asthma and copd lecture 4
TRANSCRIPT
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Respiratory System
Assessment & Disorders
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Upper Respiratory System
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Noses and Sinuses
NoseBegin respiratory systemFilter and warm air
SinusesOpenings in facial bonesLighten skull
Assist in speechProduce mucus
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Pharynx and Larynx
PharynxNasopharynxOropharynxLaryngopharynx
LarynxConnects laryngopharynx to tracheaRoutes air and food to properpassageway
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Bronchi and Alveoli
Trachea divides into right and leftmainstem bronchiBronchi continue to branch and getsmaller (bronchioles) and end asalveoli
Air moves through passageways toalveoli where gas exchange occurs
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Bronchioles and Alveoli
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Pulmonary Circulation
Pulmonary arteriesPulmonary veins
Pulmonary capillary network
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Pleura
Double-layered membrane thatcovers lungs
ParietalVisceral
Hold lungs out to chest wall
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Rib Cage and IntercostalMuscles
Protect lungs12 pairs ribs
Intercostal muscles are between ribs Assist with process of breathing
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Ventilation
Divided into inspiration and expirationNormal is 12 20 breaths per minute
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Expiration
Lasts 2 to 3secondsPassive
Muscles relaxDiaphragm risesRibs descend
Lungs recoilPressure in chestcavity increases
(compressingalveoli)Pressure in lungshigher thanatmosphericcauses gases toflow out of the
lungs
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Factors Affecting Respiration
Respiratory center of the brainChemoreceptors in the brain, aorticarch, and carotid arteries
Airway resistanceCompliance
ElasticitySurface tension of alveoli
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Respiratory Changes Associated with Aging
Cartilage that connects ribs tosternum and spinal cord calcifies
Anterior-posterior diameter of chestincreasesRespiratory muscles weaker
Cough and laryngeal reflexes lesseffective
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Respiratory Changes Associated with Aging
Size of lungs decreases Alveoli less elastic
Older client at greater risk fordeveloping respiratory infections
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Assessment
SubjectiveCurrent complaint or existing conditionOnset or duration of symptoms
Ability to maintain ADLNasal congestion, nosebleedsSore throat, difficulty swallowingChanges in voice qualityDifficulty breathing, orthopneaPain on breathing
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Assessment (continued)
SubjectivePresence of cough frequency, duration,productive or unproductiveSputum amount, color, and consistencyExposure to infections (colds orinfluenza)
History of chronic lung conditionsOccupational exposure to chemicals,smoke, asbestos
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Assessment (continued)
SubjectiveHistory of previous respiratory problems
Allergies to medication or environmentalallergensUse of tobacco, chewing tobacco,marijuana, cocaine, injected drugs, and
alcohol
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Assessment (continued)
Objective Assess state of healthColorEase of breathingNote respiratory rate and patternObserve nasal flaringUse of accessory muscles for breathingListen for hoarseness in clients speech
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Assessment (continued)
ObjectiveInspect mucosa of nose, mouth, andoropharynxInspect neck, position of tracheaInspect anterior/posterior diameter ofchest
Palpate lips for nodules, chest fortenderness or swelling
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Pulse Oximetry
Monitors oxygen saturation (SpO 2) Amount of arterial hemoglobin that iscombined with oxygen
Nursing Care Apply to fingertip, forehead, earlobe, ornose
Remove nail polish when using fingertip
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Arterial Blood Gases
Nursing care Apply pressure to site 2 5 minutesfollowing arterial puncture
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Serum Alpha 1-Antitrypsin
Deficiency in this serum proteincontributing factor in emphysema andCOPDNormal value in adults 150 350mg/dLFasting specimen obtained in clientwith elevated cholesterol ortriglycerides
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Sputum and Tissue
Throat or nose swabSputum specimen
Culture and sensitivityGrams stain Acid-fast stain
Cytology
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Imaging Techniques
X-raysCT scans
Ventilation perfusion scansNursing care and client teachingIf contrast used remember to ask
about allergies, especially iodine andseafood
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Lung Volumes and Capacities
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Direct Visualization
Direct or indirect laryngoscopyUsed to identify and evaluate laryngealtumors
Nursing care and client teachingMake sure consent form has beensignedRemove dentures, partial plates, bridgesprior to procedureNPO before procedureNPO after procedure until gag reflexreturns
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Bronchoscopy
Visualize trachea, bronchi andbronchioles
Tumors and structural disorders
Obtain tissue biopsyObtain sputum specimen
Removal of foreign bodyNursing care and teaching
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Asthma and COPD
Dr Ibrahim Bashayreh, RN, PhD.
