Alteration in Ventilatory

NCM 118

Respiratory Problems
Parameters
- Manifest coughing (facilitates removal of secretion or any foreign materials from the
tracheobronchial tree in the lungs)
- Problem in RR (tachypnea/tachycardia)
- Oxygen Saturation
- Cyanosis (hemoglobin is reduced to 5mg/dl or more)
o Peripheral cyanosis – normal torso but peripheries (extremities and nail beds) have
bluish discoloration Acrocyanosis – in newborn
o Central Cyanosis – bluish discoloration of the lips, mucus membrane, face, tongue and
always a pathologic (there is always an underlying problem such as heart problem)
- Dyspnea – difficulty of breathing
o Ask what was the task done, time, duration (after a rest, min)
- Abnormal breath sound upon auscultation
o Adventitious breath sound
o Rales, crackles, Ronchi, wheezing, friction rub
- Breathing problems
- Ask patient for presence of sputum/phlegm
o Sputum – secretion that came from tracheobronchial tree from mouth, pharynx, nose
and sinuses
o Phlegm – secretion of tracheobronchial tree and lungs and a healthy adult has a volume
of 100 ml for 24 hours
- Color of secretion
o Yellow/green – bacterial
o White – viral infection

DIAGNOSTIC ASSESSMENT
- Bronchoscopy – to check for the presence of mass
- Sputum Examination – best time for sputum examination is during morning
o Acid-fast bacilli smear- microscopic examination of a person's sputum or other specimen
that is stained to detect acid-fast bacteria. To check for presence of tubercle bacilli
- Spirometry – form of exercise and observation for post-covid
- Mantoux test – ID route, to check if patient is exposed to pulmonary tuberculosis, 48/72 hours
- Bronchogram – radiopaque dye
- ABG – identify acid base status of the patient
- CHEST X-Ray – to check for pneumonia, atelectasis, tumor
- Pulse oximetry – 98-100% good O2 sat

Chronic Obstructive Pulmonary Disease (COPD) /Chronic Airflow Limitation (CAL)

- Chronic – matagal na
- Considered as irreversible
- Chronic-Airflow Limitation (CAL)
- Characterized bby airflow limitation that is not fully reversible
- Progressive and inflammatory
Alteration in Ventilatory
NCM 118

-Number 1 Etiology is cigarette smoking

-2 types of COPD/CAL
o Chronic bronchitis
 Productive cough that lasts at least 3 months in each 3 consecutive years
 Causes: cigarette smoking, environmental pollutant (urban/cities), occupational
exposure to hazardous airborne substances.
 Inflammation of lung parenchyma and fibrotic changes in lung airways
 There will be narrowing of airway which is irreversible leading to emphysema
and bronchiectasis (asthma is reversible)
 Hypersecretion of mucus
o Emphysema
 Presence of overdistended nonfunctional alveoli which may rupture which may
cause to
 Causes: cigarette smoking
 There is destruction of elastic recoil (inflate/deflate) resulting to retention of
carbon dioxide causing to hypoxia and respiratory acidosis
- MANIFESTATIONS
o Cough – due to inflammation which can lead to edema of mucus membrane
(hypersecretion of mucus) persistent cough
o Dyspnea
o Chest pain
o Adventitious breath sound (wheezing due to narrowing of airway)
 Pursed lip breathing – allows pt to have carbon dioxide elimination
o Alteration in the level of consciousness (low oxygen going to the brain)
o Cyanosis
o Voice changes
o Clubbing of fingers – due to poor perfusion
o Polycythemia – low 02 levels triggers the production of erythropoietin in the kidneys.
Happen also to patient with cardiac problems. Compensatory mechanism for low
perfusion
MANAGEMENT
- Rest – reduce o2 demand of tissues
- Increase fluid intake – to liquify mucus secretion
- Good oral care – to remove sputum and prevent infection
- DIET:
o high calorie (source of energy),
o high protein (helps to maintain the integrity of alveoli walls due to overdistention or loss
of elasticity of alveoli),
o low carbohydrates (it limits carbon dioxide production because carbon is end product
metabolism of carbohydrates
- Oxygen therapy (1-3 L/min) safest is 2L/ min
o It may not trigger the hypoxic drive
- Smoking cessation is the single most and cost-effective prevention and risk of COPD
PHARMACOTHERAPY
Alteration in Ventilatory
NCM 118

- Mucolytic – liquify the secretions

o Examples: Ambroxol, mucomyst, carbocisteine
o Given in the morning, do not give at night because pt may cough overnight
- Antitussive
o Cough suppressant
o Given at night to nut disturb
o Robitussin, dextrometorphan, codaine
o Can cause drowsiness
o Avoid activities with mental stimulation (driving)
o Decrease peristalsis causing constipation (Codaine)
- Bronchodilators
o Aminophylline, Ventolin, Salbutamol
o Dilates the bronchioles – increases the diameter of bronvhioles
- Antimicrobials
- Steroids
o For anti-inflammatory effects