8/24/20

Chronic Pulmonary Diseases

Asthma –a _______inflammatory disorder of the

airways characterized by recurrent episodes of
wheezing, breathlessness, chest tightness and
coughing
Risk Factors
üGenetic
üAllergens:
üIrritants
üViruses, exercise, emotional stress
Which among these are intrinsic and extrinsic
factors?

Responses
• Early Response –Mast Cells release of chemical
mediators
• Late Response –triggered by basophils and
eosinophil
Status Asthmaticus –is severe persistent asthma
that does not respond to _________________.
Attacks last longer than ____ hours.
Findings:
üChest tightness
üCough
üDyspnea
üwheezing

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Diagnosis
•Pulmonary Function Test
•Challenge or Bronchial Provocation Testing
•ABGs
•Skin Testing
Disease Monitoring –Peak Expiratory Flow
Rate
Management
•Identify and AVOID TRIGGERS

Medications • Monteleukast
üBronchodilators • Zafirlukast
• Adrenergic
stimulants*
• Methylxanthines
• Anticholinergic drugs
üCorticosteroids
üMast Cell Stabilizer
• Cromolyn sodium
• Nedocromil

üLeukotriene Modifiers

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Chronic Obstructive Pulmonary

Disease
•Chronic Bronchitis –is a disorder of
excessive ____________secretion
characterized by a productive cough
lasting __ or more months in __
consecutive years
•Emphysema –is characterized by
destruction of the_____________,
with resulting enlargement of
abnormal air space.

Feature Chronic Bronchitis Emphysema

History Onset After age 35 After age 50

Smoking Usual Usual

Cough Persistent, productive _______________

Physical Examination Appearance Often obese, edematous Usually thin and cachectic,
and cyanotic w/ signs of barrel chest; with use of
right sided heart failure accessory muscle
Chest Wheezing and ronchi, Distant or diminished breath
normal PT sounds, ___________ PT

Other Features Blood gases Hypercapnia and Normal to mild hypoxemia,

hypoxemia, respiratory ___________ pH
___________
PFT Normal to decrease TLC; Increased TLC; markedly
moderately increased increased residual volume
residual volume
Pulmonary hypertension May be severe Only when advance

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Cause:
üSmoking other inhaled irritants
ü________________deficiency (for
emphysema)
Findings
For Bronchitis
•Productive cough with thick tenacious
sputum
•_________________
•Signs of _______ sided heart failure
•Loud rhonchi and wheezes

For Emphysema
•Dyspnea
•___________________ (clear sputum)
•Barrel chest
•Tripod position, Why?
•Thin and tachypneic Why so?
•Diminished breath sounds, How so?

Diagnosis
•Pulmonary Function Test
•Ventilation Perfusion Scanning (V/Q Scan)
•Serum Alpha 1 Antitrypsin Levels
•ABGs
•Pulse oximetry
•Exhale carbon dioxide
•CBC with WBC differentials
•Chest X-ray

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Cystic Fibrosis
–is an autosomal recessive disorder that
affects the epithelial cells of the respiratory,
gastrointestinal, and reproductive tracts
and leads to abnormal exocrine gland
secretions
Cause:
Absence or lacking of CFTR (cystic fibrosis
transmembrane conductane regulator)

Findings:
üProductive cough (chronic)
üBarrel chest
üRecurrent pneumonia
üExercise intolerance
üBasilar crackles
üHyperresonant percussion tone of the chest
üSigns of right sided heart failure
üAbdominal pain
üSteatorrhea
üStunted growth

Diagnosis:
•Sweat test, to check for what?
•ABGs
Treatment:
__________ –recombinant human Dnase,
breaks down human DNA in the sputum of
clients with CF

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Management:
•Rest. To reduce oxygen demands on tissue
•Increase fluids
•Good oral care
•Diet: High Calorie, High Protein, Low
Carbohydrates
•O2 Therapy 1 to 3 lpm DO NOT GIVE HIGH
CONCENTRATION OF OXYGEN
•Avoid cigarettes smoking, alcohol and
environmental pollutants
•CPT
•Medication (refer to asthma care)