Week 1 Respiratory Conditions Flashcards
Chronic illness - epidemiology & demographic in Aus
Chronic Illness - long-term (6mo), non-communicable disease that can lead to disability, multiple morbidities, comorbidities, or premature death.
- E.g., Arthritis, asthma, back pain, cancer, COPD, CVD, diabetes, and mental health conditions
Multimorbidity - 2+ chronic health conditions that may or may not be related to each other
Comorbidity - 1 or more additional health conditions that coexist with a primary condition
- E.g, depression is a common comorbidity for a person with rheumatoid arthritis as the impacts of their arthritis (chronic pain) can contribute to the development of depression
National Strategic Framework for Chronic Conditions
8 Guiding Principles:
1. equity
2. collaboration
3. access
4. evidence-based
5. shared responsibility
6. accountability
7. sustainability
8. person-centred
Objectives:
1) Focus on prevention
2) Provide efficient, effective, and appropriate care to people with chronic conditions, and optimise quality of life
3) Target priority populations
COPD - definition & causes
COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs. They often have underlying conditions such as emphysema or chronic bronchitis.
- Symptoms: breathing difficulty, cough, mucus production, wheezing
Causes of COPD - typically by long-term exposure to irritating gases or particulate matter, e.g., cigarette smoke. Onset of COPD is insidious (gradually develops over time). Other causes; occupational exposure, indoor air pollution, early live events such as prematurity
COPD Pathophysiology
COPD Pathophysiology - Long-term exposure to irritating gases, particulate matter, and cigarette smoke can lead to…
- Chronic bronchitis:
Immune cells increase in the lung tissue and airways → chronic inflammation and tissue damage → airway remodelling by thickening of airway walls as a way to protect itself → mucus and impaired airflow due to narrowing of airways - Emphysema:
Destruction of alveoli → impaired oxygen uptake and gas exchange → SOB
Chronic bronchitis vs emphysema
Chronic bronchitis: inflammation of lining of bronchial tubes (responsible for carrying air from air sacs or alveoli to lungs) → daily cough, mucus production → increased risk of pneumonia etc
Emphysema: alveoli at the end of the bronchioles (small air passages) are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases → decrease gas exchange at the lungs → COPD, SOB
COPD Role of nurse
Exercise (pulmonary rehab), emotional wellbeing, vaccination education, referrals, positioning, oxygen therapy, medication administration
Asthma - definition & causes
Asthma - inflammation and spasm of bronchial smooth muscles causes narrowing of bronchial airways, making it difficult to breathe. Symptoms include wheezing, coughing, tightness in the chest, SOB, rapid breathing
Causes of Asthma:
- Genetics
- Environmental exposures (dust/pollen, pets, bacteria/virus, weather changes)
- Smoking
- Hormonal changes/pregnancy
- Physical exercise
- Aspirin & NSAIDs can worsen, Beta blockers are contraindicated.
Asthma - pathophysiology
Pathophysiology of Asthma:
1. Exposure to a trigger → inflammatory mediators released (mucosal mast cells, macrophages, and neutrophils) → inflammation of the lower respiratory tract and bronchial walls → acute narrowing of the airways → can cause long term scarring of bronchial tree → decrease lung function (expiratory airway obstruction)
- Acute bronchospasm of the smooth muscles that line the bronchial tree → airway hypersensitivity and impaired lung function
Relievers
Relievers (Bronchodilators) - Beta-2 agonists for rapid relief of asthma symptoms. Can be used before exercise to prevent exercise-induced bronchoconstriction
E.g., Short-acting beta 2 agonists (SABAs) for sudden onsets of asthma (salbutamol/Ventolin, terbutaline/Bricanyl), or long-acting (LABAs) for 12-24 hrs control (salmeterol, formoterol)
Mechanism of action: relax bronchial smooth muscles & widen airways of bronchi → make it easier to breathe
Preventers
Preventers (Anti-Inflammatory Drugs) - control underlying asthma symptoms. Generally through corticosteroid inhalers which deliver a low dose to the lungs, making airways less sensitive, reduces inflammation, and dries up mucus (daily)
E.g., inhaled corticosteroids (budesonide, fluticasone)
Mechanism of action: reduce airway inflammation and bronchial hyper-activity
Combination therapies
Combination therapies - the use of 2 to 3 asthma medications in combination (e.g., corticosteroid and long-acting bronchodilators)
Corticosteroid - when taken regularly will reduce risk of asthma symptoms and flare ups, stabilisation, may take a few weeks of consistent use
Long acting reliever - Beta 2 agonist can relax tight airways muscles for 12-24 hrs
Asthma - role of the nurse
Diagnosis - Pmx, physical examination, documenting variable airflow limitation using spirometry, working with a multidisciplinary team to assess
Assessment - Pt history, asthma triggers & patterns, diagnostic testing (spirometry, skin allergen testing), determine asthma control checklist
e.g., frequency of asthma symptoms at night, waking, reliver medication, restriction in day-to-day activities, attacks/flare ups
Education - Help patients understand their asthma action plan (emergencies, drug therapy) to have well controlled asthma, education on inhaler technique (ask patient to demonstrate)
Nursing roles -
- Asthma First Aid:
Sit the person upright and keep them calm
Administer 4 puffs of reliever medication (or 1 puff in the spacer and breathe in and out 4 times and repeat 4 times)
Wait 4 minutes, stay with the person, and reassure them
If condition worsens, call 000 and repeat dose of salbutamol
- Patient education on self-management and pharmacotherapy, avoidance of triggers
