Respiratory conditions.pdf

ASTHMA, COPD, PAH, Dr. Ruvalcaba, EdD, IDIOPATHIC PULMONARY MSN, RN FIBROSIS, & CHEST TUBES  ASTHMA Asthma is the intermittent and reversible airflow obstruction of the bronchioles either by inflammation or airway hyperresponsiveness...

ASTHMA, COPD, PAH, Dr. Ruvalcaba, EdD, IDIOPATHIC PULMONARY MSN, RN FIBROSIS, & CHEST TUBES  ASTHMA Asthma is the intermittent and reversible airflow obstruction of the bronchioles either by inflammation or airway hyperresponsiveness Chronic inflammatory disorder of the airway Cause: Immune-mediated airway inflammation Manifests as episodes of coughing, shortness of breath, and wheezing. Four categories Mild intermittent: Symptoms occur less than twice a week Mild persistent: Symptoms arise more than twice a week but not daily. Moderate persistent: Daily symptoms occur in conjunction with exacerbations twice a week. Severe persistent: Symptoms occur continually, along with frequent exacerbations that limit physical activity and quality of life ASTHMA: RISK FACTORS Older adult clients have decreased pulmonary reserves and are more susceptible to infections. Family history of asthma Why is GERD a risk factor for Smoking asthma? Shortness of breath, also called Secondhand smoke exposure dyspnea, occurs with GERD Environmental allergies because stomach acid that creeps Exposure to chemical irritants or dust into the esophagus can enter the lungs, particularly during sleep, Gastroesophageal reflux disease (GERD) and cause swelling of the airways. Obesity- fat tissue causes pressure on the This can lead to asthma reactions layers of the trachoi or cause aspiration pneumonia. -body releases mast cells. then it releases a whole bunch of white blood cells and a bunch of other mediators and so PATHOPHYSIOLOGY OF ASTHMA Exercise induced asthma, moles, some food, some medications may trigger asthma (beta blocker, cockroaches, stress, cold air WHAT IS ASTHMA? (VIDEO)  ASTHMA CUES Prolonged expiration Severe dyspnea Diminished breath sounds Chest tightness Use of accessory muscles Anxiety or stress Non-Coughing Increased heart rate and blood pressure Tachypnea Restlessness, anxiety, agitation Wheezing Poor oxygen saturation (low SaO2) Mucus production Barrel chest or increased chest diameter Use of accessory muscles (COPD patients have this too) LABORATORY/DIAGNOSTIC TESTING OF ASTHMA ABG’s Sputum culture Pulmonary function tests/Spirometry Chest x-ray Pulse oximetry (not a diagnostic but helps with the assessment process)  ARTERIAL BLOOD GASES Measurement of acidity or alkalinity of the arterial circulation It also measures gases such as oxygen and carbon dioxide This test is commonly used if you one has difficulty breathing or any of the following conditions: A serious infection (sepsis). Lung disease such as COPD or asthma. A head injury. Kidney failure. Drug overdose. Diarrhea or vomiting. Other serious illness. PH SCALE PULMONARY FUNCTION TESTS (PFTS)  CHEST X-RAY A chest X-ray is a test that creates an image of your heart, lungs and bones. Another name for a chest X-ray is chest radiograph. A chest X-ray uses a focused beam of radiation to look at your heart, lungs and bones. Diagnose or treat conditions like pneumonia, emphysema or COPD. Chest X-rays are quick, noninvasive tests. Usually, you will know the results of your X-ray within one to two days.  SPUTUM CULTURE A sputum culture is a test that checks for bacteria or another type of organism (fungi) that may be causing an infection in your lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in your lungs or airways. The thickness of sputum helps trap the foreign material. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out.  PULSE OXIMETRY Not a diagnostic test; however, it is a very useful bedside testing. Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation readings are typically within 2% accuracy of the more accurate reading of arterial oxygen saturation from arterial blood gas analysis NURSING CARE The goal is to control and prevent episodes, and relieve symptoms. Asthma is best controlled when the patient is Listen to anterior and posterior an active partner in the management plan. when listening to lung sounds; this Self-management education helps to check for various symptoms Disease process like dysrhythmias/sinus tachycardia Drug therapy- bronchodilators help relax and open the bronchioles Good oral care is needed as it can Lifestyle management strategies- staying away from people that smoke or gatherings travel up to your bloodstream and that cause allergies/ smoking cessation cause issues O2 management Family education  STATUS ASTHMATICUS Severe, life-threatening acute episode of airway obstruction- veins become extended Extremely labored breathing and wheezing. Use of accessory muscles for breathing Distention of neck veins. This is an EMERGENCY If not promptly treated: pneumothorax and cardiac or respiratory arrest Treatment: IV fluids, bronchodilators, steroids, epinephrine, and O2. Sudden absence of wheezing and low oxygen saturation: airway obstruction and requires a tracheotomy CHRONIC OBSTRUCTIVE PULMONARY DISEASE  CHRONIC OBSTRUCTIVE PULMONARY DISEASE Long-term lung disease that makes it hard to breathe. Exposure to irritants that damage your lungs and airways Refers to a group of diseases/within the COPD umbrella Emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease.  