Nursing Diagnosis for Respiratory Diseases

Respiratory diseases are diseases that affect the air passages, including the nasal passages, the bronchi and the lungs. They range from acute infections, such as pneumonia and bronchitis, to chronic conditions such as asthma and chronic obstructive pulmonary disease. These include diseases of the lung, pleural cavity, bronchial tubes, trachea, upper respiratory tract and of the nerves and muscles of breathing.

Respiratory disease is responsible for over 10% of hospitalizations and over 16% of deaths in Canada. The study of respiratory disease is known as pulmonology. A doctor who specializes in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory medicine specialist, a respirologist or a thoracic medicine specialist.

Respiratory diseases can be classified in many different ways

• by the organ involved
• by the pattern of symptoms
• by the cause of the disease

A. Obstructive lung diseases – are diseases of the lung where the bronchial tubes become narrowed making it hard to move air in and especially out of the lung.

B. Restrictive lung diseases – (also known as interstitial lung diseases) are a category of respiratory disease characterized by a loss of lung compliance, causing incomplete lung expansion and increased lung stiffness. E.g. in infant respiratory distress syndrome (IRDS)

C. Respiratory tract infections – Infections can affect any part of the respiratory system. They are traditionally divided into upper respiratory tract infections and lower respiratory tract infections.

D. Upper respiratory tract infections - The most common upper respiratory tract infection is the common cold however, infections of specific organs of the upper respiratory tract such as sinusitis, tonsillitis, otitis media, pharyngitis and laryngitis are also considered upper respiratory tract infections.

E. Lower respiratory tract infection - The most common lower respiratory tract infection in is pneumonia, a lung infection. Pneumonia is usually caused by bacteria, particularly Streptococcus pneumoniae in Western countries. Worldwide, tuberculosis is an important cause of pneumonia. Other pathogens such as viruses and fungi can cause pneumonia for example severe acute respiratory syndrome and pneumocystis pneumonia. A pneumonia may develop complications such as a lung abscess, a round cavity in the lung caused by the infection or an empyema, the spread of the infection to the pleural cavity.

F. Respiratory  Tumors – Tumours of the respiratory system are either malignant or benign.

1. Malignant tumors, or cancers of the respiratory system, particularly lung cancers, are a major health problem responsible for 15% of all cancer diagnoses and 29% of all cancer deaths. The majority of respiratory system cancers are attributable to smoking tobacco.

The major types of respiratory system cancer are:

• Small cell lung cancer
• Non-small cell lung cancer
  • Adenocarcinoma
  • Large cell undifferentiated carcinoma
• Other lung cancers (carcinoid, Kaposi’s sarcoma, melanoma)
• Lymphoma
• Head and neck cancer
• Mesothelioma, usually caused by exposure to asbestos dust.

In addition, since many cancers spread via the bloodstream and the entire cardiac output passes through the lungs, it common for cancer metastases to occur the lung. Breast cancer may invade directly through local spread, and through lymph node metastases. After metastasis to the liver, colon cancer frequently metastasizes to the lung. Prostate cancer, germ cell cancer and renal cell carcinoma may also metastasize to the lung.

Treatment of respiratory system cancer depends on the type of cancer. Surgery (usually removal of part of the lung, a lobectomy or an entire lung, a pneumonectomy), chemotherapy and radiotherapy are all used. The chance of surviving lung cancer depends on the cancer stage at the time the cancer is diagnosed and is only about 14-17% overall. In the case of metastases to the lung, treatment can occasionally be curative but only in certain, rare circumstances.

2. Benign tumors are relatively rare causes of respiratory disease. Examples of benign tumors are:

• Pulmonary hamartoma
• Congenital malformations such as pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).

G. Pleural cavity diseases -  diseases include empyema and mesothelioma which are mentioned above.

• A collection of fluid in the pleural cavity is known as a pleural effusion. This may be due to fluid shifting from the bloodstream into the pleural cavity due to conditions such as congestive heart failure and cirrhosis. It may also be due to inflammation of the pleura itself as can occur with infection, pulmonary embolus, tuberculosis, mesothelioma and other conditions.
• A pneumothorax is a hole in the pleura covering the lung allowing air in the lung to escape into the pleural cavity. The affected lung “collapses” like a deflated balloon. A tension pneumothorax is a particularly severe form of this condition where the air in the pleural cavity cannot escape, so the pneumothorax keeps getting bigger until it compresses the heart and blood vessels, leading to a life threatening situation.

