• immediate trmt to reduce total volume of circulating fluid &  improve respiratory exchange
• Lasix IV, digitalis to increase cardiac output &  decrease systolic
• O2, ABG’s, pulse ox to determine oxygenation, bronchodilators
• morphine to decrease anxiety & promote vasodilation

• bed rest to reduce workload on heart, high Fowler’s with legs & feet dangling to decrease venous return
• I&O, insert Foley catheter, daily weights
• diet restricted in sodium to prevent fluid retention

• Asthma
• Chronic Obstructive Pulmonary Disease
• Cystic Fibrosis
• Atelectasis

chronic inflammatory disorder characterized by airway constriction, secretion of excess mucus, and edema of airway mucosa

• Allergic asthma (extrinsic)--external stimulants—allergens (pollen, dander, dust), tobacco smoke
• Idiopathic asthma (intrinsic)--internal stimulants—URI’s, exercise or physical stress, emotional stress, drugs,
• Mixed asthma--most common, elements of both

disease characterized by chronic & progressive obstruction of air flow in the lungs

• smoking most common
• secondary smoke exposure
• air pollutants
• occupational pollutants
• family HX

A mucus-producing cough that cannot be explained by other health problems, and which lasts for at least three months of the year, for at least two consecutive years.   Without treatment and prevention of acute attacks, the alveolar sacs and capillaries will extend & destruct

• asthma
• acute respiratory infections (pneumonia, influenza)
• smoking
• air pollution
• familial tendencies

bronchioles become inflamed and secrete excess mucus which traps air, less airflow restricts the ability to clear the airways of mucus

• “wet cough”course crackles throughout lung fields
• symptoms of resp infections (dyspnea, cyanosis)
• productive cough with thick, white or green sputum which becomes blood tinges as the disease progresses
• cough is greatest on arising
• fatigue, HA, SOA, edema of ankles & legs, halitosis, wheezing

• H&P, pulmonary testing to r/o other diseases (tuberculosis or malignancy)
• CXR will show enlarged heart if CHF involved and will have peripheral edema & fatigue

• prevent irritation of bronchial mucosa (No smoking, change environment, job)
• decrease symptoms of irritation, decrease airway obstruction
• prevent URI, bronchodilators, ABX, corticosteroids, flu vaccine
• maintain optimum health, adequate rest, proper diet

• O2 with humidity, loosen, liquefy and remove secretions (postural drainage)
• encourage fluids, diet high in PRO, vitamins, low Na
• evaluate for signs of fluid overload, daily wt, I&O
• adequate rest & gradually increase tolerance for ADL’s

a chronic, progressive, destructive condition in which the alveolar sacs distend, rupture, and destroy the capillary beds

• smoking is most common, see discussion on bronchitis

• alveoli loses elasticity and inspired air is trapped
• inspiration is difficult & expiration is prolonged
• lung tissue becomes fibrotic & exchange of gases is not possible

• dyspnea on exertion, late with slightest exertion & even at rest, orthopnea 
• use accessory muscles (jaw, neck, intercostals)
• inspiration difficult & expiration prolonged, lung sounds faint & diminished, no wheezes
• chronic cough, increased secretions due to inability to cough forcefully
• difficulty talking, speaks in short, jerky sentences
• barrel chest as lungs hyperinflate and change shape, complexion appears ruddy (PINK PUFFERS)
• anorexia, weight loss, weakness
• if infection present will have productive cough with purulent sputum in copious amounts
• cerebral anoxia—drowsy, confused, may become unconscious and go into coma

• H&P, CXR, PFT’s, ABG’s, CBC. Sputum analysis

see discussion on bronchitis, bronchodilators, nebulizers, abx, TCDB, chest percussion & drainage

• loosen, liquefy, & remove secretions (encourage fluids, postural drainage, expectorants)
• promote respiratory fcn—breathing exercises & cough
• administer O2 in low concentrations only (1-2 L), drive to breath is driven by low O2 concentration in blood and not CO2 level)
• Prevent & control infections, avoid smoking,
• provide rest, teach pursed lip breathing & abdominal breathing
• encourage small, frequent meals
• include family in care and care plan, condition is chronic

• pulmonary infections, TB, cystic fibrosis, resp infections from early childhood
• ineffective post op cough, chronic aspiration, toxic fumes, bronchial obstruction

• bronchi become distended and lose elastic recoil, secretions become thicker & accumulate in bronchi

