Download Chapter 34 - Ukiah Adult School

Chronic Respiratory
Disorders
Week 26
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1
Chronic Obstructive
Pulmonary Diseases
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2
Asthma
• Obstructive airway disease
• Occurs across the lifespan
• Not a psychological ill
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Pathophysiology
• Potentially reversible obstructive airway
disorder: airway inflammation and
hyperresponsiveness
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Pathophysiology: Early Phase
• Triggers activate
inflammatory process
• Airways constrict
• ↑ mucus secretion
• Air trapping
• Ventilation-perfusion
mis-match
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Triggers
Tobacco smoke
Animals (pet hair or
dander)
Dust
Changes in weather (most
often cold weather)
Chemicals in the air or in
food
Exercise
Mold
Pollen
Respiratory infections,
such as the common cold
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Pathophysiology
• Late phase
• Begins 5 to 6 hours after the early phase response
• Red and white blood cells infiltrate swollen tissues
of the airways
• During this phase, which lasts several hours or
days, the airways are hyperreactive (very sensitive)
• Risk for another episode until phase subsides
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Asthma
•
•
•
•
Signs and symptoms
Medical diagnosis
Treatment
Complications
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Drug Therapy
Relievers
• Beta 2 agonists
• anticholinergics
Controllers
• Steroids
• Leukotriene modifiers
• Long-acting Beta2
agonists
• Mast cell stabilizers
• Immunmosuppressant
monoclonal antibody
• methylzantines
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Figure 31-2
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Assessment
• Essential information
• Health history
• Physical examination
• Measurement of vital signs and auscultation of lung
sounds
• Assess skin color and respiratory effor
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Nursing Process
•
•
•
•
Ineffective Breathing Pattern
Impaired Gas Exchange
Anxiety
Knowledge deficit
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Chronic Bronchitis and
Emphysema
• Independent disease states
• Frequently occur together
• Both forms of COPD
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Chronic Bronchitis
• Bronchial inflammation
• increased production of mucus and chronic cough
• persist for at least 3 months of the year for 2
consecutive years
• impaired ciliary action
• Cause: inhaled irritants, e.g., cigarette smoke
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Emphysema
•
•
•
•
Abnormal permanent enlargement of acini
Destruction of alveolar walls
Obstruction results from tissue changes
Causes
• Deficiency of alpha1 protease inhibitor
• Cigarette smoking
• Signs and Symptoms
•
•
•
•
Dyspnea on exertion
Barrel chest
Prolonged expiration
Decreased breath sounds
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Figure 31-5
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Medical Diagnosis
• Patient’s health history and physical
examination
• Pulmonary function tests
• Computed tomography (CT) scan
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Assessment
• Describe the presenting symptoms—often
dyspnea, cough, chest pain, or a combination
of these
• Obtain a complete medical history
• List of current medications and drug allergies
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Interventions
•
•
•
•
Impaired Gas Exchange
Ineffective Airway Clearance
Anxiety
Imbalanced Nutrition: Less Than Body
Requirements
• Risk for Infection
• Activity Intolerance
• Decreased Cardiac Output
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Medical Treatment of COPD
• Drug therapy
• CorticosteroidsOxygen therapy
• Initial is usually 1 to 3 L/minute
• Chest physiotherapy
• Exercise
• Nutrition
• Supplementary feedings may be needed
• Good hydration
• Treatment of respiratory failure
• Oxygen therapy, aerosol bronchodilators, chest
physiotherapy, and mechanical ventilation
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Surgical Treatment
• Lung volume reduction surgery (LVRS)
• Up to 30% of hyperinflated lung tissue excised to
improve mechanics of breathing, enabling patient to
breathe more deeply
• Bullectomy (removal of bullae)
• Lung transplantation
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Complications
• Respiratory failure
• Cor Pulmonale
• Heart failure
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Cor Pulmonale
• Etiology
• Secondary to disease affecting structure or function of
lungs
• Pathophysiology
• Hypertrophy and dilation of RV
• Signs and symptoms
• Chronic cough, exertional dyspnea, wheezes,
fatigue and weakness
• Progresses to: dyspnea at rest, tachypnea,
orthopnea, dependent edema, distended neck
veins, hepatomegaly
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Bronchiectasis
• Abnormal dilation/distortion of bronchi and bronchioles;
usually confined to one lung lobe or segment
• Follows recurrent inflammatory conditions, infections,
or obstructions but is sometimes congenital
• Signs: coughing, production of large amounts of
purulent sputum
• Also fever, hemoptysis, nasal stuffiness, sinus
drainage, fatigue, and weakness
• Goals: control symptoms and prevent spread
• Treatment: antibiotic therapy, bronchodilators, chest
physiotherapy, and oxygen therapy
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Cystic Fibrosis
• Genetic disorder
• Chronic, progressive, fatal
• Respiratory
• Accumulation of thick tenacious secretions in
bronchioles and alveoli→→frequent URI, dyspnea,
paroxysmal cough, frequent bouts of pneumonia
• GI
• Diabetes and pancreatitis
• Blockage of pancreatic ducts →Hepatic failure and
cholecystitis, malabsorption of fat soluble vitamins,
poor digestion of fats→greasy, bulky stools and
poor weight gain (in spite of excessive appetite)
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Cystic Fibrosis
• Treatment
• Pancreatic enzyme replacement, chest
physiotherapy, and aerosol and nebulizer
treatments to reduce mucus viscosity
• Infections treated with antibiotics
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Cystic Fibrosis
• Nursing care
• To clear airway: administer prescribed medications,
maintain hydration, and perform chest
physiotherapy
• Prevent infection with medical asepsis and protect
