Chapter 23- Brunner- Management of patients with chest and lower respiratory tract disorders

Atelectasis

Closure or collapse of alveoli.

Two types of atelectasis?

1) Chronic
2) Acute

Atelectasis usually occurs in patients who are ___.
-Have what kind of breathing?
-What else can cause atelectasis?

1) Immobilized
2) Shallow monotonous breathing
3) Excess secretiosn or mucous plugs.

How does excess of mucous plus lead to atelectasis?

- Block airflow

Atelectasis should also be observed on a patient with a chronic airway obstruction in the ____ (Other than the nasal airway)
- What kind of obstruction can this be?

- Lung
- Cancer!

How does atelectasis occur in adults?

- Reduced of ventilation or blockage that obstruct passage airway

How does atelectasis occur?
- How does the lung collapse?

- After the trapped alveolar air is absorbed into the bloodstream, no additional air can enter into the alveoli.
As a result the part of the lung that is affected will be " AIRLESS" & lung will collapse.

6 Things which could cause atelectasis?

1) Altered breathing patterns
2) Retained secretions
3) Pain
4) Alterations in airway functions
5) Reduced lung volume due to muskuloskeletal problems
6) Restrictive defect.

A monotonous low tidal breathing pattern may cause airway ___ and ___ ___.

- closure
- alveolar collapse

What medication can cause atelectasis? (2)

- Anesthesia
- Analgesic agents

What position can cause atelectasis?

- Supine position

Splinting of the chest wall and abdominal distention can also result in___

atelectasis

Atelectasis resulting by bronchial obstruction by secretions may also occur in patients with____

- Impaired mechanism, muscoloskeletal and neurolegic disorders.

Atelectasis cause by physicial movements includes?

- Pressure on the lung tissues

- Pressure on the lung tissues will cause? (3 things)

- Fluid accumlation in the pleural space.
- Air in the pleural space
- blood in the pleural space

Pleural effusion?

- Fluid accumlation in the pleural space.

Pneumothorax?

- Air in the pleural space

Hemopthorax?

blood in the pleural space.

What is the pleura space?

Area between the parietal and the visceral pleaurae.

Pressure may also be produced by? (3)
-related to the heart
- related to growth
-related to respiration

- Pericardium distented with fluid
- Tumor growth in the thorax
- Elevated diaphragm.

Symptoms of atelectasis? (3)

- Dyspnea
- Cough
- sputum production

Lobar atelectasis?

Large amount of lung tissues

Central cyanosis?
- This is a sign of?

- Bluish skin
- Late sign of hypoxia

Acute atelectasis?
- respiration?
-pain, where?
- Skin?

- Tachypnea
- Pleural pain
- central cyanosis

Chronic atelectasis?

- Similar signs to acute but patients may catch infections!

How to prevent atelectasis?

1) frequent turning
2) Mobilization
3) Use incentive spirometry with breathing and coughing exercise.

Atelectasis"
The use of incentive spirometry with breathing and coughing exercise. (Benefits?) (2)

1) Enhance lung expansion
2) Decrease potential airway closeure

Atelectasis "
Secretion management techniques?
- 2 kinds of suctioning

1) Suctioning (nasal & endotracheal suctioning catherers)
2) Directed cough
3) Aerosol nebulizer treatments
4) Postural drainage
4) chest percussion
5) Bronchoscopy
6) Meteredosein inhaler.

Aerosol nebulizer treatments
- What does it relieve?
- What does it reduce?

- Aerosol therapy allows the delivery of medications, humidity, or both to the mucosa of the respiratory tract and pulmonary alveoli.
- relieve spasm of the bronchial muscles
- reduce edema of the mucous membranes

Bronchoscopy

Scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways.

Meteredosein inhaler.

A metered dose inhaler is a way to deliver respiratory medication into the lungs.

Atelectasis"
Management
-Goal? (2)
Medication? (2)

- Improve ventilation
- Remove secretions
- Opioids & sedatives to prevent respiratory depression
- Nebulizer

Atelectasis"
What happens if patient has a massive atelectasis & respiratory failure?

- Endotracheal intubation
- Mechanical ventilation

Atelectasis"
Nebulizer? (contain 2 things)
- Used for?

1) bronchodilator
2) Sodium bicarbonate
used for:
-Expectoration of secretion

Thorancentesis? to prevent what?

- removal of fluid with needle aspiration.
"Large pleural effusion

Atelectasis caused by tumor. What to do? (2)

- Radiation or surgery

Acute Trancheobronchitis?

- Acute inflammation of the mucous membranes of the trachea and broncial tree.

Patients with viral infections have lower __ system and can develop a secondary bacterial infection.
Where?

- Immune
- In the lower respiratory system

Treatment of upper respiratory system will prevent acute ___.

- Bronchitis

Acute lung injury?

A term for hypoxemic (hypoxia), respiratory failure, acute respiration distress syndrome is a severe form of acute lung injury.

Acute respiratory distress syndrome?

Non specific pulmonary response to a variety of pulmonary and nonplumonary insults to the lung : characterized by interstitial infiltrates, alveolar hemorrhage, atelectasis, decreased compliance and refractory hypoxemia.

1)Preventing Atelectasis from occurring in a patient whose respiratory system is compromise falls into the category of management and goal treatment to improve ___ and remove ___.

- ventilation
-secretion

These strategies include: (5)

� Changing patient's position frequently, especially from supine to upright position.
� Encourage mobilization and physical activities or mobilization from bed to chair followed by early ambulation.
� Encourage appropriate breathing and coughing exercises

Name the common respiratory infection?

Acute Tracheobronchitis, Pneumonia and pulmonary tubercolosis

acute bronchitis

Acute inflammation of the mucous membranes of the trachea and bronchial tree.