LOWER RESPIRATORY

PROBLEMS, COPD

Lewis et al., Chapter

28

ACUTE BRONCHITIS
Inflammation of the bronchi
90% are viral
S/S: cough up to 3 weeks, sputum, headache, fever,
malaise, hoarseness, myalgia, dyspnea, chest pain
Assessment: normal breath sounds, rhonchi, crackles,
or wheezes
Treatment - supportive

PERTUSSIS
Highly contagious infection
Cause: gram-negative bacillus, Bordetella pertussis
S/S: Stages
Stage 1: mild URI, low or no fever, runny nose, watery eyes, mild
nonproductive cough
Stage 2: paroxysms of cough, especially at night; may last 6-10
weeks

PNEUMONIA
Infection of the lung parenchyma
Causes: Bacteria, viruses, mycoplasma organisms,
fungi, parasites, chemicals
Classify as community-acquired OR medical careassociated
S/S: cough (prod. or non-prod.), fever, shaking chills,
dyspnea, tachypnea, pleuritic chest pain
Evidence of consolidation

NURSING DIAGNOSES
FOR PNEUMONIA
Impaired gas exchange related to fluid and exudate
accumulation at the capillary-alveolar membrane
Ineffective breathing pattern related to inflammation
and pain
Acute pain related to inflammation and ineffective
pain management and/or comfort measures

COMPLICATIONS OF
PNEUMONIA
Pleurisy
Pleural effusion
Atelectasis
Bacteremia
Lung abscess
Empyema
Pericarditis
Meningitis
Sepsis
Acute respiratory failure
Pneumothorax

DIAGNOSTIC TESTS FOR

PNEUMONIA
Chest x-ray
Sputum specimen
Arterial blood gases (ABGs)
White blood cell count

NURSING
INTERVENTIONS:
PNEUMONIA
Pneumococcal Vaccination if >65 or high risk
Prompt treatment with antibiotics
Supportive
Health promotion

TUBERCULOSIS
Cause: mycobacterium tuberculosis
First-line TB drugs: isoniazid (INH), rifampin
S/S: initial dry cough, becomes productive; fatigue,
malaise, anorexia, weight loss, low-grade fevers, night
sweats
Late symptoms: dyspnea, hemoptysis
Acute, sudden presentation: high fever, chills, flu-like
symptoms, pleuritic pain, productive cough

TUBERCULOSIS (2)
Assessment: TST, INF-, CXR, Bacteriologic studies
Nursing diagnoses may include:
Ineffective breathing pattern related to decreased lung capacity
Ineffective airway clearance related to increased secretions,
fatigue, and decreased lung capacity
Noncompliance related to lack of knowledge of disease process,
lack of motivation, and long-term nature of treatment and lack
of resources
Ineffective self-health management related to lack of knowledge
about the disease process and therapeutic regimen
Treatment: screening, DOT, airborne infection isolation

PULMONARY FUNGAL
INFECTIONS
Endemic
Opportunistic

LUNG ABSCESS
Necrosis of lung tissue from the GI tract or oral cavity
S/S: cough-producing purulent, foul-smelling, foul
tasting sputum; hemoptysis; fever, chills, prostration,
night sweats, pleuritic pain, dyspnea, anorexia, weight
loss; diminished breath sounds, crackles later
Diagnosis: CXR
Treatment: Oxygen, IV clindamycin

ENVIRONMENTAL LUNG
DISEASE
Pneumoconiosis
Chemical pneumonitis
Hypersensitivity pneumonitis
Mesotheliomas, squamous cell carcinoma,
adenocarcinoma

RESTRICTIVE
RESPIRATORY
DISORDERS
Extrapulmonary conditions
Intrapulmonary conditions
Pleural effusion
Pleurisy
Atelectasis

THORACENTESIS
Jesjox. (2007, Nov. 7). Thoracentesis to remove 1200
cc of pleural fluid at Harbor View. Retrieved from
https://www.youtube.com/watch?v=noDxydboLrA

PULMONARY
HYPERTENSION
Elevated pulmonary pressure
Idiopathic pulmonary arterial hypertension
Secondary pulmonary arterial hypertension
Visualizing Medicine. (2013, April 13). Right sided
catheterization. Retrieved from https://
www.youtube.com/watch?v=Di7CHR4fmog

NURSING MANAGEMENT:
OBSTRUCTIVE PULMONARY
DISEASES

Lewis et al., Chapter

29

RISK FACTORS FOR

ASTHMA
Genetics
Inhaling allergens, e.g. dust, pollen, mold
Air pollutants, e.g. smoke, aerosol sprays
Inflammation and infection, e.g. sinusitis
Drugs, e.g. aspirin, NSAIDs, -blockers
Occupational exposure, e.g. paints, detergents
Food additives, e.g. beer, wine, shrimp
Other factors, e.g. stress, exercise, cold air

PEAK FLOW METER

American Lung Association. (2014). Measuring your
peak flow rate. Retrieved from
http://www.lung.org/lung-disease/asthma/living-with-a
sthma/take-control-of-your-asthma/measuring-your-peak
-flow-rate.html

TREATMENT FOR
ASTHMA
Rescue medication: -adrenergic agonist
Bronchodilators
-adrenergic agonist, short and long-acting
Anticholinergics
Methylxanthines

Antiinflammatory
Corticosteroids
Leukotriene Modifiers

Anti-IgE
Combination agents

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE:
CAUSES
Cigarette smoking
Occupational chemicals and dust
Air pollution
Infection
Genetics
1- anti-trypsin deficiency (AAT)
Aging

PULMONARY REHAB:
COPD
Smoking cessation
Drug therapy
Oxygen therapy
Breathing retraining, e.g. pursed-lip breathing
Airway clearance technique, e.g. huff coughing, chest
physiotherapy, postural drainage, percussion, vibration
Nutritional therapy
Surgical therapy

CYSTIC FIBROSIS
Genetic
Manifestations: chronic sinusitis, nasal polyposis;
meconium ileus in newborn; acute or persistent
respiratory symptoms, failure to thrive, malnutrition;
adult: frequent cough
Diagnosis at about 5 months of age

COLLABORATIVE CARE:
CYSTIC FIBROSIS
Manage pulmonary problems
Airway clearance techniques
Treat lung infections
Pancreatic enzyme replacement
Aerobic exercise
Genetic counseling

BRONCHIECTASIS
Permanent, abnormal dilation of medium-sized bronchi
r/t inflammation
S/S: persistent cough with purulent sputum
Dx: chronic prod. cough with purulent sputum, CXR,
CT, decreased FEV1 and FEV1/FVC
Treatment: culture sputum, anbx; airway clearance;
SABAs, LABAs, anticholinergics, hydration; nutrition,
oral hygiene

REFERENCES
Lewis, S., Dirksen, S.R., Heitkemper, M.M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and
management of clinical problems (9th ed.). St. Louis:
Mosby.