COPD Chronic Obstructive Pulmonary Disease 1. Chronic bronchitis 2. Bronchial asthma 3. Bronchiectasis 4.

. Pulmonary emphysema terminal stage CHRONIC BRONCHITIS - called BLUE BLOATERS inflammation of bronchus due to hypertrophy or hyperplasia of goblet mucus producing cells leading to narrowing of smaller airways. Predisposing factors: 1. Smoking all COPD types 2. Air pollution S/Sx: 1. Prod cough 2. Dyspnea on exertion 3. Prolonged expiratory grunt 4. Scattered rales/ rhonchi 5. Cyanosis 6. Pulmo HPN a.)Leading to peripheral edema b.) Cor pulmonale respiratory in origin 7. Anorexia, gen body malaise Dx: 1. ABG PO2 PCO2 Resp acidosis

2.

3. 4. 5. 6. 7.

Medsa.) Bronchodilator through inhalation or metered dose inhaled / pump. Give 1st before corticosteroids b.) Corticosteroids due inflammatory. Given 10 min after adm bronchodilator c.) Mucolytic/ expectorant d.) Mucomist at bedside put suction machine. e.) Antihistamine Force fluid O2 all COPD low inflow to prevent resp distress Nebulize & suction Semifowler all COPD except emphysema due late stage HT a.) Avoid pred factors b.) Complications: Status astmaticus- give epinephrine & bronchodilators Emphysema c.) Adherence to med

BRONCHIECTASIS abnormal permanent dilation of bronchus resulting to destruction of muscular & elastic tissues of alveoli. Predisposing factors: 1. Recurrent upper & lower RI 2. Congenital anomalies 3. Tumors 4. Trauma S/Sx: 1. Productive cough 2. Dyspnea 3. Anorexia, gen body malaise- all energy are used to increase respiration. 4. Cyanosis 5. Hemoptisis

Hypoxemia causing cyanosis Nsg Mgt: (Same as emphysema) 2.) BRONCHIAL ASTHMA- reversible inflammation lung condition due to hyerpsensitivity leading to narrowing of smaller airway. Predisposing factor: 1. Extrinsic Asthma called Atropic/ allergic asthma a.) Pallor b.) Dust c.) Gases d.) Smoke e.) Dander f.) Lints 2. Intrinsic AsthmaCause: Herediatary Drugs aspirin, penicillin, blockers Food additives nitrites Foods seafood, chicken, eggs, chocolates, milk Physical/ emotional stress Sudden change of temp, humidity &air pressure 3. mixed type: combi of both ext & intr. Asthma 90% cause of asthma S/Sx: 1. 2. 3. 4. 5. 6. 7. Dx: 1. 2. C cough non productive to productive D dyspnea W wheezing on expiration Cyanosis Mild apprehension & restlessness Tachycardia & palpitation Diaphoresis Pulmo function test decrease lung capacity ABG PO2 decrease

Dx: ABG PO2 decrease Bronchoscopy direct visualization of bronchus using fiberscope. Nsg Mgt: before bronchoscopy 1. Consent, explain procedure MD/ lab explain RN 2. NPO 3. Monitor VS Nsg Mgt after bronchoscopy 1. Feeding after return of gag reflex 2. Instruct client to avoid talking, smoking or coughing 3. Monitor signs of frank or gross bleeding 4. Monitor of laryngeal spasm DOB Prepare at bedside tracheostomy set 1. 2. Mgt: same as emphysema except Surgery Pneumonectomy removal of affected lung Segmental lobectomy position of pt unaffected side

Nsg Mgt: 1. CBR all COPD

PULMONARY EMPHYSEMA irreversible terminal stage of COPD Characterized by inelasticity of alveolar wall leading to air trapping, leading to maldistribution of gases. Body will compensate over distension of thoracic cavity Barrel chest

Predisposing factor: 1. Smoking 2. Allergy 3. Air pollution 4. High risk elderly 5. Hereditary - 1 anti trypsin to release elastase for recoil of alveoli. S/Sx: 1. 2. 3. 4. 5. 6.

