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Chapter 49
Care of the Patient with a
Respiratory Disorder
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and
Physiology
• External respiration

Exchange of oxygen and carbon dioxide between the
lung and the environment
• Internal respiration

Exchange of oxygen and carbon dioxide at the cellular
level
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Slide 2
Overview of Anatomy and
Physiology
• Upper respiratory tract

Nose
 Pharynx
 Larynx
 Trachea
• Lower respiratory tract

Bronchial tree
• Bronchioles, alveolar ducts, alveoli
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Slide 3
Overview of Anatomy and
Physiology
• Mechanics of breathing

Thoracic cavity
• Lungs

Visceral pleura and parietal pleura
• Respiratory movements and ranges

Rhythmic movements of the chest walls, ribs, and
muscles allow air to be inhaled and exhaled
• Regulation of respiration

Nervous control—medulla oblongata and pons of the
brain; chemoreceptors—in the carotid and aorta
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Slide 4
Assessment of the Respiratory
System
• Subjective data

Shortness of breath, dyspnea, cough
• Objective data

Expression, chest movement, and respirations
 Respiratory distress, wheezes, or orthopnea
 Adventitious breath sounds
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Sibilant wheezes
Sonorous wheezes
Crackles
Pleural friction rubs
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Slide 5
Laboratory and Diagnostic
Examinations
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Chest roentgenogram
Computed tomography (CT)
Pulmonary function testing
Mediastinoscopy
Laryngoscopy
Bronchoscopy
Sputum specimen
Cytological studies
Thoracentesis
Arterial blood gases
Pulse oximetry
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Slide 6
Figure 49-7
(A, Courtesy of Olympus America, Melville, New York. B, from Meduri, G.U., et al. [1991]. Protected
bronchoalveolar lavage, American Review of Respiratory Disease, 143:855, official journal of the
American Thoracic Society, © American Lung Association.)
Fiberoptic bronchoscope.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Figure 49-8
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Thoracentesis.
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Slide 8
Figure 49-9
(From Potter, P.A., Perry, A.G. [2009]. Fundamentals of nursing. [7th ed.]. St. Louis: Mosby.)
Portable pulse oximeter with spring-tension digit probe displays
oxygen saturation and pulse rate.
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Slide 9
Disorders of the Upper Airway
• Epistaxis

Etiology/pathophysiology
• Bleeding from the nose
• Congestion of the nasal membranes leading to capillary
rupture
• Primary or secondary

Clinical manifestations/assessment
• Bright red bleeding from one or both nostrils
• Can lose as much as 1 liter per hour
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Slide 10
Disorders of the Upper Airway
• Epistaxis (continued)

Medical management/nursing interventions
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Sitting position, leaning forward
Direct pressure by pinching nose
Ice compresses to nose
Nasal packing
Cautery
Balloon tamponade
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Slide 11
Disorders of the Upper Airway
• Deviated septum and nasal polyps

Etiology/pathophysiology
• Congenital abnormality
• Injury
• Nasal septum deviates from the midline and can cause
a partial obstruction
• Nasal polyps are tissue growths usually due to
prolonged inflammation
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Slide 12
Disorders of the Upper Airway
• Deviated septum and nasal polyps (continued)

Clinical manifestations/assessment
• Stertorous respirations (snoring)
• Dyspnea
• Postnasal drip

Medical management/nursing interventions
• Pharmacological management

Corticosteroids, antihistamines, antibiotics, analgesics
• Nasoseptoplasty
• Nasal polypectomy
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Slide 13
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (hay fever)

Etiology/pathophysiology
• Antigen/antibody reactions in the nasal membranes,
nasopharynx, and conjunctiva due to allergens

Diagnostic testing
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Slide 14
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (continued)

Clinical manifestations/assessment
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Edema
Photophobia
Excessive tearing
Blurring of vision
Pruritus
Excessive nasal secretions and/or congestion
Sneezing
Cough
Headache
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Slide 15
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (continued)
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Diagnostic testing
Medical management/nursing interventions
• Pharmacological management
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Antihistamines
Decongestants
Corticosteroids
Analgesics
• Avoid allergen
• Hot packs over facial sinuses
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Slide 16
Figure 49-3
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Projections of paranasal sinuses and oral nasal cavities on the skull and
face.
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Slide 17
Disorders of the Upper Airway
• Obstructive sleep apnea (OSA)

