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Tracy Petleski, MSN, RN

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Chronic bronchitis. Disease of the airways. Cough and sputum x 3 ... bronchitis ... bronchitis. Patients susceptible chronic infections. Winter. Chronic bronchitis ... – PowerPoint PPT presentation

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Title: Tracy Petleski, MSN, RN


1
Tracy Petleski, MSN, RN
  • Altered Respiratory Function
  • Unit VI

2
Chronic Obstructive Pulmonary Disease- COPD
  • Characterized by restrictive air-flow issues that
    are irreversible
  • Air flow obstruction
  • Co-exist w/ other respiratory disorders
  • COPD is not reversible

3
COPD
4
5th leading cause of death in the U.S.
  • 5th for men
  • 4th for women
  • 16 million Americans have a form of COPD
  • Over 13 million visits to the MD annually
  • 1/3 of patient receiving homecare secondary to
    COPD

5
COPD
  • Airflow limitations as well as abnormal
    inflammatory response of the lungs to noxious
    stimuli
  • Body tries to correct chronic inflammation
    causing scarring and narrowing of airway lumen.
    paraenchymal is destroyed and emphysema disease
    of alveoli and or gas exchange disruption (COPD)

6
COPD Risk factors
  • Smoking
  • Environmental exposure
  • Cigars and pipes tobacco
  • Prolonged intense occupational exposure
  • Dusts, chemicals, indoor pollution as well as
    outdoor pollution

7
COPD- other risk factors
  • Genetics
  • Alpha deficiency, antitrypsin (protects
    paraenchyma)
  • 1 cause of killer among young Americans in the
    absence of smoking
  • Sensitive to environmental factors

8
COPD
  • Symptoms
  • Cough, sputum production and exertional dyspnea
  • Weight loss
  • Accessory muscle
  • Barrel chest

9
Diagnosis
  • ABGs
  • CXR
  • Alpha1 antitrypsin deficiency screening
  • Familiar history
  • Severity stages
  • I-IV

10
COPD
  • Diagnosis
  • Spirometry. Amount of air the patient can
    forcibly exhaled. (1 second). To forced vital
    capacity. Expressed in absolute volume as a
    percentile
  • Difficult exhaling or cannot forcibly exhale.
    Obstructive disease is defined as FEV1/FVC ratio
    less than 70
  • Reversibility is demonstrated if pulmonary
    function test improves after bronchodilators

11
COPD- medical management
  • Smoking cessation
  • Bronchodilators
  • Corticosteroids
  • Oxygen therapy

12
COPD
  • Medications to reduce bronchospasm and reduce
    constricted airways (beta 2antagonist)
  • Metaproterenol (Alupent)
  • Albuterol (Proventil)
  • Xanthines (Theophyllines)
  • Others
  • Corticosteroids
  • Anticholinergics (Atropine, Atrovent)
  • Leukotrines inhibitors

13
COPD -complications
  • Life- threatening
  • Respiratory insufficiency and failure

14
Chronic bronchitis
  • Disease of the airways
  • Cough and sputum x 3 months over 2 years
  • Airway irritants results in hyper-secretion
    mucous production and inflammation
  • Bronchiole wall becomes thickened
  • Bronchiole lumen is narrowed
  • Mucous plugs the airway

15
Chronic bronchitis
  • Refers to inflammatory changes and excessive
    mucous production in the bronchial tree
  • Characterized by hyperplasia and hypertrophy of
    mucous producing glands
  • Results from prolonged exposure to irritants

16
Chronic bronchitis
  • Patients susceptible chronic infections
  • Winter

17
Chronic bronchitis- diagnosis
  • Clinically diagnosed by the presence of a cough
    with sputum occurring on most days for at least 3
    months in a year for at least 2 consecutive years
  • Alveoli are not seriously affected

18
Emphysema
  • Impaired gas exchange
  • Over distended alveoli
  • (abnormal distension of the air spaces beyond the
    terminal bronchioles w/ destruction of the walls
    of the alveoli
  • End stage of disease that progresses over many
    years
  • As alveoli is destroyed by recurrent infection
  • Alveolar surface is decreased

19
Emphysema
  • Pulmonary capillaries decrease increasing the
    dead space
  • Impaired diffusion which leads to hypoxia
  • Later CO2 elimination is impaired (hypercapnia)
  • Respiratory acidosis
  • Capillary beds are decreased, increasing blood
    flow via R ventricle to maintain higher blood
    pressure in pulmonary artery. R CHF is
    complication of emphysema (congestion, dependent
    edema,neck vein distension, liver pain and CV
    failure).