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Asthma
Asthma is achronicinflammatory
pulmonary disorderthat ischaracterized byreversible
obstruction of theairways
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Asthma
Asthma is a chronic (long-term)disease that makes it hard to breathe.
Asthma can't be cured, but it can bemanaged. With proper treatment,people with asthma can lead normal,active lives.
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Normal bronchiole/ Asthmatic bronchiole
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How asthma works
If you have asthma, your airways(breathing passages) are extra sensitive.When you are around certain things, your
extra-sensitive airways can: Become red and swollen - your airwaysget inflamed inside. They fill up withmucus. The swelling and mucus make yourairways narrower, so it's harder for the airto pass through.
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Cont.
Become "twitchy" and go intospasm - the muscles around yourairways squeeze together and tighten.
This makes your airways narrower,leaving less room for the air to passthrough.The more red and swollen yourairways are, the more twitchy theybecome.
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What are the Triggering Factors?
Domestic dustmites Air pollution
Tobacco smokeOccupationalirritants
Animal with furPollen
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Asthma: Early Clinical
ManifestationsExpiratory & inspiratory wheezingDry or moist non-productive coughChest tightnessDyspnea
Anxious &AgitatedProlonged expiratory phaseIncreased respiratory & heart rate
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Asthma: Early ClinicalManifestations
Wheezing
Chest tightness
DyspneaCoughProlonged expiratory phase [1:3 or
1:4]
h l l
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Asthma: Severe ClinicalManifestations
HypoxiaConfusionIncreased heart rate & blood pressureRespiratory rate up to 40/minute & pursed lipbreathingUse of accessory muscles
Diaphoresis & pallorCyanotic nail bedsFlaring nostrils
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Asthma: Diagnostic Tests
Pulmonary Function TestsFEV1 decreased
Increase of 12% - 15% after bronchodilator indicative ofasthma
PEFR decreased
Symptomatic patienteosinophils > 5% of total WBC
Increased serum IgEChest x-ray shows hyperinflation
ABGsEarly: respiratory alkalosis, PaO2 normal or near-normal
severe: respiratory acidosis, increased PaCO2,
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Asthma: Nursing Diagnoses
Ineffective airway clearance r/tbronchospasm, ineffective cough,excessive mucus
Anxiety r/t difficulty breathing, fear ofsuffocationIneffective therapeutic regimenmanagement r/t lack of information aboutasthmaKnowledge deficit
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Medical Management of AsthmaticPatient
Limit exposure triggering agentsMedications such as: inhaledcorticosteroids, inhaled beta 2 adrenergic agonist, and cromolynsodium
A h M di i A i
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Asthma Medications: Anti-inflammatory
CorticosteroidsNot useful for acute attackBeclomethasone: vanceril,beclovent, qvar
Cromolyn & nedocromilInhibits immediate responsefrom exercise and allergens
Prevents late-phase responseUseful for premedication forexercise, seasonal asthmaIntal, Tilade
Leukotriene modifiersInterfere with synthesis orblock action of leukotrienes
Have both bronchodilationand anti-inflammatorypropertiesNot recommended for acuteasthma attacksShould not be used as onlytherapy for persistentasthma
Accolate, Singulair, Zyflo
A h M di i
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Asthma Medications:Bronchodilators
2-adrenergic agonists Rapid onset: quick relief of bronchoconstriction
Treatment of choice for acute attacksIf used too much causes tremors, anxiety, tachycardia,palpitations, nausea
Too-frequent use indicates poor control of asthmaShort-acting
Albuterol[proventil]; metaproterenol [alupent]; bitolterol [tornalate];pirbuterol [maxair]
Long-acting
Useful for nocturnal asthmaNot useful for quick relief during an acute attackSalmeterol [serevent]
A th M di ti