CHRONIC OBSTRUCTIVE PULMONARY DISEASE Emphysema Bronchitis How is it diagnosed in terms of people that smoke? they are not able to push air OUT and this leads to the alveoli to be heavily impacted  COPD CAUSES AND RISK FACTORS Cigarette smoking - number of cause Long-term exposure to air pollution, secondhand smoke and dust, fumes and chemicals Alpha-1(protein that helps protect lungs) deficiency-related emphysema. A history of childhood respiratory infection Older adult clients- they are more exposed to infection Complications: Hypoxemia and acidosis; respiratory infection, cardiac failure (cor pulmonari); cardiac arrythmias.  ASSESSMENT OF CUES Health History Smoking history (how many packs and for how long) Breathing problems Triggers- season/allergens Activity level- short of breath with ADLs Weight Psychosocial assessment- how are they able to cope with this condition and the stress of it all Tripod position and the best position CHRONIC OBSTRUCTIVE PULMONARY DISEASE RECOGNIZE CUES Dyspnea upon exertion Hyperresonance on percussion Productive cough that is most severe Thin extremities and enlarged neck upon rising in the morning muscles Hypoxemia Dependent edema secondary to Crackles and wheezes right‑sided heart failure Rapid and shallow respirations Pallor and cyanosis of nail beds and mucous membranes (late stages of Use of accessory muscles the disease) Barrel chest or increased chest Decreased oxygen saturation levels diameter (with emphysema) (expected reference range is 95% to Irregular breathing pattern 100%) Clubbing of fingers and toes (late In older adults or clients who have stages of the disease) dark‑colored skin, oxygen saturation levels can be slightly lower. BARREL CHEST & CLUBBING The triangle helps to check for clubbing The lungs are overfilled with air and they are not able to excrete air out therefore, the barrel chest occurs in  COPD LAB TESTS AND DIAGNOSTICS Increased hematocrit level is due to Pulmonary Function Test low oxygenation levels. The lung volumes measured for COPD are vital capacity (VC), residual volume (RV), Use sputum cultures and WBC counts forced expiratory volume (FEV), and total to diagnose acute respiratory lung capacity (TLC). infections. Chest x-ray Arterial blood gases (ABGs) Reveals hyperinflation of alveoli Hypoxemia (decreased PaO2 less and flattened diaphragm in the late than 80 mm Hg) stages of emphysema Hypercarbia (increased PaCO2 Alpha1 antitrypsin levels greater than 45 mm Hg) COPD Assessment Test (CAT) Blood electrolytes  NURSING CARE Prescribed drug therapy Beta-adrenergic agents, cholinergic antagonists, methylxanthines, corticosteroids, and cromolyn Inhaler use incorrect use of inhalers can lead to the therapy to be ineffective Airway maintenance, monitoring Breathing techniques, positioning Abdominal/diaphragmatic breathing Pursed lip breathing Effective coughing Cluster breaks- taking breaks with ADLs as they Oxygen therapy don’t have the energy and we provide them with small frequent meals that are soft (so that not Exercise conditioning chewing preserves energy) and have a lot of Hydration nutrients  CARE COORDINATION AND MANAGEMENT Readmissions, morbidity, or mortality for patients with chronic diseases such as COPD Ambulatory care setting and cared for at home. Individualized action plans Prevent exacerbations Reinforcement of medications Recognizing the need for early intervention O2 therapy Case management  COMPLICATION Pneumonia Flu vaccine Pneumococcal vaccine  INTERPROFESSIONAL COLLABORATION 2 liters is safe to give b/c if you give them too Primary health care providers Physical therapists much, it will make Nurses Social workers the patient become too Registered dietitian nutritionists Patient navigator dependent on the oxygen therapy Pharmacists Community health workers but follow the order and it will Respiratory therapists Mental health practitioners. read something Occupational therapists like “titrate to maintain the patient's baseline”  PULMONARY ARTERIAL HYPERTENSION Idiopathic pulmonary artery hypertension Condition in which pulmonary vessels an other lung tissues undergo growth changes that greatly increase pressure in the lung circulatory system for unknown reasons. When PAH progresses, it can lead to cor pulmonale which causes reduced perfusion and gas exchange. Occurs mostly in women between the ages of 30 and 60 years and there is also a genetic susceptibility. Cues: dyspnea, fatigue, angina-like chest pain  PAH Interventions Diagnosis Drug therapy Right-sided heart catheterization endothelin-receptor antagonists, showing elevated pulmonary such as bosentan, ambrisentan pressures. and macitentan. Ventilation-perfusion scans Natural and synthetic Pulmonary function tests (PFTs) prostacyclin agonists as CT Scan epoprostenol sodium for injection (a prostacyclin) -EK Phosphodiesterase type 5 -blood work for HIV inhibitors as sildenafil and -pregnant woman or breastfeeding moms tadalafil need to another medication therapy as this impacts pregnancy Diuretics & Oxygen  IDIOPATHIC PULMONARY FIBROSIS Restrictive lung disease, with no known cause. Diagnosis Slow onset Pulmonary function test Early symptoms of mild dyspnea on exertion. High resolution CT Males ages 50 to 70 Drug therapy Nintedanib Risk factors history of cigarette smoking Corticosteroids chronic exposure to inhalation irritants. N-acetylcysteine Short life expectancy Immunosuppressive drugs Excessive wound healing with loss of cellular Oxygen regulation Later stages palliative care Monitoring ABGs, pursed lip breathing, position