20
Emphysema
  • Results in
  • Reduced alevolar function surface area and the
    number of pulmonary capillaries
  • Decrease in the area for gas exchange
  • Increase resistance to pulmonary blood flow
  • Expiration becomes a muscular act
  • Over time the chest becomes rigid (barrel-
    shaped)
  • Use accessory muscles of the neck, chest and
    abdomen to breath

21
Bronchiectasis
  • Not considered COPD. Separate disease process
  • Airway obstruction
  • Diffuse airway disease
  • Cystic fibrosis
  • Abnormal host
  • Ideopathic causes (recurrent respiratory
    infections)
  • Measles, influenza, TB and immunodeficiency

22
Bronchiectasis
  • Inflammatory process, seconadry to infections
    that damage bronchial walls
  • Loss of supporting structure, causing thick
    sputum
  • Leading to obstruction of of bronchi
  • The walls become permanently distended and
    distorted

23
Bronchiectasis
  • Localized and affecting lower lobes in the lung
  • Retention of secretions and subsequent
    obstruction and alveoli collaspe
  • Airway pooling of thick copious thick purulent
    secretions
  • May be congenital or due to complication of
    infection or aspiration
  • May need postural drainage and surgery

24
Bronchioectasis- assessment
  • Acute event of worsening dyspnea (even at rest)
  • Increased sputum production
  • Increased malaise
  • Nocturnal awakening with dyspnea and wheezing
  • Frequent headaches

25
Bronchioectasis -assessment
  • Patient is likely to present with respiratory
    distress
  • Often sitting upright, leaning forward to
    facilitate breathing
  • Using pursed lip breathing
  • Using accessory muscles

26
Bronchiectasis
  • Diagnosis
  • Difficult. Specific history of productive cough
    w/ tuberculi negative sputum
  • CT chest bronchiole dilation

27
Bronchioectasis
  • Medical management
  • Promote bronchiole drainage
  • Prevention of infection
  • Smoking cessation
  • Pneumonia vaccines
  • bronchodilators

28
Bronhioectasis- nursing interventions
  • Medical history
  • Establish IV access
  • Telemetry
  • If patient has a productive cough encourage
    coughing
  • Collect sputum specimen
  • Administer oxygen
  • Assist with ventilation

29
Asthma
  • Chronic diffuse inflammatory disease,
    hyperresponsiveness, mucosal edema reducing
    airway diameter causing narrowing and increased
    mucous production, blocking bronchi
  • Differs from other obstructive disease reversible
  • 17 million Americans
  • Over 14 million physician visits
  • 2 million visits to ED

30
Asthma
  • Occurs in acute episodes of variable duration
  • Characterized by reversible airflow obstruction
  • Bronchial smooth muscle and hypersecretion of
    mucous resulting bronchiole plugging
  • Inflammatory response in bronchial walls

31
Asthma
  • Alveolar hypoventilation
  • Hypoxemia
  • Hyperventilation (carbon dioxide retention)
  • Increased airway resistance- air trapping
  • Excessive demand on respiratory muscles
  • Accessory muscle use
  • Increased respiratory fatigue

32
Asthma
  • Symptoms
  • Cough, congestion, chest tightness, wheezing and
    dyspnea
  • Night time
  • Symptoms may be latent or acute periods of
    exacerbations (minutes-days- weeks)
  • Any age
  • Childhood
  • Disruptive disease
  • Allergies are strongest predisposing factor

33
Asthma
  • Symptoms
  • Symptoms worsen over time
  • Expiration is prolonged
  • Hypoxia (ventilation-perfusion mismatch)
  • Central cyanosis

34
Asthma- assessment
  • Prolonged expiratory phase with wheezing
  • Inspiratory wheezing suggests secrections in
    large airways
  • A silent chest may indicate severe obstruction
    and flow rates that are low

35
Asthma- assessment
  • Obtunded
  • Diaphoresis and pallor
  • Retractions
  • Inability to speak
  • Poor muscle tone, floppy
  • Rapid heart rate 130/min
  • Rapid respirations 30 breaths/min
  • Agitation or mentally foggy

36
Asthma
  • Diagnosis
  • Family, environmental and occupational history
  • Symptomology
  • GERD
  • Medication induced
  • Allergies

37
Asthma
  • Complications
  • Status asthmaticus
  • Respiratory failure
  • Pneumonia
  • Atelectasis
  • Hypoxia
  • Death

38
Asthma- management
  • Maintain airway
  • Supplemental oxygen
  • Reverse bronchospasm
  • IV hydration
  • Position of comfort to maximize respiration

39
Asthma- medications
  • Corticosteroids long acting
  • Long acting beta2-adrenergic agonists
  • Bronchodilators theophylline, slo-bid
  • Leukotrienes
  • Short acting Atrovent
  • Combination therapy
  • Albuterol/ ipratropium Combivent

40
Asthma- nursing
  • Anxiety
  • Pulse oximetry
  • Dyspnea
  • Vital signs
  • Dehydration
  • Medications
  • Intubation

41
COPD- medications
42
Vaccines
  • Pneumonvax
  • Pneumococcal immunization
  • Eggs are not used in the production of this
    vaccine
  • Anaphylaxis
  • Do not give more less than 3 years apart
  • Avoid w/ DPT allergy
  • Afebrile
  • Education
  • Localized reaction, fever, N,V and D.

43
Vaccines
  • Influenza
  • Influenza, promotes antibodies production.
  • Egg allergy should AVOID vaccine
  • Avoid acute respiratory infection and
    neurological disorders
  • Timing is essential
  • Dont give w/ pertussis (3 days) or w/ DPT

44
Vaccines
  • Influenza
  • Is safe in pregnant women
  • Older than 6 months
  • Occupational recommended
  • Special populations considerations?

45
Vaccine
  • Influenza
  • Education
  • Vaccine does not cause flu
  • Treat aches, fever and malaise w/ OTC
  • Safe
  • Strongly recommended for anyone older than 6
    months
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