N143 UNIT I LOWER RESPIRATORY LOWER RESPIRATORY TRACT INFECTIONS ACUTE BRONCHITIS: Inflammation of the bronchi that usually

occurs with a viral upper respiratory infection or in conjunction with chronic obstructive pulmonary disease (COPD). Cough most common symptom may last 10-20 days Self-limiting condition; treatment is supportive: o Rest, fluids, anti-inflammatory agents o Cough suppressant; If cough severe/persistent, o Bronchodilators PRN; Wheezing o Broad spectrum Abx; COPD o Intivirals; Influenza PERTUSSIS Highly contagious infection of the lower respiratory tract spread by droplets: Gram-negative bacillus, Bordella pertussis Immunization available, rates rising due to waning immunity. Pertussis cough has a whooping sound. More frequent at night and may last 6-10 weeks Thick tenacious secretions Treatment consists of antibiotics and supportive care: o Rest, fluids, anti-inflammatory agents o Cough suppressant o Bronchodilators PRN; Wheezing o Broad spectrum Abx; COPD PNEUMONIA: Acute inflammation of the lung parenchyma (essential functional elements of organ) including interstitial spaces, alveoli, and bronchioles. Classified according to the causative microorganism, such as bacteria, viruses, Mycoplasma, fungi, parasites, and chemicals. Organisms can reach the lung by three methods: aspiration, inhalation, and homogenous spread from an infection elsewhere in the body. A clinically effective way to classify pneumonia because causative agents can be predicted and empiric treatment (observation and experience) can be implemented: o Community-acquired pneumonia CAP: is a lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization. Mycoplasma pneumoniae, S. aureus o Hospital-acquired pneumonia HAP: is pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization. E.coli, Pseudomonas aeruginosa, Streptococcus pneumoniae Aspiration pneumonia refers to the sequelae (morbid condition as a result of another condition)occurring from abnormal entry of secretions or substances into the lower airway. o CVA-dysphagia Opportunistic pneumonia occurs in certain patients with altered immune responses who are highly susceptible to respiratory infections. Additional risk of fungal pneumonia, Pneumoncystis jiroveci, and cytomegalovirus (CMV) o HIV, radiation, chemotherapy, corticosteroids o Onset slow and subtle: Fever, tachycardia, tachypnea, dyspnea, nonproductive cough and hypoxemia. o IV/oral Bactrim, Septra Fungal pneumonia, Pneumoncystis jiroveci, and cytomegalovirus (CMV) 1

N143 UNIT I LOWER RESPIRATORY o Antivirals Four characteristic stages of pneumonia: o Congestion: Inflammatory response to bacterial endotoxins results in serous fluid in alveoli; organisms multiply and spread to adjacent alveoli. This edema stiffens lungs, decreases compliance and vital capacity. This causes hypoxemia due to gas exchange effected. o Red hepatization: Dilation of capillaries; alveoli fill with organisms, leukocytes, RBCs, and fibrin giving lungs red granular appearance. o Gray hepatization: Blood flow decreases, leukocytes and fibrin consolidate. o Resolution: Resolution and healing; exudate lysed and processed by macrophages. Gas exchange returns to normal. Complications frequent chronic conditions: o Pleural effusion: Transudate in pleura may require aspiration via thoracentisis. o Abscess: PNA caused by S. aureus and gram-negative organisms. o Pericarditis: Spread of infecting organism to pericardium. Pneumonia Severity Index-PSI; Helps determine treatment category and further treatment will be tailored to most likely infecting organism. Therapy will then be further modified according to: o C+S results o Clinical response: Fever, sputum purulence, leukocytosis, oxygenation, CXR. Patents who continue to deteriorate will be assessed for other infectious etiologies, complications, coexisting infections, drug-resistance organisms. Nursing role: Identifying the patient at risk and taking measures to prevent the development of pneumonia. o Essential components of nursing care monitoring: Physical assessment parameters Facilitating laboratory and diagnostic tests Providing treatment Monitoring the patients response to treatment. o Clinical Manifestations: Sudden onset: Fever, shaking, chills, SOB, cough productive of purulent sputum, pleuritic chest pain Physical exam: Pulmonary consolidation, bronchial breath sounds, crackles, rhonci and wheezes, dullness to percussion, increased fremitus, accessory muscles for breathing Elderly/debilitated: Confusion/stupor o Diagnostics: H&P, Physical exam, CXR, C+S BEFORE Abx!!!!!! o Collaborative Care: Prevent with Pneumococcal vaccine, every 5 yrs for at risk populations Chronic CV, Pulmonary, or DM >65 SNF Prompt treatment with appropriate Abx IV hydration Pain management!!!! o Nursing Assessment: Lung sound, location of alteration for baseline Multisystem, co-morbidities 2

