Management of patients with lower respiratory tract disorders
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| Acute lung injury | An umbrella term for hypoxemic respiratory failure; acute respiratory distress syndrome is a severe form of acute lung injury
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| Acute respiratory distress syndrome (ARDS) | Nonspecific pulmonary response to a variety of pulmonary and nonpulmonary insults to the lung; characterized by interstitial infiltrates, alveolar hemorrhage, atelectasis, decreased compliance, and refractory hypoxemia
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| Asbestosis | Diffuse lung fibrosis resulting from exposure to asbestos fibers
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| Aspiration | Inhalation of either oropharyngeal or gastric contents into the lower airways
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| Atelectasis | Collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression
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| Central cyanosis | Bluish discoloration of the skin or mucous membranes due to hemoglobin carrying reduced amounts of oxygen
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| Consolidation | Lung tissue that has become more solid in nature due to collapse of alveoli or infectious process (pneumonia)
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| Cor pulmonae | "Heart of the lungs"; enlargement of the right ventricle from hypertrophy or dilation or as a secondary response to disorders that affect the lungs
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| Empyema | Accumulation of thick, purulent fluid in the pleural space, often with fibrin development and a walled-off area where infection is located. Most often caused by bacterial pneumonia or lung abscess.
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| Fine-needle aspiration | Insertion of a needle through the chest wall to obtain cells of a mass or tumor; usually performed under fluoroscopy or chest computed tomography guidance
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| Hemoptysis | The coughing up of blood from the lower respiratory tract
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| Hemothorax | Partial or complete collapse of lung due to blood accumulating in the pleural space; may occur after surgery or trauma
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| Induration | An abnormally hard lesion or reaction, as in a positive tuberculin skin test
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| Open lung biopsy | Biopsy of lung tissue performed through a limited thoracotomy incision
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| Orthopnea | Shortness of breath when reclining or in the supine position
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| Pleural effusion | Abnormal accumulation of fluid in the plerual space. Rarely a primary disease, usually secondary to other dieases.
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| Pleural friction rub | Localized grating or creaking sould caused by the rubbing together of inflamed parietal and visceral pleurae
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| Pleural space | The area between the parietal and visceral pleurae; a potential space
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| Pneumothorax | Partial or complete collapse of the lung due to positive pressure in the pleural space
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| Pulmonary edema | Increase in the amount of extravascular fluid in the lung. Severe and life-threatening condition. Classified at cardiogenic of noncardiogenic.
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| Pulmonary embolism | Obstruction of the pulmonary vasculature with an embolus; embolus may be due to blood clot, air bubbles, or fat droplets
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| Purulent | Consisting of, containing, or discharging pus
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| Restrictive lung disease | Disease of the lung that causes a decrease in lung volumes
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| Tension pneumothorax | Pneumothorax characterized by increasing positive pressure in the pleural space with each breath; this is an emergent situation, and the positive pressure needs to be decompressed or released immediately
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| Thoracentesis | Insertion of a needle into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of a pleural effusion
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| Transbronchial | Through the bronchial wall, as in a transbronchial lung biopsy
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| Ventilation-perfusion ratio (V/Q) | The ratio between ventilation and perfusion in the lung; matching of ventilation to perfusion optimizes gas exchange
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| What conditions are lower respiratory disorders? | Atelectasis, respiratory infections, aspiration, pleural conditions, pulmonary edema, acute respiratory failure, ARDS, pulmonary embolism, occupational lung diseases, chest tumors, chest trauma
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| What conditions are respiratory infections? | Acute tracheobronchitis, pneumonia, severe acute respiratory syndrome (SARS), pulmonary tuberculosis, lung abscess
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| What are pleural conditions? | Pleurisy, pleural effusion, and empyema
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| What can be done to prevent atelectasis? | Frequent position changes, encourage early mobilization, encourage appropriate deep breathing/coughing, educate/reinforce incentive spirometry, administer meds, perform postural drainage and chest percussion
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| What are the classifications of pneumonia? | Community-acquired (CAP), health care-associated (HCAP) (subcategories: pneumonia in immunocompromised patients and aspiration pneumonia), hospital-acquired (HAP), and ventilator-associated (VAP)
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| Pneumonia | An inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
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| Pneumonitis | An inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion.
