18 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.2
4
PRACTICE
• Obtain two chest drainage systems from a
company sales representative, learning lab,
or other source. Have a source of water
readily available. Review the proper
procedure for setting up the system without
opening the packaging. Then, divide the
class in half. Provide each group with a
Critical Thinking Question
A patient who takes a bronchodilator by inhaler tells the nurse that she feels jittery and that
her heart pounds after she takes the medication. The patient usually has two cups of coffee
in the morning and is wondering if it’s the coffee or the medication that is causing these
symptoms. How should the nurse respond?
Discussion Guidelines: The nurse should explain to the patient that the bronchodilator relaxes
Instructor Notes/Student Feedback
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Textbook Objectives Covered
5. For selected respiratory disorders, describe the pathophysiology, signs and symptoms,
complications, diagnostic measures, and medical treatment.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: local health department representative
• Student performance evaluation of all entry-level skills required for student comprehension of
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• atelectasis (p. 561)
• crackles (p. 561)
• hypoxemia (p. 571)
• hypoxia (p. 561)
• rhonchus (pl. rhonchi)
(p. 561)
20 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Student Preparation
Assignments 2 hours
5
READ – Textbook (pp. 581-595)
REVIEW
• Table 31-4: Drugs used to treat respiratory disorders (pp. 578-580)
ANSWER – Text
ANSWER – Study Guide
• Part II I: 1-3, 5, 18, 19: 1-11 (pp. 190-191)
• Part IIIJ: 1, 5 (p. 192)
6
READ – Textbook (pp. 590-597)
REVIEW
• Figure 31-13: Open pneumothorax (p. 590)
• Figure 31-14: Vena cava filter (p. 594)
• Box 31-1: Assessment of the Patient with a Respiratory Disorder (p. 563)
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 597)
ANSWER – Study Guide
• Part IIIJ: 2-4 (p. 192)
• Part IIIK: 1-3 (p. 192)
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
50-Minute Lesson Plan
Lecture Outline 20 minutes
5
Slide 28
Drug Therapy
• Decongestants
• Antitussives
• Antihistamines
• Expectorants
• Antimicrobials
Slide 29
Acute Viral Rhinitis (Common Cold)
• Cause and risk factors
• Caused by viruses that invade the upper respiratory tract through airborne droplets
• Signs and symptoms
TALKING POINTS:
• How are droplets spread from one person to another?
• A cold lasts 2 to 14 days, and people are most contagious during the first 3 days.
Acute Viral Rhinitis (Common Cold) (cont.)
• Medical diagnosis
TALKING POINTS:
• Antibiotics and currently available antiviral agents are usually not indicated because they
are not effective against cold viruses.
Slide 31
Acute Viral Rhinitis (Common Cold) (cont.)
• Assessment
• Symptoms, medical history, and drug history
• Physical examination of the nose, throat, ears, neck, and chest
22 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Acute Viral Rhinitis (Common Cold) (cont.)
• Nursing diagnosis, goal, and outcome criteria
• Ineffective therapeutic regimen management
TALKING POINTS:
• What criteria are used to assess the effectiveness of patient management of the plan of
care?
• Absence of infection is evidenced by normal vital signs, clear breath sounds, and clear
sputum.
Acute Viral Rhinitis (Common Cold) (cont.)
• Interventions
• Rest and daily fluid intake of 2 to 3 L, if not contraindicated
TALKING POINTS:
• What is the primary nursing intervention for acute viral rhinitis?
Acute Bronchitis
• Etiology and risk factors
• Usually viral; bacterial causes also common
Slide 35
Acute Bronchitis (cont.)
• Medical diagnosis
• Health history and the physical findings
• Nursing care
TALKING POINTS:
• Treatment consists of a broad-spectrum antibiotic for 7 to 10 days; hospitalization is
usually unnecessary.
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 36
Influenza
• Cause
• Acute viral respiratory infection accompanied by fever
• Complications
TALKING POINTS:
• Who is most susceptible to the influenza virus?
• Influenza usually occurs in epidemics during the winter months.
Slide 37
Influenza (cont.)
• Signs and symptoms
• Chills, fever, sore throat, muscular pain, headache, and dry hacking cough
• Medical diagnosis
• History and physical findings
TALKING POINTS:
Slide 38
Influenza (cont.)
• Medical treatment
• Rest, fluids, proper diet, antipyretics, analgesics, and antiviral agents
• Best treatment: prevention through immunization
• Nursing care
TALKING POINTS:
• First-generation antiviral agents like amantadine hydrochloride (Symmetrel) or
rimantadine (Flumadine) can be used to treat type A influenza.
24 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 39
Pneumonia
• Cause and risk factors
• Inflammation of certain parts of the lung, such as alveoli and bronchioles
• Caused by either infectious or noninfectious agents
TALKING POINTS:
• What are examples of infectious agents? Noninfectious agents?
• Nosocomial pneumonia is a hospital-acquired infection that may be attributed to
Slide 40
Pneumonia (cont.)
• Pathophysiology
• Classified according to the causative organism, usually bacteria or viruses
• When pathogens invade lungs, inflammation causes fluid accumulation in affected
TALKING POINTS:
• What is the difference between gram-positive bacteria and gram-negative bacteria?
