Respiratory Disorders & Conditions PDF

This video begins to second part, or part two of care of the patient with a respiratory disorder and conditions. And here we're going to start with disorders of the lower airway. So the first one that we have here is acute bronchitis. This is inflammation of the trickya and the bronchial tree. It's...

This video begins to second part, or part two of care of the patient with a respiratory disorder and conditions. And here we're going to start with disorders of the lower airway. So the first one that we have here is acute bronchitis. This is inflammation of the trickya and the bronchial tree. It's usually thick. Married to a respiratory infection or exposure to inhaled irritants. Clinical manifestations. They may have a productive cough. Wheezes Chronicles Shortness of Breath, chest Pain and Tightness, A low grade fever, A lace headache. And we can diagnose these patients with chest X, ray or speed of cultures. In acute bronchitis, medical management might give them euclitics, you know, titusifs, antipyritics, or analgesics. Bronco dilators, antibiotics. They may have a vaporizer. We want to encourage fluids, but no milk, because that increases the thickness of our secretions. Monitor vital signs and lung sounds, provide rest and then encourage cough and deep breathing. And avoid smoking because it paralyzes the cilia. That makes it more difficult to move the secretions that are in that airway. Next disorder is legionaire's disease. This is Legionella pneumophelia. This thrives in water reservoirs, so things like AC units humidify. Fires, hot tubs. It causes life, threatening pneumonia, leads to respiratory failure, reno failure, back trimic shock, and ultimately death. The clinical manifestations, usually between two to 14 days from exposure. They'll start with a high fever, headache, diarrhea, malaise. And muscle pain. Then on days two or three, they'll have a non productive cough, shortness of breath and chest pain on inspiration. Crack holes or wheezes in habitaria. For diagnostic tests. We can do cultures that can be via blood spewtum or lung tissue. They can do a chest X ray. Or they can do a urine screening for LEGION L A antigens. For medical management. From a pharmacological standpoint, they'll give you antibiotics. Arythramiasin being the number one drug of choice. Antipyritics, or even vasal pressors, depending on the severity and how much it's affected the body. So they may be on dopamine or debutamine. They may be on oxygen, mechanical ventilation, if it's necessary. IV therapy. They could be on renal dialysis. They want to monitor their isonos, put on. On bad rest and comfort and support the patient and family at this time. Next we have severe acute respiratory syndrome, or SARS. This is an infection caused by coronavirus, the SARS area. This is not COVID. It is spread by close contact between people. It is airborne, so when it's aerosolized, otherwise, it is considered droplet. It may be spread by touching contaminated objects. Medical manifestations. They may have an elevated temperature, headache, muscle aches, mild respiratory symptoms like a dry cloth and shortness of breath. For the. Diagnostic tests. They can have a chest X ray, sarah antibody testing, check the white blood cells, platelets, or the CPK. They may have nasalfare and galeal swabs, depending on. The type of test that they're performing or looking for. They may have a bronchial lavage to clear out any irritation in bacteria that might sit it back there. In terms of management, they'll be on antibiotics for secondary infections, viral antiviral medications due to the virus. And then any quartercusteroids to help decrease inflammation and irritation. They'll be in respiratory isolation and provide meticulous hand washing. So remember, it is transmitted via droplet traditionally, but it also has potential to spread via airborne transmission. Which is just breathing it in if those droplets become aerosolized. So an example of an aerosolized droplet would be forceful coughing. Has aerosolized those facts. Droplets into the air, patients on high flow of oxygen. We're talking anything higher than six leaders. Names will Can you allow? Those on ventilators, bypabs and seapaps, that any type of that mechanical ventilation. Would aerosolize any of those droplets, and then they would need to be in airborne precautions. But primarily they're in droplet. Oxygen therapy, and notify the public health Department. About their positive testing. This requirement, by this. State of Ohio, but I believe it's also federally mandated, and their prognosis is generally good. But it just depends on how each patient and how aggressive the