Lower Airway Obstructive Disorders

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Lower Airway Obstructive Disorders

• COPD
• Bronchitis

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COPD

• Obstruction to expiratory flow or chronic airflow
  limitation (CAL).
• Chronic nature
• Symptoms controlled in between with periodic
  exacerbation.

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COPD cont...

• Often concurrent with resp. infection
• 2 diseases under COPD Emphysema
• Chronic Bronchitis

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COPD

• Emphysema - enlarged air space distal to
  bronchioles
• destruction of alveolar walls
• pink puffers

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COPD

• Chronic Bronchitis - excessive mucous production
• chronic cough
• enlarged bronchial mucous glands
• blue bloaters

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COPD

• Pink Puffers - over ventilate to maintain N
  blood gas levels
• Blue Bloaters - have ? secretions therefore
  hypoxemia, cyanosis ? cor pulmonale

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COPD

• COPD - usually combination of emphysema
  chronic bronchitis

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COPD Risk factors

• Cigarette smoking
• age - ?pulmonary function with age
• hereditary
• exposure to hazards
• socioeconomic factors

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COPD Pathophysiology

• Loss of elastic recoil
• - ? airway resistance
• - ? ventilation
• - airway collapse on expiration
• air trapping ? CO2 retention
• less air in ? ? O2 ?CO2

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COPD Pathophysiology cont...

• Air spaces enlarge
• - ? diffusion
• - collapse alveoli or rupture
• - ? surface area
• - compression of pulmonary capillaries
• - ? perfusion
• - hypoxemia

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COPD Complications

• Resp. Failure
• - ? ventilation at rest
• - inability to meet body requirements
• Cor Pulmonale
• - enlarged R ventricle due to ? work
• - ? fibers stretch
• - fluid output in interstitial spaces
  therefore crackles

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COPD Complications cont...

• Body compensates for hypoxemia with ? RBC
  therefore more viscous ? polycythemia

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Clinical Manifestations

• Onset symptoms insidious
• severity reflects severity of disease
• symptoms worsen overtime

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Progression of Symptoms

• Cough sputum production in AM
• ?
• mild SOB on exertion (extreme)
• ?
• ?cough sputum production (smokers cough)
• ?
• SOB on exertion
• ?

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Progression of Symptoms cont...

• Persistent cough with? sputum
• ?
• SOB with mild exertion
• ?
• Inability to perform maintenance chores
• ?
• Fatigability
• ?
• End stage, O2 dependent, confined to bed

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COPD

• Symptoms worsen with infection (URI)
• more prone to URI

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COPD Management

• No cure
• Goal - slow progression
• - improve quality of life decrease
  hospitalization

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Drugs

• Bronchodilators - beta adrenergic antagonist
  ventolin theophylline
• - ? a/w resistance
• Corticosteriods - ? edema
• Antibiotics - Rx infection
• Expectorants
• Flu vaccines, pneumococcal
• O2 Rx ? low flow

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Nursing Strategies

• Dx Activity intolerance R/T ? O2 AMB SOB,
  pallor, sweating, anxiety, ? RR, ? HR, ?B/P
• - Avoid working with arms raised
• - stabilize shoulders ? lean on elbows
• - pursed lip breathing with exhalation

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Nursing Strategies cont..

• On going assessment of RR, B/P, HR, ABGs, O2
  oximetry
• modify activity levels (rest)
• teach pursed lip breathing
• no sedatives

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Nursing Strategies cont...

• Dx 2 - Ineffective a/w clearance
• - teach/supervise effective cough
• best after bronchodilator Rx
• - maintain hydration 3 - 4 l/day
• - administer meds

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Nursing Strategies cont...

• - schedule CPT
• - no smoking
• - assess breath sounds
• - avoid excessive hot /cold fluids

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Nursing Strategies cont...

• Dx 3 - Ineffective breathing pattern
• - breathing retraining
• - optimal positioning

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Nursing Strategies cont...

• Dx 4 - Sleep pattern Disturbance
• - promote exercise in day
• - avoid caffeine
• - promote relaxation HS
• - environment

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Nursing Strategies cont...

• Dx 5 - Act/Pot/ alteration in cerebral perfusion
  R/T hypoxemia
• - Risk for injury
• - observe signs ? cerebral function
• i.e.. Confusion, restlessness
• - safety precautions

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Nursing Strategies cont...

• Dx 6 - Act/Pot. Sexual Dysfunction R/T dyspnea
  ? energy
• - positioning
• - rest ac or after Rx
• - other ways of expressing (hugging,
  communication)

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Nursing Strategies cont...

• Dx 7 - Pot/Act alteration in nutrition
• - oral hygiene
• - small frequent meals, easily chewed
• - ? calories ( not CHO) ? CO2 by product
• - ? protein
• - avoid gassy food ? abd distention ? ?SOB

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Nursing Strategies cont...

• Dx 8 - Altered bowel function
• - ? fluids
• - ? bulk
• - ? activity

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Nursing Strategies cont...

• Dx 9 - Altered family processes
• Body image disturbance
• - encourage communication
• - educate family
• - redistribute tasks
• - support services

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Nursing Strategies cont...

• Dx 10 - Potential for infection
• - flu vaccine
• - clean equipment
• Dx 11 - Anxiety

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Nursing Strategies cont...

• Dx 12 - Act/Pot altered health Maintenance R/T
  knowledge Deficit
• - breathing, coughing, relaxation, hydration
• - home Rx, O2, CPT
• - meds

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Nursing Strategies cont...

• - energy conservation
• - prevent complications
• - diet
• - follow up
• - recognize problems ( SOB ?, ? sputum, wheeze
  )

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Outcomes

• Clear breath sounds
• effective cough
• RR 12 - 20
• PO2 PCO2 within (N)
• less dyspnea easy breathing
• ? anxiety
• restful sleep
• maintain nutrition body weight

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Bronchitis

• Inflammation of trachea bronchi
• ? mucous prod. mucosa congestion
• cough major sign
• resolves without treatment ? 2 weeks
• usually viral ( rhinovirus)
• bacteria infection 2? other a/w problems
• young children males

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Signs Symptoms

• Gradual onset with rhinitis
• Nonproductive cough ? productive?
• crackles rhonchi ( ? pitch )
• malaise
• afebrile or low grade
• ? mucous
• x-ray ( N )

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Treatment

• Signs symptoms
• rest
• humidification
• ? fluids
• avoid smoke
• avoid cough suppressants
• antibiotics if ?ve bacterial culture