Asthma and COPD Lecture 4

8/13/2019 Asthma and COPD Lecture 4

1/69

Respiratory System

Assessment & Disorders

26/10/2009 1


2/69

Upper Respiratory System


3/69

Noses and Sinuses

NoseBegin respiratory systemFilter and warm air

SinusesOpenings in facial bonesLighten skull

Assist in speechProduce mucus


4/69

Pharynx and Larynx

PharynxNasopharynxOropharynxLaryngopharynx

LarynxConnects laryngopharynx to tracheaRoutes air and food to properpassageway


5/69


6/69


7/69

Bronchi and Alveoli

Trachea divides into right and leftmainstem bronchiBronchi continue to branch and getsmaller (bronchioles) and end asalveoli

Air moves through passageways toalveoli where gas exchange occurs


8/69

Bronchioles and Alveoli


9/69

Pulmonary Circulation

Pulmonary arteriesPulmonary veins

Pulmonary capillary network


10/69

Pleura

Double-layered membrane thatcovers lungs

ParietalVisceral

Hold lungs out to chest wall


11/69

Rib Cage and IntercostalMuscles

Protect lungs12 pairs ribs

Intercostal muscles are between ribs Assist with process of breathing


12/69

Ventilation

Divided into inspiration and expirationNormal is 12 20 breaths per minute


13/69


14/69

Expiration

Lasts 2 to 3secondsPassive

Muscles relaxDiaphragm risesRibs descend

Lungs recoilPressure in chestcavity increases

(compressingalveoli)Pressure in lungshigher thanatmosphericcauses gases toflow out of the

lungs


15/69

Factors Affecting Respiration

Respiratory center of the brainChemoreceptors in the brain, aorticarch, and carotid arteries

Airway resistanceCompliance

ElasticitySurface tension of alveoli


16/69

Respiratory Changes Associated with Aging

Cartilage that connects ribs tosternum and spinal cord calcifies

Anterior-posterior diameter of chestincreasesRespiratory muscles weaker

Cough and laryngeal reflexes lesseffective


17/69

Respiratory Changes Associated with Aging

Size of lungs decreases Alveoli less elastic

Older client at greater risk fordeveloping respiratory infections


18/69

Assessment

SubjectiveCurrent complaint or existing conditionOnset or duration of symptoms

Ability to maintain ADLNasal congestion, nosebleedsSore throat, difficulty swallowingChanges in voice qualityDifficulty breathing, orthopneaPain on breathing


19/69

Assessment (continued)

SubjectivePresence of cough frequency, duration,productive or unproductiveSputum amount, color, and consistencyExposure to infections (colds orinfluenza)

History of chronic lung conditionsOccupational exposure to chemicals,smoke, asbestos


20/69


SubjectiveHistory of previous respiratory problems

Allergies to medication or environmentalallergensUse of tobacco, chewing tobacco,marijuana, cocaine, injected drugs, and

alcohol


21/69


Objective Assess state of healthColorEase of breathingNote respiratory rate and patternObserve nasal flaringUse of accessory muscles for breathingListen for hoarseness in clients speech


22/69


ObjectiveInspect mucosa of nose, mouth, andoropharynxInspect neck, position of tracheaInspect anterior/posterior diameter ofchest

Palpate lips for nodules, chest fortenderness or swelling


23/69


24/69

Pulse Oximetry

Monitors oxygen saturation (SpO 2) Amount of arterial hemoglobin that iscombined with oxygen

Nursing Care Apply to fingertip, forehead, earlobe, ornose

Remove nail polish when using fingertip


25/69


26/69

Arterial Blood Gases

Nursing care Apply pressure to site 2 5 minutesfollowing arterial puncture


27/69

Serum Alpha 1-Antitrypsin

Deficiency in this serum proteincontributing factor in emphysema andCOPDNormal value in adults 150 350mg/dLFasting specimen obtained in clientwith elevated cholesterol ortriglycerides


28/69

Sputum and Tissue

Throat or nose swabSputum specimen

Culture and sensitivityGrams stain Acid-fast stain

Cytology


29/69

Imaging Techniques

X-raysCT scans

Ventilation perfusion scansNursing care and client teachingIf contrast used remember to ask

about allergies, especially iodine andseafood


30/69


31/69

Lung Volumes and Capacities


32/69

Direct Visualization

Direct or indirect laryngoscopyUsed to identify and evaluate laryngealtumors

Nursing care and client teachingMake sure consent form has beensignedRemove dentures, partial plates, bridgesprior to procedureNPO before procedureNPO after procedure until gag reflexreturns


33/69

Bronchoscopy

Visualize trachea, bronchi andbronchioles

Tumors and structural disorders

Obtain tissue biopsyObtain sputum specimen

Removal of foreign bodyNursing care and teaching


34/69

25/10/2010 34

Asthma and COPD

Dr Ibrahim Bashayreh, RN, PhD.


