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Caring for the Client with Disorders of the Respiratory System

This chapter is from the book

This chapter is from the book

Chapter 3: Caring for the Client with Disorders of the Respiratory System

Terms you'll need to understand:

  • Acute respiratory failure

  • Apnea

  • Asthma

  • Atelectasis

  • Bronchitis

  • Continuous positive airway pressure (CPAP)

  • Cor pulmonale

  • Cyanosis

  • Dyspnea

  • Emphysema

  • Empyema

  • Hemoptysis

  • Hypoxemia

  • Hypoxia

  • Pleural effusion

  • Pleurisy

  • Pneumonia

  • Pulmonary embolus

  • Tachypnea

Nursing skills you'll need to master:

  • Assessing breath sounds

  • Providing tracheostomy care

  • Collecting sputum

  • Teaching proper use of an inhaler

  • Performing postural drainage

  • Assisting with thoracentesis

  • Obtaining a throat culture

  • Performing venopuncture

  • Administering medication

  • Managing chest tubes

  • Maintaining oxygen therapy

Acute Respiratory Failure

Acute respiratory failure can be defined as the lungs’ failure to meet the body’s oxygen requirements. Two acute respiratory conditions you need to be familiar with are ARDS and RDS.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome, commonly known as ARDS or non-cardiogenic pulmonary edema, occurs mostly in otherwise healthy persons. ARDS can be the result of anaphylaxis, aspiration, pulmonary emboli, inhalation burn injury, or complications from abdominal or thoracic surgery. ARDS may be diagnosed by a chest x-ray that will reveal emphysematous changes and infiltrates that give the lungs a characteristic appearance described as ground glass. Assessment of the client with ARDS reveals

  • Hypoxia

  • Sternal and costal retractions

  • Presence of rales or rhonchi

  • Diminished breath sounds

  • Refractory hypoxemia

Care of the client with ARDS involves

  • Use of assisted ventilation

  • Monitoring of arterial blood gases

  • Attention to nutritional needs

  • Prone positioning or use of specialized beds to minimize consolidation of infiltrates in large airways

  • Investigational therapies, include the use of vitamins C and E, aspirin, interleukin, and surfactant replacements.

Respiratory Distress Syndrome

Respiratory distress syndrome (RDS), once referred to as hyaline membrane disease, occurs most often in preterm infants and is the result of insufficient surfactant production. Administering dexamethasone (Decadron) 24 hours prior to delivery has been shown to be effective in speeding fetal maturity and may be used in cases where early delivery is unavoidable. Infants with RDS are placed on ventilator support and treated with surfactant replacement.

Pulmonary Embolus

Pulmonary embolus refers to the obstruction of the pulmonary artery or one of its branches by a clot or some other undissolved matter, such as fat or a gaseous substance. Clots can originate anywhere in the body but are most likely to migrate from a vein deep in the legs, pelvis, kidney, or arms. Fat emboli are associated with fractures of the long bones, particularly the femur. Air emboli, which are less common, can occur during the insertion or use of central lines. Common risk factors for the development of pulmonary embolus include immobilization, fractures, trauma, and history of clot formation.

Symptoms of a pulmonary embolus depend on the size and location of the clot or undissolved matter. Symptoms include

  • Chest pain

  • Dyspnea

  • Syncope

  • Hemoptysis

  • Tachycardia

  • Hypotension

  • Sense of apprehension

  • Petechiae over the chest and axilla

  • Distended neck veins

Diagnostic tests to confirm the presence of pulmonary embolus include chest x-ray, pulmonary angiography, lung scan, and ECG to rule out myocardial infarction. Management of the client with a pulmonary embolus includes

  • Placing the client in high Fowler’s position

  • Administering oxygen via mask

  • Giving medication for chest pain

  • Using thrombolytics/anticoagulants

Antibiotics are indicated for those with septic emboli. Surgical management using umbrella-type filters is indicated for those who cannot take anticoagulants as well as for the client who has recurrent emboli while taking anticoagulants. Clients receiving anticoagulant therapy should be observed for signs of bleeding. PT, INR, and PTT are three tests used to track the client’s clotting time. You can refer to Chapter 13, "Caring for the Client with Disorders of the Cardiovascular System," for a more complete discussion of these tests.

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