Respiratory Ch 24 COPD
Pink Puffer
-CO2 increase -No cyanosis -Pursed lips -Ineffective cough -Barrel chest -Thin appearance -Right sided heart failure
Blue Bloater
-Color Dusky to Cyanotic -Hypoxia -Hypercapnia (CO2 increase) -Acidosis -Resp. rate increase -Use of O2 -Heavy smoker -Finger clubbing -Cardiac enlargement
Describe the pathophysiology of chronic obstructive pulmonary disease (COPD).
-Disease state characterized by airflow limitation that is not fully reversible. -Chronic Bronchitis -Emphysema -Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases -Chronic inflammation damages tissue -Scar tissue in airways results in narrowing -Scar tissue in the parenchyma decreases elastic recoil (compliance) -Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)
Discuss the medications used in asthma management. -Step 1: Mild intermittent, rescue inhaler -Step 2: Mild persistent, QD, antiinflammatory, Cromolyn, Leuk. Rescue -Step 3: Moderate persistent, QD long acting beta agonist (not doing so good), Theophylline, Zileuton -Step 4: Severe persistent, ICS & long acting beta agonist
-Epinephrine (EPI-PEN): Emergency Situation Side Effects: HR, RR, Tremors, HTN (Fight or Flight) -Theophylline (Theodar) Side Effects: Tachycardia, Hypotension, Nausea, Vomiting, Seizures -Beta Agonist (Albuterol / Proventil, Ventolin, Xopenex, Alupent) Side Effects: Tachycardia, Tremors, Angina -Anticholinergics (Atrovent) Side Effects: Nasal drying, Irritation ***Range of OFFLEN LEVEL ***SHORT TERM RELIEF VS MAINTENANCE (Rescue Inhaler VS EPI) -Salmeterol (Serevant): Maintance -Corticosteroid (Beclovent, Vanceril, Azmacort): Can cause thrush -Mast Cell Stabilizer (Intal, Tilade) -Leukotriene Modifier (Singulair, Generic)
Develop an education plan for patients with COPD.
-Health history -Inspection and examination findings -Review of diagnostic tests -MDI patient education, refer to Chart 24-4 -Nursing Care Plan, refer to Chart 24-5 -Home care check list, refer to Chart 24-6 -Pulmonary function test (COPD residual = high; inspiration works, expiration doesn't) -30 day exacerbation?
Describe the pathophysiology of cystic fibrosis
-Most common autosomal recessive disease among the Caucasian population -Genetic screening to detect carriers -Genetic counseling for couples at risk -Genetic mutation changes chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract -Respiratory infections are the leading cause of morbidity and mortality -Nursing care focused on symptoms relief such as promoting removal of pulmonary secretions
Antitussives VS Expectorants VS Mucolytics
Antitussives: Reduces coughing in nonproductive cough, but watch out for drowsiness Expectorants: Irritates mucous membranes to release the mucous creating a productive cough Mucolytics: Breaks the links that bind mucous togethers so it can be coughed up Antihistamine: -Freedom from allergies, anxiety, pain, motion sickness
Use the nursing process as a framework for care of patients with COPD.
Goal is: -Can't cure either -Preserve airflow -Control symptoms -Prevent exacerbations -Stop smoking -Bronchodilators: Open airways -Steroids: Reduce inflammation -Antibiotics: Mucous buildup leads to infection -Good nutrition (low carbs CHO = CO2) -Increase fluids (no milk or protein) ***Pursed lip breathing teaching... -Control rate and depth of respirations -Prevent collapse of airways -Release trapped air in the lungs -Expectorants: Getting sputum out -Postural drainage (vest shaking) -Flutter valve: Green apparatus, losen it up
Identify medical and nursing management of bronchiectasis.
