ASTHMA

1. Definition
Asthma is a condition in which the airways inflamed, narrow and swell and may produce
extra mucus. It is a chronic inflammatory lung disease that causes airway
hyperresponsiveness, mucus production, and mucosal edema resulting in reversible
airflow obstruction. Allergens, air pollutants, cold weather, physical exertion, strong
odors, and medications are common predisposing factors for asthma. When an individual
is exposed to a trigger, an immediate inflammatory response with bronchospasm
happens.

2. Pathophysiology
The underlying pathophysiology in asthma is reversible and diffuse airway inflammation
that leads to airway narrowing.

 Activation. When the mast cells are activated, it releases several chemicals called
mediators.
 Perpetuation. These chemicals perpetuate the inflammatory response, causing
increased blood flow, vasoconstriction, fluid leak from the vasculature, the
attraction of white blood cells to the area, and bronchoconstriction.
 Bronchoconstriction. Acute bronchoconstriction due to allergens results from a
release of mediators from mast cells that directly contract the airway.
 Progression. As asthma becomes more persistent, the inflammation progresses and
other factors may be involved in the airflow limitation.

3. Clinical Manifestation
Frequent Cough
Dyspnea
Wheezing when exhaling
increased mucus production.
Shortness of breath.
Chest tightness or pain.
Trouble sleeping
Feeling very tired or weak
Wheezing or coughing after exercise.
Feeling tired, easily upset, grouchy, or moody.
Decreases or changes in lung function as measured on a peak flow meter.
4. Assessment/Diagnostic Finding
 Assess the patient’s respiratory status by monitoring the severity of the symptoms.
 Assess for breath sounds.
 Assess the patient’s peak flow.
 Assess the level of oxygen saturation through the pulse oximeter.
 Monitor the patient’s vital signs.

5. Nursing Diagnosis
•Ineffective airway clearance related to increased production of mucus and
bronchospasm.
•Impaired gas exchange related to altered delivery of inspired O2.
•Anxiety related to perceived threat of death
•Deficient knowledge

6. Nursing Management
 Assess patient’s medical history
 Assess respiratory status.
 Monitor the severity of symptoms, breath sounds, peak flow, pulse oximetry, and
vital signs.
 Administer medications as prescribed
 Monitor the patient’s responses to those medications
 Administer fluids if the patient is dehydrated.
 Assess the client’s knowledge of care for status asthmaticus
 Identify and minimize contact with asthma triggers.
 Monitor asthma to recognize signs when it is getting worse.

7. Medical / Surgical Management

Pharmacologic Therapy
 Quick relief medications
Short- acting beta2, adregenic agonist as Ventoline used to relax smooth
muscle
 Long acting control medication
Corticosteroids- the most potent anti-inflammatory medications effecting in
alleviating symptoms and improve airways
 Antibiotics may be appropriate in treatment of acute asthma exacerbations in
patients with comorbid conditions
8. Evaluation
 Maintenance of airway patency.
 Absence /reduction of congestion with breath sound clear, noiseless respirations,
and improved oxygen exchange.
 Verbalized understanding of causes and therapeutic management regimen.
 Demonstrated behaviors to improve or maintain clear airway.
 Identified potential complications and how to initiate appropriate preventive or
corrective actions.
Chronic Obstructive Pulmonary Disease (COPD)
1. Definition
refers to a group of diseases that cause airflow blockage and breathing-related
problems. It includes emphysema and chronic bronchitis.
Two classification of COPD
Chronic Bronchitis is also called as ‘blue bloaters. It is a disease of the airways and is
defined as the presence of cough and sputum production for at least 3 months in each of
2 consecutive years.
Pulmonary Emphysema is a pathologic term that describes an abnormal distention of
airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli.
There is impaired carbon dioxide and oxygen exchange, and the exchange results from the
destruction of the walls of overdistended alveoli.
2. Pathophysiology
 An inflammatory response occurs throughout the proximal and peripheral
airways, lung parenchyma, and pulmonary vasculature.
 Due to the chronic inflammation, changes and narrowing occur in the airways.
 There is an increase in the number of goblet cells and enlarged submucosal
glands leading to hypersecretion of mucus.
 Scar formation. This can cause scar formation in the long term and narrowing of
the airway lumen.
 Wall destruction. Alveolar wall destruction leads to loss of alveolar attachments
and a decrease in elastic recoil.
 The chronic inflammatory process affects the pulmonary vasculature and causes
thickening of the vessel lining and hypertrophy of smooth muscle.

