Lung Conditions

1

• Lung Conditions Traumatic Injury to the Lung
• Read Neuro Chapter 60

2
Objectives

• To outline and discuss management of some of the
  commonly encountered lung conditions and
  traumatic injuries to the lung including
• Pneumonia
• Pulmonary embolis
• Pneumothorax
• Pleural effusion
• Barotrauma
• Flail chest

3
Figure U13-2 Structures of the Lower Airways
4
Pulmonary Embolism

• Pulmonary embolism occurs when a blood clot
  becomes lodged in a lung artery, blocking blood
  flow to lung tissue. Blood clots often originate
  in the legs.

5
Video PE
What is a Pulmonary Emoblism? What are the
symptoms associated with it?
6
Pulmonary Embolism

• Blockage makes it more difficult for the heart to
  pump blood through lungs. As a result, less
  oxygen is available to the rest of the body. If
  the blockage is large enough, tissue death
  (infarction) occurs in the lung area cut off
  from circulation. Pulmonary embolisms are
  commonly misdiagnosed.

Nurses need to watch for it!
7
Signs and Symptoms

• Easily attributed to other conditions and vary
  with the size and number of clots.
• Such as a heart attack
• Pneumonia
• Hyperventilation
• Congestive heart failure
• Panic attacks.

Misdiagnosed for
8
No Classic Pattern Most common symptoms

• A sudden unexplained onset of shortness of
  breath, tachypnea or tachycardia, as well as
  sharp knife-like chest pains (pleuritic chest
  pain), when taking a breath, sense of impending
  doom.

9
WHAT ELSE?

• Blood may be coughed up as a result of lung
  tissue damage
• If the clot is particularly large, it can lead to
  dizziness and even fainting due to dangerously
  low blood pressure.

10
Who is at risk?

• Immobilization Being immobilized puts a strain
  on the circulatory system. Although the heart
  acts as the bodys main pump, movement also
  assists in keeping blood circulating properly.
• Long periods of inactivity may increase risk of
  blood clots. Examples include lengthy road trips
  or flights, or bed rest due to illness or
  surgery.
• Blood abnormalities Some people are born with
  blood thats more prone to clotting those
  dehydrated, septic, have Ca, those giving birth.

11
Other Risk Factors for Pulmonary Embolism

• Advanced age (especially over age 70)
• Significantly overweight
• Birth control pills, HRT drugs the osteoporosis
  drug raloxifene (Evista) are examples of drugs
  that list a small risk of developing blood clots.
  

12
About 90 of Pulmonary Emboli Result When a Clot
Travels from a Leg to a Lung - often no symptoms

• Blood tests, a chest X-ray, an electrocardiogram
  to help rule out other possible reasons for
  symptoms.
• Sometimes a leg blood clot may cause redness,
  swelling and pain in the calf muscle area. Refer
  to a physician promptly.
• A pulmonary angiogram is a more definitive test,
  although it involves some risk and is more
  expensive.
• the CT scan (computed tomography scan) instead
  of lung scan or pulmonary angiogram. CT scan is a
  less invasive test that provides fast and
  accurate results.

13
Thoracic Surgery

• Teaching why frequent monitoring of vital signs,
  hematocrit, and amount of plural drainage is
  important following thoracic surgery.
• At what point should the attending physician be
  called?
• Explain why regular assessment of the trachea is
  important post-op.
• Why are pulmonary function tests important? What
  results may indicate an increased risk of
  complications?

14
The patient is nursed upright in bed to allow for
maximum chest expansion and unrestricted drainage
and may even be extubated in the upright
position. Because the patient is not in the
recovery position, particular care must be taken
that the airway is not obstructed and respiration
rate, effort and oxygen saturation levels are
closely monitored. As there is a risk of CO
retention, a maximum of four litres per minute of
oxygen is given and blood gases may have to be
checked. The ECG is checked for cardiac
arrhythmias, a potential complication for these
patients (Schedel Connolly)
15
Think

• What should you do, if while turning a client
  just back from the OR following a segmental or
  wedge resection, there is a sudden gush of fluid
  through the chest tube?
• Shouldnt pooled blood have clots in it?
• Following post-op chest surgery, why is the
  client at risk of hypoxemia? Identify how gas
  exchange may be improved. Should the good lung
  or bad lung be down?

16
Common Respiratory Problems Following Thoracic
Surgery

• Refer also to student presentations
  presentation on Lung Cancer earlier in term they
  all relate

17
Keep in mind!!

• Patients tend to gasp milliseconds before a crash
  or a fall.
• This fills lungs with air, distends alveoli,
  making them more prone to rupture.

