Week 3 Flashcards
Purpose of respiration
The lungs, in conjunction with the circulatory system, deliver oxygen to and expel carbon dioxide from the cells of the body
Upper respiratory tract includes
Nose
Trachea
Warms & filters
Lower respiratory tract includes
Bronchi
Lungs (alveoli)
Gas exchange
Three processes of respiration
Ventilation (inspiration & expiration)
Diffusion (exchange of O2 & CO2 at the alveolar-capillary membrane)
Perfusion (blood flow through the pulmonary circulature)
Arterial blood gases
Measurement of arterial oxygen and carbon dioxide levels in the arterial circulation
Used to assess the adequacy of respiration
Also assesses acid-base balance
The lungs & kidneys attempt to compensate to maintain acid-base balance
COPD
Common, preventable & treatable
Characterised by a progressive, persistent airflow limitation
Enhanced chronic inflammatory response to noxious particles/gases
Made more severe by exacerbations/co-morbidities
Characteristics of COPD
Often from long term exposure to cigarette smoke Chronic asthma Chronic bronchitis Emphysema Some cases of Bronchiectasis Alpha 1 anti-trypsin deficiency (rare)
Diagnosis and presentation of COPD
Evidence of airway obstruction by spirometric testing, that does not return to normal with treatment
History of progressive symptoms of cough and/or dyspnoea and/or chronic sputum production
Recurrent respiratory infections
Weight loss
Cigarette smoking history (80-90%)
Occupational/air pollution exposure
Genetic disposition
Frequent exacerbations leads to progressive destructive changes leading to a worsening condition (becomes cyclic)
Signs and symptoms of COPD
Over inflated lungs Pursed lip breathing and use of accessory muscles Possible weight loss SOBOE Decreased exercise tolerance Cough: Non-productive Productive
Dry cough
Develops without the presence of secretions caused by irritant in upper airway eg smoke
Productive cough
Excess mucus or sputum (phlegm) is present in the respiratory tract. When airways are inflamed (infection) excess secretion of mucus accumulates in the airways. Expectorated by coughing.
Sputum observations
The nurse should observe the colour, consistency, quantity and odour of any sputum produced
record in nursing notes
Sputum specimen must be sent for MC&S
Characteristics of sputum
White Mucoid - Severe ‘Cold’
Yellow/green Containing pus (Purulent) – bacterial infection, Common in COPD/CF
Red – Containing Blood (Haemoptysis). Caused by Cancer, pneumonia, TB, trauma, PE
Sputum consistency
Viscous/sticky – difficult to exporate ?dehydration
Copious watery, frothy secretions – Pulmonary oedema – usually white can have pink tinge
Sputum quantity
Increasing or decreasing amounts should be documented
Sputum odour
Foul smelling sputum may be indicative of bronchiectasis or lung abscess or Empyema.
Differences between COPD and asthma
Symptoms consistent and rarely variable
Asthma is reversible/ COPD is usually not
Asthma is not generally associated with sputum production
Smoking history
COPD destruction of alveoli (bullae)
Mild COPD
FEV1 60 – 80% predicted
No abnormal signs
Smoker’s cough
Little or no breathlessness
Moderate COPD
FEV1 40 – 50% predicted
Breathlessness (+/- wheeze on moderate exertion
Cough (+/- sputum)
Variable abnormal signs (reduction in breath sounds, wheezes
Severe COPD
FEV1 < 40% predicted Breathlessness on any exertion/at rest Wheeze and cough often prominent Ung over inflation Cyanosis Peripheral oedema Polycythemia Hypoxemia
Collaborative management for COPD
General Nursing Care as per “breathless pt”
Medication therapy:
Various inhaled gluco-corticoids & broncho-dilators
Oxygen therapy:
Long-term
During exercise
For acute exacerbation
The goal is to increase PaO² over 60mmHg/SaO² over 90%
Pulmonary rehabilitation
Multi disciplinary (chest physiotherapy)
Breathing exercises (pursed lip, diaphragmatic breathing)
Lifestyle changes
Activity rehabilitation
Discharge patient teaching
This is to prevent/improve pulmonary hypertension/right ventricular hypertrophy/cor pulmonale – pt education is extremely important in this area
COPD complications
Acute exacerbations frequent/year Asthma Influenza or pneumonia Pulmonary hypertension Heart failure (cor pulmonale) Polycythaemia Cachexia Depression Osteoperosis Cardiovascular diseases
Pneumonia
Community-acquired or hospital-acquired
Immuno-compromised or aspiration type
Acute inflammation of the lung
By an infection (bacterial/viral/fungal/mycobacterial)
Resulting in:
Alveoli & surrounding tissues become oedematous
Alveoli fill with exudate & then consolidate
Affects ventilation & diffusion
Shunting occurs
hypoxia/arterial hypoxaemia
High mortality rate
Nursing assessment for pneumonia
Varies with type/organism/co-morbidities
Vital signs: Changes in temperature/pulse/respirations
Dyspnoea/use of accessory muscles
Cough
Productive (rusty/blood-tinged/purulent)/dry/expectorating(?)
Changes in physical assessment (IPPA)
Changes in CXR (? areas of consolidation)
Concomitant heart failure (especially in elderly patients)
Changes in mental status
Fatigue/dehydration
Nursing diagnosis for pneumonia
Ineffective airway clearance
Impaired gas exchange
Nursing expected outcomes for pneumonia
Improved gaseous exchange
Improved airway clearance
Nursing implementation for pneumonia
Oxygen therapy
Humidification may be used to loosen secretions
With air (face mask)
Deep breathing & coughing exercises (physio)
Antibiotics (as ordered)
For bacterial types
For viral types to prevent secondary bacterial infections
Promoting rest
Regular position changes
Promoting fluid intake:
To at least 2 L a day
Maintaining nutrition
General nursing care
Patient teaching
Low flow oxygen systems
Nasal Cannula All age groups 1-5L/Min Comfortable Can dry mucous membranes Hudson Mask
6-8L/Min
Inexpensive
Comfortable
Non-Rebreather
12-15L/Min
HighO2 Concentration
High flow oxygen systems
Venturi Mask
4-8L/Min
Provides Low levels of supplemental O2
Precise FiO2
Other devices used in VERY specialist areas
