Respiratory - PowerPoint PPT Presentation

1 / 161
About This Presentation
Title:

Respiratory

Description:

Respiratory Medical Surgical Nursing P10B Lung CA left bronchus * Correct answer: A When a problem falls outside a nurse's experience or knowledge, it is ... – PowerPoint PPT presentation

Number of Views:66
Avg rating:3.0/5.0
Slides: 162
Provided by: portervill
Category:

less

Transcript and Presenter's Notes

Title: Respiratory


1
Respiratory
  • Medical Surgical Nursing
  • P10B

2
Nasal Cavity
  • Location
  • Btw mouth cranium
  • Function
  • Remove foreign bodies
  • Warm
  • Moisten
  • Olfactory

3
Nasal Cavity
  • Contains
  • Cilia
  • Hair-like
  • Sensitive nerve endings
  • Sneeze

4
Para-Nasal Sinuses
  • Description
  • 4 pairs
  • Facial area
  • Continuous w/ nasal cavity
  • Function
  • Speech

5
Pharynx (throat)
  • Passageway
  • Food liquids ?
  • Digestive tract
  • Air ?
  • Respiratory tract
  • Lowest portion
  • Opens into 2 space

6
Pharynx (throat)
  • Location
  • Behind nasal cavity
  • Contains
  • Adenoids
  • Tonsils
  • Lymph system
  • Eustachian tubes

7
Larynx (voice box)
  • Location
  • Btw pharynx trachea
  • Function
  • Vocalization
  • Facilitates cough/sneeze

8
Larynx (voice box)
  • Epiglottis
  • Gateway / trap door
  • Flap of elastic cartilage
  • Thyroid cartilage
  • Adams apple

9
Larynx (voice box)
  • Vocal cords
  • Speech

10
Trachea (Windpipe)
  • Location
  • Btw larynx bronchi
  • Description
  • 4-5 inches long
  • Palpate
  • Above sternal notch
  • C-shaped rings of cartilage

11
Trachea (Windpipe)
  • Function
  • Conduct air

12
Bronchi
  • Location
  • Below trachea
  • Center of chest
  • Behind the heart
  • Branches into 2 tubes
  • Rt
  • h diameter
  • More vertical
  • Shorter in length

13
Question?
  • Mr. Henderson had a CVA 5 days ago and is having
    some difficulty swallowing. There is some
    question that he may have aspirated some food and
    developed pneumonia. What side pneumonia would
    you except him to have?
  • A. Right sided
  • B. Left sided

14
Lungs
  • Location
  • Thoracic cage
  • Description
  • Airtight
  • Mult. Air sacs
  • Rt
  • 3 lobes
  • Lf
  • 2 lobes

15
Lungs
  • Bronchi
  • Bronchial tree
  • Bronchioles
  • No cilia
  • No cartilage
  • Patency d/t
  • elastic recoil of the smooth muscles
  • alveolar pressure

16
Lungs
  • Alveolar ducts
  • Smallest tubes
  • Alveoli
  • Functional unit
  • Air sacs
  • Gas exchange
  • Surrounded by pulm. Capillaries

17
Lungs
  • Alveoli
  • Thin membrane
  • Tendency to collapse
  • Alveolar Pressure
  • surfactant

18
Pleural membrane
  • Location
  • Surrounds surface of lung interior wall of
    thorax
  • Function
  • Protects
  • Neg. pressure
  • Allows movement (i friction)

19
Pleural membrane
  • Pleural space/cavity
  • Btw
  • Contains fluid

20
Mediastinum
  • Location
  • Space btw lungs
  • Contains
  • Heart
  • Large blood vessels
  • Esophagus
  • Trachea
  • Bronchi

21
Diaphragm
  • Location
  • Muscle btw lungs abd. Cavity
  • Aids in resp

22
Skeletal System
  • Ribs
  • 12 pairs
  • Thoracic cage
  • Sternum

23
Pulmonary circulation
  • Main function of resp. system is to deviler O2 to
    the blood remove CO2 from it.
  • Pulm. Art.
  • CO2 / deoxygenated
  • Pulm vein
  • O2 / oxygenated

24
Blood flow heart and lungs
  • Inf/sup vena cave
  • Rt atrium
  • Tricuspid
  • Rt ventricle
  • Pulm
  • Pulm art
  • Pulm cap
  • Pulm vein
  • Lt atrium
  • Bicuspid / mitral
  • Left venticle
  • Aorta

25
Small Group Questions
  • Name the structures that air flows past on its
    way to the lungs
  • What is the function of the epiglottis?
  • What are the supporting structures of the
    trachea?
  • Where in the circulation of blood do you find
    deoxygenated blood?

