Management of Patients With Chronic Pulmonary Diseases PDF

Learning objectives Describe the pathophysiology, clinical manifestations, and treatment...

Learning objectives Describe the pathophysiology, clinical manifestations, and treatment Describe of patient with chronic pulmonary disease (COPD &Asthma). CHAPTER 24 MANAGEMENT OF PATIENTS WITH CHRONIC Discuss Discuss the major risk factors for developing COPD and nursing PULMONARY DISEASES interventions to minimize or prevent these risk factors. Use the nursing process as a framework for care of patients with By : Adult nursing Team Use chronic pulmonary disease (COPD &Asthma). Design an education plan for patients with chronic pulmonary Design disease (COPD &Asthma). Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Management of Patients With Chronic Nurse role Pulmonary Disease 1. As nurse you need to provide care for a patient with Chronic pulmonary diseases(CPDs) in all care settings : COPD o ED), critical care, wards, outpatient clinic OR At home 2. To deliver proper care for a patient with CPDs the nurse need to have; Asthma o Smart assessment and clinical management skills o Knowledge of palliative and end-of-life care o Patient and family education skills Bronchiectasis Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Chronic Obstructive Pulmonary disease (COPD) RISK FACTORS of COPD COPD is a common ,preventable and treatable disease Exposure to tobacco smoke (80% to 90% of COPD cases) that is characterized by persistent reparatory systems and airflow limitation that is due to airway and/or Passive smoking (i.e., secondhand smoke) alveolar abnormalities usually caused by significant Increased age exposure to noxious particles or gases (GOLD,2020). There are two classifications of COPD: chronic Occupational exposure—dust, chemicals bronchitis and emphysema. Indoor and outdoor air pollution These two types of COPD can be sometimes confusing because there are patients who have overlapping Genetic ; Deficiency of alpha1-antitrypsin signs and symptoms of these two distinct disease processes Lung growth and development Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Pathophysiology of COPD Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases Chronic inflammation damages tissue Scar tissue in airways results in narrowing Scar tissue in the parenchyma decreases elastic recoil (compliance) Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension) Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Chronic Bronchitis ; blue bloaters Pathophysiology of Chronic Bronchitis  Cough and sputum production for at least 3 months in each of 2 consecutive years  Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways  Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes  The patient is more susceptible to respiratory infections Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Emphysema ; “pink puffers”. Changes in Alveolar Structure  Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli  Decreased alveolar surface area increases in “dead space,” impaired oxygen diffusion result in Hypoxemia  Increased pulmonary artery pressure may cause right- sided heart failure (Cor pulmonale) Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Clinical Manifestations of COPD  Three primary symptoms o Chronic cough o Sputum production ; There is a hyperstimulation of the goblet cells and the mucus-secreting gland leading to overproduction of sputum o Dyspnea on exertion; is usually progressive, persistent, and worsens with exercise. o Dyspnea at rest. As COPD progress, dyspnea at rest may occur  Weight loss ; Dyspnea interferes with eating and the work of breathing is energy depleting  Barrel chest; In patients with emphysema, results from a more fixed position of the ribs in the inspiratory position and from loss of elasticity  Extrapulmonary manifestations of COPD. o Musculoskeletal wasting o Metabolic syndrome o Depression Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Normal Chest versus Barrel-Shaped Chest Typical Posture of a Person With COPD Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessment and Diagnosis of COPD Health history. The nurse should obtain a thorough health history from patients with known or potential COPD. Physical examination: focus on resp, cardio Pulmonary function studies. Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor 1-Health history, Chart 24-2 Summarize the key factors disease progression. to assess for patients with known or suspected COPD. Spirometry. Spirometry is used to evaluate airway obstruction, which is 2- PE determined by the ratio of FEV1 to forced vital capacity. ABG. is used to assess baseline oxygenation and gas exchange and is 3-Pulmonary function tests especially important in advanced COPD. 4-Arterial blood gas Chest x-ray. May reveal hyperinflation of lungs, flattened diaphragm, decreased vascular markings/bullae (emphysema), increased bronchovascular markings 5- Chest x-ray (bronchitis). Bronchogram: Can show cylindrical dilation of bronchi on inspiration; bronchial collapse on forced expiration (emphysema); enlarged mucous ducts (bronchitis). Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Grades of Chronic Obstructive Pulmonary Disease  1-2-Spirometry: the presence of a post-bronchodilator FEV1/FVC