Productive cough Dyspnea at rest due terminal Anorexia & gen body malaise Rales/ rhonchi Bronchial wheezing Decrease tactile fremitus (should have vibration) palpation 99. Decreased - with air or fluid 7. Resonance to hyperresonance percussion 8. Decreased or diminished breath sounds 9. Pathognomonic: barrel chest increase post/ anterior diameter of chest 10. Purse lip breathing to eliminated PCO2 11. Flaring of alai nares 1. Pulmonary function test decrease vital lung capacity 2. ABG a.) Panlobular / centrolobular emphysema pCO2 increase pO2 decrease hypoxema resp acidosis Blue bloaters b.) Panacinar/ Centracinar pCO2 decrease pO2 increase hyperaxemia resp alkalosis Pink puffers

Eg. rupture of bleb (alveoli filled sacs) in pt with inflammed lung conditions Eg. open pneumothorax air enters pleural space through an opening in chest wall -Stab/ gun shot wound 2. Tension Pneumothorax air enters plural space with @ inspiration & cant escape leading to over distension of thoracic cavity resulting to shifting of mediastinum content to unaffected side. Eg. flail chest paradoxical breathing Predisposing factors: 1.Chest trauma 2.Inflammatory lung conditions 3.Tumor S/Sx: 1. Sudden sharp chest pain 2. Dyspnea 3. Cyanosis 4. Diminished breath sound of affected lung 5. Cool moist skin 6. Mild restlessness/ apprehension 7. Resonance to hyper resonance Diagnosis: 1. ABG pO2 decrease 2. CXR confirms pneumothorax Nursing Mgt: 1. Endotracheal intubation 2. Thoracenthesis 3. Meds Morphine SO4 Anti microbial agents 4. Assist in test tube thoracotomy Nursing Mgt if pt is on CPT attached to H2O drainage 1. Maintain strict aseptic technique 2. DBE 3. At bedside a.) Petroleum gauze pad if dislodged Hemostan b.) If with air leakage clamp c.) Extra bottle 4. Meds Morphine SO4 Antimicrobial 5. Monitor & assess for oscillation fluctuations or bubbling a.) If (+) to intermittent bubbling means normal or intact - H2O rises upon inspiration - H2o goes down upon expiration b.) If (+) to continuous, remittent bubbling 1. Check for air leakage 2. Clamp towards chest tube 3. Notify MD c.) If (-) to bubbling 1. Check for loop, clots, and kink 2. Milk towards H2O seal 3. Indicates re-expansion of lungs When will MD remove chest tube: 1. If (-) fluctuations 2. (+) Breath sounds 3. CXR full expansion of lungs Nursing Mgt of removal of chest tube 1. DBE 2. Instruct to perform Valsalva maneuver for easy removal, to prevent entry of air in pleural space. 3. Apply vaselinated air occlusive dressing Maintain dressing dry & intact

Diagnosis:

Nursing Mgt: 1. CBR 2. Meds a.) Bronchodilators b.) Corticosteroids c.) Antimicrobial agents d.) Mucolytics/ expectorants 3. O2 Low inflow 4. Force fluids 5. High fowlers 6. Neb & suction 7. Institute P posture E end E expiratory to prevent collapse of alveoli P pressure 8. HT a.) Avoid smoking b.) Prevent complications 1.) Cor pulmonary R ventricular hypertrophy 2.) CO2 narcosis lead to coma 3.) Atelectasis 4.) Pneumothorax air in pleural space 9. Adherence to meds

RESTRICTIVE LUNG DISORDER PNEUMOTHORAX partial / or complete collapse of lungs due to entry or air in pleural space. Types: 1. Spontaneous pneumothorax entry of air in pleural space without obvious cause.