chap. 31 - obstructive pulmonary diseases

obstructive pulmonary diseases

• bronchiectasis

• cystic fibrosis (CF)

• asthma

• COPD

bronchiectasis

permanent abnormal dilation of 1 or more bronchi

• repeated infection/inflammation damages → elastic tissue, smooth muscle, bronchial walls

• causes airways to become permanently widened and makes it difficult to clear mucus

• excessive secretions

• diagnosis → CT scan = gold standard

bronchiectasis manifestations

• persistent/recurrent cough

• large amounts of purulent sputum (sometimes exceed 500 mL/day)

• complications → recurrent respiratory infections, hemoptysis, pulmonary hypertension

chest x-ray

• 2D/basic

• less detail

• very quick

• lower radiation

• less expensive

• quick overview

CT scan

• detailed cross-sectional images

• much more detail

• takes longer

• higher radiation

• more expensive

• looking closely at structures

bronchiectasis treatment

• treat infection

• clear secretions

• prevent further lung damage

• maintain nutrition + hydration

bronchiectasis nursing interventions

• hydration

• airway clearance

• chest physiotherapy

• effected coughing

• rest

• adequate nutrition

• patient education

cystic fibrosis (CF)

autosomal recessive genetic disease affecting exocrine glands

• multi-system disease (DO NOT ONLY think abt lungs)

• initially = airway obstruction → thick, sticky mucus blocks airways

• over time:

  • thick mucus → airway obstruction

  • obstruction → mucus trapping + infection

  • infection → chronic inflammation

  • inflammation → fibrosis + lung tissue damage

  • fibrosis → stiff lungs → restrictive changes

• diagnosis → sweat chloride test

  • chloride HIGH b/c CF is caused by defective CFTR protein (regulates chloride + salt movement)

  • in CF, chloride not reabsorbed normally in sweat glands

  • result = high chloride concentration in sweat

CF manifestations

• chronic/frequent cough

• recurrent respiratory infections

• new-onset diabetes

• infertility

• complications → diabetes, pancreatic insufficiency, distal intestinal obstruction syndrome (DIOS), sinus disease, liver disease, bone disease, cardiovascular complications

CF treatment

• bronchodilators

• mucolytics

• chest physiotherapy

• postural drainage

• antibiotics

• pancreatic enzyme replacement

• GI meds

• nutritional support

CF nursing interventions

• promote airway clearance

• monitor respiratory status

• prevent + treat infections

• promote adequate nutrition

• administer meds as prescribed

asthma

reversible airway obstruction caused primarily by inflammation and bronchoconstriction

• diagnosis → health history, s/s, physical examination, spirometry, peak expiratory flow (PEF)

  • FEV — forced expiratory volume in 1 sec

  • PEF + FEV → help assess airway obstruction + response to treatment

asthma manifestations

• wheezing

• cough

• dyspnea

• chest tightness

• worse in early morning + late at night

asthma treatment

• inhaled corticosteroids (ICS)

• fluticasone

• budesonide

• short-acting B2 agonists (SABA)

  • albuterol = rapid relief of bronchospasm

  • may cause → tremor, tachycardia/palpitations, nervousness

• long-acting beta2 agonist (LABA)

  • NOT USED alone for asthma (in combination)

  • fluticasone/salmeterol

  • budesonide/formoterol

asthma patient education

• med name, purpose, dose, schedule, side effects, administration

• proper inhaling technique

• device cleaning

• trigger avoidance

• when to seek emergency care

• devices:

  • metered-dose inhalers — puffs dose of medicine when pressed on

  • dry-powdered inhalers — delivers powder medicine when inhaled

  • nebulizers — sprays dose of medicine when pressed on

status asthmaticus

severe asthma attack that does not respond adequately to usual treatment

• EMERGENCY

• patient may develop:

  • severe respiratory distress

  • hypoxemia

  • exhaustion

  • respiratory failure

• may require:

  • ICD admission

  • intubation

  • mechanical ventilation

COPD

persistent, not fully reversible airflow limitation

• usually progressive and associated w/ chronic inflammation caused by exposure to harmful particles/gases

• air trapping → hyperinflation → impaired gas exchange

• most important risk factor = cigarette smoking

• other risks → occupational chemicals, air pollution, recurrent respiratory infections, a1-antitrypsin deficiency

• involves inflammation of → airways, lung parenchyma, pulmonary blood vessels

• airflow obstruction results from → loss of elastic recoil, mucus hyper-secretion, mucosal edema, bronchospasm

• consequences = hypoxemia, hypercapnia

• diagnosis → spirometry

COPD manifestations

• earliest symptom = chronic/intermittent cough

• cough becomes more persistent

• dyspnea worsens

• exercise tolerance decreases

• ADL become more difficult

• sputum may occur

COPD exacerbation

• dyspnea

• cough

• sputum production or change in sputum characteristics

• complications = acute-on-chronic respiratory failure

FEV1/FVC ratio

• how much air can you blow out in the first second

• how much air can you blow out total

COPD treatment

• relieve symptoms

• improve exercise tolerance

• improve ability to perform ADLs

• prevent complications

• slow disease progression

• improve quality of life

• smoking cessation

• bronchodilators + corticosteroids

• mucolytics

corticosteroids

mimic hormones produced by adrenal cortex

• decrease inflammation + decrease immune response (suppresses immune system)

• decrease airway edema/swelling

• decrease mucus production

• reduce airway hyper-responsiveness

• decrease frequency/severity of exacerbations

why might a COPD patient receive solumedrol (methylprednisolone)

• steroid helps reduce inflammatory component of exacerbation

• patient may receive → albuterol with or w/o ipratropium

  • adresses bronchoconstriction

  • receive both b/c they do different things

corticosteroid side effects

THINK → steroids affect metabolism + immunity

• hyperglycemia (increase blood glucose)

• increased infection risk

• fluid retention

• increased BP

• mood changes

• increased appetite

• weight gain

• GI irritation

• hypothyroidism — cushings syndrome

• with long-term use → osteoporosis, adrenal suppression

why can’t patients suddenly stop long-term steroids

• external steroid stops → adrenal glands may not immediately produce enough cortisol → adrenal insufficiency

• tapered NOT abruptly stopped

COPD surgical options

• lung volume reduction surgery (LVRS) → removes diseased lung tissue

• bronchoscopic lung volume reduction (BLVR) → uses 1-way valves to allow trapped air to leave diseased areas but prevents air from entering

• bullectomy → removes large bullae (damaged, air-filled spaces in lungs)

• lung transplantation → replaces diseased lung w/ donor lung in those w/ very advanced disease