treatment is. Next we have tuberculosis. This is inflammation at the tubercular bacillus. Or the micropacterium tuberculosis. It is an infection versus active disease type of situation. So if they have the infection, it. Can be inactive or latent or dormant, versus the act of disease that makes them contagious. If they they would be placed in airborne precautions until they determine which they have. Clinical manifestations. It usually attacks the lungs, but it can affect the kidneys, a spy and brainer heart. They would have a fever, chills, night sweats. Hypothesis. Weight loss weakness, a chronic, productive cough, clubbing of the fingers or toes swollen or tender lip notes in the neck. Flew it around the lungs of practice. Tuberculosis, we have presumptive diagnosis. So a couple of tests that we can do are the man to tuberculative skin test, which is what you've had getting into this program. This can be one to two steps. For this test, you would note that that less than 5 mm in duration. Um. Would indicate it being negative. A positive test would be if it had greater than or equal to ten millimeter in duration. Then we have the quantifier in TB GOLD test, both of these tests, the man to TB skin test, and the quantifier in. Are a test for infection, not disease itself. So these would appear two to a week, ten weeks after the exposure. Then we have the chest X ray, or the acid fast, the sili smear, three. This is three speed and samples. If they're positive, that equals the disease being present. And then the chest X ray obviously would show if it was present as well. For a confirmed diagnosis, we would send a spew on culture, checking for that positive TP semi And then is usually a six to week. Eight, week growth period. Medical Management. They're going to be an INH or iottles it. This can be given prophylactically. It's a six to nine month duration. It's given, it's part of a for drug treatment for active TB. It's side effects. You can get peripheral naritis, which is this numbness and tingling, which can decrease if you take Vitamin B, six. It is hepatatoxic, so the hepatitis is a concern. The next medication that they would have in that four month, or that four drug series would be worthamping. This is a four month duration. It can change your fluid's orange in the body, so you're in. And secretions, and it can affect oral contraceptives. So we have to be careful of that. Then we have ethanbutal, which is an optic neuritis, or can cause color blindness, looking at missing red and green when seeing colors. And then we have that pipe resinide, which can be hepatic toxic. Tuberculosis Medical Management again, or fampin is given for active TB, that side effects can have liver problems, changes in vision, those orange and brown tears or rash. And gi, we want to make sure that we're giving it with food. With them beautiful. We talked about those side effects. Cinema broken down there. Medical management resistance or recurrence. So, dot, this is direct observation therapy. We want to watch patients take their medicine. We want to encourage the BCG vaccine. This is more in foreign countries, and it's used with kids. And it can show a false, positive. Be in respiratory isolation for negative air pressure. Patient is to wear a mask when leaving the room, and they'll have good hand washing. Those are good in nursing interventions. Next we're going to talk about pneumonia. This is an inflammatory process of the parochials and the LVL, or spaces due to infection. This is more common in young children and older Adults. The pulmonaries that lea cannot remove the accumulating secretions, so those routine secretions become infected, that inflammation develops, leading to a demo. We have decreased oxygen and carbon dioxide. The exchange of the capillaries, and the causes of this are typically bacteria. Area of viruses, mycoplasm, fungi, and parasites over sedation. Inadequate ventilation and even aspiration. These patients would present with a productive, painful cough, severe cheers, chills, elevated temperature or night sweats increase heart rate and respiratory rate. Shortness of breath, crack holes or cyanosis. Their sputum can be classified based on certain stages or what the bacteria may be. So if it's rust colored, be expected to be streptococo or numercoccal. If it's salmon colored, it would be staphlococcal, yellow or green, colored as hemaphylus mucopurulent, or bloody, it would be viral. Nonproductive would be microplasma. For diagnostic tests, we can do blood sputum cultures, sputum for culture sensitivity prior to any antibiotic administration. A chest X ray, which you see pictured here. CBC Hall SOXES ABGS Pulmonary Function