Pulmonary Disorders Flashcards
Pneumonia
Inflamm of lung parenchyma d/t bacterial, viral, fungal infection
Pneumonia risk factors
- Advanced age
- Long-term care residents
- Smoking
- Chronic resp disease
- Immunocompromised
- Prolonged immobility
- Aspiration of stomach content (AMS can cause this)
- Prolonged NPO status
- Diminished consciousness, gag reflex, swallow reflex
- *Hospitalization longer than 48 hrs
- Recent abx therapy
Pneumonia clinical manifestations
- *Fever
- Tachypnea
- *Chills
- Cough, non-prod/prod
- *Pleuritic chest pain
- *Fatigue
- *Myalgias, arthralgias
Severe: purulent/blood tinged sputum, hypotension, dysrhythmia
Types of pneumonia
- Community-acquired
- MRSA community-acquired
- Hospital-acquired (occurs 48 hrs after admission)
Pneumonia labs
- Elevated WBC (>10, 500)
- Elevated C-reactive Protein (>1)
- Elevated bands (>5%)
Pneumonia nursing action
- Administer *humidifed O2 as ordered
- Administer meds: antibiotics
- *Pulmonary hygiene: incentive spirometer, ambulation, make sure pt coughing up secretions
- Pt positioning
- *Monitor intake & output
- *Ensure adequate nutritional support (most pts tired so don’t wanna eat + difficulty breathing)
- Activity
Pneumonia pt teaching
- *Hand hygiene
- Adequate rest, nutrition, fluid intake
- *Understand S&S of worsening resp status
- Pneumonia vaccine
Obstructive sleep apnea
Muscle tone relaxes during sleep –> can’t overcome increase in resistance –> airway collapse
- Hypoxia
- Hypercapnia
- Apnea
OSA risk factors
- Male
- *Obesity
- Smoking
- Alc use
- *Age 40-45
- Craniofacial or upper airway abnormalities
Other:
- Menopause
- Atrial fibrillation
- Nocturnal dysrhythmia
- Type 2 DM
- HF
- Pulm hypertension
OSA clinical manifestations
- Loud snoring
- Snorting
- Witnessed apnea
- Recurrent waking during sleep
- Choking
OSA risks what?
Increased risk of CV disease bc excessive inflamm process d/t decreased blood flow. Also cause scarring.
OSA treatment (supportive)
- CPAP (pressure keeps airway open)
- Nonsupine sleeping
- No alc or sedative before bed
- Oral appliance to forward tongue to keep airway open
OSA treatment (surgery)
- Tonsillectomy
- Adenoidectomy
- Uvulopalatopharyngoplasty
- Septoplasty
- Nasal polypectomy
- Tongue reduction
- Epiglottoplasty
- Bariatric surgery (reduce weight)
OSA pt teaching
- Disease process
- Instruct pt on CPAP + meds
- Instruct pt on weight reduction
Asthma
- Affect bronchial airways, resulting in airway obstruction & bronchial hyperresponsive
- Cause bronchospasm or contraction of small airways –> inflamm
- Triggered by exposure to inhaled irritants
Asthma clinical manifestations
- Chest tightness
- Wheezing (concern when on inspiration & expiration)
- Dyspnea
- Coughing
- Increased sputum
- *Inability to speak in full sentences bc not getting enough air
- Tachycardia, increased RR
Asthma medications
- Inhaled corticosteroids (Flovent, Pulmicort) = long term
- Bronchodilator (Albuterol) = rescue
- Anticholinergics (Sprivia - tiotropium)
- Leukotriene receptor antagonist (Montelukast)
Inhaled corticosteroid action
Anti-inflammatory
Decrease mucuous prod & swelling, airways becomes less sensitive to triggers
Bronchodilator action
Eg. beta-2 adrenergic agonist
Relax bronchial smooth muscle leading to open airways & less obstruct
Anticholinergic action
Relax muscle around larger airway
Leukotriene receptor antagonist action
Block leukotriene
COPD
Results in airflow limitations that are progressive and not fully reversible.
Types of COPD
- Emphysema
- Chronic bronchitis
Emphysema
- Alveolar destruction
- CO2 can’t leave and O2 can’t enter: ineffective gas exchange
- Loss of lung elasticity causes air trapping and distension in alveolar
Chronic bronchitis
- Inflamm of bronchi and bronchioles
- Small vessels are affected first
- Increased mucus production, causing vessel wall thickening and airflow obstruction
COPD nursing assess
- Vital signs
- *Lung sounds: crackles or wheezes
- Pursed lip breathing: keeps airways open for gas exchange
- *Cough
- Dyspnea (subjective finding)
- Weight loss d/t pt fatigue from breathing & not eating
COPD nursing action
- Administer meds as ordered: bronchodilators, anticholinergics d/t keeping airway open
- Provide O2: maintain SpO2 > 90%, continuous O2 for SpO2 below 88% or PaO2 below 60 mmHg
- Position: semi-fowlers to maximize lung expansion
- Provide small frequent meals: less energy consumption, no distension of stomach which can prevent maximal lung expansion
What to be careful about COPD O2 administration?
Don’t give too much O2 becuz used to O2 saturation in the 80s. High O2 will decrease respiration drive.
COPD pt teaching
- Breathing technique: pursed lip
- Pacing of activities
- Smoking cessation
- Med regiment: inhaler use, regimen, schedule
- Vaccine prophylaxis: pneumococcal, influenza, covid
- Exacerbation recognition
- Coping: depression, social, isolation, lifestyle changes