35/69

26/10/2009 35

Asthma

Asthma is achronicinflammatory

pulmonary disorderthat ischaracterized byreversible

obstruction of theairways


36/69

26/10/2009 36

Asthma

Asthma is a chronic (long-term)disease that makes it hard to breathe.

Asthma can't be cured, but it can bemanaged. With proper treatment,people with asthma can lead normal,active lives.


37/69


38/69

26/10/2009 38

Normal bronchiole/ Asthmatic bronchiole


39/69

26/10/2009 39

How asthma works

If you have asthma, your airways(breathing passages) are extra sensitive.When you are around certain things, your

extra-sensitive airways can: Become red and swollen - your airwaysget inflamed inside. They fill up withmucus. The swelling and mucus make yourairways narrower, so it's harder for the airto pass through.


40/69

26/10/2009 40

Cont.

Become "twitchy" and go intospasm - the muscles around yourairways squeeze together and tighten.

This makes your airways narrower,leaving less room for the air to passthrough.The more red and swollen yourairways are, the more twitchy theybecome.


41/69


42/69


43/69

26/10/2009 43

What are the Triggering Factors?

Domestic dustmites Air pollution

Tobacco smokeOccupationalirritants

Animal with furPollen


44/69


45/69

26/10/2009 45

Asthma: Early Clinical

ManifestationsExpiratory & inspiratory wheezingDry or moist non-productive coughChest tightnessDyspnea

Anxious &AgitatedProlonged expiratory phaseIncreased respiratory & heart rate


46/69

26/10/2009 46

Asthma: Early ClinicalManifestations

Wheezing

Chest tightness

DyspneaCoughProlonged expiratory phase [1:3 or

1:4]

h l l


47/69

26/10/2009 47

Asthma: Severe ClinicalManifestations

HypoxiaConfusionIncreased heart rate & blood pressureRespiratory rate up to 40/minute & pursed lipbreathingUse of accessory muscles

Diaphoresis & pallorCyanotic nail bedsFlaring nostrils


48/69


49/69

26/10/2009 49

Asthma: Diagnostic Tests

Pulmonary Function TestsFEV1 decreased

Increase of 12% - 15% after bronchodilator indicative ofasthma

PEFR decreased

Symptomatic patienteosinophils > 5% of total WBC

Increased serum IgEChest x-ray shows hyperinflation

ABGsEarly: respiratory alkalosis, PaO2 normal or near-normal

severe: respiratory acidosis, increased PaCO2,


50/69

26/10/2009 50

Asthma: Nursing Diagnoses

Ineffective airway clearance r/tbronchospasm, ineffective cough,excessive mucus

Anxiety r/t difficulty breathing, fear ofsuffocationIneffective therapeutic regimenmanagement r/t lack of information aboutasthmaKnowledge deficit


51/69

26/10/2009 51

Medical Management of AsthmaticPatient

Limit exposure triggering agentsMedications such as: inhaledcorticosteroids, inhaled beta 2 adrenergic agonist, and cromolynsodium

A h M di i A i


52/69

26/10/2009 52

Asthma Medications: Anti-inflammatory

CorticosteroidsNot useful for acute attackBeclomethasone: vanceril,beclovent, qvar

Cromolyn & nedocromilInhibits immediate responsefrom exercise and allergens

Prevents late-phase responseUseful for premedication forexercise, seasonal asthmaIntal, Tilade

Leukotriene modifiersInterfere with synthesis orblock action of leukotrienes

Have both bronchodilationand anti-inflammatorypropertiesNot recommended for acuteasthma attacksShould not be used as onlytherapy for persistentasthma

Accolate, Singulair, Zyflo

A h M di i


53/69

26/10/2009 53

Asthma Medications:Bronchodilators

2-adrenergic agonists Rapid onset: quick relief of bronchoconstriction

Treatment of choice for acute attacksIf used too much causes tremors, anxiety, tachycardia,palpitations, nausea

