Pulmonary Disorders Pt 3 (CHRONIC PULMONARY DISORDERS)
What are other complications of COPD?
- Pneumonia - Chronic atelectasis - Pneumothorax - Pulmonary arterial hypertension (results in cor pulmonale)
What are delivery methods for bronchodilators?
- Metered dose inhaler (MDI) - Dry powder inhalers - Nebulizer - Oral route
What are the benefits of pursed lip breathing?
- Prolonges exhalation - Prevents collapse of small bronchioles - Helps the patient to control the rate and depth of expiration - Reduces the amount of trapped air - Enables the patient to gain control of dyspnea - Helps reduce feelings of panic (hypercapnia)
In what ways can COPD be medically managed?
- Promoting smoking cessation - Supplemental oxygen as needed - Prescribe medications - Surgical intervention - Palliative care
What assessments are essential when administering oxygen therapy to a pt with COPD?
- Pulse Ox - ABG - level of consciousness - respiratory rate
What are s/s of pneumothorax? Bolded factor not included in ppt; from textbook.
- Rapid onset of SOB - Chest pain - Asymmetry of chest movement - Absence of breath sounds on the affected side - decrease in pulse oximetry
What are some nursing considerations associated with the management of COPD?
- Assessing the patient: obtain history, review diagnostic tests - Achieving airway clearance - Improving breathing patterns - Improving activity tolerance - Metered dose inhaler patient education
What pharmacologic therapy can be used to treat COPD?
- Bronchodilators ; * key for symptom management in stable COPD - corticosteroids - influenza vaccine and pneumococcal vaccine (prevention)
What are key indications for oxygen therapy?
- Change in respiration rate or pattern is an early indicator of need for O2 therapy - Hypoxemia because it usually leads to hypoxia, which can be life-threatening
What are the three primary symptoms of COPD?
- Chronic cough - Sputum production - Dyspnea *they worsen over time
What is barrel chest? What occurs with inspiration and expiration?
- Chronic hyperinflation caused by a loss of lung elasticity, which causes the ribs to be in a more fixed position Characteristics: - Shoulders may heave upward and abdominal muscles may contract with inspiration * Tends to lean forward
What are factors that interfere with coping?
- Constant SOB and fatigue: may make the patient irritable and apprehensive to the point of panic - Restricted activity and realization that the disease is unrelenting: may make the patient angry, depressed, and anxious
What are risk factors associated with the development of COPD?
- Exposure to tobacco (80 % - 90% of cases) - Secondhand smoke - Increased age - Occupational exposure (i.e., dust and chemicals) - Air pollution (indoor and outdoor) - Certain genetic abnormalities (deficiency in alpha-1 antitrypsin; an enzyme inhibitor that prevents the destruction of lung tissue) - Intensity of smoking is related to the decline of pulmonary function
What occurs in emphysema? Describe the pathophysiology. Describe what happens in later stages.
- Impaired O2 & Co2 exchange resulting from destruction of the walls of over distended alveoli Pathophysiology: Destruction of alveolar walls --> direct contact of alveolar surface with pulmonary capillaries decreases --> increase in dead space --> ↓O2 diffusion --> hypoxemia In later stages: Co2 elimination is impaired --> Co2 retention --> Respiratory acidosis
For patients with COPD, what do bronchodilators do?
- Relieve bronchospasm - Reduce airway obstruction - Improve alveolar ventilation - Allow increased oxygen distribution
What are nursing considerations regarding nutritional therapy?
- Rest for 30 minutes prior to eating - Use a short acting bronchodilator before meals - Use of O2 via nasal cannula - Need extra protein and calories to restore muscle mass - May need to have 6 small meals/day - Fluid intake should be 3L/day unless contraindicated - Fluid intake between meals (Since fluids are lost with breathing pattern (tachypnea). Fluids also keep secretions moist so they are easier to expectorate)
How can smoking cessation be promoted?
- Smoking cessation programs - Nicotine replacement (first line of pharmacotherapy) - Zyban or Aventyl - Chantix
What is COPD? Is it reversible?
- a preventable and treatable, slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both - no, not fully
Respiratory insufficiency and failure, associated with COPD, can be what? Acute respiratory insufficiency and failure may necessitate the need for what until other acute complications, such as infection, can be treated?
- acute or chronic - the pt may need ventilatory support
What are other considerations of oxygen therapy?
- assess color - assess for presence of lung disease - humidification should be used when O2 is set to 4-6 liters to prevent drying of nasal passages
How can nurses monitor for complications?
- assess s/s of respiratory failure - assess cognitive changes - assess for increased temperature or changes in sputum color (s/s of infection) - assess s/s of pneumothorax (caused by rupture of bullae)
What components are used during assessment and diagnosis of COPD?
- conduction of a thorough health history - physical assessment - chest x-ray - ABG - pulmonary function test (PFT)
As COPD worsens, what may develop?
- dyspnea at rest - weight loss; dyspnea interferes with eating - increased WOB; takes more energy, so accessory muscles are recruited in an effort to help breathe - increased risk for respiratory infections
Anything that interferes with breathing has the ability to do what? What three things can it cause r/t a patients mood/emotional status?
- interfere with normal breathing This can cause: - anxiety (associated w/ hypercapnia) - irritability - depression
What are the benefits of diaphragmatic breathing?
