MS I Sims - Scenario 1 & 2 (Pre-Questions)

Briefly describe the pathophysiology of chronic obstructive pulmonary disease (COPD) and offer at least four changes in the lungs that occur as a result of COPD pathology.

Chronic obstructive pulmonary disease (COPD) is a life-threatening condition. It affects your lungs and ability to breathe. The pathophysiology of the disease, or the physical changes associated with it, start with damage to your airways and the air sacs in your lungs. It progresses from a cough with mucus to difficulty breathing. Unfortunately, the damage done by COPD can't be undone. But there are some preventive measures you can take to lower your risk of developing COPD Pathophysiology Mucus hypersecretion, cilia dysfunction, airflow limitation, Hyperinflation of lungs, Alveolar destruction, loss of elastic recoil, gas exchanges abnormalities, pulmonary hypertension, Cor pulmonale, Systemic effects. Changes in the lungs 1.subsequent lysis of lung tissue due to α1-antitrypsin (AAT) deficiency 2. gradual loss of the elastic recoil 3. inflammation in respiratory bronchioles 4. inflammation in alveoli

The nursing care plan for a 69-year-old male diagnosed with pneumonia indicates a nursing diagnosis of Ineffective breathing pattern related to inflammation and pain, as evidenced by dyspnea, tachypnea, nasal flaring, and altered chest excursion. Suggest at least 4 nursing interventions with rationales for this patient.

1. Prompt specimen collection and antibiotic initiation: to treat inflammation 2. Force fluids to at least 3000 mL/day (unless contraindicated, as in heart failure): Offer warm, rather than cold, fluids. Fluids, especially warm liquids, aid in mobilization and expectoration of secretions. 3. Elevate Head of Bed to high or semi fowler's position and reposition frequently: Doing so would lower the diaphragm and promote chest expansion, aeration of lung segments, mobilization and expectoration of secretions. 4. Administer oxygen therapy by appropriate means: nasal prongs, mask, Venturi mask: The purpose of oxygen therapy is to maintain PaO2 above 60 mmHg. Oxygen is administered by the method that provides appropriate delivery within the patient's tolerance. Note: Patients with underlying chronic lung diseases should be given oxygen cautiously. 5. Teach and assist patient with proper deep-breathing exercises. Demonstrate proper splinting of chest and effective coughing while in upright position. Encourage her to do so often: Deep breathing exercises facilitates maximum expansion of the lungs and smaller airways. Coughing is a reflex and a natural self-cleaning mechanism that assists the cilia to maintain patent airways. Splinting reduces chest discomfort and an upright position favors deeper and more forceful cough effort. 6. adequate activity 7. Aspiration precautions 8. Nutrition 9. Gradual increase in activity level 10. Re-educate on health promotion

A patient with pneumonia and emphysema is on O2 therapy per nasal cannula. Why do you think the physician selected this method of oxygen administration? Offer a possible reason that the physician did not select each of the following: Simple face mask Partial rebreathing mask High-flow delivery devices (Venturi mask)

A nasal cannula is a hollow tube with half-inch prongs placed into the client's nostrils. It is used for administering a low concentration of oxygen to clients who are not extremely hypoxic and are diagnosed with chronic lung disease. Nasal cannula and tubing administers oxygen concentrations at 22% to 44%. The nasal cannula, or nasal prongs, is used at flow rates of 1 to 6 L/min. Oxygen concentrations of 24% (at 1 L/min) to 44% (at 6 L/min) can be achieved. Flow rates greater than 6 L/min do not increase oxygenation because the anatomic dead space (places where air flows but the structures are too thick for gas exchange) is full. In addition, high flow rates increase mucosal irritation. - A simple mask allows the administration of higher levels of oxygen than a cannula. Simple facemasks are used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency. A minimum flow rate of 5 L/min is needed to prevent the rebreathing of exhaled air. Ensure the mask fits well to maintain inspired oxygen levels. Care for the skin under the mask and strap to prevent skin breakdown. - Partial rebreather masks provide oxygen concentrations of 60% to 75% with flow rates of 6 to 11 L/min. It is a mask with a reservoir bag but no flaps. With each breath, the patient rebreathes one third of the exhaled tidal volume, which is high in oxygen and provides a higher fraction of inspired oxygen (FiO2). Be sure that the bag remains slightly inflated at the end of inspiration; otherwise, the desired amount of oxygen is not delivered. If needed, call the respiratory therapist for assistance. High-flow systems include the Venturi mask, aerosol mask, face tent, tracheostomy collar, and T-piece. These devices deliver an accurate oxygen level when properly fitted. - Venturi masks (commonly called Venti masks) deliver the most accurate oxygen concentration without intubation. It works by pulling in a proportional amount of room air for each liter flow of oxygen. An adaptor is located between the bottom of the mask and the oxygen source (Fig. 30-7). Adaptors with holes of different sizes allow specific amounts of air to mix with the oxygen. More precise delivery of oxygen results. Each adaptor uses a different flow rate. Humidification is not needed with the Venturi mask.Venturis masks are best for the patient with chronic lung disease because it delivers a more precise oxygen concentration.

Describe the pathophysiology of pneumonia.

Pneumonia is a lung infection that actually describes some 30 types of infections. It's dangerous because it reduces the amount of oxygen in the body - sometimes greatly - and can be caused by viruses, bacteria, fungi, or inhaled particles or liquids. For COPD patients, life-threatening complications can develop rapidly and be fatal if not treated. People who suffer from COPD and other lung conditions are at a greater risk of developing pneumonia.

