## Obstructive Sleep Apnea ### Pathophysiology Obstructive sleep apnea (OSA) occurs when the upper airway collapses during sleep, leading to pauses in breathing (apnea). This collapse is often due to relaxation of the muscles in the throat and tongue, narrowing the airway. Obesity is a significant risk factor, as excess tissue can further obstruct the airway. Remember that even small amounts of negative pressure during inspiration can trigger airway collapse in susceptible individuals. ### Manifestations/Complications * Daytime sleepiness * Headaches * Arrhythmias * Snoring (often loud and disruptive) * Morning headaches * Irritability Don't confuse OSA with central sleep apnea, where the brain fails to signal the respiratory muscles. ### Treatment * Weight loss (for obese individuals) * CPAP (Continuous Positive Airway Pressure) therapy * Surgery (e.g., tonsillectomy, uvulopalatopharyngoplasty) * Oral appliances (to maintain airway patency) Lifestyle changes, such as avoiding alcohol and sleeping pills before bed, can also help manage OSA. ### Nursing Management * Educate patients on risk factors and management strategies. * Monitor oxygen saturation levels during sleep studies. * Assess for daytime sleepiness and other symptoms. * Encourage weight loss and lifestyle modifications. ### Education * Explain the importance of adherence to CPAP therapy (if prescribed). * Discuss strategies to improve sleep hygiene. * Emphasize the importance of weight management. ### Diagnostic Tests * Polysomnography (sleep study) ## Pneumonia ### Pathophysiology Pneumonia is an infection of the lungs characterized by inflammation of the alveoli. Bacteria, viruses, or fungi can cause this inflammation, leading to fluid buildup and impaired gas exchange. This fluid buildup interferes with the diffusion of oxygen and carbon dioxide, resulting in hypoxemia and hypercapnia. ### Manifestations/Complications * Chills * Fever * Pleuritic chest pain * Productive cough (with purulent sputum) * Crackles in the lungs * Dyspnea (shortness of breath) * Decreased oxygen saturation ### Treatment * Antibiotics (for bacterial pneumonia) * Antivirals (for viral pneumonia) * Antifungals (for fungal pneumonia) * Oxygen therapy * IV fluids * Antipyretics (to reduce fever) ### Nursing Management * Monitor vital signs (including oxygen saturation). * Administer medications as prescribed. * Encourage deep breathing, coughing, and ambulation. * Provide respiratory treatments (e.g., nebulizers). * Maintain hydration. * Position the patient in high-Fowler's position to facilitate breathing. ### Education * Emphasize the importance of hand hygiene and respiratory etiquette (covering coughs and sneezes). * Instruct patients on the proper use of inhalers or nebulizers. * Encourage rest and adequate hydration. * Educate on the importance of completing the entire course of antibiotics. ### Diagnostic Tests * Chest X-ray * Sputum culture ## Respiratory Tuberculosis (TB) ### Pathophysiology TB is an infectious disease caused by *Mycobacterium tuberculosis*. It primarily affects the lungs, but can spread to other organs. The bacteria form granulomas (nodules) in the lungs, which can calcify and scar the lung tissue. Airborne transmission occurs when an infected person coughs or sneezes, releasing bacteria into the air. ### Manifestations/Complications * Low-grade fever * Night sweats * Fatigue * Productive cough (with sputum) * Crackles in the lungs * Weight loss * Loss of appetite ### Treatment * Anti-tuberculosis medications (e.g., isoniazid, rifampin) for 6-12 months. ### Nursing Management * Maintain airborne precautions (negative pressure room, N95 mask). * Administer medications as prescribed. * Monitor for adverse effects of medications. * Encourage rest and adequate nutrition. * Educate patients on medication adherence and infection control measures. ### Education * Emphasize the importance of completing the entire course of medication. * Instruct patients on proper hand hygiene and respiratory etiquette. * Explain the importance of follow-up appointments and testing. ### Diagnostic Tests * Chest X-ray * Mantoux test (tuberculin skin test) * QuantiFERON-TB Gold Plus or T-SPOT.TB blood tests * Sputum culture ## Pleural Effusion ### Pathophysiology Pleural effusion is the accumulation of fluid in the pleural space (the area between the lungs and the chest wall). This fluid can be transudative (clear) or exudative (containing blood or pus), depending on the underlying cause. The underlying cause needs to be addressed for effective treatment. ### Manifestations/Complications * Dullness to percussion over the affected area * Pleuritic chest pain * Shortness of breath (dyspnea) * Decreased or absent breath sounds on auscultation ### Treatment * Treatment of the underlying cause. * Thoracentesis (removal of fluid with a needle). * Chest tube insertion (for large effusions). ### Nursing Management * Monitor respiratory status (oxygen saturation, breath sounds). * Assess for pain and administer analgesics as needed. * Maintain patient comfort and provide emotional support. * Monitor chest tube drainage (if present). ### Education * Educate patients about the procedure and potential complications of thoracentesis or chest tube insertion. * Instruct patients on signs and symptoms to report (e.g., increased shortness of breath, chest pain). ### Diagnostic Tests * Chest X-ray * CT scan of the chest ## Lung Cancer ### Pathophysiology Lung cancer begins with the transformation of a single epithelial cell in the airways. Carcinogens damage the cell's DNA, leading to uncontrolled cell growth and the formation of a malignant tumor. Smoking is a major risk factor. Genetic predisposition and exposure to asbestos or other environmental carcinogens also increase the risk. ### Manifestations/Complications * Dry cough * Hemoptysis (coughing up blood) * Wheezing * Shortness of breath (dyspnea) * Chest pain * Fatigue * Weight loss ### Treatment * Surgery (e.g., lobectomy, pneumonectomy) * Chemotherapy * Radiation therapy * Immunotherapy * Palliative care ### Nursing Management * Assess respiratory status and provide oxygen therapy as needed. * Manage pain and other symptoms. * Provide emotional support and address psychological concerns. * Educate patients and families about treatment options and prognosis. ### Education * Smoking cessation counseling. * Information about treatment options and side effects. * Resources for support groups and palliative care. ### Diagnostic Tests * Chest CT scan * Bronchoscopy with biopsy * Full-body scan (if metastasis is suspected) ## Practice Questions Answers and Rationale: **Obstructive Sleep Apnea:** 1. **d. “If I could lose 50 pounds, I might stop having so many apneic episodes.”** Weight loss is a key intervention for OSA as excess weight contributes to airway obstruction. 2. **a. Daytime sleepiness, headaches, and arrhythmias.** These are common symptoms associated with OSA due to interrupted sleep and reduced oxygen levels. **Pneumonia:** 1. **c. Obtain a sputum culture.** A sputum culture helps identify the causative organism and guide antibiotic therapy. 2. **a. Crackles.** Crackles are a bubbling sound heard on auscultation and are characteristic of fluid in the alveoli. **Respiratory Tuberculosis:** 1. **d. Lethargy.** Lethargy, along with other symptoms like low-grade fever, night sweats, and a productive cough, are common in pulmonary TB. 2. **d. A negative pressure room.** This is crucial for preventing the spread of airborne pathogens. **Pleural Effusion:** 1. **c. Pneumothorax.** Increased shortness of breath, low oxygen saturation, and orthopnea after thoracentesis suggest a pneumothorax (collapsed lung), a potential complication. 2. **d. Call the doctor.** This is the priority action as a pneumothorax is a life-threatening complication requiring immediate medical attention. **Lung Cancer:** 1. **a. "It’s okay to feel scared. Let’s talk about what you are afraid of.”** This response provides empathy and opens a dialogue to address the patient's concerns. 2. **All options are correct.** Fever, dry cough, bloody sputum, wheezing, shortness of breath, dyspnea, chest pain/tightness, fatigue, and significant weight loss are all potential symptoms of lung cancer.