Etiology and pathophysiology
• Characterized by partial or complete upper airway
obstruction during sleep
• Apnea refers to the cessation of spontaneous
respirations
• Hypopnea is the presence of unusually shallow or slow
respirations
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Slide 18
Disorders of the Upper Airway
• Obstructive sleep apnea (OSA)
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Clinical manifestations
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Frequent awakening at night
Insomnia
Excessive daytime fatigue
Witnessed apneic episodes
Loud snoring
Hypercapnia
Personality changes
Irritability
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Slide 19
Disorders of the Upper Airway
• Obstructive sleep apnea (continued)
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Complications
Diagnostic tests
Medical management/nursing interventions
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Avoid sedatives
Avoid alcoholic beverages
Support groups
Oral appliances
nCPAP
Surgery
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Slide 20
Disorders of the Upper Airway
• Upper airway obstruction
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Etiology and pathophysiology
• Precipitated by a recent respiratory event
• Common airway obstructions
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Choking on food
Dentures
Aspiration of vomitus or secretions
The tongue
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Slide 21
Disorders of the Upper Airway
• Upper airway obstruction (continued)

Clinical manifestations/assessment
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Stertorous respirations
Altered respiratory rate and character; apneic periods
Hypoxia; cyanosis
Wheezing; stridor
Medical management/nursing interventions
• Open the airway
• Remove obstruction
• Artificial airway; tracheostomy
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Slide 22
Disorders of the Upper Airway
• Cancer of the larynx
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Etiology/pathophysiology
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Squamous cell carcinoma
Heavy smoking and alcohol use
Chronic laryngitis
Vocal abuse
Family history
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Slide 23
Disorders of the Upper Airway
• Cancer of the larynx (continued)

Clinical manifestations/assessment
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Progressive or persistent hoarseness
Pain radiating to the ear
Difficulty swallowing
Hemoptysis
Medical management/nursing interventions
• Radiation
• Surgery


Partial or total laryngectomy
Radical neck dissection
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Slide 24
Respiratory Infections
• Acute rhinitis (common cold)

Etiology/pathophysiology
• Inflammation of the mucous membranes of the nose
and accessory sinuses
• Virus(es)

Clinical manifestations/assessment
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Thin, serous nasal exudate
Productive cough
Sore throat
Fever
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Slide 25
Respiratory Infections
• Acute rhinitis (common cold) (continued)

Medical management/nursing interventions
• Pharmacological management
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Analgesic
Antipyretic
Cough suppressant
Expectorant
Antibiotic (if infection present)
• No specific treatment
• Encourage fluids
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Slide 26
Respiratory Infections
• Acute follicular tonsillitis
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Etiology/pathophysiology
• Inflammation of the tonsils
• Bacterial or viral infection
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Clinical manifestations/assessment
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Enlarged, tender, cervical lymph nodes
Sore throat
Fever; chills
Enlarged, purulent tonsils
Elevated WBC
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Slide 27
Respiratory Infections
• Acute follicular tonsillitis (continued)

Medical management/nursing interventions
• Pharmacological management

Antibiotics; analgesics; antipyretics
• Warm saline gargles
• Tonsillectomy and adenoidectomy

Postoperative
o Assess for excessive bleeding
o Ice-cold liquids—ice cream
o Ice collar
o Avoid coughing, sneezing, or vigorous nose blowing
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Slide 28
Respiratory Infections
• Laryngitis

Etiology/pathophysiology
• Inflammation of the larynx due to virus or bacteria
• May cause severe respiratory distress in children under
5 years old

Clinical manifestations/assessment
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Hoarseness
Voice loss
Scratchy and irritated throat
Persistent cough
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Slide 29
Respiratory Infections
• Laryngitis (continued)

Medical management/nursing interventions
• Pharmacological management
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Analgesics
Antipyretics
Antitussives
Antibiotics—bacterial
• Viral—no specific treatment, supportive care
• Warm or cool mist vaporizer
• Limit use of voice
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Slide 30
Respiratory Infections
• Pharyngitis

Etiology/pathophysiology
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Inflammation of the pharynx
Chronic or acute
Frequently accompanies the common cold
Viral, most common
Bacterial
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Slide 31
Respiratory Infections
• Pharyngitis (continued)

Clinical manifestations/assessment
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Dry cough
Tender tonsils
Enlarged cervical lymph glands
Red, sore throat
Fever
Medical management/nursing interventions
• Pharmacological management

