Nurs 3366 - Obstructive lung dzs

What are Obstructive lung diseases?

difficulty with exhalation

• some sort of obstruction of airways

What are the S&S Obstructive lung diseases?

“forcing out“ of air

• use accessory muscles to do this which is called retractions

  • supraclavicular, substernal, & intercostal muscles “sucking in” upon expiration to help get air OUT of lungs

• prolonged expiratory phase - length of time to exhale begins to get

  longer

What is a test used to measure how well someone can force air out?

peak flow (PF) test

• the less the PF, the worse the obstructive pulmonary disease

What is Asthma?

chronic inflammatory disorder of the airways due to bronchial hyperresponsiveness to stimuli such as allergens in environment

What is the patho of Asthma?

inhaled irritants→ inflammatory mediators (histamine, leukotriene, prostaglandins)→vasodilation → swelling of bronchial lining

What are the S&S of Asthma?

wheezing sound caused by expiration of air through narrow passageways

• respiratory alkalosis - can’t expire CO2

What are treatments of Asthma?

• bronchodilators

• anti-inflammation drugs

What is COPD?

collective term for emphysema and/or chronic bronchitis

What is the cause of Emphysema?

smoking

What is the patho of Emphysema?

increased activity of proteolytic enzymes like elastase

• destruction of patches of the alveolocapillary membrane results in

  large, stiff, hyperinflated alveoli that have no elastic recoil

due to this loss of elastic recoil, these areas act as air “traps” called blebs

What is the S&S of Emphysema?

a degree of tachypnea is almost always present—RR of 26 to 30 beats/min

chronic hyperventilation

• because of hyperventilation, patients with emphysema known as “pink

  puffers” --they can stay pink (ie, fairly well-oxygenated) as long as

  they keep “puffing.

“tripod” position - maximize chest expansion and decrease work of breathing

“pursed lip” breathing - prolong expiratory time

What is the ABG for Emphysema?

respiratory alkalosis

• pH: >7.45; PCO2:<35; HCO3: norm; PO2 & SO2 is often chronically a little low (~92-95%).

What is Chronic Bronchitis?

defined as hypersecretion of mucus and chronic productive cough that has occurred for 2 years or more

What is the patho for Chronic Bronchitis?

irritants (usually from smoking)→ irritation to bronchial walls→inflammation→ bronchial edema & thick mucus→ obstruction→air trapping→difficulty expelling air

What is the S&S of Chronic Bronchitis?

known as “blue bloaters”

etiology of “blue”

• hyperventilating is not seen in a pt with chronic bronchitis

  • no “pink” instead, there is “blue” ie - cyanosis develops

etiology of “bloater”

• need to conserve energy-- they don’t hyperventilate & they don’t move around a lot→ gain weight

• cor pulmonale, which means usually lots of peripheral edema

What are the ABGs for Chronic Bronchitis?

respiratory acidosis

• pH:<7.35 PCO2:>45 HCO3:norm PO2: <80 SO2: <97%