Class3_GasExchange_StudentCopy_2024 (1).pptx

Gas Exchange CLASS 3 NRSG3301 C RY S TA L T R E I G E B S C N R N M N N P Concept(s) & Exemplar(s) Concept(s): Gas exchange Exemplar(s): Asthma Chronic obstructive pulmonary disease (COPD) Learning Review the anatomy of the respiratory system Objectives...

Gas Exchange CLASS 3 NRSG3301 C RY S TA L T R E I G E B S C N R N M N N P Concept(s) & Exemplar(s) Concept(s): Gas exchange Exemplar(s): Asthma Chronic obstructive pulmonary disease (COPD) Learning Review the anatomy of the respiratory system Objectives Review the concept of gas exchange Discuss the pathophysiology, manifestations, and Review the anatomy of the respiratory system nursing interventions related to asthma Discuss the pathophysiology, manifestations, and nursing interventions related to COPD Group case study Gas Exchange Gas exchange refers to the process by which oxygen is transported to cells and carbon dioxide is transported from cells. Interrelated Concepts Anatomy of the Respiratory System Key Terms Hypoxemia is reduced oxygenation of arterial blood. Hypoxia is insufficient oxygen reaching cells, whereas anoxia is the total lack of oxygen in body tissues. Ischemia refers to insufficient flow of oxygenated blood to tissues that may result in hypoxemia and subsequent cell injury or death. Gas Exchange Upper Respiratory Tract Oropharynx ◦ Common passage for air and food ◦ Epiglottis protects opening into larynx. ◦ Closes over glottis at swallowing to prevent aspiration Larynx ◦ Two pairs of vocal cords Trachea ◦ Lined by pseudostratified ciliated epithelium ◦ C-shaped rings of cartilage Lower Respiratory Tract Bronchial tree (continuous branching) ◦ Trachea branches into: ◦ Right and left primary bronchi ◦ Secondary bronchi ◦ Bronchioles ◦ Terminal bronchioles ◦ Respiratory bronchioles ◦ Alveolar ducts ◦ Alveoli—lined by simple squamous epithelium and surfactant to reduce surface tension and maintain inflation ◦ End point for inspired air ◦ Site of gas exchange Types of Lung Disorders Restrictive - Restrictive lung diseases are a heterogeneous set of pulmonary disorders defined by restrictive patterns on spirometry. These disorders are characterized by a reduced distensibility of the lungs, compromising lung expansion, and, in turn, reduced lung volumes, particularly with reduced total lung capacity, and include asbestosis, sarcoidosis, and pulmonary fibrosis (Account for approximately 20% of pulmonary syndromes). Obstructive - characterized by increased resistance to flow due to obstruction ,partial or complete at any level, from the trachea to the terminal bronchioles such as chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma, emphysema, CF, lung cancer, aspiration, OSA, and bronchiolitis (Account for approximately 80% of pulmonary syndromes) Obstructive Pulmonary Disease Airway obstruction is worse with expiration. More force or more time is required to expire a given volume of air; emptying the lungs is slowed. Unifying signs and symptoms Wheezing and dyspnea Clinical manifestations Increased work of breathing, ventilation-perfusion mismatching, decreased forced expiratory volume in one second (FEV1) Types of COPD Chronic bronchitis Emphysema. Chronic bronchitis is a long- Emphysema is a chronic lung term inflammation of the condition in which alveoli (air bronchi (breathing passages in sacs in the lungs) may be: the lungs), which results in Destroyed increased production of mucus, Narrowed as well as other changes. Collapsed These changes may result in Stretched breathing problems, frequent Over-inflated infections, cough, and This can cause a decrease in disability. respiratory function and breathlessness. Damage to the air sacs is irreversible and results in permanent "holes" in the lung tissue. (Stanford, 2023) Asthma A chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma include the following: The lining of the airways become swollen