26
  • How many lobes do the rt and lf lungs each have?
  • What is the purpose of the serous fluid btw the
    pleural membranes?

27
Processes of respirations
  • Ventilation
  • Movement of air in out of the the
    tracheobronchial tree. Delivering O2 to the
    alveoli removing CO2
  • Perfusion
  • Blood flow in the capillary bed in the lungs
  • Diffusion
  • Movement of gases (O2 CO2) across the alveoli
    membrane
  • Flows from area of greater concentration to
    lesser concentration

28
Patient airway
  • Choking

29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
Changes assoc. with aging
  • Cartilage hardens
  • Muscles weaker
  • i cough reflex
  • i elasticity

33
Assessment Subjective
  • Nasal Congestion
  • Sore throat
  • Change in voice
  • Difficulty breathing
  • Orthopnea
  • Pain
  • Cough
  • Sputum
  • Affect on ADLs

34
History
  • Physical problems
  • Function problems
  • Life style
  • Smoking
  • Family Hx
  • Occupation hx
  • Allergens / environment
  • Anxiety

35
Inspection
  • Normal chest
  • 2x as wide as deep
  • Anterior/posterior diameter
  • 12

36
Inspection
  • Barrel chest
  • D/t over inflation of lungs
  • anterior-posterior diameter
  • 22

37
Inspection
  • Kyphosis
  • AKA
  • Hunchback
  • Abnormal curvature of the thoracic spine

38
Inspection
  • Lordosis
  • AKA
  • Sway-back
  • Abnormal curvature of the lumbar spine

39
Inspection
  • Uniform expansion of the chest
  • Intercostal spaces

40
Inspection
  • Shoulder rise
  • Accessory muscles
  • Posture

41
Inspection
  • Trachea
  • midline
  • Color
  • LOC
  • Emotional state

42
Inspection Breathing patterns
  • Rate
  • Eupnea
  • Normal
  • 12-20 / min
  • Tachypnea
  • h rate
  • Bradypnea
  • i rate

43
Inspection Breathing patterns
  • Depth
  • Hyperventilation
  • h depth rate
  • Hypoventilation
  • i depth rate

44
Auscultation
  • Purpose
  • Asses air flow through bronchial tree
  • Procedure
  • Diaphragm of stethoscope
  • Superior ? inferior
  • Compare rt to lf

45
Auscultation Results
  • Normal
  • Vesicular
  • Lung field
  • Soft and low
  • Bronchial
  • Trachea bronchi
  • Hollow

46
Auscultation Results
  • Adventitious
  • Crackles
  • air ? bronchi with secretions
  • Fine crackles
  • Air ? suddenly reinflated
  • Course Crackles
  • Moist

47
Auscultation Results
  • Wheezes
  • Sonorous wheezes
  • Deep low pitched
  • Snoring
  • Caused by air ? narrowed passages
  • D/t h secretions
  • Sibilant Wheezes
  • High pitched
  • Whistle-like
  • Caused by air ? narrowed passages
  • D/t constriction
  • Asthma

48
Early late signs of hypoxia
  • Anxiety
  • Bradycardia
  • Cyanosis
  • Depressed respirations
  • Diaphoresis
  • Disorientation
  • Dyspnea
  • Restlessness
  • Headache
  • Agitation
  • Poor judgment
  • Retraction
  • Tachycardia
  • Tachypnea

49
Dyspnea
  • Definition
  • SOB
  • SOB, flat affect, BS x 4

50
Dyspnea
  • Significance
  • Common with cardiac resp. disease

51
Dyspnea
  • Orthopnea
  • Sit up to breath
  • COPD
  • CHF

52
Dyspnea
  • Right ventricle
  • If chronic airway resistance ?
  • h pressure ?
  • Rt ventricle h work ?
  • Rt. Vent damage

