Respiratory Diseases II
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Transcript of Respiratory Diseases II
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Nursing Management of Respiratory Diseases and
Disorders Laurie Phillips RN, MSN, PHN
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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)
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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
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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
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Anatomy and Physiology
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Restrictive Lung Disease
VS
Obstructive Lung Disease
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Acute Bronchitis
inflammation of tracheobronchial tree relationship with infection
– viral vs. bacteria frequent in winter months often mistaken for asthma
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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.)
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Clinical Manifestations Quick Assess Bronchitis
a purulent cough fever malaise and myalgias rhinorrhea or nasal congestion sore throat wheezing dyspnea and chest pain
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Diagnostics - Bronchitis
Sputum specimen Chest xray
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Medication Management Acute Bronchitis
Antibiotics Analgesics/antipyretics Antitussives and expectorants Bronchodilators Antiviral agents
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MDI Administration
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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
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Causative Factors
Direct Lung Injury
Vs.
Indirect Lung Injury
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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
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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
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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
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Management of ARDS
Supportive Measures Oxygen Mechanical ventilation Prone positioning Maintenance of fluid balance Current research in Pharmaceutical
management
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Asthma
altered immunological response increased airway resistance increased lung compliance Impaired mucociliary function altered oxygen-carbon dioxide
exchange
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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
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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
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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
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Medication Management Asthma
Nonsteroidal antinflammatory drugs Corticosteroids Leukotriene inhibitors Theophylline Anticholinergic Bronchodilators
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Small Volume Nebulizer Therapy
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Chronic Obstructive Pulmonary Disease
COPD
expiratory airflow obstruction not completely reversible two categories
– chronic bronchitis– emphysema
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Chronic Bronchitis
impaired ciliary function hypertrophy of mucous-secreting glands increased airway resistance altered oxygen-carbon dioxide exchange right ventricular decompensation
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Emphysema
permanent enlargement of air spaces distal to the bronchioles
hyperinflation of alveoli destruction of alveolar capillary walls narrowed airways loss of lung compliance
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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.
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Causative Factors COPD
Cigarette smoking Infection Air pollution Heredity Aging
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Clinical ManifestationsQuick Assess COPD
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The Pink Puffers
VS
The Blue Bloaters
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Diagnostic Testing and Monitoring
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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
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Severe Respiratory System Complications
Pulmonary edema Pulmonary hypertension Cor pulmonale
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Pulmonary Edema
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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
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Cor Pulmonale
secondary to primary pulmonary hypertension
characterized by right ventricle enlargement
acute vs. chronic
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Management of COPD
Oxygen Bronchodilators Corticosteroids Antibiotics Electrolyte supplements CPAP/BiPAP Heliox Intubation
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Oxygen Therapy
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Respiratory Nursing Assessment
Medical History– subjective data
Current Medications Physical Assessment
– objective data See Assessment Handout
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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
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Nursing Diagnoses
Impaired Gas Exchange
Ineffective Airway Clearance
Altered Breathing Pattern
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Nursing Interventions
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Respiratory Care Pharmacology