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32 noninfect resp

noninfectious lower respiratory problems

COPD characterized by bronchospasms and dyspnea. The tissue damage is nonreversible and increases in severity, eventually leading to respiratory failure.
asthma intermittent & reversible airflow obstruction. overreaction w/ bronchospasms and edematous swelling of the mucous membranes. o Inflammation occurs in response to specific allergens; cold air, dry air or fine airborne particles; microorganisms and aspirin.
asthma in older adults lung & airway changes w/ aging makes breathing problems more serious. dec sensitivity of beta-adrenergic receptors, with age receptors less sensitive, no longer respond as quickly. Proper teaching how to avoid attacks and to use preventive drugs properly
History of asthma pt dysnpnea, chest tightness, coughing, wheezing and increased mucus production. Seasonally, continuously or association with activity? Smoking, if so teach cessation,
S/S of asthma audible exhalatory wheeze and inc RR, when inflammation occurs with asthma, couching may increase. Check nail beds for cyanosis and pulse OX for hypoxemia (poor blood O2 levels), may be barrel chested, muscle retraction, change in LOC and tachycardia.
interventions w/ asthma improve airflow, relieve symptoms and prevent episodes. Keep adults as active partners in plan management. Pt understand illness and preventions. assess symptoms 2x a week with peak flowmeter and adjust drugs to manage inflammation and bronchospasms.
Peak expiratory flow Keep PEF in green zone: at least 80% or above the “personal best”, Yellow: 50-80% needs to use rescue drug, Red: <50% immediately use rescue drugs and seek emergency help
preventative vs rescue asthma drugs change airway responsiveness to prevent asthma attacks, everyday use. Rescue drugs: used to stop an attack once it’s started.
Long acting Beta2 agonists vs short acting . LABAs: long acting beta2 agonists, need time to build up but the effects last longer (Do not use as rescue). SABA: short acting beta2 agonists, fast acting for emergencies.
Anticholinergic drugs block parasympathetic NS, resulting in increased bronchodilation and decreased pulmonary secretions. Ex: Atrovent and Spiriva
NSAIDS for prevention, should be taken on a daily basis. Inhaled NSAIDS are not effective in reversing symptoms during an asthma attack
Exercise/activity with asthma regular exercise, including aerobic is recommended. May need to pre-medicate with SABA before. adjusting environment may be needed (indoor ice-skating vs outside)
Status Asthmaticus severe, life-threatening acute episode of airway obstruction that intensifies and does not respond to common therapy. If condition not reversed pt may develop pneumothorax and cardiac or respiratory arrest. IV fluids, O2, prepare to intubate
bronchitis vs pulmonary emphysema Chronic bronchitis= airway problems. Pulmonary emphysema= alveolar problems
emphysema loss of lung elasticity and hyperinflation of the lung. An increased amount of air becomes trapped in the alveolar walls, overstretching and enlargement of the alveoli into airfilled spaces called bullae, and collapse of small airways.
chronic bronchitis ncrease in number and size of mucous glands, which produce large amounts of thick mucus. The bronchial walls thicken and impair airflow. Small airways are affected before large airways become involved.
Risk factors of COPD cigarette smoking is the most important risk factor, harmful effects of tobacco, inhaled smoke triggers the release of excessive amounts of the proteases from cells in the lungs. Alpha1-antitrypsin deficiency also risk factor. Air pollution
Complications of COPD oxygenation and tissue perfusion to all tissues. Hypozemia, acidosis, respiratory infection, cardiac failure and dysrhythmias. Cardiac failure normally cor pulmonale (right sided caused by pulmonary disease),
History with COPD occupation,nd ethnic. Smoking,any breathing problems and relationship between activity intolerance and dyspnea. Weigh pt, unplanned weight loss occurs with an increase in COPD severity, due to increase metabolic needs from increased work of breathing.
physical findings of COPD similar to asthma, check for abnormal retractions, symmetric chest expansions, barrel chest (diameter of chest and its lateral is 2:2 instead or 1:2), nail beds for clubbing and oral mucous membranes
breathing techniques for COPD Abdominal/ diaphragmatic: lay on back knees bent, hands or a book on abdomen, breath from abdomen while keeping chest still. pursed close mouth breathe through nose, purse lips like when you whistle, breathe out slowly without puffing checks.
