Pulmonary Disease
(C.O.P.D)
Chronic Obstructive Lung Disease
Chronic Airway Limitation
Description
A group of diseases that include:
Chronic Bronchitis- chronic
inflammation of bronchi
unrelieved in 3 consecutive
months and in 2 consecutive
years
Chronic Asthma (Status
Astmaticus)- S/sx of allergic
attack unrelieved within 24
hours of adequate therapy
Bronchiectasis- dilation of
bronchioles r/t chronic
airway obstruction
Pulmonary Emphysemaoverdilatation of alveoli
(compliance) and resulting
in Recoil
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Basis
Chronic
airway blockage
Airway resistance
Progressive airflow limitations both
ways
Irreversible alveolar distention air
trapping alveolar damage ABG
imbalances: Low pO2, High pCO2
Possible Complications
Pulmonary hypertension
Respiratory insufficiency or
Respiratory failure
Cor Pulmonale
CO2 Narcosis
Alveolar Rupture
Atelectasis
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Bronchial Asthma
Description
Also
Etiology
Extrinsic Allergens
Inhalants
Ingestants
Contactants
Temperature changes
Intrinsic allergens
Fatigue
Stress / anxiety
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Types of Asthma
Immunologic asthma
Occurs in childhood r/t
allergens; Allergic asthma
or atopic asthma; heredity;
high lgE
Non-Immunologic
Occurs in adulthood, usu.
Associated with URTI or LRTI
Non-allergic asthma or nonatopic asthma;
onset usually > 35 years
Mixed Asthma
Any age; any allergen; nonspecific stimuli
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Pathophysiology
Allergens
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Capillary
Permebility
Vasodilation
Hypotension
Shock
Blood
congestion
(Hyperemia)
Escape of
Colloids
Edema
BV
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Other
DOB
Wheezing (classic)
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Nursing Interventions
Administer medications, as
ordered
Administer nebulizer as
ordered
Provide patient teaching
about preventing attacks
and proper use of
medications
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Pharmacotherapy:
Bronchodilators to relieve bronchospasm
Beta-Adrenergic agents: rapid onset of
actions when administered by aerosol
Theophylline check pulse and blood pressure
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Chronic Bronchitis
Is
an inflammation
of bronchioles that
impairs airflow.
16
May
be
oAcute when the bronchus
becomes inflamed
oChronic results when
inflammation occurs several
times a year; can be diagnosed
by the presence of cough that
persists for 3 months a year for
2 years
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Etiology
Exposure
to pulmonary irritants
Infections including RTI and
influenza
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PATHOPHYSIOLOGICAL PROCESS
Causes : Cigarette
Smoking
RTI
INFLAMMATION
Environmental
Pollutants
Bradykinin
Fluid / Cellular
Exudation
Edema of Mucous
Membrane
Capillary
Permeability
Hypersecretion
of Mucus
Histamine
Prostaglandin
Persist
ent
Cough
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Signs
and symptoms
Coughing
Excessive sputum production
Rhonchi
Shortness of breath
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Nursing Interventions
Eliminate
/ minimize patients
exposure to irritants and people with
RTI.
Clear airways with chest physical
therapy or suctioning as ordered.
Mucolytics as prescribed.
Deep-breathing exercises.
Patient teaching about adequate
nutrition and medication therapy.
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Pulmonary
Emphysema
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Description
Terminal
stage of COPD
Overdilated alveoli and
bronchioles
Damage to alveoli and failure
of alveolar diffusion
NSg. Dx: Imp. Gas Exchange
ABG: paO2
paCO2
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Etiology
Predisposing Fxs:
A-ge
H-eredity (low alpha1 antitrypsin)
A-uto-Immune tendency
Precipitating Fxs:
B- ronchitis, chronic
A-ir Pollution
S-moking
A-sthma, chronic
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Based on Types:
CENTRIBULAR
Blue
Bloater Type
Cyanotic
Edematous
W/ prod. Cough
D.O.E.
Weakness
Nail Clubbing
ABG: Resp. Acidosis
S/S of hypoxia
S/S of R-sided CHF
Barrel-shaped chest
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PAN-LOBULAR
2nd stage
Most alveoli and
bronchioles dilated
Mucus expelled
Hyperventilating
(compensation to high
pCO2)
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Pink
Puffers
Pinkish skin color
Emaciated
Non-productive cough
Severe weakness
Anorexia
Dyspnea
ABG: Resp. Alkalosis
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fatigue
Pursed lip breathing
Barrel Chest
Dyspnea, orthopnea
Retractions
Prolonged I:E ratio
Wheezing on expiration
Clubbing
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Nursing Interventions
NDx1: Gas Exchange, Imp. R/t
ventilation: perfusion
mismatching (Physiologic
shunting)
Goal 1: Normal ABG values
2: No Hypoxia
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Dysrhythmias
HR, BP
Excitation (L.O.C.)
N&V
Tremors
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Respiratory therapy
Antibiotics or antihistaminics as
ordered
Position: High fowlers lean
forward. Use overbed table
Administer steroids as ordered to
decrease swelling of airway
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Position
Pursed-lip breathing
Blow bottle exercises
IPPB with nebulization
Alternate activities with rest
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NDx5: Ineffective
Individual/Family Coping
Goal 1: Optimum coping level
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Encourage catharsis
Involve in self-care and improve
self-esteem
Allow to make decisions about his
care (shaving, bathing , eating, etc)
Adopt a hopeful and encouraging
attitude towards pt
Encourage activity to level of
tolerance to improve self-esteem
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LUNG CANCER
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Description
Refers
to malignant tumor
growth within the bronchial
tissue or lung parenchyma.
Types include:
Squamous cell 35 50% of all
lung cancers.
Adenocarcinoma 15 35% of all
lung cancers.
Small cell (oat cell) 20-25% of all
lung cancers
Large cell 10-15% of all lung
cancers
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factors chronic
exposure to pulmonary irritants
Family
Tend
Pathophysiology
As the lung tissue experiences
irritation, it undergoes a series of
changes and eventually gives rise
to a tumor.
Metastases can occur, especially
when the mother tumor is near
areas of lymph drainage.
Some tumors secrete hormones:
ADH reabsorption of water
ACTH stimulates adrenal glands
to produce steroids
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Symptoms
may include:
Cough
Wheezing
Shortness of breath
Chest pains
Hoarseness
Dysphagia (compression of
esophagus)
Weight loss
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Nursing Interventions
Prepare the patient for surgery if
tumor is small enough to be removed
Prepare patient for planned
treatments chemotherapy /
radiation therapy
Analgesics as ordered to control pain
Adequate oxygenation through
oxygen therapy or planned activityrest
Maintain nutritional status
Provide emotional support to the
patient and family
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