respiratory 8 web

8/6/2019 Respiratory 8 Web

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Respiratory Module

C.O.P.D.


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COPD

Characterized by

airflow limitation

Irreversible Dyspnea on exertion

Progressive

Abn. inflammatory response of the lungs to

noxious particles or gases


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Pathophysiology

Noxious particles of gas

Inflammatory response

(occurs throughout the airways, parenchyma andpulmonary vasculature)

Narrowing of airway


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Pathophysiology

Injury Repair

Injury repair

Injury repair Injury Repair

Injury repair scar tissue

Narrowing of lumen


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Pathophysiology

Inflammation

Thickening of the wall of the pulmonary

capillaries (Smoke damage & inflammatory process)


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COPD

Includes

Emphysema

Chronic bronchitis Does not include

Bronchiectasis

Asthma


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COPD - FYI

COPD 4th leading cause of death in the US

12th leading cause of disability

Death from COPD is on the rise while deathfrom heart disease is going down


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COPD

Risk Factors for COPD

Exposure to tobacco smoke

80-90% of COPD Passive smoking

Occupational exposure

Air pollution


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COPD risk factors

#1

Smoking

Why is smoking so bad?? scavenger cell ability

cilia function

Irritates goblet cells & Mucus glands

mucus production


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Chronic Bronchitis

Disease of the airway

Definition:

cough + sputum production > 3 months

2 consecutive years


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Chronic Bronchitis

Pathophysiology

Pollutant irritates airway

Inflammation + K secretion of mucus

K goblet cells +

Kmucus secreting glands + KMucus

L ciliary function


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Chronic Bronchitis

Plugs become areas for bacteria to grow and

chronic infections which increases mucus

secretions and eventually, areas of focal

necrosis and fibrosis


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Chronic Bronchitis

Bronchial walls thicken

Bronchial Lumen narrows

Mucus plugs airway Alveoli/bronchioles become damaged

alveolar macrophages

susceptibility to LRI


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What do you think?

Exacerbation of Chronic bronchitis is most likely

to occur during?

A. FallB. Spring

C. Summer

D. Winter


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Emphysema

Pathophysiology

Over distended alveoli

Damage to adjacent pulmonary capillaries K dead space

Impaired passive expiration

Impaired gas exchange


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Emphysema


impaired expiration

Hypoxemia

K CO2

Hypercapnia

Respiratory acidosis


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COPD

Compare and contrast

Chronic Bronchitis is a disease of the

___________?

Airway

Emphysema is a disease affecting the

___________?

Alveoli


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C.O.P.D.

Clinical Manifestation (primary)

1. Cough

2. Sputum production3. Dyspnea on exertion(Secondary)

Wt. loss

Resp. infections

Barrel chest


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C.O.P.D.

Nrs. Assessment

Risk factors

Past Hx / Family Hx

Pattern of development

Presence of comobidities

Current Tx

Impact


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C.O.P.D.

Diagnostic exams/procedures

Pulmonary function test

Tidal Volume

L

Functional residual

K

Spirometry / FEV (force of expired vol.) L


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C.O.P.D.

Diagnostic exams/procedures

Bronchodilator reversibility test

Check FEV

Give Bronchodilator

If improved FEV = Asthma

If no improvement FEV = COPD


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ABGs

Baseline PaO2

Rule out other diseases CT scan

X-ray


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C.O.P.D.

Medical Management

Risk reduction

Smoking cessation!

(The only thing that slows down the progression of the

disease!)


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Glucocorticoids

Action

Potent anti-inflammatory agent

Route Inhaled

Systemic

(oral or intravenous)


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Endocrine Flashback

Which of the following is an iatrogenic eventsecondary to prolonged use of corticosteroidmedications?

A. SIADH

B. Diabetes Insipidus

C. Cushing disease

D. Addisons disease

E. Acromegaly


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What electrolyte imbalance is assoc with

Cushing Syndrome?

A. Hypercalcemia

B. Hypocalcemia

C. HypernatremiaD. Hyponatremia

E. Hyperkalemia

F. Hypokalemia


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Corticsteriods

S/E

Cushing

Moon face

Na+ & H20 retention

Never discontinue abruptly


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What affect do corticosteroids have of

blood sugar levels?


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Glucocorticoids

Examples

Prednisone

Methyprednisone

Beclovent


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C.O.P.D.

Medical Management

Treatment

O2

When PaO2 < 60 mm Hg

Pulmonary rehab

Breathing exercises

Pulmonary hygiene


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Nursing Management


Ineffective airway clearance

Ineffective breathing patterns

Activity intolerance

Deficient knowledge about self-care

Ineffective coping


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Nursing Management


Bronchodilators

Corticosteroids

Monitor for side effects Measure FEV (force of expired volume)

Assess dyspnea

Smoking cessation


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Nursing Management

Ineffective airway clearance

Eliminate pulmonary irritants

Directed cough

Chest physiotherapy Fluids

Aerosol mists


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Nursing Management

Ineffective breathing patterns

Teach and encourage breathing exercises


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Nursing Management

Breathing exercises (usually have shallow, rapid, inefficient breathing)

Diaphragmatic breathing

rate

ventilation

expelled air

Pursed lip breathing

Slows respiration

Prevents collapse of small airways

Helps control rate and depth Relax ( anxiety)


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Nursing Management

Activity intolerance Activity pacing

More fatigued in AM

Plan activities for best times

Physical conditioning Exercise training

tolerance

dyspnea

fatigue

Graded exercise

Regular vs. sporadic


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Nursing Management

Deficient knowledge about self-care

participation ( improvement)

Coordinate diaphragmatic breathing with

activities Avoid fatigue

Fluids always available


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Knowledge Deficit

O2 therapy

Flow rate

# hours required

No smoking

Regular blood oxygenation levels

Regular ABGs


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Knowledge Deficit

Set realistic goals

Modify life style

Avoid temperature extremes Heat

O2 demand

Cold

bronchospasms


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Nursing Management

Ineffective coping Set realistic goals

Listen

Empathy Refer


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C.O.P.D.