Tests. For medical management. We would give antibiotics like penicillin or cephalosporins, analgesics for comfort, expectorates to get rid of the secretions spronto diliders. Those airways, oxygen. We would want to keep their spot greater than are equal to 92 %. They may be ordered chess, percussion and postural change, which is pictured here. We can do cupping on the back of the patient's back to kind of break up secretions that would be good therapies to provide. For education to the patient at home or their family members to help with some of that breaking up mucus. But pictured here, we have a machine that a lot of patients Have. Who have severe mucus issues, or even in the ICU, particularly where they stick a vest around you, and then they hook it up to this machine, and it shakes you to help loosen up some of those secretions. They would be encouraged to cough and deep breathe, and they may be provided a humidifier. Or nebilizer. We would also force fluids on them to three leaders a day, oral or IV. And, of course, that would be counter, indicated in cha for other conditions that may not be able to manage those fluids. We want to monitor their lung sounds, their positioning. We want to have their good log down or high fowlers. We want to assist with edls. Meals, small, caloric, packed meals that tire easily. So we want to make sure we get as much in as we can in small periods of time. They may need a chess tube if they develop an empiema, which is that pus in that pearl's place. And then consideration for older adults is how they develop with the disease and how they present with it. Maybe confusion with science of ammonia. We also want to make sure that they end up having pneumonia vaccine. Upon discharge, or at least staying up with it on a regular basis, which would be every five years for them. The next disorder is pluacy. This is inflammation of the visceral and parietal plura. So if you remember the plural spaces. The visceral plura is on the lung tissue, and then the parietal plura lines the sac around the lungs. And then there is that plural space in between those two. This is bacterial or viral. It could be related to plural trauma or the early stages of TB or lung tumors. Patients are going to present with a sharp inspiratory pain that radiates to their shoulder or abdomen, of shortness of breath, cough, elevated temperature. They may have the plural friction rub, which is diagnostic for this. They may have plural effusions. In diagnostics, we would use chest X rays. To determine any irritation there. We may also use speed on tests for bacteria or viruses. Medical management. They're going to be given antibiotics if it's bacterial in nature, any analgesics for pain antipyritics for fevers, they're going to need oxygen. For patients with claracy, we want to position them with a good lung up. This helps maximize use of the best lung that we have for oxygenation. May give them heat. Complications with this analepticsis or pneumonia. This is due to a lack of coughing and deep breathing, that fluid is sitting down in the lungs. And not going anywhere, so they may develop that atalactuses or pneumonia. Next, we have a plural effusion. This is an accumulation of fluid in the pearl space, which is between those two plural that we were just talking about. This is rarely independent. It's usually secondary to another issue. That accumulation of fluid in that plural space leads to inflammation, and then an empima is an infection of that plural fluid. Clinical manifestation shortness of breath, air, hunger. They're just striving to get oxygen to get me out. Feelings of fear or anxiety. Respiratory distress. They may have diminished lung sounds crackles in the lung bases, or even have nasal flaring and have a fever. For diagnostics. They may have a chest X ray or do a thoresynthesis to aspirate the fluid out. And test, send it for testing. Medical management, they're going to have that thoresynthesis. This is not just for testing, but it's also for fluid removal. When it's in excess, we're limited to 13 hundred MLS per removal. This prevents any fluid shifting, and in further complications, they may need to chest two with closed water seal drainage system. They may be on antibiotics or need a plurodisis, so we can administer these via the chest tube as well. And a plurodisis is where you remove that plural space to prevent future infections. So we keep pulling that stuff out to get prevent any further infection itself. And then they may need a clear X drainage kit, which is an at, home device. It's similar to a pick line, but it's for self drainage of their plural cavities. So here is just a picture of the plural and where a plural