- reduces respiratory rate - increases alveolar ventilation - helps expel as much air as possible during expiration
What is the breathing pattern of a patient with COPD? What is a key thing to remember about the breathing pattern?
- shallow, rapid, and insufficient - the more severe the disease the more inefficient the breathing pattern
In regard to nutrition, what is a major problem of COPD? What is weight loss a predictor of? What may be needed as a result?
- significant weight loss and cachexia, which leads to muscle wasting - predictor of poor prognosis - supplemental nutrition may be needed
What are s/s of respiratory faiure?
- ↑ dyspnea - Tachypnea - Tachycardia - ↓ O2 saturation
What are some physical assessment findings associated with COPD?
- ↓ breath sounds (result of hyperinflation and decreased movement of air in/out of lungs) - Expiratory wheeze - Use of accessory muscles - Barrel chest - Clubbing of the fingers - Unable to finish a sentence without becoming short of breath
What two ways can corticosteroids be administered and what are the benefits of use?
1. inhaled: combined with bronchodilators 2. systemic (oral or IV): not used long term due to side effects Benefits: - can improve symptoms BUT they do not slow the decline of lung function
What three benefits does tripod positioning provide?
1. it helps decrease the work of breathing 2. it increases the anteroposterior diameter of the chest 3. it changes pressure in the thorax
What is the normal saturation?
95-100%
The appropriate form of O2 therapy is determined by what?
ABG levels, which indicate the patient's oxygenation status
What are the different oxygen therapy devices? Which are low-flow and which are high-flow systems?
Low-Flow Systems 1. Nasal Cannula (1-6 litter) 2. Simple Face Masks (at least 5L) 3. Partial non-rebreather (6-15 L) 4. Non-rebreather (10-15 L) High-Flow Systems 5. Face Tent 6. Venturi Mask (most reliable for delivering precise concentrations of oxygen) 7. Aerosol Mask 8. Trach-Collar
T or F: Respiratory collapse can be deadly in COPD patients.
True
What is chronic bronchitis? Describe the pathophysiology.
a disease of the airways, defined as the presence of cough and sputum production for at least three months in each of 2 consecutive years Pathophysiology: Lungs respond to smoke or other pollutants --> inflammation occurs --> hypersecretion of mucus occurs --> bronchial walls thicken, further narrowing lumen --> alveoli adjacent to bronchioles become damaged/fibrosed and impair alveolar macrophage function --> increased susceptibility to respiratory infections
Pulmonary rehab is usually what?
a six week program (inpatient or outpatient)
When it comes to oxygen therapy in COPD patients, what should the nurse do?
administer oxygen with caution to avoid oxygen toxicity and depression of ventilation (lethal adverse effects)
What is the go to, short-acting bronchodilator?
albuterol
In patients with COPD, who have a primary emphysematous component, chronic hyperinflation leads to what physical development? What would their AP-Transverse ratio be? What is the normal ratio?
barrel chest; AP-Transverse ratio = 1/1 Normal ratio = 1/2
Describe the pathology behind a pneumothorax in a COPD patient.
development of bullae from severe emphysematous changes --> bullae rupture w/ activity (severe coughing or large intrathoracic pressure changes) --> pneumothorax
For a pt with COPD, what do you want to keep the O2 saturation at?
greater than or equal to 90%
When it comes to nutrition in a pt with COPD, what happens with eating?
it becomes an effort due to dyspnea, reduction of airflow while swallowing, and O2 desaturation * appetite decreases as a result
Describe the pathophysiologic pathway of chronic obstructive pulmonary disorder (COPD).
lungs have and abnormal inflammatory response to noxious particles or gas --> chronic inflammation occurs and the body attempts to repair it --> leads reconstruction and narrowing of the airways --> hypersecretion of mucus (caused by increased globlet cells and enlarged submucosal glands) --> overtime scar tissue is formed, which further narrows the airway lumen
Pulmonary rehabilitation services are what? What are the disciplines? Bolded items not on ppt slide; from textbook.
multidisciplinary disciplines include: - Exercise training - Energy conserving techniques - Smoking cessation - Nutritional counseling - Education - Health promotion - Breathing exercises - psychosocial support - assessment
What are life threatening complications of COPD?
respiratory insufficiency and respiratory failure are major life-threatening complications of COPD
What is cor pulmonale? List s/s.
right sided heart failure brought on by long-term high blood pressure in the pulmonary arteries s/s: - dependent edema - distended neck veins - pain in the region of the liver
Chronic complications of COPD =
severe COPD
Acute complications of COPD =
severe bronchospasm or pneumonia in a patient with severe COPD
In order to be in tripod position, how should a patient be sitting?
sit with arms propped on the overbed table OR sit with arms propped on knees
What occurs at a saturation of 90%?
the tissue is not receiving enough O2 for adequate perfusion
Why are influenza and pneumococcal vaccines used in pharmacologic therapy? What do they help reduce the risk of?
they are used because they are vital for health maintenance and prevention Reduce risk of: - hospitalization - pneumonia - death
What is the goal of breathing retraining?
to decrease the work of breathing
What is the goal of oxygen therapy?
to provide adequate transport of oxygen in the blood while (1) decreasing the work of breathing and (2) reducing stress of myocardium
What is the goal of COPD management for stable patients?
to reduce risk and symptoms
How do most patients with COPD present?
with overlapping signs and symptoms of emphysema and chronic bronchitis