53
Dyspnea
  • Nrs Management
  • Find cause
  • Give O2
  • HOB h
  • Communication
  • KISS

54
Cough
  • Definition
  • To expel air from the lungs suddenly
  • Irritation of mucous membrane

55
Cough
  • Significance
  • Infection
  • Irritants
  • Protective mechanism

56
Cough
  • Nrs management
  • Assess
  • Describe
  • Directed
  • Pain control
  • Splinting
  • Infection control
  • Suppressants / Anti-tussives

57
Sputum Production
  • Definition
  • Matter discharged from resp. track that contains
    mucus and pus, blood, fibrin, or bacteria

58
Sputum Production
  • Significance
  • Purulent
  • Thick, yellow/green
  • Bacteria

59
Sputum Production
  • Nrs Management
  • Thick
  • Hydrate
  • h water
  • Nebulizer
  • Humidifier
  • TCDB
  • No smoking
  • Oral care
  • h Appetite

60
Do You Know?????
  • What breath sound would you expect to hear on a
    patient with increased sputum production?
  • Vesicular
  • Crackles
  • Sonorous wheezes
  • Sibilant wheezes

61
Obtaining a sputum specimen
  • Explain
  • From lungs
  • Sterile cup
  • Deep breath x 3 ?
  • Cough deeply
  • Expectorate
  • Best time for specimen collection?
  • AM

62
Chest pain
  • Significance
  • Cardiac or pulmonary

63
Chest pain
  • Nrs Management
  • Assess
  • Analgesics OK, but
  • Position for pain
  • Affected side
  • Splint

64
Hemoptysis
  • Definition
  • Expectoration of blood from the respiratory tract

65
Hemoptysis
  • Significance
  • Pulm or cardiac

66
Hemoptysis
  • Hemoptysis
  • Definition?
  • Coughed up blood
  • From?
  • Pulm hemorrhage
  • Description
  • Pink, red, mixed with sputum
  • Hematemesis
  • Definition?
  • Vomited blood
  • From?
  • Stomach / GI
  • Description
  • Coffee ground

67
Hemoptysis
  • Nrs Management
  • Determine source
  • Serious

68
Cyanosis
  • Definition
  • Bluish coloring of skin

69
Dx tests
70
Pulse Oximeter
  • Purpose
  • Noninvasive O2 Sat
  • Normal
  • 95-100
  • lt85 ?
  • Tissue is not receiving enough O2

71
Pulse oximeter
  • Not reliable in
  • Cardiac arrest
  • Dyes
  • Anemia

72
Radiographic exams
  • Chest x-ray
  • CT scan
  • Angiography
  • Bronchoscopy
  • Thoracoscopy
  • Thoracentesis

73
Chest x-ray
  • Description
  • 2-d image
  • Purpose
  • Fluid
  • Tumor
  • Foreign bodies

74
Chest X-ray
  • Nrs management
  • Normal heart size clear lung field

75
CT Scan
  • Description
  • Computerize Tomography
  • With or without contrast medium
  • Purpose
  • Tissue
  • Tumor
  • Foreign bodies
  • Fluid

76
CT scan
  • Nrs management
  • Without contrast medium
  • No prep
  • With contrast medium
  • NPO 6 hrs
  • Assess for allergies

77
Angiography
  • Purpose
  • Visualize Pulm. Circulation
  • Description
  • Dye
  • Femoral vein ?
  • Heart ?
  • Pulm Arteries

78
Angiography
  • Nrs. Management
  • Pre-op
  • NPO
  • Check Allergies
  • Shellfish/iodine
  • Post-op
  • Lie flat 8 hrs
  • Sandbag
  • Check pedal pulses
  • Assess hemorrhaging
  • Push fluids

79
Bronchoscopy
  • Description
  • Direct inspection of larynx, trachea bronchi
    via flexible tube (fiberoptic)
  • Purpose
  • Examine
  • Tissue sample

80
Bronchoscopy
  • Nrs Management
  • Pre-op
  • NPO 6-8 hrs
  • Sedation
  • Lung CA obstruction

81
Bronchoscopy
  • Nrs management
  • Post-op
  • Side-ling until gag back
  • NPO till gag back
  • Check gag
  • Check bleeding
  • Glottis stenosis