infusion would sit. And then down here to the right would be one of those. Poor extraneage kids that a patient would have at home see how they have a catheter attached to the lower portion of their lung, and they would just hook themselves up and drain, either on an older basis or an as needed. Based on how the patient was feeling, in terms of their breathing. Next this analepticsis. This is common after surgery related to the anesthesia. It is a collapse of the lung tissue due to a collusion of air of a portion of the lung and alvial art deflation. These patients would have shortness of breath to kidney. A oral friction rub chronicles diminished lung sounds, restlessness, anxiety, fatigue. Hypertension, followed by hypertension, altered levels of consciousness, or even a low, grade fever. Diagnostics. We would see serial chest X rays. We'd just be looking for changes in the lungs. ABGS to check for R PH balances and gases. Halsoxymmetry, or even a broncoscopy, might get down there and look and see at the Adalactuses itself. For medical management. They're going to need Bronco dilators like Fordel or Servant to help open up those airways. They'd be on antibiotics if it was bacterial in nature, those euclitic agents to help thin up those secretions. And the analgesics for pain, cough and deep breathe, and then encourage emulation. In terms of respiratory treatments for these patients, they're going to want to be on incentive sperometer. They're going to use their incentive sperometer ten times an hour while awake. They would be on oxygen as needed, chest percussion and postural drainage. As we talked before. They may need a chess tube, but that's usually reserved for severe cases, and some complications with that would be stasis, pneumonia, and that's related to retained secretions. In the Times. Next we're going to talk about the neumothorex. Neumorphorex is a collection of air, or gas in the plural space, causing the lung to collapse. This is an interruption of negative pressure. Causes for this would be emphysema, severe coughing, a penetrating chest injury, fractured ribs, or any injury from a medical procedure like a central line placement. Those at risk for a spontaneous All right, I'm sorry. Those at risk for these numothorexes would be men smokers, those with a history of lung disease. Any history of numothorexes. Tall, thin, and then there's also a risk for spontaneous nemetorex would be focused into that particular group of individuals that are tall and thin. Some clinical manifestations. They'd have decreased. Our absent breast sounds on the affected side, sudden sharp chest pain was shortness of breath, direpheresis, techocardia and to kidney. No chest movement on the affected side, they would have a sucking chest wound if it was caused by a penetrating in a dream. Or even a media final shift, and that's usually attention neumothorex. This pushes on the heart and the vessels and the airway and decreases the. Cardiac will flow. Diagnostics for a new author. X would be a chess X ray, maybe cheese. To treat this, they would need a chest tube to water, seal, drainage system, oxygen, cough and deep breathe. Analgesics, courage, fluids, positioning. We want good luck down. In half hours position. I want to assist with adls and protect from infection. Here's a diagram showing you what a collapsed lung would look like due to the gas built up in the plural space. Chest tubes. Chest tubes are placed in the plural cavity to drain any fluid, blood, or air, and reestablish that negative pressure system and help re, expand the lungs. These are typically attached to a closed system, water seal drainage system, and possibly section. The section is a one, way system. Sutured in place. The bottle system they can is old and really used anymore. And now you have more commercial vices, like the Pliravac, which is what you would see in hospitals Now. So this is a Ploravac. It's got three separate chambers. One is the suction Chamber. Which has the. First chamber, 300 mi of sterile water is put in it, and that's the red arrow that you're looking at. The section amount would be indicated, so it'd be negative 1020, 30 or 40. Then we have the water seal area, which is the green arrow. This is this fluctuates with breathing. It should go up with inspiration and down with expiration. And that's also called tidling. That tidling would stop when the lungry expands. And then the third one, the purple arrow is the collection chamber that measures every shift, and you would expect to see a decrease in output over time. So nursing interventions for these patients, you would proper system function. You would see tidling. If you have an air leak, you would