14 Chapter 32Chronic Disorders of the Lower Respiratory Tract _______________________________________
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LESSON 32.1
Pathophysiology (cont.)
• Cavities develop that are filled with infectious material, which eventually liquefies and is
coughed up as sputum
TALKING POINTS:
• The infected site usually heals, creating scar tissue (the lesion is called a tubercle) and
sometimes shelters inactive bacteria.
• What other organs in the body may be infected with tuberculosis?
Slide 33
Signs and Symptoms
• Cough, night sweats, chest pain and tightness, fatigue, anorexia, weight loss, and low–
grade fever
TALKING POINTS:
Slide 34
Medical Diagnosis
• History and physical examination
• Sputum cultures, acid-fast smears of potentially infected body fluids, tuberculin skin tests,
and chest radiographs
TALKING POINTS:
• People who have been infected mount an immune response that causes a local reaction
when tuberculin, a protein fraction of the tubercle bacillus, is injected intradermally.
• What indicates a positive reaction to tuberculin?
Slide 35
Medical Treatment
• Individuals with latent tuberculosis may be treated with INH alone, INH with rifampin, or
rifampin with pyrazinamide
• Multidrug-resistant TB will not respond to INH, rifampin; other drug combinations used
TALKING POINTS:
• Patients who have positive results for tuberculosis on skin tests and negative results on
chest radiographs but are at increased risk for the disease are usually treated
prophylactically to prevent development of active tuberculosis.
Slide 36
Assessment
• A complete health history and a physical examination
______________________________________ Chapter 32Chronic Disorders of the Lower Respiratory Tract 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Slide 37
Interventions
• Impaired gas exchange
• Social isolation
• Risk for injury
• Fatigue
• Imbalanced nutrition: Less than body requirements
• Ineffective therapeutic regimen management
Interstitial Lung Disease
• Inflammation of the lower respiratory tract and thickening and fibrosis of the alveolar walls;
Slide 39
Idiopathic Pulmonary Fibrosis
• Pathophysiology
• Formation of scar tissue in lung tissue after inflammation or irritation
• Cigarette smoking, frequent aspiration, or exposure to environmental or occupational
substances
• Complications
• Pulmonary hypertension, cor pulmonale, and ventilatory failure
TALKING POINTS:
Slide 40
Idiopathic Pulmonary Fibrosis (cont.)
• Signs and symptoms
• Nonproductive cough and progressive dyspnea
• Inspirational crackles heard in the lungs on auscultation
• Clubbing of the fingertips
Slide 41
Idiopathic Pulmonary Fibrosis (cont.)
• Medical treatment
• Corticosteroids, immunosuppressants, mucolytic, O2 therapy
• No treatment significantly improves survival or quality of life
• Interventions
• Avoid additional exposure to offending substances
• Lung transplantation may be recommended for end-stage disease
Occupational Lung Diseases
• Inhalation of particles in the work setting such as dust, ammonia, chlorine, plant and
16 Chapter 32Chronic Disorders of the Lower Respiratory Tract _______________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Slide 43
Acute Respiratory Irritation
• Inhalation of gases such as ammonia or chlorine
• Effects usually temporary, but if the lower airways are affected, pulmonary edema or
alveolar damage and airway obstruction
• May have coughing, wheezing, and dyspnea
• Symptoms resolve within a few days to several weeks; usually no permanent lung
damage
• Treatment: managing symptoms and avoiding exposure
Slide 44
Occupational Asthma
• Inhalation of plant or animal proteins; cause an allergic reaction
• Treatment: same as for bronchial asthma
• Initial acute symptoms last only a few hours, but patient may have hyperreactive airway
for years
• This means that future exposure to irritants may trigger acute asthmatic symptoms
• Patient should avoid continued exposure to the offending substance
Slide 45
Hypersensitivity Pneumonitis
• Allergic inflammatory response of the alveoli to inhaled organic particles
• May resolve in a few days, or patient may contract pulmonary edema or interstitial
fibrosis with permanent restrictive or restrictive-obstructive disease
• Treated with corticosteroids and avoidance of irritants; respiratory support may be needed
if symptoms are severe
Pneumoconiosis
• Caused by inhalation of various dusts
• In response to repeated exposure to silica, asbestos, or coal dust; characterized by
TALKING POINTS:
• Asbestosis is a pneumoconiosis caused by occupational exposure to asbestos, an
insulating material.