Pneumonia (cont.)
• Complications
• Pleurisy, pleural effusion, and atelectasis
TALKING POINTS:
• Although most people recover from pneumonia, it remains among one of the leading
causes of death, especially in older adults.
• What is pleurisy? Pleural effusion? Atelectasis?
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 42
Pneumonia (cont.)
• Signs and symptoms
• Fever, chills, sweats, chest pain, cough, sputum production, hemoptysis, dyspnea,
headache, and fatigue
• Medical diagnosis
TALKING POINTS:
• People with bacterial pneumonia may experience an abrupt, almost explosive onset:
severe shaking chills; sharp, stabbing lateral chest pain, especially with coughing and
Pneumonia (cont.)
• Medical treatment
• Increased fluid intake (at least 3 L every 24 hours), limited activity or bedrest,
TALKING POINTS:
Slide 44
Pneumonia (cont.)
• Interventions
• Ineffective airway clearance; Impaired gas exchange
Slide 45
Pleurisy (Pleuritis)
• Inflammation of the pleura
• Causes: pneumonia, tuberculosis, injury to the chest wall, pulmonary infarction, and
tumors
• Symptom of pleurisy is abrupt and severe pain
26 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 46
Pleurisy (Pleuritis) (cont.)
• Interventions
• Acute pain
• Ineffective breathing pattern
TALKING POINTS:
Slide 47
Chest Trauma
• Cause
• Nonpenetrating or blunt injuries
• From automobile accidents, falls, or blast injuries
TALKING POINTS:
• Chest trauma can result in changes in normal pressure relationships between air inside
Chest Trauma (cont.)
• Signs and symptoms
Slide 49
Chest Trauma (cont.)
• Medical treatment
• Treat bleeding
• Cover open chest wound with an airtight dressing taped on three sides
TALKING POINTS:
• Immediate care of a person with a chest injury is directed at stabilization and prevention of
further injury.
• What is the purpose of a vented dressing?
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Pneumothorax
• Cause
• Accumulation of air in pleural cavity: results in complete or partial collapse of a lung
TALKING POINTS:
• What is a mediastinal shift and what causes it to occur? A mediastinal flutter?
Pneumothorax (cont.)
• Signs and symptoms
• Dyspnea, tachypnea, tachycardia, restlessness, pain, anxiety, decreased movement
Pneumothorax (cont.)
• Medical treatment
• Physician may insert an 18-gauge needle through chest wall into pleural space and
Slide 53
Pneumothorax (cont.)
• Interventions
• Ineffective breathing pattern
• Fear
TALKING POINTS:
• Monitor the patient closely for increasing respiratory distress as indicated by tachycardia,
dyspnea, cyanosis, restlessness, and anxiety.
Slide 54
Hemothorax
• Blood accumulation between chest wall and lung that is often associated with
pneumothorax
• From lacerated or torn blood vessels or lung tissues, lung malignancy, or pulmonary
embolus
28 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 55
Rib Fractures
• Cause
• Most common cause: blunt injury
• Signs and symptoms
TALKING POINTS:
• Which ribs are most frequently fractured?
adequate breathing.
Slide 56
Rib Fractures (cont.)
• Assessment
• For signs of increasing respiratory distress
• Nursing diagnosis, goal, and outcome criteria
Rib Fractures (cont.)
• Interventions
• Breathing exercises
TALKING POINTS:
Slide 58
Flail Chest
• Cause
• An injury in which two adjacent ribs on the same side of the chest are broken into two
TALKING POINTS:
• What is paradoxical movement?
• Ventilation is impaired, and the patient becomes hypoxemic.
Flail Chest (cont.)
• Signs and symptoms
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Flail Chest (cont.)
• Medical treatment
TALKING POINTS:
• The treatment of flail chest varies depending on the severity of the condition.
• What can be monitored by repeated radiographs and arterial blood gas tests?
Slide 61
Flail Chest (cont.)
• Assessment
• Respiratory status, vital signs, other medical diagnoses, and a drug history
• Interventions
TALKING POINTS:
• Flail chest is more serious and the patient may be acutely ill; anxiety may be very high.
• What measures may help reduce the patient’s anxiety?
Pulmonary Embolus
• Cause and risk factors
TALKING POINTS:
• Where do most pulmonary emboli originate?
• The effects depend on the extent of the lung tissue that is deprived of blood.
Pulmonary Embolus (cont.)
• Signs and symptoms
• Sudden chest pain that worsens with breathing, tachypnea, and dyspnea
Pulmonary Embolus (cont.)
• Medical diagnosis
30 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 65
Pulmonary Embolus (cont.)
• Medical and surgical treatment
• Anticoagulation therapy
• Oxygen therapy, endotracheal intubation, and/or mechanical ventilation
• IV fluids and drugs: improve cardiac function
Slide 66
Pulmonary Embolus (cont.)
• Assessment
• Monitor cardiopulmonary function
• Homans’ sign should be assessed in each leg
• Interventions
• Ineffective tissue perfusion
TALKING POINTS:
• How is a Homans’ sign assessed?
