respiratory diseases ii
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Nursing Management of Respiratory Diseases and
Disorders Laurie Phillips RN, MSN, PHN
Lecture Objectives Review key elements of normal respiratory
anatomy and physiology Differentiate between restrictive and obstructive
pulmonary diseases Examine relative pulmonary disease epidemiology Describe the pathophysiology, clinical
manifestations, and nursing management of acute bronchitis and Acute Respiratory Distress Syndrome (ARDS)
Lecture Objectives Discuss the pathophysiology, clinical
manifestations, and nursing management for chronic bronchitis, emphysema, and asthma
Compare the pathophysiology and clinical manifestations of secondary complications such as pulmonary edema, pulmonary hypertension, and Cor pulmonale
Apply the nursing process to plan care for patients with restrictive and obstructive pulmonary diseases
Lecture Objectives Relate the nursing process including patient
teaching to drugs commonly used for restrictive and obstructive pulmonary diseases
Learn how to correctly use a metered dose inhaler (MDI), small volume nebulizer (SVN), and oxygen
Anatomy and Physiology
Restrictive Lung Disease
VS
Obstructive Lung Disease
Acute Bronchitis
inflammation of tracheobronchial tree relationship with infection
– viral vs. bacteria frequent in winter months often mistaken for asthma
Epidemiology - Bronchitis
Internationally - top 5th reason for physician visits
Mortality - low in absence of other cardiopulmonary disease
Sex - little difference; women diagnosed more
Age - 11 out of 100 (<5yrs.) ; 4 out of 100 (>5yrs.)
Clinical Manifestations Quick Assess Bronchitis
a purulent cough fever malaise and myalgias rhinorrhea or nasal congestion sore throat wheezing dyspnea and chest pain
Diagnostics - Bronchitis
Sputum specimen Chest xray
Medication Management Acute Bronchitis
Antibiotics Analgesics/antipyretics Antitussives and expectorants Bronchodilators Antiviral agents
MDI Administration
Acute Respiratory Distress Syndrome - ARDS
sudden and progressive form of respiratory failure
alveolar capillary membranes becomes damaged
intravascular fluid fills alveoli– severe dyspnea and hypoxemia– reduced lung compliance (surfactant)– diffuse pulmonary infiltrates
Causative Factors
Direct Lung Injury
Vs.
Indirect Lung Injury
Epidemiology - ARDS
In the U.S. - reported 150,000 cases annually Internationally - unknown Mortality - 40-60% of affected persons; 70-
90% of affected persons with comorbidity of septic shock
Clinical ManifestationsQuick Assess ARDS
S/S of acute respiratory distress - tachypnea, dyspnea, accessory muscle breathing, central cyanosis
dry cough and fever fine crackles throughout all lung fields S/S of hypoxemia - confusion, agitation,
coma
Diagnostics - ARDS
Pulmonary Function Tests (PFTs) Chest xray
– bilaterally, equal interstitial and alveolar infiltrates
ABG– Hypoxemia, PO2 less than 50 mm Hg– Hypocapnia and respiratory alkalosis (early)– Hypercapnia and respiratory acidosis
Management of ARDS
Supportive Measures Oxygen Mechanical ventilation Prone positioning Maintenance of fluid balance Current research in Pharmaceutical
management
Asthma
altered immunological response increased airway resistance increased lung compliance Impaired mucociliary function altered oxygen-carbon dioxide
exchange
Epidemiology - Asthma
In the U.S. - 8% of the population affected (18-20 million persons); half of these are children
Internationally - increases with urbanization and affluence
Morbidity/Mortality - 150 million worldwide; increased 40% in last 10 yrs. 29 deaths per million per year
Clinical Manifestations Quick Assess Asthma
wheezing, crackles, diminished or absent breath sounds
breathlessness and prolonged expiration dyspnea; tachypnea with hyperventilation cough with accompanied bronchospasm thick, tenacious, white, gelatinous mucous signs of hypoxemia during attack status asthmaticus
Diagnostics - Asthma
Pulmonary Function Tests (PFTs) Peak Expiratory Flow Rates (PEFR) Chest xray ABGs and oximetry Allergy skin testing ( if applicable) Blood levels of eosinophils and IgE
Medication Management Asthma
Nonsteroidal antinflammatory drugs Corticosteroids Leukotriene inhibitors Theophylline Anticholinergic Bronchodilators
Small Volume Nebulizer Therapy
Chronic Obstructive Pulmonary Disease
COPD
expiratory airflow obstruction not completely reversible two categories
– chronic bronchitis– emphysema
Chronic Bronchitis
impaired ciliary function hypertrophy of mucous-secreting glands increased airway resistance altered oxygen-carbon dioxide exchange right ventricular decompensation
Emphysema
permanent enlargement of air spaces distal to the bronchioles
hyperinflation of alveoli destruction of alveolar capillary walls narrowed airways loss of lung compliance
Epidemiology - COPD
In the U.S. - two thirds of men and one fourth of women have emphysema at death
Internationally - the WHO estimates 2.74 million deaths worldwide in 2000 were due to COPD
Mortality - affects 32 million adult Americans Sex - Men are affected more than women Age - older than 40 yrs.
Causative Factors COPD
Cigarette smoking Infection Air pollution Heredity Aging
Clinical ManifestationsQuick Assess COPD
The Pink Puffers
VS
The Blue Bloaters
Diagnostic Testing and Monitoring
Factors Determining Severity of COPD
severity of symptoms severity of airflow limitation frequency and severity of exacerbations presence of complications of COPD presence of respiratory insufficiency number of medications needed to
manage disease
Severe Respiratory System Complications
Pulmonary edema Pulmonary hypertension Cor pulmonale
Pulmonary Edema
Pulmonary Hypertension
primary pulmonary hypertension secondary pulmonary hypertension
– increased left ventricular pressures– increased blood flow through pulmonary
circulation– obstruction or obliteration of pulmonary
vascular bed– Vasoconstriction of vascular bed
Cor Pulmonale
secondary to primary pulmonary hypertension
characterized by right ventricle enlargement
acute vs. chronic
Management of COPD
Oxygen Bronchodilators Corticosteroids Antibiotics Electrolyte supplements CPAP/BiPAP Heliox Intubation
Oxygen Therapy
Respiratory Nursing Assessment
Medical History– subjective data
Current Medications Physical Assessment
– objective data See Assessment Handout
Nursing Goals in Respiratory Management
prevent disease progression relieve symptoms improve exercise tolerance improve physical health prevent exacerbations and
complications minimize side effects from treatment
Nursing Diagnoses
Impaired Gas Exchange
Ineffective Airway Clearance
Altered Breathing Pattern
Nursing Interventions
Respiratory Care Pharmacology
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