18
PNEUMOTHORAX
19
Pneumothorax
20
Pneumothorax

• Tension
• Air enters but cannot leave the chest. As the
  pressure increases, the heart great vessels are
  compressed the mediastinal structures are
  shifted towards the opposite side of the chest.
  The trachea is pushed from its normal midline
  position toward the opposite side of the chest
  the unaffected lung is compressed
• (see picture- next)

• Open
• Air enters the chest during inspiration exits
  during expiration. A slight shift of the
  affected lung may occur because of a decrease in
  pressure as air moves out of the chest
  (Smeltzer, 2000, p. 468)

21
Pneumothorax
Chest Tube
CT scan of the chest showing a pneumothorax on
the patient's left side. A chest tube is in
place (small black mark on the right side of the
image), the air-filled pleural cavity (black) and
ribs (white) can be seen. The heart can be seen
in the center.
22
Tension Pneumothorax
Inspiration
Expiration
23
Nursing Alert

• Traumatic open pneumothorax is an acute emergency
  requiring immediate intervention.
• Stopping the air from entering the chest is life
  saving. Relief of tension pneumothorax is an
  emergency measure

24
Signs and Symptomsof an open/closed pneumothorax

• Respiratory distress
• hypotension
• compensatory tachycardia
• Increased central venous pressure
• pallor
• cyanosis

• Sounds of an air leak, bubbles in blood from
  wound in chest wall.
• Compression/compromise of heart and unaffected
  lung is a LIFE-THREATENING EMERGENCY!!!

25
Open versus Closed Pneumothorax

• If chest injury is caused by blunt trauma and
  chest wall remains intact, pneumothorax is
  CLOSED. Air enters chest cavity from the lungs.
• If chest injury is penetrating and chest wall is
  compromised, pneumothorax is OPEN. Air enters
  chest cavity from the wound.

26
Nursing Alert

• Traumatic open pneumothorax is an acute emergency
  requiring immediate intervention.
• Stopping the air from entering the chest is life
  saving.
• Relief of tension pneumothorax is an emergency
  measure

27
Chest Tube
Chest Tube
28
Pleural Effusion

• Abnormal buildup of fluid between linings of the
  lung and chest wall
• result of a disease process or inflammation
• Normally 5 to 10 mL of serous fluid in the
  visceral and parietal pleura.
• Any more can cause great changes in intrathoracic
  pressure.

29
Pleural Effusion
Pleural Pleural Cavity
Effusion abnormal, excessive collection of this
fluid
30
Signs and Symptoms

• Pleural effusion in itself does not cause
  symptoms.
• If effusion expands and presses on lung, patient
  may develop
• sharp, localized pain that worsens with coughing,
  or deep breathing.
• Dyspnea
• non-productive cough.

31
Signs and Symptoms cont...

• Early signs include decreased or bronchial breath
  sounds on the affected side, dullness to
  percussion, and decreased fremitus over area of
  fluid accumulation
• Auscultation EGOPHONY
• Hear A over fluid accumulation when patient
  speaks E.

32
Complications of Pleural Effusion

• Respiratory compromise and distress from fluid
  compressing lung.
• Infection in pleural space---Sepsis/Empyema
• Fistulas in bronchi or chest wall
• Inflammation/infection in pleural space leads to
  increased potential for adhesions. Adhesions
  isolate effusion to one lung and complicates
  treatment.

33
(No Transcript)
34
Barotrauma

• Barotrauma results from increased airway pressure
  and decreased expiratory flow
• mechanical bag-valve-mask ventilation
• faulty equipment
• misuse of positive pressure ventilation
• Thus, Barotrauma is physical damage to body
  tissues caused by a difference in pressure
  between an air space inside or beside the body
  and the surrounding gas or liquid

35
Barotrauma

• 4 of all mechanically ventilated patients
  develop a pneumothorax
• 20 of patients receiving positive end-expiratory
  pressure develop a pneumothorax

36
Cor Pulmonale

• Enlarged right side of heart due to diseases that
  affect the structure and function of the lung
• Signs and symptoms
• Increased edema in hands and feet
• Distended neck veins
• Enlarged liver
• Pleural effusion
• Ascites and heart murmur
• SOB
• Wheeze
• Cough and fatigue

37
Atelectasis

• Collapsed or airless condition of alveoli
• Caused by
• hypoventilation, obstruction to the airways or
  compression
• Manifestations
• Shallow breathing, dyspnea, pleural pain, central
  cyanosis, increased heart rate, cough, sputum
  production and low grade fever

38
Atelectasis
39
Cardiac Tamponade

• Compression of the heart as a result of fluid
  within the pericardial sac
• Usually due to chest trauma
• Manifestations
• Hypotension
• Jugular-venous distention
• Muffled heart sounds