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Respiratory system

Keep the client in semi-Fowlers or high

Fowlers position to promote chest expansion
and ventilation.
Maintain diet restrictions. Fluid restrictions and a low-sodium diet may be necessary to
avoid fluid overload.
Administer medications, as prescribed,
to treat infection, dilate airways, and reduce
inflammation.
Monitor chest tube system to assess for
lung re-expansion.

Teaching topics
Explanation of the disorder and treatment
plan
Recognizing the early signs and symptoms
of respiratory difficulty
Performing deep-breathing and coughing
exercises and incentive spirometry
Drug therapy
Nutritional therapy
Importance of adequate rest

In asbestosis,
my spaces are filled
with and inflamed by
asbestos fibers!

Asbestosis
Asbestosis is characterized by widespread
filling and inflammation of lung spaces with
asbestos fibers. In asbestosis, asbestos fibers
assume a longitudinal orientation in the
airway, move in the direction of airflow, and
penetrate respiratory bronchioles and alveolar
walls. This causes diffuse interstitial fibrosis
(tissue is filled with fibers).
Asbestosis can develop as long as 15 to 35
years after regular exposure to asbestos has
ended. It increases the risk of lung cancer in
cigarette smokers. No treatment can reverse
the effects of asbestosis. Treatment focuses
on relieving symptoms.

CAUSES
Inhalation of asbestos fibers

ASSESSMENT FINDINGS
Cor pulmonale
Dry crackles at lung bases
Dry cough
Dyspnea on exertion (usually first
symptom)
Dyspnea at rest (in advanced disease)
Finger clubbing

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Pleuritic chest pain

Pulmonary hypertension
Recurrent respiratory infections
Right ventricular hypertrophy
Tachypnea

DIAGNOSTIC TEST RESULTS

ABG analysis reveals decreased PaO2 and
low PaCO2.
Chest X-rays show fine, irregular, and
linear diffuse infiltrates; extensive fibrosis
results in a honeycomb or ground-glass
appearance. X-rays may also show pleural
thickening and pleural calcification, with
bilateral obliteration of costophrenic angles
and, in later stages, an enlarged heart with a
classic shaggy heart border.
PFTs show decreased vital capacity, forced
vital capacity, and total lung capacity and
reduced diffusing capacity of the lungs.

NURSING DIAGNOSES
Impaired gas exchange
Ineffective breathing pattern
Ineffective airway clearance
Ineffective peripheral tissue perfusion
Imbalanced nutrition: Less than body
requirements
Fatigue

TREATMENT
Chest physiotherapy
Fluid intake: at least 3 qt (3 L)/day unless
contraindicated
O2 therapy or mechanical ventilation (in
advanced cases)

Drug therapy
Antibiotics: according to susceptibility
of infecting organism (for treatment of
respiratory tract infections)
Cardiac glycoside: digoxin (Lanoxin)
Diuretic: furosemide (Lasix)
Mucolytic inhalation therapy: acetylcysteine

INTERVENTIONS AND RATIONALES

Perform chest physiotherapy techniques,
such as controlled coughing and segmental
bronchial drainage, with chest percussion
and vibration to relieve respiratory symptoms.
Aerosol therapy, inhaled mucolytics, and

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