Adult Health 1

Adult Health 1 - Respiratory Disorders - COPD Use of Steroid with Respiratory Disorder Reduces airway inflammation Use of Bronchodilator with Respiratory Disorder Relax airway muscles Mild COPD - use short acting bronchodilator Severe COPD - use long acting bronchodilator Advair and Symbacor - combination of long and short acting bronchodilators Severe COPD FEV1 60% 2 ppd smoker x 38 yrs = ? pack year history 2 x 38 = 76 COPD and % oxygen Around 93% is ideal, dont want to have 99% because they need a stimulus (lower O2 level) to have their body breathe, otherwise they'd become too dependent. COPD possible orders Steroids (Prednisone) - reduces airway inflammation Antibiotic (Azithromycin) Albuterol (rescue drug to help breathing) Atrovent (anticholinergic, often given with albuterol) Vasotec (ACE inhibitor - treats HTN) *COPD pts often have heart failure, keep tract of fluids COPD definition Disease state characterized by progressively increased airflow obstruction that is NOT reversible Onset of symptoms is slow Includes diseases that cause airflow obstruction (emphysema - destruction of alveoli, Chronic Bronchitis - inflammation of conducting air tubules) Must be coughing daily for at least 3 months Decreased breath sounds on exhalation *Common feature in all COPD (whether emphysema, chronic bronchitis) = airflow obstruction Pathophyisology of COPD Airflow limitation is progressive, associated with abnormal inflammatory response to noxious agents (eg. smoking) Inflammatory response occurs throughout airways, lung parenchyma (imbalance between proteinase, antiproteinase), inflammatory response and pulmonary vasculature (thicker vessels, inflammatory cells infiltrate, collagen deposit, destruction of capillary beds) Scar tissue and narrowing occur in airways Risk Factors of COPD Tobacco smoke Passive smoking Occupational exposure Ambient air pollution Infections Genetic Abnormalities (Alpha- antitrypsin deficiency = protein that is made in liver, travels to other organs and helps protect, in deficient state, these proteins are the wrong shape and cant get out to the other organs, onset age = 30-40) Childhood lung infections Clinical Manifestations of COPD Dyspnea (progressive), dyspnea at rest (later stages), cough (first symptom present), wheezing (dec breath sounds throughout lung fields, expiration), chest tightness, hypoxemia (PaO260) (risk inc due to ventilation perfusion mismatch), Hypercapnea (PaCO2 45) (evident in later stages), weight loss, lung hyperinflation, altered blood gases (respiratory acidosis), Cor pulmonale (increased pressure on pulmonary artery -- R sided heart failure) ABGs would indicate respiratory acidosis Nursing Interventions of COPD Timing of activities, pt education on breathing techniques - pursed lip breathing & diaphragmatic breathing, increase fluids, promote optimal lung expansion through positioning, reduction of risk factors, O2 therapy if indicated, Nutritional therapy, sit up in bed, prevent infection, ambulation Hydration to liquify secretions, incentive spirometry Bronchodilators, steroids Treatment for COPD Smoking cessation, medications (bronchodilators - inhaled steroids, combination inhalers, oral steroids, antibiotics); oxygen therapy, pulmonary rehab (work with patients on increasing their stamina) Lung volume reduction surgery (take out most diseased portion of lung), lung transplant Nursing Diagnoses Impaired gas exchange, impaired nutrition, ineffective breathing, activity intolerance