What are the characteristics of obstructive respiratory disorders?
increased resistance to airflow as a result of airway obstruction or airway narrowing...can result from secretions, edema, swelling of inner lumen of airways, bronchospasm or destruction of lung tissue
What are the two major changes that happen w/ emphysema? What does it result in?
1) loss of lung elasticity 2) hyperinflation of the lung ...results in dyspnea and the need for an incr. RR
Discuss characteristics of emphysema
-aka "the pink puffer" -emphysema= narrowing of the airways and trapping of air and destructive changes in their walls -leads to progressive airflow limitation -elevated airway resistance -irreversible lung distention (loss of elasticity) -ABG insufficiency (pt. can't eliminate c02 fast enough, it's retained=resp. acidosis)
What ar the characteristics of
-aka "the blue bloater" -caused from exposure to irritants/infection...mainly SMOKE -effects small and large airways (not alveoli) -chronic inflammation causes mucous gland hypertrophy -hyperplasia, incr. viscid mucus -bronchial wall thickening -impaired air exchange -hypoxemia, incr. pC02 and acidosis
What are the characteristics of
-intermittent, reversible airway obstruction not affecting the alveoli -bronchospasm...edema in airway -result of physical and chemical irritants such as pollen, smoke, temp. changes, URI, activity, stress -may coexist w/ bronchitis and emphysema
What are some common assessments in the pt. w/ COPD?
-cough -dyspnea w/ exertion -wheezing/crackles -sputum -wt. loss -barrel chest (1:1 ratio) -use of accessory muscles -hypercarbia: ABG may show chronic resp. acidosis (w/ COPD ABG's always show low O2 and might show high CO2 -hypoxemia - PFT= decr. FEV1/FEV, incr. residual volume ('dead space') -cyanosis -clubbing -orthopnea -cardiac dysrhythmias -x-ray: flattened diaphragm/hyperinflation
What are the results of COPD?
-blunting of chemoreceptors in CO2 retainers, need baseline ABGs to evaulate (normally our capacity to breathe is triggered by high CO2 levels...chemoreceptors in the medulla tell body to incr. RR) -pulmonary insufficiency -pulm HTN...cor pulmonale
Discuss collaborative care for a pt. w/ COPD
-VS -O2< or equal to 2L/min -pulse ox -chest physiotherapy -HOB up -pursed-lip berathing -diaphragmatic breathing -monitor sputum -suction prn -humidification -small frequent meals of high calorie and high pro -encourage fluids 2-3L/day -monitor wt. -activity as tolerated -bronchodilatros by med neb or inhaler -steroids (common late in disease) -mucolytics -AB -lung reduction surgery (esp. w/ emphysema-removes lung tissue that no longer works)
What are some key pt. education points for the pt. w/ COPD?
-stop smoking, aviod irritants, avoid crowds and infected ppl -recognize infection (such as sputum color change) and hypoxia -alternate rest w/ activity -demonstrate pursed-lip, diaphragmatic or abdominal breathing -instruct on proper inhaler use and O2 use -instruct in nutritional requirements, avoid gassy foods -flu vacc -dust w/ cloth to avoid odors -avoid temp extremes -pulmonary rehab- all about progressively incr. exercise tolerance to help recondition muscles to be more O2 efficient -
What are the goals of
-to imporve airflow, relieve s/sx and prevent episodes -teach pt. to assess sx severity at least BID w/ peak flowmeter and adjust drugs to manage inflammation and bronchospasms to prevent or relieve sx -establish a baseline peak expiratory flow (PEF) by measuiring PEF BID for 2-3 wks when asthma is well controlled and recording the results -once pt. gets a baseline of FEV1 (green zone) they can use it to monitor and make sure they stay w/in 80% or else use inhaler
Discuss proper administration of metered dose inhalers
-shake prior to use (unless powder form) -have pt. exhale completely -hold inhaler 1-2 inches in front of mouth and breathe in deeply for about 3-5 sec while pressing down firmly on inhaler -hold breath for about 10 sec after -wait at least 1 min between puffs (can also use a spacer or put lips directly around inhaler)
What are LABA's? When should they be avoided?
