conditions of lower airway

7/28/2019 Conditions of Lower Airway

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It is the accumulation of air in the pleural space, which results inpartial or complete lung collapse (atelectasis).

Types are:a. Tension air enters but cant leave pleural space.b. Secondary air enters the pleural space as a result of

injury to the chest wall, respiratory structures andesophagus.

c. Spontaneous air enters the pleural space when air-filled blebs (blisters) on the lung surface rupture.

Etiology:a. Tension unknown causesb. Secondary injury to chest wall from traumac. Spontaneous ruptured bleb (common to smokers)

Pathologic Process and Manifestations:

Severity of symptoms depends on the size of injuryand at the amount of tissue left intact.

Symptoms can include:1. Pleuritic pain (sharp pain occurring during

inhalation)2. Increased Respiratory Rate3. Dyspnea4. Asymmetry of chest wall (from rib fractures)5. RHONCHI

Overview of Nursing Interventions:1. Monitor vital signs, signs of shock2. Observe respirations; changing pattern may indicate

worsening situation3. Semi-Fowlers Position

4. Administer Oxygen if necessary5. Analgesics as ordered6. Chest Tube:

a. Maintain sterile dressing at chest tube insertionsite

b. Maintain patency and integrity of closed chestdrainage system

c. Evaluate amount of fluid and breath sounds


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Refers to an abnormal accumulation of fluid in the pleural cavity.

May be:1. Hydrothorax water/transudate (CRACKLES)2. Pyothorax/Empyema pus/exudates3. Hemothorax blood4. Chylothorax chyle

Etiology:1. Hydrothorax

a. CHF (Congestive Heart Failure)b. RF (Rheumatic Factor)

c. Nephrosisd. Liver Failure

2. Pyothorax/Empyemaa. Infectionsb. Malignanciesc. SLE (Systemic Lupus Erythematous)

3. Hemothoraxa. Chest injuriesb. Chest injury complicationsc. Malignanciesd. Blood vessel rupture

Severity of Hemothorax is determined byvolume of fluid:A. Minimal (300 500 cc)

o Resolves in 10 14 days

B. Moderate (500 1 000 cc)o Fills about 1/3 of the pleural cavity

o Lung compression and signs of

hypovolemiaC. Large (1 000 cc or more)

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Fills half or more of the chest andrequires immediate drainage

4. Chylothoraxa. Traumab. Inflammationc. Malignant infiltration

Other Symptoms are:a. Dyspneab. Pleuritic pain

c. Constant discomfort

Overview of Nursing Interventions:1. Observe patient for signs of shock.2. Administer analgesics as required.3. For moderate to large:

a. Maintain fluid replacement as ordered.


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b. Assist with insertion of chest tube insertion asordered.

c. Maintain patency of tube.d. Prepare for surgery if bleeding doesnt stop.

Causes of Pneumothorax and Pleural Effusion:1. Trauma2. Thoracic Injury3. Positive pressure ventilation4. Thoracentesis5. CVP insertion6. Emphysema7. Cancer8. Infection

Assessment in Pneumothorax and pleural Effusion:

1. Sudden, sharp chest pain2. SOB (shortness of breath)3. Anxiety/restlessness4. Tachycardia5. Diminished/absent breath sounds6. Increased Respiratory rate7. Chest tightness8. Chest asymmetry (there is no chest movement on the side of

atelectasis)9. Deviation of larynx/ trachea towards unaffected side10. Cyanosis

11. Hyperresonance on chest percussion (pneumothorax);dullness (hemothorax)

Collaborative Management for Pneumothorax and Pleural

Effusion:1. Remain with patient, stay calm.2. Place the client in High-Fowlers Position.3. Pain management4. Oxygen Therapy (high flow: 10 15 Lpm)5. Chest tube/thoracentesis6. Chest X-ray7. ABGs8. Monitor for shock.

For tension pneumothorax, needle thoracentesis isdone if chest tube insertion is not immediatelyavailable.

For open pneumothorax, cover wound with sterile,non-porous dressing and tape on three sides; oneside is left open to vent excess pressure.

For hemothorax, prepare for blood transfusion. (to

prevent hypovolemic shock)


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( Chronic Obstructive Pulmonary Disease / Chronic Airflow Limitation[CAL] )

A chronic inflammatory disease of the respiratory systemresulting in airway hyperresponsiveness, mucosal edema,and mucus production. It is largely a reversible process.

