obstructive resp 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

• 1) loss of lung elasticity
• 2) hyperinflation of the lung
• ...results in dyspnea and the need for an incr. RR

• -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)

• -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

• -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

• -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

• -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

• -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)

• -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
• -

• -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

• -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)

• 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)

short acting/rescue first followed by long acting bc you want to open airway immediately first

• -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
• -never shake your inhaler
• -keep in dry place at room temp
• -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

• -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

• -s/e: nervousness, irritability, tachycardia and cardiac dysrhythmias, palaitations, tremors, HTN
• -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

• -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

• -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

• -anti-inflammatory effect helps prevent and tret accute episodes
• -cushingoid effects are minimized when inhaled
• rinse mouth after inhaler

• -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

• -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