflammatory drugs (NSAIDs)

However, response not a true allergyHowever, response not a true allergy Results from increased production of Results from increased production of

leukotriene when other inflammatory leukotriene when other inflammatory pathways are suppressedpathways are suppressed

CollaborativeCollaborative ManagementManagement AssessmentAssessment HistoryHistory

– (dyspnea), chest tightness, coughing, wheezing, and (dyspnea), chest tightness, coughing, wheezing, and excessive mucus productionexcessive mucus production

– history of such symptoms lasting history of such symptoms lasting 4 4 to to 8 8 weeks weeks following a chest cold or other upper respiratory tract following a chest cold or other upper respiratory tract infectioninfection

– the client with atopic or allergic asthma may also the client with atopic or allergic asthma may also have other allergic symptoms such as rhinitis, skin have other allergic symptoms such as rhinitis, skin rash, or pruritusrash, or pruritus

– family membersfamily members Physical assessment and clinical Physical assessment and clinical

manifestations:manifestations:– No manifestations between attacksNo manifestations between attacks– Audible wheeze and increased respiratory rateAudible wheeze and increased respiratory rate– Use of accessory musclesUse of accessory muscles– ““Barrel chest” from air trappingBarrel chest” from air trapping

Laboratory AssessmentLaboratory Assessment

Assess arterial blood gas level.Assess arterial blood gas level. Arterial oxygen level may Arterial oxygen level may

decrease in acute asthma attack.decrease in acute asthma attack. Arterial carbon dioxide level may Arterial carbon dioxide level may

decrease early in the attack and decrease early in the attack and increase later indicating poor gas increase later indicating poor gas exchange.exchange.

(Continued)(Continued)

Laboratory AssessmentLaboratory Assessment (Continued)(Continued)

Atopic asthma with elevated Atopic asthma with elevated serum eosinophil count and serum eosinophil count and immunoglobulin E levelsimmunoglobulin E levels

Sputum with eosinophils and Sputum with eosinophils and mucous plugs with shed mucous plugs with shed epithelial cellsepithelial cells

Pulmonary Function TestsPulmonary Function Tests

The most accurate measures for The most accurate measures for asthma are pulmonary function asthma are pulmonary function tests using spirometry including:tests using spirometry including:– Forced vital capacity (FVC)Forced vital capacity (FVC)– Forced expiratory volume in the Forced expiratory volume in the

first second (FEVfirst second (FEV11))– Peak expiratory rate flow (PERF)Peak expiratory rate flow (PERF)– Chest x-rays to rule out other Chest x-rays to rule out other

causescauses

Interventions Interventions

Client education: asthma is often an Client education: asthma is often an intermittent disease; with guided intermittent disease; with guided self-care, clients can co-manage self-care, clients can co-manage this disease, increasing symptom-this disease, increasing symptom-free periods and decreasing the free periods and decreasing the number and severity of attacks.number and severity of attacks.

Peak flow meter can be used twice Peak flow meter can be used twice daily by client.daily by client.

Drug therapy plan is specific.Drug therapy plan is specific.

Drug TherapyDrug Therapy

Pharmacologic management of Pharmacologic management of asthma can involve the use of:asthma can involve the use of:

BronchodilatorsBronchodilators BetaBeta22 agonists agonists Short-acting betaShort-acting beta22 agonists agonists

Long-acting betaLong-acting beta22 agonists agonists Cholinergic antagonistsCholinergic antagonists

(Continued)(Continued)

Drug TherapyDrug Therapy (Continued) (Continued)

MethylxanthinesMethylxanthines Anti-inflammatory agentsAnti-inflammatory agents CorticosteroidsCorticosteroids Inhaled anti-inflammatory agentsInhaled anti-inflammatory agents Mast cell stabilizersMast cell stabilizers Monoclonal antibodiesMonoclonal antibodies Leukotriene agonistsLeukotriene agonists

Other Treatments for Other Treatments for AsthmaAsthma

Exercise and activity is a Exercise and activity is a recommended therapy that recommended therapy that promotes ventilation and promotes ventilation and perfusion.perfusion.

Oxygen therapy is delivered via Oxygen therapy is delivered via mask, nasal cannula, or mask, nasal cannula, or endotracheal tube in acute endotracheal tube in acute asthma attack.asthma attack.

Status AsthmaticusStatus Asthmaticus

Status asthmaticus is a severe, life-Status asthmaticus is a severe, life-threatening acute episode of threatening acute episode of airway obstruction that intensifies airway obstruction that intensifies once it begins and often does not once it begins and often does not respond to common therapy.respond to common therapy.

If the condition is not reversed, the If the condition is not reversed, the client may develop pneumothorax client may develop pneumothorax and cardiac or respiratory arrest.and cardiac or respiratory arrest.

Emergency department treatment Emergency department treatment is recommended.is recommended.

