Medsurge RESPIRATORY DISEASES study guide

Medsurge RESPIRATORY DISEASES study guide A. Chronic Obstructive Pulmonary Disease (COPD)/ Chronic airflow limitation Chronic bronchitis- 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