and inflamed. The muscles that surround the airways tighten. The production of mucus is increased, leading to mucus plugs Causes airway hyper-responsiveness leading to wheezing, breathlessness, chest tightness, and cough Often brief episodes, but maybe longer Requires treatment COPYRIGHT © 2019 ELSEVIER CANADA, A DIVISION OF REED ELSEVIER CANADA, LTD. Significance About 8% of Canadians over the age of 12 have been diagnosed with asthma About 11% of people with asthma visit an ED one or more times a year Only 34% of clients report asthma as well-controlled May be seasonal, (allergens) or exercise-induced (cooling or rewarming of air) Asthma Triggers Allergens Hormones Viral Upper Respiratory Infections GERD Sinusitis Drugs Exercise Occupations Exposure Cold Dry Air Food Additives Stress Asthma Chronic inflammatory disorder of the bronchial mucosa. Causes bronchial hyperresponsiveness, constriction of the airways and variable airflow obstruction that is reversible. Pathophysiology Episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production*** This Photo by Unknown Author is licensed under CC BY Asthma. Asthma (Cont.) Early asthmatic response Late asthmatic response Vasodilation Begins 4–8 hours after the early response. Increased capillary permeability Chemotactic recruitment of lymphocytes, Mucosal edema eosinophils, basophils, neutrophils, and lymphocytes occurs. Bronchial smooth muscle contraction Airway scarring (bronchospasm) Tenacious mucous secretion Increased bronchial hyperresponsiveness Impaired mucociliary function with the accumulation of mucous and cellular debris, forming plugs in the airways Decreased Treg cells Leads to airway remodeling if left untreated Asthma (Cont.) Clinical manifestations Asymptomatic between attacks Chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, tachypnea (>30breaths/min) Pulsus paradoxus (drop in BP during inspiratory cycle >10mmhg) Status asthmaticus Bronchospasm not reversed by usual measures Life-threatening Ominous signs of impending death Silent chest (no audible air movement) and a PaCO2 greater than 70 mmHg Copyright © 2019, Elsevier Inc. All rights reserved. Signs and Symptoms (Cont.) Respiratory alkalosis Initially caused by hyperventilation Respiratory acidosis Caused by air trapping Severe respiratory distress Hypoventilation leads to hypoxemia and respiratory acidosis. Respiratory failure Indicated by decreasing responsiveness, cyanosis Copyright © 2019 by Elsevier Inc. All rights reserved. Diagnostic Tests Detailed history & physical exam Pulmonary Function test ABG Peak flow monitoring CBC Oximetry Sputum culture & sensitivity Allergy testing CXR Blood level of eosinophils Cat Scan (VQ scan) Nursing Management Nursing Implementation (Cont.) Peak flow results Green Zone Green zone Usually 80% to 100% of personal best Remain on medications COPYRIGHT ©, LTD. 2019 ELSEVIER CANADA, A DIVISION OF REED ELSEVIER CANADA Nursing Management Nursing Implementation (Cont.) Peak flow results Yellow Zone Yellow Zone Usually 50% (60%) to 79% of personal best Indicates caution Something is triggering asthma COPYRIGHT © 2019 ELSEVIER CANADA, A DIVISION OF REED ELSEVIER CANADA, LTD.  Nursing Management Nursing Implementation (Cont.) Peak flow results Red Zone Red Zone 56% to 60% or less of personal best Indicates a serious problem Definitive action must be taken with a health care provider COPYRIGHT © 2019 ELSEVIER CANADA, A DIVISION OF REED ELSEVIER CANADA, LTD. Nursing Assessment Health history ABG’s Lung function tests Physical exam - accessory muscle use, diaphoresis, cyanosis, lung sounds Potential nursing diagnosis: Ineffective airway clearance, anxiety, deficient knowledge Treatment General measures Skin tests for allergic reactions Avoidance of triggering factors Good ventilation of the environment Swimming and walking Use of maintenance inhalers or drugs Measures for acute attacks Controlled breathing