N143 UNIT I LOWER RESPIRATORY VS, fatigue, MS ADL NDx: Impaired gas exchange, Ineffective breathing pattern, Acute pain o Nursing Interventions: 02 , monitor respirations, cyanosis, cold/clammy skin Nutrition/hydration to 3/L day Activity to improve diaphragm movement and chest expansion, mobilize secretions, prevent venous stasis, and improve immune function. HOB 30*-Prevent Aspiration, Fowlers Asepsis: Hands, suction, nebulizer Good lung down: gravity assist drainage of congestion I/S, TCDB Bronchial Hygiene: >30ml sputum Chest physiotherapy Postural drainage Percussion Drainage Vibration o Nursing Evaluation: VS improvement, Lungs clear auscultation/cxr, T100, RR24, HR 100, Sp02 90% Medications: o Macrolides: erythomcin, Zithromax (shorter cycle of compliance 5 days) , Biaxin Highly effective o Respiratory fluorqinolones: Tequin, Levaquin o Amoxicillin Oral, IV o Piperacillin/tazobactam (Zoysyn) Combination drug, very common, want to save for acucte cases and not over use it TUBERCULOSIS Tuberculosis (TB) is gram-positive, acid-fast bacillus Mycobacterium tuberculosis that is spread via airborne droplets. Transmission factors: o Number of organisms expelled o Concentration of organisms (small spaces) o Length of time of exposure o Immune status of exposed purpose Resurgence of TB in those with human immunodeficiency virus (HIV) infection and an emergence of multidrug resistant strains of M. tuberculosis due to poor compliance Clinical Manifestations: o LTBI: Positive skin test; asymptomatic o Active TB: Fatigue, malaise, anorexia, weight loss, low grade fever, night sweats Cough-mucoid-mucopurulent productive, pleuritic pain Late stage: Hemoptysis 3

N143 UNIT I LOWER RESPIRATORY TB can present with a number of complications: o Miliary TB: Spread of the disease with involvement of many organs simultaneously o Pleural effusion: Can result from active or latent TB, protein rich exudate o Empyema: Large concentration of organism in pleural space o PNA: Large numbers of bacilli discharge into lungs or lymph nodes o Organs: Various organs such as CNS/meninges, bone, kidney, joints, adrenal glands, lymph nodes, genital tract. Diagnostics: o Skin test: Purified protein derivative (PPD) Tuberculin skin test (TST); 0.1 ml ID injection. Induration + for exposure and development of antibodies. Best way to screen!! o CXR: Infiltrates, cavitary infiltrates, lymph node involvement o Culture: Acid fast smear X3. o QuantiFERON-TB test: Blood responds to antigens RAPID!!! Few hours!!! Medication: o Active TB: Four drugs are used for a 6-month regimen for maximum effectiveness!! INH- Isoniazid, rifampin, pyrazinamide, ethambutol After 2-3 weeks of treatment risk of transmission is reduced LTBI: To prevent disease in a TB-infected person with latent TB infection (LTBI), isoniazid (INH) is used alone. Isoniazid for 6-9mo Rifampin for 4mo; resistant to Isoniazid Rifampin/pyrainamide- combination drug- severe live injuries and deaths Nursing Assessment: o Cough; productive, night sweats, pm T , weight loss, pleuritic chest pain, crackles over lung apices Nursing Dx: Ineffective breathing pattern-capacity, Imbalanced nutrition, Noncompliance, Activity intolerance Nursing Planning: o Comply with regimen o No recurrence o Normal pulmonary function o Prevent spread Nursing Implementation: o Health promotion: Screening F/U screen Public Health Department o Intervention: Airborne Isolation-3 negative smears needed to be clinically cleared!!! Negative pressure room HEPA N95 mask, fit teste Medical workup: CXR, smear, culture, Drug therapy Teach respiratory etiquette Screen close contacts/family members 4

