Nursing 211

N211: Health Differences Across the Lifespan I Coal Worker’s Pneumoconiosis is also known as “black lung disease: and occurs in the lungs of coal miners due to the accumulation of coal dust that causes a reaction of the tissue to foreign substances. The respiratory tract attempts to rid the body of the coal dust but eventually is unsuccessful. The respiratory tract becomes clogged with coal, dust, macrophages, and fibroblasts which lead to the production of the coal macule, the primary lesion of black lung, which appear as black dots on the lung. The patient has massive lesions of dense fibrotic material, which destroy blood vessels and the bronchi of the affected lung. Manifestations are cough, dyspnea, and expectorations of black sputum, melanoptysis. Cor pulmonale and respiratory failure eventually occur. 2.27 Pulmonary Embolism Pulmonary Embolism is when emboli is lodged in the pulmonary vasculature and impedes blood flow through pulmonary capillaries. Ventilation-perfusion mismatch is a clinically significant imbalance between volume of air and volume of blood circulating to gas exchange area of the lungs, which leads to impaired gas exchange. Pulmonary embolism more commonly occurs in immobilized clients who develop deep vein thrombosis. Risk factors include immobility, hypercoagulability, trauma to endothelial layer of blood vessels and long bone fractures. Venous thrombus dislodges and circulates to pulmonary vasculature; fat emboli travel from the site of long bone fractures. Emboli obstruct small to large areas of pulmonary vasculature, preventing adequate perfusion and gas exchange. A massive area of obstructed tissue leads to pulmonary infarction. Severe impairment of gas exchange can be rapidly fatal. Nursing Assessment Includes restlessness, anxiety, agitation, apprehension. Monitor vital signs, tachycardia, tachypnea, hypotension and low-grade fever. Monitor dyspnea, shortness of breath, chest pain, cough, hemoptysis, mental status changes with possible decreasing level of consciousness. Possible diaphoresis and cyanosis. Recent history of thromboembolism and/or long bone fractures. Lung crackles on auscultation. S3 and or S4 gallop; atrial fibrillation. Chest x-ray may be normal or show pulmonary infiltrates. Pulmonary angiogram reveals site of pulmonary emboli. Abnormal ABGs (significantly low PaO2). Nursing Diagnosis • Impaired gas exchange related to inability to perfuse pulmonary capillary bed • Altered tissue perfusion, pulmonary, related to obstructed pulmonary artery • Pain related to necrosis of pulmonary tissue Nursing I terventi ns


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