Respiratory System

RESPIRATORY SYSTEM

Upper Respiratory Tract

Nose

Sinuses

Pharynx

Larynx “voice box”

Epiglottis

Anatomy and Physiology

Lower Respiratory Tract

Trachea

Main stem bronchi

Bronchioles

Alveolar ducts and alveoli

lungs

Respiratory process

The diaphragm descends into the abdominal cavity during inspiration, causing negative pressure in the lungs

The negative pressure draws air from the area of greater pressure, the atmosphere, into the area of lesser pressure, the lungs

In the lungs, air passes through the terminal bronchioles into the alveoli to oxygenate the body tissues

Respiratory process

At the end of inspiration, the diaphragm and interscostal muscles relax and the lungs recoil

As the lungs recoil, pressure within the lungs becomes higher than atmospheric pressure, causing the air, which now contains cellular waste products carbon dioxide and water to move from the alveoli in the lungs to the atmosphere

Diagnostic tests

Chest x-ray film (radiography)

Description: Provides information regarding the anatomical location and appearance of the lungs

Preprocedure

Remove all jewelry and other metal objects

Assess the clients ability to inhale and hold his or her breath

Question woman regarding pregnancy or the possibility of pregnancy

Postprocedure

Help the client get dressed

Diagnostic tests

Sputum specimen

Description: specimen obtained by expectoration or tracheal suctioning to assist in the identification of organism

Diagnostic tests

Bronchoscopy

Description: direct examination of the larynx, trachea, and bronchi with fiberoptic bronchoscope

Preprocedure

Obtain informed consent

NPO

Obtain v/s

Remove dentures or eyeglasses

Prepare suction equipment

Administer medication for sedation as prescribed

Have emergency resuscitation equipment available

Diagnostic tests

Postprocedure

Monitor v/s

Maintain the client in semi fowler’s position

Assess for the return of gag reflex

Maintain NPO until gag reflex returns

Have emesis basin readily available

Monitor for bloody sputum

Monitor respiratory status

Diagnostic tests

Pulmonary angiography

Description: an invasive fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches

Involve s injection of iodine or radiopaque contrast material

Diagnostic tests

Pre procedure


Assess for allergies to iodine

Maintain NPO for 8 hours before procedure

Monitor v/s

Administer sedation as prescribed

Instruct client to lie still during procedure

Instruct client that he or she may feel an urge to cough, flushing, nausea, or a salty taste following injection of dye

Have emergency resuscitation available

Diagnostic tests

Monitor v/s

Avoid taking blood pressure for 24 hours in the extremity used for the injection

Monitor peripheral neurovascular status of the affected extremity

Assess insertion for bleeding

Diagnostic tests

Thoracentesis

Descripton: removal of fluid or air from the pleural space vial a transthoracic aspiration

Preprocedure:


Obtain vital signs

Prepare the client for ultrasound or chest radiograph

Client is positioned sittiing up right, with arms and shoulders supported by a table at the bedside during the procedure

If the client cannot sit up, the client is placed lying in bed toward the unaffected side, with HOB elevated

Instruct the client not to move, cough or deep breathe during the procedure

Diagnostic tests

Post procedure

Monitor the v/s

Monitor respiratory status

Apply pressure dressing and assess the puncture site for bleeding and crepitus

Bronchial Asthma

Intermittent & reversible airflow obstruction affecting the lower airway.

Obstruction is due to:

Inflammation

Airway hyper-responsiveness (bronchospasm)

Constriction of bronchial smooth muscle due to stimulation of the nerve fibers

Etiology:

allergens, cold air, dry air, airborne particles, microorganism, aspirin à inflammation

exercise, upper respiratory illness (viruses), unknown reasons à bronchospasm

Bronchial Asthma

Bronchial Asthma

Physical assessment findings:

Audible wheezing & #RR (acute episode)

Wheezing is louder during exhalation

Dyspnea, cough, use of accessory muscle of respiration, barrel chest (chronic severe asthma)

Cyanosis, poor O2 saturation (pulse oximetry)

Change of LOC & tachycardia due to hypoxemia

Bronchial Asthma

Laboratory assessment:

ABG, elevated eosinophil count, elevated IgE levels

PuLmOnArY fUnCtiOn teSts – most accurate test for asthma

Forced Vital Capacity (FVC) – volume of air exhaled from full inhalation to full exhalation

