Diseases of the Lower Respiratory System Nursing II Valencia Community College

Diseases Diseases of theof the

Lower Respiratory Lower Respiratory System System

Nursing IINursing IIValencia Community CollegeValencia Community College

CCHRONICHRONICOOBSTRUCTIVEBSTRUCTIVEPPULMONARY ULMONARY

DDISEASEISEASE

The client with

COPDCOPD DescriptionDescription

– Chronic airflow obstructionChronic airflow obstruction Irreversible Irreversible

– Chronic bronchitis and/or Chronic bronchitis and/or emphysemaemphysema

IncidenceIncidence– 13.5 million Americans have 13.5 million Americans have

bronchitisbronchitis– 2 million Americans have 2 million Americans have

emphysemaemphysema– 44thth leading cause of death leading cause of death– Death rate still risingDeath rate still rising– 22ndnd cause of disability in people > cause of disability in people >

6565

COPD (cont.)COPD (cont.)

Risk FactorsRisk Factors– SMOKINGSMOKING– AgeAge– Male genderMale gender– Air pollutionAir pollution– Occupational exposureOccupational exposure– Respiratory infectionsRespiratory infections– Familial & genetic factorsFamilial & genetic factors

COPD (cont.)COPD (cont.)

Pathophysiology Pathophysiology – Slow, progressiveSlow, progressive– Exacerbations Exacerbations destructive changes destructive changes– Usually have both chronic bronchitis Usually have both chronic bronchitis

and emphysemaand emphysema And frequently asthmaAnd frequently asthma

Emphysema PathoEmphysema Patho

Loss of lung elasticity Loss of lung elasticity Hyperinflation of the lungsHyperinflation of the lungs Alveolar walls and small airways Alveolar walls and small airways

damageddamaged– Airways narrow or collapseAirways narrow or collapse– Air trappingAir trapping– Alveolar damage = poor gas Alveolar damage = poor gas

exchangeexchange

Chronic Bronchitis Chronic Bronchitis PathoPatho

Inflammation caused by chronic Inflammation caused by chronic irritationirritation

Cause vasodilation Cause vasodilation → congestion → → congestion → edema → bronchospasmedema → bronchospasm

mucous productionmucous production Thickened bronchial wallsThickened bronchial walls Narrowing of airways = poor gas Narrowing of airways = poor gas

exchangeexchange

DiagnosticsDiagnostics

ABGABG Sputum C & SSputum C & S CXRCXR CBCCBC ElectrolytesElectrolytes Pulmonary Pulmonary

function testingfunction testing Genetic testingGenetic testing

Manifestations of COPDManifestations of COPD

Absent or minor earlyAbsent or minor early Client usually seeks care after 10 Client usually seeks care after 10

yrs of signs and symptomsyrs of signs and symptoms– When ADLs affectedWhen ADLs affected

ManifestationsManifestations

General AppearanceGeneral Appearance– Thin with loss of Thin with loss of

muscle mass in muscle mass in arms and legsarms and legs

– Stooped postureStooped posture– Slow movingSlow moving


RespiratoryRespiratory– Shallow, rapid respirationsShallow, rapid respirations– Use of accessory musclesUse of accessory muscles– Crackles, rhonchi, distant breath Crackles, rhonchi, distant breath

soundssounds– DyspneaDyspnea– Barrel chestedBarrel chested– Bronchitis;Bronchitis;

Cyanotic, increased mucus, clubbing, Cyanotic, increased mucus, clubbing, coughcough


CardiacCardiac– TachycardiaTachycardia– Irregular pulseIrregular pulse– Dependent edemaDependent edema

JVDJVD

– ClubbingClubbing– Emphysema:Emphysema:

Cyanosis with Cyanosis with advanced diseaseadvanced disease

PallorPallor


PsychosocialPsychosocial– IsolationIsolation

FatigueFatigue EmbarrassmentEmbarrassment SmokingSmoking

– Negative self imageNegative self image Change in role Change in role

– Anxiety and fearAnxiety and fear

Collaborative CareCollaborative Care Impaired Gas ExchangeImpaired Gas Exchange

– Patent airway = pulmonary toiletPatent airway = pulmonary toilet– Assess frequentlyAssess frequently– OxygenOxygen

Keep O2 sat > 88%Keep O2 sat > 88%

– MedicationsMedications– Energy managementEnergy management– Surgical Surgical

Lung transplantLung transplant Lung reductionLung reduction

Collaborative CareCollaborative Care

Ineffective Breathing PatternIneffective Breathing Pattern– Teach effective breathing techniquesTeach effective breathing techniques

Pursed lipPursed lip Diaphragmatic/AbdominalDiaphragmatic/Abdominal

– Exercise conditioning Exercise conditioning Respiratory rehabRespiratory rehab

– Energy Conservation Energy Conservation Rest between ADLsRest between ADLs


Ineffective Airway ClearanceIneffective Airway Clearance– Effective coughingEffective coughing

Controlled coughingControlled coughing

– Chest PT Chest PT – Postural drainage/positioningPostural drainage/positioning– SuctioningSuctioning– HydrationHydration

Careful if bronchitis presentCareful if bronchitis present


Nutrition: Less Than Body Nutrition: Less Than Body RequirementsRequirements– Small, frequent mealsSmall, frequent meals

