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Chapter024management patient with pulmonary disease
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Chapter024management patient with pulmonary disease Chapter024management patient with pulmonary disease Presentation Transcript

  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 24Management of Patients WithChronic Pulmonary Disease
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCOPD:• Chronic Obstructive Pulmonary Disease• A disease state characterized by airflow limitation that isnot full reversible (GOLD).• COPD is the currently is 4thleading cause of death and the12thleading cause of disability.• COPD includes diseases that cause airflow obstruction(emphysema, chronic bronchitis) or a combination ofthese disorders.• Asthma is now considered a separate disorder but cancoexist with COPD.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of COPD• Airflow limitation is progressive and is associated withabnormal inflammatory response of the lungs to noxiousagents.• Inflammatory response occurs throughout the airways,lung parenchyma, and pulmonary vasculature.• Scar tissue and narrowing occurs in airways.• Substances activated by chronic inflammation damagethe parenchyma.• Inflammatory response causes changes in pulmonaryvasculature.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChronic Bronchitis• The presence of a cough and sputum production for atleast 3 months in each of 2 consecutive years.• Irritation of airways results in inflammation andhypersecretion of mucous.• Mucous-secreting glands and goblet cells increase innumber.• Ciliary function is reduced, bronchial walls thicken,bronchial airways narrow, and mucous may plug airways.• Alveoli become damaged, fibrosed, and alveolarmacrophage function diminishes.• The patient is more susceptible to respiratory infections.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of Chronic Bronchitis
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?For patients with chronic bronchitis, the nurse expects tosee the major clinical symptoms of tachypnea andtachycardia.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerFalseFor patients with chronic bronchitis, the nurse expects tosee the major clinical symptoms of sputum andproductive cough, not tachypnea and tachycardia.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsEmphysema:• Abnormal distention of air spaces beyond the terminalbronchioles with destruction of the walls of the alveoli.• Decreased alveolar surface area causes an increase in“dead space” and impaired oxygen diffusion.• Reduction of the pulmonary capillary bed increasespulmonary vascular resistance and pulmonary arterypressures.• Hypoxemia result of these pathologic changes.• Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale).
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChanges in Alveolar Structure withEmphysema
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNormal Chest Wall and Chest WallChanges with Emphysema
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhat is the primary clinical symptom of emphysema?A.Chest painB.Productive coughC.SputumD.Wheezing
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerDThe primary symptom of emphysema is wheezing. Sputumand productive cough are the primary symptoms ofchronic bronchitis.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTypical Posture of a Person with COPD
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsRisk Factors for COPD• Tobacco smoke causes 80-90% of COPD cases!• Passive smoking• Occupational exposure• Ambient air pollution• Genetic abnormalities– Alpha1-antitrypsin
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of Patientswith COPD- Assessment• Health history• Inspection and examination findings• Review of diagnostic tests
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of Patientswith COPD- Diagnoses• Impaired gas exchange• Impaired airway clearance• Ineffective breathing pattern• Activity intolerance• Deficient knowledge• Ineffective coping
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems• Respiratory insufficiency or failure• Atelectasis• Pulmonary infection• Pneumonia• Pneumothorax• Pulmonary hypertension
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of Patientswith COPD- Planning• Smoking cessation• Improved activity tolerance• Maximal self-management• Improved coping ability• Adherence to therapeutic regimen and home care• Absence of complications
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsImproving Gas Exchange• Proper administration of bronchodilators andcorticosteroids• Reduction of pulmonary irritants• Directed coughing, “huff” coughing• Chest physiotherapy• Breathing exercises to reduce air trapping– diaphragmatic breathing– pursed lip breathing• Use of supplemental oxygen
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsImproving Activity Tolerance• Focus on rehabilitation activities to improve ADLs andpromote independence.• Pacing of activities• Exercise training• Walking aides• Utilization of a collaborative approach
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsOther Interventions• Set realistic goals• Avoid extreme temperatures• Enhancement of coping strategies• Monitor for and management of potential complications
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• Disease process• Medications• Procedures• When and how to seek help• Prevention of infections• Avoidance of irritants; indoor and outdoor pollution, andoccupational exposure• Lifestyle changes, including cessation of smoking
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?A commonly prescribed methylxanthine is theophylline.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueA commonly prescribed methylxanthine is theophylline.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsBronchiectasis• Bronchiectasis is a chronic, irreversible dilation of the bronchiand bronchioles.• Caused by:– Airway obstruction– Diffuse airway injury– Pulmonary infections and obstruction of the bronchus orcomplications of long-term pulmonary infections– Genetic disorders such as cystic fibrosis– Abnormal host defense (eg, ciliary dyskinesia or humoralimmunodeficiency)– Idiopathic causes
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsBronchiectais: Clinical Manifestations• Chronic cough• Purulent sputum in copious amounts• Clubbing of the fingers
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsBronchiectasis: Medical Management• Postural drainage• Chest physiotherapy• Smoking cessation• Antimicrobial therapy
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsBronchiectasis: Nursing Management• Focuses on alleviating symptoms and clearing pulmonarysecretions• Patient teaching
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAsthma• A chronic inflammatory disease of the airways thatcauses hyperresponsiveness, mucosal edema, andmucous production.• Inflammation leads to cough, chest tightness, wheezing,and dyspnea.• The most common chronic disease of childhood.• Can occur at any age.• Allergy is the strongest predisposing factor.
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of AsthmaRefer to fig. 24-6
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedications Used for Asthma• Quick-relief medicationsSee Table 24-2– Beta2-adrenergic agonists– Anticholinergics• Long-acting medicationsSee Table 24-4– Corticosteroids– Long acting beta2-adrenergic agonists– Leukotriene modifiers
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsExamples of Metered Dose Inhalers, andSpacers A Metered Dose Inhaler andSpacer in Use
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• The nature of asthma as a chronic inflammatory disease• Definition of inflammation and bronchoconstriction• Purpose and action for each medication• Identification of triggers and how to avoid them• Proper inhalation techniques• How to perform peak flow monitoring• How to implement an action plan• When and how to seek assistance
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsUsing a Peak Flow Meter
  • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCystic Fibrosis• The most common fatal autosomal recessive diseaseamong the Caucasian population.• Genetic screening is able to detect carriers of thisdisease.• Genetic counseling for couples at risk.• A mutation of a gene causes changes in chloridetransport which leads to thick, viscous secretions in thelungs, pancreas, liver, intestines, and reproductive tract.• Pulmonary problems are the leading cause of morbidityand mortality.