Forced Expiratory Volume (FEV1) – volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after

the greatest full inhalation

Peak Expiratory Rate Flow (PERF) – fastest airflow rate reached at any time during exhalation

Methacholine is inhaled (induces bronchospasm) & then FVC, FEV1 & PERF is measured then brochodilators will be given à an # 12% of values: asthma

Bronchial Asthma

Nursing interventions:

Goals:

To improve airflow

Relieve symptoms

Prevent episodes

Management plan includes

Client education

Drug therapy

Lifestyle management including exercise

Bronchial Asthma

Client Education Guide

Avoid factors that triggers asthma attack

Use bronchodilator 30 minutes before exercise to prevent or reduce exercise-induced asthma

Proper technique & correct use of metered dose inhalers

Adequate rest & sleep, reduce stress & anxiety; learn relaxation techniques

Failure of medications to control worsening symptoms, seek immediate emergency care

Bronchial Asthma

Bronchodilators :

β2 agonist

Albuterol (Ventolin), Bitolterol, Pirbuterol, Salmeterol, Formoterol

Methylxanthines

Theophylline, Aminophylline, Oxtriphylline]

Monitor for SE: excessive cardiac & CNS stimulation (check pulse & BP)

Cholinergic antagonist

Ipratropium (Atrovent)

Bronchial Asthma

Anti-inflammatory Agents :

Corticosteroids

oral – Prednisolone, Prednisone

inhaler – Budesonide, Fluticasone, Beclomethasone, Triamcinolone, Flunisolide

Mast cell stabilizer

Cromolyn sodium (Intal); helps prevent atopic asthma attacks (prevent mast cell membranes from opening when an allergen binds to IgE) but are not useful during an acute episode

Monoclonal antibodies

Omalizumab (Xolair), approved in 2003 only – binds to IgE receptor sites on mast cells & basophils preventing the release of chemical mediators for inflammation

Bronchial Asthma

Exercise/ Activity

Aerobic exercise (recommended)

assist in maintaining cardiac health, enhancing skeletal muscle strength, and promoting ventilation and perfusion

Swimming

Oxygen Therapy

Often used during an acute asthma attack

Bronchitis

Acute Bronchitis

Typically begins as an URTI (viruses, bacteria)

H. influenzae, S. pneumoniae, M. pneumoniae

Chemical irritants (noxious fumes, gases, air contaminants)

Assessment Findings:

Fever, chills, malaise, headache, dry irritating nonproductive cough (initial) à mucopurulent sputum

Medical Management:

Usually self-limiting

Bedrest, antipyretics, expectorants, antitussives, #Fluids, humidifiers, antibiotics

Bronchitis

Acute Bronchitis

Nursing Management:

Encourage client to cough & deep breath q 2 hrs while awake & to expectorate rather than swallow sputum

Provide humidification of surrounding (loosens bronchial secretions)

Changes the bedding & clients clothes if they become damp with perspiration

Offers fluid frequently

Prevent infection (teach to wash hands frequently)

Teach to cover the mouth when sneezing & coughing

Discard soiled tissues in a plastic bag; avoid sharing of eating utensils & personal articles

Bronchitis

Chronic Bronchitis

Prolonged inflammation of the bronchi accompanied by a chronic cough & excessive production of mucus for at least 3 months each year for 2 consecutive years

Etiology:

CIGARETTE SMOKING

Long history of bronchial asthma, RTI, air pollution


Chronic productive cough – thick white mucus (earliest

symptom) à yellow, purulent, copious, blood streaked sputum

Bronchospasm, Acute respiratory infections, cyanosis, DOE, RSHF (cor pulmonale)

Chronic Bronchitis

Medical Management

SMOKING CESSATION

Bronchodilators, #fluid intake, Well-balanced diet, Postural drainage, Steroid therapy, Antibiotic therapy

Nursing Management

Focus: educating clients in managing their disease

Smoking cessation, occupational counseling, monitoring air quality & pollution levels, avoiding cold air & wind exposure (triggers bronchospasm)

Emphysema

A chronic disease characterized by loss of lung elasticity & hyperinflation of the lung

most common COPD

Emphysema

Etiology/ Genetic Risk:

Major cause:

Smoking

Air pollution (minimal)

Emphysema

Pathophysiology:

Loss of elasticity

Air trapping

Impaired gas exchage

Signs/ symptoms

Bullae/ blebs

Pneumothorax

use of accessory muscles in the process of breathing due to flattening of the diaphragm