N143 UNIT I LOWER RESPIRATORY o Home Care Teach compliance!!! PH Notification! Directly Observed Therapy DOT: Important for compliance issues!!! Relapse teaching: Recognize symptoms Seek medical attention Reactivation factors: o Immunosupressive, malignancy, prolonged illness F/U CXR, smear in 12 months Nursing Evaluation: o Resolution o Normal pulmonary function o Absence of complications o No transmission of TB

ATYPICAL MYCOBACTERIA Atypical mycobacteria cause disease that resembles TB, both in manifestations and treatment. Disease typically occurs in those who are immunosuppressed or have chronic pulmonary disease. PULMONARY FUNGAL INFECTIONS Infections are found frequently in seriously ill patients being treated with corticosteroids; antineoplastic, immunosuppressive drugs; or multiple antibiotics. They are also found in patients with acquired immunodeficiency syndrome (AIDS) and cystic fibrosis. Skin tests, serology and biopsy help identify the infecting organism. Since these infections are not transmitted from person to person, the patient does not have to be placed in isolation. Antifungal medications are the mainstay of treatment. NURSING AND COLLABORATIVE MANAGEMENT: LUNG ABSCESS A lung abscess is a pus-containing lesion of the lung. The causes and pathogenesis of lung abscess are similar to those of pneumonia. o Mainly aspiration of bacteria, malignancy, TB, fungal, parasitic. The onset of a lung abscess is usually insidious, especially if anaerobic organisms are the primary cause. A more acute onset occurs with aerobic organisms. o Manifestations: Cough producing purulent sputum; dark brown foul smelling/tasting Hemoptysis; common Fever, chills, prostration, pleurtic pain, dyspnea, weight loss Physical exam: Lungs: Dull to percussion over affected area Decreased breath sounds Bronchial sounds transmitted to periphery; Bronchus patent with drainage Crackles as abscess drains o Complications: Chronic abscess, bronchopleural fistula, bronchiectasis, empyema, brain abscess. 5

N143 UNIT I LOWER RESPIRATORY Antibiotics given for a prolonged period (up to 2-4 months) are usually the primary method of treatment. Diagnostics: CXR, CT, Cultures: Sputum, blood, pleural fluid. Nursing Implementation: o Teach importance of compliance o Teach SE to report o Importance of F/U C+S Teach Bronchial Hygiene: Postural drainage Percussion Drainage Vibration o Rest, nutrition, fluids, dental hygiene ENVIRONMENTAL LUNG DISEASES Environmental or occupational lung diseases are caused or aggravated by workplace or environmental exposure and are preventable. Pneumoconiosis is a general term for a group of lung diseases caused by inhalation and retention of dust particles. The best approach to management of environmental lung diseases is to try to prevent or decrease environmental and occupational risks. LUNG CANCER Cigarette smoking is the most important risk factor in the development of lung cancer. Smoking is responsible for approximately 80% to 90% of all lung cancers. Primary lung cancers are often categorized into two broad subtypes: nonsmall cell lung cancer (80%) and small cell lung cancer (20%). CT scanning is the single most effective noninvasive technique for evaluating lung cancer. Biopsy is necessary for a definitive diagnosis. Staging of nonsmall cell lung cancer is performed according to the TNM staging system. Staging of small cell lung cancer by TNM has not been useful because the cancer is very aggressive and always considered systemic. o Tumor: Size, location, degree of invasion o N: Node involvement o M: Metastases Treatment options are dependent upon the stage of disease. o Surgical resection is the treatment of choice in nonsmall cell lung cancer stages I and II, because the disease is potentially curable with resection. o Radiation therapy may be used as adjuvant therapy after resection or with the intent to cure if the patient is unable to tolerate surgical resection caused by co-morbidities. Stereotactic: Beams concentrated from different directions o Chemotherapy and targeted therapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery in nonsmall cell lung cancer. o Prophylactic cranial radiation: Prevent cerebral metastases o Bronchioscopic laser therapy: Laser accessible bronchial lesions that may be causing obstruction o Photodynamic: Photofrin injected into tumor; 48 hrs later laser light destroys tumor cells. o Stenting: Relief of dyspnea, cough or respiratory insufficiency, supports airway against collapse or outside compression keeping lumen open 6

N143 UNIT I LOWER RESPIRATORY o Cryotherapy: Freezing polyoid lesions The overall goals of nursing management of a patient with lung cancer will include effective breathing patterns, adequate airway clearance, adequate oxygenation of tissues, minimal to no pain, and a realistic attitude toward treatment and prognosis.

