Case Study #7 Emphysema Flashcards
Describe the etiology and pathophysiology of emphysema and chronic bronchitis
Emphysema
Cause
-smoking, irritants/pollution, hereditary
Patho
- alveolar destruction causes loss of elasticity
- walls of deteriorate and form bullae
- small airways collapse/narrow
- hyperinflation causes diaphragm to flatten
Chronic bronchitis
cause
-exposure to infectious and noninfectious irritant
-smoking
Patho
- inflammation and thickening of bronchioles
- excessive mucous production
- airflow obstruction
Compare and contrast the clinical manifestations of emphysema and chronic bronchitis
Emphysema
- barrel chest
- weight loss
- Dyspnea,orthopnea
- Cough is dry; productive for clear sputum
- Starts inspiration before expiration completed -(I: E ratio altered)
- Progressive SOB, possibility crackles
- Decreased air entry
- pink puffer
- -lack of cyanosis
- -use of accessory muscles
- -pursed-lip breathing
- -decreased breath sound
Chronic Bronchitis
- Productive cough
- SOB
- Expiratory wheezes
- Decreased breath sounds in severe episodes
- rhonchi
- Decreased O2 saturation
- Bronchospasms
- Tenacious green or yellow sputum
- Acute exacerbations triggered by infection
“Blue bloater” (cyanosis)
- -right sided heart failure
- -fluid retention
- -dramatic cyanosis
Describe the diagnostic assessments for COPD
Arterial blood gases (ABGs): Determines degree and severity of disease process, e.g., most often Pao2is decreased, and Paco2 is normal or increased in chronic bronchitis and emphysema, but is often decreased in asthma; pH normal or acidotic, mild respiratory alkalosis secondary to hyperventilation (moderate emphysema or asthma).
Complete blood count (CBC) and differential: Increased hemoglobin (advanced emphysema), increased eosinophils (asthma).
Chest x-ray: May reveal hyperinflation of lungs, flattened diaphragm, increased retrosternal air space, decreased vascular markings/bullae (emphysema), increased bronchovascular markings (bronchitis), normal findings during periods of remission (asthma).
Pulmonary function tests: Done to determine cause of dyspnea, whether functional abnormality is obstructive or restrictive, to estimate degree of dysfunction and to evaluate effects of therapy, e.g., bronchodilators. Exercise pulmonary function studies may also be done to evaluate activity tolerance in those with known pulmonary impairment/progression of disease.
Sputum culture: Determines presence of infection, identifies pathogen
Echocardiogram: determine any heart involvement mainly on the right sided heart failure
Identify therapeutic and pharmacological management
-Tiotropium
oBronchodilator and anticholinergic
oMOA: Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways. THERAPEUTIC: decreases incidence and severity of bronchospasm
oAE: dry mouth, tachycardia, constipation
-Prednisone
oantiinflammatories (steroid)
oMOA: suppresses inflammation and immune response (therapeutic)
oAE: moonface, buffalo humps, increase infection, adrenal suppression, depression
Non-pharmacologic
- smoking cessation
- how to recognize exacerbation
- oxygen therapy
- deep breathing
- pulmonary rehabilitation
- nutrition therapy
Discuss the nursing role in the management of a patient with emphysema
Maintain airway patency.
Assist with measures to facilitate gas exchange.
Enhance nutritional intake.
Prevent complications, slow progression of condition.
Provide information about disease process/prognosis and treatment regimen.
