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Respiratory Patho Chronic Obstructive Pulmonary Disease Also called COLD-- chronic obstructive lung disease Emphysema Chronic bronchitis Asthma Emphysema What is it? Destruction of alveolar walls-- below the bronchioles Decreases surface area Decreases area available for exchange Increase resistance to pulmonary blood flow Emphysema cont... Can lead to pulmonary hypertension Cor pulmonale = right heart failure Lungs can not recoil and air is trapped Residual lung capacity increases PO2 decreases over time Increased RBC Polycythemia-- high hematocrit Emphysema cont... PCO2 increased Hypoxic drive Causes Complications of disease Pneumonia URI Dysrhythmias cancer Emphysema cont... Home drugs Bronchodilators Steroids Later-- oxygen Emphysema cont.. Assessment Weight loss-- thin Dyspnea esp on exertion Cough only in AM Barrel chest Tachypnea Emphysema cont.. Pink puffers Enlarged accessory muscles Clubbing of fingers Pursed lips-- prolonged expiration-- active now Wheezing or rhonchi may or may not be present Chronic bronchitis Increase in the number of mucous cells Large amount of sputum Diffusion normal Hypercarbia due to deceased alveolar ventilation Chronic bronchitis Assessment Overweight Blue bloaters Rhonchi RHF-- JVD, pedal edema Management of COPD Goal??? Treat hypoxia Reverse bronchoconstriction Reassure patient-- EMONTIONAL support Oxygen using patient distress to determine amount Monitor for cardiac dysrhythmias Management of COPD IV 5% D/W or NS KVO Nebulizer Albuterol, Proventil Ventolin isoethharine, Bronksol metrproterenol, Alupent Sympathomimetic, Beta agonist B2 selective Management of COPD Bronchodilation Uses-- COPD, Pul edema, asthma, severe allergic reactions Contraindications-- tachycardia Monitor B/P, pulse, ECG Side effects-- tachycardia, palpitations, anxiety,headache, dizzy Asthma Asthma patients do die Increasing deaths over 45 years old Higher death rate in Afro-Americians definition Chronic disease due to air flow obstruction Small airways consrtict Asthma Causes of acute excerbations allergens cold air irritants-- smoke, pollen medications Asthma Phase one Release of histamine Bronchoconstriction and bronchial edema Usually will respond to Beta agonist Phase two WBC invade bronchioles Cause edema and swelling of bronchioles Asthma Phase 2 will not respond well to Beta agonists May need steroids Assessment Dyspnea and wheezing Cough Hyperressonance Asthma Assessment cont. Tachypnea Use of accessory muscles Speech dyspnea History-- what did pt take beta agonist?, steroids, anticholinergics, bronchodilators? Asthma History of admissions to hospital for asthma Hx of intubations? Management Corect hypoxia, reverse bronchospasm Treat inflammatory process Asthma treatment Emotional support Primary and secondary survey Oxygen EKG and pulse ox Beta agonist-- nebulizer Epinephrine SQ 0.3-0.5 mg or cc 1:1000 solution Peds 0.01 mg.kg up to 0.3mg Asthma treatment Aminophyllin-- Xanthine bronchodilator (not a beta agonist) Solu Medrol--- steroid Status Asthmaticus Severe, prolonged asthma attack which can not be broken by usual treatment Wheezing may be absent-- silent chest Severe acidosis May have to intubate Pneumonia More prevalent in??? Elderly HIV positive Peds Infection in the lungs Bacterial, viral, fungal Pneumonia Assessment “looks sick” fever and chills tachypnea, tachycardia general weakness-- malaise Productive cough-- yellow, blood-tinged Chest pain-- upper abd pain Pneumonia Rhoncho, wheezing, rales percussion??? Management Emotional support Primary and secondary survey O2, EKG, Pulse ox, IV-- may be dehyrated Position, when would nebulizer be used? Toxic inhalation May cause inflammation and constriction or laryngospasm or edema of larynx superheated air toxic products chemicals inhaled steam Toxic inhalation Scene safety If hoarseness, brassy cough or stridor-possible laryngeal edema-- be careful May need to intubate Humidified O2, IV, EKG, Pulse ox Be careful about nebulized drugs Carbon monoxide Odorless, tasteless gas binds with hemoglobin 200 faster than oxygen receptor sites do not transport oxygen cellular hypoxia history-- how long and where Carbon monoxide Signs and symptoms headache and irritability confusion or agitation vomiting, chest pain, LOC, seizures Cyanotic, cherry red is late sign Carbon monoxide Management Remove from site Airway, high oxygen treat for respiratory depression or shock Hyperbaric Pulmonary embolus Blood, air, foreign body that lodges in pulmonary artery Many are diagnosed on autopsy S and S Sudden unexplained SOB Chest pain may or may not be present Shock symptoms Pulmonary embolus Who is at risk long term immoblization BCP Hx of thrombophlebitis Delivery long bone fx Pulmonary embolus Management Transport ASAP High O2, position Emotional support IV, pulse ox, EKG, 12 lead May need to tube Hyperventilation syndrome Anxiety or situational problem consider other medical problems do not minimize loss of CO2 cause Respiratory Alkalosis rapid and shallow respirations nervous, dizzy, chest pain Hyperventilation syndrome Numbness and tingling-- mouth, hands, feet carpopedal spasms Treatment EMOTIONAL SUPPORT slow respirations Central nervous system dysfunction Head trauma, stroke, brain tumor, drugs dysfunctional of spinal cord, nerves, respiratory muscles spinal cord trauma, polio, myasthenia gravis, Lou Geriigh’s disease, MS, MD
