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recognize cues/physical signs and symptoms

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recognize cues/physical signs and symptoms

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Advanced Age ( Older adults have a decreased pulmonary reserve due to lung changes)

Cigarette Smoking

Alpha 1- Antitrypsin (AAT) deficiency

Exposure to environmental factors ( air pollution)

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ORGANS INVOLVED: lungs, digestive tract/intestines, pancreas, etc

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Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

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Stage 1: This is the mildest stage of emphysema. Your lungs operate at least 80% as well as the healthy lungs of someone who’s the same age, height and sex.

Stage 2: This is moderate emphysema. Your lungs operate between 50% and 79% as well as the healthy lungs of someone who’s the same age, height and sex.

Stage 3: This is severe emphysema. Your lungs operate between 30% and 49% as well as the healthy lungs of someone who’s the same age, height and sex.

Stage 4: This is very severe emphysema. Your lungs operate less than 30% as well as the healthy lungs of someone who’s the same age, height and sex.

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Sputum Cultures

WBC counts

Arterial Blood Gases (ABGs)

Hypoxemia ( decreased PAO2, less than 80 mm Hg)

Hypercarbia (increased PACO2, greater than 45 mm hg)

Blood Electrolytes

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Most Common

Shortness of Breath (usually happens over time)

Tightness of chest

Fatigue

Can also include

Wheezing

increased mucus production

Long-term coughing

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Emphysema can't be cured, but treatments is the best way to manage the symptoms, some include.

Bronchodilators. These drugs can help relieve coughing, shortness of breath and breathing problems by relaxing constricted airways.

Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help relieve shortness of breath

Surgery could be done also be done based on severity -

Lung volume reduction surgery. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue expand and work more efficiently and helps improve breathing.

Lung transplant. Lung transplantation is an option if you have severe lung damage and other options have failed

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Dyspnea upon exertion

Severe cough ( in the morning when you first wake up)

Hypoxemia

Crackles & Wheezes

Rapid & shallow respirations

Use of accessory muscles

Barrel Chest or increased chest diameter (w/ Emphysema)

Hyperresonance on percussion deu to " trapped air" ( w/ Emphysema)

Irregular breathing pattern

Thin extremities & enlarged neck muscles

dependent edema secondary to R sided HF

Clubbing of fingers & toes ( late stages)

Pallor & cyanosis of nail beds & mucous membranes ( late stages)

Decreased O2 levels ( ERR is 95-100%)

In older adults or clients who have DARK COLORED SKIN, O2 levels can be slightly lower

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Pulmonary function tests

Chest x-ray

reveals hyperinflation of alveoli and flattened diaphragm in the late stages of emphysema

often not useful for the diagnosis of early or moderate disease

Alpha1, antitrypsin levels

used to assess for deficiency in AAT, an enzyme produced by the liver that helps regulate other enzymes (which help break down pollutants) from attacking lung tissue

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INTERVENTIONS- assess vital signs, teach special breathing and coghing techniques, adminster medications, vaccinations, increase fluid intake, maintain airway, assess sputum, prevent infection, high fat diet, decrease anxiety, exercise, assess skin,

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PREVENTION- it is NOT possible, but you can practice good hygiene and recieve all vaccinations, eat a high calorie/ high- sodium diets.

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Chronic bronchitis (COPD) - causes, symptoms, diagnosis, treatment & pathology

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COPD encompasses two diseases ( Emphysema & Chronic Bronchitis). Most who have Emphysema will also have Chronic Bronchitis

COPD is irreversible

Usually affects MIDDLE age - OLDER adults

Chronic Bronchitis

Inflammation of the bronchi & bronchioles due to chronic exposure to irritants.

