Diseases of the Lower Respiratory System Nursing II Valencia Community College

CHRONIC OBSTRUCTIVE PULMONARY DISEASE The client with

COPD Description Description –Chronic airflow obstruction Irreversible Irreversible –Chronic bronchitis and/or emphysema Incidence Incidence –13.5 million Americans have bronchitis –2 million Americans have emphysema –4 th leading cause of death –Death rate still rising –2 nd cause of disability in people > 65

COPD (cont.) Risk Factors Risk Factors –SMOKING –Age –Male gender –Air pollution –Occupational exposure –Respiratory infections –Familial & genetic factors

COPD (cont.) Pathophysiology Pathophysiology –Slow, progressive –Exacerbations  destructive changes –Usually have both chronic bronchitis and emphysema And frequently asthma And frequently asthma

Emphysema Patho Loss of lung elasticity Loss of lung elasticity Hyperinflation of the lungs Hyperinflation of the lungs Alveolar walls and small airways damaged Alveolar walls and small airways damaged –Airways narrow or collapse –Air trapping –Alveolar damage = poor gas exchange

Chronic Bronchitis Patho Inflammation caused by chronic irritation Inflammation caused by chronic irritation Cause vasodilation → congestion → edema → bronchospasm Cause vasodilation → congestion → edema → bronchospasm  mucous production  mucous production Thickened bronchial walls Thickened bronchial walls Narrowing of airways = poor gas exchange Narrowing of airways = poor gas exchange

Diagnostics ABG ABG Sputum C & S Sputum C & S CXR CXR CBC CBC Electrolytes Electrolytes Pulmonary function testing Pulmonary function testing Genetic testing Genetic testing

Manifestations of COPD Absent or minor early Absent or minor early Client usually seeks care after 10 yrs of signs and symptoms Client usually seeks care after 10 yrs of signs and symptoms –When ADLs affected

Manifestations General Appearance General Appearance –Thin with loss of muscle mass in arms and legs –Stooped posture –Slow moving

Manifestations Respiratory Respiratory –Shallow, rapid respirations –Use of accessory muscles –Crackles, rhonchi, distant breath sounds –Dyspnea –Barrel chested –Bronchitis; Cyanotic, increased mucus, clubbing, cough Cyanotic, increased mucus, clubbing, cough

Manifestations Cardiac Cardiac –Tachycardia –Irregular pulse –Dependent edema JVD JVD –Clubbing –Emphysema: Cyanosis with advanced disease Cyanosis with advanced disease Pallor Pallor

Manifestations Psychosocial Psychosocial –Isolation Fatigue Fatigue Embarrassment Embarrassment Smoking Smoking –Negative self image Change in role Change in role –Anxiety and fear

Collaborative Care Impaired Gas Exchange Impaired Gas Exchange –Patent airway = pulmonary toilet –Assess frequently –Oxygen Keep O2 sat > 88% Keep O2 sat > 88% –Medications –Energy management –Surgical Lung transplant Lung transplant Lung reduction Lung reduction

Collaborative Care Ineffective Breathing Pattern Ineffective Breathing Pattern –Teach effective breathing techniques Pursed lip Pursed lip Diaphragmatic/Abdominal Diaphragmatic/Abdominal –Exercise conditioning Respiratory rehab Respiratory rehab –Energy Conservation Rest between ADLs Rest between ADLs

Collaborative Care Ineffective Airway Clearance Ineffective Airway Clearance –Effective coughing Controlled coughing Controlled coughing –Chest PT –Postural drainage/positioning –Suctioning –Hydration Careful if bronchitis present Careful if bronchitis present

Collaborative Care Nutrition: Less Than Body Requirements Nutrition: Less Than Body Requirements –Small, frequent meals High calorie, high protein, low sodium High calorie, high protein, low sodium Pulmocare Pulmocare –Oral hygiene –Rest before meals –Assist with eating –No treatments at meal time

Collaborative Care Anxiety Anxiety –Inform patient of all aspects of care –Know what to do if ↑ in signs and symptoms –Support group –Complementary therapy

Collaborative Care Activity Intolerance Activity Intolerance –Pacing activities –Assess during activities for hypoxia –May need supplemental O2

Collaborative Care Potential For Infection (Respiratory) Potential For Infection (Respiratory) –Flu and Pneumonia vaccines yearly –Avoid large crowds

Home Care –Infection prevention –Breathing exercises –ADL assistance –Pulmonary rehab program –Dealing with chronic illness –May need a social worker

The Client with Pneumonia

Definition Excess fluid in lungs from inflammatory process Excess fluid in lungs from inflammatory process Types Types –Infectious → Viral or Bacterial Community acquired Community acquired Nosocomial Nosocomial –Inhalation of Irritants

Incidence 2 – 4 million cases in US yearly 2 – 4 million cases in US yearly 5 th leading cause of death 5 th leading cause of death  incidence  incidence –Elderly –LTC residents –Hospitalized clients –On ventilators

Incidence Continued More in fall and winter months More in fall and winter months Community acquired > nosocomial Community acquired > nosocomial

Risk Factors Community Acquired Community Acquired –Older Adult –No pneumococcal or flu vaccines –Chronic illness –Smoking –Alcohol –Exposure to viral or bacterial infections

Risk Factors Continued Nosocomial Nosocomial –Older adult –COPD –  LOC –Aspiration –Poor nutrition –Immune suppressed –Mechanical ventilation

Pathophysiology Organism invades airway Organism invades airway Multiples in alveoli Multiples in alveoli Inflammation in interstitial spaces, alveoli, and bronchioles Inflammation in interstitial spaces, alveoli, and bronchioles Fluids collect in alveoli Fluids collect in alveoli  gas exchange  gas exchange

Patho Continued Fibrin and RBCs move into alveoli Fibrin and RBCs move into alveoli –Causes stiffening =  compliance Alveoli collapse Alveoli collapse Consolidation occurs Consolidation occurs Infection spreads to other lung areas Infection spreads to other lung areas

Sites of Pneumonia Lobar pneumonia Lobar pneumonia –Segment or lobe of the lung Bronchopneumonia Bronchopneumonia –In bronchus and bronchioles

Diagnostics ABGs ABGs CBC, Lytes CBC, Lytes –May need HIV testing Sputum gram stain and C & S Sputum gram stain and C & S CXR CXR Bronchoscopy Bronchoscopy

Manifestations General Appearance General Appearance –Flushed fever fever –Anxious –Muscle weakness –Headache –Chills –Poor appetite

Manifestations Respiratory Respiratory –Productive cough –Tachypnea, orthopneic –Use of accessory muscles –Crackles, wheezing –Pleuritic pain

Complications of Pneumonia Hypoxemia Hypoxemia Respiratory failure Respiratory failure Atelectasis Atelectasis Pleural effusion Pleural effusion Pleurisy Pleurisy Empyema Empyema Sepsis Sepsis

Collaborative Care Impaired Gas Exchange/Airway Clearance Impaired Gas Exchange/Airway Clearance –Oxygen –Pulmonary toilet –Effective cough –Hydration –Medications

Collaborative Care Acute Pain Acute Pain –Medicate for effective coughing Splinting Splinting –Positioning

Collaborative Care Fluid Volume Deficit Fluid Volume Deficit Disturbed Sleep Patterns Disturbed Sleep Patterns Potential for Sepsis Potential for Sepsis –What interventions would you do?

Home Care Inquire about medical equipment for home use Inquire about medical equipment for home use Activity tolerance Activity tolerance