more resp disorders

  1. Asthma
    • is a condition in which you airway narrows and swell and produce extra mucus
    • this can make breathing difficult and trigger coughing wheezing and SOB
  2. Asthma 2
    • reactive airway disease.
    • periods of reversible bronchospasm, airway inflammation and hyperresponsiveness
    • affects at least 1 in 20 americans
    • most common chronic disease in children and adults
    • can present at any time
  3. asthma 3
    • obstructive disorder
    • predisposing factor
    • obstructive disorder- thought to have genetic component that reacts with environmental factors
    • precipating factors- stress, laughing, crying, excerise, temp changes, strong odors
  4. Patho of asthma
    • IgE produced on exposure to allergen
    • see slides
  5. patho phases asthma
    • Early phase reaction- develops immediately and last @ 1 hr
    • late phase reaction- symptoms start 4-8 hours after exposure of and may last hours or days
    • - mediators attract other inflammatory cells & create chronic inflammation leading to hyper responsiveness
  6. Asthma
    • clinical manifestation
    • dyspnea
    • wheezing
    • dec peak expiratory flow- hard for pts to get
    • dec o2 stat
    • incr RR, HR
    • coughing- compensating
    • things to avoid
    • brunner
  7. asthma
    • diagnostic test
    • peak flow- measurement of lung function
    • spirometer
    • chest x-ray
    • labs- abg's, cbc (w/diff), theophylline level, lytes- well hydrated
  8. status asthmaticus
    • severe and life threatening
    • intensifying bronchospasm, inc work of breathing can lead to r side heart failure
    • acidosis results in continued poor gas exchange
    • can cause resp or cardiac arrest if left untx
  9. asthma tx
    • goal
    • maintain patent airway
    • maintain effective gas exchange
    • prevent complications
  10. emergency phase- asthma
    • inhaled beta adrenergics/bronchodilators
    • nebulize atropine sulfate w/albuterol
    • IV Theophylline
    • IV steriods
    • Leukotriene receptor antagonists
  11. critical care phase asthma
    • Bronchial dilators
    • steriods
    • O2- if PaO2 < 60mmHg
    • may need ETT endotracheal tube
    • sedation
    • pt education
    • - precipating factors
    • - steriod taper
    • - skin testing- bc of allergy
  12. asthma nx interventions
    • resp assessment
    • monitor abg's/o2 stat
    • monitor peak flow
    • emotional support for anxiety
    • fowler's position
    • o2 as ordered
    • bronchodilators/steriods as ordered
  13. asthma nursing intervention
    • suction PRN- **carefully**
    • monitor sputum
    • emcourage PO fluids
    • CPT, freq position changes
    • pt education- effect of inc albuterol use, ed visit
    • - avoid extreme weather
    • - caution with certain foods
    • - wash clothing/bedding in hot water
  14. medication- asthma
    • beta adrenergics- MDI, nenulized, po, SC,IV
    • - albuterol, metaproterenol, bitolterol, epi, terbutaline
    • Theophylline- watch for toxicity
    • Antihistamine- hismanol, diphenhydramine
    • steriods- fluticasone, methylprednisolone, beclomethasone, prednisone, adair (comb)
    • - take after bronchdilators, rinse mouth
    • go to the ed with no relieve
  15. Chronic obstructive Pulmonary disease (COPD)
    • COPD, chronic airflow limitation (CAL)
    • progressive, inflamm response of lungs- noxious particles, irreversible
    • obstructive- affect air movt in/out of lungs
    • enlargement of airways/destruction of alveoli wall
    • 4th leading cause of death > 35 million americans living with COPD
  16. two types of COPD
    • chronic bronchitis- inflam of mucous
    • emphysema- hard to expand lungs
  17. COPD risk factors
    • smoking- occupational hx, social hx, fam hx
    • chronic respiratory infections
    • environmental pollutants
    • aging
    • heredity and genetic predispositions
  18. Chronic Bronchitis
    • patho
    • bronchial inflam leads to inc mucous production and cough
    • submucous glands hypertrophy and multiply
    • inc number of goblet cells that also secrete mucus***