EmphysemaEmphysema

In pulmonary emphysema, loss of In pulmonary emphysema, loss of lung elasticity and hyperinflation of lung elasticity and hyperinflation of the lungthe lung

Dyspnea and the need for an Dyspnea and the need for an increased respiratory rateincreased respiratory rate

Air trapping, loss of elastic recoil in Air trapping, loss of elastic recoil in the alveolar walls, overstretching and the alveolar walls, overstretching and enlargement of the alveoli into enlargement of the alveoli into bullae, and collapse of small airways bullae, and collapse of small airways (bronchioles)(bronchioles)

Classification of Classification of EmphysemaEmphysema

Panlobular: Panlobular: destruction of the destruction of the entire alveolusentire alveolus

Centrilobular:Centrilobular: openings openings occurring in the bronchioles that occurring in the bronchioles that allow spaces to develop as tissue allow spaces to develop as tissue walls break downwalls break down

Paraseptal:Paraseptal: confined to the confined to the alveolar ducts and alveolar sacsalveolar ducts and alveolar sacs

Chronic BronchitisChronic Bronchitis

Inflammation of the bronchi and Inflammation of the bronchi and bronchioles caused by chronic exposure bronchioles caused by chronic exposure to irritants, especially tobacco smoketo irritants, especially tobacco smoke

Inflammation, vasodilation, congestion, Inflammation, vasodilation, congestion, mucosal edema, and bronchospasmmucosal edema, and bronchospasm

Affects only the airways, not the alveoliAffects only the airways, not the alveoli Production of large amounts of thick Production of large amounts of thick

mucusmucus

Complications Complications

Hypoxemia and acidosis Hypoxemia and acidosis Respiratory infectionsRespiratory infections Cardiac failure, especially cor Cardiac failure, especially cor

pulmonalepulmonale Cardiac dysrhythmiasCardiac dysrhythmias

Physical Assessment and Physical Assessment and Clinical ManifestationsClinical Manifestations

Unplanned weight loss; loss of Unplanned weight loss; loss of muscle mass in the extremities; muscle mass in the extremities; enlarged neck muscles; slow enlarged neck muscles; slow moving, slightly stooped moving, slightly stooped posture; sits with forward-bendposture; sits with forward-bend

Respiratory changesRespiratory changes Cardiac changesCardiac changes

Laboratory AssessmentLaboratory Assessment

Status of arterial blood gas values for Status of arterial blood gas values for abnormal oxygenation, ventilation, abnormal oxygenation, ventilation, and acid-base statusand acid-base status

Sputum samplesSputum samples Hemoglobin and hematocrit blood Hemoglobin and hematocrit blood

teststests Serum alphaSerum alpha11-antitrypsin levels drawn-antitrypsin levels drawn Chest x-rayChest x-ray Pulmonary function testPulmonary function test

Impaired Gas ExchangeImpaired Gas Exchange

Interventions for chronic Interventions for chronic obstructive pulmonary disease:obstructive pulmonary disease:– Airway managementAirway management– Monitoring client at least every 2 Monitoring client at least every 2

hours hours – Oxygen therapyOxygen therapy– Energy managementEnergy management

Drug TherapyDrug Therapy

Beta-adrenergic agentsBeta-adrenergic agents Cholinergic antagonistsCholinergic antagonists MethylxanthinesMethylxanthines CorticosteroidsCorticosteroids Cromolyn sodium/nedocromilCromolyn sodium/nedocromil Leukotriene modifiersLeukotriene modifiers MucolyticsMucolytics

Surgical ManagementSurgical Management

Lung transplantation for end-Lung transplantation for end-stage clientsstage clients

Preoperative care and testingPreoperative care and testing Operative procedure through a Operative procedure through a

large midline incision or a large midline incision or a transverse anterior thoracotomytransverse anterior thoracotomy

Postoperative care and close Postoperative care and close monitoring for complicationsmonitoring for complications

Ineffective Breathing Ineffective Breathing PatternPattern

Interventions for the chronic Interventions for the chronic obstructive pulmonary disease obstructive pulmonary disease client:client:– Assessment of clientAssessment of client– Assessment of respiratory infectionAssessment of respiratory infection– Pulmonary rehabilitation therapyPulmonary rehabilitation therapy– Specific breathing techniquesSpecific breathing techniques– Positioning to help alleviate Positioning to help alleviate

dyspneadyspnea– Exercise conditioningExercise conditioning– Energy conservation Energy conservation

Ineffective Airway Ineffective Airway ClearanceClearance

Assessment of breath sounds Assessment of breath sounds before and after interventions before and after interventions

Interventions for compromised Interventions for compromised breathing:breathing:– Careful use of drugsCareful use of drugs– Controlled coughingControlled coughing– Suctioning Suctioning – Hydration via beverage and Hydration via beverage and

humidifierhumidifier (Continued)(Continued)

