Atelectasis
Atelectasis is marked by incomplete expansion
of lobules (clusters of alveoli) or lung segments,
which may result
in partial
or complete
lung collapse. The collapsed areas
are
unavailable for gas exchange; blood that lacks
O
passes through unchanged, thereby producing hypoxemia.
2
Atelectasis may be chronic or acute. It occurs to some degree in many clients undergoing upper
abdominal or thoracic surgery. The prognosis depends on prompt removal of any airway obstruction,
relief of hypoxia, and re-expansion of the collapsed lung.
CAUSES
Bronchial occlusion by mucus plugs, as in clients with COPD, bronchiectasis, or cystic fibrosis or
those who smoke heavily
CNS depression
External compression, such as from upper abdominal surgical incisions, rib fractures, pleuritic chest
pain, tight dressings around the chest, or obesity
Occlusion by foreign bodies, bronchogenic carcinoma, and inflammatory lung disease
Prolonged immobility
Cor pulmonale
A chronic heart condition, cor pulmonale is hypertrophy (enlargement) of the hearts right ventricle
that results from diseases affecting the function or the structure of the lungs. To compensate for the
extra work needed to force blood through the lungs, the right ventricle dilates and enlarges.
Invariably, cor pulmonale follows some disorder of the lungs, pulmonary vessels, chest wall, or
respiratory control center. For example, COPD produces pulmonary hypertension, which leads to right
ventricular
hypertrophy, which can lead to
right-sided
heart failure (although cor
pulmonale
can occur without heart failure).Because
cor pulmonale generally occurs
late
during the course of COPD and other
irreversible
diseases,
the prognosis is
generally poor.
CAUSES
COPD (about 25% of clients with COPD eventually develop cor pulmonale)
Living at high altitudes (chronic mountain sickness)
Loss of lung tissue after extensive lung surgery
Obesity-hypoventilation syndrome (pickwickian syndrome) and upper airway obstruction
Obstructive lung diseases such as bronchiec
tasis
and cystic fibrosis
Pulmonary vascular diseases, such as recurrent thromboembolism, primary pulmonary hypertension,
schistosomiasis, and pulmo nary vasculitis
Respiratory insufficiency without pulmonary
disease, as seen in chest wall disorders, such
as kyphoscoliosis, neuromuscular incompetence
resulting from muscular dystrophy
and amyotrophic lateral sclerosis, poly
myositis,
and spinal cord lesions above C6
Restrictive lung diseases, such as pneumoconiosis,
interstitial pneumonitis, scleroderma,
and sarcoidosis
Lung cancer
In lung cancer, unregulated cell growth and uncontrolled cell division result in the development of a
neoplasm. Cancer may also affect the lungs as a result of metastasis from other organs, mainly the
liver, brain, bone, kidneys, and adrenal glands.
Four histologic types of lung cancer include:
squamous cell (epidermoid), a slowgrowing
cancer that originates from bronchial epithelium.
It metastasizes late to the surrounding
area, but may cause bronchial obstruction.
adenocarcinoma, a moderately growing cancer located in peripheral areas of the lung. It metastasizes
through the bloodstream to other organs.
large-cell anaplastic, a very fast-growing cancer associated with early and extensive metastasis. Its
more common in peripheral lung tissue.
small-cell (oat cell cancer), a very fast-growing cancer that metastasizes very early through lymph
vessels and the bloodstream
to other organs.
CAUSES
Tobacco use
Exposure to environmental pollutants
Exposure to occupational pollutants
ASSESSMENT FINDINGS
Hypoxemia
Hypotension
Chest pain
Chills, fever
Cough, hemoptysis
Dyspnea, wheezing
Respiratory alkalosis
Respiratory alkalosis is characterized by a deficiency of CO
in the blood (hypocapnia), as indicated by a decrease in Pa
CO
2
2
. PaCO
is below 35 mm Hg (normal level is 45 mm Hg).
This condition is caused by alveolar hyperventilation. Elimination of CO
by the lungs exceeds the production of CO
at the cellular level, leading to deficiency of CO
2
in the blood.
Uncomplicated respiratory alkalosis leads to a decrease in hydrogen ion concentration, which causes
elevated blood pH.
CAUSES
Pulmonary causes
Acute asthma
Interstitial lung disease
Pneumonia
Pulmonary vascular disease
Nonpulmonary causes
Anxiety
Aspirin toxicity
CNS disease (inflammation or tumor)
Fever
Hepatic failure
Metabolic acidosis
Pregnancy
Sepsis
ASSESSMENT FINDINGS
Agitation
Cardiac arrhythmias that fail to respond to conventional treatment (severe respiratory alkalosis)
Carpopedal spasms (spasms affecting the wrist and the foot)
Circumoral or peripheral paresthesias (a prickling sensation around the mouth or extremities)
Deep, rapid breathing, possibly exceeding 40 breaths/minute (cardinal sign)
Light-headedness or dizziness (from decreased cerebral blood flow)
Muscle weakness
Seizures (severe respiratory alkalosis) Twitching (possibly progressing to
tetany)
2
DIAGNOSTIC TEST RESULTS
ABG analysis confirms respiratory alkalosis and rules out respiratory compensation for metabolic
acidosis. In the acute stage, Pa
CO
is below 35 mm Hg and pH is elevated in proportion to the fall in Pa
CO
2
, but pH drops toward normal in the chronic stage. Bicarbonate level is normal in the acute stage but
below normal in the chronic stage.
NURSING DIAGNOSES
Anxiety
Impaired gas exchange
Ineffective breathing pattern
Ineffective peripheral tissue perfusion
TREATMENT
Correction of underlying cause, which may include removal of ingested toxins, treatment of CNS
disease, or treatment of fever or sepsis
Increasing CO
levels (for respiratory alkalosis
caused by hyperventilation) by having the
client breathe into a paper bag
2
INTERVENTIONS AND RATIONALES
Assess neurologic, neuromuscular, and cardiovascular functions to ensure prompt recognition
and treatment.
Monitor ABG and serum electrolyte levels closely, watching for any variations to detect early changes and
prevent complications.
Perform appropriate interventions for the underlying cause.
Teaching topics
Explanation of the disorder and treatment plan
Relaxation techniques
Breathing into a paper bag during an acute anxiety attack