see bubbling. In it. We want to monitor the drainage, not just its amount, but its color and consistency positioning for the patient. Be careful with emulation. We have to make sure it's secured and not pulling out. And then the dressing change. When we do finally change our dressing, we want to look for indema infection, any crepitous, any excess of drainage. Make sure the vaseline causes at the insertion site. Some other key notes to note about this. There's no clamping for long periods of time, which because that could lead to attention Numatorax. Who want a clamp to change the system and check for leaks only. We want to keep the section system below the insertion site. We want to secure to the floor, because if it tips over and the drainage flows into another chamber, we have to replace it because we can't keep accurate INO anymore. And then keep at the bedside, vaseling glaws, clamps and sterile water. And the event of displacement or separation anywhere. I just reviewed all of this information, but here's a picture of an insertion site. Some of the nursing interventions continued. When you want to prevent any potential analyticsis from hyper ventilation that's related to pain and discomfort, they don't want to decree because it hurts. So we want to watch for shortness of breath. We want to get chest X rays to check on progress and then encourage cough and deep breathing. They also have increased air in the plural space. So we want to make sure we're not contributing to that. We want to have our vessel in laws at the insertion site. We want to check for leaks or kinks. Check for crap. It is, or subcutaneous emphysema around the site and the surrounding extremities. And then what if the two pulls out? So if the two pulls out, we want to cover it with Macelene gauze. If it is separated from the suction ganister, and just the tubing is, you want to immerse the tube in a bottle of sterile water to continue with that negative pressure system. We also have a risk for complication of infections. So we want to monitor our white blood cells, our temperature in any site drainage. Next disorder is lung cancer, that is the primary tumor, or metastasis. So it can be the first It can originate in the lung, or it could have come from another organ. It's typically broken down into small cell, non smell cell, squamous cell, and large cell carcinomas. In terms of manifestations. The early stages, they are asymptomatic. They may have a new cough that won't go away, or some hoarseness. And then in the late stages, they end up With. Peripheral lesions. They may have a central lesion that would develop with. I'm opticis, disney fever chills or easing. In the advanced stages. They may have metastasis to deliver esophagus, the heart, paracardium, bone or brain. They would still have weight loss, fatigue, pain. Or even loss a function of the lung at heart. In terms of diagnostics, we went our chest X rays, CT, or MRI. They may have a PET scan, which is called Positive emission Tomography. Or on coscopy or curtaneous needle aspiration spewed on. Psychology. They could have a media status copy and saline lymph no biopsy. To determine metastasist, whether not or not. Three. For medical management. They may have surgery. Most are not diagnosed early enough for curative surgical intervention. So it becomes palated at that point. They may have a new mannectomy, which removes the entire along the other side. Must be able to sustain respiratory efforts in order for the patient to be a candidate for this. Then we also have the lobe back to me, which is where they remove one lobe of each lung. And then you can have a wedger section, which is a chunk is taken out. The patient may undergo radiation or chemotherapy, and their prognosis is variable based on the size, timing, location, and whether there is or is not metastasis. I got plenty of money. Next week, pulmonary edema, which is an accumulation of serious fluid in the interstitial tissue. And LV, OI causes, most common is left ventricular failure. Or you can have inhalation of irritating gases. Rapid IV administration, drug overdose, or pneumonia. These patients would present with shortness of breath, cyannosis, nasal flaring, external retractions. To kidney tacocardia, hypertension, a classic sign for them would be pink or blood tinged, frothy spewtum. They may have restlessness, agitation. Lengths of impending death, raising crack holes decrease urinary output or sudden weight gain because of that retention and disorientation. Diagnostics would be chest X rays, feudal culture and sensitivity. Their medical managements can be focused around medications, so diuretics, they could be having narcotic analgesics