Medical Management: -Postural drainage -Chest physiotherapy -Smoking cessation -Antimicrobial therapy Nursing Management: -Focus is on alleviating symptoms and clearing pulmonary secretions -Patient teaching
Describe asthma self-management strategies. -Pursed Lip Breathing (In nose Out mouth CO2) -Diaphragmatic Abd. Breathing -Keep humidity 30-50% -No canopy beds -No under bed -No carpet -Central vac or HEPA filter -Clean air ducts 1 x yr -Keep humidity 30-50% -No canopy beds -No under bed -No carpet -Central vac or HEPA filter -Clean air ducts 1 x yr
Nutritional Teaching: -Easily prepared foods -Crock pot -Large batches and freeze -Sit on tall stool for prep -Use paper plates -Chew slowly -Relax while eating -Avoid very hot & cold -Small frequent meals -Fluids before or after meals -Hydration 8oz -Prevent constipation -Limit salt intake -Low CHO diet -Avoid milk (mucous producing)
Describe the pathophysiology of bronchiectasis and relate it to signs and symptoms of bronchiectasis. Definition: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles Caused by: -Airway obstruction, pulmonary infections -Diffuse airway injury -Genetic disorders -Abnormal host defenses -Idiopathic causes -Low immunity
Pathophyiology: -Pulmonary infections damages the bronchial wall -Loss of its supporting structure and resulting in thick sputum brondchial obstruction -Walls distended and distorted -Impaired rnucocilliarv clearance -Retention of secretions and subsequent obstruction alveoli distal to the obstruction collapse (atelectasis) -Inflammatory scarring or fibrosis replaces functioning lung tissue Signs & Symptoms: -Chest Pain -Chronic cough -Purulent sputum in copious amounts -Clubbing of the fingers
Status Asthmaticus
Respiratory Acidosis (pH decreases, PaCO2 increases)
Discuss the major risk factors for developing COPD and nursing interventions to minimize or prevent these risk factors.
Risk Factors: -Exposure to tobacco smoke accounts for an estimated 80%-90% of cases of COPD -Passive smoking (ie., secondhand smoke) -Increased age -Occupational exposure-dust, chemicals -Indoor and outdoor air pollution -Genetic abnormalities, including a deficiency of alpha, antitrypsin.
Describe the pathophysiology of asthma. Pathophysiology: 1. Infectious agent 2. Inflammation of pulmonary tissue 3. Edema of alveolar - Alveoli fill with exudate 4. Gases cannot cross edematous alveolar membrane - Air cannot enter fluid-filled alveoli 5. Hypoxia (CO2 retention)
Signs & Symptoms: -"Wheezing" -Cough early nonprod late prod -SOB -Chest tightness -Bronchospasms -Use accesory muscles -Tachypnea -Tachycardia -Paradoxical Pulse -Overinflation -Decreased PEFR - Peek expiratory flow rate ***Early Warning Signs: -Funny feeling in chest - change in breathing -H/A, dry mouth, itchy chin -Glassy eyes, circle under eyes -Nervous, runny nose -What happens in Pulmonary Function Test? -Also: Check Hx of GERD
Emphysema Definition: -Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the "walls of the alveoli" -Decreased "alveolar" surface area increases in "dead space," impaired oxygen diffusion. -Hypoxemia results Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale) -Hyperinflation of air spaces beyond terminal resp bronchiloes & destruction of cap walls, narrow, tortuous, sm airways = loss of lung elasticity. -Inherited deficiency -alpha 1 antitrypsin (AAT) - proteolysis in lung tissue (before 40)
Signs & Symptoms: -Dyspnea -Decreased breath sounds but no wheezing -Chronic non productive cough -Dyspnea on exertion -Barrel chest -Increased expiratory effort -Chest pain
Chronic Bronchitis Definition: -Cough and sputum production for at least 3 months in each of 2 consecutive years -Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways -Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes -The patient is more susceptible to respiratory infections
Signs & Symptoms: -Inc sputum -Cough -Inc PCO2 -Hypoxia -Hypercapnea -RV hypertrophy -Constriction causes temp increase: 98.6, -Risk for infection (Prone to it), Pneumonia -Increase HR, Tachycardia, Tachypnea -Blue Bloater -Wheezes
Signs & Symptoms of COPD
Three primary symptoms: -Chronic cough, -Sputum production, -Dyspnea Others: -"Pink puffers:" Pursed breathing when even walking around, bronchioles constricted, breathe in but out is poor -"Blue Bloaters:" Large chest, big stomach -Barrel chest -Pursed-Iip breathers -Distant quiet breath sounds -Wheezes -Pulmonary blebs on radiograph