Hyperreactive airway disease

An airflow obstruction caused by bronchoconstriction,which results from an allergic or hypersensitive reaction

Allergy is the strongest factor for the development of

asthma. Common allergens are: grass, tree, weeds, pollens, mold,dust, roaches, cat/dog danders; histamine-rich foods: eggs,sea foods, snack foods.

Common triggers for asthma symptoms and exacerbationsinclude: airway irritants: air pollutants, cold, heat, weather


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changes, strong odors or perfume, smoke, also exertion,stress, laughing, sinusitis, gastro-esophageal reflux.

Status Asthmaticus - is severe, persistent asthma that doesnot respond to conventional therapy. The attacks last longer 24

hours.

Blue-bloater

Inflammation of the bronchioles that impairs airflow

Types:a. Acute occurs when the bronchus becomes inflamedb. Chronic productive cough that persists for 3 months in

each of 2 consecutive years.

Presence of overdistended, non-functional alveoli, whichmay rupture, resulting to loss of aerating surface.

Assessment in COPD:a. Cough


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b. Dyspneac. Chest paind. Sputum productione. Adventitious breath sounds (e.g. wheezing)f. Pursed-lip breathing

g. Tends to assume upright, leaning forward positionh. Alteration in LOC (level of consciousness)i. Alteration in skin color (pallor to cyanosis)j. Alteration in skin temperature (cold to touch)k. Voice changesl. Decreased metabolism

Weakness

Fatigue

Anorexia

Weight lossm. Alteration in thoracic anatomy (barrel chest)

n. Clubbing of fingers

o. Polycythemia


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Collaborative Management for COPD/ CAL:a. Rest. (to reduce oxygen demands of tissues)b. Increased fluid intake. (to liquefy mucus secretions)

c. Good oral care. (to remove sputum and preventinfection)d. Diet: High Calorie, High Protein (CHON), Low

Carbohydrates (CHO)

High caloric diet provides adequate source ofenergy

High protein diet helps maintain integrity ofalveolar walls.

Low carbohydrate diet limits carbon dioxideproduction (natural end product of carbohydratemetabolism). The client with COPD has difficulty in

exhaling cardon dioxide.e. Oxygen Therapy: 1-3 Lpm (safest amount: 2 Lpm)

Do not give high concentration of oxygen toclients with COPD. The drive for breathing may bedepressed.

In COPD, the carbon dioxide level in the blood isconsistently high. This causes damage of thecentral chemoreceptors in the medulla oblongata.The peripheral chemoreceptors in the carotid andaortic bodies take up the work of breathing. Thestimulus for the peripheral chemoreceptors is lowoxygen levels in the blood.

f. Avoid cigarette smoking, alcohol, environmentalpollutants. (these inhibit mucociliary function)

g. CPT (chest physiotherapy) postural drainage,percussion, vibration

h. Bronchial hygiene measures

Steam inhalation


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Aerosol inhalation

Medimist inhalationi. Pharmacotherapy:

1. Expectorants (Guaiafenessin) / Mucolytic (Mucomyst/Mucosulvan)

2. Antitussives (best given during the night to preventsleep pattern disturbance due to persistent cough)

Dextrometorphan

Codeineo Observe for drowsiness.

o Avoid activities that involve mental

alertness (e.g. driving, operatingelectrical machines)

o Causes decrease of peristalsis thereby

constipation3. Bronchodilators

Aminophylline (Theophylline)

Ventolin (Salbutamol)

Bricanyl (Terbutaline)

Spiriva (Tiotropium)

Xopenex (Levalbuterol)

Brethine (Terbutaline)

Alupent (Metaproterenol)o Observe for tachycardia and palpitations.

These are the most common side effectsof bronchodilators.

o Administer bronchodilator inhalationbefore steroid inhalation. (to openairways and ensure adequate absorptionof drugs)

4. Antihistamine

Benadryl (Diphenhydramine)o Observe for drowsiness and dizziness.

Avoid driving and operating electricalmachines to prevent accidents.

Steroidso Administered for anti-inflammatory effect

[e.g. Beclovent (Beclomethasone), Solu-medrol (Methylprednisone)]

o Rinse mouth after steroids inhalation. (to

prevent oral thrush [oral moniliasis])

Antimicrobials as ordered, if infection ispresent.

Leukotriene antagonistso Prevent bronchoconstriction, derease

mucosal edema and mucus production(e.g. Singulair/Montelukast)


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conditions of lower airway

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