to help with anxiety and respiratory Depression. Night pride would baso, dilate the pulmonary congestion and allow better pumping the Jackson to make the heart pump better. Pulmonary ezemas, continued oxygen therapy. They may be on a fending mask, between 40 and 70 % mechanical ventilation if it becomes necessary. Strict eyes and nose daily weights, a low sodium diet. We want to monitor their file science, like their SPOTW Check adgs. They want to maintain a high hours position for optimal Breathing. Maintain their IV slow infusion. We want to give as little fluid as possible at a slow rate. And assist with their adls. Next is our pulmonary embolism. This is a foreign substance in the pulmonary artery, such as a blood clot, fat, clot, air, or amniotic fluid, causes of this history of thrombophobitis, which is clots. And the blend beans. Any recent surgeries related to the immobility or even a bone surgery for. Fat clots, fat emmeli pregnancy, oral contraceptives increase the risk CHF obesity, immobility. Central line placement, or even injury. So a pulmonary embolism would present with, like a sudden, sharp, constant, non radiating chest pain. It does not go away with rest. It's sudden, unexplained shortness of breath, or to gypneum hamopticis, hypertension, analactuses crackles, or a plural friction rub. They may have Pitikii. This is more common with the fat of AI. Clammy or bluish skin, or decrease the oxygenating levels. Diagnostics. We check AVGS, chest X rays, maybe that then VQ scan, spiral CT. CTAS are more common this. CT angiogram, they would need a number 20 IV in the forearm or higher for the IV contrast. We also want to check for allergies. They may have a pulmonary angiogram. This is an invasive procedure. They may check their plasma tea timer. This is a byproduct of fibrine breakdown. So that being elevated would indicate there's a class somewhere. And then we made to Venus, or dopplers, or ultrasounds to roll out. For DVT, but that would not indicate whether a patient had a pe or not, unless there was a DVT. And then you scan that extremity again. And the DVT has, is gone unexpectedly. So here's just a slide showing you where a DVT would have broken off and migrated, and where it lodges, and how it affects the body. Medical management for these patients, they're going to need anti coagulants, a hepron drip, so we're going to monitor their PTTS. We would check their PTT level every 6 H. An important thing to note is an antidote for heprin. It's protamine sulfate. I have had to give that probably three times in my career through the emergency department and ICU. These patients would be on that ever driven, then they would start on. Midden, and would, then we would be checking their PTNR, looking for a goal of two to three. And then that antidote for Kumidin is vitamin K. They would also be on Fibral and other like agents. They'd be on bedrest initially. They'd be Ted Hoes elevate their lower extremities. Check for petal pulses, for circulation. Check circumference to make sure it's not getting worse or migrating. Elevate the head of Ben. They may be on oxygen. We want to monitor them for bleeding, because they'll be on the hepron drips. And then patient teaching. We want to prevent dvts, so patients may be on medications like Heprin, lovinox, or fragment. Those are subcutaneous and given prophylactically. They may also oral contraceptives contribute to clotting. And then they may also have an IBC filter placed or a green film filter. This is a device they put in. The veins that helps catch and break up the clots, and that's usually reserved patients who have frequent. Dvds. Next we have arts or acute respiratory distress syndrome. This results from direct or indirect pulmonary injury caused by pneumonia, chest trauma, aspiration, a near drowning, maybe a fat MLI sepsis, shah drug overdose, regal failure, pancreatitis, COPD. Any neuromuscular conditions, such as gambaret or myistaneous gravis, or any prolonged ventilation, sepsis is the most common cause. And we see about this about twelve to 24 h after the course of infection started. The albl or capillary membranes are altered in resulting increased permeability, creating pulmonary edema and hypoxia. So what would normally just be a gas exchange that turns into a fluid and gas Exchange. Making it difficult to do primarily gases, and that results in hypoxia. These patients would present with respiratory distress, crackles or wheezes, tackle cardia, hypertension, decrease urinary output, or a change in mental status. For diagnostics. We're going to run ABGS to look for gas changes, chest X rays, and pulmonary function tests. For medical management. They're going to