82
  • http//video.search.yahoo.com/search/video_yltA0
    oGdXBnY59OcnwAuNNXNyoA?eiUTF-8pbronchoscopyfr2
    tab-webfrmoz2-ytff-

83
Thoracentesis
  • Purpose
  • Remove fluid

84
Thoracentesis
  • Nrs Management
  • Position patient
  • Support
  • Post-op
  • Vital signs q 15

85
  • http//video.search.yahoo.com/search/video_yltA0
    oGdWeLZJ9OvQsAZ1lXNyoA?eiUTF-8pthoracentesisfr
    2tab-webfrmoz2-ytff-

86
Sputum studies
  • Check for
  • Pathogens
  • CS

87
White Blood Cell Count
  • Normal
  • 5,000 10,000 cell/mm3
  • Elevated
  • Bacterial infection
  • Decreased
  • Viral infection

88
Hemoglobin
  • Normal
  • Female 12-16 g/dl
  • Male14-18 g/dl
  • Elevated
  • COPD
  • Dehydration
  • Decreased
  • Anemia
  • Hemorrhaging

89
Hematocrit
  • Normal
  • Female 37-47
  • Male 42-52
  • Elevated
  • Dehydration
  • Burns
  • COPD
  • Decreased
  • Anemia
  • Leukemia

90
PTT/PT Partial Thromboplastin Time
  • Prolonged
  • Anticoagulant

91
Quiz?
  • The main function of platelets is to
  • Provide oxygen to tissue
  • Fight viral infections
  • Fight bacterial infections
  • Form a blood clot
  • Platelets adhere to one another and play a very
    important role in coagulation

92
Deep Breathing Coughing
  • Airway clearance
  • Nrs Dx
  • Ineffective airway clearance
  • h fluids
  • Splinting
  • Infection Control

93
Oxygen therapy
  • Goal
  • Provide adequate transport of O2
  • i work
  • i stress to myocardium
  • Need for O2 based on
  • ABGs
  • Clinical assessment

94
Oxygen therapy
  • Cautions on O2 tx
  • Med!
  • Except in an emergency situation is administered
    only with Dr. order
  • Give O2 only to bring the pt back to baseline
  • COPD
  • WHY?

95
Oxygen therapy
  • COPD O2
  • Normal - CO2 indicator to breath
  • COPD O2 indicator to breath
  • d/t h CO2 levels burned medulla sensor for CO2
  • Medulla uses O2 to initiate breath

96
COPD O2
  • COPD h O2 ?
  • i Resp

97
Oxygen therapy
  • Precautions
  • Catalyst for combustion
  • No smoking sign
  • Tanks ? missiles
  • No friction toys

98
Smoker's home destroyed and neighbor injured
  • Kalispell MO, 15 July 2004 A home on Kalispell's
    west side was extensively damaged Wednesday
    morning by a fire that was probably started by a
    cigarette and was accelerated by oxygen from
    medical oxygen tanks. A neighbor, who was trying
    to help was knocked down by the explosion of one
    oxygen tank, which also caused temporary hearing
    loss for a police officer.
  • A report by F. Ray Ruffatto of the fire
    department's prevention division said that while
    the exact cause of the fire is still
    undetermined, "initial investigation indicates
    the fire may be the result of carelessly
    discarded smoking materials."

99
Smoker dies in house fire
  • Hudson MA 21 July 2004
  • The victim of yestrerday's fire died after
    suffering second- and third-degree burns from a
    devastating blaze at her Manning Street home
    Sunday.
  • The resident was a smoker, according to State
    Fire Marshal Stephen Coan, and he said the
    combination of cigarettes and the multiple oxygen
    tanks in the home either caused or exacerbated
    the fire.
  • She was in critical condition after being pulled
    from the house by a neighbor and then died
    yesterday at UMass Memorial Medical Center,
    University Campus in Worcester.
  • The combination of oxygen tanks and cigarettes
    have sparked fires that since 1997 have killed 16
    people in the state and caused severe burns or
    smoke inhalation in 20, said Coan.

