Review Chapter 24 Management of Patients With Chronic Pulmonary Disease, Study Guides, Projects, Research of Nursing

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Review Chapter 24 Management of Patients With Chronic Pulmonary Disease COPD • Chronic obstructive pulmonary disease • A disease state characterized by airflow limitation that is not fully reversible • COPD (and lower respir. disease) is currently the 3rd leading cause of death in US • COPD includes diseases that cause airflow obstruction • • • Asthma is now considered a separate disorder but can coexist with COPD Chronic Bronchitis • The presence of a cough and sputum production for at least _ months in each of _ consecutive years • Irritation of airways results in inflammation and of mucus • Mucus-secreting glands and goblet cells increase in number • Ciliary function is , bronchial walls thicken, bronchial airways narrow, and mucus may plug airways • Alveoli become damaged • The patient is more susceptible to respiratory infections Pathophysiology of Chronic Bronchitis Emphysema • Abnormal distention of air spaces with destruction of the walls of the • Decreased alveolar surface area causes an increase in “ ” • Reduction of the pulmonary capillary bed increases pulmonary vascular resistance Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease and pressures • Hypoxemia is the result of these changes • Increased pulmonary artery pressure may cause -sided heart failure ( ) • Pursed-lip breathing o Inhale through the nose o Exhale through pursed lips o Extends exhalation o Reduces the amount of trapped air and airway resistance Changes in Alveolar Structure with Emphysema Posture of a Person with COPD Chest Wall Changes with Emphysema COPD • S/S o Chronic cough o Sputum o DOE o Respiratory failure • Risk Factors o o Passive smoking o Occupational exposure Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease o Breathe in through the nose and exhale through pursed lips (as if to whistle) o Do not puff cheeks full of air o Spend at least twice as long with exhalation as with inhalation o Use abdominal muscles to squeeze out as much air as possible with exhalation o Slows (prolongs) exhalation and also promotes relaxation • Diaphragmatic breathing o Also known as abdominal breathing o Sit on edge of bed/chair with feet on floor and body bent slightly forward o Take a gentle breath through nose and mouth o Then, take a deep breath – hold it for 5 seconds – and exhale o Or lay on back with book on abdomen o Book should move up and down with breathing • Improving Activity Tolerance o Focus on rehabilitation activities to improve ADLs and promote independence o Pacing of activities o Exercise training o Walking aids o Use a collaborative approach ▪ Rehabilitation therapist, OT, PT • Other Interventions o Set realistic goals. o Avoid extreme temperatures. ▪ Hot- increases body temp raising O2 requirements ▪ Cold- promotes bronchospasm o Enhance coping strategies. ▪ Stress management, sufficient sleep o Monitor for and manage potential complications. ▪ Cognitive changes, dyspnea, tachypnea, tachycardia, s/s of infection • Patient Teaching o Disease process o Medications o Procedures o When and how to seek help o Prevention of infections o Avoidance of irritants; indoor and outdoor pollution and occupational exposure o Lifestyle changes, including cessation of smoking Bronchiectasis • Chronic irreversible dilation of the bronchi and bronchioles Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease • Often caused by a pulmonary infection or obstruction • Thick sputum permanently distends and distorts the bronchial wall • More common in the lower lobes • Atelectasis occurs • S/S o Chronic cough o Purulent sputum o Hemoptysis o Clubbing of the fingers o Repeated pulmonary infections Bronchiectasis • Medical Management o Clear secretions o Prevent / Control infection o Smoking cessation o Surgery- removal of diseased lung tissue • Nursing Management o Chest physiotherapy o Postural drainage o Teach smoking cessation o Adhere to antibiotic therapy o Vaccinations Asthma • A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production • Inflammation leads to cough, chest tightness, wheezing, and dyspnea • The most common chronic disease of childhood • Can occur at any age • Allergy is the strongest predisposing factor • Usually reversible Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Pathophysiology of Asthma Asthma Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Dose Inhalers and Spacers • Examples of Metered-Dose Inhalers and Spacers • Using a Peak Flow Meter o Measures the highest volume of airflow during a forced expiration Status Asthmaticus • Severe and persistent asthma • Nonresponsive to therapy • Often occur acutely • Rapid progression • S/S o Labored breathing o Prolonged exhalation o JVD o Wheezing o Cessation of wheezing • Medical Management o Medications o IV fluids o Mechanical ventilation • Nursing Management o Monitor the client’s respiratory status o Monitor for s/s of dehydration o Eliminate irritants ▪ Flowers, tobacco smoke, perfumes, cleaning agents o Maintain a calm environment Cystic Fibrosis • The most common fatal autosomal recessive disease among the Caucasian population • Genetic screening • Genetic counseling • A mutation of a gene causes changes in chloride transport, which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract • Pulmonary problems are the leading cause of morbidity and mortality Review Chapter 24 Management of Patients With Chronic Pulmonary Disease Review Chapter 24 Management of Patients With Chronic Pulmonary Disease • Cystic Fibrosis • S/S o Productive cough o Wheezing o GI problems o DM o GU problems o Clubbing of fingers and toes o Elevated sweat chloride • Medical Management o Antibiotic medications o Bronchodilators o Clearance of secretions o Anti-inflammatory medications o Supplemental oxygen o Lung transplant o Gene therapy • Nursing Management o Chest physiotherapy o Postural drainage o Breathing exercises o Reduction of risk factors o Fluid intake Review Chapter 24 Management of Patients With Chronic Pulmonary Disease