Acute Respiratory Distress Syndrome (ARDS)
• Cause and risk factors
• Progressive pulmonary disorder that follows trauma to the lung
TALKING POINTS:
• Fluid shifts into the interstitial spaces in the lungs and into the alveoli, causing pulmonary
edema.
• What complication may occur as a result of ARDS?
Slide 68
ARDS (cont.)
• Medical diagnosis
• History and physical; arterial blood gas analysis and chest radiographs
• Medical treatment
TALKING POINTS:
• What occurs with the arterial blood gas values in the patient with ARDS?
• Early detection and treatment are critical factors in treating ARDS successfully.
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 31
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
Slide 69
ARDS (cont.)
• Should be treated in intensive care setting
• Nurses must be aware of the risk of ARDS and respond promptly when a patient exhibits
progressive respiratory distress
• Rapid progression of the condition is frightening to patient and family
• Recognize their anxiety and fear and offer emotional support and simple explanations
Activities
Classroom Choose from below to make 30 minutes
Online
5
DISCUSS
• Divide the class into small groups, and ask
each group to identify nursing interventions
and patient education for patients with acute
viral rhinitis for the following patients:
PRACTICE
• Divide the class into pairs. Have students
take turns role-playing a nurse educating a
patient with bronchitis. Ask for volunteers to
present scenarios to the class and discuss
what they learned from the activity. Then
have the class critique scenarios for
proper administration.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
cause, risk factors, symptoms, diagnosis,
and treatment of acute bronchitis.
• Post the following discussion topic online
and have students comment. Discuss the
cause, risk factors, symptoms, diagnosis,
and treatment of influenza.
• Post the following discussion topic online
and have students comment. Discuss the
pathophysiology, risk factors, symptoms,
32 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.3
6
DISCUSS
• Discuss the data a nurse should collect
while obtaining a health history from a
patient with a common cold.
PRACTICE
• Present the following scenarios to the class,
and ask the students to assume the role of
the nurse. Ask for feedback about how the
nurse should respond.
• You (the nurse) feel as though you’re
• Have a pair of students role-play a nurse
advising a patient with acute viral rhinitis
how to treat his or her cold, avoid spreading
the virus, and reduce the risk of acquiring a
secondary bacterial infection. Afterward,
have the rest of the class critique the
exchange, offering improvements.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss how to
reduce the risk of contracting and spreading a
cold and of acquiring a secondary bacterial
infection using the Patient Teaching Plan:
Common Cold..
Critical Thinking Question
A 15-year-old patient goes to a provider’s office with his mother for a scheduled physical
before starting competitive sports. He has the sniffles and a slight cough, so his mother
asks for an antibiotic that will “knock out the bug” right away and not interfere with sports
or infect teammates. The provider diagnoses a common cold and offers over-the-counter
(OTC) and prescription medications to relieve the symptoms. As the nurse is reviewing the
medications with the patient and mother, the mother asks why her child wasn’t given
antibiotics. What might the nurse tell the mother?
Discussion Guidelines: The nurse should explain that antibiotics are useful for treating bacterial
Instructor Notes/Student Feedback
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 33
Introduction to Medical-Surgical Nursing, 6th ed.
31
Assessments for
Acute Disorders of the Lower Respiratory Tract
CHAPTER OBJECTIVES
Lesson 31.1:
1. Identify data to be collected in the nursing assessment of the patient with a respiratory disorder.
3. Describe diagnostic tests or procedures for respiratory disorders and nursing interventions.
Lesson 31.2:
Lesson 31.3:
5. For selected respiratory disorders, describe the pathophysiology, signs and symptoms, complications,
diagnostic measures, and medical treatment.
6. Assist in developing a nursing care plan for the patient who has an acute respiratory disorder.
Assessments by Lesson & Objective
Lesson 31.1
1
Study Guide
• Part IA: 1-14 (p. 187)
• Part IB: 1-3 (p. 188)
Evolve Instructor Resources
• Test Bank: 1, 2, 4, 5, 6
Evolve Student Resources
2
Study Guide
• Part IC: 1, 2 (p. 188)
Evolve Instructor Resources
• Test Bank: 6
• Open Book Quiz: 1
Evolve Student Resources
• NCLEX Review: 5
3
Study Guide
Evolve Instructor Resources
• Test Bank: 7–11
• Open Book Quiz: 4-7
Evolve Student Resources
• NCLEX Review: 3
34 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IF: 1-4 (p. 189)
Evolve Instructor Resources
• Test Bank: 12–14
Evolve Student Resources
• NCLEX Review: 4, 6
Lesson 31.3
5
Study Guide
• Part II I: 1-3, 5, 18, 19: 1-11 (pp. 190-191)
• Part IIIJ: 1, 5 (p. 192)
Evolve Instructor Resources
• Test Bank 15–18
• Open Book Quiz: 8, 9
Evolve Student Resources
• Prioritization: 1, 2, 3
6
Study Guide
• Part IIIJ: 2-4 (p. 192)
Evolve Instructor Resources
• Open Book Quiz: 10
Evolve Student Resources
• NCLEX Review: 7
Instructor’s Notes/Student Feedback