interventions of COPD: diet and dyspnea high protein, high caloric 4 or 5 small meals , avoid drinking fluids before or during meals to increase appetite. SOB most common problem, during mealtimes can be reduced by resting before meals, use a bronchodilator 30 minutes before the meal
cystic fibrosis Genetic disease, caused by blocked chloride transport in the cell membrane. Thick, sticky, mucus causes problems in lungs, pancreas, liber, salivary glands and testes. Primary cause of death is respiratory failure
assessment of CF diagnosed in childhood, sweat chloride analysis (range 60-200 mEq/L positive CF), nonpulmonary manifestations are abdominal distention, gastroespohageal reflux, rectal prolapse, foul-smelling stool and excessive fat in stool (steatorrhea)
complications CF pneumothorax, arterial erosion and hemorrhage and respiratory failure.When infection present, pt has fever, elevated WBC count, decreased O2 saturation.
nonsurgical management CF Nutritional management of weight management, vitamin supplementation, diabetes management and pancreatic enzyme replacement. Chest physiotherapy, exercise, exacerbation therapy needed if change in baseline. avoid mechanical ventilation last!
surgical management of CF lung or pancreatic transplantation. Reduced manifestation but still at continuing risk for lethal pulmonary infection, especially with anti-rejection drug therapy. Transplants extends life 10-20 years
Primary pulmonary hypertension Occurs in absence of another lung disorders. Blood vessel constriction w/ inc vascular resistance in the lung. Pulmonary Bp rises, blood flow dec = poor perfusion. Right side heart fails from continuous workload. W/o treatment death occurs within 2 years
Assessment of PPH most common manifestations are dyspnea and fatigue in an otherwise healthy adult. Some have angina like chest pain. Diagnosis made from right-sided heart catheterization showing elevated pulmonary pressures.
Management of PPH reduce pulmonary pressure and slow development of cor pulmonale with drugs to dilate pulmonary vessels and prevent clot formation (warfarin) to achieve INR of 1.5-2.0. Calcium channel blockers (Cardizem) to dilate. Meds given through small IV pump
Nursing priority with PPH death has been reported if drug delivery is interrupted even for a matter of minutes. Teach pt t always have back up drug cassettes and battery packs, if not available or if line is disrupted go to ER immediately
Interstitial pulmonary disease Category of interstitial pulmonary disease aka fibrotic lung diseases. All affect the alveoli, blood vessels, and surrounding support tissue of the lungs rather than airway. Air trapping doesn’t happen and pt doesn’t develop a barrel chest.
Sarcoidosis granulomatous disorder causing autoimmune response to damage lung tissue. Causes fibrosis (scar tissue), reduced lung compliance (elasticity) and Cor pulmonale. Affects young adults. S/S: cough, dyspnea and abnormal chest x-ray. tx corticosteroids
Idiopathic pulmonary fibrosis older adult with Hx of cigarette smoking or chronic exposure to irritants. Excessive wound healing, once lung injury occurs an inflammatory process heals the lung, continues beyond normal healing causing extensive fibrosis and scarring
occupational pulmonary disease Exposure to occupational or environmental agents. Consider this cause for all patients with new onset asthma or dyspnea. Prevention is important to avoiding disability from occupation-related disease. Teach use of respiratorys and adequate ventilation
Bronchiolitis obliterans organizing pneumonia (BOOP) Inflammatory connective tissue plugs to form in the lower airways and in the tissue between the alveoli. Leads to restricted lung volume with decreased vital capacity. Not true pneumonia. dyspnea, fever, crackles, flu-like symptoms,tx corticosteroid
Lung cancer Leading cause of cancer-related deaths. Tx mainly palliative. Staging performed at dx to assess size & extent of disease. Primary prevention is directed at reducing tobacco smoking (85%), teaching industrial setting about safety precautions
warning signs of lung cancer hoarseness, change in respiratory apttern, persistent cough, blood-streaked sputum, rust-colored sputum, chest pain, shoulder or chest wall pain, dyspnea, wheezing, weight loss,
treatment for lung cancer palliative, radiation (mainly before surgery) 5-6wk intervals. Chemotherapy, photodynamic therapy to remove small bronchial tumors when accessible by bronchoscopy, surgery.
Created by: smarti13