Chronic Airflow Limitation (CAL)
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Transcript Chronic Airflow Limitation (CAL)
Nursing Management of Clients
with Stressors of Respiratory
Function
Chronic Airflow Limitation (CAL)
Pneumonia
Tuberculosis
NUR133 Lecture #5
K. Burger, MSEd, MSN, RN, CNE
Chronic Airflow Limitation (CAL)
Term used for Chronic lung diseases:
- Emphysema
- Chronic Bronchitis
- Bronchial Asthma
COPD
Chronic Obstructive Pulmonary Disease
Emphysema
Chronic Bronchitis
Bronchospasm, dyspnea
Non-reversible and progressive
Continously symptomatic
Asthma
Reversible airflow obstruction d/t:
Inflammation
Airway hyperresponsiveness
Hyperresponsiveness leading to
bronchospasms
Asthma
- stimulus or allergen- chemical mediators
released. Within minutes:
Dyspnea
Wheezing
Cough
Mucus production
Inflammatory process
TRIGGER
Allergen binds to IgE
Release of inflammatory
chemicals
WBCs come to
the area
WBCs release Mediators which
produce more inflammation
Blood vessel dilation/ Capillary leak
Tissue swelling / Increased secretion
Asthma
Common agents or stimuli:
-fog, smog, smoke
-odors, aerosols
-exercise
-cold air
Allergens- dust mites, animal dander, pollen,
cockroaches, foods, medicines.
Asthma
FOCUSED Respiratory assessment
1. Expiratory and Inspiratory wheezing
2. Dry or moist cough
3. Dyspnea, signs of hypoxemia, anxiety
4. increased HR, BP, RR
5. Diaphoresis, Pallor
6. Cyanosis
7. Nasal flaring
8. Use of accessory muscles
Asthma
Diagnostic Assessment
ABGs / PO2 low, PCO2 high, PH low
SaO2 low
Eosinophils / serum and sputum
PFTs / FEV and PERF
CXR
Asthma
STEP SYSTEM
MILD INTERMITTENT
MILD PERSISTENT
MODERATE PERSISTENT
SEVERE PERSISTENT
Complications of Asthma
- Respiratory infections
- Status Asthmaticus
- pneumothorax
- respiratory arrest
- cardiac arrest
Asthma
Nursing Diagnoses
1. Impaired Gas Exchange related to
alveolar
membrane changes, airflow
limitation, respiratory muscle fatigue,
excess production of mucus.
2. Ineffective Breathing pattern related to
airflow obstruction (narrowed airways),
and fatigue.
3. Ineffective Airway Clearance related to
excessive secretions, fatigue and
ineffective cough.
Asthma Interventions
Client Education
A. Identify causes
B. Proper environmental changes
C. Stress management, rest, and sleep
D. Correct use of inhalers
E. Correct use of peak flow meter and step wise
approach to med management
F. What to do if an attack occurs
Asthma
– How to use a METERED DOSE inhaler
(without spacer) correctly:
1. Shake inhaler
2. Tilt head back, breathe out fully
3. Open mouth, mouthpiece 1-2” away
4. As you begin to breathe in deeply, press down
and release medicine.
5. Breathe in deeply and slowly for 3-5 sec.
6. Hold your breathe for 10 sec
7. Breathe out slowly
Asthma
Drug Therapy
Bronchodilator
Anti-inflammatory
Beta agonists
short-acting
long-acting
Anti-cholinergics
Methylxanthines
Corticosteroids
Anti-leukotriene
Mast cell stabilizers
Monoclonal antibodies
Inhaled agents
Asthma
Pharmacologic stepped approach to treating
asthma symptoms
Step 1- mild intermittent- beta 2 agonist
Step 2.- mild persistent – add cromolyn
Step 3.- moderate persistent- add inhaled
corticosteroid , may add theophylline.
Step 4.- Severe persistent- add po steroids
Chronic Obstructive Pulmonary Disease
EMPHYSEMA
Loss of lung elasticity
Hyperinflation of lungs / air trapping
Diaphragm flattening
Increased airflow resistance
Ineffective gas exchange
Retained CO2 (hypercapnia)
Chronic respiratory acidosis
Chronic Obstructive Pulmonary Disease
CHRONIC BRONCHITIS
Chronic inflammation of airways
Mucosol edema
Increased # of mucous glands
Bronchial wall thickening
Impaired airflow AND gas exchange
Hypoxemia, hypercapnia, respiratory acidosis
COPD
FOCUSED assessment
1. Rapid, shallow respirations & dyspnea
2. Irregular breathing patterns
3. Moist cough
4. Limited diaphragmatic excursion
5. Decreased fremitus
6. Hyperresonant percussion
7. Crackles
8. Barrel chest
9. Cyanosis
10.Clubbing
11.Orthopneic posturing
COPD
DIAGNOSTIC ASSESSMENT
ABGs
SaO2
CXR
PFT
Serum AAT
ECG
H&H, Electrolytes, WBC
Complications of COPD
Respiratory infection
Cor pulmonale
Cardiac dysrhythmias
Nursing Diagnoses for COPD
Impaired gas exchange
Ineffective breathing pattern
Ineffective airway clearance
Activity intolerance
Interventions for COPD
Airway maintenance
Cough enhancement
Oxygen therapy
Energy conservation
Drug therapy
Surgical interventions
COPD Drug Therapy
Bronchodilators
Anti-Inflammatory drugs
Inhalants AND systemic drugs
PLUS Mucolytics
Pneumonia
Community acquired pneumonia (CAP)
Versus
Nosocomial pneumonia
Higher incidence in:
Elderly, immunocompromised, CAL,
mechanically vented, chronically ill
5th leading cause of death in US
Pneumonia
Assessment
Chest pain, dyspnea, tachypnea, SOB
Cough & hemoptysis
Crackles & wheezes
Tactile fremitus
Percussion
Fever and chills
Hypoxemia
Pneumonia
Nursing Diagnoses
Impaired gas exchange
Ineffective airway clearance
Potential for sepsis
Acute pain
Pneumonia
Interventions
C&DB q2h/ incentive spiro
O2 therapy / Positioning HOB elevated
Maintain hydration
Medications: bronchodilators, expectorants,
antibiotics
Client teaching: completion of med rx,
influenza and pneumococcal vaccinnations
Tuberculosis
Causative organism:
Mycobacterium tuberculosis
Incidence increasing worldwide
Highest prevalence: immunocompromised,
people living in crowded and or poor living
conditions
Exposure versus infection versus active
Tuberculosis
Assessment
Persistent, productive cough
Hemoptysis
Fever and night sweats
Fatigue
Anorexia
Weight loss
Progressive and persistent S & S
Tuberculosis
Diagnostic Assessment
Purified Protein Derivative PPD
Positive = 10mm induration or > general
5mm induration or > Hx HIV
CXR
Sputum for acid-fast bacillus AFB
Sputum culture; BACTEC
PCR assay
NEW: Quantiferon TB Gold Test QFT-G
Tuberculosis
Nursing Diagnoses
Impaired gas exchange
Ineffective airway clearance
Fatigue
Deficient knowledge
Ineffective therapeutic regimen maintenance
Tuberculosis
Interventions
Combination drug therapy
Isoniazid (INH)
Rifampin (RIF)
Plus
Pyrazinamide (PZA)
Ethambutol or Streptomycin
RIFATAR = NEW med combo of INH, RIF, & PZA
LONG TERM THERAPY!!!!!
6-12 months duration
CLIENT EDUCATION!!!!!