Lower Respiratory Tract Disorders – Chapter 23

Topics:  Bronchitis, Pneumonia, Tuberculosis, Pulmonary Embolism, Pulmonary Edema, Chest Trauma, Pleural Effusion, Respiratory Medications, Pleurisy Atelectasis: Collapse of the alveoli (you can not hear)  Common especially post-op  Lung Sounds diminished  Treatment: Turn/Cough/Deep Breathe, Ambulate, Incentive spirometry, CPT (Chest physiotherapy- to loosen secretions)  Important patient moves, post op patients Bronchitis (Acute): Inflammation of bronchial tubes (passageway that brings air to lungs)  Cough with mucus, mild fever, mild form-usually self-limiting, Can be SOB, tightness in chest  Treatment: OTC medications, Humidifier, Rest, ASA or Acetaminophen, (don’t usually use antibiotics) Pneumonia: Inflammation and infection of the lung parenchyma  Edema and inflammation make the lungs still and decreases the compliance and vital capacity causes of hypoxemia  Lobar pneumonia: takes over an entire lung  Classification: CAP (Community acquired - within first 48 hours), HCAP (Health care associated pneumonia – multi dry resistant, occurs in patients who have visited health care facility but not necessary a hospital [dialysis, IV clinics, long term care facility]), HAP (Hospital acquired pneumonia, occurs after 48 hours in hospital), VAP (Ventilator associated pneumonia, intubated for 48 hours +, infection not there before intubation)  Aspiration Pneumonia: Entry of infectious substances, entering the lower respiratory tract, aspiration of upper airways secretions o People aspirate by not having HOB 30 degrees  Risk Factors: o CAP: older Adult, never received vaccine, chronic health problems, recent exposure, uses tobacco, co-morbidies o HCAP/HAP/VAP: older adult, chronic lung disease, altered LOC, poor nutrition, mechanical ventilation, increase use of the drugs to increase pH  Manifestations: Increase RR & HR, cough, hypoxemia, myalgia, fever, pleuritic chest pain (aggravated by deep breathing and coughing), WBC (normal or elevated), abnormal breath sounds (crackles, diminished), Sputum (Purulent [yellow/green], blood-tinged, rest-colored), egophony/bronchophony, whispered pectoriloquy, confusion, headache, sudden onset of chills, rapidly rising fever, tachypnea, myalgia o Pneumonia patients in beginning will look like sepsis  Assessment: Bronchial breath sounds (normal, but when you hear them in areas of lungs where its not normal for them to be then it is abnormal.) o Where do we normally hear bronchial breath sounds: over clavicles o With Pneumonia you will hear bronchial sounds over any area of consolidation o Sputum sample off color, collect early in the morning o Egophony- say E over and over, if it sounds like A something is wrong o Bronchophony- When they say 99 it will sound clear, because air is better transmitted in areas of consolidation, this is an abnormal finding o Whispered pectoriloquy: should sound far but sounds close and clear, abnormal o Formitis: put hand on patients chest, have them say 99, and you can feel vibrations, with pneumonia- increase formitis, air transmitted better in areas of consolidation  Diagnosis: History, chest x-ray (consolidation, pulmonary infiltrates, pleural effusion) sputum cultures, bronchoscopy o White count, ABG (respiratory acidosis) o Blood cultures: septicemia o Lactate level: to rule out sepsis  Treatments: Antibiotics (broad spectrum), oxygen, hydration (keep secretions thin), T/C/DB, CPT, Rest o Medications: Bronchodilators (open up airway), IV steroids (decreased inflammation), Expectorants (makes you cough), Prevention is key, high risk (Vaccine- PCV13, PPSV23) o Want patients to get both vaccines 12 months apart o High risk: over 65 years old (Vaccine lasts 5 year) o 19-64: patients must have specific risk factors to get vaccine o Example of Bronchodilator: albuterol o Example of IV steroid: dexomethosone, o Example of Expectorants: Musinex Empyema: Complication of pneumonia o Puss in pleural cavity o Complication of pneumonia Pleural Effusion: Can be complication of pneumonia  Accumulation of pleural fluid in the pleural space  Diagnostic Test: Chest x-ray  Treatment: Thoracentesis, antibiotics (if they think it was a disease), diuretics, does not happen often but can put in a chest tube  Symptoms: cough, chest pain, short of breath