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Pulmonary Nursing: Key Topics

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Pulmonary Nursing: Key Topics

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Pulmonary Nursing Overview

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Zoey Brar-Avelar
Zoey Brar-Avelar
United States

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Pulmonary Nursing: Key Topics
 

Pulmonary Nursing: Key TopicsOnline version

Pulmonary Nursing Overview

by Zoey Brar-Avelar
1

III. Sarcoidosis

Definition: An inflammatory, multisystem, granulomatous interstitial lung disease of unknown origin

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Patient Demographics: Most common in African American women between ages 30 and 50

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Clinical Manifestations: Insidious onset; symptoms include dyspnea, cough, fatigue, anorexia, and weight loss

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Assessment: Requires biopsy for definitive diagnosis (showing noncaseating granulomas)

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Nursing Priorities:

Medication Education: Educate on corticosteroids (tapering doses over 12 months) and monitoring for side effects like hypercalcemia

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Symptom Reporting: Instruct the patient to notify the provider if respiratory symptoms worsen

2

IV. Chest Tumors & Lung Cancer

Epidemiology: Leading cause of cancer death; >85% caused by cigarette smoke

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Classifications: Small Cell Lung Cancer (SCLC) is very aggressive and fast-growing; Non-Small Cell Lung Cancer (NSCLC) is more common (84%)

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Clinical Manifestations:

Red Flag: A new cough or a change in a chronic cough character

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Dyspnea, hemoptysis, chest pain, and late-stage symptoms like bone pain or weight loss

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Screening: USPSTF recommends annual Low-Dose CT (LDCT) for adults 50–80 with a 20 pack-year history who currently smoke or quit within 15 years

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Nursing Management:

Airway Clearance: Implement deep-breathing exercises, CPT, and directed coughing

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Symptom Management: Strategies to manage dyspnea, fatigue, and nausea

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Psychosocial Support: Coordinate with nurse navigators and community programs for end-of-life care

3

V. Chest Trauma

Nursing Assessment Priority: Assess Airway, Breathing, and Circulation (ABCs) immediately; look for symmetric chest movement and signs of shock

1. Sternal/Rib Fractures & Flail Chest

Rib Fractures: Lead to shallow breathing to avoid pain, which increases risk for atelectasis and pneumonia

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Flail Chest: Occurs when 3+ adjacent ribs are fractured in 2+ places, causing paradoxical chest movement (inward on inspiration, outward on expiration)

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Priority Intervention: Management ranges from clearing secretions to mechanical ventilation (internal pneumatic stabilization) for severe flail chest

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2. Pneumothorax (Simple vs. Tension)

Simple: Air enters the pleural space; trachea remains midline

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Tension Pneumothorax (Medical Emergency): Air is trapped in the pleural space, increasing pressure and causing mediastinal shift

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Critical Signs: Tracheal deviation to the unaffected side, JVD, hypotension, and tachycardia

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Immediate Action: Emergency decompression with a large-bore needle at the 2nd intercostal space followed by chest tube insertion

4

VI. Chest Tube Management

Purpose: To remove air/fluid from the pleural space and restore negative pressure to re-expand the lung

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Monitoring Chambers:

Water Seal Chamber: Should show tidaling (fluctuation with breathing); continuous bubbling indicates an air leak

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Collection Chamber: Notify the provider if drainage is >100–150 mL/hr or changes suddenly

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Nursing Care & Safety:

Emergency Kit: Always keep sterile water and Vaseline gauze at the bedside

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Disconnection: If the tube becomes disconnected from the system, submerge the end in sterile water to create a temporary water seal

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Insertion Site: Monitor for crepitus (subcutaneous emphysema), which feels like "Rice Krispies" under the skin

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Do Not Clamp or hemostat a chest tube unless specifically ordered or during system changes
 
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