Antibiotics; analgesics; antipyretics
• Warm or cool mist vaporizer
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Slide 32
Respiratory Infections
• Sinusitis
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Etiology/pathophysiology
• Inflammation of the sinuses
• Usually begins with an upper respiratory infection; viral
or bacterial

Clinical manifestations/assessment
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Constant, severe headache
Pain and tenderness in involved sinus region
Purulent exudate
Malaise
Fever
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Slide 33
Respiratory Infections
• Sinusitis (continued)

Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Antihistamines
Vasoconstrictor nasal spray (Afrin)
Warm mist vaporizer
Warm, moist packs
Nasal windows
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Slide 34
Disorders of the Lower Airway
• Acute bronchitis

Etiology/pathophysiology
• Inflammation of the trachea and bronchial tree
• Usually secondary to upper respiratory infection
• Exposure to inhaled irritants

Clinical manifestations/assessment
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Productive cough; wheezes
Dyspnea; chest pain
Low-grade fever
Malaise; headache
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 35
Disorders of the Lower Airway
• Acute bronchitis (continued)
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Medical management/nursing interventions
• Pharmacological management
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Cough suppressants
Antitussives
Antipyretics
Bronchodilators
Antibiotics
• Vaporizer
• Encourage fluids
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 36
Disorders of the Lower Airway
• Legionnaires’ disease
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Etiology/pathophysiology
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Legionella pneumophila
Thrives in water reservoirs
Causes life-threatening pneumonia
Leads to respiratory failure, renal failure, bacteremic
shock, and ultimately death
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Slide 37
Disorders of the Lower Airway
• Legionnaires’ disease (continued)
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Clinical manifestations/assessment
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Elevated temperature
Headache
Nonproductive cough
Difficult and rapid respirations
Crackles or wheezes
Tachycardia
Signs of shock
Hematuria
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 38
Disorders of the Lower Airway
• Legionnaires’ disease (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Antipyretics
Vasopressors
• Oxygen
• Mechanical ventilation, if necessary
• IV therapy
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Slide 39
Disorders of the Lower Airway
• Severe Acute Respiratory Syndrome (SARS)
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Etiology/pathophysiology
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Infection caused by coronavirus
Spread by close contact between people
Airborne
May be spread by touching contaminated objects
Clinical manifestations/assessment
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Temperature
Headache
Muscle aches
Mild respiratory symptoms

Dry cough and SOB
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Slide 40
Disorders of the Lower Airway
• Adult respiratory distress syndrome (continued)
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Diagnostic tests
• Chest radiograph
• Serum antibody testing
• Nasopharyngeal and oropharyngeal swabs
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Medical management/nursing interventions
• Pharmacological management


Antibiotics
Antiviral medications
• Respiratory isolation
• Oxygen
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 41
Disorders of the Lower Airway
• Anthrax

Etiology/pathophysiology
• Bacillus anthracis
• Spread by direct contact with bacteria or spores
• Three types: Cutaneous, GI, inhalational

Clinical manifestations/assessment
• Cold or flu-like symptoms
• Hemorrhage, tissue necrosis, and lymphedema

Medical management
• Antibiotics
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Slide 42
Disorders of the Lower Airway
• Tuberculosis
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Etiology/pathophysiology
• Inhalation of tubercle bacillus (Mycobacterium
tuberculosis)
• Infection versus active disease
• Presumptive diagnosis
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Mantoux tuberculin skin test
Chest x-ray film
Acid-fast bacilli smear  3
• Confirmed diagnosis
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Sputum culture; positive for TB bacilli
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Slide 43
Disorders of the Lower Airway
• Tuberculosis (continued)
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Clinical manifestations/assessment
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Fever
Weight loss; weakness
Productive cough; hemoptysis
Chills; night sweats
Medical management/nursing interventions
• Tuberculosis isolation (acid-fast bacilli [AFB])
• Multiple medications to which the organisms are
susceptible
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Slide 44
Disorders of the Lower Airway
• Pneumonia
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Etiology/pathophysiology
• Inflammatory process of the bronchioles and the
alveolar spaces due to infection
• Bacteria, viruses, mycoplasma, fungi, and parasites
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Clinical manifestations/assessment
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Productive cough
Severe chills; elevated temperature
Increased heart rate and respiratory rate
Dyspnea
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Slide 45
Disorders of the Lower Airway
• Pneumonia (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Expectorants
Bronchodilators
Oxygen
Chest percussion and postural drainage
Encourage to cough and deep-breathe
Humidifier or nebulizer
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Slide 46
Disorders of the Lower Airway
• Pleurisy
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Etiology/pathophysiology
• Inflammation of the visceral and parietal pleura
• Bacterial or viral
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Clinical manifestations/assessment
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Sharp inspiratory pain
Dyspnea
Cough
Elevated temperature
Pleural friction rub
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Slide 47
Disorders of the Lower Airway
• Pleurisy (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Antipyretics
• Oxygen
• Anesthetic block for intercostal nerves
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 48
Disorders of the Lower Airway
• Pleural effusion/empyema
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Etiology/pathophysiology
• Pleural effusion
• Accumulation of fluid in the pleural space
• Empyema—infection