Emphysema

the loss of lung elasticity & hyperinflation of lung tissue

Causes: Destruction of Alveoli, leading to decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis

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high-fowlers position

encourage effective coughing, or suction to remove secretions

encourage deep breathing and use of an incentive spiromenter

admin breathing treatments and medications

admin oxygen as prescribed

clients who have COPD can need 2 to 4 L/min of oxygen via nasal cannula or up to 40% via Venturi mask

clients who have chronically increased PaCO2 levels usually require 1 to 2 L/min of oxygen via nasal cannula

monitor for skin breakdown around the nose and mouth from the oxygen device

promote adequate nutrition

monitor weight and note any changes

instruct the client to practice breathing techniques to control dyspneic episodes

instruct the client to: take deep breaths from the diaphragm, lie on back with knees bent, rest a hand over the abdomen to create resistance inhalation and exhalation, the breathing is being performed correctly

Pursed lip breathing: form the mouth as if preparing to whistle, take a breath in through the nose and mouth through the lips/mouth, not puff the cheeks, take breaths deep and slow

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Respiratory Infection

avoid crowds and people who have respiratory infections

obtain pneumonia and influenza immunizations

Right-sided heart failure

monitor respiratory status and administer oxygen therapy

monitor for GI disturbances (nausea, anorexia)

monitor HR and rhythm

admin meds as prescribed

admin IV fluids and diuretics to maintain fluid balance

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spontaneous pneumothroax

poor growth

malnutrition

delayed puberty

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https://www.youtube.com/watch?v=0fVoz4V75_E&t=551s YOUTUBE VIDEO!

The main function of the lungs is to facilitate gas exchange. From inspiration oxygen from incoming air enters the blood and carbon dioxide, a waste product from metabolism leaves the blood through expiration.

There are 3 lobes of Right Lung- RUL (right upper lobe) RML (right middle lobe) RLL (right lower lobe)

There are 2 Lobes of the Left Lung- LUL (left upper lobe) LLL (left lower lobe)

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Pathology

- A Genetic disorder that causes mucus secretions to be thicker & stickier than normal. This mucus builds up in the lungs leading to recurrent respiratory infections & digestive system leading to poor weight gain & failure to thrive for younger patients.

- Chronic Respiratory Disease affecting the Lower Respiratory Tract

Inherited Autosomal Recessive Disorder and or mucus blocks Exocrine Glands, Respiratory, GI, Reproductive Systems

Etiology

a faulty gene that a child inherits from both of their parents.

common in white people

cystic fibrosis patients are diagnosed by the time they are two years old, and others are diagnosed in adulthood

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Bronchodilators

Nursing Actions:

monitor for toxicity when taking theophylline

watch for tremors and tachycardia when taking abuterol

observe for dry mouth when taking ipratropium

Client education:

suck on hard candies to help moisten dry mouth while taking ipratropium

increase fluid intake, report headaches, or blurred vision

monitor HR

Anti-inflammatory agents

Nursing Actions:

watch for decrease in immunity function

monitor for delayed wound healing

monitor for hyperglycemia

observe for fluid retention and weight gain

Client education:

fluids

report black tarry stools

do not discontinue medication suddenly

mouth care

Mucolytic agents

Therapeutic procedures:

chest physiotherapy

raising the foot of the bed slightly higher than the head can facilitate optimal drainage and removal of secretions by gravity

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Incentive Spirometer: Monitors optimal lung expansion (inhale & hold breath for 3-5 secs)

O2 level is 88-92% ( moderate - severe COPD)

Bronchodilators ( Inhalers):

Short-Acting Beta 2 Agonists: Albuterol provides RAPID relief

Cholinergic Antagonists " Anticholinergic meds" : Ipratropium blocks the Parasympathetic Nervous System) (*LONG acting & PREVENT bronchospasm*)

Methylxanthines (Theophylline): relaxes the smooth muscles of the bronchi ( closely monitor blood medication levels due to narrow therapeutic ranges & ONLY use when tx are INEFFECTIVE)

Breathing Techniques

Positive Expiratory Pressure Device:

1) Assist client to remove airway secretions

2) Client inhales deeply & exhales through device

3) While exhaling, a ball inside moves which causes a vibration that loosens secretions

Exercise Conditioning

Improves pulmonary status by strengthening the condition of the lungs

Walks at a self paced rate until dyspnea occurs then stops to rest. Once dyspnea resolves client resumes.

Walks 20 min daily , 2-3 x weekly

Provide rest periods for older adults ( have room & always for relaxation)

Increase fluid intake (2-3 L/day to liquify mucus)