Occupational lung disease & respi failure & other respi failure


pneumonconiosis

fine particles and gaseous agent entering the lung -> once inhaled particulate matters are deposited on various areas of the respiratory tract

3 major types

silicosis

caused by inhalation and pulmonary deposition of crystalline silicon dioxide dust -> deposited in alveoli

nodular lesion-> often progress to fibrosis; show no symptoms

asbestosis

Deposition of small asbestos particles on bronchioles/ alveolar walls -> non nodular lesion, involving usually the lower lungs & often has pleural thickening, plaque formation, pleural calcification

coal workers' pneumoconiosis

chronic pathologic condition due to prolonged exposure to coal dust

phagocytosis move them to the terminal bronchioles; involve the upper lobe

S/S (along the progression of disease)

sob

loss of appetite

chest pain

severe scarring of lung

management

screening and monitoring of individual at risk (assessing history of exposure to environmental agents; make referrals to assess pulmonary function

promote measure to reduce exposure of hazards (use protective devices: facemask. hoods, industrial respirators)

education: pursed-lip breathing, abdominal breathing exercise; signs of complication of pneumoconiosis such as dyspnoea, cough....

provide supportive therapy aiming to prevent infections and managing complication

Respiratory failure

sudden & life-threatening deterioration of gas exchange function of lung -> lung failed to provide adequate oxygen for blood

causes

drug overdose, head trauma, infection, sleep apnea -> impaired CNS

,COPD, asthma -> pulmonary dysfunction

myasthenia gravis (cause weakness in skeletal muscle, such as breathing)/ spinal cord trauma -> neuromuscular dysfunction

chronic respiratory failure

acute respiratory failure

(deterioration in the gas exchange that has developed insidiously/ has persisted for a long period after an episode of acute respiratory failure

indicated by the presence of a chronic respiratory acidosis, absence of acute symptoms. gradual worsening hypoxemia & hypercapnia

decrease in arterial oxygen tension(PaO2) to <50mmhg (hypoxemia) & increase in PaCo2 (>50mmhg) (hypercapnia), eith arterial pH <7,35

S/S

early signs

restlessness, fatigue, headache, tachycardia, bp rise

when hypoxemia progresses

confusion, tachycardia, decrease in breathing sound, cyanosis

management

restore adequate gas exchange in lungs (endotracheal intubation & mechanical ventilation)

treat the underlying cause (drug overdose...)

nursing intervention

(if patient is undergoing mechanical ventilation) -> provide related nursing management

monitoring indications of altered tissue perfusion (ABG, Spo2, vital signs...)

monitoring & promote effective breathing pattern

prevent complication of immobility

promote comfort & self care

SARS (severe acute respiratory syndrome)

a viral respiratory infection caused by coronavirus (SARS-CoV)

Transmission route: close person-to-person contact, via respiratory droplets (coronavirus is stable in environment for upto 2 days at rm temp.)

diagnostic & lab test

can be detected in bld, respi secretion, urine & stool

serological test detect antibodies to SARS-CoV, which are produced from ard 10 days after onset of illness

S/S

high fever, associated with chills, rigors, headache, muscle pain, non productive cough & sob -> may progress to respi failure

later stage:CXR shows area of consolidation

management

limit transmission

use negative-pressure isolation rm, PPE, maintain hand hygiene,

nursing care & interventions (similar to that of pneumonia)

improving airway patency

promote rest

promote fluid intake & maintain nutrition

pleural effusion

collection of fluid in the pleural space, usually secondary to other disease (tb, pneumonia...)

fluid can be divided into transudate & exudate

transudate: pleural membrane are not diseased and it is commonly due to heart failure

exudate: usually resulted from inflammation of bacterial products/ tumors involving the pleural surface

could be clear fluid. blood stained fluid/ purulent

S/S (depending the underlying cause & severity)

pneumonia cause: fever, chills, pleuitic chest pain

malignant effusion causes: dyspnea (sob), coughing

dyspnea possibly absent for small effusion

decrease/ absent of breathing sound

dull. flat sound on percussion

tracheal deviation

assessment & diagnostic investigation

physical exam

CXR

chest ct scan

thoracetesis (chest tap)

pleural biopsy

management

perform thoracentesis (remove fluid + collect some for analysis)

chest tube placement & connect to water-seal drainage

pleurodesis to obliterate the pleural space and prevent further accumulation

nursing management

thoracentesis: prepare and position the patient, ensure adequate analgesia prior procedure

monitor chest drain

monitor respiration function

evaluate pain level & administer analgesic to relieve pain

atelectasis

due to reduction of ventilation/ airway obstruction -> no additional air can enter alveoli -> collapse of alveoli

S/S: dyspnea, cough, sputum production

acute atelectasis-> tachycardia, tachypnea, central cyanosis

chronic atelectasis: s/s of pulmonary infection may also present

diagnostic & assessment

CXR -> patchy infiltrate/ consolidated areas

spo2 <90%

decrease in breathing sound

management

frequent turning, early mobilization to promote ventilation

voluntary deep breathing maneuvers

use of incentive spirometry enhance lung expansion, decrease potential for airway closure

secretion management

directed cough, suctioning, aerosol nebulizer treatment followed by chest physiotherapy & bronchoscopy

pulmonary embolism (obstruction of pulmonary artery by a thrombus)

thrombus -> blood clot, air, fat

cause: trauma, surgery, prolonged immobility

prevention: active leg exercise, use of elastic pressure stocking, low dose of heparin used after surgery

dyspnea, tachypnea

assessment: clinical history, s/s, CXR, ECG, pulse oximetry, ABG, pulmonary angiogram

management

general: o2 therapy, elastic stocking, elevating legs

anticoagulation therapy: heparin, warfarin

thrombolytic therapy: therapy that resolve the thrombus(e.g. by streptokinase)/ surgical embolectomy

semi fowler for breathing

Monitor pt's s/s, pao2 and other lab result