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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
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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
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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
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Patho of asthma
- IgE produced on exposure to allergen
- see slides
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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
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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
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asthma
- diagnostic test
- peak flow- measurement of lung function
- spirometer
- chest x-ray
- labs- abg's, cbc (w/diff), theophylline level, lytes- well hydrated
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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
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asthma tx
- goal
- maintain patent airway
- maintain effective gas exchange
- prevent complications
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emergency phase- asthma
- inhaled beta adrenergics/bronchodilators
- nebulize atropine sulfate w/albuterol
- IV Theophylline
- IV steriods
- Leukotriene receptor antagonists
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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
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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
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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
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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
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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
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two types of COPD
- chronic bronchitis- inflam of mucous
- emphysema- hard to expand lungs
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COPD risk factors
- smoking- occupational hx, social hx, fam hx
- chronic respiratory infections
- environmental pollutants
- aging
- heredity and genetic predispositions
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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
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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
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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
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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
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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
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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
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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
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emphysema extra
chronic hyperinflation leads to barrel chest-thorax configuration
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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
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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
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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
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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
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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
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community resources
- pulmonary rehab
- american lung association
- smoking cessation program
- websites
- local organizations/meetings/clubs
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nursing diagnoses
- impaired gas exchange
- ineffective airway clearance
- activity intolerance
- anxirety
- altered nutrition- less than body requirements
- sleep pattern disturbance
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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
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