Week 7- Chronic Respiratory Diseases Interventions

BPD develops in preterm neonates who have been treated with

oxygen and positive pressure ventilation

What is administered to infants to improve infant lung development in individuals at risk of preterm delivery?

antenatal glucocorticoids (IM injection that goes through the placenta)

What is the most common therapy used for post premature delivery?

surfactant therapy

Surfactant therapy is used to prevent and treat

BPD

Surfactant therapy is a ____ that lowers the ____ in the alveoli

lipoprotein, surface tension

How is surfactant therapy administered?

liquid from via and endotracheal tube

Other common therapies for post premature delivery

antibiotics (prone to resp infection), corticosteroids (ongoing O2 complications), diuretics (pulmonary edema), electrolyte replacement PRN (ex. K+), and bronchodilators PRN

Nutrition (energy) requirements for infants with BPD should be >

130 kcal/kg/day

What is the recommended protein intake for infants with BPD?

3.5-4g/kg/day

Infants with BPD should be ______ and ______ frequently

weighed, measured (length and head circumference)

What supplements are common for patients with BPD due to risk of metabolic bone disease?

calcium, phosphorus, and vitamin D

Infants with BPD may be put on a

fluid restriction

O2 sat for infants with BPD should be between

90-95%

Why do we not want high or low oxygenation for infants with BPD?

risk of retinopathy

Ventilation can be ____ or ____-

invasive or non-invasive (intubated/non-intubated)

Infants with BPD may experience sudden episodes of

pulmonary decompensation

What are the 2 main symptoms of pulmonary decompensation?

worsening gas exchange and respiratory distress

Episodes of decompensation may be caused by

bronchospasm, fluid retention in the lungs, pulmonary air leak, endotracheal tube displacement, or asymptomatic tracheobronchomalacia

Thick mucosal secretions in CF traps ___ and causes ____

bacteria, obstruction

Before we give antibiotics for CF we need to obtain

blood cultures (in order to give the correct antibiotic)

Other STAT orders for CF patients with a suspected infection is

sputum, CBC, and lactate

Antibiotics should be given to a CF patient within

1 hour

CTFR modulator therapy helps

repair CFTR protein (upstream treatment for CF)

Other pharmacological interventions for CF are

airway clearance therapies (hypertonic saline DNase or dornase alfa), vaccinations, bronchodilators, intermittent antibiotics as needed, and pancreatic enzymes

Bronchodilators given to patients with CF are

beta-2 adrenergic receptor agonists

Bronchodilators should be given to a patient prior to ____ and ____

chest physio, nebulized medications

Type of CFTR medications are tailored to age and genetic defects making ____ essential for treatment

genotyping

90% of patients in Canada are treated with

trikafta (CFTR therapy drug)

Common side effect/monitoring for trikafta is

liver injury/liver failure (monitor LFTs)

Trikafta adverse effects

skin rash, abdominal pain, diarrhea, headache, upper respiratory tract infection, and elevated LFTs

Trikafta should be administered with

fat containing foods and should be swallowed whole

Chest physiotherapy is essential for CF

prevention and treatment

Chest physio is usually done

multiple times per day

Chest physiotherapy includes

percussion and postural drainage, positive expiratory pressure, active cycle of breathing, autogenic drainage, oscillatory PEP devices, high frequency chest compression, exercise, and percussive vests

Nutritional (energy) requirements for individuals with CF is body weight is below target should be ____ to _____ times the dietary reference intake for age

1.2-1.5

Individuals with CF must take replacement of

pancreatic enzymes (in order to digest food)

How many pancreatic replacement pills are usually taken per meal?

1-5

What is the goal amount of stools/day?

max 1-2

In individuals with CF we should always anticipate the risk of

bowel obstruction

Common endocrine co-morbidity with CF is

cystic-fibrosis related diabetes (CFRD) (due to destroyed pancreatic cells)

What is the first line therapy for individuals with CFRD?

insulin

What type of diet is recommended for individuals with CF?

high fat and calorie (based on BMI and overall GI absorption effectiveness)

Exacerbation of COPD is marked by the worsening of

dyspnea, cough, and/or sputum production (can also include tachypnea/tachycardia)

Exacerbation of COPD can last up to

2 weeks

Exacerbation of COPD is usually caused by

airway infection, pollution, or other irritants

Purse-lipped breathing for COPD is used to

help expire air from the alveoli

Other technique for air expiration in COPD is

tripoding

Prevention for COPD

vaccinations, avoiding contagious individuals, hand hygiene, balanced diet, exercise, deep breathing/coughing, and pure-lipped breathing

Goals of COPD treatment is to alleviate ____, improve ____, prevent ____, and reduce ____

dyspnea, health status, acute exacerbation of COPD, mortality

Reducing risk factors for COPD includes ____ and _____

smoking cessation, avoiding exposure to irritatns

Education on medications help prevent

future exacerbations and slow disease process (ensure assessment/education on correct inhaler technique)