Your patient is a frail, older adult with a diagnosis of pneumonia and emphysema. Suggest some predisposing factors that may have led to the pneumonia.

Smoking is the main risk for COPD and many people who smoke or used to smoke suffer from COPD. Other risk factors include: Age. Most people who have COPD are at least 40 years old when they first notice symptoms. Long-term exposure to lung irritants such as secondhand smoke, chemical fumes and dust from the workplace or environment, and air pollution. Family history. People who have a family history of COPD are more likely to develop the disease, particularly if they smoke.

Suggest acute effects that smoking might have on the respiratory system in the following areas: a. Nasopharyngeal b. Tongue c. Vocal cords d. Bronchus and bronchioles e. Cilia f. Mucous glands g. Alveolar macrophages h. Elastin and collagen fibers

a.Nasopharynx The high number of pathogens and the low number of interfering organisms found in the nasopharynx of smokers revert to normal levels after complete cessation of smoking. Since parents who smoke harbor more potential pathogens and fewer interfering organisms, they may serve as a source of pathogens that can colonize and/or infect their children. b. Tongue Changes in Taste Smoking may affect the taste buds on your tongue, leading to a decreased ability to taste normally. The researchers suggested that this was due to changes in the shape and number of papillae -- small bumps on the surface of the tongue where the taste buds reside. However, smoking may not alter all types of taste sensation. only bitter taste was affected. Black Hairy or Coated Tongue The surface of the tongue is protected by a thin layer of dead cells composed largely of keratin. This layer is normally shed at the same rate that it is produced. Chronic irritation, as occurs with smoking, can upset this balance, causing keratin to accumulate, particularly along the midline of the tongue. When the accumulation is not severe, the condition is called a coated tongue. A black hairy tongue occurs when the accumulation becomes severe, creating the appearance of hair. Tobacco pigment, food or mouth bacteria collect between the hair-like structures, causing a black or brown discoloration. Black hairy tongue is not harmful but it can be unsightly and contribute to bad breath. White or Red Patches Leukoplakia and erythroplakia are patches that can develop anywhere in the mouth, including the tongue. They are more common in tobacco smokers than nonsmokers. Leukoplakia usually appears as a white patch that can't be rubbed off, whereas erythroplakia appears as a flat or depressed bright red area that may bleed easily if scraped. Neither condition tends to cause symptoms, although mild discomfort is sometimes noted. Both may be precancerous, though erythroplakia is more likely to become malignant. If leukoplakia or erythroplakia appears, a biopsy will often be performed by removing the patch and sending it to a laboratory to look for the presence of cancer cells. Cancer Tobacco smoke contains known cancer-causing molecules that may contribute to the development of squamous cell carcinoma of the tongue -- the most common type of oral cancer. People who both drink an excessive amount of alcohol and smoke have a particularly increased risk of developing tongue cancer. This cancer typically appears as a firm ulcer -- like a crater -- with raised borders that does not heal, and it is usually located on the sides or underside of the tongue. It can spread to the soft tissue in the floor of the mouth and interfere with tongue mobility and speech. C. Vocal chord: Smoking and exposure to smoke--even if you're not the one who lights up the cigarette--can irritate and dry the tissues of the throat, in particular the vocal cords. Improper vocal cord vibration and function can result. Smoking can also promote acid reflux, which affects the vocal cords, and smoking also degrades lung function leading to decreased airflow through the vocal cords. Risk for developing throat cancer Vocal Nodules: Nodules can develop on vocal cords as a result of smoking habit, leading to vocal changes. D. Bronchus and bronchioles Smoker's cough leads to chronic bronchitis, caused by destroyed respiratory cilia. Mucus production increases and the lining of the bronchioles thickens, making breathing difficult. The bronchioles lose elasticity and are no longer able to absorb the pressure within the alveoli (microscopic air sacs) enough to rupture the delicate alveolar walls; this condition is the hallmark of smoking-induced emphysema. The burst alveoli cause worsening of the cough, fatigue, wheezing, and impaired breathing. Emphysema is fifteen times more common among individuals who smoke a pack of cigarettes a day than among nonsmokers. E. Cilia Tobacco smoke contains 250 known harmful chemicals; some of these are toxic to the cilia, resulting in their paralysis and an inability to produce mucus effectively. Without this filter, the potentially irritating impurities from the air remain in the airways and this can cause infection. Experts have long agreed that this is one of the reasons that smokers experience a higher incidence of pulmonary infection. F. Mucous glands In long-term cigarette smokers, chronic inhalation of smoke from burning tobacco leaves also stimulates the mucous glands in the bronchial tubes to make excess mucus, giving rise to daily cough with phlegm. G. Alveolar macrophages In addition to nicotine, nearly 1000 other chemicals have been identified in cigarette smoke, including carcinogenic polycyclic aromatic alcohols, cocarcinogenic phenols and fatty acids, carbon monoxide, hydrogen sulfide, hydrocyanic acid, nitrogen oxides, and various irritants that suppress protease inhibition and impair alveolar macrophage function. H. Elastin and collagen fibers Wrinkles appear when the skin loses tightness and elasticity. These qualities are actually maintained by proteins called collagen and elastin. Smoking causes decrease of these proteins from skin. Smoking forms harmful free radicals in skin, which weakens the elastin and collagen fibers and that affects the wrinkling of skin.