Emphysema


Exertional dyspnea - 1st symptom

shortness of breath with minimal activity

Chronic productive cough with mucopurulent sputum

Decreased breath sounds, wheezing, crackles

“Barrelshaped chest”

Use of accessory muscle of respiration

Toxic CO2 levelsà Lethargy, stupor, coma (carbon dioxide narcosis)

Emphysema

Medical management:

Meds: Bronchodilators, mucolytics, antibiotics, corticosteroids (limited basis to assist with bronchodilation & removal of secretions)

Physical therapy: deep breathing, CPT, postural drainage

Nursing Management:

Administer O2 via nasal cannula (2-3 L/min)

High flow of O2 may lead to lost of hypoxic drive

Teach abdominal breathing (using the diaphragm effectively), pursed-lip breathing

Most important risk factor for COPD is SMOKING!!!

Effects of Tobacco Smoke:

Tobacco smoke triggers the

release of EXCESSIVE amounts

of elastase protease that

breaks down elastin which is a major component of alveoli

Impairs & inhibits the action of cilia

COPD

Clinical Manifestations

General appearance

RR of 40-50 breaths/min

Presence of “Barrel chest”

Cyanosis, Clubbing of fingers

Manifestations of RSHF

(dependent edema)

COPD

Psychosocial assessment

Socialization may be reduced when friends avoid the client with COPD because of annoying coughs, excessive sputum, or dyspnea

COPD

Laboratory assessment

Abnormal ABG results (hypoxemia, hypercarbia),

CXR to rule out other chest diseases & to check the progress of clients with

respiratory infections or chronic disease

COPD

Interventions:

Mainstays of COPD management:

Airway maintenance

Monitoring

Drug Therapy

O2 therapy

COPD

Airway maintenance:

Keep the client’s head, neck and chest in alignment

Assist the client to liquefy secretions and clear the airway of secretions

Breathing Techniques

COPD

Airway maintenance:

Controlled coughing

advise client to cough on arising on the morning, before mealtimes, before bedtimes

to cough effectively, the client sits in a chair or on the side of a bed with feet placed firmly on the floor. Instruct the client to turn the shoulders inward and to bend the head slightly downward hugging a pillow against the stomach. The client then takes a few deep breaths.

After the 3rd to 5th deep breath ( pursed-lip breathing), instruct the client to bend forward slowly while coughing two or three times from the same breath

Chest physiotherapy & postural drainage

Postural Drainage

COPD

Monitoring:

Assess COPD client at least q2°

O2 Therapy:

The need for O2 therapy & its effectiveness can be determined by ABG values & O2 saturation by pulse oximetry

usually, 2-4 L/min or even 1-2 L/min via nasal cannula or up to 40% via venturi mask

Low-flow O2 because low arterial oxygen level is the COPD client’s primary drive for breathing

COPD

Drug Therapy:

involves the same inhaled and systemic drugs for asthma

mucolytics [acetylcysteine (Mucomyst), Guaifenesin]

PNEUMONIA

one of the most common complications of COPD:

* Teach clients to avoid large crowds and stress the importance of receiving a pneumonia vaccination and a yearly influenza vaccine “flu shot”

Bronchiectasis

An abnormal and permanent dilatation of bronchi & bronchioles

It results from inflammation and destruction of the structural components of the bronchial wall brought about by:

chronic pulmonary infection (P. aeruginosa, H. influenzae)

tumor or foreign body

congenital abnormalities

exposure to toxic gases

Bronchiectasis

The structure of the wall tissue changes, resulting in the formation of saccular dilatations which collects purulent materials causing more dilatation, structural damage & more infection

Bronchiectasis

Bronchiectasis


Chronic cough (copious, purulent, blood-streak sputum)

Coughing worsens when the client changes position

Sputum collected settles in three distinct layers (top layer is frothy & cloudy, middle layer is clear saliva, bottom layer is heavy, thick & purulent)

Fatigue, weight loss, anorexia, dyspnea

CXR & bronchoscopy – reveals incresed size of bronchioles, atelectasis & changes in the pulmonary tissues

Sputum C/S identify causative microorganism

Bronchiectasis

Medical Management:

Drainage of purulent material from the bronchi

Antibiotics

Bronchodilators

Mucolytics

Humidification

Surgery removal of bronchiectasis if confined to a small area

Bronchiectasis

Nursing Management:

Instruct client in postural drainage techniques

CPT

Oral hygiene

Pneumonia

An inflammatory process affecting the bronchioles & alveoli

Most common cause of death from an infection in the US (Smeltzer & Bare, 2004)