100
  • The nurse is to teach a client with Chronic
    Obstructed Pulmonary Disease safety precautions
    for using oxygen at home. The nurse knows that
    the client understands the safety principles
    discussed when he says the following
  • "Smoking is permitted when oxygen is in use."
  • "Fire extinguishers do not need to be stored."
  • "Acetone, oil, and alcohol are appropriate
    substances to use with clients who are using
    oxygen."
  • "Avoid materials that generate static
    electricity."  

101
  • A client is being discharged and will receive
    oxygen therapy at home. The nurse is teaching
    the client and family oxygen safety measures.
    Which of the following statements by the cleint
    indicated the need for further teaching?
  • I realize that I should check the oxygen level of
    the portable tank on a consistent basis
  • I will keep my scented candles within 5 feet of
    my oxygen tank
  • I will not sit in front of my wood-burning
    fireplace with my oxygen on.
  • I will call the physician if I experience any
    shortness of breath

102
  • A cyanotic client with an unknown diagnosis is
    admitted to the emergency room. In relation to
    oxygen, the first nursing action would be to
  • Wait until the clients lab work is done (ABGs)
  • Not administer oxygen unless ordered by the
    physician
  • Administer oxygen at 2 Liters flow per minute
  • Administer oxygen at 10 Liters flow per minute
    and check the clients nail beds frequently

103
Oxygen
  • Side effects
  • O2 ?
  • Hyper or hypo ventilation?
  • Hypoventilation ?

104
Method of O2 Administration
  • Nasal Cannula
  • Flow rate
  • 1-6 L/min
  • FiO2
  • 20-40
  • Nrs
  • Talk eat
  • Comfort
  • Nose breather

105
Method of O2 Administration
  • Simple Mask
  • Flow rate
  • 6-10 L/min
  • FiO2
  • 40-60
  • Nrs
  • Higher flow rate

106
Method of O2 Administration
  • Partial Re-breather Mask (Reservoir)
  • Flow rate
  • 6-10 L/min
  • FiO2
  • 60-100
  • Nrs
  • Uses reservoir to capture some exhaled gas for
    rebreathing
  • Vents allow room air to mix with O2

107
Method of O2 Administration
  • Non-rebreather Mask
  • Flow rate
  • 6-10 L/min
  • FiO2
  • 70-100

108
Method of O2 Administration
  • Nrs
  • Side vents closed
  • Reservoir vent closed for I, open for E
  • Reservoir bag stores O2 for I but does not allow
    E air in
  • Reservoir never collapse to lt½

109
Method of O2 Administration
  • Venturi
  • Flow rate
  • 4-8
  • FiO2
  • 20-40
  • Nrs.
  • Precise of O2
  • i.e. COPD

110
  • Which one of the following conditions could lead
    to an inaccurate pulse oximetry reading if the
    sensor is attached to the clients ear?
  • Artificial nails
  • Vasodilation
  • Hypothermia
  • Movement of the head

111
  • A nurse is having difficulty setting up
    humidified oxygen at 40 per Venturi mask and
    does not know how many liters of flow she should
    use. Which of the following actions is most
    appropriate to ensure safe oxygen administration?
  • Consult with a respiratory therapist.
  • Look at the package directions and try to figure
    it out.
  • Ask the nursing assistant how to set it up.
  • Use a regular oxygen mask.

112
When oxygen therapy via nasal cannula is ordered
for a patient, the first action by the nurse is
to
  • Post an oxygen in use sign on the door to the
    room
  • Adjust the oxygen level before applying the
    cannula
  • Explain the rules of fire safety and oxygen use
  • Lubricate the nares with water-soluble jelly

113
The nurse is beginning the shift and is assessing
the oxygen exchange on a neonate. The nurse
reviews the chart for pulse oximetry reading for
the last 8 hours.
114
  • The pulse oximetry reading at 330 PM is 75.
    What should the nurse do first?
  • Administer oxygen via mask
  • Swaddle the neonate in heated blankets
  • Reassess the oximetry reading in 30 minutes
  • Draw blood gases for oxygen and carbon dioxide
    levels.

