Chronic Obstructive Pulmonary Disease
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| Emphysema causes | smoking; air pollution; age; may lead to cor pulmonale
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| Emphysema clinical manifestation | exertional dyspnea; septum; accessory muscle use; spontaneous pursed-lip breathing; development of barrel-chest; wheezing; chronic weight loss
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| Emphysema Assessment | Hx; tachycardia; tachypnea; peripheral cyanosis; clubbing of fingers; lung examination
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| finger clubbing | enlargement of fingertips and loss of normal angle of nail bbed
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| emphysema diagnostic tests | pulmonary function test (PFT)
arterial blood gas
chest x-ray
Labs
alpha-antitrypsin assay
Complete Blood count
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| Nursing interventions for PT with ineffective airway clearance r/t narrowed bronchioles | 1) assist with chest physiotherapy and postural drainage
2) encourage fluids 2-3L/day
3) assist with respiratory treatments
4) auscultate lungs frequently and notify physician of changes
5) administer medications as ordered
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| Nursing interventions for PT with activity intolerance related to imbalance between O2 demand secondary to inefficient work of breathing | 1) organize care so PT can have periods of uninterrupted rest
2) advise PT to rest 30 minutes before meals
3) assist PT with ADLs and exercises to increase stamina
4) asses PTs respiratory response to activity
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| PT teaching for Emphysema | Nutrition
Smoking cessation
Infection control
Relazation techniques
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| ________ is usually irreversible and is the fourth leading cause of death in the US | COPD
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| chronic bronchitis is... | recurrent chronic productive cough for a minimum of 3 months for at least 2 months.
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| causes of chronic bronchitis | chemical irritants or bacteria or viral infection; SMOKING IS THE MOST COMMON CAUSE
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| in chronic bronchitis... | the cilia are impaired; hypersecretion of mucous
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| chronic bronchitis risks | infection; chronic infection leads to scarring which causes obstruction. this leads to increased airway resistance and bronchospasm, hypoxia, and hypercapnia
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| chronic bronchitis clinical manifestations | productive cough most pronounced in the morning; dyspnea; cyanosis and right ventricle failure; polycythemia; cyanosis; dependant edema
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| chronic bronchitis assessment | assess cough, severity of dyspnea, patient's anxiety/restlessness level; auscultation for presence of wheezing; vital signs
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| Chronic bronchitits diagnostic tests | CBC
ABG
Pulse Oximetry
PFT
Electrolyte abnormalities
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| Chronic bronchitis medical management | aimed at minimizing disease progresion and facilitating optimal air exchange
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| chronic bronchitis medication | Bronchodilators
Mucolytics
antibiotics
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| NI for PT with fatigue related to increased respiratory effort | 1) assess degree of fatigue
2) provide treatments in a calm, unhurried manner
3) encourage adequate periods of rest
4) Identify support systems and support if needed
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| NI for PT with ineffetive breathing pattern related to retained pulmonary secretions | 1) assess degree of dyspnea
2) teach/assess understanding of effective breathing techniques
3) suction as needed
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| Causes of extrinsic asthma | caused by external factors and occurs in response to allergens, such as pollens, dust, spores, feathers, or animal dander, food etc
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| causes of intrinsic asthma | from internal causes. not fully understood but often triggered by upper respiratory infection and emotional upsets
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| COPD is an umbrella term that includes | Asthma
C. Bronchitis
Bronchiectasis
Emphysema
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| Emphysema symptoms begin in ____ progressing to disability in ____ and _____ | 40s
50s and 60s
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| emphysema is characterized by... | changes in alveolar walls and capillaries
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| In emphysema ___, ______, and ______ become inflamed | bronchi, bronchioles, and alveoli
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| pulmonary blebs are | air-filled alveolar dilation less than 1 cm in diameter on the edge of the lung at the apex of upper lobe or superior segment of lower lobe; usually occurs in young people and can rupture, producing primary pneumothorax.
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| cor pulmonale definition | right side of heart fails in later stages of COPD.
