Pulmonary Fibrosis NCLEX Review Care Plans
Nursing Study Guide on Pulmonary Fibrosis
Pulmonary fibrosis (PF) is a medical condition that happens when there is damage and scarring of the lung tissue. It features a stiff and thickened lung tissue, making it difficult for the lungs to function properly, as evidenced by dyspnea or shortness of breath.
Some patients may experience an acute exacerbation of the symptoms of pulmonary fibrosis, which can be life-threatening especially to an elderly patient.
There are many factors that can affect the scarring of lung tissue, but many cases of pulmonary fibrosis are called “idiopathic” because the doctors are unable to tell the root cause of the disease.
Currently, there is no treatment to repair damaged and scarred lung tissues. The management of pulmonary fibrosis is focused on symptom control and the improvement of quality of life.
Severe cases of pulmonary fibrosis may require a lung transplant to prevent respiratory arrest. Severe dyspnea or acute exacerbation due to pulmonary fibrosis may call for the use of mechanical ventilator in combination with medications.
Signs and Symptoms of Pulmonary Fibrosis
- Dyspnea – shortness of breath
- Fatigue and/or generalized body weakness
- Dry cough
- Muscular or joint pains
- Clubbing – the rounding and widening of the digits (fingers or toes)
- Unexplained weight loss
Types of Pulmonary Fibrosis
According to the American Lung Association, there are over 200 types of pulmonary fibrosis but in many cases the cause remains unknown. The following are the types of pulmonary fibrosis according to its cause:
- Idiopathic Pulmonary Fibrosis (IPF). The most common PF type, IPF accounts for about 50,000 new cases of PF every year in the U.S.
- Disease-related Pulmonary Fibrosis. These kinds of PF are caused by different illnesses such as gastroesophageal reflux disease (GERD), and autoimmune disorders, like rheumatoid arthritis and Sjogren’s syndrome. In GERD, the stomach acid may not only come up the gastrointestinal tract and back, but can also fall into the lungs of the individual.
- Exposure-related Pulmonary Fibrosis. PF can result from being exposed to asbestos, silica, or other hazardous materials. Cigarette smoking and prolonged exposure to radiation for therapy may cause this type.
- Familial Pulmonary Fibrosis. This is a rare, genetic type of PF wherein two or more members of the family (children) have idiopathic PF or interstitial lung disease
Causes and Risk Factors of Pulmonary Fibrosis
Different factors may result to the development of pulmonary fibrosis. These include:
- Environmental and Occupational Factors. Many pollutants, toxins, and substances can irritate and damage the lungs. Long-term exposure to them may cause pulmonary fibrosis. These include:
- Bird and animal droppings
- Grain dust
- Coal dust
- Asbestos fibers
- Silica dust
- Hard metal dust
2. Medical Conditions. The following diseases may cause the development of pulmonary fibrosis:
- Rheumatoid arthritis
- Systemic lupus erythematosus (SLE)
- Mixed connective tissue disease
3. Medications. Some drugs have the risk of damaging the lungs. These include:
- Systemic anti-cancer therapy (SACT) agents
- Anti-inflammatory drugs
- Some antibiotics
Aside from the above causes, the risk factors that may increase the chance of developing pulmonary fibrosis include:
- Age – middle-aged adults and elderly patients
- Sex – men are found to be more susceptible to IPF than women
- Genetic factors
- Living condition
Complications of Pulmonary Fibrosis
The following are the complications of pulmonary fibrosis that should be avoided with urgent treatment:
- Pulmonary hypertension – high blood pressure in the arteries of the lungs occurs when the blood vessels are compressed due to the increased blood flow resistance caused by scar tissue formation
- Cor pulmonale or right-sided heart failure – the lower right ventricle of the heart pumps harder than normal in order to move the blood through the arteries because the latter are partially blocked due to scar tissue
- Respiratory failure – happens when there is a significant fall in the blood oxygen levels
- Lung cancer – chronic pulmonary fibrosis may increase the risk for tumor formation
- Pneumothorax or lung collapse
- Blood clot formation in the lungs
- Lung infections
- Gastro-esophageal reflux disease (GERD)
Diagnosis of Pulmonary Fibrosis
- Physical examination, medical, family and occupational history
- Imaging – chest X-ray, CT scan, and echocardiogram can help visualize lung damage
- Lung function tests – include pulse oximetry, spirometry, exercise stress test, and arterial blood gas (ABG) tests
- Biopsy of the lungs – the collection of tiny issue samples from the lung; can be done through bronchoscopy or surgical biopsy
- Blood tests – used to check for liver and kidney function; also help to rule out other lung conditions
Treatment for Pulmonary Fibrosis
The scarred lung tissue is irreversible and pulmonary fibrosis has no current definitive treatment. However, researchers are still trying to find a cure for PF. At present, the management of PF is focused on slowing down the progression of the disease, treating symptoms, and improving the quality of life of the patients with PF. These include:
- Medications. Symptom control is central to the management of PF. There are new medications prescribed to slow down the progression of idiopathy pulmonary fibrosis, but with side effects such as diarrhea and nausea. Anti-acid medications may be prescribed to manage GERD alongside PF.
