Nursing Care for Patients

with Complex
Respiratory Disorders
Heather LaPoint, RN, BSN, CCRN

Objectives
Describe the purpose, methods, and nursing
responsibilities related to patients requiring chest
tubes and ventilator management.
Identify the mechanism, clinical manifestations, and
collaborative care for the patients experiencing
pneumothorax, fractured ribs, and flail chest.
Compare the pathophysiologic mechanisms,
complications, and collaborative care for clients
experiencing hypoxemic and hypercapnic respiratory
failure.

Objectives
Describe the nursing, pharmacologic, and
collaborative management of the patient with
ARDS.
Describe the nursing, pharmacologic, and
collaborative management of the patient with
sepsis.
Explain the risk factors, pathogenesis, clinical
manifestations, and nursing collaborative
management for patients experiencing lung
cancer.
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Upper Respiratory Disorders

Airway Obstruction
Causes
Nursing Management

Upper Respiratory Disorders

Airway Obstruction
Causes
Nursing Management

Lower Respiratory Disorders

Lung Cancer
Pathophysiology
Clinical Manifestations
Collaborative Care
Nursing Management
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Lower Respiratory Disorders

Lung Cancer
Cancer

Growth

(NSCLC)
Squamous cell
Carcinoma

Slow Growth

(NSCLC)
Adenocarcinoma

Nature

Treatment

Prevalence 20-30%.
Mostly men. Symptoms
of chronic respiratory
illness.
Usually does not
metastasize.

May try surgery. Stage

I-IIIa = surgical resect if
nodes are not involved.
Chemo/radiation in
addition.
Depending on staging,
life expectancy can be
good.

Moderate
Growth

Prevalence 30-40%.
Mostly women & nonsmokers.
No symptoms until
widely metastasized.

Depending on staging,
surgery may be
attempted.
Does not respond to
chemo

(NSCLC) Large
Cell Carcinoma

Rapid Growth

Prevalence 10%.
Often found in the
bronchi.
Highly metastatic via
lymph.

No surgery related to
metastatic rate.
May respond short term
to radiation, but recurs.

(SCLC) Small Cell

Carcinoma

Very Rapid
Growth

Prevalence 20%.
Most malignant,
metastasizes easily via
lymph to brain.
Symptomatic endocrine
disorders (i.e.
paraneoplastic
syndrome)

Chemo/radiation.
Chemo is primary
treatment with radiation
as adjuvant.
Usually palliative
therapy due to poor
prognosis and poor
response to therapy.

Lower Respiratory Disorders

Lung Cancer
Pathophysiology
Clinical Manifestations
Collaborative Care
Nursing Management
9

Lower Respiratory Disorders

Chest Trauma and Thoracic
Injuries
Pneumothorax
(spontaneous, iatrogenic,
traumatic, tension, hemo)
Flail Chest
Chest Tubes
Nursing Management
1

Lower Respiratory Disorders

Restrictive
Intra vs. Extra
Pulmonary
Causes
Pleural Effusion
(intrapulmonary)
Collaborative Care
1

Lower Respiratory Disorders

Vascular Lung Disorders - PE
Pulmonary Embolism
Clinical Manifestations
Diagnostic Studies
Collaborative Care
Nursing Management
1

Artificial Airways
Tracheostomy
Endotracheal Tubes
Intubation
Nursing Management
13

Mechanical Ventilation
Negative vs. Positive
Pressure
(Volume/Pressure
Ventilation)
Modes (AC, SIMV,
PSV)
PEEP
cPAP

14

Mechanical Ventilation
Positive Pressure Ventilation
Volume
Ventilatio
n

Pressure
Ventilatio
n

Other
Vent
Settings

AssistControl (AC)

Pressure
Support
Ventilation
(PSV)

Positive EndExpiratory
Pressure
(PEEP)

Synchronized
Intermittent
Mandatory
Ventilation
(SIMV)

Continuous
Positive
Airway
Pressure
(cPAP)

15

Mechanical Ventilation
Potential
Complications
Nutrition
Weaning
Nursing Management
16

Acute Respiratory
Failure

Hypoxemic vs.
Hypercapnic
Pathophysiology of
Hypoxemic
Respiratory Failure
Pathophysiology of
Hypercapnic
Respiratory Failure
17

Acute Respiratory
Failure
Clinical Manifestations
Collaborative Care
Nursing Management
Pharmacology
18

Acute Respiratory Distress

Syndrome (ARDS)
Pathophysiology
Clinical Manifestations
Complications
Collaborative Care
Nursing Management
19

Shock, SIRS, MODS

Sepsis
Septic Shock =
Distributive Shock
SIRS Criteria
Sepsis Criteria
Shock Criteria
MODS Criteria
20

Shock, SIRS, MODS

Sepsis
Pathophysiology
Compensatory, Progressive, &
Irreversible Stages
Collaborative Care
Pharmacology
Nursing Management
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References

Castillo, S. (2014). Strategies, Techniques, Approaches to Critical Thinking:

A Clinical Reasoning Workbook for Nurses (5th Ed). St. Louis, MO: Elsevier.
Hudak, C., Gallo, B., & Morton, P. (1998). Critical Care Nursing: A Holistic
Approach (7th Ed) Philadelphia, PA: Lippincott.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Harding, M. (2014).
Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (9th Ed). St. Louis, MO: Elsevier.
Lilley, L., Collins, S., & Snyder, J. (2014). Pharmacology and the Nursing
Process (7th Ed). St. Louis, MO: Elsevier.
Lutz, C, Mazure, D. & Litch, N. (2015). Nutrition and Diet Therapy (6th Ed).
Philadelphia, PA: G.A. Davis Company.

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