    • impaired cilary function
    • too much production of Mucus
  19. Chronic Bronchitis
    • patho 2
    • starts in large bronchi and spreads
    • thick mucus & inflamm obstructs expiration
    • airways collapse and air trapped distally
    • alveolar ventilation reduced
    • - abnormal VQ rations, dec PaO2, +/- inc PCO2
    • - secondary polycythemia to compensate
  20. Chronic Bronchitis
    • s/s
    • s/s for 3 month a yr x 2 yrs
    • productive cough
    • dec exercise tolerance
    • prolonged expiration
    • peripheral edema
    • tachyapnea
    • polycythemia/ in hgb- bc kidneys produce erothopoten- trying to compensate for poor o2 control. tells kidneys to make more
  21. emphysema
    • patho
    • destruction of terminal bronchi +/- alveolar walls
    • inflammatory process- mediators release protease
    • protease and elastase can attack & destroy connective tissue ** elasticity is impaired
    • normal lungs can defend themselves
    • inability may lead to emphysema
  22. emphysema
    • patho 2
    • elastin and collagen are destroyed and alveolar walls are destroyed
    • airspaces become permanently over distended
    • airways partially collapse and air is trapped between alveolar spaces (blebs) and in parenchyma (bullae0
    • pulmonary capillaries are destroyed
    • inc shunt and dead space
  23. emphysema
    • two types
    • Centrilobular- most common- central proximal bronchioles 1st, upper zone common with smokers
    • panlobulars- alveoli 1st. lower zones affect areas of maximal blood flow- dec antitrypsin- dec elasticity
    • may be a combination of both
  24. Emphysema
    • manifestations
    • progressive DOE
    • tachyapnea, long expiration
    • barrel chest
    • normal abg until late
    • dependent edema
    • RV failure late
    • cachectic- look sick
    • tripod position
    • hyperresonant- excessive air
    • pink skin color
    • pink buffers
    • always look sick
  25. emphysema extra
    chronic hyperinflation leads to barrel chest-thorax configuration
  26. COPD management
    • improve ventilation- pursed lip breathing
    • facilitate secretion removal
    • prevent complication
    • promote health maintenance
    • promote client management of disease
    • dec exacerbation/freq ED visits and hospitalization
  27. Improving ventilation
    • bronchodilators
    • steriods
    • respiratory depressants cautiously
    • BiPap, CPAP
    • o2 cautiously, CO2 narcosis (caution)
    • CO2 narcosis is a condition of confusion, tremors, and possibly coma that occur if blood levels of Co2 incr to 70mm Hg or higher
  28. removal of bronchial secretions
    • pulmonary toilet
    • - nebulized bronchodilators
    • PEEP (positive end expiratory pressure) if intubated
    • CPT, postural drainage
    • suction PRN
    • exercise
    • - important but pay attention how much exercise
  29. Control Complication
    • edema & cor pulmonale
    • cor pulmonale is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs
    • diuretics, digitalis (digoxin)
    • improved contractility
  30. general health teaching
    • STOP SMOKING ***
    • avoid people with resp infection
    • dec exposure to allergens
    • avoid high altitudes- extreme weather
    • adequate nutrition, hydration
    • small, frequent meals if tachypneic
    • maintain resp muscle strength
    • f/u/pne shots
  31. community resources
    • pulmonary rehab
    • american lung association
    • smoking cessation program
    • websites
    • local organizations/meetings/clubs
  32. nursing diagnoses
    • impaired gas exchange
    • ineffective airway clearance
    • activity intolerance
    • anxirety
    • altered nutrition- less than body requirements
    • sleep pattern disturbance
  33. Surgical management
    • bullectomy- uncommon
    • this is the surgical removal of bulla, which is a dilated air space in the lung parenchyma measuring > 1 cm
    • - lung volume reduction
    • - bullae removed
    • - improves resp mechanics
    • - improves functional capacity
Author
Prittyrick
ID
327932
Card Set
more resp disorders
Description
part 2
Updated