Asbestosis

WHAT WENT WRONG?
Asbestos fibers enter the lungs, causing inflammation in the bronchioles and in the
walls of the alveoli. After inhalation, the fibers settle into the lung tissue. Fibrosis
develops and ultimately pleural plaques form. The changes within the lung result
in a restrictive lung disease. The damage to the lung causes impairment in breath-
ing and air exchange.
PROGNOSIS
It may take a decade or longer from the time of exposure before symptoms begin
to develop. Some patients have worked in occupations known for asbestosis ex-
posure (mining, shipyards, fireproofing, and construction before the mid-1970s),
for 10 or 15 years prior to symptom development. There is an increased risk of
lung cancer (mesothelioma) in patients with history of asbestosis exposure, espe-
cially if the patient has also smoked. Mesothelioma may develop 2 to 4 decades
postexposure.

SIGNS AND SYMPTOMS
• Difficulty breathing (dyspnea) on exertion and at rest due to changes in the
lung tissue
• Chest pain or tightness due to changes within the lung tissue and restrictive
air movement
• Dry cough due to irritation within the lungs
• Frequent respiratory infections due to changes within the lung, increasing
susceptibility to infection
• Respiration greater than 20 breaths per minute (tachypnea) due to decreased
vital capacity
• Rales or crackles when listening to breath sounds

TEST RESULTS

• Chest x-ray to reduce chance of illness. Lungs show linear opacities, irreg-
ular opacities. Opacities are increased tissue density on the lung indicating
fibrosis or pleural plaque.
• CT scan shows opacities indicating increased tissue density of fibrosis or
pleural plaque.
• Arterial blood gas shows decreased oxygen due to restrictive pattern of
respiration.
• Pulse oximetry shows decreased pattern.
• Pulmonary Function Test (PFT) shows a restrictive pattern, decreased vital
capacity.

TREATMENT
There is no specific treatment for asbestosis, nor is there a cure.
• Flu vaccine and pneumoccocal vaccine to reduce chance of illness.
• Oxygen therapy (1 to 2 liters per minute) to ease breathing discomfort by in-
creasing available oxygen to meet body’s needs.
• Administer antibiotics for exacerbations of respiratory symptoms—to treat
infectious process based on results of culture and sensitivity study or
empirically.

NURSING DIAGNOSES
• Fatigue
• Impaired gas exchange
• Imbalanced nutrition: less than the body requires

NURSING INTERVENTION
• Administer chest percussion and vibration to loosen and expel secretions.
• Explain to patient:
• How to avoid infections (reduced exposure to others with an infection and
vaccines administered according to physician’s orders).
• Proper use of oxygen therapy.