Nursing of the adult with chronic airflow limitation
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| Define chronic airflow limitation (CAL). | Chronic lung diseases including chronic bronchitis, pulmonary emphysema, and asthma
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| What diseases are included in the term COPD? | bronchitis and emphysema
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| What are the characterizing symptoms of COPD? | bronchospasm and dyspnea
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| Discuss the prognosis for lung damage resulting from COPD. | damage to the lung is not reversible and increases in severity
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| What is the primary cause of COPD in the United States? | tobacco smoke
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| How does asthma differ from COPD? | Asthma is an intermittent disease with reversible airflow limitation and wheezing
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| 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
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| 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
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| 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
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| 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
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| 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)
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| What will the nurse expect to find in regards to ABGs in the patient with chronic airflow limitation? | increased CO2 levels
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| What will the nurse expect the client’s O2 saturation to be if they have chronic airflow limitation? | lower than average
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| What are the expected findings regarding activity and nutrition for the client with chronic airflow limitation? | Activity intolerance, poor nutrition
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| 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
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| Why is gastric distention a big deal for the client with chronic airflow limitation? | because it elevates the diaphragm and inhibits full lung expansion
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| 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
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| 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.
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| Describe the Blue Bloater. | Insufficient oxygenation occurs with chronic bronchitis and leads to generalized cyanosis (Blue) and often right-sided heart failure (Bloater).
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| Give four applicable nursing diagnoses for the patient with chronic airflow limitation. | ineffective airway clearance, ineffective breathing pattern, impaired gas exchange, activity intolerance
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| How does inadequate oxygenation affect the body’s cells? | interferes with the cell’s ability to function
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| What are a couple of easily assessable signs of inadequate arterial oxygenation? | slow capillary refill and cyanosis
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| 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.
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| 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)
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| 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
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| 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.
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| 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.
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| What nursing interventions assist the client with chronic airflow limitation to improve nutrition? | Offer small frequent meals, favorite foods, and dietary supplements
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| What recommendations does the nurse give the client with chronic airflow limitation about fluid intake? | 3 liters a day
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| What lifestyle change is imperative for the client with chronic airflow limitation? | stop smoking
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| 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
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| Name three ways a client can avoid secondary infections. | avoid crowds, people with infectious diseases, and respiratory irritants (like tobacco smoke)
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| How does the nurse prioritize nursing actions? | ABCs – airway, breathing, circulation
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| 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
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