Pneumonia

Causes:

Usually Infection

Bacterial pneumonia “Typical pneumonia”

S. pneumoniae, P. carinii, S. aureus, K. pneumoniae, P. aeruginosa, H. influenzae

Atypical pneumonia

Mycoplasma pneumonia, Chlamydia pneumoniae, Chlamydia psittaci, Legionella pnemophila, Mycobacterium tuberculosis, viruses, parasites, fungi

Pneumonia

Causes:

Radiation Therapy (Radiation pneumonia)

Damage to the normal lung mucosa during radiation therapy for Breast CA, Lung CA

Chemical ingestion or inhalation (Chemical pneumonia)

Ingestion of kerosene, gasoline or other chemical

Inhalation of volatile hydrocarbons

Aspiration of foreign bodies or gastric contents (Aspiration pneumonia)

Inhalation of foreign object or gastric contents during vomiting or regurgitation

Pneumonia

Bronchopneumonia

Infection is patchy, diffuse & scattered throughout both lungs

Lobar pneumonia

Inflammation is confined to one or more lobes of the lung

Pneumonia

4 General Categories of Pneumonia:

CAP (Community-acquired pneumonia)

Illness is contracted in a community setting or within 48 hrs of admission to a healthcare facility

HAP (Hospital-acquired pneumonia)/ Nosocomial pneumonia

Occurs in healthcare setting >48 hrs after admission

Oppurtunistic Pneumonia (immunocompromised host)

P. carinii pneumonia (Pneumocystis jirovecii ), Fungal pneumonia, pneumonia related to TB

Aspiration Pneumonia

Pneumonia


Fever

Chills

Productive cough, sputum (rust colored)

Discomfort in the chest wall muscles

General malaise

Pain during breathing (patient exhibits shallow breathing)

Pneumonia

Diagnostic Findings:

Wheezing, crackles, decreased breath sounds

Cyanosis (nail beds, lips, oral mucosa)

Sputum culture reveals infectious microorganism

CXR shows areas of infiltrates & consolidation

#WBC

Pneumonia

Medical Management:

Prompt initiation of antibiotic therapy for bacterial pneumonia

Hydration to thin secretions

Supplemental O2 to alleviate hypoxemia

Bed rest, CPT, bronchodilators, analgesics, antipyretics, & cough expectorants or suppressants

F&E replacement 2° to fever, dehydration & inadequate nutrition

Severe respiratory difficulty – intubation along with mechanical ventilation

Pneumonia

Nursing Management:

Auscultate lung sounds & monitor the client for signs of respiratory difficulty

Check oxygenation status (pulse oximetry) & monitor ABGs

Position: semifowler’s position

Encourage # fluid intake

Monitor I&O, skin turgor, VS & serum electrolytes

Administer antipyretics as indicated

Encourage at-risk & elderly clients to receive vaccination

against pneumoccocal & influenza infections

Pleural Effusion

Abnormal collection of fluid between the visceral & parietal pleurae as a complication of

Pneumonia

Lung CA

TB

Pulmonary embolism

CHF

Normal: 5-15ml

Pleural Effusion

General Classification

Transudative effusion (protein-poor, cell-poor)

HYDROthorax- accumulation of water/serous fluid

Exudative effusion (protein rich fluid)

PYOthorax or Empyema- accumulation of pus

Hemothorax- accumulation of blood

Chylothorax- accumulation of lymph and lipoprotein

Pleural Effusion


Fever

Pain

Dyspnea

Dullness over the involved area during chest percussion

Diminished or absent breath sounds

Friction rub

CXR & CT scan – shows fluid accumulation

Pleural Effusion

Medical management:

Main goal: eliminate the cause & relieve discomfort

Antibiotics

Analgesics

Cardiotonic drugs to control CHF if present

Thoracentecis

Insertion of a CTT

Surgery if cause by CA

Pleural Effusion

Fractured Ribs/ Sternum

Common injury resulting from a hard fall or a blow to the chest

Automobile & household accidents (frequent cause)

Sharp end of the broken rib may tear the lung or thoracic blood vessels

Flail Chest

Complication of chest trauma occurring when 2 or more adjacent ribs are fractured at two or more sites, resulting in free-floating rib segments


Paradoxic movement of the chest:

The chest is pulled INWARD during inspiration, reducing the amount of air that can be drawn into the lungs

