Obstructive Pulmonary Disease

1
Obstructive Pulmonary Disease

• N1228
• class 7/8
• 2003

2
Asthma

• Triggers
• allergens
• Respiratory Infection
• Nose Sinus problems
• Exercise
• Drugs food additives
• GERD
• Emotional Stress

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• Pathophysiology
• airway inflammation and nonspecific
  hyperirritability or hyperresponsiveness of
  tracheobronchial tree
• reduction in airway diameter and an increase in
  airway resistance related to mucosal
  inflammation, constriction of bronchial smooth
  muscle, and excess production of mucus

4

• Management
• a person with asthma has difficulty with air
  movement in and out of the lungs, which creates a
  feeling of suffocation

5

• Clinical Manifestations
• wheezing, chest tightness, dyspnea,
  cough,breathlessness
• abrupt or gradual onset
• air trapping d/t contraction of bronchioles
• sometime no audible wheeze ( r/t air exchange)
• secretion thick, tenacious,white,gelatinous
• hypoxemia, restlessness,resp rate increased
• use of accessory muscles

6

• Complications
• rib fractures, pheumothorax, atelectasis,
  pheumonia, status asthmaticus
• Status Asthmaticus
• emergent situation

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Pediatric Considerations

• Many children lose their symptoms at puberty
• exacerbation continue AMB airway
  hyperresponsiveness and cough as adults
• Be alert for
• refusal to lie down, profuse sweating
• agitated child that suddenly becomes quiet
• Use games for compliance or teaching

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Diagnostic Tests

• Break into 4 groups
• Identify and report the diagnostic studies that
  are used to determine
• 1)if respiratory distress is caused by asthma
• 2)what the triggering agents are
• 3)how severe the airway obstruction is
• 4)evaluation of the severity and response to
  treatment of an attack

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Collaborative Care

• Mild Intermittent Persistant Asthma
• Stepwise approach (table 27-5)
• Drug therapy (table 27-6)
• Care Plan ( 27-1)
• Management Plan (table 27-10)
• Teaching Plan (table 27-12)

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Nursing Management of Asthma

• Assessment (list)(table 27-9)

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• Nursing DX
• Ineffective breathing pattern
• Ineffective airway clearance
• Anxiety
• Risk for infection

12
Emphysema and Chronic Bronchitis

• Etiology
• Smoking, Infection, pollution, heredity, aging
• Pathophysiology
• enlargement of air spaces distal to the terminal
  bronchioles, destruction of walls, without
  fibrosis
• centrilobular, panlobular
• elastin, collagen destroyed

13
Complications

• Cor Pulmonale
• Acute exacerbation of chronic Bronchitis
• Respiratory Failure
• Peptic Ulcer
• GE Relfux
• Pneumonia

14
Emphysema vs (chronic) Bronchitis

• Dyspnea on exertion
• Air is trapped
• chest breather
• Ribs (inspiratory position)
• Malnutrition-loss of protein,sq fat
• secondary bronchitis

• Cough
• cilia-disappears
• Freq infections
• Normal weight robust appearance
• emphysema of the centrilobular type

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• Diagnostic Studies
• Chest x-ray
• Pulmonary function studies
• ABGs CO2 begins to elevate
• pulse ox
• ECG

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• Collaborative Care
• Smoking Cessation
• assess environmental irritants
• influenza virus vaccine yearly with pneumococcal
  vaccine

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Nursing Management Emphysema and Chronic
Bronchitis

• Assessment
• Table 27-22

18

• NDX
• Self care deficit
• Sleep pattern disturbance
• sexual dysfunction
• disturbance in self-concept
• risk for infection

19

• Planning
• return to baseline resp function
• perform adls
• relief of dyspnea
• No complication r/ t COPD
• knowledge and ability to implement a long-term
  treatment regimen
• maintain quality of life

20

• Implementation
• Health promotion
• Acute intervention
• Ambulatory Home Care
• Pulmonary Rehab
• Activity considerations
• Sexual activity
• Sleep
• Psychosocial considerations

21

• Evaluation
• What supportive documentation would be seen if
  the patient has met all of their outcomes?