Nutrition (energy) requirements for patients with COPD is

1.2-1.3x normal calories

Diet for COPD should be

high calorie and protein

Individuals with COPD should have frequent meals to avoid

pressure/discomfort on the diaphragm

Self care strategies for individuals with COPD

pulmonary rehab, maintain activity to prevent deconditioning/build resilience, pursed lip breathing, and maintaining emotional well being

First line treatment for COPD does not include

corticosteroids

Low symptoms burden COPD medication regimine

LAMA or LABA

Low acute exacerbation COPD (AECOPD) risk medication regimine

LAMA/LABA and ICS

High AECOPD risk medication regimine

LAMA/LABA/ICS and prophylactic macrolide/PDE-4 inhibitor/mucolytic agents

Hospital support/mediccations for individuals with COPD is

systemic glucocorticoids, antibiotics, supplemental O2, ventilatory support, and palliative care

COPD action plan

plan that includes personal goals, emergency contact information, common symptoms of flare ups, and common triggers

COPD plans emphasize the importance of being

proactive and not waiting more than 48hrs to consult healthcare team

If patients cannot inhale fully for a dry powder inhaler an

alternative method of administration is necessary

Disease trajectory for COPD depends on correct

inhaler technique

Nebulizers are a

passive way to inhale medication

Nebulizers are set at how many L O2?

5L O2

Nebulizers can be given through

pipe or facial mask

When using a nebulizer mask, after the medication is administered it is important to

remove the mask immediately to prevent CO2 retention

Goal of BIPAP is to

force CO2 out of the lungs

The dilemma about BIPAP is that if using on the unit and the patient gets worse there is

time lost when they could have been intubated

If a patient in unable to be weened off a ventilator a _____ will be inserted for extended ventilator therapy

tracheostomy

Once a patient starts to improve on a tracheostomy it can be

corked intermittently

PDE-4 inhibitors are not indicated for

sudden/acute respiratory distress

PDE-4 inhibitors are less frequently used as they

have a lot of side effects that make patients feel unwell

Carbocysteine N-acetylcysteine (NAC) may reduce ____ and improve ____ in patients not receiving ICS

exacerbations, health status

Erdosteine may have significant effects on

mild exacerbations +/- ICD

Systemic glucocorticoids are used in treatment of pulmonary diseases due to the

anti-inflammatory effects

Glucocorticoids are preferably administered ____ but ordered ____ for severe exacerbations

inhalation, systemically

The goal of oxygen therapy for COPD is to prevent ___ without inducing ____

hypoxia, hypercapnia

SpO2 goal for patients with COPD is

88-92%

Bilevel positive airway pressure (BPAP)

delivers a preset inspiratory positive airway pressure and expiratory positive airway pressure

BIPAP is used to support people who develop respiratory

fatigue (despite supportive therapies)

BIPAP is contraindicated when patients are

nauseated due to aspiration risk

BIPAP has a higher positive air pressure on

inspiration (positive pressure on inspiration and expiration)

It is very important for BIPAP masks to be

sealed properly for proper machine functioning

Other BIPAP contraindications

inability to protect airway/clear secretions, severely imparied conciousness, non-respiratory organ failure that is life threatening, high aspiration risk, inability to cooperate, facial surgery/trauma/deformity, and recent anastomosis

Continuous positive airway pressure (CPAP)

provides minimum pressure to eliminate apneas, snoring, and other obstructive events in the upper airway

CPAP is not intended for treating

hypercapnia

COPD surgical interventions inclyde

lung volume reduction and lung transplantation

Patients with interstitial lung disease (idiopathic pulmonary fibrosis) should be put on ____ and begin ____

supplemental oxygen, pulmonary rehab

Education for patients with interstitial lung disease includes

that the disease is progressive and terminal and palliative care principles

Patients with interstitial lung disease should prevent _____ and ____

infections, acute exacerbations

Prevention strategies for individuals with interstitial lung disease includes

avoid crowds or people who are potentially contagious and vaccinations against respiratory infections

Patients with interstitial lung disease should have what type of diet?

high fat and protein to increase calories

Patients with interstitial lung disease should eat ___ and ____ meals and possibly take ____

smaller, more frequent, nutritional supplements

Pharmacological treatment for interstitial lung disease is

antifibrotic therapy (nintedanib and pirfenidone)

Antifibrotic therapy drugs help

slow progression of the disease

Common lung disorders that cause pulmonary hypertension include

obstructive lung disease (COPD), restrictive lung disease (interstitial lung disease), mixed obstruction/restriction (pulmonary fibrosis with emphysema), hypoxia without lung disease, and developmental lung disorders (BPD)

To treat pulmonary HTN we must treat the

underlying condition(s)

Other interventions for pulmonary HTN include

exercise as tolerated, low sodium diet, routine vaccinations, smoking cessation, supportive measures (oxygen/diuretics), and palliative measures (as indicated)