The chest Bulges OUTWARD during expiration because the intra-thoracic pressure exceeds atmospheric pressure. The patient has impaired exhalation


This paradoxical movement will lead to:

Increased dead space

Reduced gas exchange

Decreased lung compliance, retained airway secretions

Atelectasis, Hypoxemia

Assessment findings:

Severe PAIN on inspiration & expiration & obvious trauma

Shortness of breath

Hypotension & inadequate tissue perfusion 2° to # CO

Respiratory acidosis

CXR – confirms the diagnosis


Medical Management:

Immobilize the fractured ribs

rib belt or elastic bandage is used especially in multiple rib fractures

it can lead to decreased lung expansion followed by pulmonary complications (pneumonia & atelectasis)

Pain: Analgesics (codeine), regional nerve block

Support ventilation, clear lung secretions

Antibiotics

ET intubation & mechanical ventilation


Nursing Management:

Apply the immobilization device

Stress the importance of taking deep breaths every 1-2° even though breathing is painful

Plan & implement care based on respiratory needs of clients with more severe injuries

Assess, monitor the client for signs of respiratory distress, infection & #pain

Pneumothorax

Accumulation of air

in the pleural space

it can lead to partial or complete collapse of the lung

Types:

Spontaneous pneumothorax

Open pneumothorax

Tension pneumothorax

Pneumothorax

Spontaneous pneumothorax

Most common type of closed pneumothorax

Air accumulates within the pleural space without an obvious cause (no antecedent trauma to thorax)

Pneumothorax

Open pneumothorax

usually caused by stabbing or gunshot wound

Pneumothorax

Tension pneumothorax

pressure in the pleural space is POSITIVE throughout the respiratory cycle

occurs in mechanical ventilation or resuscitation

air enters the pleural space with each inspiration but cannot escape

Hemothorax

Accumulation of BLOOD in the pleural space

frequently found w/ an open pneumothorax resulting in a hemopneumothorax

Pneumothorax/ Hemothorax


PAIN, Dyspnea

Diminished/absent breath sounds on affected side

#respiratory excursion on affected side

Hyperresonance on percussion

#vocal fremitus

Tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift)

Weak, rapid pulse; anxiety; diaphoresis



Diagnostic tests

Chest x-ray reveals area and degree of pneumothorax

ABG



Provide nursing care for the client with an ET tube

suction secretions, vomitus, blood from nose, mouth, throat,

monitor mechanical ventilation

Restore/promote adequate respiratory function

Assist with thoracentesis and provide appropriate nursing care

Assist with insertion of a CTT to water- seal drainage and provide appropriate nursing care





Continuously evaluate respiratory patterns and report any changes.

Provide relief/control of pain.

Administer narcotics/ analgesics/ sedatives as ordered and monitor effects

Position client in high-Fowler’s position.

Myasthenia Gravis

A neuromuscular disorder in which there is a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular

junction, causing extreme muscle weakness

Guillain-Barré Syndrome

Symmetrical, bilateral, peripheral polyneuritis characterized by ascending paralysis

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)(Maladie de Charcot)

Progressive motor neuron disease, which usually leads to death in 2-6 years

Acute Respiratory Distress Syndrome

“Noncardiogenic pulmonary edema”, “Adult respiratory distress syndrome”, “Shock lung”

An acute respiratory failure with the following indications

Hypoxemia that persists even when 100% O2 is given

Decreased pulmonary compliance

Dyspnea

Non-cardiac-associated bilateral pulmonary edema

Dense pulmonary infiltrates on x-ray (ground-glass appearance)


Etiology:

Often ARDS occurs after an acute traumatic event with no previous pulmonary disease

Aspiration (near drowning, vomiting)

Drug ingestion/ overdose

Hematologic disorders (DIC, massive

transfusions)

Direct damage to the lung (inhalation injury)

Metabolic disorders (pancreatitis, uremia)

Shock, Trauma, Major surgery, Embolism, Septicemia


Pathophysiology:



Severe respiratory distress develops within 4-8° after the onset of illness or injury

#RR, shallow, labored respirations, use of accesory muscles, cyanosis

Respiratory distress unrelieved w/ O2 administration

Anxiety, restlessness, mental confusion, agitation, drowsiness


Medical Management:

Initial cause must be diagnosed & treated

Administration of humidified oxygen

ET or tracheostomy tube insertion

Mechanical ventilation (PEEP, CPAP)

Client’s pulmonary status, determined by ABG findings & pulse oximetry results, dictates the oxygen concentration & ventilator settings