3. Clinical Manifestation
 Chronic cough.
 Sputum production.
 Dyspnea on exertion.
 Dyspnea at rest.
 Unintended weight loss.
 Barrel chest.
 Shortness of breath
 Wheezing.
 Chest tightness.
 A chronic cough that may produce mucus (clear, white, yellow or greenish)
 Frequent respiratory infections.
 Lack of energy.
4. Assessment/Diagnostic Findings
 Health history.
 Spirometry. measures how much air you can breathe in and out of your lungs, as
well as how easily and fast you can the blow the air out of your lungs
 Arterial blood gas measurement (ABG) measurement used to assess baseline
oxygenation and gas exchange and is especially important in advanced COPD.
 Chest x-ray.
 CT scan.
 Screening for alpha1-antitrypsin deficiency for patients younger than 45 years old
and for those with a strong family history of COPD.
 Pulmonary function tests
 DL CO test: Assesses diffusion in lungs.
 Bronchogram
 Complete blood count (CBC)
 Blood chemistry: alpha1-antitrypsin is measured to verify deficiency and diagnosis
of primary emphysema.
 Sputum culture: Determines presence of infection, identifies pathogen.
 Cytologic examination: Rules out underlying malignancy or allergic disorder.
 Electrocardiogram (ECG) Helps in assessing degree of pulmonary dysfunction,
evaluating effectiveness of bronchodilator therapy, planning/evaluating exercise
program.

5. Nursing Management
 Assess patient’s exposure to risk factors.
 Assess the patient’s past and present medical history.
 Assess the signs and symptoms of COPD and their severity.
 Assess the patient’s knowledge of the disease.
 Assess the patient’s vital signs.
 Assess breath sounds and pattern
 Administer bronchodilators and corticosteroids
 Instruct the patient in direct or controlled coughing
 Educate patient about Inspiratory muscle training.
 Manage daily activities
 Monitor cognitive changes.
 Monitor pulse oximetry values.
 Prevent infection.

6. Medical / Surgical Management

  Smoking cessation and elimination of environmental pollutants
 Palliative measure such as regular exercise, good nutrition, flu and pneumonia
vaccines
 Bronchodilators, corticosteroids, anticholinergics, and NSAIDs

Pharmacologic Therapy
 Bronchodilators. relieve bronchospasm by altering the smooth muscle tone and
reduce airway obstruction by allowing increased oxygen distribution throughout
the lungs and improving alveolar ventilation.
 Corticosteroids. may be prescribed for patients to determine whether pulmonary
function improves and symptoms decrease.

Surgical Management:
 Bullectomy is a surgical option for select patients with bullous emphysema and
can help reduce dyspnea and improve lung function.
 Lung Volume Reduction Surgery is a palliative surgery in patients with
homogenous disease or disease that is focused in one area and not widespread
throughout the lungs.
 Lung transplantation is a viable option for definitive surgical treatment of end-
stage emphysema.

7. Nursing Diagnosis
 Impaired gas exchange due to chronic inhalation of toxins.
 Ineffective airway clearance related to bronchoconstriction, increased mucus
production, ineffective cough, and other complications.
 Ineffective breathing pattern related to shortness of breath, mucus,
bronchoconstriction, and airway irritants.
 Self-care deficit related to fatigue.
 Activity intolerance related to hypoxemia and ineffective breathing patterns.

8. Evaluation
 Identifies the hazards of cigarette smoking.
 Identifies resources for smoking cessation.
 Enrolls in smoking cessation program.
 Minimizes or eliminates exposures.
 Verbalizes the need for fluids.
 Is free of infection.
 Practices breathing techniques.
 Performs activities with less shortness of breath.
Cystic Fibrosis
1. Definition
Cystic fibrosis (CF) is a disease of exocrine gland function that involves multiple organ
systems but chiefly results in chronic respiratory infections, pancreatic enzyme
insufficiency, and associated complications in untreated patients. It is an autosomal
recessive disorder, and most carriers of the gene are asymptomatic.

2. Pathophysiology
 Cystic fibrosis is caused by defects in the cystic fibrosis gene, which codes for a
protein transmembrane conductance regulator (CFTR) that functions as a chloride
channel and is regulated by cyclic adenosine monophosphate (cAMP).
 Mutations in the CFTR gene result in abnormalities of cAMP-regulated chloride
transport across epithelial cells on mucosal surfaces.
 Defective CFTR results in decreased secretion of chloride and increased
reabsorption of sodium and water across epithelial cells.
 The resultant reduced height of epithelial lining fluid and decreased hydration of
mucus results in mucus that is stickier to bacteria, which promotes infection and
inflammation.
 Secretions in the respiratory tract, pancreas, GI tract, sweat glands, and other
exocrine tissues have increased viscosity, which makes them difficult to clear.
 In individuals with cystic fibrosis, the lungs are normal in utero, at birth, and after
birth, before the onset of infection and inflammation (except possibly for the
presence of dilated submucosal gland ducts in the airways).
 Shortly after birth, many persons with cystic fibrosis acquire a lung infection, which
incites an inflammatory response.
 Infection becomes established with a distinctive bacterial flora.
 A repeating cycle of infection and neutrophilic inflammation develops.