OTHER TYPES OF LUNG TUMORS Secondary lung tumors are rare, accounting for only 5% of lung masses. They include chondromas, hamartomas, leiomyomas, and mesotheliomas. The lungs are a common site for secondary metastases for a number of cancers. CHEST TRAUMA AND THORACIC INJURIES PNEUMOTHORAX Pneumothorax is air in the pleural space resulting in a rise in intrthoracic pressure and reduced vital capacity. Loss of negative pressure results in partial or complete collapse of the lung, There are several types: o Closed pneumothorax has no associated external wound. The most common form is a spontaneous pneumothorax, which is accumulation of air in the pleural space without an apparent antecedent event possibly due to rupture of a pulmonary bleb. o Open pneumothorax occurs when an opening in the chest wall allows positive atmospheric air to enter the pleural space. Examples include stab or gunshot wounds and surgical thoracotomy. o A tension pneumothorax may be open or closed; there is a rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels. o Hemothorax is an accumulation of blood in the intrapleural space. Chylothorax is lymphatic fluid in the pleural space caused by a leak in the thoracic duct. Causes of both include trauma, surgical procedures, and malignancy. o Spontaneous pneumothorax: Clinical Manifestatons: o Absent breath sounds on effected side o Decreased expansion unilaterally o Dypsnea, cyanosis, tachypnea o Hypotension o Tachycardia, sharp chest pain o Sucking sound, open wound o Tracheal deviation to unaffected side in tension pneumothorax o Crepitus on palpation SQ emphysema Nursing Interventions: o Occlusive dressing over wound o 02 o Fowlers o Prep for Chest tube o Monitor chest tube drainage system o Monitor for crepitus, SQ emphysema Treatment depends on the severity of the pneumothorax and the nature of the underlying disease.

FRACTURED RIBS Rib fractures are the most common type of chest injury resulting from blunt trauma. 7

N143 UNIT I LOWER RESPIRATORY Clinical manifestations include pain at the site, especially with inspiration and coughing. The main treatment goal is to decrease pain to promote effective breathing. Patients also need to be taught deep breathing, coughing, and use of incentive spirometry.

FLAIL CHEST Flail chest results from multiple rib fractures, causing an unstable chest wall. The diagnosis of flail chest is made on the basis of fracture of two or more ribs, in two or more separate locations, causing an unstable segment. Nursing assessment: o Paradoxical respirations o Severe chest pain o Dypsnea, cyanosis, tachypnea, shallow respirations o Tachycardia, hypotension o Diminished breath sounds Nursing Interventions: o Fowlers o Humidified 02 o Monitor for increased respiratory distress o Encourage cough deep breathe o Pain medication o Bed rest and limit activity to limit 02 demands o Prep for intubation, vent with positive end-expiratory pressure (PEEP) for severe flail chest with shock and respiratory failure Initial therapy consists of airway management, adequate ventilation, supplemental oxygen therapy, careful administration of intravenous (IV) solutions, and pain control. The definitive therapy is to reexpand the lung and ensure adequate oxygenation. CHEST TUBES AND PLEURAL DRAINAGE The purpose of chest tubes and pleural drainage is to remove the air and fluid from the pleural space and to restore negative intrapleural pressure so that the lungs can reexpand. Drainage collection chamber: Chest tube connects here, calibrated columns Chest tube malposition is the most common complication. Routine monitoring is done by the nurse to evaluate if the chest drainage is successful by observing for tidaling in the water-seal chamber, listening for breath sounds over the lung fields, and measuring the amount of fluid drainage. Water-Seal chamber: o Tip of tube under water, prevents air backflow o Water moves up/down as client inhales/exhales o Excessive bubbling indicated air leak in system Suction-Control Chamber: o Suction can be controlled to provide negative pressure o Various levels of water control amount of suction o Gentle bubbling indicates that there is suction Dry suction system: o Dry suction = No bubbling in suction chamber o Dial control for suction amount, floater valve in window indicates amount of suction provided 8