patient from others with infections
• Maintain adequate nutrition: administer pancreatic
enzymes as ordered, allow for rest around
mealtimes, and encourage to consume adequate
nutrients
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Tuberculosis
• Etiology: mycobacterium tuberculosis
• Risk Factors
•
•
•
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Old age, infants
Immunosuppressed
Poor nutrition
Crowded living conditions
• Symptoms
•
•
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Cough (usually cough up mucus), Coughing up blood
Excessive sweating, especially at night
Fatigue, Fever
Unintentional weight loss
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Pathophysiology
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Transmission
Immune Response
Tubercle formation
Dissemination
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Medical Treatment
• Common preventive treatment is isoniazid
therapy for 9 to 12 months
• Individuals with inactive tuberculosis may be
treated with INH alone, INH with rifampin, or
rifampin with pyrazinamide
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Interventions
•
•
•
•
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Impaired Gas Exchange
Social Isolation
Risk for Injury
Fatigue
Imbalanced Nutrition: Less Than Body
Requirements
• Ineffective Therapeutic Regimen Management
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Interstitial Lung Disease
• Inflammation of the lower respiratory tract
→thickening and fibrosis of alveolar walls
• May be caused by inhaled substances or
connective tissue disorders; sometimes no
specific cause identified
• Examples: idiopathic pulmonary fibrosis
(occupational lung diseases), sarcoidosis
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Idiopathic Pulmonary Fibrosis
• Pathophysiology
• Formation of scar tissue in lung
• Irritants
• Complications
• Pulmonary hypertension, cor pulmonale, and
ventilatory failure
• Signs and symptoms
• Nonproductive cough and progressive dyspnea
• Inspirational crackles heard in the lungs on
auscultation
• Clubbing of the fingertips
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Occupational Lung Diseases
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Acute Respiratory Irritation
• Inhalation of gases such as ammonia or
chlorine
• Effects usually temporary
• May have coughing, wheezing, and dyspnea
• Symptoms resolve within a few days to several
weeks; usually no permanent lung damage
• Treatment: symptom management and
prevention
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Occupational Asthma
• Inhalation of plant or animal proteins; cause an
allergic reaction
• Treatment: same as for bronchial asthma
• Initial acute symptoms last only a few hours,
but patient may have hyperreactive airway for
years
• This means that future exposure to irritants
may trigger acute asthmatic symptoms
• Patient should avoid continued exposure to the
offending substance
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Hypersensitivity Pneumonitis
• Allergic inflammatory response of the alveoli to
inhaled organic particles
• May resolve in a few days, or patient may
contract pulmonary edema or interstitial fibrosis
with permanent restrictive or restrictiveobstructive disease
• Treated with corticosteroids and avoidance of
irritants; respiratory support may be needed if
symptoms are severe
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Pneumoconiosis
• Caused by inhalation of various dusts
• Characterized by diffuse pulmonary fibrosis
and restrictive lung disease
• Aggravated by cigarette smoking
• Treatment is symptomatic
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Chronic Restrictive
Pulmonary Disorders
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Sarcoidosis
• Pathophysiology
• Inflammatory condition
• Immune processes→formation of granulomas
• May be acute or chronic and disabling
• Signs and symptoms
• Some have no symptoms, others experience dry
cough, dyspnea, chest pain, hemoptysis, fatigue,
weakness, weight loss, and fever
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Sarcoidosis
• Medical diagnosis
• Chest radiography, pulmonary function tests, and
flexible bronchoscopy with transbronchial lung
biopsy
• Medical treatment
• If patient is asymptomatic, no treatment is indicated
• 6- to 12-month course of systemic corticosteroids
• Methotrexate used as an alternative to
corticosteroids
• Lung transplantation only option for patients with
end-stage disease who do not respond to drug
therapy
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Lung Cancer
• Etiology and risk factors
• Leading cause of cancer death in the United States
• Cigarette smoking: leading cause
• Risk increased more for smokers exposed to other
carcinogenic substances, such as arsenic,
asbestos, and radioactive materials
• Evidence that “secondhand” smoke a threat to
nonsmokers
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Lung Cancer
• Medical diagnosis
• Radiographic procedures (chest radiography, CT
scan, MRI), fiberoptic bronchoscopy, sputum
cytology studies, and biopsy of tissue obtained
through bronchoscopy, percutaneous transthoracic
fine-needle biopsy, thoracotomy, or other methods
• Radionuclide scans of bones, liver, or brain to
detect metastatic lesions
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Lung Cancer
• Medical treatment
•
•
•
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Radiotherapy
Chemotherapy
Targeted biologic therapies
Surgical treatment
• Wedge resection, sleeve lobectomy, segmental resection,
lobectomy, or pneumonectomy
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Figure 31-9
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Lung Cancer
• Nursing care
• Nurses must continue to educate the public about
the dangers of cigarette smoking to help eliminate
the primary cause of lung cancer
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Extrapulmonary Disorders
• Chest deformities interfere with lung expansion
• Neuromuscular diseases such as myasthenia
gravis and amyotrophic lateral sclerosis affect
the muscles of respiration
• Head or spinal cord injuries can disrupt the
breathing center in the brain or the neural
control of the diaphragm
• Heart failure with pulmonary edema fills lungs
with fluid, interfering with the exchange of
gases
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