Long Acting Beta Agonists- NOT used as rescue inhaler...if they are it can make the attack worse and lead to death -examples of LABAs: formoterol (Foradil) and salmeterol (Serevent)
If you need a short-acting/rescue inhaler and a long acting which sequence do you use them?
short acting/rescue first followed by long acting bc you want to open airway immediately first
What is the proper technique for using dry powdered inhalers?
-place lips over mouthpiece, breathe in forcefully (there is no propellant in inhaler, only your mouth pulls med in) -remove inhaler from mouth as soon as you have breathed in - never exhale/breathe out into your inhaler- your breath will cause powder to clump - never wash or place the inhaler in H20-keep in dry place at room temp -never shake your inhaler -if inhaler is preloaded discard after it is empty, insert capsule if not pre-loaded -bc drug is dry powder w/ no propellant you may not feel, smell, or taste as you inhale
-Serevent (Salmeterol slow onset of action)
-stimulate sympathetic (beta 2) receptors on the respiratory tract, resulting in smooth muscle relaxation and bronchodilation -when admon by metered-dose inhaler these drugs are the tx of choice for acute bronhial asthma
-: nervousness, irritability, tachycardia and cardiac dysrhythmias, palaitations, tremors, HTN s/e - nursing considerations: -caution use in HTN, cardiovascular disease or dysrhythimia, hyperthyroidism or DM (may worsen) -when given by MDI, wait 1-2 min between puffs to allow airway to dilate, permitting the sencod dose to reach distal airways -rinse mouth after to reduce systemic absorbtion -observe for s/e and report for dose adjustment -LABAs like salmeterol are useful in preventing attacks, but have no value in treating an acute attack of wheezing
Methyxanthines (given PO or IV)
-theodur, theolair (theophylline), aminophylline
-chemically related to caffeine, inducing respiratory smooth muscle relaxation -used primarily to prevent nocturnal asthma in adult clients -high potentail for toxicity: monitor serum levels!
- s/e: anorexia, nausea, restlessness, insomnia, cardiac dysrhythmias, seizures (sx of toxicity) - nursing considerations: andmin PO doses w/ full glass of h2o or milk to minimize GI irritation -many drug interactions (barbitruates, anticonvulsants, thyroid hormone, beta blockers, bronchodilators) - IV aminophylline is incompatible w/ many other IV drugs, use a seperate line for infusion
Atropine, Atrovnet (ipratropium bromide), Sprivia (tiotropium bromide)
-blocks input from the parasympathetic NS, atropine also dries mucous memb. secretions -s/e: N/V, abd. cramping, anxiety, dizziness, HA - nursing considerations: cautious use w/ glaucoma (bc they dilate pupils), prostatic hypertrophy or bladder obstruction -provide ice chips, fluids or candy as appropriate for dry mouth -place capsule in hadihaler (spirva) and press button to puncture -instruct pt to breathe in deeply and slowly, remove handihaler and hold breath for at least 10 sec, then exhale slowly, rinse mouth
Corticosteroids for asthma
-anti-inflammatory effect helps prevent and tret accute episodes -cushingoid effects are minimized when inhaled rinse mouth after inhaler
Mast cell stabilizers (used for long term tx)
Cromolyn sodium (intal), Nedocromil (tilade)
-inhibit inflammatory cells in the airway, blocking early and late responses for inhaled atigens, prevent bronchoconstriction in response to cold air -s/e: unpleasant taste -used only as prevention, not to tx acute attack -several wks may be required before beneficial effect is noted
Montelukast (Singulair) oral
-given to slown down inflammatory sx, not a rescue med, given to prevent asthma attacks triggered by allergens -given orally, slow onset
-given sub-q every 2-3wk -idea is that it prevents IgE rxn from occuring...but it can actually cause anaphylaxis -purpose is prevention of allergen-triggered asthma attacks - s/e: large injections can cause site rxns w/ bruising, erythema, warmth, burning, stinging, pruritus, hives, pain, induration, and inflammation lasting up to 7 days - nursing considerations:-admin at a facility equipped to handle anaphylaxis! (happen most often in the first 30-60 min after injection, keep pt there for at least 60 min so you can tx for anaphylaxis PRN) -teach pt not to decr dose or stop taking other asthma drugs unless instructed by HCP