Nurse 2550 Exam 1: Pulmonary Disease

General Categories of Lung Disease

Obstructive (most common): Emphysema, Alpha-1 Antitrypsin Deficiency, Obliterative Bronchiolitis, Lymphangioleiomyomatosis

- Loss of elastic lung recoil- easier to get air in but hard to get out

Fibrotic: Idiopathic Pulmonary Fibrosis, Sarcoidosis, Chemo/XRT

- Scars and thickens to accommodate

Vascular: Primary Pulmonary HTN, Eisenmenger's, CVD

Septic: Cystic Fibrosis, Bronchiectasis

Common Pulmonary Diagnostic Procedures

- pulmonary function testing

- six minute walk test

- arterial blood gas

- chest x-ray

- chest CT scan

- bronchoscopy

Pulmonary function testing (PFT or spirometry)

pt must be fully able to participate, pt breathes in and out on command, typically done by respiratory therapist

- Describes lung function as normal, obstructive, or restrictive

- Trends are informative re: staging and response to therapy

- Can be done in office setting

- Done pre-/post- bronchodilator demonstrates reactivity of airways

- Measurement of inspiratory & expiratory pressures describes musculoskeletal strength

Six minute walk test

- Measures distance, endurance, SpO2 on exertion, Borg Scale (pt perception 1-10 difficulty)

- 6:00 on level ground, paced by patient

- Rests allowed but discouraged

- Determines amount of oxygen to be administered with exertion

- Inexpensive, trendable, can be done in office

Arterial blood gas

- pH: acid-base level in arterial blood

- PCO2: levels of CO2 (acid)

- PO2: level of O2

- HCO3: level of bicarb (base)

- Document dose of FiO2 at time of study

- A-line indicated if frequent testing necessary

Bronchoscopy

- Therapeutic or diagnostic

- Direct visual inspection of airways

- Specimen collection via brushing, swabbing, lavage or biopsy

- Provides data for microbiology cytology, pathology

- Performed under conscious sedation with flouroscopic guidance

- Risk of pneumothorax, hemorrhage

Four Distinct Densities of Radiology

Air: black

Fluid: shades of gray

Fat/muscle: shades of gray

Bone: white bc full of calcium, absorbs light from beam

Common Pulmonary Disorders in Older Adults

- Colds & flu

- COPD & asthma

- Community acquired pneumonia

- Hospital acquired pneumonia

- TB

Influenza Prevention

Older adults should receive a flu shot, not a nasal spray vaccine.

Approved vaccines for older adults

- Standard flu shots

- Enhanced vaccines approved for us in people >65yo may provide a better immune response

A high dose flu vaccine contains 4 times the amount of antigen as a regular flu shot. The additional antigen creates a stronger immune response in the person getting vaccinated.

An adjuvanted vaccine is a standard dose flu vaccine with an adjuvant added. An adjuvant is an ingredient added to a vaccine to help create a stronger immune response to vaccination.

- Basic hand hygiene and vector avoidance

Diagnostic Studies of Influenza

- H&P

- Clinical symptoms

- Local outbreaks

- Rapid flu test

Nasal swab

48 hours on onset

Viral cultures "gold standard"

Takes 3-10 days for results

Influenza Treatment: antiviral therapy

- Initiate as soon as possible (ideally c in 48h of onset of sx)

- Available only c prescription

- Mechanism of action: disrupt virus replication

- Antiviral drugs can make illness milder and hasten recovery time

- May also prevent serious complications

Triggers of Asthma Attacks

Air pollutants

Allergen inhalation

Drugs

Food additives

Occupational exposure

Idiopathic Pulmonary Fibrosis

Prevalence: estimated 0.33-4.51 per 10k people (internationally)

- Chronic, progressive inflammation → scarring of the lung interstitium

- Typically presents in the 6th-8th decade of life

- Features: dry cough, progressive hypoxemia, clubbing of fingers

- 5-year survival from diagnosis approximately 30-40%

- Therapy aimed at slowing progression of disease

Community Acquired Pneumonia

Risk Factors: chronic lung disease, cigarette smoking, brain injury, immunocompromised host, recent surgery or trauma, surgery for cancer of the mouth/throat/neck, diabetes mellitus, cardiac disease, liver disease, GERD, influenza co-infection

Signs and symptoms: cough that may bring up green/yellow/bloody mucus, fever/chills/severe shaking, shortness of breath, breathing and heartbeat that are faster than usual, pain in chest or back c deep breathing or coughing, fatigue and loss of appetite, confusion

Hospital Acquired Pneumonia

Definition: onset of symptoms >48h from hospital admission

Associated w/ increased length of stay, higher costs and inferior outcomes

Risk Factors: chronic lung disease, mechanical ventilation, immunocompromised host, post-operative, advanced age, nasogastric feeding tube

Pneumonia Diagnostic Studies

CXR

Sputum culture and sensitivity

Nasopharyngeal swab

CT scan (with or without contrast)

SaO2

Blood culture

Bronchoscopy

Pneumonia Interdisciplinary Treatment

Therapy is guided by culture and sensitivity; HCP may opt to give broad spectrum abx empirically until results available

Bronchodilators

Supplemental oxygen to maintain SaO2>92%

Hospitalization may or may not be indicated

Smoking cessation

Warm humidified air

Incentive spirometry with coughing and deep breathing

Hydration

Gentle exercise

Sleep

Health History and Nursing Assessment

Health perception-health management

Nutritional-metabolic

Elimination

Activity-exercise

Sleep-rest

Cognitive-perceptual

Self-perception-self-concept

Role-relationship

Sexuality-reproductive

Coping-stress tolerance

Value-belief

Extrapulmonary sequelae of lung disease

Right heart failure

Malnutrition

Frailty

Sarcopenia

Anxiety

Depression

Pulmonary Health Promotion Strategies

Policy and action to ensure clean air

Eradication of tobacco smoking

Support for medication adherence

Pulmonary rehabilitation optimize conditions of the living environment