start with medications. It's going to be geared to add symptom management with medications and other treatments. So O, two, or ventilation based on what they Need. We want to treat the cause. So if it's a pneumonia, antibiotics, trauma, et cetera, we want to give them corticoteroids, diaretics. This decreases the fluid in adema. It might be on morphine that helps decrease the respiratory drive, helps them relax and. Stop contributing to the factor. So we're breathing faster, we're anxious. It's going to cause them more inflammation and decrease respiratory effort. We might give them to Jackson, which increases cardiac function, antibiotics to treat any infection that might be the cause of it. Nyprid, which would get cause veso dilation, anticoagulence, to prevent any dbts. And we want to maintain fluid status. For our nursing interventions. We're obviously going to administer any oxygen we may give sectioning if it's necessary. We want to pay close attention to their vital signs, respiratory cardiac function, to make sure it's not. Worsening in any way. Position changes, coughing and deep breathing. We want to monitor their eyes and nose prognosis. 40 % on the lungs in terms of success, a hundred percent mortality, if it is a multisystem field. Affected. Next we're going to start talking about COPD, or chronic constructive pulmonary disease. It is chronic and progressive. It is two diseases itself, so it's emphysema and bronchitis. Emphysema itself is also referred to as the pink puffer. The bronchai bronchials and alvioli become inflamed as a result of chronic irritation. Air becomes trapped in the alvioli during expiration. Causing alviol, our distention, rupture and scar tissue, and then we have impaired gas exchange. Risk factors would be smoking, inhaled irritants, or even hereditary And this is mostly related due to a deficiency of the alpha antitrypsum. Clinical manifestations. Initially, they would have shortness of breath on exertion, a little bit of sputum production, external retractions, personal breathing weight loss. Attack, a cardiac to give me a peripheral syannosis, like a central ready color, ready, meaning red. And they would have a one to one breathing. Ratio, which means they breathe in for 1 s, E.G., and they exhale for 1 s. Normal breathing is a one to two ratio. You've taken one. Second of inspiration, and it takes 2 s of expiration. So with the COPD, they're unable to get rid of that trap there. Now, as. The disease advances, the clinical manifestations change, so they start to develop a barrel chest that's due to chronic inflammation in trapped air. They have shortness of breath, even at rest. They have copious spew and production. They're emaciated because they have trouble in eating and breathing at the same time. They have clubbing of the fingers hypercapinia, which is due to cotwo retention, hotlysythemia, which is we'll have an elevated hemoglobin and amadicret. Because the body's trying to produce more oxygen due to a lack of receiving oxygen, so it thinks, if I stimulate more of red blood cell. Or hemoglobin and hematicate, with our oxygen binding capabilities, it might be better. They'll have core pulmonel, which is an increased pressure in the pulmonary arteries and the right ventricle, which leads to more edema. They may even have personality changes. They're very anxious, demanding. They have liver enlargement, and they have bull A which is nonfunctioning, sac ruptures, which equals. Author X. For diagnostic tests. They may have pulmonary function tests. All soxymmetry. These patients typically are ordered to be at 88 % or higher. Obviously we're going to follow physician's order, but these patients are at impaired gas exchange, so we're just going to not want to hyper oxygenate them, and we'll get to that a little bit later. We might check ADGS, chess X rays, CBC, and then look for that alpha antitrips in the sea, which is that hereditary marker that would indicate predispecisticion for. Or emphysema. Medical management is broken down into acute and chronic care. So acute care, they're going to need oxygen therapy. We want slow and low, too much. Oxygen will shut down your bear receptors, which is these patients have brain triggered to say, oh, breathe, you need more oxygen. If we provide them with a bunch of oxygen, their brain is going to shut down and say, you don't need to breathe anymore. and it's going to contribute to more respiratory Failure. They're going to be on Bronco dilators, corticus steroids, or combinations of the two. That you have diaretics, antibiotics, and even CNS, the presence to help decrease some anxiety. But you have to be careful with large doses on those patients. Have