Chronic Obstructive Pulmonary Disease (C.O.P.

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Chronic Obstructive Lung Disease Chronic Airway Limitation

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

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BronchiectasisBronchiectasis- dilation of bronchioles r/t chronic airway obstruction Pulmonary EmphysemaEmphysemaoverdilatation of alveoli (compliance) and resulting in Recoil
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Basis
airway blockage  Airway resistance  Progressive airflow limitations both ways  Irreversible alveolar distention air trapping alveolar damage ABG imbalances: Low pO2, High pCO2 
Chronic

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Possible Complications 
 

 

Pulmonary hypertension Respiratory insufficiency or Respiratory failure Cor Pulmonale CO2 Narcosis Alveolar Rupture Atelectasis
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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 AllergensAllergens± ± ± ± Inhalants Ingestants Contactants Temperature changes  Intrinsic allergens ± Fatigue ± Stress / anxiety 8 .

heredity. high lgE  NonNon-Immunologic ± Occurs in adulthood. ± onset usually > 35 years 9 .Types of Asthma  Immunologic asthma ± Occurs in childhood r/t allergens. ³Allergic asthma´ or atopic asthma. Associated with URTI or LRTI ± ³Non-allergic asthma´ or non³Nonnonatopic asthma. usu.

 Mixed Asthma ± Any age. nonnonspecific stimuli 10 . any allergen.

Pathophysiology Allergens q Release of IgE by B-lymphocytes Bq IgE + mast cells (respiratory tract) q Damage to mast cells q 11 .

prostaglandin) Vasodilation Hypotension Blood congestion (Hyperemia) Capillary Permebility Shock Escape of Colloids qBV 12 Edema . bradykinin. serotonin.Release of chemical mediators (Histamine.

 Other signs and symptoms ± DOB ± Wheezing (classic) 13 .

as ordered Administer nebulizer as ordered Provide patient teaching about preventing attacks and proper use of medications 14 .Nursing Interventions    Administer medications.

inhibits histamine release in the lungs and prevents attack  15 .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.

16 .Chronic Bronchitis Is an inflammation of bronchioles that impairs airflow.

can be diagnosed by the presence of cough that persists for 3 months a year for 2 years 17 . May be o Acute ± when the bronchus becomes inflamed o Chronic ± results when inflammation occurs several times a year.

Etiology  Exposure to pulmonary irritants  Infections including RTI and influenza 18 .

PATHOPHYSIOLOGICAL PROCESS Causes : Cigarette Smoking RTI Environmental Pollutants Bradykinin Fluid / Cellular Exudation o Capillary Permeability INFLAMMATION Histamine Prostaglandin Edema of Mucous Membrane Hypersecretion of Mucus Persist ent Cough 19 .

 Signs and symptoms ± Coughing ± Excessive sputum production ± Rhonchi ± Shortness of breath 20 .

 Clear airways with chest physical therapy or suctioning as ordered. 21 .  Mucolytics as prescribed. Deep Patient teaching about adequate nutrition and medication therapy.  Deep-breathing exercises.Nursing Interventions  Eliminate / minimize patient¶s exposure to irritants and people with RTI.

Pulmonary Emphysema 22 .

Dx: Imp.Description  Terminal stage of COPD  Overdilated alveoli and bronchioles  Damage to alveoli and failure of alveolar diffusion  NSg. Gas Exchange  ABG: paO2 paCO2 23 .

Etiology  Predisposing Fxs: ± A-ge ± H-eredity (low alpha1 antiantitrypsin) ± A-uto-Immune tendency uto-  Precipitating Fxs: ± ± ± ± B.ronchitis. chronic A-ir Pollution S-moking A-sthma. chronic 24 .

Signs and Symptoms 25 .

Based on Types:  CENTRIBULAR ±Blue Bloater Stage ±1st stage ±Most bronchioles and alveoli plugged with mucus ±Central airway dilated ±Danger: Cor Pulmonale 26 .

Cough ± D. ± Weakness ± Nail Clubbing ± ABG: Resp. Blue Bloater Type ± Cyanotic ± Edematous ± W/ prod. Acidosis ± S/S of hypoxia ± S/S of R-sided CHF R± Barrel-shaped chest Barrel27 .O.E.

 PAN-LOBULAR PAN- ±2nd stage ±Most alveoli and bronchioles dilated ±Mucus expelled ±Hyperventilating (compensation to high pCO2) 28 .

 Pink Puffers ± Pinkish skin color ± Emaciated ± Non-productive cough Non± 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) Goal 1: Normal ABG values 2: No Hypoxia 31 .

s/sx of hypoxia. acidosis. Check side effects: ± ± ± ± ± Dysrhythmias HR.O.   Monitor: ABGs. IV.C. rectal. nebulizer).o.) N&V Tremors 32 .. pulse oximeter (O2 sat) Give bronchodilators as ordered (p. BP Excitation (L. s/sx of resp.

depress RR narcotics- 33 .     Low flow O2 therapy with venturi mask at 24-30% concentration or 24nasal cannula at 1-3 L/min 1Good humidification Liquify secretions Suction PRN Avoid narcotics.

Ineffective r/t chronic asthma. pollution Goal 1: Open airway Goal 2: Adequate ventilation 34 . smoking. bronchitis.NDx2: Airway clearance.

I. Nebulization as ordered Mucolytics as ordered Avoid milk. record consistency of sputum secretion. cough.o.glasses (3L)/day unless C.-6-10 p.     Assess: VS. s/sx of hypoxia Increase fluids p.o. creams 35 .

Use overbed table Administer steroids as ordered to decrease swelling of airway 36 .    Respiratory therapy Antibiotics or antihistaminics as ordered Position: High fowlers ± lean forward.

impaired r/t airway obstruction Goal 1: Improve pattern of breathing or ventilation Goal 2: Relief of Dyspnea 37 .NDx3: Breathing pattern.

     Position PursedPursed-lip breathing Blow bottle exercises IPPB with nebulization Alternate activities with rest 38 .

bathing Teach postural drainage 39 .    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.

NDx4: High Risk : Complications Goal 1: Prevent complications: CO2 Narcosis Resp. acidosis Cor Pulmonale Respiratory Failure 40 .

0Rsided CHF or pulmonary edema Diuretics as ordered IVF tkvo-use D5W tkvoTracheostomy tube if necessary 41 .      Ensure low flow O2 Monitor ABG Fluid intake= 1.0-1.5 l/day if w/ R1.

NDx5: Ineffective Individual/Family Coping Goal 1: Optimum coping level 42 .

eating.     Encourage catharsis Involve in self-care and improve selfselfself-esteem Allow to make decisions about his care (shaving. bathing . etc) Adopt a hopeful and encouraging attitude towards pt Encourage activity to level of tolerance to improve self-esteem self43 .

Tech 44 .     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.

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 20lung cancers ± Large cell ± 10-15% of all lung 10cancers 46 .

Etiology and Incidence  Predisposing factors ± chronic exposure to pulmonary irritants history of lung cancer  Family  Tend to have poor prognosis. 47 . unless it is very well defined and removed by surgery.

it undergoes a series of changes and eventually gives rise to a tumor.Pathophysiology  As the lung tissue experiences irritation.  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 48 to produce steroids .

 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 activityactivityrest  Maintain nutritional status  Provide emotional support to the patient and family 50  .

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