Ineffective Airway Ineffective Airway ClearanceClearance (Continued) (Continued)

– Postural drainage in sitting position Postural drainage in sitting position when possiblewhen possible

– Tracheostomy Tracheostomy

Imbalanced NutritionImbalanced Nutrition

Interventions to achieve and Interventions to achieve and maintain body weight:maintain body weight:– Prevent protein-calorie malnutrition Prevent protein-calorie malnutrition

through dietary consultation.through dietary consultation.– Monitor weight, skin condition, and Monitor weight, skin condition, and

serum prealbumin levels.serum prealbumin levels.– Address food intolerance, nausea, Address food intolerance, nausea,

early satiety, loss of appetite, and early satiety, loss of appetite, and meal-related dyspnea meal-related dyspnea

Anxiety Anxiety

Interventions for increased Interventions for increased anxiety:anxiety:– Important to have client understand Important to have client understand

that anxiety will worsen symptomsthat anxiety will worsen symptoms– Plan ways to deal with anxietyPlan ways to deal with anxiety

Health TeachingHealth Teaching

Instruct the client:Instruct the client:– Pursed-lip and diaphragmatic Pursed-lip and diaphragmatic

breathingbreathing– Support of family and friendsSupport of family and friends– Relaxation therapyRelaxation therapy– Professional counseling accessProfessional counseling access– Complementary and alternative Complementary and alternative

therapytherapy

Activity IntoleranceActivity Intolerance

Interventions to increase activity Interventions to increase activity level:level:– Encourage client to pace activities Encourage client to pace activities

and promote self-care.and promote self-care.– Do not rush through morning Do not rush through morning

activities.activities.– Gradually increase activity.Gradually increase activity.– Use supplemental oxygen therapy.Use supplemental oxygen therapy.

Potential for Pneumonia or Potential for Pneumonia or Other Respiratory Other Respiratory

InfectionsInfections Risk is greater for older clientsRisk is greater for older clients Interventions include:Interventions include:

– Avoidance of large crowdsAvoidance of large crowds– Pneumonia vaccinationPneumonia vaccination– Yearly influenza vaccineYearly influenza vaccine

Cystic FibrosisCystic Fibrosis

Genetic disease affecting many Genetic disease affecting many organs, lethally impairing organs, lethally impairing pulmonary function pulmonary function

Present from birth, first seen in Present from birth, first seen in early childhood (many clients now early childhood (many clients now live to adulthood)live to adulthood)

Error of chloride transport, Error of chloride transport, producing mucus with low water producing mucus with low water contentcontent

Problems in lungs, pancreas, Problems in lungs, pancreas, liver, salivary glands, and testesliver, salivary glands, and testes

Nonpulmonary Nonpulmonary ManifestationsManifestations

Adults: usually smaller and thinner Adults: usually smaller and thinner than average owing to than average owing to malnutritionmalnutrition

Abdominal distentionAbdominal distention Gastroesophageal reflux, rectal Gastroesophageal reflux, rectal

prolapse, foul-smelling stools, prolapse, foul-smelling stools, steatorrheasteatorrhea

Vitamin deficienciesVitamin deficiencies Diabetes mellitusDiabetes mellitus

Pulmonary ManifestationsPulmonary Manifestations

Respiratory infectionsRespiratory infections Chest congestionChest congestion Limited exercise toleranceLimited exercise tolerance Cough and sputum productionCough and sputum production Use of accessory musclesUse of accessory muscles Decreased pulmonary functionDecreased pulmonary function Changes in chest x-ray resultChanges in chest x-ray result Increased anteroposterior Increased anteroposterior

diameter of chestdiameter of chest

Exacerbation TherapyExacerbation Therapy

Avoid mechanical ventilationAvoid mechanical ventilation Airway clearanceAirway clearance Increased oxygenationIncreased oxygenation Antibiotic therapyAntibiotic therapy Heliox (50% oxygen, 50% helium) Heliox (50% oxygen, 50% helium)

therapytherapy Bronchodilator and mucolytic Bronchodilator and mucolytic

therapiestherapies

Surgical TherapySurgical Therapy

Lung and/or pancreatic Lung and/or pancreatic transplantation do not cure the transplantation do not cure the disease; the genetic defect in chloride disease; the genetic defect in chloride transport and the thick, sticky mucus transport and the thick, sticky mucus remain.remain.

Transplantation extends life by 10 to Transplantation extends life by 10 to 20 years.20 years.

Single-lung transplant as well as Single-lung transplant as well as double-lung transplantation is double-lung transplantation is possible.possible.

Primary Pulmonary Primary Pulmonary HypertensionHypertension

The disorder occurs in the absence The disorder occurs in the absence of other lung disorders, and its of other lung disorders, and its cause is unknown although cause is unknown although exposure to some drugs increases exposure to some drugs increases the risk.the risk.

