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Nursing of the adult with chronic airflow limitation

Define chronic airflow limitation (CAL). Chronic lung diseases including chronic bronchitis, pulmonary emphysema, and asthma
What diseases are included in the term COPD? bronchitis and emphysema
What are the characterizing symptoms of COPD? bronchospasm and dyspnea
Discuss the prognosis for lung damage resulting from COPD. damage to the lung is not reversible and increases in severity
What is the primary cause of COPD in the United States? tobacco smoke
How does asthma differ from COPD? Asthma is an intermittent disease with reversible airflow limitation and wheezing
Why is it imperative to get baseline blood gases for the patient with chronic lung disease? because their “normal” will be different than that of healthy people; compensation occurs over time so that ABGs are altered
What is the nurse likely to note about the client’s breathing on assessment of the person with a chronic airway limitation? Changes in pattern (for example increased rate and decreased depth), accessory muscles, dyspnea, orthopnea, anxiety about breathing
What findings would the nurse expect on auscultation of the client with chronic airway limitation? decreased breath sounds, coarse crackles in lung fields that tend to improve after coughing, wheezing
How might signs of anxiety about breathing be manifested by the client with chronic airway limitation? Anger, fear of being alone, fear of not being able to catch breath
What are signs a nurse might notice on visual inspection of the client with chronic airway limitation? barrel chest, cyanosis of lips, moucous membranes, or nail beds (blue bloater)
What will the nurse expect to find in regards to ABGs in the patient with chronic airflow limitation? increased CO2 levels
What will the nurse expect the client’s O2 saturation to be if they have chronic airflow limitation? lower than average
What are the expected findings regarding activity and nutrition for the client with chronic airflow limitation? Activity intolerance, poor nutrition
What position is useful for promoting productive cough and comfort in the client with orthopnea due to chronic airflow limitation? Why? Semi- or high fowler lessen pressure on the diaphragm by abdominal organs
Why is gastric distention a big deal for the client with chronic airflow limitation? because it elevates the diaphragm and inhibits full lung expansion
Name the normal blood gas values for the adult and for the child. Adult/child Pco2 35-45mmHg, Po2 80-100%, HCO3 21-28 mEq/L; pH adult 7.35 to 7.45, pH child 7.36 to 7.44
Describe the Pink Puffer. Barrel chest is indicative of emphysema and is caused by use of accessory muscles to breathe. The person works harder to breathe but gets enough oxygen to keep them pink.
Describe the Blue Bloater. Insufficient oxygenation occurs with chronic bronchitis and leads to generalized cyanosis (Blue) and often right-sided heart failure (Bloater).
Give four applicable nursing diagnoses for the patient with chronic airflow limitation. ineffective airway clearance, ineffective breathing pattern, impaired gas exchange, activity intolerance
How does inadequate oxygenation affect the body’s cells? interferes with the cell’s ability to function
What are a couple of easily assessable signs of inadequate arterial oxygenation? slow capillary refill and cyanosis
What affect does chronic poor oxygenation have on the fingers and fingernails? Clubbing of the nails comes first. Clubbing of the finger is a late sign.
How do we teach the client with chronic airflow limitation to position themselves to promote breathing? sit upright and lean forward; in bed-sit with arms resting on over-bed table; in chair – lean forward with elbows resting on knees (tripod)
What breathing methods can the nurse teach to help the client with chronic airflow limitation? diaphragmatic and pursed lip breathing; teach the client to prolong the expiratory phase to release trapped air
How much O2 will the client with chronic airflow limitation receive? Why not more than that? 1-2 liters per nasal cannula -The stimulus to breath is hypoxia (rather than hypercapnea as with a healthy person), so giving too much oxygen can cause the client to lose their drive to breath.
Why does a person who is having a hard time breathing have trouble with appetite? What can the nurse do to help? Eating consumes energy needed for breathing. The nurse can offer mechanically soft diets which do not require as much energy to chew or digest. Assist with feeding if needed.
What nursing interventions assist the client with chronic airflow limitation to improve nutrition? Offer small frequent meals, favorite foods, and dietary supplements
What recommendations does the nurse give the client with chronic airflow limitation about fluid intake? 3 liters a day
What lifestyle change is imperative for the client with chronic airflow limitation? stop smoking
What should the nurse discuss with the client with chronic airflow limitation in regards to health promotion? relaxation techniques, prevent secondary infections, medication regime, pace activities to conserve energy, report change in sputum, hydrate well, get flu and pneumonia immunizations
Name three ways a client can avoid secondary infections. avoid crowds, people with infectious diseases, and respiratory irritants (like tobacco smoke)
How does the nurse prioritize nursing actions? ABCs – airway, breathing, circulation
Discuss when it is necessary to bubble oxygen through some type of water solution so it can be humidified and when it isn’t. In adults O2 must be humidified if given at >4 L/min or if delivered directly to the trachea. When O2 is delivered at 1-4 L/min or by mask or nasal prongs the oropharynx and nasal pharynx provide adequate humidification