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| causes of asthma | reoccurrence of attacks is influenced by mental or physical fatigue
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| asthma is... | the narrowing of the airways resulting from an altered immune response
acute attacks are casued by the release of histamine
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| COPD diet | high calorie and high protein
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| Clinical manifestations | mild asthma
acute asthma
status asthmaticus
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| asthma assessment | gather information
identify S/S suggesting severity of respiratory distress
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| asthma diagnostic tests | ABG
PFTs
Chest xray
Sputum Culture
CBC
Theophyllline level
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| emphysema medical management classification | bronchodilators
antibiotics
corticosteroids
diuretics
oxygen therapy
anti-anxiety agents
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| NI for PT with ineffective breathing pattern related to narrow airway PART 1 | 1) assess ventilation and respiratory effort
2) monitor closely for S/S of increased dyspnea
3) maintain position to facilitate optimal ventilation
4) administer prescribed meds and monitor effects
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| NI for PT with ineffective breathing pattern related to narrow airway PART 2 | 5) assist with respiratory treatments
6) provide care in calm manner
7) attempt to minimize exposure to triggers
8) maintain adequate hydration
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| NI for PT with ineffective Health maintenance related to possible allergen exposure in the home PART 1 | 1) assist PT and family identify allergens and asthma triggers
2) facilitate allergy testing if necessary
3) teach/assess understanding of the importance of allergy avoidance
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| NI for PT with ineffective health maintenance related to possible allergen exposure in the home PART 2 | 4) Teach/asses use of medications i.e. hold breath for seceral seconds then exhale slowly p inhaling the med.
5) teach/assess understanding of use of peak flow meter and goals for individual PT
6) teach/assess understanding of reasons to call physician
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| Death rate for asthma has increased by ___% over the past 10 years | 50%
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| _______ is fatal if not reversed | Status asthmaticus
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| Bronchiectasis is... | a gradual irreversile process of chronic dilation of the bronchi following repeated lung infections. it is secondary to failure of normal lung tissue defenses (cystic fibrosis, lung tumor, foreign body..) and is a complication of inflammation
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| Bronchiectasis assessment | note complaints of dyspnea, weight loss, and fever; dyspnea, cyanosis, and clubbing of fingers; paroxysmal coughing episodes; foul-smelling sputum; fatigue, weakness, and anorexia; crackles and wheezing; prolonged expiratory phase; hemoptysis
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| Medical management of bronchiectasis | low-flow O2
chest physiotherapy
adequate hydration
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| bronchiectasis medications | mucolytic agents
bronchodilators
antibiotics
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| NI for PT with ineffective airway clearance related to retained pulmonary secretions | 1) assess PTs ability to mobilize secretions
2) encourage postural drainage, cough, and suction as needed
3) encourage frequent position changes
4) maintain adequate hydration
5) admin meds as prescribed and monitor effects
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| asthma medications/therapy | used to prevent or minimize symptoms. the medications are taken long-term
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| asthma acute or rescue therapy | works immediately to relieve symptoms
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| NI for PT with impaired physical mobility related to exercise tolerance | 1) assess PTs activity tolerance and promote adequate rest periods
2) promote gradual increase of activity
3) problem solve with PT and family on energy conserving technques
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| antiasthmatics use | management of acute and chronic episodes of reversible bronchoconstriction
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| antiasthmatics--adrenergic | ex_: epinephrine (Adrenalin, Asthma-Haler mist, Primatene)
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| antiasthmatics--anticholinergics | ex_: ipratropium (Atrovent HFA)