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Asthma Medications:Bronchodilators cont
Methylxanthines Less effective than beta-adrenergics
Useful to alleviatebronchoconstriction ofearly and late phase,nocturnal asthmaDoes not relievehyperresponsivenessSide effects: nausea,headache, insomnia,tachycardia, arrhythmias,seizuresTheophylline,aminophylline
Anticholinergics Inhibit parasympatheticeffects on respiratorysystem
Increased mucus
Smooth musclecontractionUseful for pts w/adversereactions to beta-adrenergics or incombination w/beta-adrenergics
Ipratropium [atrovent]
Ipratropium + albuterol[Combivent]
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Management of Asthmatic Patient
Identify and assess status Avoid precipitating factorsBring inhaler for each appointmentDrug considerations: Avoid ASA, NSAIDs,barbiturates, and narcoticsDrug interactions with asthmatic medications (ex.Theophylline vs. Antibiotics, Cimetidine)Chronic corticosteroid users may require steroid
supplementationFor sedation, nitrous oxide/oxygen and/or smalldoses of oral diazepam is recommended
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Asthma: Client Teaching
Correct use of medicationsSigns & symptoms of an attack
Dyspnea, anxiety, tight chest, wheezing, cough
Relaxation techniquesWhen to call for help, seek treatmentEnvironmental control
Cough & postural drainage techniques
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COPD
Chronic obstructive pulmonarydisease is a slowly progressivedisease that is characterized by agradual loss of lung functionCOPD includes chronic bronchitis,chronic obstructive bronchitis, or
emphysema, or combinations of theseconditions
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Epidemiology
20.3 million Americans report havingasthma5,000 deaths annually from asthma12.1 million Americans reported beingdiagnosed with COPD119,000 deaths annually from COPDCOPD is the 4 th leading cause ofdeath in the U.S.
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Chronic Bronchitis
Inflammation of themain airway passages(bronchi) to the lungs,which results in the
production of excessmucous, a reduction inthe amount of airflowin and out of the lungs,
and shortness ofbreath
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Emphysema
A respiratorydiseasecharacterized by
breathlessnessbrought on by theenlargement, orover-inflation of,
the air sacs(alveoli) in thelungs
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Signs and symptoms
WheezingCoughingSputum productionShortness of breathChest tightness
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Nursing DX
Ineffective breathing pattern r/tmusculoskeletal impairment , decreasedenergyInability to sustain spontaneousventilation r/t muscle fatigue
Activity intolerance r/t imbalance of O2supply
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Clinical Features of COPD Patients
Mild COPD: no abnormal signs, smokerscough, little or no breathlessnessModerate COPD: breathlessness
with/without wheezing, cough with/withoutsputumSevere COPD: breathlessness on anyexertion/at rest, wheeze and coughprominent, lung inflation usual, cyanosis,peripheral edema, and polycythemia inadvanced disease
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Diagnosis
SpirometryBreathing test which measures the amount and rate atwhich air can pass through the airways
Bronchodilator Reversibility Testing
Relaxing tightened muscles around the airways andopening up airways quickly to ease breathing
Other pulmonary function testingDiffusion capacity
Chest X-ray Arterial Blood Gas
Shows oxygen level in blood
Medical Management of COPD
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Medical Management of COPDPatient
Smoking cessation and elimination ofenvironmental pollutantsPalliative measure such as regularexercise, good nutrition, flu andpneumonia vaccinesBronchodilators, corticosteroids,anticholinergics, and NSAIDs
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Management of COPD Patient
Review history for concurrent heart disease Avoid treatment if upper respiratory tract infection ispresentTreat in upright position
Avoid rubber dam in severe casesUse pulse oximetry (if pulse ox
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