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Chapter 21 - Caring for Clients with Lower Respiratory Disorders
Terms in this set (77)
inflammation of the mucous membranes that line the major bronchi and their branches. usually self-limiting, lasting for several days. suggested treatment is bedrest, antipyretics, expectorants, antitussives, and increased fluids.
if the inflammatory process involves the trachea.
fever; chills; malaise; headache; and a dry, irritating, and nonproductive cough. later, the cough produces mucopurulent sputum, which may be blood streaked if the airway mucosa becomes irritated with severe tracheobronchitis and coughing.
what are the signs and symptoms of acute bronchitis?
an inflammatory process affecting the bronchioles and alveoli. although its associated with an acute infection, it can also result from radiation therapy, chemical ingestion or inhalation, or aspiration of foreign bodies or gastric contents.
pneumonia combined with influenza
ranks as a major cause of death in the United States.
bacterial pneumonias. less common but more serious. causative bacterial organisms include Streptococcus pnemoniae, Pneumocystis jiroveci, Staphylococcus aureus, Klesbsiella pneumonia, Pseudomonas aeruginosa, and H. influenza. onset is sudden. client experiences fever, chills, a productive cough, and discomfort in the chest wall muscles from coughing.
onset is sudden
. Sputum May be rust colored.
those caused by mycoplasmas. more scattered.
results from damage to the normal lung mucosa during radiation therapy for breast or lung cancer.
results from ingestion of kerosene or inhalation of volatile hydrocarbons (kerosene, gasoline, or other chemicals), which may occur in industrial settings.
occurs when a person inhales a foreign body or gastric contents during vomiting or regurgitation.
hypoventilation of the lung over a prolonged period. bronchial secretions subsequently accumulate, which may lead to hypostatic pneumonia.
what can occur when a client is bedridden and breathing with only part of the lungs?
means that the infection is patchy, diffuse, and scattered throughout both lungs.
means that the inflammation is confined to one or more lobes of the lung.
occurs in other types of healthcare facilities, such as long-term care facilities and outpatient clinics. similar in nature to HAP.
. the client contracted the illness in a community setting or within 48 hours of admission to a healthcare facility.
. occurs in a healthcare setting more than 48 hours after admission.
pneumonia in the immunocompromised host
includes P. jiroveci pneumonia, fungal pneumonia, and pneumonia related to tuberculosis.
inflammation of the trachea
collection of pus in the pleural cavity
inflammation of the pleura. usually a consequence of a primary condition such as pneumonia or other pulmonary infections. the inflammatory process spreads from the lungs to the parietal pleura. also may develop with TB, lung cancer, cardiac and renal diseases, systemic infections, or pulmonary embolism.
ineffective microorganisms in the blood
results of blood cultures are sterile, sputum may be more copious, chills are less common, and pulse and respiratory rates are characteristically slow. less severe. mortality rate is low but rises when bacterial pneumonia occurs as a secondary infection. clients are weak and ill for a longer period than those with successfully treated bacterial pneumonia.
to aid breathing and increase the amount of air taken with each breath
why are clients with pneumonia positioned in the semi-Fowler's position?
it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate.
why is increased fluid intake important to encourage for clients with pneumonia?
promote coughing and expectoration of secretions if client experiences increased mucus production; change positon frequently if client is immobilized for any reason; encourage deep-breathing and coughing exercises at least every 2 hours; administer chest physical therapy as indicated; suction client if he or she cannot expectorate; prevent aspiration in clients at risk; prevent infections; cleanse respiratory equipment on a routine basis; promote frequent oral hygiene; administer sedatives and opioids carefully to avoid respiratory depression; encourage client to stop smoking and reduce alcohol intake.
how do you prevent pneumonia?
the pleurae are inflamed, thick, and swollen; and an exudate forms from fibrin and lymph. eventually, the pleurae become rigid. during inspiration, the inflamed pleurae rub together, causing sever, sharp pain
what happens during the acute phase of pleurisy?
the fluid separates the pleurae
how does pain decreases as fluid increases with pleurisy?
course sounds heard during inspiration and early expiration. heard during auscultation early in the disease process with pleurisy.
atelectasis, hypoxemia, and hypercapnia
what may decreased ventilation result in?
an abnormal collection of fluid between the visceral and parietal pleurae. under normal conditions, approximately 5 to 15 mL of fluid between the pleurae prevent friction during pleural surface movement. may be a complication of pneumonia, lung cancer, TB, pulmonary embolism, and CHF. amount of accumulated fluid may be so large that the lung partially collapses on the affected side. as a consequence, pressure is place on the heart and other organs of the mediastinum.
a localized area of pus formation in the lung parenchyma. as it increases, the tissue becomes necrotic. later, the affected area collapses and creates a cavity. the infection can then extend into one or both bronchi and the pleural cavity. may develop from aspiration, bacterial pneumonia, or mechanical obstruction of the bronchi, such as with a tumor. other causes include necrosis of lung tissue after an infection and necrotic lesions resulting from inhalation of dust particles. clients with an impaired cough reflex or altered immune function are at risk.
detects an area of dullness
general term used to denote pus in a body cavity, usually refers, however, to pus or infected fluid in the pleural cavity.
