Module 3 : Altered Ventilatory Function

Acute/Chronic Obstructive Pulmonary Disease

• A disease characterized by airflow limitation that is not fully reversible.

Emphysema

Manifestation

• pink puffer

• Mild production of sputum

• barrel chest

• dyspnea

• cough may be present

Chronic bronchitis

Manifestation

• Blue bloater

• Productive Cough

• Thick, gelatinous sputum

• Wheezing might be present

• Notable dyspnea

Diagnostic Procedures

• Spirometry

• ABG levels

• Chest X-ray

• Alpha1-antitrypsin assay

Medical management

• Bronchodilators

• Inhaled and systemic corticosteroids

• Alpha1-antitrypsin augmentation therapy

• Antibiotic Agents

• Mucolytic agents

• Antitussive agents

• Vasodilators and

• Narcotics

Surgical management

• Bullectomy

• Lung Volume Reduction Surgery

Nursing Care Management

1. symptoms reductions

2. Pursed-lip breathing & diaphragmatic breathing

3. small frequent meals & hydration

4. administer low flow of oxygen

5. pulmonary rehabilitation

Acute Respiratory Distress Syndrome

• s a severe form of acute lung injury. This clinical syndrome is characterized by a sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of Patients often demonstrate reduced lung compliance

Manifestation

• develops over 4 to 48 hours

• severe dyspnea, severe hypoxemia

• Arterial hypoxemia

• chest x-ray are similar to those seen with cardiogenic pulmonary edema

• increased alveolar dead space

• Severe crackles and rhonchi heard on auscultation

• Labored breathing and tachypnea

Diagnostic Procedures

• Clinical presentation and history of findings

• Hypoxemia on ABG despite increasing inspired oxygen level

• Chest x-ray shows bilateral infiltrates

• Plasma Brain Natriuretic Peptide (BNP)

• Echocardiography

• Pulmonary Artery Catheterization

Management

• Treatment of the underlying condition

• Optimize oxygenation

• Intubation and mechanical ventilation

• Sedation may be required

• Paralytic agents may be necessary

• Antibiotics, as indicated

• PEEP usually improves oxygenation

Pneumonia

• Inflammation of the lung parenchyma

Manifestation

• Sudden onset, rapidly rising fever of 38.3° C to 40.5° C

• Cough productive of purulent sputum

• Pleuritic chest pain aggravated by deep respiration/coughing

• Dyspnea, tachypnea accompanied by respiratory grunting, nasal flaring, use of accessory muscles of respiration, fatigue

• Rapid, bounding pulse

• Orthopnea, Rusty, blood-tinged sputum

• Poor appetite & Diaphoresis

Diagnostic Procedures

• CXR for extent of pulmonary disease

• Gram Stain and culture for organism identity

• Blood culture detects bacteremia

Management

• Antibiotics, anti pneumococcal,

• Oxygen therapy

Nursing Interventions

• coughing and deep breathing

• semi-fowler position and monitor pulse oximeter

• hydration

• health teaching about antimicrobial therapy

Pneumothorax

• occurs when the parietal or visceral pleura is breached and the pleural space is exposed to\ positive atmospheric pressure

Manifestation

• Hyperresonance & Diminished breath sounds.

• Reduced mobility of affected half of thorax.

• Tracheal deviation

• Air hunger, agitation, hypotension, cyanosis and profuse diaphoresis

• Mild to moderate dyspnea and chest discomfort may be present with spontaneous

  pneumothorax

Kinds

• Spontaneous Pneumothorax

• Tension Pneumothorax

• Open Pneumothorax

Nursing Intervention

• Apply petroleum gauze to sucking chest wound

• position patient upright

• administer pain medications

• monitor oximetry and ABG levels

• provide oxygenation

SARS-COV 2/ COVID-19 Disease

• Newly discovered Corona Virus originated from Wuhan, China (December 2019). This serious disease attacks the respiratory system that may lead to imminent death.

Predisposing Factors

1. Host

• Age (Older populations)

• Smokers

• Immunosuppressed individuals

• existing comorbidities

• family life and culture

• Lack of discipline and education

2. Environment

• population density

• high level exposure to wet market with wildlife animal trading

3. Agent

• SARS-COV-2

• attaching protein spikes in the lungs

• phases of attack

  1. Viral replication

  2. Hyperactivity of pulmonary system

  3. pulmonary destruction

Manifestation

• Cough, Sore Throat & Headache

• Diarrhea & Fever

• Loss of Smell & Loss of Taste

• Difficulty of Breathing & Shortness of Breath

• Haziness and tiny white spots in the X-ray Result

Diagnostic test

• SWAB TEST: rt-PCR (Real-Time Polymerase Chain Reaction)

Medications

• Tocilizumab

• Remdesivir \

• Baricitinib + Remdesivir

• Low dose Heparin or Enoxapin

Management

• Supportive Care

• Providing fluids

• Providing oxygen

• Ventilatory support (Mechanical Ventilator) if indicated

Acute Lung Failure

Symptoms

• Hypoxemia

• Hypercapnia

• Hypoxia (Hallmark sign)

Pathophysiology

• pulmonary system fails to maintain adequate gas exchange; another disorder alters normal pulmonary function to lower ventilatory drive, decreased muscle strength, decreased chest wall elasticity, decreased lung’s capacity for gas exchange, and increase resistance, or increased metabolic O2 requirements

Assessment and Diagnosis

• ABG analysis

  • Increased or decreased levels of PaCo2, PaO2, &pH

  • PaO2< 60 mmHg. if patient with hypercapnia, PaCo2 > 45 mm Hg

  • increased PaCo2, includes pH <7.35

• Bronchoscopy for airway surveillance or specimen retrieval

• chest radiography, thoracic ultrasound, Thoracic CT, lung function studies

Medical Management

• promote adequate gas exchange, correct acidosis, provide nutritional support, & prevent complications

• supplemental O2 for hypoventilation & V/Q mismatch, PEEP for increased gas exchange

Medications

• Beta2 agonist & anticholinergics - smooth muscle relaxation and bronchial dilation

• steroids - airway inflammation & enhance beta2 agonists

• sedation - comfort and decreased work of breathing

• Analgesics - pain control

Nursing Intervention

• positioning - HOB 30 -35, reposition Q2

• Prevent desaturation - hyper oxygenate before suctioning

• Minimize oxygen consumption - limit physical activity

• Education and Emotional support

Acute Respiratory Distress Syndrome

• occurs when capillary membrane that surrounds alveolar sac to leak fluids causing it to collapse

• fast onset for patients who are already hospitalized w/ another conditions

• develops due to systemic inflammation

Symptoms

• hypoxemia

Causes

• Indirect

  • source is not the lungs

    • Sepsis

    • burns

    • blood transfusion

    • inflammation pancreas

    • drug overdose

• Direct

  • source is the lungs

    • Pneumonia

    • Aspiration

    • Inhalation injury

    • near-drowning

    • embolism

Phases

1. Exudative

• 24 hrs. after injury, damage to capillary membrane

• fluid start to leak on the sac. protein rich fluid that draws more water to the sac causing pulmonary edema

• Diminished lung sounds and Crackles

• decreased surfactant causing decreased surface tension leading to atelectasis

• hyaline membrane making the lungs more stiff and decreased lung compliance causing VQ mismatch

• Hallmark sign : Refractory hypoxemia : increased RR, Low O2, Low CO2 leading to alkalosis

1. Proliferative

2. Fibrotic