High calorie, high protein, low sodiumHigh calorie, high protein, low sodium PulmocarePulmocare

– Oral hygieneOral hygiene– Rest before mealsRest before meals– Assist with eatingAssist with eating– No treatments at meal timeNo treatments at meal time


AnxietyAnxiety– Inform patient of all aspects of careInform patient of all aspects of care– Know what to do if Know what to do if ↑ in signs and ↑ in signs and

symptomssymptoms– Support groupSupport group– Complementary therapyComplementary therapy


Activity IntoleranceActivity Intolerance– Pacing activitiesPacing activities– Assess during activities for hypoxiaAssess during activities for hypoxia– May need supplemental O2May need supplemental O2


Potential For Infection Potential For Infection (Respiratory)(Respiratory)– Flu and Pneumonia vaccines yearlyFlu and Pneumonia vaccines yearly– Avoid large crowdsAvoid large crowds

Home CareHome Care

– Infection preventionInfection prevention– Breathing exercisesBreathing exercises– ADL assistanceADL assistance– Pulmonary rehab programPulmonary rehab program– Dealing with chronic illnessDealing with chronic illness– May need a social workerMay need a social worker

The Client with The Client with PneumoniaPneumonia

Definition Definition

Excess fluid in lungs from Excess fluid in lungs from inflammatory processinflammatory process

TypesTypes– Infectious Infectious → Viral or Bacterial→ Viral or Bacterial

Community acquiredCommunity acquired NosocomialNosocomial

– Inhalation of IrritantsInhalation of Irritants

IncidenceIncidence

2 – 4 million cases in US yearly2 – 4 million cases in US yearly 55thth leading cause of death leading cause of death incidenceincidence

– ElderlyElderly– LTC residentsLTC residents– Hospitalized clientsHospitalized clients– On ventilatorsOn ventilators

Incidence ContinuedIncidence Continued

More in fall and winter monthsMore in fall and winter months Community acquired Community acquired > >

nosocomialnosocomial

Risk FactorsRisk Factors

Community AcquiredCommunity Acquired– Older AdultOlder Adult– No pneumococcal or flu vaccinesNo pneumococcal or flu vaccines– Chronic illnessChronic illness– SmokingSmoking– AlcoholAlcohol– Exposure to viral or bacterial Exposure to viral or bacterial

infectionsinfections

Risk Factors ContinuedRisk Factors Continued

NosocomialNosocomial– Older adultOlder adult– COPDCOPD LOCLOC– AspirationAspiration– Poor nutritionPoor nutrition– Immune suppressedImmune suppressed– Mechanical ventilationMechanical ventilation

PathophysiologyPathophysiology

Organism invades airwayOrganism invades airway Multiples in alveoliMultiples in alveoli Inflammation in interstitial Inflammation in interstitial

spaces, alveoli, and bronchiolesspaces, alveoli, and bronchioles Fluids collect in alveoliFluids collect in alveoli gas exchangegas exchange

Patho ContinuedPatho Continued

Fibrin and RBCs move into alveoliFibrin and RBCs move into alveoli– Causes stiffening = Causes stiffening = compliance compliance

Alveoli collapseAlveoli collapse Consolidation occursConsolidation occurs Infection spreads to other lung Infection spreads to other lung

areasareas

Sites of PneumoniaSites of Pneumonia

Lobar pneumoniaLobar pneumonia– Segment or lobe of the lungSegment or lobe of the lung

BronchopneumoniaBronchopneumonia– In bronchus and bronchiolesIn bronchus and bronchioles

DiagnosticsDiagnostics

ABGsABGs CBC, LytesCBC, Lytes

– May need HIV testingMay need HIV testing Sputum gram stain and C & SSputum gram stain and C & S CXRCXR BronchoscopyBronchoscopy


General AppearanceGeneral Appearance– FlushedFlushed

feverfever

– AnxiousAnxious– Muscle weaknessMuscle weakness– HeadacheHeadache– ChillsChills– Poor appetitePoor appetite


RespiratoryRespiratory– Productive coughProductive cough– Tachypnea, orthopneicTachypnea, orthopneic– Use of accessory musclesUse of accessory muscles– Crackles, wheezingCrackles, wheezing– Pleuritic painPleuritic pain

Complications of Complications of PneumoniaPneumonia

HypoxemiaHypoxemia Respiratory failureRespiratory failure AtelectasisAtelectasis Pleural effusionPleural effusion PleurisyPleurisy EmpyemaEmpyema SepsisSepsis


Impaired Gas Exchange/Airway Impaired Gas Exchange/Airway ClearanceClearance– OxygenOxygen– Pulmonary toiletPulmonary toilet– Effective coughEffective cough– HydrationHydration– MedicationsMedications


Acute PainAcute Pain– Medicate for effective coughingMedicate for effective coughing

SplintingSplinting

– PositioningPositioning


Fluid Volume DeficitFluid Volume Deficit

Disturbed Sleep PatternsDisturbed Sleep Patterns

Potential for SepsisPotential for Sepsis

– What interventions would you do?What interventions would you do?

Home CareHome Care

Inquire about medical equipment Inquire about medical equipment for home usefor home use

Activity toleranceActivity tolerance

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Diseases of the Lower Respiratory System Nursing II Valencia Community College