Chapter 19: Managing Chest & Lower Respiratory Disorders

The text examines infectious pathologies extensively, categorizing pneumonia into community-acquired (CAP), hospital-acquired (HAP), and ventilator-associated (VAP) types, while also addressing aspiration pneumonia risks and the unique pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to COVID-19 and potential complications like acute respiratory distress syndrome (ARDS). Tuberculosis (TB) management is detailed through airborne transmission precautions, diagnostic methods like the Mantoux test and interferon-gamma release assays (IGRAs), and pharmacological regimens involving first-line agents such as isoniazid and rifampin. Further exploration of pulmonary pathology includes lung abscesses, pleurisy, and pleural effusions requiring thoracentesis or chest tube insertion for drainage, as well as the management of empyema. A significant portion of the chapter is dedicated to critical care interventions for acute respiratory failure, detailing artificial airway management via endotracheal intubation and tracheostomy, along with the principles of mechanical ventilation using modes such as continuous mandatory ventilation (CMV), synchronized intermittent mandatory ventilation (SIMV), and positive end-expiratory pressure (PEEP). The text outlines the nursing role in preventing ventilator-associated events through evidence-based bundles and managing the weaning process. Discussion extends to pulmonary vascular disorders like pulmonary hypertension and cor pulmonale, as well as occupational lung diseases classified as pneumoconioses. Malignant neoplasms are analyzed by differentiating non-small cell lung cancer (NSCLC) from small cell lung cancer (SCLC), with treatment modalities ranging from chemotherapy and immunotherapy to surgical interventions like lobectomy, pneumonectomy, and video-assisted thoracoscopic surgery (VATS). Finally, the chapter addresses chest trauma, including blunt and penetrating injuries that result in conditions such as flail chest, pulmonary contusion, and various forms of pneumothorax (simple, traumatic, and tension), necessitating emergency interventions and the maintenance of water-seal or dry suction chest drainage systems to restore negative intrathoracic pressure.