• Exposure to asbestos has been linked to what disorders?
Slide 47
Sarcoidosis
• Pathophysiology
• Inflammatory condition: affects the skin, eyes, lungs, liver, spleen, bones, salivary
glands, joints, and heart
• An unknown factor triggers a series of immune processes; leads to formation of
clusters of cells and debris in affected tissues called granulomas
• Signs and symptoms
• Some have no symptoms, others experience dry cough, dyspnea, chest pain,
hemoptysis, fatigue, weakness, weight loss, and fever
______________________________________ Chapter 32Chronic Disorders of the Lower Respiratory Tract 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Slide 48
Sarcoidosis (cont.)
• Medical diagnosis
• Chest radiography, pulmonary function tests, and flexible bronchoscopy with
transbronchial lung biopsy
• Medical treatment
• If patient is asymptomatic, no treatment is indicated
• 6- to 12-month course of systemic corticosteroids
• Methotrexate used as an alternative to corticosteroids
• Lung transplantation only option for patients with end-stage disease who do not
respond to drug therapy
Sarcoidosis (cont.)
• Nursing care
Slide 50
Lung Cancer
• Cause and risk factors
• Leading cause of cancer death in the United States
• Cigarette smoking: leading cause
• Risk increased more for smokers exposed to other carcinogenic substances, such as
arsenic, asbestos, and radioactive materials
• Evidence that “secondhand” smoke a threat to nonsmokers
TALKING POINTS:
• The incidence is decreasing among men but has been rising steadily among women.
• What disorder has been exceeded by lung cancer in regard to death rate for women?
Slide 51
Lung Cancer (cont.)
• Pathophysiology
• Small cell (“oat cell”) lung carcinoma (SCLC)
• Non–small cell lung carcinoma (NSCLC)
• Squamous cell carcinomas, adenocarcinomas, large cell carcinomas, and
bronchial carcinoids
• Small cell and large cell undifferentiated carcinomas grow rapidly: other lung cancers
grow slowly
Slide 52
Lung Cancer (cont.)
• Signs and symptoms
• Persistent cough, hemoptysis, chest pain, and recurring pneumonia or bronchitis
• May have dyspnea, weight loss, and pain in the shoulder, arm, or hand
• Other signs and symptoms may be related to metastatic lesions
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Slide 53
Lung Cancer (cont.)
• Medical diagnosis
• Radiographic procedures (chest radiography, CT scan, MRI), fiberoptic
bronchoscopy, sputum cytology studies, and biopsy of tissue obtained through
bronchoscopy, percutaneous transthoracic fine-needle biopsy, thoracotomy, or other
methods
• Radionuclide scans of bones, liver, or brain to detect metastatic lesions
Slide 54
Lung Cancer (cont.)
• Medical treatment
• Radiotherapy
• Brachytherapy
• Chemotherapy
• Targeted biologic therapies
TALKING POINTS:
• Radiotherapy may be used alone or in combination with other treatment methods.
• Chemotherapy may be used alone or with radiation in the treatment of SCLC.
• Targeted biologic therapies that block the activity of growth factor receptors are being
studied for their value in cancer treatment.
• What are examples of targeted biologic therapies?
• The goal of surgery is to remove the entire tumor while removing as little healthy
surrounding tissue as possible.
Slide 55
Lung Cancer (cont.)
• Nursing care
• Nurses must continue to educate the public about the dangers of cigarette smoking to
help eliminate the primary cause of lung cancer
Extrapulmonary Disorders
• Chest deformities interfere with lung expansion
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 57
Question 1
• Chronic obstructive pulmonary disease (COPD) is the ______ leading cause of death in
the United States.
A. first
B. second
C. third
D. fourth
TALKING POINTS:
Slide 58
Question 2
• Which of the following is not true of the effects that can occur with repeated episodes of
status asthmaticus?
A. Hypertrophy of bronchial smooth muscle
B. Thickening of the tissues in the airways
C. Underinflation of the lungs
D. Hypertrophy of mucus glands
TALKING POINTS:
20 Chapter 32Chronic Disorders of the Lower Respiratory Tract _______________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
DISCUSS
• Discuss the key characteristics of the most
common chronic obstructive pulmonary
disorders. Identify why these diseases are
classified as obstructive.