. may follow chest trauma, such as a stab or gunshot wound, or a preexisting disease, such as pneumonia or TB. the pus-filled area may become walled off and enclosed by a thick membrane. takes a long time to resolve.
aspiration of purulent fluid by thoracentesis
may be necessary to identify microorganisms with lung abscess, remove pus or fluid, and select appropriate antibiotic therapy.
surgical opening of the thorax.
removal of the coating
an acute respiratory disease of relatively short duration. major strains are A, B, and C.
a bacterial infectious disease primarily caused by M. tuberculosis. second leading cause of death from a single infectious agent.
gram positive, rod-shaped, acid fast, and aerobic. although the can live in the dark for months as spores in particles of dried sputum, exposure to direct sunlight, heat, or uv light destroys them in a few hours. difficult to kill with ordinary disinfectants and are destroyed by pasteurization to prevent the spread of TB.
most commonly through the inhalation of droplets produced by coughing, sneezing, and spitting from a person with active disease
how is TB transmitted?
usually involves reactivation of the initial infection. person already has had an immune response and thus the lesions that form tend to remain in the lungs.
expectoration of blood or bloody sputum
course of secondary TB
acute local inflammation and necrosis occur; infected lung tissue becomes ulcerated; tubercles cluster together and become surrounded by inflammation; exudate fills the surrounding alveoli; the client develops bronchopneumonia; TB tissue becomes caseous and ulcerates into the bronchus; cavities form; ulcerations heal, with scar tissue let around cavities; pleurae thicken and retract.
removal of a lobe segment
removal of a wedge of diseased tissue
removal of a lobe
removal of an entire lung
found in clients with COPD and is characterized by chronic infection and irreversible dilation of the bronchi and bronchioles. clients experience a chronic cough with expectoration of copious amounts of purulent sputum and possible hemoptysis.
the collapse of alveoli
prolonged inflammation of the bronchi, accompanied by a chronic cough and excessive production of mucus for a least 3 months each year for 2 consecutive years.
a chronic disease characterized by abnormal distension of the alveoli. the alveolar walls and capillary beds also show marked destruction. this process of destruction occurs over a long period. by the time of diagnosis, damage to the lungs usually is permanent. a common cause of disability and the most common obstructive lung disorder.
alveolar walls form one large sac instead of multiple, small air spaces
air in the thorax
shortness of breath with minimal activity and often is the first symptom of emphysema. breathlessness occurs even at rest.
shows a barrel-chested person breathing through pursed lips and using the accessory muscles of respiration.
improving client's quality of life, slowing the disease progression, and treating the obstructed airways
what are the goals of medical management for pulmonary emphysema?
bronchodilators; aerosol therapy; supplemental oxygen; antibiotics; corticosteroids on a limited basis to assist with bronchodilation and removal of secretions; physical therapy to increase ventilation--deep breathing, coughing, chest percussion, vibration, and postural drainage
what does the treatment for pulmonary emphysema include?
therapeutic breathing exercises
effectively use the diaphragm, thus relieving the compensatory burden on the muscles of the upper thorax.
usually a reversible obstructive disease of the lower airway. inflammation of the airway and hyperresponsiveness of the airway to internal and external stimuli.
usually is audible with expiration, resulting from air being forced out of a narrowed airway. most clients report it as one of their first symptoms with asthma.
when an acute attack intensifies and progresses. can be life threatening.
disorder that affects infants, children, and young adults. it obstructs the lungs, leading to major lung infections, as well as obstructing the pancreas. results from a defective autosomal recessive gene.
major abnormalities of CF
faulty transport of sodium and chloride in cells lining organs, such as the lungs and pancreas, to their outer surfaces;
production of abnormally thick, sticky, mucus in many organs, especially the lungs and pancreas
; altered electrolyte balance in the sweat glands.
a fibrous inflammation or chronic induration of the lungs after prolonged exposure to dust or gases. specifically refers to diseases caused by the inhalation of silica, coal dust, or asbestos.
restrictive lung disease
the lungs have decreased volume and inability to expand completely.
coal miners' pneumoconiosis
black lung disease
. condition caused by inhalation of coal dust and other dusts. initially, lungs clear particles by phagocytosis and transport out the lungs, when dust inhalation becomes too great, macrophages collect in the bronchioles, leading to clogging of the airways with dusts, macrophages, and fibroblasts. this results in local emphysema and eventually massive blackened lung lesions. coal macules eventually form, seen as black dots on radiography.
results from inhalation of silica dust and is seen in workers involved with mining, quarrying, stone cutting, and nodular lesions that enlarge and form dense masses over time. the results are loss of lung volume and restrictive and obstructive lung disease.
results from inhalation of asbestos dust. laws restrict the use, but old materials still contain it. fibers enter the alveoli and cause fibrous tissue to form around them. pleura also have fibrous changes and plaque formation. results are restrictive lung disease, decreased lung volume, and decreased gas exchange.
pulmonary arterial hypertension
refers to continuous high pressure in the pulmonary arteries and results from heart disease, lung disease, or both. does not become clinically apparent until the client is quite ill. diagnosis, is difficult without invasive testing. clients experience difficulty breathing and usually present as quite ill.
involves the obstruction of one of the pulmonary arteries or its branches. the blockages is the result of a thrombus that forms in the venous system or ight side of the heart.
in deep veins of the lower extremities or pelvis and become the source for pulmonary emboli
where do clots usually form?
usually occurs after a fracture of a long bone, especially the femur.
may be administered to prevent extension of the thrombus and the development of additional thrombi in veins from which the embolus arose.
what is the best management of pulmonary emboli?
accumulation of fluid in the interstitium and alveoli of the lungs. pulmonary congestion results when the right side of the heart delivers more blood to the pulmonary circulation thatn the left side of the heart can handle.
complications of pneumonia
CHF, empyema, pleurisy, septicemia, atelectasis, hypotension, and shock
Pursed lip breathing
Breathing with the lips pursed or puckered on expiration
What are most clients aware of and report it as one of their symptoms with asthma?
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