• frequent or chronic productive cough of thick purulent copious amts, maybe bloody
• cyanosis, wheezing
• fatigue, wt loss , dyspnea,SOA

•  H&P, sputum C&S, CBC with increased H&H

• goal to remove secretions, prevent infections & maintain adequate O2
• plenty of fluids, stop smoking, chest physiotherapy, ABX (Augmentin)
• bronchoscopy to remove plugged secretions

• postural drainage, breathing trmts, mucomyst
• bronchoscopy to remove sputum
• flu vaccine & Pneumovax, bronchodilators, prednisone
• diet increase CHO & calories
• daily wt, monitor I&O to assess for CHF
• activity depends client tolerance

partial or total lung collapse and airlessness

• usual cause is obstruction of airway to affected lung (foreign body, mucus plugs), & compression of lung (tumors, aneurysms, enlarged lymph nodes
• hypoventilation and ventilation with inadequate tidal volumes

• if happens suddenly or lg amt of lung tissue involved, will have dyspnea, cyanosis, pleural pain, tachycardia
• anxious, may sit upright, affected side moves little

• H&P, auscultation with decreased lung sounds, percussion with dullness
• inspect for dyspnea, inspiratory retractions, & diaphoresis
• bronchoscopy to remove secretions & obtain specimens, ABG’s

• improve ventilation (IS, TCDB, postural drainage)
• administer O2 as ordered, may need suctioning
• may do thoracentesis to remove secretions & get spec
• prevention is primary treatment

• freq respiratory assessments
• place on unaffected side with involved side up to promote drainage
• move frequently
• encourage TCDB
• encourage fluids

• inflammation damages alveoli and lung tissue
• normal lung tissue replaced by scar tissue
• lungs become stiff & difficult to inflate
• normally lung defenses try to remove but this process is impaired by smoking, ETOH, and allergic reactions

• Pneumoconioses:  Inhale inorganic dusts & particulates (silica, coal dust, asbestos)
• Hypersensitivity:  Allergic response to organic dusts

Systemic disease of unknown cause, lesions on lungs, lymph nodes, liver, eyes, skin & other organs

•  PFTs, CXR, bronchoscopy for bx, lung scans

• nonspedific, anti-inflammatories, similar to COPD

• teach prevention

• Primary—strongly r/t smoking, air pollution, and chemical irritants
• Secondary—usually from metatastasis

• occurs in late stages
• productive cough & blood tinged sputum
• dyspnea, chest pain
• anorexia, fatigue, weight loss

• H&P, CT, MRI, examination of sputum cells (cytology), bronchial bx

• surgery depends on size & location of tumor (lobectomy, wedge resection, pneumonectomy, lap thoracotomy
• radiation
• photodynamic therapy with laser

• care of symptoms
• pre & post surgery—(Patent airway, O2, TCDB except with pneumonectomy)
• keep off operative side unless Dr orders
• chest tube care if necessary (rare but still a possibility)

malignant growth, either primary or secondary, in the lung

• Bronchiogenic is most common primary tumor
• usually without symptoms until late and mets occurred (brain, esophagus & spinal cord)
• trmt difficult and is usually symptomatic
• prognosis is poor unless detected & treated early

• Small cell (oat cell)
• Adenocarcinoma
• Squamous cell carcinoma
• Metastatic
• Fungal granuloma
• Mesothelioma

• obstruction of one or more pulmonary arteries by a thrombus that originates somewhere else in the venous system (usually deep veins in legs)
• can also have fat embolusfrom long bone fracture or air embolism from IV

• risk increases with age, arteriosclerosis & other vascular changes, Diabetes, post op state & immobility, oral contraceptives, smoking, heredity

• H&P, ABG’s show hypoxia & resp alkalosis
• ventilation perfusion lung scans

• abrupt restlessness, dyspnea, sudden chest pains, cough with hemoptysis
• JVD, diaphoresis, low grade fever (increased indicates lung infarct with necrosis),syncope, shock, death

• prevent (TED hose, early ambulation post op, SCD’s, activity)
• if clot present, activity is restricted (bed rest)
• O2, analgesics, meds (lovenox, heparin, coumadin),
  streptokinase given to dissolve clots within 6 hours of occurrence

air or blood in pleural space allowing for partial or complete collapse of lung

• may be spontaneous, trauma (knife wound, fractured rib),  
• postop (when thoracic cavity has been entered), diagnostic (central line, thoracentesis, pleural bx)

