PNEUMONIA
-inflammation of alveolar lung spaces resulting into consolidation of the lung as exudates fill alveoli
CAUSES:
-infections
-aspiration of food
-inhalation of toxic or caustic substances
Common Infecting Organisms:
GRAM POSITIVE
-Strep pneumonia: community acquired pneumonia (cap)
-Staph. Aureus:DM, drug users, patient's on hemodialysis
GRAM NEGATIVE
-H. influenza: children
-P.aeroginosa:hospital acquired
-L.pneumophila:inhalation with airconditioning units
FUNGAL
-P. carinii:AIDS, transplanted, chemotherapy or corticosteroid therapy, malnourished infants
Tx: cotrimoxazole
-H. capsulatum:bird & bat manure
S/SX:
-cough with sputum -respiratory distress -rales/crackles
-fever & chills -cyanosis -pleuritic chest pain
-tachycardia -hemoptysis
Diagnosis:
- CXR-->hazy infiltrates on lower lung fields -CBC (increase WBC)
-Dullness on percussion -definitive: sputum c & s
Nursing Care:
a. facilitate adequate ventilation
b.facilitate removal of secretions
c. isolation precautions
-MRSA: contact precaution--private room
d. administer medications as ordered
e. deep breathing exercises
Chest Physiotherapy -used to mobilize secretions
Techniques:
a.postural drainage :uses gravity & various positions
b.percussion :clapping with cupped hands
c.vibration :flat hand firmly pressed over affected segment with use of isometric contraction
Nursing Care:
a. done before meals or 2-3 hours after meals to decrease the risk of aspiration
b. dilators given about 20-30 mins prior
c. remove all tight / constricting clothings
d. postural drainage position:3-5 mins
e. percussion: 2-3 minutes duration
f. perform vibration during exhalation
Chronic Obstructive Pulmonary Disease (COPD)
aka.Chronic Airflow Limitation (CAL)
-group of disorders that affect movement of air in & out of lungs
-USA:1/14 people age >45
-RISK FACTORS:
-smoking
-air pollution
-aging
EMPHYSEMA
-enlargement & destruction of alveolar walls
-main problem:ELASTICITY
-there is difficult expiration due to destructed walls/septa between alveoli-->OBSTRUCTION
-aka. PINK PUFFERS due to their normal arterial oxygen levels and marked dyspnea
Causes:
-smoking -infection -inhaled irritants
-heredity -allergic factors -aging
S/SX:
-dyspnea on exertion -cough & sputum -signs of respiratory distress
-fatigue -weight loss -PE: hyper resonant on percussion
Nursing Care:
a. administer medications as ordered
b.O2 at 1-3LPM ONLY
c. facilitate removal of secretions
d. teach about pursed-lip breathing
e. diet: increase protein, carbohydrates & vitamin C
f. immunize against pneumonia & influenza
g. avoid smoking, abrupt changes in temperature
h. exercise: walking
i. plan activities with adequate rest
COMPLICATIONS;
-acute respiratory failure
- pneumothorax due to bleb rupture
-cor pulmonale due to increase cardiac workload
CHRONIC BRONCHITIS
-inflammation of the bronchi with excessive production of mucus accompanied by persistent cough
-chronic inflammation results to:
-hypertrophy & hyperplasia of
mucus secreting glands
-decrease ciliary activity
-narrowing of small airways
Diagnostic Criteria:
-symptoms must continue for 3 months for 2 consecutive years
S/SX:
- productive cough with copious sputum - dyspnea on exertion
- rales/rhonch -cyanosis
BRONCHIAL ASTHMA
-chronic inflammatory disorder of the airways where many cells play a role
-REVERSIBLE obstructive disease of the lower respiratory tract with 3 main airway responses
Categories:
a. Extrinsic (Allergic) -due to dust, pollen, insects, smoke, medications , food
b.Intrinsic (Non-allergic) -due to pathophysiologic conditions within the respiratoy tract
-->BOTH:AIRWAY IS HYPERACTIVE!
S/SX:
Cardinal:
-waxing & waning with nocturnal occurrence
-dyspnea
-expiratory wheeze
-cough
-chest discomfort/tightness
-irritability
-diaphoresis
-cyanosis (late)
DIAGNOSIS:
Spirometry:
-decrease VC
-increase FRC
-increase TLC
-increase RV
Hallmark: Reversibility of increase 200 ml FEV1 with bronchodilator
COMPLICATION: - Status Asthmaticus
Nursing Care:
a.administer medications as ordered
-reliever medications
-controller medications
-antibiotics
b.position: High Fowlers
c. oxygen as needed
d. chest percussion & postural drainage when bronchodilation improves
-Discharge Planning:
-well ventilated room -damp dusting, avoid rugs,stuffed animals, natural fibers
-moderate exercise: swimming -deep breathing exercises
-early treatment for URTI -avoid extremes of temperature
-avoid powerful odors
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