N143 UNIT I LOWER RESPIRATORY Portable system: Flutter and Heimlich Valve o Flutter valve prevents backflow Intervention: o Collection chamber: Monitor drainage; Notify MD: >70-100ml/hr, bright red, sudden increase Mark drainage at 1-4 hr intervals, use tape o Water seal chamber: Monitor fluctuation of fluid level NO FLUCTUATION: Tube obstructed, dependent loop, suction not working, lung reexpanded Pneumothorax: Intermittent bubbling expected, continuous bubbling = leak Notify MD for continuous bubbling o Suction control chamber: Gentle bubbling should be noted o Occlusive sterile dressing maintained at insertion site Always keep a sterile clamp and sterile occlusive dressing at bedside!!! o CXR to assess position of Chest tube and lung reexpansion o Assess respiratory status and lung sounds o Monitor for signs of extended pneumothorax and hemothorax o Keep drainage below level of chest and tubes free of kinks, dependent loops, and obstructions o Ensure connections secure o Encourage CDB o Change position frequently to promote drainage and ventilation o Do not strip/milk chest tube unless MD order o Never clamp chest tube without written MD order. o Drainage system breaks insert tube in sterile water and replace system o Chest tube emoval: Client hold deep breath Tube removed Dressing applied: Dry sterile, petroleum gauze, Teflon Per MD client Valsalva maneuver when removed: Deep breath, exhale, bear down

CHEST SURGERY A thoracotomy, or the surgical opening into the thoracic cavity, is considered major surgery because the incision is large, cutting into bone, muscle, and cartilage. The two types of thoracic incisions are median sternotomy, performed by splitting the sternum, and lateral thoracotomy. Video-assisted thoracic surgery (VATS) is a minimally invasive thoracoscopic surgical procedure that in many cases can avoid the impact of a full thoracotomy. RESTRICTIVE RESPIRATORY DISORDERS PLEURAL EFFUSION Pleural effusion is a collection of fluid in the pleural space. It is not a disease but rather an indication of another disease. 9

N143 UNIT I LOWER RESPIRATORY Pleural effusion is frequently classified as transudative or exudative according to whether the protein content of the effusion is low or high, respectively. o A transudate occurs primarily in noninflammatory conditions and is an accumulation of proteinpoor, cell-poor fluid. o An exudative effusion is an accumulation of fluid and cells in an area of inflammation. o An empyema is a pleural effusion that contains pus. The type of pleural effusion can be determined by a sample of pleural fluid obtained via thoracentesis (a procedure done to remove fluid from the pleural space). The main goal of management of pleural effusions is to treat the underlying cause. Assessment: o Pleuritic sharp pain increases with inspiration o Progressive dypsnea and decreased movement on affected side o Dry non productive cough due to bronchial irritation or mediastinal shift o Tachycardia o T o Breath sounds over affected area o CXR shows pleural effusion and mediastinal shift away from effected side if fluid >250 ml Interventions: o Indentify/treat underlying cause o Monitor breath sounds o Fowler position o Encourage CDB o Prepare for thoracentisis o Recurrent effusion: Prepare for pleurectomy or pleurodesis Pleurectomy: Surgically stripping parietal pleura from visceral pleura Produce inflammatory reaction that promotes adhesions Pleurodesis: Instilling sclerosing substance via thoracotomy tube Inflammatory response scleroses tissue together

PLEURISY Pleurisy, or pleuritis, is an inflammation of the pleura. The most common causes are pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms. Usually occurs on one side of chest in lower lateral portions of chest wall. Treatment of pleurisy is aimed at treating the underlying disease and providing pain relief. Assessment: o Knife like pain aggrevated by breathing/coughing o Dyspnea o Pleural friction rub on auscultation o Apprehension Interventions: o Identify/treat cause o Monitor lung sounds o Analgesics o Hot/cold as prescribed o Encourage CDB 10

N143 UNIT I LOWER RESPIRATORY o Line on affected side and splint chest ATELECTASIS Atelectasis is a condition of the lungs characterized by collapsed, airless alveoli. The most common cause of atelectasis is airway obstruction that results from retained exudates and secretions. This is frequently observed in the postoperative patient. INTERSTITIAL LUNG DISEASES IDIOPATHIC PULMONARY FIBROSIS Idiopathic pulmonary fibrosis is characterized by scar tissue in the connective tissue of the lungs as a sequela to inflammation or irritation. The clinical course is variable and the prognosis poor, with a 5-year survival rate of 30% to 50% after diagnosis. Although corticosteroids, cytotoxic agents, and antifibrotic agents are used in treating the disease, there is no evidence that their use is effective.