Clinical manifestations/assessment
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Dyspnea
Air hunger
Respiratory distress
Fever
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 49
Disorders of the Lower Airway
• Pleural effusion/empyema (continued)

Medical management/nursing interventions
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Thoracentesis
Chest tube with closed water-seal drainage system
Antibiotics
Cough and deep-breathe
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Slide 50
Disorders of the Lower Airway
• Atelectasis
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Etiology/pathophysiology
• Collapse of lung tissue due to occlusion of air to a
portion of the lung

Clinical manifestations/assessment
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Dyspnea; tachypnea
Pleural friction rub; crackles
Restlessness
Elevated temperature
Decreased breath sounds
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Slide 51
Disorders of the Lower Airway
• Atelectasis (continued)
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Medical management/nursing interventions
• Pharmacological management
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
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Bronchodilators
Antibiotics
Mucolytic agents
Analgesics
• Cough and deep-breathe
• Early ambulation
• Respiratory treatments
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

Incentive spirometry; intermittent positive-pressure breathing
(IPPB)
Oxygen
Chest percussion and postural drainage
• Chest tube
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Slide 52
Disorders of the Lower Airway
• Pneumothorax

Etiology/pathophysiology
• A collection of air or gas in the pleural space, causing
the lung to collapse

Clinical manifestations/assessment
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•
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Decreased breath sounds
Sudden, sharp chest pain with dyspnea
Diaphoresis; tachycardia; tachypnea
No chest movement on affected side
Sucking chest wound
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Slide 53
Figure 49-13
(From Wilson, S., Thompson, J. [1991]. Respiratory disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Pneumothorax
(complete collapse of the right lung).
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 54
Disorders of the Lower Airway
• Pneumothorax (continued)

Medical management/nursing interventions
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•
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Chest tube to water-seal drainage system
Oxygen
Analgesics
Encourage fluids
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 55
Disorders of the Lower Airway
• Lung cancer

Etiology/pathophysiology
• Primary tumor or metastasis
• Small-cell, non–small-cell, squamous cell, and large-cell
carcinoma

Clinical manifestations/assessment
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•
Hemoptysis
Dyspnea; wheezing
Fever; chills
Pleural effusion
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Slide 56
Disorders of the Lower Airway
• Lung cancer (continued)

Medical management/nursing interventions
• Surgery




Most are not diagnosed early enough for curative surgical
intervention
Segmental resection
Lobectomy
Pneumonectomy
• Radiation
• Chemotherapy
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Slide 57
Disorders of the Lower Airway
• Pulmonary edema

Etiology/pathophysiology
• Accumulation of serous fluid in interstitial tissue and
alveoli

Clinical manifestations/assessment
•
•
•
•
•
•
Dyspnea; cyanosis
Tachypnea; tachycardia
Pink or blood-tinged, frothy sputum
Restlessness; agitation
Wheezing; crackles
Decreased urinary output; sudden weight gain
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Slide 58
Disorders of the Lower Airway
• Pulmonary edema (continued)

Medical management/nursing interventions
• Pharmacological management



•
•
•
•
Diuretics
Narcotic analgesics
Nipride
Oxygen
Mechanical ventilation, if necessary
Strict I&O; daily weight
Low-sodium diet
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 59
Disorders of the Lower Airway
• Pulmonary embolism

Etiology/pathophysiology
• Foreign substance in the pulmonary artery


Blood clot, fat, air, or amniotic fluid
Clinical manifestations/assessment
•
•
•
•
•
Sudden, unexplained dyspnea, tachypnea
Hemoptysis
Chest pain
Elevated temperature
Increased WBCs
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 60
Disorders of the Lower Airway
• Pulmonary embolism (continued)

Medical management/nursing interventions
• Pharmacological management


Anticoagulants
Fibrinolytic agents
• Oxygen
• HOB up 30 degrees
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 61
Disorders of the Lower Airway
• Acute respiratory distress syndrome (ARDS)