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| antiastmatics--bronchodilators | ex_: albuterol (Proventil, Proventil HFA)
salmeterol (Serevent)
terbutaline (Brethaire)
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| antiasthmatics--coricosteroids | ex_: beclomethasone (Beclovent)
flunisolide (Aerobid)
triamcinolone (Azmacort)
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| antiasthmatics--leukotriene receptor antagonist | ex_: zileuton (Zyflo)
zafirlukast (Acculate)
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| antiasthmatics--mast cell stabilizers | ex_: cromolyn (Intal)
nedocromil (Tilade)
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| antiasthmatics contraindications | inhaled coricosteroids
long-acting adrenergic agents
mast cell stabilizers should not be used during acute asthma attacks
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| antiasthmatics precautions | should be used cautiously in PTs with CV disease
chronic use of systemic corticosteroids should be avoided
diabetic PTs may experience loss of glycemic control
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| antiasthmatics side effects | MOST COMMON: tremors, anxiety, nausea, vomiting, throat irritation
SERIOUS ADVERSE REACTION: bronchospasm, dyspnea
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| intiasthmatics interactions | May have additive CNS and CV effects with other adrenergic agents
cimetidine increases theophylline levels
corticosteroids may decrease effectiveness of antidiabetic agents, cause hypokalemia, or increase risk of digoxin toxicity
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| antiasthmatics nursing implications | ASSESSMENT
lung sounds, respiratory function, CV status of PT taking bronchodilators or anaticholinergics
can be inhaled or PO
gum, small sips of water for dry mouth
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| antiasthmatic PT teaching | take as directed; avoid smoking; proper technique for using inhalers; instruct client on use of peak flow meters; prevention adn reduction in symptoms of asthma
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| Leukotriene Antagonists | long-term control for asthma (prevention of exercise-induced broncoconstriction in pts 15yrs+)
antagonize leukotrienes to mediate airway edema, smooth muscle contraction, and cellular activity
SE: headache, dizziness, nausea, dyspepsia, diarrhea
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| leukotriene antagonists NI | assess lung sounds and respiratory; assess allergy symptoms
monitor liver function periodically during therapy; may cause increase AST and ALT concentrations
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| Leukotriene antagonists implementation | Administer 1 hr before or 2 hr after meals
For asthma, administer once daily in the evening
For allergic rhinitis, may be administered at any time of day
Administer granules directly into mouth
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| lekotriene antagonists PT teaching | Instruct pt to take medication on an empty stomach as directed; pt not to discontinue or reduce other asthma meds; Advise pt that leukotrienes ain't used to treat acute asthma attacks; Advise pt to notify doc if symptoms of Churg-Strauss syndrome occur
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| action of zafirlukast | a leukotriene receptor antagonist
Leukotrienes are a class of anti-inflammatory agents that block leukotriene formation. Leukotrienes are part of the inflammatory pathway that causes bronchoconstriction.
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| Bronchodilator use | Treatment of reversible airway obstruction due to asthma or COPD
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| bronchodilator action | Adrenergic
Relaxation of airway smooth muscle
Allows use in management of acute attacks
Xanthines
Anticholingerics
Leukotrienes
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| bronchodilators--adrenergices | albuterol (Proventil).
epinephrine (Adrenalin).
salmeterol (Serevent).
Terbutaline (Bricanyl).
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| bronchodilators--anticholinergics | ipratropium (Atrovent HFA).
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| bronchodilators--leukotriene antagonists | montelukast (Singular).
zafirlukast (Accolate
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| bronchodilators--Xanthines | aminophylline (Phyllocontin, Truphylline).
theophylline (Theo-Dur, Uniphyl).
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| Bronchodilators contraindications and precautions | Contraindications:
Hypersensitivity to agents.
Avoid use in uncontrolled cardiac arrhythmias.
Precautions:
Diabetes.
CV disease.
Hyperthyroidism.
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| Bronchodilators side effects | Nervousness, restlessness, tremor.
Palpitations, angina, arrhythmias.
Nausea, vomiting.
Hyperglycemia.
