Nursing Care for Acute Respiratory Disorders

Medical and Nursing Management

Medical management focuses on identifying the causative agent via sputum cultures and chest X-rays. Once identified, targeted antibiotic therapy is administered for bacterial infections; however, antibiotics are not indicated for purely viral infections.

Nursing interventions are centered on maintaining airway patency and optimizing gas exchange:

1. Oxygen Therapy: Administering oxygen via nasal cannula or face mask, often with humidification to help loosen thick secretions.
2. Pulmonary Hygiene: Utilizing incentive spirometry, teaching effective coughing techniques, and performing chest physiotherapy.
3. Positioning and Hydration: Frequent position changes to improve lung expansion, maintaining adequate hydration to thin secretions, and ensuring proper nutrition.

Aspiration Risk and Prevention

Aspiration is a critical risk factor for developing pneumonia. It occurs when foreign substances (such as food, gastric contents, or saliva) enter the airway.

High-Risk Populations:

• Patients with a decreased level of consciousness (LOC).
• Individuals with swallowing disorders (dysphagia).
• Patients experiencing seizures or brain injuries.

To mitigate these risks, nurses must implement specific preventative measures:

• Keep the Head of the Bed (HOB) elevated $>30$ degrees at all times.
• Verify tube feeding placement and check residuals before administration.
• Use thickened fluids for patients with known swallowing problems.
• Avoid the overuse of sedatives, which can suppress the gag reflex.
• Avoid stimulating the gag reflex unnecessarily during suctioning procedures.

Pleural Disorders: Pleurisy and Empyema

While pneumonia affects the lung tissue itself, pleural disorders involve the space surrounding the lungs.

Pleurisy

Pleurisy is the inflammation of both layers of the pleurae. When these inflamed surfaces rub together during respiration, it causes sharp, intense pain that is exacerbated by inspiration.

• Nursing Care: Management focuses on pain control and assisting the patient with comfortable breathing through strategic positioning and splinting the chest.

Empyema

Empyema is a more severe condition characterized by the accumulation of thick, purulent (pus-filled) fluid within the pleural space. This accumulation can significantly impair lung expansion.

• Management: Patients often require chest tube drainage to evacuate the fluid.
• Recovery: Resolution is often a prolonged process, frequently requiring 4 to 6 weeks of continuous antibiotic therapy.

Comprehensive Nursing Assessment and Collaborative Problems

Effective care for respiratory disorders relies on a systematic nursing process.

Nursing Assessment Priorities

Nurses must prioritize the following assessments to detect early signs of deterioration:

• Vital Signs & Oxygenation: Continuous monitoring of pulse oximetry and, if necessary, Arterial Blood Gases (ABGs) to assess gas exchange.
• Respiratory Pattern: Auscultating all lung lobes to note changes in air exchange, observing for tachypnea, and inspecting the color and thickness of secretions.
• Neurological Status: Monitoring for changes in mental status, which can be an early indicator of hypoxia (low oxygen levels).
• Physical Indicators: Checking for fatigue, edema, dehydration, and signs of concomitant heart failure, particularly in older adults.

Collaborative Problems

Respiratory disorders rarely exist in isolation. Nurses must be vigilant for the following collaborative problems:

• Sepsis and Septic Shock: Systemic infection resulting from localized respiratory infections.
• Respiratory Failure: The inability to maintain adequate gas exchange.
• Atelectasis: Collapse of lung tissue.
• Pleural Effusion: Fluid accumulation in the pleural space.
• Confusion: Often a secondary symptom of hypoxia or metabolic changes.