SARCOIDOSIS Sarcoidosis is a chronic, multisystem granulomatous disease of unknown cause that primarily affects the lungs. The disease may also involve the skin, eyes, liver, kidney, heart, and lymph nodes. The disease is often acute or subacute and self-limiting, but in others it is chronic with remissions and exacerbations. Treatment is supportive and aimed at suppressing the inflammatory response. o Assessment: Night sweats Fever Weight loss Cough/dyspnea Skin nodules Polyarthritis Kveim test: Positive nodular lesion in response to antigen o Interventions: Corticosteroids Monitor T Fluid intake Rest periods Small nutritious meals VASCULAR LUNG DISORDERS PULMONARY EDEMA Pulmonary edema is an abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs. It is considered a medical emergency and may be life-threatening. The most common cause of pulmonary edema is left-sided heart failure. PULMONARY EMBOLISM 11

N143 UNIT I LOWER RESPIRATORY Pulmonary embolism is the blockage of pulmonary arteries by a thrombus, fat, or air emboli, or tumor tissue. Most pulmonary embolisms arise from thrombi in the deep veins of the legs. The most common risk factors for pulmonary embolism are immobilization, surgery within the last 3 months, stroke, history of deep vein thrombosis, obesity, CHF, advanced age, and malignancy. Pulmonary infarction (death of lung tissue) and pulmonary hypertension are common complications of pulmonary embolism. It may be diagnosed by spiral CT scan, V/Q scan, and/or pulmonary angiography. The objectives of treatment are to prevent further growth or multiplication of thrombi in the lower extremities, prevent embolization from the upper or lower extremities to the pulmonary vascular system, and provide cardiopulmonary support if indicated. o Assessment: Apprehension and restlessness Blood tinged sputum Chest pain Cough Crackle/wheezes Cyanosis Distended neck veins Dypsnea with anginal/pleuritic chest pain worse with inspiration Feeling of impending doom Hypotension Petechiae over chest and axilla Tachpenea and tachycardia o Interventions: RRT!! Reassure client High fowlers 02 VS and lung sounds ABG Prepare to administer heparin, embolectomey, or vena cava filter Document event, interventions, client response

PULMONARY HYPERTENSION Pulmonary hypertension can occur as a primary disease (primary pulmonary hypertension) or as a secondary complication of a respiratory, cardiac, autoimmune, hepatic, or connective tissue disorder (secondary pulmonary hypertension [SPH]). Primary pulmonary hypertension is a severe and progressive disease. It is characterized by mean pulmonary arterial pressure greater than 25 mm Hg at rest (normal 12-16 mm Hg) or greater than 30 mm Hg with exercise in the absence of a demonstrable cause. Primary pulmonary hypertension is a diagnosis of exclusion. All other conditions must be ruled out. Although there is no cure for primary pulmonary, treatment can relieve symptoms, increase quality of life, and prolong life. SPH occurs when a primary disease causes a chronic increase in pulmonary artery pressures. Secondary pulmonary hypertension can develop as a result of parenchymal lung disease, left ventricular 12

N143 UNIT I LOWER RESPIRATORY dysfunction, intracardiac shunts, chronic pulmonary thromboembolism, or systemic connective tissue disease. COR PULMONALE Cor pulmonale is enlargement of the right ventricle resulting from diseases of the lung, thorax, or pulmonary circulation. Pulmonary hypertension is usually a preexisting condition in the individual with cor pulmonale. The most common cause of cor pulmonale is COPD. The primary management of cor pulmonale is directed at treating the underlying pulmonary problem that precipitated the heart problem. LUNG TRANSPLANTATION There are four types of transplant procedures available: single lung transplant, bilateral lung transplant, heart-lung transplant, and transplant of lobes from living related donor. Lung transplant recipients are at high risk for bacterial, viral, fungal, and protozoal infections. Infections are the leading cause of death in the early period after the transplant. Immunosuppressive therapy usually includes a three-drug regimen of cyclosporine or tacrolimus, azathioprine (Imuran) or mycophenolate mofetil (CellCept), and prednisone.

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