• Discuss how the drugs used to treat asthma
are classified. Can patients with asthma
exercise
PRACTICE
• Divide the class into two groups. Assign
chronic inflammatory obstructive disease to
group 1 and restrictive pulmonary disease to
group 2. Have the groups identify and
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
2
DISCUSS
• Discuss the diagnosis and treatment of
COPD. Review the common elements in the
treatments of various disorders in terms of
the outcomes sought from treatment.
PRACTICE
• Divide the class into five groups, and assign
each group one chronic respiratory disorder.
Ask each group to identify and discuss the
pathophysiology, signs and symptoms,
complications, diagnostic measures, and
medical treatments for the disorder. Then
have each group deliver a presentation on
22 Chapter 32Chronic Disorders of the Lower Respiratory Tract _______________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
3
DISCUSS
• Discuss the Nursing Care Plan for the
patient with chronic obstructive pulmonary
disease. Focus particularly on the nursing
diagnosis, goals and outcomes, and the
interventions that support these. Discuss the
steps that would be taken if these
interventions proved unsuccessful.
• Lead a class discussion with the following
questions:
• What is the hypoxic drive for breathing?
PRACTICE
• Divide the class into small groups. Have
each group refer to Nursing Diagnoses,
Goals, and Outcome Criteria: Tuberculosis,
4
DISCUSS
• Discuss the increased risks of chronic
pulmonary disease that apply to those who
smoke and the physiologic reasons for these
risks.
• Invite a primary care nurse practitioner to
speak to the class about the importance of
smoking cessation for the general
population, and then more specifically for
patients with chronic respiratory disorders.
______________________________________ Chapter 32Chronic Disorders of the Lower Respiratory Tract 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 32.1
Critical Thinking Question
A 30-year-old man who is having an asthma attack presents to the emergency department
with dyspnea, the use of accessory muscles to breathe, and audible wheezing. The man is
receiving an albuterol nebulizer for treatment. For which complications should the nurse
monitor this patient?
Discussion Guidelines: A severe and persistent bronchospasm can lead to a condition called
Instructor Notes/Student Feedback
24 Chapter 32Chronic Disorders of the Lower Respiratory Tract _______________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
32
Assessments for
Chronic Disorders of the Lower Respiratory
Tract
CHAPTER OBJECTIVES
Lesson 32.1:
2. For selected chronic respiratory disorders, describe the pathophysiology, signs and symptoms,
complications, diagnostic measures, and medical treatment.
4. Explain the relationship between cigarette smoking and chronic respiratory disorders.
Assessments by Lesson & Objective
Lesson 32.1
1
Study Guide
• Part IA: 1-7, 9, 10 (p. 193)
• Part IE: 5 (p. 195)
• Part IIF: 1 (p. 195)
Evolve Instructor Resources
• Test Bank: 14, 28
• Open Book Quiz: 7, 9
Evolve Student Resources
• NCLEX Review: 2
2
Study Guide
• Part IA: 8 (p. 193)
• Part IB: 8, 9, 10 (p. 194)
• Part IC: 1 (p. 194)
• Part IE: 1-3 (p. 194)
• Part IIF: 2-14, 16, 19-27 (pp. 195-196)
• Part IIIG: 1-3, 5 (p. 197)
• Part IIIH: 4, 5 (p. 198)
Evolve Instructor Resources
• Open Book Quiz: 1, 2, 4, 5, 8, 10
Evolve Student Resources
• NCLEX Review: 3-5, 7
• Prioritization: 3
______________________________________ Chapter 32Chronic Disorders of the Lower Respiratory Tract 25
Assessments by Lesson & Objective
3
Study Guide
• Part IB: 1-7 (p. 194)
• Part IIF: 15, 17, 18 (p. 196)
• Part IIIG: 4, 6 (p. 197)
• Part IIIH: 1-3, 6, 7 (p. 198)
Evolve Instructor Resources
• Test Bank: 2-5, 7, 13, 17, 24, 27
• Open Book Quiz: 3, 6
Evolve Student Resources
4
Study Guide
• Part IE: 4 (p. 194)
Evolve Instructor Resources
• Test Bank: 20, 23
Evolve Student Resources
• Prioritization: 4, 5
Instructor’s Notes/Student Feedback