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| bronchodilators interactions | Therapeutic effectiveness may be antagonized by concurrent use of beta blockers
Additive sympathomimetics effects with other adrenergic drugs, including vasopressors and decongestants
CV effects may be potentiated by antidepressants and MAO inhibitors
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| bronchodilators assessment | Assess BP, P, R, lung sounds, and character of secretions before and throughout therapy
Patients with a history of CV disease should be monitored for EKG changes and chest pain
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| bronchodilators PT teaching | Avoid OTC cough, cold or breathing preparations
Avoid foods that contain xanthine
Avoid smoking
Use bronchodilator first and allow 5 minutes to elapse before administering the other medication
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| adrenergics use | Used as a bronchodilator to control and prevent reversible airway obstruction
Used as a quick-relief agent for acute bronchospasm
Used as a long-term control agent
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| adrenergics action | Binds to beta 2-adrenergic receptors in airway smooth muscle
Relaxation of airway smooth muscle with subsequent bronchodilation.
Relatively selective for beta2 (pulmonary) receptors.
Therapeutic Effects: bronchodilation.
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| adrenergics category | Therapeutic: bronchodilators.
Pharmacologic: adrenergics.
Examples:
albuterol (Proventil).
epinephrine (Adrenalin).
salmeterol (Serevent).
terbutaline (Bricanyl).
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| adrenergics contraindications and precautions | Contraindications:
Hypersensitivity to adrenergic amines
Hypersensitivity to fluorocarbons
Precautions:
Cardiac disease
Hypertension
Hyperthyroidism
Diabetes
Glaucoma
Seizure disorders
Lactation
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| adrenergics side effects | nervousness, restlessness, tremor, headache, insomnia, hyperactivity in children
chest pain, palpitations, angina, arrhythmias, hypertension
nausea, vomiting
hyperglycemia
tremor
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| adrenergics interactions | Use with MAO inhibitors may lead to hypertensive crisis; Beta blockers may negate therapeutic effect; May lower serum digoxin levels; Risk of hypokalemia increases with concurrent use of K-losing diuretics
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| adrenergics assessment | Assess lung sounds, pulse, and blood pressure
Note amount, color, and character of sputum
Monitor pulmonary function tests
Observe for paradoxical bronchospasm
May cause transient decrease in serum potassium
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| adrenergics pt teaching | Administer oral medication with meals
Shake inhaler well
Contact doc if shortness of breath is not relieved
Prime unit with 4 sprays before using
Consult health care professional before taking any OTC medications
Use albuterol first
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| xanthines use | Long-term control of reversible airway obstruction
Increases diaphragmatic contractility
Unlabeled Use: respiratory and myocardial stimulant in premature infant apnea
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| Xanthines category | Therapeutic: bronchodilators.
Pharmacologic: xanthines
Examples:
aminophylline (Phyllocontin, Truphylline).
theophylline (Theo-Dur, Uniphyl)
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| Xanthines contraindications and precautions | Contraindications:
Hypersensitivity to aminophylline or theophylline.
Precautions:
CHF, liver disease, or hypothyroidism
Cardiac arrhythmias
Peptic ulcer disease
Seizure disorder
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| Xanthines side effects and interactions | SE: SEIZURES, Anxiety, headache, insomnia, irritability.
Arrhythmias, tachycardia, angina, palpitations
Nausea, vomiting, anorexia, tremor, rash
Interactions:
May ↓the therapeutic effect of lithium and phenytoin
Nicotine
Decreased metabolism
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| Xanthines assessment | Assess BP, pulse, respiratory status
Ensure that oxygen therapy is correctly instituted
Monitor intake and output and for chest pain and ECG changes
Monitor pulmonary function tests
Monitor ABGs, acid-base, and fluid and electrolyte balance
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| Xanthines NI | Admin round the clock to maintain therapeutic plasma levels; Do not refrigerate elixirs
Admin oral preps with food or a full glass of water
Wait at least 4-6 hr after stopping IV therapy to begin immediate-release oral dose.
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| Xanthines PT teaching | drink adequate liquids
avoid OTC cough, cold, or breathing preparations
not to smoke
not to change brands
Advise patient to minimize intake of xanthine-containing foods or beverages
Importance of having serum levels routinely tested
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| xanthines evaluation | Increased ease in breathing
Clearing of lung fields on auscultation
Respiratory and myocardial stimulation in apnea of infancy (aminophylline)
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