Brush up on key concepts

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Respiratory refresher (continued)

COR PULMONALE (CONTINUED)
Cardiac glycoside: digoxin (Lanoxin)
Diuretic: furosemide (Lasix)
Vasodilators: diazoxide, hydralazine, nitroprusside (Nitropress),
prostaglandins (in primary pulmonary hypertension)
Calcium channel blocker: diltiazem (Cardizem)
Angiotensin-converting enzyme inhibitor: captopril (Capoten)
Key interventions
Limit the clients fluid intake to 1 to 2 qt (1 to 2 L)/day, and provide a low-sodium diet.
Reposition the client every 2 hours.
Provide meticulous respiratory care, including O2 therapy and,
for clients with chronic obstructive pulmonary disease, pursedlip breathing exercises.
Monitor ABG levels and watch for signs of respiratory failure
such as a change in pulse rate; deep, labored respirations; and
increased fatigue produced by exertion.
EMPHYSEMA
Key signs and symptoms
Barrel chest
Dyspnea
Pursed-lip breathing
Key test results
Chest X-ray in advanced disease reveals a flattened diaphragm, reduced vascular markings in the lung periphery,
enlarged anteroposterior chest diameter, and a vertical heart.
PFTs show increased residual volume, total lung capacity,
and compliance as well as decreased vital capacity, diffusing
capacity, and expiratory volumes.
Key treatments
Chest physiotherapy, postural drainage, and incentive
spirometry
Fluid intake up to 3 qt (3 L)/day, if not contraindicated
O2 therapy at 2 to 3 L/minute; transtracheal therapy for home
O2 therapy
Antibiotics: according to sensitivity of infective organism
Bronchodilators: terbutaline, aminophylline, theophylline
(Theochron); via nebulizer: albuterol (Proventil-HFA), ipratropium
(Atrovent)
Influenza and Pneumovax vaccines
Steroids: hydrocortisone (Solu-Cortef), methylprednisolone
(Solu-Medrol)
Steroids (via nebulizer): beclomethasone (Beconase AQ),
triamcinolone (Azmacort)

Key interventions
Assess respiratory status, ABG levels, and pulse oximetry.
Assist with diaphragmatic and pursed-lip breathing.
Monitor and record the color, amount, and consistency of
sputum.
Provide chest physiotherapy, postural drainage, and suction.
IDIOPATHIC PULMONARY FIBROSIS
Key signs and symptoms
Dyspnea
Dry, hacking, paroxysmal cough
Rapid, shallow breathing
In late cases
Cyanosis
Profound hypoxemia
Pulmonary hypertension
Key test results
Lung biopsy findings vary based on the stage of the disease.
In general, the alveolar walls are swollen with chronic
inflammatory infiltrates. In the late disease stages, the alveolar
walls are destroyed and are replaced by honeycombing cysts.
Key treatments
Lung transplant: in younger, otherwise healthy clients
O2 therapy
Corticosteroids and cytotoxic drugs: to suppress inflammation,
but are usually unsuccessful
Key interventions
Assess respiratory status.
Monitor oxygen levels and administer O2 as needed.
Encourage activity to the extent that the client is able.
Provide emotional support.
LUNG CANCER
Key signs and symptoms
Cough, hemoptysis
Weight loss, anorexia
Key test results
Chest X-ray shows a lesion or mass.
Key treatments
Resection of the affected lobe (lobectomy) or lung (pneumonectomy)
Radiation therapy

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