concepts of care for pt. with noninfectious lower respiratory problems Flashcards
asthma
- chronic disease that occurs intermittently
- inflammation and airway tissue sensitivity
asthma symoms
- daytime symptoms of wheezing, dyspnea, coughing presents more than 2 a week
- waking from night sleep with symptoms of wheezing, dyspnea, coughing
- relieved drug needed more than twice weekly
- number of times per week activity was limited or stopped by symptoms
asthma history
- history of dsypna, shortness of breath, chest tightness, coughing, wheezing, increased mucous production
- same pt. have symptoms 4-8 weeks after a cold or other upper respiratory infection
- pt. with atopic (allergic) asthma may have other allergic problems
common symptoms with acute asthma
audible wheezing
increased respiraotry effort
asthma attack cues
inflammation occurs, coughing may increase
- accessory muscle use
- breathing cycle is longer, prolonged exhalation and requires more effort
- unable to speak
- hypoxia
- poor o2 levels
- examine oral mucosa, nail beds, change in loc, & tachycardia
pulmonary function tests
- forced vital capacity: total amount of air exhaled
- forced expiratory volume in first second- how much air a person exhale during forced breath
- peak expiratory rate flow- air flowing out of lungs
asthma interventions
- control and prevent episodes
- improve air flow and gas exchange
- relieve symptoms
- self management education
- ASSESSMENT OF ASTHMA SEVERITY DAILY WITH A PEAK FLOW METER IS RECOMMENDED FOR PT. WHOSE ASTHMA IS NOT WELL CONTROLLED
asthma drug therapy
- control therapy drugs
- reliever drugs
- bronchodilators
- anti-inflammatory agents
control therapy drugs (used daily)
used to reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and maintain gas exchange
- inhaled cortical steroid- reduce inflammation
reliever drugs
used to stop an attack
- short acting bronchodilator
bronchodilators
induce rapid bronchodilation through relaxing the smooth muscle
what do anti-inflammatory agents do?
help to improve bronchiolar airflow and increase gas exchange
high flow delivery cause
bronchospasms are severe and limit flow of oxygen through bronchiole tubes
status asthmaticus
- severe life threatening acute episode of airway obstruction
- intensifies once it begins, often does not respond to common therapy
- can develop pneumothorax and cardiac or respiratory arrest
treatment for status asthmaticus
Iv fluids potent systemic bronchodilator steroids epinephrine oxygen prepare for emergency intubation
emphysema
destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung
- changes result in dyspna with reduced gas exchange and the need for an increased respiratory rate
chronic bronchitis
inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke
- trigger inflammation, vasodilation, mucosal edema, congestion, and bronchospasm
- affects airways not alveoli
why is chronic bronchitis a blue bloater
- presence of cyanosis of skin and mucous membranes
- hypoxemia occurs early in disease
- c02 retention
when does dyspnea occur for bronchitis
occurs later in disease
when does hypoxemia and hypercapnia occur for chronic bronchitis
early in disease
why is emphysema a pink puffer
- there color and the way they breathe through pursed lips on expiration
- hypoxemia occurs late in disease
- damage not in bronchioles therefore no c02 retention
- no cyanosis just pink
when does dyspnea occur in emphysema
-occurs early
when does hypoxemia and hypercapnia occur
later in disease
complications of COPD
- hypoxemia
- acidosis: decreased 02, increased c02
- respiratory infection
- CARDIAC FAILURE: cor pulmonale- ride sides heart failure
- dysrhthmias: due to acidosis and perfusion
- respiratory failure: hypoxemia
copd history & risk factors
risk factors:
- age
- gender
- occupational history
- SMOKING
- breathing problems
- activity level
- weight
the general appearance of copd
- weight is proportionate to height, posture, mobility, muscle mass, and overall hygiene
- pt. with severe copd are THIN
- orthopneic or tripod position
respiratory changes in copd assessment
- assess chest size
- fatigue
- breathing rate and pattern
- chest for retractions and asymmetric chest expansion
- depth of inspiration
- abnormal breath sounds
- degree of dyspnea
- barrel chest
- cyanosis
cardiac changes
- assess heart rate and rhythm
- swelling of feet or ankles
- nail beds
- oral mucous membranes
copd assessment cues: lab
- abg value
- sputum specimens
- WBC count
- h&h serum
- electrolyte levels
copd assessment cues: imaging assessmenr
chest x ray
copd assessment cues: other test
- pulmonary function test: primary testing
- COPD assessment test
- lung volumes
- diffusion test
- oxygen saturation
- peal expiratory flow meter
COPD analysis
- decreased gas exchange
- weight loss
- decreased endurance
- potential for pneumonia
COPD planning and implementation
- improve gas exchange and reduction of carbon dioxide retention
- ensure consistent use of drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxyen therapy, exercise conditioning, suctioning, and hydration
- surgical intervention
- preventing weight loss
- minimizing anxiety
- improving endurance
- preventing respiratory infection
surgical intervention for copd
lung transplantation
- lung volume reduction surgery
preventing weight loss for copd
dyspnea management
food selection
improving endurance for copd
- energy conservation
what is common complication of COPD
- PNA is a common complication of COPD
- teach pt. to reduce the risk of infection
COPD evaluating outcomes
- attain and maintain gas exchange at a level within his or her chronic baseline values
- achieve an effective breathing pattern that decrease the work of breathing
- maintain a patent airway
- achieve and maintain a body weight within 10% of his or her ideal weight
- have decreased anxiety
- increase activity to a level of acceptance to him or her
- avoid serious respiratory infections
Cystic Fibrosis
- autosomal recessive genetic disease
- diagnosed in early childhood
- blocked chloride transport in cell mebranes
- thick, sticky mucous
- affects lungs and non-pulmonary ograns and pancreatic function
- blocks chloride transport and cell membrane
- impaired gas exchange
cystic fibrosis assessment clues: nonpulmonary symtoms
- abdominal distension
- GERD, rectal prolapse, foul smelling stool, steatorrhea
- malnourishment
- DIABETES
- OSTEOPOROSIS, OSTEOPENIA
cystic fibrosis assessment clues: pulmonary symtoms
- respiratory infections
- chest congestion and sputum production
- limited exercise tolerance
cystic fibrosis interventions nonsurgical: nutrition management
- focus on WEIGHT maintenance (protein & fat intake), vitamin supplementation, diabestes management, and pancreatic enzyme replacement
cystic fibrosis interventions nonsurgical: preventitive/maintenance therapy
- use of positive expiratory pressure
- active cycle of breathing techniques
- indivdualized exercise program
- adn chest physiotherapy with postural drainage
cystic fibrosis interventions nonsurgical: drugs
bronchodilators
anti-inflammatories
mucolytics
antibiotics
cystic fibrosis interventions nonsurgical: exacerbation therapy
- increased chest congestion
- reduced activity
- onset of crackles
- 10% decrease in FEV1
- bipap for advanced disease 14-21 day course of antibiotics
cystic fibrosis interventions nonsurgical: gene therapy
- pt. with specific gene mutations
- drug Ivacaftor aka CFTR modulator or potentiator is valuable to pt. with CF
cystic fibrosis interventions nonsurgical: surgical
lung transplantation
- does not cure
- extends life by 1-15 years
- transplant rejection is high
- continue for infections