The pathologic problem is blood The pathologic problem is blood vessel constriction with increasing vessel constriction with increasing vascular resistance in the lung.vascular resistance in the lung.

The heart fails (cor pulmonale).The heart fails (cor pulmonale). Without treatment, death occurs Without treatment, death occurs

within 2 years.within 2 years.

Interventions Interventions

Warfarin therapyWarfarin therapy Calcium channel blockersCalcium channel blockers Prostacyclin agentsProstacyclin agents Digoxin and diureticsDigoxin and diuretics Oxygen therapyOxygen therapy Surgical managementSurgical management

Interstitial Pulmonary Interstitial Pulmonary DiseaseDisease

Affects the alveoli, blood vessels, Affects the alveoli, blood vessels, and surrounding support tissue of and surrounding support tissue of the lungs rather than the airwaysthe lungs rather than the airways

Restrictive disease: thickened lung Restrictive disease: thickened lung tissue, reduced gas exchange, tissue, reduced gas exchange, “stiff” lungs that do not expand “stiff” lungs that do not expand wellwell

Slow onset of disease Slow onset of disease Dyspnea commonDyspnea common

SarcoidosisSarcoidosis

Granulomatous disorder of unknown Granulomatous disorder of unknown cause that can affect any organ, but cause that can affect any organ, but the lung is involved most oftenthe lung is involved most often

Autoimmune responses in which the Autoimmune responses in which the normally protective T-lymphocytes normally protective T-lymphocytes increase and damage lung tissueincrease and damage lung tissue

Interventions (corticosteroids): Interventions (corticosteroids): lessen symptoms and prevent lessen symptoms and prevent fibrosisfibrosis

Idiopathic Pulmonary Idiopathic Pulmonary FibrosisFibrosis

Common restrictive lung diseaseCommon restrictive lung disease Example of excessive wound healingExample of excessive wound healing Inflammation that continues beyond Inflammation that continues beyond

normal healing time, causing normal healing time, causing extensive fibrosis and scarringextensive fibrosis and scarring

Mainstays of therapy: corticosteroids, Mainstays of therapy: corticosteroids, which slow the fibrotic process and which slow the fibrotic process and manage dyspneamanage dyspnea

Occupational Pulmonary Occupational Pulmonary Disease Disease

Can be caused by exposure to Can be caused by exposure to occupational or environmental occupational or environmental fumes, dust, vapors, gases, fumes, dust, vapors, gases, bacterial or fungal antigens, or bacterial or fungal antigens, or allergensallergens

Worsened by cigarette smokeWorsened by cigarette smoke Interventions: special respirators Interventions: special respirators

that ensure adequate ventilationthat ensure adequate ventilation

Lung CancerLung Cancer

A leading cause of cancer deaths A leading cause of cancer deaths worldwideworldwide

Metastasizes at late-stage Metastasizes at late-stage diagnosisdiagnosis

Paraneoplastic syndromesParaneoplastic syndromes Staged to assess size and extent Staged to assess size and extent

of diseaseof disease Etiology and genetic risk Etiology and genetic risk

(Continued)(Continued)

Lung CancerLung Cancer (Continued) (Continued)

Incidence and prevalence make Incidence and prevalence make lung cancer a major health lung cancer a major health problem.problem.

Health promotion and illness Health promotion and illness prevention is primarily through prevention is primarily through education strategies and education strategies and reduced tobacco smoking.reduced tobacco smoking.

Manifestations of Lung Manifestations of Lung CancerCancer

Often nonspecific, appearing late Often nonspecific, appearing late in the disease processin the disease process

Chills, fever, and coughChills, fever, and cough Assess sputumAssess sputum Breathing patternBreathing pattern PalpationPalpation PercussionPercussion Auscultation Auscultation

Surgical ManagementSurgical Management

LobectomyLobectomy PneumonectomyPneumonectomy Segmentectomy (wedge Segmentectomy (wedge

resection)resection)

Chest TubesChest Tubes

Placement after thoracotomyPlacement after thoracotomy Drainage systemDrainage system Care required:Care required:

– Monitor hourly to ensure sterility Monitor hourly to ensure sterility and patency.and patency.

– Tape tubing junctions.Tape tubing junctions.– Keep occlusive dressing at insertion Keep occlusive dressing at insertion

site.site.– Position correctly to prevent kinks Position correctly to prevent kinks

and large loops.and large loops.

Interventions for PalliationInterventions for Palliation

Oxygen therapyOxygen therapy Drug therapyDrug therapy Radiation therapyRadiation therapy Laser therapyLaser therapy Thoracentesis and pleurodesisThoracentesis and pleurodesis Dyspnea managementDyspnea management Pain managementPain management