3. Clinical Manifestation
 Very salty-tasting skin
 Persistent coughing, at times with phlegm
 Frequent lung infections including pneumonia or bronchitis
 Wheezing or shortness of breath
 Poor growth or weight gain in spite of a good appetite
 Frequent greasy, bulky stools or difficulty with bowel movements
 Nasal polyps
 Chronic sinus infections
 Clubbing or enlargement of the fingertips and toes
 Rectal prolapse
 Male infertility
4. Assessment/Diagnostic Findings
 Noninvasive CFTR analysis involves a technique for recovering DNA from cells
obtained by buccal brushing; this technique can be used to determine the carrier
status of the parents of a fetus with suspected CF based on sonographic findings of
meconium ileus.
 Restriction fragment length polymorphism (RFLP) analysis.
 Newborn screening.
 Sweat chloride test. to confirm CF is a sweat chloride test using the pilocarpine
iontophoresis method to collect sweat and perform a chemical analysis of its
chloride content
 Radiography.
 Genotyping.

5. Nursing Management
 Assess vital signs.
 Assess skin condition.
 Improve airway clearance.
 Monito for signs of respiratory distress
 Educate the child to cough effectively
 Increase fluid intake
 Improve breathing.
 Position in a semi-Fowler’s position
 Maintain oxygen saturation higher than 90%
 administer oxygen as ordered
 administer mouth care every 2 to 4 hours
 Perform chest physiotherapy every 2 to 4 hours as ordered
 Prevent infection.
 Maintain adequate nutrition.
 Reducing anxiety.

6. Medical / Surgical Management

 Diet.
 Exercise.
 Monitoring. Patients are monitored in the CF clinic every 2-3 months to achieve
maintenance of growth and development, maintenance of as nearly normal lung
function as possible, intervention and retardation of the progression of lung
disease, clinical assessment to monitor gastrointestinal tract involvement, and
monitoring for complications and their treatment .
 Vaccines. Routine vaccinations are indicated in patients with cystic fibrosis,
including seasonal influenza vaccination
 7. Nursing Diagnosis
 Ineffective airway clearance related to thick, tenacious mucus production.
 Ineffective breathing pattern related to tracheobronchial obstruction.
 Risk for infection related to bacterial growth medium provided by pulmonary
mucus and impaired body defenses.
 Imbalanced nutrition: less than body requirements related to impaired absorption
of nutrients.
 Anxiety related to hospitalization.

8. Evaluation
 Relief of immediate respiratory distress.
 Maintainance of adequate oxygenation.
 Freedom from infection.
 Improvement of nutritional status.
 Relief of anxiety.

Atelectasis
1. Definition
Atelectasis refers to incomplete expansion or collapse of part of the lung. It may
include a lung subsegment or the entire lung and is almost always a secondary
phenomenon, with no sex or race proclivities
It develops when the alveoli become airless from absorption of the air without
replacement of the air with breathing

2. Pathophysiology
Reduced alveolar condition or any type of blockage
Impeded the passage of air
The trapped alveolar air becomes absorbed into the bloodstream, but outside air cannot
replace the absorbed air because of the blockage
Isolated portion of the lung becomes airless and the alveoli collapse
Excessive pressure on the lung tissue
Restrict normal lung expansion on inspiration
Become airless for prolong period
Alveolar collapse

3. Clinical Manifestation
 Trouble breathing (shortness of breath)
 Increased heart rate.
 Coughing.
 Chest pain.
 Skin and lips turning blue.
 Anxious
 Dyspnea
 Difficulty breathing in supine position

4. Assessment/Diagnostic Findings
 Medical History
 Physical Examination
 CT Scan
 Oximetry
 Ultrasound of the thorax
 Bronchoscopy

5. Nursing Management
 Assess the patient’s vital sign
  Administer supplementary oxygen
 Elevate the head of the bed
 Assist the patient to semi-flower position
 Monitor the chest

6. Medical / Surgical Management

 Prevention
 Appropriate antibiotics depend on culture result
 Hydration
 Antipyretic for fever and headache
 Warm moist inhalation to revive irritation
 Antihistamine to relieve sneezing and rhinorrhea

Surgical Management
Removal of the involved part of lung via LOBECTOMY or segment resection may be needed.

7. Nursing Diagnosis
 Risk for Respiratory Failure
 Activity intolerance
 Anxiety
 Fatigue

8. Evaluation
The patient will maintain optimal gas exchange as evidenced by increase of respiratory
rate
Verbalize ease of breathing