Respiratory Diseases II

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Respiratory Diseases II

  1. 1. Nursing Management of Respiratory Diseases and Disorders Laurie Phillips RN, MSN, PHN
  2. 2. Lecture Objectives <ul><li>Review key elements of normal respiratory anatomy and physiology </li></ul><ul><li>Differentiate between restrictive and obstructive pulmonary diseases </li></ul><ul><li>Examine relative pulmonary disease epidemiology </li></ul><ul><li>Describe the pathophysiology, clinical manifestations, and nursing management of acute bronchitis and Acute Respiratory Distress Syndrome (ARDS) </li></ul>
  3. 3. Lecture Objectives <ul><li>Discuss the pathophysiology, clinical manifestations, and nursing management for chronic bronchitis, emphysema, and asthma </li></ul><ul><li>Compare the pathophysiology and clinical manifestations of secondary complications such as pulmonary edema, pulmonary hypertension, and Cor pulmonale </li></ul><ul><li>Apply the nursing process to plan care for patients with restrictive and obstructive pulmonary diseases </li></ul>
  4. 4. Lecture Objectives <ul><li>Relate the nursing process including patient teaching to drugs commonly used for restrictive and obstructive pulmonary diseases </li></ul><ul><li>Learn how to correctly use a metered dose inhaler (MDI), small volume nebulizer (SVN), and oxygen </li></ul>
  5. 5. Anatomy and Physiology
  6. 6. Restrictive Lung Disease VS Obstructive Lung Disease
  7. 7. Acute Bronchitis <ul><li>inflammation of tracheobronchial tree </li></ul><ul><li>relationship with infection </li></ul><ul><ul><li>viral vs. bacteria </li></ul></ul><ul><li>frequent in winter months </li></ul><ul><li>often mistaken for asthma </li></ul>
  8. 8. Epidemiology - Bronchitis <ul><li>Internationally - top 5th reason for physician visits </li></ul><ul><li>Mortality - low in absence of other cardiopulmonary disease </li></ul><ul><li>Sex - little difference; women diagnosed more </li></ul><ul><li>Age - 11 out of 100 (<5yrs.) ; 4 out of 100 (>5yrs.) </li></ul>
  9. 9. Clinical Manifestations Quick Assess Bronchitis <ul><li>a purulent cough </li></ul><ul><li>fever </li></ul><ul><li>malaise and myalgias </li></ul><ul><li>rhinorrhea or nasal congestion </li></ul><ul><li>sore throat </li></ul><ul><li>wheezing </li></ul><ul><li>dyspnea and chest pain </li></ul>
  10. 10. Diagnostics - Bronchitis <ul><li>Sputum specimen </li></ul><ul><li>Chest xray </li></ul>
  11. 11. Medication Management Acute Bronchitis <ul><li>Antibiotics </li></ul><ul><li>Analgesics/antipyretics </li></ul><ul><li>Antitussives and expectorants </li></ul><ul><li>Bronchodilators </li></ul><ul><li>Antiviral agents </li></ul>
  12. 12. MDI Administration
  13. 13. Acute Respiratory Distress Syndrome - ARDS <ul><li>sudden and progressive form of respiratory failure </li></ul><ul><li>alveolar capillary membranes becomes damaged </li></ul><ul><li>intravascular fluid fills alveoli </li></ul><ul><ul><li>severe dyspnea and hypoxemia </li></ul></ul><ul><ul><li>reduced lung compliance (surfactant) </li></ul></ul><ul><ul><li>diffuse pulmonary infiltrates </li></ul></ul>
  14. 14. Causative Factors Direct Lung Injury Vs . Indirect Lung Injury
  15. 15. Epidemiology - ARDS <ul><li>In the U.S . - reported 150,000 cases annually </li></ul><ul><li>Internationally - unknown </li></ul><ul><li>Mortality - 40-60% of affected persons; 70-90% of affected persons with comorbidity of septic shock </li></ul>
  16. 16. Clinical Manifestations Quick Assess ARDS <ul><li>S/S of acute respiratory distress - tachypnea, dyspnea, accessory muscle breathing, central cyanosis </li></ul><ul><li>dry cough and fever </li></ul><ul><li>fine crackles throughout all lung fields </li></ul><ul><li>S/S of hypoxemia - confusion, agitation, coma </li></ul>
  17. 17. Diagnostics - ARDS <ul><li>Pulmonary Function Tests (PFTs) </li></ul><ul><li>Chest xray </li></ul><ul><ul><li>bilaterally, equal interstitial and alveolar infiltrates </li></ul></ul><ul><li>ABG </li></ul><ul><ul><li>Hypoxemia, PO2 less than 50 mm Hg </li></ul></ul><ul><ul><li>Hypocapnia and respiratory alkalosis (early) </li></ul></ul><ul><ul><li>Hypercapnia and respiratory acidosis </li></ul></ul>
  18. 18. Management of ARDS <ul><li>Supportive Measures </li></ul><ul><li>Oxygen </li></ul><ul><li>Mechanical ventilation </li></ul><ul><li>Prone positioning </li></ul><ul><li>Maintenance of fluid balance </li></ul><ul><li>Current research in Pharmaceutical management </li></ul>
  19. 19. Asthma <ul><li>altered immunological response </li></ul><ul><li>increased airway resistance </li></ul><ul><li>increased lung compliance </li></ul><ul><li>Impaired mucociliary function </li></ul><ul><li>altered oxygen-carbon dioxide exchange </li></ul>
  20. 22. Epidemiology - Asthma <ul><li>In the U.S . - 8% of the population affected (18-20 million persons); half of these are children </li></ul><ul><li>Internationally - increases with urbanization and affluence </li></ul><ul><li>Morbidity/Mortality - 150 million worldwide; increased 40% in last 10 yrs. 29 deaths per million per year </li></ul>
