Oxygenation COPD-Emphysema and Chronic Bronchitis Preventable and treatable slow progressive respiratory disease Pathophysiology Decrease in lung function (Vital capacity & FEV-1) Progressive airflow limitation Inflammation Increased goblet cells & enlarged submucosal gland (hypersecretion of mucus) Scar tissue formation Alveolar wall destruction Thickening and lining of vessel
NSG 3800 Let's Compare Emphysema Easily fatigued -- wheezing. cough, dyspnea Weight loss Impaired oxygen exchange
Chronic Bronchitis Easily fatigued -- wheezing. cough, dyspnea Weight loss Impaired oxygen exchange
Damaged alveoli -- rupture Damaged alveoli -- become causing less alveoli to perform boggy and therefore do not 02 exchange expel c02 as readily and therefore they cannot take in as much 02 Productive cough for 3 or more months Increase in mucus Increase in dead space Thick bronchial walls Pulmonary hypertension Frequent infections Inflammation
PINK PUFFER
BLUE BLOATER
What types of diagnostics & Physical Assessment Thorough health history X-ray CT chest scan Screening of alpha 1 antitrypsin deficiency PFTs Spirometer is used to evaluate airflow - CXR, ABGs (impaired gas exchange low PaO2, high PaC020), pulmonary function tests
What does it look like? Easily fatigued, dyspnea, use of accessory muscles, orthopneic, chronic cough, digital clubbing; emphysema - barrel chest and emaciated; bronchitis -- cyanotic and edematous How is it managed? Smoking cessation Bronchodilators Corticosteroids oxygen (< 3L/min) mucolytics nutrition, exercise, anti-anxiety medications Complications Hypoxemia/tissue anoxia Acidosis respiratory infections cardiac failure Sarcoidosis How is it managed? Corticosteroids Smoking cessation
Sarcoidosis What is it? An inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands. Abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs of the body. Risk factors hypersensitivity response in people with inherited or acquired predisposition to the disorder. Diagnosis CXR, Pulmonary Function Tests, CT scan, bronchoscopy What does it look like? Dyspnea Cough Hemoptysis Congestion Anorexia Weight loss Pneumothorax What is it? It is a collapsed lung that occurs when air leaks into the space between your lung and chest wall.
Nursing Interventions Improving breathing pattern Improving nutritional status Hydration Exercise
Complications Hyperglycemia (from corticosteroids) Inflammation of joints Cardiac dysrhythmias
Pleural Effusion What is it? A build-up of excess fluid between the layers of the pleura. Some of the causes are lung disorders/infections, heart
Types - spontaneous or simple, traumatic, tension pneumothorax Diagnosis -- CXR, clinical manifestations What does it look like? Pain, dyspnea, agitation, cyanosis, tracheal deviation, tachypnea, hypotension How is it managed? Needle aspiration or chest tube insertion Morphine Sulfate Complication? Mediastinal shift with tension pneumothorax leading to decreased cardiac output and cardiac arrest.
failure, renal failure, liver failure Diagnosis - Chest x-ray, chest CT What does it look like? Fever, chills, pleuritic pain, dyspnea Decreased or absent breath sounds; decreased fremitus; and a dull, flat sound on percussion How is it managed? Medications -- diuretics, antibiotics Thoracentesis Chest tube placement Treat underlying cause Nursing interventions Positioning client for thoracentesis Emotional support Instruct the patient not to take any deep breaths during procedure. Complication -collapsed lung with thoracentesis
Pleurisy