Care of Patients With Noninfectious lower respiratory problems Flashcards
Asthma Risk Factors:
- Inherited Disorder
- Environmental Factors: Viral infection, Allergens, pollutants
- Excitatory States: Stress, Laughing, Crying
- Aspirin & NSAIDS
- GERD
- Exercise, changes in temperature, strong odors
Asthma Pathophysiology: Early Phase
Shortness of breath, chest tightness, wheezing
Asthma Pathophysiology: Immune Activation
IgE, Mast cells, chemical mediators
Asthma Pathophysiology: Vasodilation
Edema in airway, attempt to dilute the allergen
Asthma Pathophysiology: Bronchospasm
narrowing of bronchial tubes by constriction of the smooth muscle around and within the bronchial walls
Asthma Pathophysiology also includes Late Phase
Bronchial Hyperresponsiveness, cyanosis (late sign)
Asthma Clinical Manifestations
Cough Wheezing Chest tightness Dyspnea Nasal flaring Use of accessory muscles Cyanosis
Nursing Interventions
Auscultate breath sounds Monitor respiratory pattern Monitor oxygen saturation Elevate head of bed Deep breathe Activity Encourage fluid intake
Asthma Treatment
Inhaled Beta2 agonists Corticosteroids Anticholinergics Mast cell stabilizers Leukotriene modifiers Oxygen
Chronic Obstructive Bronchitis Risk Factors
Chronic productive cough Smoking Exposure to air pollution Older adults Repeated infections
Chronic Bronchitis Pathophysiology:
Irritant triggers:
- Inflammation of airway
- Infiltration of inflammatory cells
- Continuous irritation and inflammation
- Bronchial edema
- Hypersecretion of mucus
- Bacterial colonization
- Airway obstruction: not alveoli
- Air trapping
Chronic Bronchitis Clinical Manifestations:
Acute versus Chronic Productive cough “smoker’s cough” Decrease exercise tolerance Wheezing Shortness of breath Prolonged expiration
Emphysema Risk Factors
Cigarette smoking
Alpha1-antitrypsin deficiency
Air pollution
Occupational chemicals or dust
Emphysema Pathophysiology:
Irritant or Alpha 1 antitrypsin deficiency triggers:
- Inflammation of airway
- Infiltration of inflammatory cells: Inhibition of normal endogenous antiproteases
- Increased protease activity
- Destruction of alveolar septa: Loss of elastic recoil
- Blebs
- Bullae
- Air trapping
Emphysema Clinical Manifestations:
- Dyspnea on exertion
- Dyspnea at rest
- Anteroposterior diameter of chest enlarges
- Chest hyperresonant sound with percussion
- Cyanosis lips
- Neck vein distention
- Pitting peripheral edema
Chronic Obstruction Pulmonary Disease(COPD) Risk factors:
- Primary risk factor = SMOKING
- Air pollution
- Second-hand smoke
- History of childhood respiratory tract infections
- Hereditary
COPD stimulates
excessive mucus production
COPD causes
- Cough
- Destroy ciliary function
- Inflammation
- Damage to bronchiolar and alveolar walls
- Increased airway resistance secondary to bronchial mucosal edema
- Decreased elastic recoil
COPD manifestations:
Easily fatigued Frequent Respiratory Infections Use of Accessory to Breathe Orthopneic Cor Pulmonale (late in disease) Thin in appearance Wheezing Pursed lip breathing Chronic cough Dyspnea Prolonged expiratory time Bronchitis - increased sputum Digital clubbing
Laboratory assessments for all these diseases:
-Arterial Blood Gas (ABG): Identify abnormal gas exchange, oxygenation, ventilation & acid-base status -Sputum & WBC: Acute respiratory infection -Hemoglobin & hematocrit: polycythemia -Electrolytes: acidosis
Diagnostics:
-Chest x-ray:
Rule out lung disease
Check progress of infection or chronic disease
Emphysema – hyperinflation & flattened diaphragm
-Pulmonary Function Test:
Determines lung flow volumes
Medications For Treatment of COPD:
-Bronchodilator: Beta2-agonists (albuterol/ Proventil) Adrenergic (salmeterol/ Serevent) Leukotriene antagonist (montelukast/ Singulair) -Anticholinergic: Ipratropium bromide (Atrovent) -Methylxanthines: Theophylline, Aminophylline -Corticosteroid: (fluticasone/ Flovent) -Glucocorticosteroids: Prednisone (prednisone/ Deltasone)
Other Therapies for COPD
Long term oxygen therapy Pulmonary hygiene Deep venous thrombosis Influenza vaccine Pneumococcal vaccine Exercise Smoking Cessation Nutrition