Too-frequent use indicates poor control of asthmaShort-acting

Albuterol[proventil]; metaproterenol [alupent]; bitolterol [tornalate];pirbuterol [maxair]

Long-acting

Useful for nocturnal asthmaNot useful for quick relief during an acute attackSalmeterol [serevent]

A th M di ti


54/69

26/10/2009 54

Asthma Medications:Bronchodilators cont

Methylxanthines Less effective than beta-adrenergics

Useful to alleviatebronchoconstriction ofearly and late phase,nocturnal asthmaDoes not relievehyperresponsivenessSide effects: nausea,headache, insomnia,tachycardia, arrhythmias,seizuresTheophylline,aminophylline

Anticholinergics Inhibit parasympatheticeffects on respiratorysystem

Increased mucus

Smooth musclecontractionUseful for pts w/adversereactions to beta-adrenergics or incombination w/beta-adrenergics

Ipratropium [atrovent]

Ipratropium + albuterol[Combivent]


55/69

26/10/2009 55

Management of Asthmatic Patient

Identify and assess status Avoid precipitating factorsBring inhaler for each appointmentDrug considerations: Avoid ASA, NSAIDs,barbiturates, and narcoticsDrug interactions with asthmatic medications (ex.Theophylline vs. Antibiotics, Cimetidine)Chronic corticosteroid users may require steroid

supplementationFor sedation, nitrous oxide/oxygen and/or smalldoses of oral diazepam is recommended


56/69

26/10/2009 56

Asthma: Client Teaching

Correct use of medicationsSigns & symptoms of an attack

Dyspnea, anxiety, tight chest, wheezing, cough

Relaxation techniquesWhen to call for help, seek treatmentEnvironmental control

Cough & postural drainage techniques


57/69

26/10/2009 57

COPD

Chronic obstructive pulmonarydisease is a slowly progressivedisease that is characterized by agradual loss of lung functionCOPD includes chronic bronchitis,chronic obstructive bronchitis, or

emphysema, or combinations of theseconditions


58/69

26/10/2009 58

Epidemiology

20.3 million Americans report havingasthma5,000 deaths annually from asthma12.1 million Americans reported beingdiagnosed with COPD119,000 deaths annually from COPDCOPD is the 4 th leading cause ofdeath in the U.S.


59/69

26/10/2009 59

Chronic Bronchitis

Inflammation of themain airway passages(bronchi) to the lungs,which results in the

production of excessmucous, a reduction inthe amount of airflowin and out of the lungs,

and shortness ofbreath


60/69

26/10/2009 60

Emphysema

A respiratorydiseasecharacterized by

breathlessnessbrought on by theenlargement, orover-inflation of,

the air sacs(alveoli) in thelungs


61/69

26/10/2009 61

Signs and symptoms

WheezingCoughingSputum productionShortness of breathChest tightness


62/69


63/69


64/69

26/10/2009 64

Nursing DX

Ineffective breathing pattern r/tmusculoskeletal impairment , decreasedenergyInability to sustain spontaneousventilation r/t muscle fatigue

Activity intolerance r/t imbalance of O2supply


65/69

26/10/2009 65

Clinical Features of COPD Patients

Mild COPD: no abnormal signs, smokerscough, little or no breathlessnessModerate COPD: breathlessness

with/without wheezing, cough with/withoutsputumSevere COPD: breathlessness on anyexertion/at rest, wheeze and coughprominent, lung inflation usual, cyanosis,peripheral edema, and polycythemia inadvanced disease


66/69

26/10/2009 66

Diagnosis

SpirometryBreathing test which measures the amount and rate atwhich air can pass through the airways

Bronchodilator Reversibility Testing

Relaxing tightened muscles around the airways andopening up airways quickly to ease breathing

Other pulmonary function testingDiffusion capacity

Chest X-ray Arterial Blood Gas

Shows oxygen level in blood

Medical Management of COPD


67/69

26/10/2009 67

Medical Management of COPDPatient

Smoking cessation and elimination ofenvironmental pollutantsPalliative measure such as regularexercise, good nutrition, flu andpneumonia vaccinesBronchodilators, corticosteroids,anticholinergics, and NSAIDs


68/69

26/10/2009 68

Management of COPD Patient

Review history for concurrent heart disease Avoid treatment if upper respiratory tract infection ispresentTreat in upright position

Avoid rubber dam in severe casesUse pulse oximetry (if pulse ox


69/69

Asthma and COPD Lecture 4

Documents

Transcript of Asthma and COPD Lecture 4