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| Community-acquired pneumonia (CAP) | Pneumonia occurring in the community of
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| Health care-associated pneumonia (HCAP) | Pneumonia occurring in a nonhospitalized patient with extensive health care contact with 1 or more: hospitalization >/= 2 days w/in 90 days of infection; live in nursing home; ATB, chemo, or wound care win 30 days of infection; hemodialysis at hosp/clinic
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| Hospital-acquired pneumonia (HAP) | Pneumonia occurring >/=48 hours after hospital admission that did not appear to be incubating at the time of admission
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| Ventilator-associated pneumonia (VAP) | A type of HAP that develops >/=48 hours after endotracheal intubation
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| What are risk factors for infection withpenicillin-resistant and drug-resistant pneumococci? | Age > 65 years, alcoholism, beta-lactam therapy, immunosuppressive disorders, multiple medical comorbidities, exposure to a child in a day care facility
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| What are risk factors for infection with enteric gram-negative bacteria? | Residency in a LTC facility, underlying cardiopulmonary disease, multiple medical comorbidities, recent antibiotic therapy
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| What are risk factors for infection with Pseudomonas aeruginosa? | Structural lung disease (e.g bronchiectasis), corticosteroid therapy, broad-spectrum ATB therapy (?7 days in the past month), malnutrition
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| How is pneumonia diagnosed? | History (particularly of a recent resp tract infection), physical examination, chest x-ray, blood culture, and sputum examination
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| What are complications of pneumonia? | Continuing symptoms after initiation of therapy, sepsis and septic shock, respiratory failure, atelectasis, pleural effusion, confusion
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| What are nursing interventions for pneumonia? | Improving airway patency, promoting rest and conserving energy, promoting fluid intake, maintaining nutrition, promoting patient's knowledge, monitoring and managing potential complications, promoting home/community-based care, educating the patient.
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| What are risk factors for aspiration? | Seizure activity; brain injury: decreased level of consciousness from trauma, drug or alcohol intoxication, excessive sedation, or general anesthesia; flat body positioning; stroke; swallowing disorders; cardiac arrest
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| Pulmonary tuberculosis | An infectious disease caused by an acid-fast aerobic rod that grows slowly and is sensitive to heat and ultraviolet light. Primarily affect the lung parenchyma, but can affect meninges, kidneys, bones, and lymph nodes. Spread by airborne droplet nuclei
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| Risk factors for tuberculosis | Close contact w/ person w/ active TB. Immunocompromised status. Substance abuse. Those w/o adequate health care. Preexisting med conditions. Immigrants from countries w/ high prev of TB. Institutionalization. Living in overcrowded, substandard housing. Be
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| CDC recommendations for preventing TB transmission in health care settings | 1. Early ID and Tx of persons with active TB
2. Prevention of spread of infectious droplet nuclei by source control methods and by reduction of microbial contamination of indoor air.
3. Surveillance for TB transmission.
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| Nursing management of tuberculosis | Promote airway clearance, adherence to treatment regimen, activity, and adequate nutrition. Prevention of spread to others.
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| Lung abscess | Necrosis of the pulmonary parenchyma caused by microbial infection, generally caused by aspiration of anaerobic bacteria.
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| Risk factors for lung abscess | Impaired cough reflexes who can't close the glottis; swallowing difficulties; CNS disorders; drug addiction, alcoholism; esophageal disease; compromised immune function; those without teeth; N/G tube feedings; altered state of consciousness due to anesthe
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| Pleurisy | Inflammation of both the parietal and visceral plurae. When inflamed pleural membranes rub together during respiration (intensified on inspiration), the result is severe, sharp, knife-like pain. Parietal pleura has nerve endings, visceral does not.
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| What conditions may pleural effusion be a complication of? | Heart failure, TB, pneumonia, pulmonary infections (esp viral), nephrotic syndrome, connective tissue disease, PE, and neoplastic tumors (most common malignancy is brochogenic carcinoma).
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| Pleurodesis | Once the pleural space is adequately drained, a chemically irritating agent is instilled or aerosolized into the pleural space to obliterate the space and prevent reaccumulation of fluid.
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| What are common causes of empyema? | Most occur as complications of bacterial pneumonia or lung abscess. May result from penetrating chest trauma, hematogenous infection or pleural space, nonbacterial infections, and iatrogenic causes.
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| Medical management of empyema | 4-6 weeks of ATB to sterilize the cavitiy. Drainage of fluid via: needle aspiration; tube thoracostomy; or open chest drainage via thoracotomy. If exudate formed over the lung, must be removed surgically (treatment may take weeks to months).
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| What are causes of noncardiogenic pulmonary edema? | Damage of the pulmonary capillary lining due to: direct injury to lung (chest trauma, aspiration, smoke inhalation); hematogenous injury (sepsis, pancreatitis, multiple transfusions, cardiopulmonary bypass), or injury plus elevated hydrostatic pressures.
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| Acute respiratory failure | Sudden and life-threatening deterioration of the gas exchange function of the lung; indicates failure of the lungs to provide adequate oxygenation or ventilation for the blood. ↓PaO2 to<50mmHg, and ↑PaCO2 to >50mmHg, with an arterial pH <7.35
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