Chronic Obstructive Pulmonary Disease (C.O.P.

D)
Chronic Obstructive Lung Disease Chronic Airway Limitation

Description
A group of diseases that include: Chronic Bronchitis- chronic inflammation of bronchi unrelieved in 3 consecutive months and in 2 consecutive years Chronic Asthma (Status Astmaticus)- S/sx of allergic attack unrelieved within 24 hours of adequate therapy

Bronchiectasis- dilation of bronchioles r/t chronic airway obstruction Pulmonary Emphysemaoverdilatation of alveoli (compliance) and resulting in Recoil
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Basis
Chronic

airway blockage Airway resistance Progressive airflow limitations both ways Irreversible alveolar distention air trapping alveolar damage ABG imbalances: Low pO2, High pCO2

Possible Complications

Pulmonary hypertension Respiratory insufficiency or Respiratory failure Cor Pulmonale CO2 Narcosis Alveolar Rupture Atelectasis
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Bronchial Asthma

Description
Also

called RAD (Reactive Airway Disease) and ROAD (Reversible Obstructive Airway Disease) A complex inflammatory process that results to increased airway resistance and later, alveolar damage Airway inflammation r/t hyperresponsiveness (hypersensitivity) to allergens

Etiology

Extrinsic Allergens Inhalants Ingestants Contactants Temperature changes

Intrinsic allergens
Fatigue Stress / anxiety
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Types of Asthma

Immunologic asthma
Occurs in childhood r/t allergens; Allergic asthma or atopic asthma; heredity; high lgE

Non-Immunologic
Occurs in adulthood, usu. Associated with URTI or LRTI Non-allergic asthma or nonatopic asthma; onset usually > 35 years

Mixed Asthma
Any age; any allergen; nonspecific stimuli

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Pathophysiology
Allergens Release of IgE by B-lymphocytes IgE + mast cells (respiratory tract) Damage to mast cells

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Release of chemical mediators (Histamine, bradykinin, serotonin, prostaglandin)

Vasodilation Hypotension

Capillary Permebility

Blood congestion (Hyperemia)

Shock

Escape of Colloids BV
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Edema

 Other

signs and symptoms

DOB Wheezing (classic)

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Nursing Interventions

Administer medications, as ordered Administer nebulizer as ordered Provide patient teaching about preventing attacks and proper use of medications
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Pharmacotherapy: Bronchodilators to relieve bronchospasm Beta-Adrenergic agents: rapid onset of actions when administered by aerosol

Corticosteroids to relieve inflammation and edema Antibiotics if secondary infection Cromolyn sodium not used during acute attack; inhaled; inhibits histamine release in the lungs and prevents attack

Theophylline check pulse and blood pressure

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Chronic Bronchitis
Is

an inflammation of bronchioles that impairs airflow.

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 May

be o Acute when the bronchus becomes inflamed o Chronic results when inflammation occurs several times a year; can be diagnosed by the presence of cough that persists for 3 months a year for 2 years
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Etiology
Exposure

to pulmonary irritants Infections including RTI and influenza

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PATHOPHYSIOLOGICAL PROCESS
Causes : Cigarette Smoking

RTI
Environmental Pollutants

INFLAMMATION

Bradykinin

Fluid / Cellular Exudation

Capillary Permeability

Histamine
Prostaglandin

Edema of Mucous Membrane

Hypersecretion of Mucus

Persist ent Cough

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 Signs

and symptoms Coughing Excessive sputum production Rhonchi Shortness of breath

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Nursing Interventions
Eliminate

/ minimize patients exposure to irritants and people with RTI. Clear airways with chest physical therapy or suctioning as ordered. Mucolytics as prescribed. Deep-breathing exercises. Patient teaching about adequate nutrition and medication therapy.
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Pulmonary Emphysema

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Description
Terminal

stage of COPD Overdilated alveoli and bronchioles Damage to alveoli and failure of alveolar diffusion NSg. Dx: Imp. Gas Exchange ABG: paO2 paCO2

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Etiology

Predisposing Fxs:
A-ge H-eredity (low alpha1 antitrypsin) A-uto-Immune tendency

Precipitating Fxs:
B- ronchitis, chronic A-ir Pollution S-moking A-sthma, chronic

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Signs and Symptoms

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Based on Types:
CENTRIBULAR

Blue Bloater Stage 1st stage Most bronchioles and alveoli plugged with mucus Central airway dilated Danger: Cor Pulmonale
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 Blue

