NCM1128

Care of Clients with Problems in Oxygenation, Fluid and

Electrolytes, Infectious, inflammatory and Immunologic
Response, Cellular Aberrations, Acute and Chronic
MANAGEMENT
OF PATIENTS
WITH CHRONIC
PULMONARY
DISEASE
Maria Erica P. Lat RN MAN
 • COPD is a slowly
progressive respiratory
disease of airflow
Chronic obstruction
Obstructive • Emphysema, chronic
Pulmonary bronchitis
Disease • Preventable and
treatable but not fully
and Associated reversible
Respiratory • Involving the airways,
Diseases pulmonary
parenchyma, or both
• Other
• Cystic fibrosis,
bronchiectasis, asthma
 • Cough and sputum production
for at least 3 months in each of
2 consecutive years
• Ciliary function is reduced,
bronchial walls thicken,
Chronic bronchial airways narrow, and
mucous may plug airways

Bronchitis • Alveoli become damaged,

fibrosed, and alveolar
macrophage function
diminishes
• The patient is more
susceptible to respiratory
infections
Pathophysiology of Chronic Bronchitis
Pathophysiology of Chronic Bronchitis
Pathophysiology of COPD
Airflow limitation is progressive,
associated with abnormal
inflammatory response to noxious
particles or gases
Chronic inflammation
damages tissue
Scar tissue in
airways results in
narrowing

Scar tissue in pulmonary Scar tissue in the

vasculature causes thickened parenchyma decreases
vessel lining and hypertrophy of elastic recoil (compliance)
smooth muscle (pulmonary
hypertension)
 • Abnormal distention of
air spaces beyond the
terminal bronchioles with
destruction of the walls
of the alveoli
• Decreased alveolar
Emphysema surface area increases in
“dead space,” impaired
oxygen diffusion
• Hypoxemia results
• Increased pulmonary
artery pressure may
cause right-sided heart
failure (cor pulmonale)
CHANGES IN
ALVEOLAR
STRUCTURE
 • Three primary
symptoms
• Chronic cough
• Sputum
Clinical
Manifestations production
of COPD • Dyspnea
• Weight loss due to
dyspnea
• “Barrel chest”
NORMAL
CHEST VERSUS
BARREL-
SHAPED CHEST
TYPICAL
POSTURE OF A
PERSON WITH
COPD
 • Health history
Assessment • Pulmonary
and function tests
Diagnosis of • Spirometry
COPD • Arterial blood gas
• Chest x-ray
 • Respiratory
insufficiency and
failure
Complications • Pneumonia
of COPD • Chronic
atelectasis
• Pneumothorax
• Cor pulmonale
 • Promote smoking
cessation
• Reducing risk factors
• Managing exacerbations
Medical • Providing supplemental
oxygen therapy
Management
• Pneumococcal vaccine
• Influenza vaccine
• Pulmonary rehabilitation
• Managing exacerbations
Surgical Management

Lung
Lung
Bullectomy volume
transplant
reduction
 • Bronchodilators, Multi-
Dose Inhalers
• Beta-adrenergic
agonists
• Muscarinic
Medications antagonists
to Treat (anticholinergics)
COPD • Combination agents
• Corticosteroids
• Antibiotics
• Mucolytics
• Antitussives
 • Obtain history
• Review of diagnostic
tests
• Achieving airway
Nursing clearance
Management • Improving breathing
pattern
• Improving activity
tolerance
• MDI patient education
 • Bronchiectasis is a
chronic, irreversible
dilation of the bronchi
and bronchioles
• Caused by:
• Airway obstruction,
Bronchiectasis pulmonary infections
• Diffuse airway injury
• Genetic disorders
• Abnormal host
defenses
• Idiopathic causes
 • Chronic cough
• Purulent sputum in
copious amounts
Bronchiectasis: • Clubbing of the fingers
Clinical
• Postural drainage
Manifestations
• Chest physiotherapy
and Medical
• Smoking cessation
Management
• Antimicrobial therapy
• Bronchodilators and
mucolytics
 • Focus is on alleviating
symptoms and
clearing pulmonary
secretions
Bronchiectasis: • Patient teaching
Nursing • Smoking cessation
Management • Postural drainage
• Early signs and
symptoms of
respiratory
infections
• Conserving energy
 • Chronic inflammatory
disease of the airways that
causes
hyperresponsiveness,
mucosal edema, and
mucus production
Asthma • Inflammation leads to
cough, chest tightness,
wheezing, and dyspnea
• Asthma is largely
reversible; spontaneously
or with treatment
• Allergy is the strongest
predisposing factor
 Cough, dyspnea, wheezing

Exacerbations
Clinical • Cough, productive or not
Manifestations • Generalized wheezing
• Chest tightness and dyspnea
• Diaphoresis
• Tachycardia
• Hypoxemia and central cyanosis
 • Stepwise
• Quick-relief medications
• Beta2-adrenergic
agonists
Medications • Anticholinergics
Management • Long-acting
medications
for Asthma • Corticosteroids
• Long-acting beta2-
adrenergic agonists
• Leukotriene
modifiers
 How to identify and avoid
triggers
Proper inhalation techniques

Patient How to perform peak flow

Teaching monitoring
How to implement an action
plan
When and how to seek
assistance
 • Most common autosomal
recessive disease among the
Caucasian population
• Genetic screening to detect
carriers

Cystic • Genetic counseling for couples

at risk

Fibrosis
• Genetic mutation changes
chloride transport which leads
to thick, viscous secretions in
the lungs, pancreas, liver,
intestines, and reproductive
tract
• Respiratory infections are the
leading cause of morbidity and
mortality
 • Chronic: control of infections;
antibiotics
• Acute: aggressive therapy
involves airway clearance and
antibiotics based on results of
sputum cultures
• Anti-inflammatory agents
Medical • Corticosteroids; inhaled, oral, IV
Management during exacerbations

of CF • Inhaled bronchodilators
• Oral pancreatic enzyme
supplementation with meals
• Cystic fibrosis transmembrane
conductance regulator (CFTR)
modulators are a new class of
drugs and help to improve
function of the defective CFTR
protein
 Strategies that
promote removal of Remind patient to
pulmonary secretions reduce risk factors for
• CPT and breathing resp infection
exercises

Nursing
Management Adequate fluid and
electrolyte intake
Palliative care

of CF
Discuss end-of-life
issues and concerns