• life threatening, usually occurs with traumatic injuries
• air escapes into pleural cavity from a bronchus but can’t be expelled through bronchus
• lung continues to collapse, emergency tx to prevent cardiopulmonary arrest

• sudden, sharp chest pain (when spontaneous)
• anxiety, diaphoresis, rapid pulse & resps,
• decreased breath sounds, dyspnea,
• decreased BP, vertigo,
• lDx—H&P, CXR

• closure of wound with airtight drsg, thoracentesis to remove air,
• aspiration of fluids/air with chest tube
• analgesics

• high-Fowler’s,
• monitor VS & breathing, administer O2,
• care of chest tube

• 16-24 Fr catheter for air, 28-36 Fr catheter for fluid is inserted through chest wall into pleural space
• if air will be inserted anteriorly thru 2nd intercostal space, for blood or fluid insert through the 8th or 9th intercostal space

• Unit has 3 chambers
• 1 collects air or fluid,
• 2 functions as underwater seal which allows for expansion of lung and prevent air from entering pleural cavity,
• 3 provides vacuum regulation)

• after CT in place, an occlusive drsg is applied
• collection tube approx 6 ft long for adults is hooked to the pleur-evac  ensure tubes are free of kinks, drainage unit 1 foot below the chest tube
• bubbling is normal in water seal during expiration but excessive bubbling on inspiration & expiration indicates a leak in the system
• Absence of bubbles indicates the lung has fully expanded & evacuation is complete
• if drainage system is accidentally turned over, must change system so measurements can continue
• if CT accidentally removed, quickly place petroleum gauze over insertion site & have pt exhale forcefully, notify MD

• Dr will remove CT after no bubbling, normal breath sounds, expansion confirmed by CT, 
• Place client in semi-Fowler’s or on unaffected side, MD removes tube in quick continuous motion as pt performs Valsalva

• most common chest wall injury, pain on inspiration & coughing
• breath sounds diminished because of splinting,
• may feel crepitus when breathing

2 or more adjacent ribs broken in several places the chest wall becomes free floating

• the flail segment moves in with inspiration & out with expiration
• affects expansion

• lung tissue injury occurring with trauma
• alveoli & Vessels rupture causing hemorrhage & edema
• SOA, chest pain, restlessness & apprehension, copious sputum may be blood tinged, tachycardia, tachypnea, dyspnea, cyanosis

• may lead to burns of airway, Carbon monoxide or cyanide poisoning, lung damage from noxious gases
• dyspnea, wheezes or crackles
• possibly ash like material in sputum

• HA, dyspnea, nausea
• cherry-red skin & membranes
• Progress to confusion, hallucinations
• hypotension, seizures, coma

•  bronchospasm & edema of airways and alveoli

• have aspiration & O2 deprivation
• Hypoxemia, cyanosis, and loss of consciousness in 3-5 minutes, death within 5-10 minutes
• altered consciousness, apprehension
• HA, CP, hypothermic, vomitingapnea, tachypnea, wheezing, pink froth in mouth and nose

lungs are unable to oxygenate blood and remove carbon dioxide to meet body’s need, even at rest

• Results from severe respiratory dysfunction

• too much CO2, depresses respiratory center so that drive to breath is driven by too little O2 in blood, (if we give too much O2 client will lose drive to breath)

severe form of respiratory failure which follows direct or indirect lung injury, usually in 24-48 hours

• massive inflammatory response damages lungs, alveolar-capillarymembrane allows plasma & blood cell to leak into lung tissue & alveoli, surfactant does not work & is not replaced, alveoli collapse, O2 down, CO2 rises

• trauma, sepsis, CABG, major thoracic or vascular surgery, lung contusion (seat belt or CPR), fat embolism, surface burns, near drowning, O2 toxicity (inspired O2>50% for days), pancreatitis, renal failure, severe pulmonary infections, inhalation lung injuries, acute drug poisoning,

• first dyspnea & tachypnea, cyanosis, falling BP, increasing respiratory distress & refractory hypoxemia (doesn’t respond to O2)
• May recover but, if develop sepsis & multiple organ dysfunction syndrome (MODS), prognosis poor

• ventilator support, treat cause, bronchodilators, ABX, corticosteroids, lasix, dopamine for falling BP

drainage tubes inserted between ribs & into pleural cavity to allow for drainage of secretions, blood or air.