H. Pulmonary vascular diseases

• Pulmonary embolism, a blood clot that forms in a vein, breaks free, travels through the heart and lodges in the lungs (thromboembolism). Large pulmonary emboli are fatal, causing sudden death. A number of other substances can also embolise to the lungs but they are much more rare: fat embolism (particularly after bony injury), amniotic fluid embolism (with complications of labour and delivery), air embolism (iatrogenic).
• Pulmonary arterial hypertension, elevated pressure in the pulmonary arteries. It can be idiopathic or due to the effects of another disease, particularly COPD. This can lead to strain on the right side of the heart, a condition known as cor pulmonale.
• Pulmonary edema, leakage of fluid from capillaries of the lung into the alveoli (or air spaces). It is usually due to congestive heart failure.
• Pulmonary hemorrhage, inflammation and damage to capillaries in the lung resulting in blood leaking into the alveoli. This may cause blood to be coughed up. Pulmonary hemorrhage can be due to auto-immune disorders such as Wegener’s Granulomatosis and Goodpasture’s syndrome.

I. Disorders of breathing mechanics

The brain co-ordinates breathing and sends messages via nerves to the muscles of respiration. The muscles produce the movements of breathing. Disorders of the brain’s control of breathing, the nerves or the muscles of respiration can affect the respiratory system. Common disorders of breathing mechanics are:

• Obstructive sleep apnea
• Central sleep apnea
• Amyotrophic lateral sclerosis
• Guillan-Barre syndrome
• Myasthenia gravis

Obesity is often associated with sleep apnea and can cause either an obstructive or a restrictive pattern on spirometry. Obesity reduces the movement of the chest wall which can, in extreme cases, result in the obesity-hypoventilation syndrome, a cause of respiratory failure.

POTENTIAL NURSING DIAGNOSIS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA

1. Ineffective airway clearance
2. Impaired gas exchange
3. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

VIEW NURSING CARE PLAN FOR BRONCHIAL ASTHMA

POTENTIAL NURSING DIAGNOSIS FOR PNEUMONIA

1. Ineffective airway clearance
2. Impaired gas exchange
3. Risk for (spread) infection
4. Activity intolerance
5. Acute pain
6. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs
7. Risk for deficient fluid volume
8. Risk for imbalanced nutrition less than body requirements

VIEW NURSING CARE PLAN FOR PNEUMONIA

POTENTIAL NURSING DIAGNOSIS FOR LUNG CANCER: POSTOPERATIVE CARE

1. Impaired gas exchange
2. Ineffective airway clearance
3. Acute pain
4. Fear/ Anxiety
5. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR PNEUMOTHORAX/ HEMOTHORAX

1. Ineffective breathing pattern
2. Trauma/ Suffocation
3. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR RADICAL NECK SURGERY: LARYNGECTOMY (POSTOPERATIVE CARE)

1. Ineffective airway clearance
2. Risk for aspiration
3. Impaired verbal communication
4. Impaired skin or tissue integrity
5. Impaired oral mucus membrane
6. Acute pain
7. Imbalanced nutrition less than body requirements
8. Disturbed body image / Ineffective role performance
9. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR VENTILATORY ASSISTANCE (MECHANICAL)

1. Ineffective breathing pattern/ Impaired spontaneous ventilation
2. Ineffective airway clearance
3. Impaired verbal communication
4. Fear/ anxiety
5. Impaired oral mucus membrane
6. Imbalanced nutrition less than body requirements
7. Risk for infection
8. Risk for dysfunctional ventilatory weaning response
9. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR PULMONARY TUBERCULOSIS (PTB)

1. Risk for (spread/ reactivation) infection
2. Ineffective airway clearance
3. Risk for impaired gas exchange
4. Imbalanced nutrition, less than body requirements
5. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

Source:

http://wikipedia.org

http://cdc.gov

Lippincott Review Series