Complications associated with PEEP include tension pneumothorax & pneumomediastinum

Colloids (albumin) for pulmonary edema

Adequate nutritional support: enteral feeding (tube feeding), parenteral (hyperalimentation)


Nursing Management:

Focus: promotion of oxygenation & ventilation, prevention of complications that includes:

Deteriorating respiratory status,

Infection, Renal failure, Cardiac complications

Assess lung sounds hourly & suction as needed to maintain a patent airway

Provide explanations & support

Provide alternative methods for the client to communicate if hook up to a ventilator

Pulmonary Embolism

Obstruction of one of the pulmonary arteries or its branches caused by a thrombus that forms in the venous system or right side of the heart

Pulmonary Embolism

Pulmonary Embolism

Pulmonary Embolism


Pain, tachycardia, dyspnea, fever, cough, blood streaked-sputum

Larger areas are involved : more pronounced S/Sx

Severe dyspnea, Severe pain, Cyanosis, Tachycardia, Restlessness, Shock

Massive pulmonary infarction: SUDDEN DEATH will occur

CXR – may reveal areas of atelectasis

Lung scan, CT scan, pulmonary angiography – identify & detect the involved lung tissue

Pulmonary Embolism

Medical & Surgical Management:

Administration of IV heparin

Administration of thrombolytic drugs

Urokinase, streptokinase, t-PA

Anticoagulants are given after thrombolytic therapy

CBR, O2, analgesics

Pulmonary embolectomy

Insertion of umbrella filter device (greenfield filter)

Inserted using a catheter into the right internal jugular vein & threaded downward to an area below the renal arteries

Teflon clips (inferior vena cava)

Pulmonary Embolism

Pulmonary Embolism

Lung Resections

Lobectomy

removal of one lobe of a lung; treatment for bronchiectasis, bronchogenic carcinoma,

emphysematous blebs, lung abscesses

Pneumonectomy

removal of an entire lung; most commonly done as treatment for bronchogenic CA

Segmentectomy/ Segmental resection

segment of lung removed; most often done as treatment for bronchiectasis

Wedge resection

removal of lesions that occupy only part of a segment of lung tissue; for excision of small nodules or to obtain a biopsy

Lung Resections

Lung Resections

Nursing interventions: PREOPERATIVE

Provide routine pre-op care.

Perform a complete physical assessment of the lungs to obtain baseline data.

Explain expected post-op measures: care of incision site, oxygen, suctioning, chest tubes (except if pneumonectomy performed)

Teach client adequate splinting of incision with hands or pillow for turning, coughing, and deep breathing.

Demonstrate ROM exercises for affected side.

Provide chest physical therapy to help remove secretions

Lung Resections

Nursing interventions: POSTOPERATIVE

Provide routine post-op care

Promote adequate ventilation

Perform complete physical assessment of lungs and compare with pre-op findings.

Auscultate lung fields every 1-2 hours.

Encourage turning, coughing, and deep breathing every 1-2 hours after pain relief obtained.

Perform tracheobronchial suctioning if needed.

Lung Resections


cont… Promote adequate ventilation.

Assess for proper maintenance of chest drainage system (except after pneumonectomy).

Monitor ABGs and report significant changes.

Place client in semi-Fowler’s position

If pneumonectomy is performed, follow surgeon’s orders about positioning, often on back or operative side, but not turned to unoperative side).

If Lobectomy, patient is usually positioned on the UNOPERATIVE SIDE

Lung Resections


Provide pain relief.

Administer narcotics/analgesics prior to turning, coughing, and deep breathing.

Assist with splinting while turning, coughing, deep breathing.

Provide client teaching and discharge planning concerning

Need to continue with coughing/deep breathing for 6-8 weeks post-op and to

continue ROM exercises

Importance of adequate rest with gradual increase in activity levels

Lung Resections


cont… Provide client teaching and discharge planning concerning

High-protein diet with inclusion of adequate fluids (at least 2 liters/day)

Chest physical therapy

Good oral hygiene

Need to avoid persons with known upper respiratory infection

Lung Resections


cont… Provide client teaching and discharge planning concerning

Adverse signs and symptoms

recurrent fever, anorexia, weight loss, dyspnea, increased pain, difficulty swallowing,

shortness of breath, changes in color, characteristics of sputum, & importance of reporting to physician

Avoidance of crowds and poorly ventilated areas.

Documents

Respiratory System