Emergency nursing management of a bilateral lung infiltration

Anandhi1*, Arputha Mary2, Esthar Rani3

1Nursing Supervisor, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

2Deputy Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

*Correspondence

Abstract

Bilateral lung infiltration refers to the presence of abnormal substances such as fluid, inflammatory cells, or pus within lung tissue, commonly identified on chest imaging. It is associated with various conditions including infections, pulmonary edema and inflammatory disorders. This case highlights the role of early diagnosis, bronchoscopy (FOB-BAL) and prompt nursing management in improving patient outcomes.

Key words: Bilateral lung infiltration; Fiber-Optic Bronchoscopy (FOB); Broncho Alveolar Lavage (BAL)

Introduction

Bilateral lung infiltration is a clinical condition characterized by diffuse involvement of both lungs, often leading to respiratory distress. Early identification of the underlying cause is crucial for targeted management. Diagnostic procedures such as Fiber-Optic Bronchoscopy (FOB) with Broncho Alveolar Lavage (BAL) play an essential role in identifying infectious and non-infectious etiologies. Nurses play a vital role in monitoring, supportive care and early intervention.

Case Presentation

A 77-year-old female patient presented with complaints of breathlessness for two months, which had worsened on exertion and was relieved at rest. There was no history of fever, hemoptysis, chest pain, palpitations or syncope. No significant weight loss or loss of appetite was reported. The patient had a recent history of hospitalization for acute pulmonary edema and right-sided pleural effusion, which had been managed with pigtail catheter insertion.

On examination

The patient was conscious and oriented. She was afebrile with a pulse rate of 78/min and blood pressure of 140/80 mmHg. Oxygen saturation was 93% on room air. Bilateral scattered crepitation’s were present on auscultation.

Investigations Revealed

CT chest revealed mild right pleural effusion, cardiomegaly and bilateral patchy consolidation. ECG showed sinus rhythm with left bundle branch block. Echocardiography revealed global hypokinesia with severe left ventricular dysfunction and an ejection fraction of 35%. Hemoglobin level was 8.6 g/dL.

The patient underwent Fiber Optic Bronchoscopy (FOB) with Broncho Alveolar Lavage (BAL) for diagnostic evaluation. Bronchoscopy findings revealed normal vocal cords, trachea, carina, and bilateral bronchial tree anatomy with thin secretions throughout the airway. BAL samples were collected from the Right Middle Lobe (RML) and Right Upper Lobe (RUL).

Diagnosis: Bilateral Lung Infiltration under Evaluation

Procedure

FOB – BAL Fiber-Optic Bronchoscopy (FOB) Bronchoalveolar Lavage (BAL): DONE on  10.01.2026

Bronchial wash report showed

AFBNegative
Aspergillus antigenPositive
KOHNegative
CultureNo significant growth

Procedure (FOB with BAL)

Pre-Operative Orders

Nebulization with Budecort BD was administered as advised. Tablet Pyregesic 1 g and Tablet Alprax 0.5 mg were administered one hour before the procedure.

Procedure Details

The procedure was performed under local anesthesia with IV sedation. Continuous monitoring of vital signs and oxygen saturation was maintained throughout the procedure. Strict aseptic precautions were followed during bronchoscopy and Broncho Alveolar Lavage (BAL) sample collection.

Post-Operative Management

  • Post-procedure, the patient was monitored closely for respiratory distress, bleeding, desaturation, and hemodynamic instability.
  • Oxygen therapy and nebulization were continued as advised.
  • Chest physiotherapy was initiated to improve airway clearance.
  • Intake-output monitoring and supportive care were maintained.

Bronchial wash Report.

AFB staining.

  • No AFB seen in the specimen.
  • Aspergillus Antigen – 0.6322 (Positive)
  • Gram stain: 0-2 pus cells and occasional gram positive cocci
  • Culture Report: No significant growth in culture.
  • KOH: No fungal element seen.
  • Mycobacterium tuberculosis complex: Not detected

Nursing Management

Comprehensive nursing care was provided throughout the patient’s hospitalization.

  • Continuous monitoring of vital signs, respiratory status, and oxygen saturation was performed.
  • Nebulization therapy and chest physiotherapy were administered regularly.
  • Strict aseptic technique was maintained during all procedures and nursing interventions.
  • Psychological support and reassurance were provided to reduce patient anxiety.
  • The patient and family members were educated regarding breathing exercises, medication compliance, infection prevention, and follow-up care.
  • Timely reporting of laboratory investigations and coordination with the multidisciplinary team were ensured.

Outcome

The patient remained hemodynamically stable post-procedure with maintained oxygen saturation and no respiratory distress. She showed gradual clinical improvement with supportive care and medical management. The patient was discharged in stable condition with advice for regular follow-up.

Conclusion

This case highlighted the importance of early diagnosis, multidisciplinary management, and vigilant nursing care in elderly patients with bilateral lung infiltration and pleural effusion. Prompt assessment, continuous monitoring, timely bronchoscopy and evidence-based nursing interventions contributed significantly to the successful management and recovery of the patient.

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