115
Nebulizer Mist Treatment
  • Deliver Moisture OR medication directly into the
    lungs
  • Topical i systemic S/E
  • Indications
  • Must be able to deep breath

116
Nebulizer Mist Treatment
  • Meds
  • Bronchodilators
  • Albuteral (ventolin)
  • Corticosteroids
  • Mucolytic agents
  • Acetylcysteine
  • Antibiotics

117
Metered Dose Inhaler
  • Admin. Topical meds directly into the lungs
  • i systemic S/E
  • Meds
  • Corticosteroids
  • Bronchodilators
  • Mast cell inhibitors

118
Metered Dose Inhaler
  • Procedure
  • Canister into unit correctly
  • Shake gently
  • Hold inhaler breath out slowly (not into
    inhaler)

119
Metered Dose Inhaler
  • Place mouthpiece into your mouth
  • Close lips around it
  • Tilt head back
  • Keep tongue out of way
  • Press top of the canister firmly breath in
    through your mouth

120
Metered Dose Inhaler
  • Remove inhaler from mouth
  • Hold breath for several seconds
  • Breath out slowly

121
Metered Dose Inhaler
  • Rinse your mouth afterward to help reduce
    unwanted side effects

122
  • The nurse is teaching a client with asthma about
    the proper use of a metered-dose inhaler. Which
    statement by the client indicates that the
    teaching was effective?
  • "I'll flex my head forward and breathe out
    forcefully before inhaling the drug."
  • "As I press down on the canister, I'll inhale
    slowly over 10 seconds."
  • "I'll hold my breath for 5 seconds after inhaling
    the drug to allow the drug to reach my lungs."
  • "I'll wait one minute between puffs."

123
Incentive Spirometry
  • Device enc. Deep breath
  • Prevent tx Atelectasis
  • Procedure
  • Inhale!

124
Nursing Diagnosis- Respiration
  • Airway Clearance, ineffective
  • Aspiration, risk for
  • Breathing Pattern, ineffective
  • Gas Exchange, impaired

125
Ineffective Airway Clearance
  • R/T
  • Artificial airway
  • Excessive or thick secretions
  • Inability to cough effectiviely
  • Infection
  • Obstruction / restriction
  • Pain
  • Other

126
Ineffective Airway Clearance
  • AMB (AEB)
  • Ineffective cough
  • Inability to remove airway secretions
  • Abnormal breath sounds
  • Abnormal respiratory rate, rythm depth

127
Ineffective Airway Clearance
  • Plan / Outcome / Goal
  • Maintain patent airway AEB
  • Clear breath sounds
  • Respiratory easy and unlabored
  • Normal respiratory rate

128
Ineffective Airway ClearanceNursing interventions
  • Encourage fluids
  • Facilitate airway clearance
  • Deep breathing
  • Pursed lips
  • Incentive spirometry
  • Cough Aerosol therapy
  • Chest physiotherapy
  • Assess respiratory rate, depth, rhythm, effort
    and breath sounds
  • Position HOB elevated
  • Promote optimum level of activity for best
    possible lung expansion
  • Ambulate / Chair
  • Turn/reposition
  • Suction prn

129
COPD - overview
  • COPD?
  • Chronic Obstructive Pulmonary Disease
  • Broad classifications of disease

130
COPD
  • Characterized by
  • airflow limitation
  • Irreversible
  • Dyspnea on exertion
  • Progressive
  • Abn. inflammatory response of the lungs to
    noxious particles or gases

131
Pathophysiology
  • Noxious particles of gas ?
  • Inflammatory response ?
  • Narrowing of airway

132
Pathophysiology
  • Inflammation ?
  • Thickening of the wall of the pulmonary
    capillaries
  • (Smoke damage inflammatory process)

133
COPD
  • Includes
  • Emphysema
  • Chronic bronchitis
  • Does not include
  • Asthma

134
COPD - FYI
  • COPD 4th leading cause of death in the US
  • 12th leading cause of disability
  • Death from COPD is on the rise while death from
    heart disease is going down

135
COPD
  • Risk Factors for COPD
  • Exposure to tobacco smoke
  • 80-90 of COPD
  • Passive smoking
  • Occupational exposure
  • Air pollution

136
COPD risk factors
  • 1
  • Smoking
  • Why is smoking so bad??
  • ? phagocytes
  • ? cilia function
  • ? mucus production