- Oxygen Therapy. This can help the patient breathe better, improving the pressure of the right side of the heart, as well as their sleep, mobility and exercise, and overall quality of life.
- Pulmonary Rehabilitation. These includes learning different breathing techniques, doing physical exercises through a program tailored to the patient’s needs, getting nutritional support, counselling and continuous education about PF.
- Lung Transplant. Severe PF may be eligible for lung transplant to improve breathing and quality of life. However, the patient must consider the procedure’s risks such as infection and organ rejection.
Nursing Care Plans for Pulmonary Fibrosis
Nursing Care Plan 1
Decreased cardiac output related to arrhythmias secondary to pulmonary fibrosis, as evidenced by palpitations, heart rate of 120 bpm (tachycardia), high blood pressure level of 190/100, fatigue, and inability to do ADLs as normal
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Assess the patient’s vital signs and characteristics of heartbeat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Heart murmur or gallop upon auscultation could indicate pulmonary hypertension. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer prescribed medications for pulmonary hypertension.||Vasodilators – to relax the blood vessels, thereby opening the narrowed blood vessels and improve blood flow|
Guanylate cyclase (GSC) stimulators – to increase the level of nitric oxide which can relax the pulmonary arteries, thereby decreasing the pressure in them
Endothelin receptor antagonists – to stop the endothelin from narrowing the arterial walls
Calcium channel blockers – to relax the muscles in the arterial walls
Digoxin – to help the heart pump more blood and treat arrhythmias
Anticoagulants (usually warfarin) – to reduce the formation of blood clots in the pulmonary arteries
Diuretics – to reduce excess fluid in the body through urination, thereby decreasing cardiac workload
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is within the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.|
Nursing Care Plan 2
Nursing Diagnosis: Risk for Shock (Cardiogenic) related to severe pulmonary fibrosis
Desired Outcome: The patient with establish normal vital signs, balanced input and output, and usual mentation.
|Place the patient on continuous vital signs monitor. Assess and monitor for any signs of impending cardiogenic shock or heart attack.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment or worsening of illness.|
|Start strict input and output monitoring. Measure the urine output hourly.||Decreased urinary output is a sign of diminished renal perfusion, indicating damage to the kidneys.|
|Assess for changes of level of consciousness/ mentation.||Decreasing level of consciousness indicate diminished cerebral perfusion and/or hypoxemia.|
|Administer intravenous fluid therapy.||To facilitate effective tissue perfusion and maintain circulatory blood volume.|
|Administer the cardiac medications and diuretics as prescribed.||To alleviate the symptoms of pulmonary fibrosis and to treat its cardiac complications.|
|Place the patient on bed rest. Assist him/her with important activities of daily living or ADLs.||To decrease myocardial workload and oxygen consumption.|
|Strongly encourage the patient to join a smoking cessation program.||Smoking increases the risk for respiratory distress, cardiogenic shock and myocardial infarction.|
Nursing Care Plan 3
Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand secondary to pulmonary fibrosis, as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To prevent respiratory distress by allowing the patient to pace activity versus rest.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
Other nursing diagnoses:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Please follow your facilities guidelines, policies, and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.