Download Ignatavicius: Medical-Surgical Nursing, 7th Edition

Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 32: Care of Patients with Noninfectious Lower Respiratory Problems
Key Points
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Lower airway disorders affect gas exchange, oxygenation, and tissue perfusion.
Many problems are chronic and progressive, requiring changes in lifestyle.
CHRONIC AIRFLOW LIMITATION
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Asthma is an intermittent disease with reversible airflow obstruction and wheezing, affecting
only the airways.
Status asthmaticus is a severe, life-threatening, acute episode of airway obstruction that
intensifies once it begins and often does not respond to common therapy. It requires
immediate emergency treatment.
With poor control of asthma, chronic inflammation leads to damage and hyperplasia of the
bronchial epithelial cells and smooth muscle.
Airway obstruction can occur as a result of inflammation, which obstructs the lumen of the
airways, or from airway hyper-responsiveness.
Patients have episodes of dyspnea, chest tightness, coughing, wheezing (which is louder on
exhalation), increased mucus production, and accessory muscle use.
Pulse oximetry demonstrates hypoxemia related to the degree of dyspnea.
Laboratory tests include arterial blood gases, serum eosinophil count, immunoglobulin E
levels, and sputum cultures.
The most accurate tests for asthma are pulmonary function tests.
The goals of therapy are to improve airflow, relieve symptoms, and prevention.
Pharmacologic management includes bronchodilators, anti-inflammatory agents, and
leukotriene inhibitors.
Daily preventive therapy drugs change airway responsiveness to prevent asthma attacks.
Rescue drugs are those used to stop an attack.
Aerobic exercise assists in maintaining cardiac health, enhancing skeletal muscle strength,
and promoting ventilation and perfusion.
Patients must be able to self-assess respiratory status, adjust the frequency and dosage of
prescribed drugs, and determine when to consult the health care provider.
Teach patients with chronic airflow limitation how to use a peak flowmeter, since readings
determine if rescue treatment is working.
Teach the patient who has a reading in the red zone to immediately use the rescue drugs and
seek emergency help.
Remind patients with asthma to have their rescue inhalers with them at all times.
Emphysema and chronic bronchitis are termed chronic obstructive pulmonary disease,
known as COPD, and result in irreversible and increasingly severe tissue damage.
Pulmonary emphysema involves loss of lung elasticity and hyperinflation of the lung,
causing dyspnea, increased respiratory rate, and, eventually, cardiac failure.
Bronchitis is an inflammation of the bronchi and bronchioles caused by chronic exposure to
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
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32-2
irritants, especially tobacco smoke, triggering inflammation with vasodilation, congestion,
mucosal edema, and bronchospasm.
Chronic obstructive pulmonary disease is classified from mild to severe.
Arterial blood gases identify oxygenation, ventilation, and acid-base status.
Good management strategies help maintain adequate oxygenation and tissue perfusion, as
well as overall health, even with irreversible damage.
Careful use of drugs combined with controlled coughing, hydration, postural drainage, and
flutter valves may help in airway clearance.
The mainstays of nursing management for patients with COPD include airway maintenance,
monitoring, breathing techniques, positioning, effective coughing, oxygen therapy, exercise
conditioning, suctioning, hydration, and use of a flutter valve.
Remember to assess the airway and breathing for patients who experience shortness of breath or
changes in mental status, and apply oxygen to anyone who is hypoxemic.
Before any intervention, assess the patient to determine the breathing pattern, especially the
rate, rhythm, depth, and use of accessory muscles. The patient with COPD relies more on
accessory muscles than on the diaphragm for breathing.
Ensure proper oxygen flow rate for patients with long-term carbon dioxide retention.
Teach patients to monitor the peak expiratory flow rates at home and adjust drugs.
Teach the patient techniques of pursed-lip breathing, diaphragmatic breathing, coughing and deep
breathing, positioning, relaxation therapy, and energy conservation.
Diaphragmatic or abdominal and pursed-lip breathing may be helpful for managing dyspneic
episodes.
Perform suctioning only when needed, not on a routine schedule. Assess for improved breath
sounds after suctioning.
Maintaining hydration may thin the thick, tenacious (sticky) secretions, making them easier
to remove by coughing.
The use of a flutter valve device can help assist patients to remove airway secretions.
The patient with COPD often has food intolerance, nausea, early satiety, loss of appetite, and
meal-related dyspnea.
Ensure there are no open flames or combustion hazards in rooms where oxygen is in use.
Assess the degree to which breathing problems interfere with the patient’s ability to perform
ADLs, work, and leisure time activities.
Monitor the rate and depth of respiration at least every hour for any patient with hypercarbia
and CO2 narcosis who is receiving oxygen by mask or nasal cannula.
Assess the airway and breathing effectiveness for any patient who experiences shortness of
breath or any change in mental status.
o Apply oxygen to anyone who is hypoxemic; avoid high liter flow rates of oxygen for
patients with COPD.
Ensure that oxygen therapy delivered to the patient is humidified.
Monitor arterial blood gases and oxygen saturation of all patients receiving oxygen therapy.
Lung transplantation and lung reduction are surgical treatments.
The goal of lung reduction surgery is improved oxygenation after removing hyper-inflated
tissue
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.