137
Chronic Bronchitis
  • Disease of the airway
  • Definition
  • cough sputum production
  • gt 3 months

138
Chronic Bronchitis
  • Pathophysiology
  • Pollutant irritates airway ?
  • Inflammation
  • h secretion of mucus

139
Chronic Bronchitis
  • Plugs become areas for bacteria to grow and
    chronic infections which increases mucus
    secretions and eventually, areas of focal
    necrosis and fibrosis

140
Chronic Bronchitis
  • Bronchial walls thicken
  • Bronchial Lumen narrows
  • Mucus plugs airway
  • Alveoli/bronchioles become damaged
  • ? susceptibility to LRI

141
What do you think?
  • Exacerbation of Chronic bronchitis is most likely
    to occur during?
  • Fall
  • Spring
  • Summer
  • Winter

142
Emphysema
  • Pathophysiology
  • Affects alveolar membrane
  • Destruction of alveolar wall
  • Loss of elastic recoil
  • Over distended alveoli

143
Emphysema
  • Pathophysiology
  • Over distended alveoli?
  • Damage to adjacent pulmonary capillaries
  • h dead space
  • Impaired passive expiration
  • ? Impaired gas exchange

144
Emphysema
  • Impaired gas exchange
  • impaired expiration
  • Hypoxemia
  • h CO2

145
Emphysema
  • Damaged pulmonary capillary bed
  • h pulmonary pressure ?
  • h work load for right ventricle ?
  • Right side heart failure

146
COPD Compare and contrast
  • Chronic Bronchitis is a disease of the
    ___________?
  • Airway
  • Emphysema is a disease affecting the ___________?
  • Alveoli

147
C.O.P.D.
  • Risk factors, SS, treatment, Dx, Rx
  • - same for Chronic Bronchitis Emphysema

148
C.O.P.D.
  • Clinical Manifestation (primary)
  • Cough
  • Sputum production
  • Dyspnea on exertion
  • (Secondary)
  • Wt. loss
  • Resp. infections
  • Barrel chest

149
C.O.P.D.Nrs. Assessment
  • Risk factors
  • Past Hx / Family Hx
  • Pattern of development
  • Presence of comobidities
  • Current Tx
  • Impact

150
  • ABGs
  • Baseline PaO2
  • Rule out other diseases
  • CT scan
  • X-ray

151
C.O.P.D. Medical Management
  • Risk reduction
  • Smoking cessation!
  • (The only thing that slows down the progression
    of the disease!)

152
C.O.P.D. Rx. therapy
  • Primary
  • Bronchodilators
  • Corticosteriods
  • Secondary
  • Antibiotics
  • Mucolytic agents
  • Anti-tussive agents

153
Bronchodilators
  • Action
  • Relieve bronchospasms
  • Reduce airway obstruction
  • ? ventilation

154
Bronchodilators
  • Examples
  • Albuterol (Proventil, Ventolin, Volmax)
  • Metaproterenol (Alupent)
  • Ipratropium bromide (Atrovent)
  • Theophylline (Theo-Dur)
  • Oral

155
Glucocorticoids
  • Action
  • Potent anti-inflammatory agent

156
Corticsteriods
  • S/E
  • Cushing
  • Moon face
  • Na H20 retention
  • Never discontinue abruptly

157
  • What affect do corticosteroids have of blood
    sugar levels?

158
Glucocorticoids
  • Examples
  • Prednisone
  • Methyprednisone
  • Beclovent

159
C.O.P.D. Medical Management
  • Treatment
  • O2
  • When PaO2 lt 60 mm Hg
  • Pulmonary rehab
  • Breathing exercises
  • Pulmonary hygiene

160
Nursing Management
  • Impaired gas exchange
  • Ineffective airway clearance
  • Ineffective breathing patterns
  • Activity intolerance
  • Deficient knowledge about self-care
  • Ineffective coping

161
Exercise has which of the following effects on
clients with asthma, chronic bronchitis and
emphysema?
  • It enhances cardiovascular fitness
  • It improves respiratory muscle strength
  • It reduces the number of acute attacks
  • It worsens respiratory function and is discouraged
Write a Comment
User Comments (0)
About PowerShow.com