techniques Inhalers Bronchodilators Glucocorticoids Copyright © 2019 by Elsevier Inc. All rights reserved. Collaborative Care General management – confirm the diagnosis, monitor the level of asthma control, reduce exposure to environmental triggers, provide adequate medication, education and provide a written action plan Education – integrate at every point Self-management Overall goal –to achieve asthma control with the minimum level of pharmacotherapy while enhancing the quality of lives with asthma and reducing the personal and social burdens inflicted by the condition Asthma Management Pharmacotherapy Anti-inflammatory: corticosteroids (fluticasone, prednisone) suppress inflammatory response, in haled form is used in long term control, systemic form to control exacerbations. They reduce bronchial hyperresponsiveness. Oral candidiasis, hoarseness, and dry cough can be reduce by using space and gargling Leukotriene modifiers (montelukast, block leukotrienes – potent bronchoconstrictors & anti-inflammatory properties, not for acute attacks Bronchodilators B2 adrenergic agonists (albuterol) effective for acute bronchospasm, onset in minutes for 4-8hours Anticholinergics (ipratropium) blocks acetylcholine * dry mouth Asthma Action Plan Status Asthmaticus Description Severe asthma attack unresponsive to bronchodilators Etiology Upper respiratory infection Allergen exposure Decrease in anti-inflammatory medications COPYRIGHT © 2018 BY ELSEVIER, INC. ALL RIGHTS RESERVED. Status Asthmaticus (Cont.) Pathophysiology Pulmonary effects Increased airway resistance Cardiovascular effects Assessment and diagnosis Cough, wheezing, and dyspnea Deterioration of pulmonary function tests (PFTs) COPYRIGHT © 2018 BY ELSEVIER, INC. ALL RIGHTS RESERVED. Status Asthmaticus (Cont.) Medical management Bronchodilator (salbutamol) Systemic corticosteroids (IV every 4-6hours) Oxygen therapy (mask or nasal cannula for 90% saturation) Intubation and mechanical ventilation IV fluids may be considered COPYRIGHT © 2018 BY ELSEVIER, INC. ALL RIGHTS RESERVED. Status Asthmaticus (Cont.) Nursing management Optimizing oxygenation and ventilation Providing comfort and emotional support Maintaining surveillance for complications Educating the patient and family COPYRIGHT © 2018 BY ELSEVIER, INC. ALL RIGHTS RESERVED. Chronic Obstructive Pulmonary Disease (COPD) Airflow limitation that is not fully reversible Usually progressive and associated with chronic bronchitis and emphysema (can often co-exist) Irreversible airflow limitation during forced exhalation due to loss of elastic recoil Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm Primary process of inflammation (inhalation of noxious particles, mediators released causing damage to lung tissue, airways inflamed and parenchyma destroyed) Eventually supporting structures of lungs destroyed and air goes in easily but gets trapped, bronchioles tend to collapse and cause barrel chest Copyright © 2019, Elsevier Inc. All rights reserved. COPD (Old terminology): Bronchitis vs. Emphysema COPD Etiology Risk factors Cigarette smoking (R/T smoking 80-90%) *secondary exposure to cigarette smoking Occupational chemicals and dust Air pollution Infection (recurring infection, HIV, TB) Hereditary  -Antitrypsin (AAT) deficiency, destruction of lung tissue (severe occurs 1/5000) Aging Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (Air trapping) Copyright © 2019, Elsevier Inc. All rights reserved. Lung Changes in COPD Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. COPD Complications Cor pulmonale Exacerbations of COPD Acute respiratory failure Peptic ulcer disease Depression/anxiety Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. COPD Diagnostic Studies Diagnosis confirmed by pulmonary function tests Chest x-rays, spirometry, history, and physical examination are also important in the diagnostic workup Spirometry typical findings Reduced FEV1/FVC ratio