Medsurge RESPIRATORY DISEASES study guide
A. Chronic Obstructive Pulmonary Disease (COPD)/ Chronic airflow limitation
Chronic bronchitis-
... [Show More] inflammation of the bronchioles
Emphysema- destruction of the alveoli
Risk factors:
• Cigarette smoking (how many packs per day?; pack-years= packs/day x years)
• Over exposure to infections (URTI)
• Pollution (fumes/smoke)
• Deficiency in a-antitrypsin (hereditary lung disorder)
Patho:
1. Inflammation and infection: chronic bronchitis(blue bloaters)
* ineffective airway clearance
*increase mucus production- causes crackles
*productive cough (thick and tenacious white/ grey sputum)
2. Decreased blood Oxygen(hypoxemia)
3. Decreased oxygen in cells and tissues (hypoxia)
4. Bluish discoloration(cyanosis)=chronic bronchitis
5. Destruction/damage of alveoli (over distended alveoli): emphysema(pink puffers)
*impaired gas exchange
*CO2 trapping
*respiratory acidosis (prolonged expiration, hyperventilate-“Puffing”)
6. Decreased oxygen
Signs and symptoms:
• Hypoxia (restlessness, irritability)
• Dyspnea (SOB, RR > 30 cpm,
use of accessory muscles)
• Cough
• Cyanosis
• Nasal flaring
• Orthopnea (DOB when supine/ flat on bed)
• Barrel chest (increased chest AP diameter of 1:1)
• Hyper-resonance
• Clubbing of the fingers
Diagnostic test:
• ABG:
• X-RAY:
COPD: + increased secretions (dirty lung)
Emphysema: + hyperinflated chest
• O2 saturation: <95%
Management:
• Bronchodilators
Action: relaxes the bronchus (dilation)
(“ol”- salbutamol)
(“phylline”- xanthines)
*inhalation through metered dose inhalers(MDI)
*DOG given first before steroids
• Steroids (“sone”)
Action: reduces inflammation
*inhalation through MDI
• Mucolytics (“cysteine” / flumocil)
Action: loosens secretions
• Expectorants (robitussin)
Action: help expel secretions
• Promote airway
• Increase fluid intake (at least 3L per day)- loosens secretions
• Coughing exercise
• Suctioning as needed (Hyper-oxygenate before and after- elevate HOD- less than 10 secs max of 15 secs of suctioning, suction upon withdrawal)
• Chest physiotherapy (CPT)- done before meals/ 2-3 hrs after meals
*percussion- cupped hands to dislodge secretions
*vibrations- flat hands to loosen secretions
*postural drainage- position by gravity to drain secretions
• Promote breathing
• Tripod position/ orthopneic position
• Oxygenation- 2L/min
• Ventilator- Intermittent positive pressure breathing
• Pursed lip breathing- to eliminate CO2
• Promote rest
• Increased calories (increased protein, decrease carbohydrate)
B. Asthma (reactive airway disease)-narrowing of the airway
Risk factors:
• Allergens
• Infection
• Beta blockers “olol”- can cause broncho constriction
• Aspirin-causes broncho constriction
• Strenuous activities
PATHO:
1. Histamine release
2. Allergic reaction
3. 3 airway responses
*spasms- broncho constriction
*swelling- inflammation
*secretions- increased production
*priority: open airway/ patent airway
4. Narrowing of the airway
Signs and symptoms:
• Wheezing/ high pitched musical sound
• Dyspnea (orthopnea, >30 cpm RR, use of accessory muscles, SOB, DOB)
• Productive cough
• Tachycardia
• Hypoxemia-hypoxia (cyanosis)
• ALERT: signs of worsening: + sudden absence of wheezing = total obstruction
Complications:
• Status Asthmaticus- does not respond to treatment
DOG: Epinephrine
Position: high fowlers/ orthopneic/ tripod
Diagnostic test:
• Peak flow meter- to monitor narrowing degree
Green- 80-100% normal
Yellow-50-79% borderline
Red- <50% life threatening; + occlusion/ obstruction
• ABG (early/ initial results: Resp alkalosis)(late result: Resp acidosis)
Management:
• Bronchodilators
Action: relaxes the bronchus (dilation)
(“ol”- salbutamol)
(“phylline”- xanthines)
*inhalation through metered dose inhalers(MDI)
*DOG given first before steroids
• Mast cell stabilizers (chromolyn (Intal))- given to prevent asthma [Show Less]