a chronic care for these patients. Is also going to include oxygen therapy, slower, low, long, acting bronco dilators and cortusteroids, and then pulmonary. Some nursing innovations. We want to elevate the head of bed. We want them in that orthogning position. Oxygen still low and slow. We encourage purse slip breathing. We want them to breathe in through their nose and purse their lips close tight and then blow out slowly. So we want them to breathe in for 3 s and breathe out for 6 s. They might have chest physiotherapy, which helps break up the secretions. That's that vest that we were talking about before. Want to increase fluids to help decrease the secretions or thin those secretions out, they may need assistance with their adls. We want to monitor their nutritional intake, stop smoking, offer the flu in vaccine and pneumonia vaccine, and then learn to be patient. The second part of copd is the chronic bronchitis, or called blue bloters. The hypertrophy of mucus clans causes a hyper secretion and alters the cilia function in the lungs. This increased airway resistance causes broccoli spasms that make it difficult to. These patients would present with a productive cough, shortness of breath to kidney attack, a cardia, the use of accessory muscles to breathe, restlessness, wheezing. Or even a dusky color. To cyanotic diagnostics, we do chest X or EKGS echoes, ABGS, check their CBTS or pulmonary function tests. These patients are also going to be on procotylators or muucalytics, cortico steroids, antibiotics for infections. They're also going to be on oxygen, low flow. They're going to be purse lit, breathing, encouraged fluids, assist with any adls. They're going to be in high calorie, high protein diets. Avoid smoking and have a relatively poor prognosis. Here's just the slide, breaking down blue bloaders and pink covers from COPD. Next we have asthma. Asthma is a narrowing of the airways due to a various stimuli. There can be extrinsic factors which are. Cold, air, allergens, or food. They may have intrinsic factors like infection, exercise or fatigue, or it could be related to an antigen antibody reaction. And in an acute attack. These are recurrent reversible obstruction of airflow due to BRONCOS spasms. They have increased capillary permeability, which causes the dema in increased mucus secretions. And then mass cells in the lungs release history, causing more inflammation. These patients will present with the following signs and symptoms with the wheezing that's more in the upper airway, like inspiratory or exploratory. They may have syannosis, particularly if the lips, and then status is mad, because is severe, unrelenting attacks. Some early morning signs will be a frequent cough, shortness of breath, feeling tired, that cough, making them weak. Diagnostics. They would have the pulmonary Function test check, X, chest X rays spew them. And cbcs. They're looking for eosynaphylls. These appear in allergic reactions. They may draw theophylline levels, and then they may check for mettholine, which is causes a mild constriction of airways. And an asthmatic will be overreact and be diagnosed. In terms of medical management, acute or rescue therapy, we would give Bronco dilators, aminofiling, or theofiling. Cortuscoid and cortusteroid and epinefrine, oral or subcutaneous These patients would be on oxygen or in continuous pulsacs is needed. And then encourage rest for maintenance therapy. They're going to be unprophylactic treatment, so lucatine inhibitors or massl stabilizers for allergic reactions. They may have a long term heart of criteroid inhalants. We want to avoid any allergens or triggers. They're going to take home what's called a peak flow meter, which measures peak exploratory flow rate. And their overall prognosis is good. Next we have bronchia. This is, this is gradual, irreversible process that involves chronic dilation of the bronchia, resulting in loss of elasticity by. Repeated pulmonary infection, cystic fibrosis, foreign bodies or tumors. These patients are going to have shortness of breath, coughing, leasing at crackles. They have cyannosis with clubbing of the fingers, fatigue, weakness, loss of appetite, fever, or spouse smelling sputum. For diagnostics limitations. We're going to have chest X rays dispute on cultures, CBCS, looking for that polysateemia pulmonary function tests, or even CTS. For management, earning new politic agents, antibiotics FROMCO dilates, low flow oxygen, chest physiotherapy and pastoral change. Hydration, co mis vaporizers, position changes, rest, and in extreme circumstances, they may need surgery, which would be the. To go back to me, which is remover of one or more lobes of lungs.