Professional Documents
Culture Documents
Pulmonary Disease
(C.O.P.D)
Chronic Obstructive Lung Disease
Chronic Airway Limitation
1
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
2
Bronchiectasis- dilation of
bronchioles r/t chronic
airway obstruction
Pulmonary Emphysema-
overdilatation of alveoli
(compliance) and resulting
in Recoil
3
Basis
Chronic airway blockage
Airway resistance
4
Possible Complications
Pulmonary hypertension
Respiratory insufficiency or
Respiratory failure
Cor Pulmonale
CO2 Narcosis
Alveolar Rupture
Atelectasis
5
Bronchial Asthma
6
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
7
Etiology
Extrinsic Allergens-
– Inhalants
– Ingestants
– Contactants
– Temperature changes
Intrinsic allergens
– Fatigue
– Stress / anxiety
8
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 non-
atopic asthma;
– onset usually > 35 years
9
Mixed Asthma
– Any age; any allergen; non-
specific stimuli
10
Pathophysiology
Allergens
Release of IgE by B-lymphocytes
IgE + mast cells (respiratory tract)
Damage to mast cells
11
Release of chemical mediators
(Histamine, bradykinin, serotonin,
prostaglandin)
Capillary
Vasodilation Permebility
Edema BV
12
Other signs and symptoms
– DOB
– Wheezing (classic)
13
Nursing Interventions
Administer medications, as
ordered
Administer nebulizer as
ordered
Provide patient teaching
about preventing attacks and
proper use of medications
14
Pharmacotherapy:
Bronchodilators – to relieve bronchospasm
Beta-Adrenergic agents: rapid onset of
actions when administered by aerosol
– Theophylline – check pulse and blood pressure
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
15
Chronic Bronchitis
Is an inflammation
of bronchioles that
impairs airflow.
16
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
17
Etiology
Exposure to pulmonary irritants
Infections including RTI and
influenza
18
PATHOPHYSIOLOGICAL PROCESS
Causes : Cigarette
Smoking
INFLAMMATION
RTI
Environmental
Pollutants
Bradykinin
Fluid / Cellular Capillary Histamine
Exudation Permeability
Prostaglandin
19
Signsand symptoms
– Coughing
– Excessive sputum production
– Rhonchi
– Shortness of breath
20
Nursing Interventions
Eliminate / minimize patient’s
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.
21
Pulmonary
Emphysema
22
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
23
Etiology
Predisposing Fxs:
– A-ge
– H-eredity (low alpha1 anti-trypsin)
– A-uto-Immune tendency
Precipitating Fxs:
– B- ronchitis, chronic
– A-ir Pollution
– S-moking
– A-sthma, chronic
24
Signs and Symptoms
25
Based on Types:
CENTRIBULAR
27
PAN-LOBULAR
–2nd stage
–Most alveoli and
bronchioles dilated
–Mucus expelled
–Hyperventilating
(compensation to high
pCO2)
28
Pink Puffers
– Pinkish skin color
– Emaciated
– Non-productive cough
– Severe weakness
– Anorexia
– Dyspnea
– ABG: Resp. Alkalosis
29
Common Signs and Symtoms
(Both Types)
Easy fatigue
Pursed lip breathing
Barrel Chest
Dyspnea, orthopnea
Retractions
Prolonged I:E ratio
Wheezing on expiration
Clubbing
30
Nursing Interventions
NDx1: Gas Exchange, Imp. R/t
ventilation: perfusion
mismatching (Physiologic
shunting)
31
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
32
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
33
NDx2: Airway clearance,
Ineffective r/t chronic asthma,
bronchitis, smoking, pollution
34
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
35
Respiratory therapy
Antibiotics or antihistaminics as
ordered
Position: High fowlers – lean
forward. Use overbed table
Administer steroids as ordered to
decrease swelling of airway
36
NDx3: Breathing pattern, impaired
r/t airway obstruction
37
Position
Pursed-lip breathing
Blow bottle exercises
IPPB with nebulization
Alternate activities with rest
38
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
39
NDx4: High Risk : Complications
40
Ensure low flow O2
Monitor ABG
Fluid intake= 1.0-1.5 l/day if w/ R-
sided CHF or pulmonary edema
Diuretics as ordered
IVF tkvo-use D5W
Tracheostomy tube if necessary
41
NDx5: Ineffective
Individual/Family Coping
42
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
43
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
44
LUNG CANCER
45
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
Predisposingfactors – chronic
exposure to pulmonary irritants
48
Symptoms may include:
– Cough
– Wheezing
– Shortness of breath
– Chest pains
– Hoarseness
– Dysphagia (compression of
esophagus)
– Weight loss
49
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 activity-rest
Maintain nutritional status
Provide emotional support to the
patient and family
50