In this blogpost we will be going through some respiratory conditions, namely Pulmonary Embolism (PE), Pneumothorax, Empyema, Pleurisy, Pulmonary Oedema and Pleural Effusion.
Pulmonary Embolism (PE)
Pulmonary Embolism (PE), which is a life threatening emergency, is the result of an obstruction of the pulmonary artery or one of its branches caused by a thrombus, which starts anywhere within the venous system or in the right side of the heart. This obstruction compromises gas exchange in the affected part of the lung.
Pulmonary Embolism clinical manifestations include:
- dyspnoea
- tachypnoea
- chest pain
- anxiety
- fever
- tachycardia
- apprehension (feeling something wrong is about to happen)
- cough
- diaphoresis (excessive sweating)
- haemoptysis (coughing up blood)
- shock
Pulmonary Embolism assessment may include:
- chest x-ray
- ECG
- ABGs
- pulmonary angiogram (CT PA)
Pulmonary Embolism prevention:
- ambulate
- encourage leg exercises if patient is on bed rest
- advise against prolonged sitting, immobility and constrictive clothing
- advise against leg dangling and/or leg crossing
- do not leave IV catheters in situ for long periods
- use compression stockings
- administer anti-coagulation therapy
Pulmonary Embolism Management:
- oxygen therapy – relieves hypoxaemia, respiratory distress & central cyanosis; assess for signs of hypoxaemia and monitor pulse oximetry; teach deep breathing exercises; if necessary administer nebuliser therapy or percussion and postural drainage to help with secretions
- anti-coagulation therapy
- place patient in semi fowler’s position and administer analgesics if patient experiences severe chest pain
Pulmonary Embolism complications:
- cardiogenic shock (heart becomes unable to pump enough blood to meet the body’s needs)
- right sided heart failure (right side of the heart is not pumping enough blood to the lungs a.k.a. cor pulmonale or pulmonary heart disease)
Pneumothorax
Pneumothorax happens when the parietal or visceral pleura is breached, causing air to enter the pleural cavity, leading to partial or full lung collapse. Similarly, haemothorax results from a collection of blood within the pleural cavity due to torn intercostal vessels or laceration of the lungs through trauma.
- Simple Pneumothorax (does not shift the mediastinal structures)
- Traumatic Pneumothorax (caused by an injury that tears the lung and allows air to enter the pleural space)
- Tension Pneumothorax (life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function)
Pneumothorax clinical manifestations include:
- sudden onset of pleuritic pain
- minimal respiratory distress (in small pneumothorax) or acute respiratory distress (in large pneumothorax)
- anxiety
- hypotension
- tachycardia
- profuse diaphoresis (excessive sweating)
- dyspnoea & air hunger
- use of accessory muscles during breathing
- central cyanosis (in severe hypoxaemia)
- diminished or absent breathing sounds
- normal or hyperresonant percussion on pneumothorax side (depending on its size)
- decreased chest expansion
- shifting of the trachea to one side (depending on pneumothorax size)
Pneumothorax assessment is done through a chest x-ray.
Pneumothorax medical management:
- thoracentesis with suction
- antibiotics (due to contamination infection)
- oxygen therapy
- thoracotomy (a surgical procedure in which a cut is made between the ribs to see and reach the lungs or other organs in the chest or thorax)
Pneumothorax nursing management includes:
- assist chest tube insertion
- assess chest drainage process and water seal
- monitor respiratory status and lung re-expansion with the use of pulmonary support interventions
- provide information and reassurance to the patient and family members
Empyema
Empyema refers to a collection of thick purulent (infected) fluid in the pleural space.
Empyema clinical manifestations:
- fever
- night sweats
- pleural pain
- cough
- dyspnoea
- anorexia
- weight loss
Empyema assessment:
- auscultation of the chest for decreased or absent breathing sounds in the affected area
- dullness on chest percussion
- CT scan
- thoracentesis
Empyema medical management:
- drain pleural cavity to promote complete lung re-expansion
- administer antibiotics
- needle thoracentesis (if fluid amount is small and not too thick)
- tube thoracostomy
- open chest drainage via thoracotomy to remove thickened pleura, pus and debris as well as diseased pulmonary tissue
Empyema nursing management should be done in the same way as in pneumonia.
Pleurisy
Pleurisy happens when there is inflammation of the visceral and parietal pleurae. When these two rub together, the individual experiences severe sharp knife-like pain during breathing, which increases on inspiration. Pleurisy may develop when the individual has pneumonia, plumonary embolism and other respiratory conditions.
Pleurisy clinical manifestations:
- pain that worsens with deep breathing, coughing or sneezing, and which is usually focused on one side only
- pain may be localised as well as radiating towards the shoulder or the abdomen
- pain decreases when the individual holds breath
- on auscultation, friction rub can be heard
- pain diminishes once pleural fluid develops again
Pulmonary Oedema
Pulmonary Oedema refers to an accumulation of fluid in the interstitial spaces of the lungs that diffuses into the alveoli.
Pulmonary Oedema clinical manifestations:
- restlessness
- anxiety
- breathlessness
- sense of suffocation
- cyanotic nail beds
- greyish skin tone
- cold and moist hands
- weak and rapid pulse
- jugular vein distension
- coughing
- increasing foamy sputum
- confusion and stuporous (as pulmonary oedema progresses)
- rapid noisy moist-sounding breathing
- significant decrease in oxygen saturation level
Pulmonary Oedema assessment includes crackles on auscultation.
Pulmonary Oedema medical and nursing management:
- oxygen therapy (patient may need to be intubated and provided with mechanical ventilation)
- position patient in an upright position or with legs and feet down or ideally dangling over the side of bed to promote better circulation
- reassure patient to reduce anxiety
- administer diuretics (monitor for medication effects)
Pleural Effusion
Pleural Effusion is a collection of fluid within the pleural space, commonly seen in pneumonia, congestive heart failure and respiratory infections.
Pleural Effusion clinical manifestations:
- dullness/flatness to percussion over affected area
- minimal or absent breathing sounds
- decreased fremitus (vibratory sensation felt on chest during speech)
- tracheal deviation to the unaffected side
- dyspnoea may not be present in small to moderate effusions
- shortness of breath leading to acute respiratory distress (in large effusions)
Pleural Effusion assessment:
- physical examination
- chest x-ray
- CT scan
- thoracentesis with pleural fluid analysis (culture, chemistry and cytology)
Pleural Effusion medical and nursing management:
- thoracentesis
- chemical pleurodesis (a procedure to achieve symphysis between the two layers of pleura by sclerosing agents)
- the nurse should monitor chest tube drainage and water seal system, as well as document the amount of drainage
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels RadiometerMedical, MotionLit, RegisteredNurseRN, SurgEdVidz, Dr Aishwarya Kelkar, Respiratory Therapy Zone, Larry Mellick and FSUMedMedia.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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