  21. 25. Clinical Manifestations Quick Assess Asthma <ul><li>wheezing, crackles, diminished or absent breath sounds </li></ul><ul><li>breathlessness and prolonged expiration </li></ul><ul><li>dyspnea; tachypnea with hyperventilation </li></ul><ul><li>cough with accompanied bronchospasm </li></ul><ul><li>thick, tenacious, white, gelatinous mucous </li></ul><ul><li>signs of hypoxemia during attack </li></ul><ul><li>status asthmaticus </li></ul>
  22. 26. Diagnostics - Asthma <ul><li>Pulmonary Function Tests (PFTs) </li></ul><ul><li>Peak Expiratory Flow Rates (PEFR) </li></ul><ul><li>Chest xray </li></ul><ul><li>ABGs and oximetry </li></ul><ul><li>Allergy skin testing ( if applicable) </li></ul><ul><li>Blood levels of eosinophils and IgE </li></ul>
  23. 27. Medication Management Asthma <ul><li>Nonsteroidal antinflammatory drugs </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Leukotriene inhibitors </li></ul><ul><li>Theophylline </li></ul><ul><li>Anticholinergic </li></ul><ul><li>Bronchodilators </li></ul>
  24. 28. Small Volume Nebulizer Therapy
  25. 29. Chronic Obstructive Pulmonary Disease <ul><li>expiratory airflow obstruction </li></ul><ul><li>not completely reversible </li></ul><ul><li>two categories </li></ul><ul><ul><li>chronic bronchitis </li></ul></ul><ul><ul><li>emphysema </li></ul></ul>COPD
  26. 30. Chronic Bronchitis <ul><li>impaired ciliary function </li></ul><ul><li>hypertrophy of mucous-secreting glands </li></ul><ul><li>increased airway resistance </li></ul><ul><li>altered oxygen-carbon dioxide exchange </li></ul><ul><li>right ventricular decompensation </li></ul>
  27. 31. Emphysema <ul><li>permanent enlargement of air spaces distal to the bronchioles </li></ul><ul><li>hyperinflation of alveoli </li></ul><ul><li>destruction of alveolar capillary walls </li></ul><ul><li>narrowed airways </li></ul><ul><li>loss of lung compliance </li></ul>
  28. 32. Epidemiology - COPD <ul><li>In the U.S . - two thirds of men and one fourth of women have emphysema at death </li></ul><ul><li>Internationally - the WHO estimates 2.74 million deaths worldwide in 2000 were due to COPD </li></ul><ul><li>Mortality - affects 32 million adult Americans </li></ul><ul><li>Sex - Men are affected more than women </li></ul><ul><li>Age - older than 40 yrs. </li></ul>
  29. 33. Causative Factors COPD <ul><li>Cigarette smoking </li></ul><ul><li>Infection </li></ul><ul><li>Air pollution </li></ul><ul><li>Heredity </li></ul><ul><li>Aging </li></ul>
  30. 34. Clinical Manifestations Quick Assess COPD
  31. 35. The Pink Puffers VS The Blue Bloaters
  32. 36. Diagnostic Testing and Monitoring
  33. 37. Factors Determining Severity of COPD <ul><li>severity of symptoms </li></ul><ul><li>severity of airflow limitation </li></ul><ul><li>frequency and severity of exacerbations </li></ul><ul><li>presence of complications of COPD </li></ul><ul><li>presence of respiratory insufficiency </li></ul><ul><li>number of medications needed to manage disease </li></ul>
  34. 38. Severe Respiratory System Complications <ul><li>Pulmonary edema </li></ul><ul><li>Pulmonary hypertension </li></ul><ul><li>Cor pulmonale </li></ul>
  35. 39. Pulmonary Edema
  36. 41. Pulmonary Hypertension <ul><li>primary pulmonary hypertension </li></ul><ul><li>secondary pulmonary hypertension </li></ul><ul><ul><li>increased left ventricular pressures </li></ul></ul><ul><ul><li>increased blood flow through pulmonary circulation </li></ul></ul><ul><ul><li>obstruction or obliteration of pulmonary vascular bed </li></ul></ul><ul><ul><li>Vasoconstriction of vascular bed </li></ul></ul>
  37. 42. Cor Pulmonale <ul><li>secondary to primary pulmonary hypertension </li></ul><ul><li>characterized by right ventricle enlargement </li></ul><ul><li>acute vs. chronic </li></ul>
  38. 43. Management of COPD <ul><li>Oxygen </li></ul><ul><li>Bronchodilators </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Antibiotics </li></ul><ul><li>Electrolyte supplements </li></ul><ul><li>CPAP/BiPAP </li></ul><ul><li>Heliox </li></ul><ul><li>Intubation </li></ul>
  39. 44. Oxygen Therapy
  40. 45. Respiratory Nursing Assessment <ul><li>Medical History </li></ul><ul><ul><li>subjective data </li></ul></ul><ul><li>Current Medications </li></ul><ul><li>Physical Assessment </li></ul><ul><ul><li>objective data </li></ul></ul><ul><li>See Assessment Handout </li></ul>
  41. 46. Nursing Goals in Respiratory Management <ul><li>prevent disease progression </li></ul><ul><li>relieve symptoms </li></ul><ul><li>improve exercise tolerance </li></ul><ul><li>improve physical health </li></ul><ul><li>prevent exacerbations and complications </li></ul><ul><li>minimize side effects from treatment </li></ul>
  42. 47. Nursing Diagnoses <ul><li>Impaired Gas Exchange </li></ul><ul><li>Ineffective Airway Clearance </li></ul><ul><li>Altered Breathing Pattern </li></ul>
  43. 48. Nursing Interventions
  44. 49. Respiratory Care Pharmacology

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