Etiology and pathophysiology
• Results from direct or indirect pulmonary injury
• Alveolar capillary membranes are altered resulting
increased permeability creating pulmonary edema and
hypoxia
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 62
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Clinical manifestations
•
•
•
•
•
Respiratory distress
Changes in level of consciousness
Tachycardia
Hypotension
Decreased urinary output
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 63
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Medical management/nursing interventions
• Pharmacological management









Corticosteroids
Antibiotics
Vasodilators
Bronchodilators
Mucolytics
Diuretics
Morphine sulfate
Neurologic blocking agents
Cardiotonic glycosides (digoxin)
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 64
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Medical management/nursing interventions
(continued)
• Oxygen
• Position changes
• Close assessment of vital signs
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 65
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema

Etiology/pathophysiology
• The bronchi, bronchioles, and alveoli become inflamed
as a result of chronic irritation
• Air becomes trapped in the alveoli during expiration,
causing alveolar distention, rupture, and scar tissue

Complication
• Cor pulmonale

Right-sided congestive heart failure due to pulmonary
hypertension
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 66
Figure 49-14
(From Lewis, S.M., Collier, I., & Heitkemper, M.M. [1996]. Medical-surgical nursing: assessment and
management of clinical problems. [4th ed.]. St. Louis: Mosby.)
Disorders of the airways in patients with chronic bronchitis, asthma,
and emphysema.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 67
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
Dyspnea on exertion
Sputum
Barrel chest
Chronic weight loss
Emaciation
Clubbing of fingers
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 68
Figure 49-16
Barrel chest. Note increase in AP diameter.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 69
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema (continued)

Medical management/nursing interventions
• Pharmacological management

•
•
•
•
•
Bronchodilators; corticosteroids; antibiotics; diuretics
Oxygen (low-flow)
Chest physiotherapy
Humidifier
Pursed-lip breathing
High-protein, high-calorie diet
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 70
Chronic Obstructive Pulmonary
Disease (COPD)
• Chronic bronchitis

Etiology/pathophysiology
• Hypertrophy of mucous glands causes hypersecretion
and alters cilia function
• Increased airway resistance causes bronchospasm

Clinical manifestations/assessment
•
•
•
•
Productive cough
Dyspnea
Use of accessory muscles to breathe
Wheezing
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 71
Chronic Obstructive Pulmonary
Disease (COPD)
• Chronic bronchitis (continued)

Medical management/nursing interventions
• Pharmacological management



Bronchodilators
Mucolytics
Antibiotics
• Oxygen (low-flow)
• Pursed-lip breathing
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 72
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma

Etiology/pathophysiology
•
•
•
•
Narrowing of the airways due to various stimuli
Extrinsic or intrinsic factors
Influenced by secondary factors
Antigen-antibody reaction
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 73
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma (continued)

Clinical manifestations/assessment
• Mild asthma


Dyspnea on exertion
Wheezing
• Acute asthma attack




Tachypnea
Expiratory wheezing; productive cough
Use of accessory muscles; nasal flaring
Cyanosis
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 74
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma (continued)

Medical management/nursing interventions
• Maintenance therapy



Serevent inhalant, prophylactic
Corticosteroid inhalant
Avoid allergens
• Acute or rescue therapy



Proventil inhalant; aminophylline IV
Corticosteroid and epinephrine oral or subcutaneous
Oxygen
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 75
Chronic Obstructive Pulmonary
Disease (COPD)
• Bronchiectasis

Etiology/pathophysiology
• Gradual, irreversible process that involves chronic
dilation of bronchi resulting in loss of elasticity

Clinical manifestations/assessment
•
•
•
•
Dyspnea; coughing; wheezes and crackles
Cyanosis; clubbing of fingers
Fatigue; weakness
Loss of appetite
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 76
Chronic Obstructive Pulmonary
Disease (COPD)
• Bronchiectasis (continued)

Medical management/nursing interventions
• Pharmacological management



•
•
•
•
•
Mucolytic agents
Antibiotics
Bronchodilators
Oxygen (low-flow)
Chest physiotherapy
Hydration
Cool mist vaporizer
Surgery: Lobectomy
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 77
Nursing Process
• Nursing diagnoses

Airway clearance, ineffective
 Breathing pattern, ineffective
 Gas exchange, impaired
 Anxiety
 Activity intolerance
 Nutrition, imbalanced: less than body requirements
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 78