Chapter 14 CARE OF PATIENTS WITH DISORDERS OF THE LOWER RESPIRATORY SYSTEM
Learning Objectives Theory 1.Compare and contrast commonalities and differences in nursing care for patients with bronchitis, influenza, pneumonia, empyema, and pleurisy. 2.Chose nursing interventions appropriate for the care of patients with problem statements of Alteration in airway clearance, Altered breathing pattern, Altered gas exchange, and Fatigue due to hypoxia 3.Analyze ways a nurse can contribute to prevention and treatment of tuberculosis. 4.Summarize the pathophysiologic changes that occur during an asthma attack. 5. Evaluate problems that occur with aging that may cause a restrictive pulmonary disorder. 6. Describe the specifics of nursing care for the patient who has had thoracic surgery and has chest tubes in place. Clinical Practice 1.Complete a nursing care plan, including home care, for the patient with chronic obstructive pulmonary disease. 2.Review a nursing interventions for the tracheostomy patient on oxygen therapy. 3.Teach a patient how to use a peak flowmeter 4.Observe a respiratory therapist (RT) who is responsible for a patient on a mechanical ventilator and identify how RTs and nurses work together to deliver safe care.
Acute Bronchitis Often extension of upper respiratory infection Also from inhalation of dust, automobile exhaust, fumes, & smoke Early symptoms mimic the common cold Cough with some sputum, sore throat, runny/stuffy nose, fatigue Conservative treatment: Antibiotics How do we decide what one to start? Humidification Cough mixtures or bronchodilators Bed rest To prevent acute bronchitis from becoming chronic bronchitis
Influenza Etiology: Acute, highly infectious disease of upper and lower respiratory tract Three major types (A, B, and C) and numerous subtypes of viruses Spread through direct and indirect contact via droplets Pathophysiology: Inflammation/destruction of tissue -> shedding of virus into secretions Destroyed tissue provides environment for the growth of bacteria leading to secondary infections Bacterial pneumonia often times the secondary infection Signs and symptoms Appear suddenly 2-3 days after exposure Headache, fever (101-103) chills, anorexia, muscle aches Nausea, vomiting, and diarrhea more common in children
Influenza Diagnosis: Chest x-ray and auscultation usually reveal no abnormality Diagnosis is usually based on clinical findings Can do viral culture, serology, or rapid antigen testing Treatment: Rest, increased fluid intake, acetaminophen or ibuprofen, cough suppressant, humidified air, and saline gargles High-risk patients may receive prophylactic medications if exposed to Influenza A Tamiflu, Symmetrel, Flumadine, Relenza Must be started within 48 hours of start of symptoms Look at health promotion points pg 291 – who should get vaccinated?
Pneumonia Extensive inflammation of the lung with either consolidation
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