Nursing Management

Imbalanced Nutrition: Less than Body

requirement

(frequently weight loss and protein breakdown)

Monitor weight

Protein

Nutritional supplements


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Question?

A patient is getting discharged from a SNF facility. The patient has a history ofsevere COPD and PVD. The patient is primarily concerned about theirability to breath easily. Which of the following would be the bestinstruction for this patient?

A. Deep breathing techniques to increase O2 levels.

B. Cough regularly and deeply to clear airway passages.C. Cough following bronchodilator utilization

D. Decrease CO2 levels by increase oxygen tank output during meals.


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Bronchiectasis

Pathophysiology

Form sacs

Secretion pool

Infections


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BronchiectasisEtiology

2nd chronic disorder

Pulmonary infection

Aspiration

Bronchus obstruction

Genetic disorder

Cystic fibrosis


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Bronchiectasis

Clinical Manifestations

Recurrent LRI

Cough

Sputum Copious (>200ml)

Purulent

Foul smelling

Auscultation Wheezes

Crackles


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Bronchiectasis

If wide spread

Dyspnea

Clubbing of thefingers

K pulmonary blood

pressure Cor

pulmonale


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Bronchiectasis

Dx

S&S

Sputum cultures r/o TB

CT*


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Bronchiectasis

Tx

Bronchodilators

Mucolytic agents Antibiotics

Surgery

O2

If hypoxemia

Postural drainage

Chest physiotherapy

Smoking cessation


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Asthma

Pathophysiology

Characterized by intermittent airway

obstruction

In response to variety of stimuli Epithelial lining of the airway respond by

becoming inflamed and edematous

Bronchospasms

Secretions increase in viscosity


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Asthma

Pathophysiology

The airway hyper-responsiveness, mucosal edema &Kmucus production leads to

Recurrent episodes of symptoms Cough

Chest tightness

Wheezing

dyspnea


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Asthma

What is the strongest predisposing factor for

asthma?

A. Smoking

B. Family history

C. Allergy

D. Having a weird middle name


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What is the action of a

mast-cell stabilizer

A. Reduces histamine release

B. Increases the effectiveness of the whiteblood cells

C. Increase WBC production

D. Bronchodilatation


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Thought question?

Why is Asthma not considered a form ofC.O.P.D?

A. Smoking is not a risk factor

B. It is not irreversible

C. It doesnt start with the letter C

D. It is not a chronic disease

E. It is not an obstructive disease


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Asthma

S&SPrimary

Cough

Dyspnea

Wheezing

Expiratory

Nasal flaring


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Asthma

Assessment & Dx

History

Co-mobid conditions Gastro-esophageal reflux


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Asthma

During an Acute episode

Respiratory rate Increased (initially)

CO2? Decreased

Resp. alkalosis

Tired

Decreased Resp. rate CO2 ?

Increased

Resp acidosis


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Asthma

Prevention Manipulate known

triggers

Stress

Pollen

Exercise


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Asthma

Rx therapy

2 general classes of asthma medications

1. Quick-relief

2. Long-acting

Because of the underlying pathology of asthma is

inflammation, controlled primarily with anti-

inflammatory meds


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Asthma

Rx therapy Bronchodilators

Aminophylline

Anticholinergics

Atropine Sulfate

Atrovent

Corticosteriods

Prednisone

Decreased inflammation

Mucolytic agents

Acetylcysteine


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Asthma

Diet

Fluids

Activity

Rest periods

Relaxation techniques

Not overexert self

Sit down and sip warm water


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Status Asthmaticus

Pathophysiology

Attack lasting > 24 hours

Do not respond to normal treatment


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The term pink puffer refers to the client

with which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema


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A 66 year old client has marked dyspnea at rest, is

thin and uses accessory muscles to breathe. Hes

tachypneic, with a prolonged expiratory phase.

He has no cough. He leans forward with his arms

braced on his knees to support his chest and

shoulders for breathing. This client has

symptoms of which disease?

A. Asthma

B. Chronic Bronchitis

C. Emphysema


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Its highly recommended that clients with

asthma, chronic bronchitis and emphysema

have Pneumovax and flu vaccinations for

which of the following reasons?


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A. All clients are recommended to have these vaccines

B. These vaccines produce bronchodilation and

improve oxygenation

C. These vaccines can reduce tachypnea

D. Respiratory infections can cause severe hypoxia and

possible death in these clients


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Exercise has which of the following

effects on clients with asthma,

chronic bronchitis and emphysema?

A. It enhances cardiovascular fitness

B. It improves respiratory muscle strengthC. It reduces the number of acute attacks

D. It worsens respiratory function and is

discouraged


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Clients with Chronic Obstructive Bronchitis

are given diuretics. Which of the following

best explains why?

A. Reducing fluid volume reduces oxygen demand

B. Reducing fluid volume improves the clients mobility

C. Reducing fluid volume reduces sputum production

D. Reducing fluid volume improves respiratory function

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