Bloater Type Cyanotic Edematous W/ prod. Cough D.O.E. Weakness Nail Clubbing ABG: Resp. Acidosis S/S of hypoxia S/S of R-sided CHF Barrel-shaped chest
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 PAN-LOBULAR

2nd stage Most alveoli and bronchioles dilated Mucus expelled Hyperventilating (compensation to high pCO2)
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 Pink

Puffers Pinkish skin color Emaciated Non-productive cough Severe weakness Anorexia Dyspnea ABG: Resp. Alkalosis
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Common Signs and Symtoms (Both Types)

Easy

fatigue Pursed lip breathing Barrel Chest Dyspnea, orthopnea Retractions Prolonged I:E ratio Wheezing on expiration Clubbing
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Nursing Interventions
NDx1: Gas Exchange, Imp. R/t ventilation: perfusion mismatching (Physiologic shunting) Goal 1: Normal ABG values 2: No Hypoxia

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Monitor: ABGs, s/sx of resp. acidosis. s/sx of hypoxia, pulse oximeter (O2 sat) Give bronchodilators as ordered (p.o., IV, rectal, nebulizer). Check side effects:
Dysrhythmias HR, BP Excitation (L.O.C.) N&V Tremors
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Low flow O2 therapy with venturi mask at 24-30% concentration or nasal cannula at 1-3 L/min Good humidification Liquify secretions Suction PRN Avoid narcotics- depress RR

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NDx2: Airway clearance, Ineffective r/t chronic asthma, bronchitis, smoking, pollution Goal 1: Open airway Goal 2: Adequate ventilation

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Assess: VS, cough, record consistency of sputum secretion, s/sx of hypoxia Increase fluids p.o.-6-10 glasses (3L)/day unless C.I. Nebulization as ordered Mucolytics as ordered Avoid milk, creams
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Respiratory therapy Antibiotics or antihistaminics as ordered Position: High fowlers lean forward. Use overbed table Administer steroids as ordered to decrease swelling of airway

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NDx3: Breathing pattern, impaired r/t airway obstruction Goal 1: Improve pattern of breathing or ventilation Goal 2: Relief of Dyspnea

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Position Pursed-lip breathing Blow bottle exercises IPPB with nebulization Alternate activities with rest

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Teach use of inspiratory muscle traininer (use 10 min/day to strengthen respiratory muscles) Teach to coordinate diaphragmatic breathing with activity Use controlled breathing while bending, walking, bathing Teach postural drainage
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NDx4: High Risk : Complications Goal 1: Prevent complications: CO2 Narcosis Resp. acidosis Cor Pulmonale Respiratory Failure
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Ensure low flow O2 Monitor ABG Fluid intake= 1.0-1.5 l/day if w/ Rsided CHF or pulmonary edema Diuretics as ordered IVF tkvo-use D5W Tracheostomy tube if necessary
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NDx5: Ineffective Individual/Family Coping Goal 1: Optimum coping level

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Encourage catharsis Involve in self-care and improve self-esteem Allow to make decisions about his care (shaving, bathing , eating, etc) Adopt a hopeful and encouraging attitude towards pt Encourage activity to level of tolerance to improve self-esteem
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Monitor compliance to regimen Allow use of O2 during activities Teach relaxation tech, energy conservation Gradually increasing exercise program using an insp. Resistive device (blow bottle) Pulmonary Rehab. Tech
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LUNG CANCER

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Description
Refers

to malignant tumor growth within the bronchial tissue or lung parenchyma. Types include:
Squamous cell 35 50% of all lung cancers. Adenocarcinoma 15 35% of all lung cancers. Small cell (oat cell) 20-25% of all lung cancers Large cell 10-15% of all lung cancers 46

Etiology and Incidence

Predisposing

factors chronic exposure to pulmonary irritants history of lung cancer

Family Tend

to have poor prognosis, unless it is very well defined and removed by surgery.
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Pathophysiology
As the lung tissue experiences irritation, it undergoes a series of changes and eventually gives rise to a tumor. Metastases can occur, especially when the mother tumor is near areas of lymph drainage. Some tumors secrete hormones: ADH reabsorption of water ACTH stimulates adrenal glands to produce steroids

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 Symptoms

may include:

Cough Wheezing Shortness of breath Chest pains Hoarseness Dysphagia (compression of esophagus) Weight loss
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Nursing Interventions
Prepare the patient for surgery if tumor is small enough to be removed Prepare patient for planned treatments chemotherapy / radiation therapy Analgesics as ordered to control pain Adequate oxygenation through oxygen therapy or planned activityrest Maintain nutritional status Provide emotional support to the patient and family 50