COPD PDF

COPD Inflammation results into Chronic obstructive pulmonary increase bradykinin, histamine, disease prostaglandin, serotonin and Combination of three disorders...

COPD Inflammation results into Chronic obstructive pulmonary increase bradykinin, histamine, disease prostaglandin, serotonin and Combination of three disorders leukotrienes o Chronic bronchitis Increase of this can cause o Asthma bronchospasm o Emphysema Bronchoconstriction due to Also called as CAL or chronic bronchospasm airflow limitations Edema on the mucous membrane Also known as blue bloaters Hyper secretion of mucous due to which means cyanotic and edema bloated There will be narrowing of the All of us are prone to this due to airway smoking Wheezing sounds Increase tachypnea due to Etiology bronchoconstriction cigarette smoking RTI or Respiratory Tract Signs and Symptoms Infection Restlessness – early signs of Secondary to environmental hypoxia pollutants o Upright position, orthopneic position All of this will result in Dyspnea due to tachypnea bronchioles inflammation which Tachycardia can cause increase bradykinin, Use of accessory muscles histamine, and prostaglandin Nasal flaring Increase prostaglandin can cause Cold and clammy due to anxiety pain specifically chest pain Diaphoresis Increase of all of this can result From palor to cyanotic into increase capillary Exhaustion due to many minutes permeability na may pumapasok of hard breathing na tubig which can cause cell Hypoventilation exudation Carbon dioxide retention or After that there will be edema on hypercardia due to mucous membrane hypoventilation If there’s edema on mucous Hypoxia membrane there will be hyper Respiratory acidosis secretions Persistent cough REMEMBER: Don’t give water when having asthma attack ASTHMA Usually characterized by the wheezing sound EMPHYSEMA Etiology Pink puffers Common is allergy due to Over distention of the alveoli but irritation of allergens like dust it is not collapse collecting things Barrel chest is common Extrinsic – outside Intrinsic – inside Etiology  Cigarette smoker Hereditary Aging process Management Pathophysiology Rest to reduce oxygen demand Result to disequilibrium in Increase oral fluid intake to elastase and anti elastase which liquify secretions are responsible for elasticity of Good oral care alveoli Diet If madami ang elastase that anti o High Calorie for us to hindi na have energy Destruction of elastic recoil o High protein to Nakafix na lang na inflated so increase and maintain ther is over distention of alveoli the integrity of the There will be carbon dioxide alveolar walls retention hypercarbia o Low carbohydrates for Hypoxia us to limit production Respiratory acidosis of carbon dioxide o Mataas na carbs results Signs and Symptoms into high carbon dioxide production Barrel chest Give oxygen therapy Cough – common sign o 1-3 liters per minute if Tachypnea that results into wala pang doctors dyspnea order Cyanosis Avoid cigarette smoking Chest pain – cause by high level CPT or chest Physiotherapy of prostaglandin o Postural drainage Productive cough due to Bronchial hygiene hypersecretion o Suctioning Possible for adventitious breath o Nebulization sounds if there’s asthma attack o Steam inhalation Crackles if there’s no asthma Medications attack o Expectorants to expel Restlessness secretions Pursed lip breathing – parang ▪ Guaiferucin nakanguso pag humihinga o Mucolytic to liquify Orthopneic position phlegm Nasal flaring ▪ Carbosistine Voice changes due to obstruction ▪ Mucumist of airway o Antitussive anti kahol Muscle weakness or fatigue ▪ Sinicod Anorexia ▪ Dextromethropha Weight loss n Clubbing of nails due to low ▪ Codine oxygen observe signs for drowsiness Avoid using antitussive if there is activity  Can cause There is a positive pressure constipatio ventilation n then Wrong procedure of thoracentesis increase CVP line insertion oral intake Secondary to emphysema o Bronchodilators ▪ Salbutamol Signs and Symptoms ▪ Aminophylline DOB ▪ Terbutaline Shortness of breath Monitor Sudden sharp chest pain the heart Restlessness rate Tachycardia because Tachypnea this can Positive to decrease of breath cause sounds to absent of breath sounds tachycardi due to lung consolidation a o Antihistamine Chest tightness ▪ Cetirizine Chest asymmetry ▪ Diphenhyronel Deviation of larynx and trachea Watch out moving to unaffected site for Cyanosis drowsiness Dullness or tympanic on Monitor percussion LOC and safety Management o Steroids Stay calm and stay with the ▪ For lung patient expansions High fowler position ▪ For anti- Pain management inflammatory o Medication effect o Deep breathing and o Antimicrobials coughing exercise ▪ Antibiotics like Oxygen therapy amoxicillin Chest tube drainage ▪ Check for skin Chest x ray to monitor patient’s testing lung ABG monitoring REMEMBER: Suctioning is not Monitor for any signs of shock appropriate due to airway obstruction o BP PLEURAL EFFUSION AND PNEUMOTHORAX Accumulation of either air or fluid in the pleural space Etiology Secondary to trauma VA and has ruptured Secondary to thoracic surgery  Blood Urea Nitrogen (Bun) Trop I Blood Lipids Enzyme Studies Urinalysis Blood Uric Acid Stress Test Or Treadmill Test Cardiac Catheterization COMPLETE BLOOD COUNT For evaluation of general health status Elevated RBC suggests inadequate tissue oxygenation (Hypoxia). Hypoxia stimulates renal secretion of crythropoietin. This stimulates the bone marrow to increase RBC production (polycythemia). Elevated WBC may indicate infectious heart disease and/or myocardial infarction. ERYTHROCYTE SEDIMENTATION RATE (ESR) It is a measurement of the rate at which RBC seetle out of anticoagulated blood in an hour. It is elevated in infectious heart disorders or myocardial infarction Normal Values (NV): Males 15- 20 mm/hr; Females 20-30 mm/hr BLOOD COAGULATION TESTS Prothrombin time (PT, Pro- time) o It measures the time required for clotting to CARDIOVASCULAR occur after thromboplastin and calcium are added to Diagnostic Tests decalcified plasma. o It is valuable in evaluating Laboratory Tests the effectiveness of Complete Blood Count coumadin. Erythrocyte Sedimentation Rate (ESR) Blood Coagulation Tests  o Therapeutic range is 1.5 to Heart injury cases has elevated 2 times the normal or Trop I control. o Normal range is 11 to 16 seconds BLOOD LIPIDS Cholesterol Partial Thromboplastin Time o NPO for 10 to 12 hours (PTT) o Normal values 150 to 250 o It measures the time mg/dl required for clotting to Triglycerides occur after a partial o NPO for 10 to 12 hours thromboplastin reagent is o Normal values 140 to 200 added to blood plasma. mg/dl o It is the best single Blood Cultures screening test for disorders o To assist in the diagnosis of of coagulation. infectious diseases of the o It is determined to evaluate heart the effectiveness of o Caution is taken to prevent heparin. contamination of the o Therapeutic range is 2 to specimen 2.5 times the normal or control. o Normal range is 60 to 70 seconds. Activated Partial Thromboplastin Time (APTT) ENZYME STUDIES o It has the same purpose as PTT. It is most specific test Creatine Phosphokinase (CK- to evaluate effectiveness of MB) heparin. o It is the most cardiac o Therapeutic range is 2 to specific enzyme 2.5 times the normal or o It is an accurate indicator control. of myocardial damage o Normal range is 30 to 45 o Normal range: Male 50- seconds. 325 mu/ml; Female 50-250 mu/ml o Range with Myocardial BLOOD UREA NITROGEN (BUN) Infarction (MI) ▪ Onset 3 to 6 hours It is an indicator of renal ▪ Peak 12 to 18 function. hours Decreased cardiac output leads to ▪ Returns to normal low renal tissue perfusion and 3 to 4 days reduction in glomerular filtration Lactic Dehydrogenase (LDH) rate. BUN level becomes o Among the five LDH elevated. isoenzymes, LDH1 is the Normal range is 10 to 20 mg/dl most sensitive indicator of myocardial damage. o In Myocardial Infarction, TROP I LDH1 is elevated and its level exceeds LDH2. Normal value below 14 mg/L  o Normal range 100 to 225 Cardiovascular disorders result to mu/ml decreased renal tissue perfusion. o Range with Myocardial This will cause impairment of the Infarction ability of the kidneys to clear the ▪ Onset 12 hours plasma of end products of ▪ Peak 48 hours metabolism like uric acid. ▪ Returns to normal Normal range 2.5 to 8 mg/dl 10 to 14 days Hydroxybutyrate Dehydrogenase (HBD) STRESS TEST OR TREADMILL TEST o Elevation of HBD is ECG is monitored during always accompanied by exercise on a treadmill elevation of LDH levels Its purpose is to: o It is valuable in detecting o Identify ischemic heart Silent MI because it disease remains elevated for a long o evaluate patients with chest period of time, even after pain; evaluate effectiveness the other enzymes have of therapy returned to normal. o develop individual fitness o The HBD/LDH ratio may program. be increased in MI o Normal range 140 to 350 Nursing Interventions mu/ml Get adequate sleep the night o Range with MI before the test ▪ Onset 10 to 12 Avoid tea, coffee, and alcohol on hours the day of the test ▪ Peak 48 to 72 Avoid smoking and taking hours nitroglycerine 2 hours before the ▪ Return to normal test 12 to 13 days Wear comfortable, loose-fitting clothes Eat a light breakfast/ lunch at URINALYSIS least 2 hours before the test Wear rubber-soled pair of shoes Use to assess the effects of Inform the physician if any cardiovascular disease on renal unusual sensations develop function and the existence of during the test concurrent renal or systemic diseases Rest after the test Albuminuria is detected in clients with malignant hypertension and Congestive Heart Failure CARDIAC CATHETERIZATION Myoglobinuria supports diagnosis of MI Use to assess oxygen levels, pulmonary blood flow, cardiac output, and heart structures BLOOD URIC ACID Use for coronary artery visualization This test reflects adequacy of Right-sided heart catheterization renal tissue perfusion thereby is done by insertion of catheter glomerular filtration of via a cutdown into a large vein metabolites. (medial cubital or brachial vein)  Left-sided heart catheterization is done by passing a catheter into the aorta via brachial or femoral artery. Nursing Interventions BEFORE Before the procedure: Provide psychological support Assess for allergy to iodine/seafoods Obtain baseline VS Withold meals before the procedure Have client void Administer sedative as ordered Mark distal pulses Do cardiac monitoring Done under local anesthesia May experience warm or flushing sensation as the contrast (medium) is injected. Fluttering sensation is felt, as the catheter enters the chambers of the heart Nursing Interventions BEFORE Bedrest if the catheter insertion site is an upper extremity until VS are stable while if at the lower extremity is for 24 hours Monitor VS especially peripheral pulses Monitor ECG, note for dysrhythmias Apply pressure dressing and small sandbag or ice over the puncture site to prevent bleeding Immobilize affected extremity in extension to promote adequate circulation Do not elevate head of the bed more than 30 degrees if femoral site was used Monitor extremities for color, temperature and tingling sensations