Chapter 24 Management of Patients with Chronic Pulmonary Disease

GROUP I

Abdullah, Allyzah
Abdulmalik, Hanima
Abraham, Mitch Ayessa
Ala, Ranyah
Ali, Analisah
Anticamara, Dimple
Ashary, Yaharah
Balindong, Junnali
Bendijo, Anne Frances
Buale, Jeddah Mae

In Partial Fulfillment
Of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING

Presented to
Bucayan, Lucy May
Gayao, Karlo
Jangulan, Exerlyn
Pontilan, Meilen

October 27, 2021

1. Howard Long, 50 years of age, is a male patient diagnosed with bronchiectasis. He has
smoked 1 pack per day of cigarettes for 35 years. He has a long history of recurrent bronchial
infections. He has a chronic productive cough with copious amounts of purulent sputum. The
patient complains that he is short of breath even at rest. He has clubbing of his fingers. The chest
CT scan reveals bronchial dilation. (Learning Objectives 2, 5 and 6)

a. How should the nurse explain to the patient and family the pathophysiology of
bronchiectasis as it is related to the symptoms the patient is experiencing?

 After some time as an individual has repeated pulmonary diseases or substances that
bother the bronchi (the enormous aviation routes used to inhale), the irritation harms the
bronchial wall. The bronchial wall as it is harmed loses its supporting structure and the
outcome is thick sputum that can without much of a stretch deter the bronchi. The wall
become for all time widened and change shape, which makes it hard to clear bodily fluid
from the lungs. The body's hack reflex is utilized when there is irritation in the aviation
route, for example, discharges. There is a lot of thick bodily fluid created every day,
which clarifies the perpetual hack endeavoring to remove the bothering from the aviation
routes. Maintenance of a portion of the discharges and the subsequent obstruction reason
the alveoli (the little aviation routes where oxygen and carbon dioxide are traded) to fall
so that there is less surface territory in the lung to get the oxygen required and dispose of
the waste result of carbon dioxide. Scar tissue replaces the once working lung tissue. The
diminishing in working lung tissue prompts the respiratory framework being inadequate
to address the body's issues, which prompts shortness of breath even while very still. The
emissions will in general pool into a fragment or lower flaps of the lungs and microscopic
organisms can develop in the discharges prompting incessant diseases and the sputum
ends up purulent (changes shading and grabs a smell). There is no known explicit reason
for clubbing of the fingers, however it is seen with different lung sicknesses, including
bronchiectasis.
Rationale: It is important to explain to the patient that a history of chronic bronchitis paired
with their current symptoms of chronic cough with copious sputum, shortness of breath and
clubbed fingers are indicative of chronic obstructive pulmonary disease.
 Informing and explaining to the patients is their right, we nurses promote an honest
environment and, we never want to lie about their condition. Also, we nurses should inform
and explain it to the patient in a way they could easily comprehend it.

b. How should the nurse explain to the patient and family the goals of medical
management that may be used to treat the bronchiectasis?

The nurse should explain to the patient and to their family the goals of medical management is:
 Promote bronchial waste and clear emissions from territories of the lung that are
influenced:
- Chest physiotherapy and postural waste.
- Bronchoscopy to evacuate purulent sputum, if necessary.
 Prevent or control infections as early as possible.
- Annual influenza vaccination.
- Pneumococcal immunization, and repeat the vaccine once in 5 years.
- To report signs of an infections. (e.g., fever, chill, purulent body fluid)
 Smoking cessation is important to impaired bronchial drainage by paralyzing ciliary
action and increasing bronchial secretions and causing inflammation of the mucous
membranes result in hyperplasia of mucous glands.
 Antibiotics are cornerstone therapy for management of bronchiectasis exacerbation.
 Antimicrobial therapy results of sensitivity studies on organisms’ culture from sputum
however empiric coverage broad spectrum is effective in treating commonly implicated
pathogens.
 Nebulized mucolytic help to clear airway secretion.

Rationale: Over all, the nurse should explain to their patients the process of their treatment
in medical management. The nurse should explain to the patient that the patient’s goals
should be to participate in Bronchiectasis management and management of their symptoms.
c. What does the nursing management for bronchiectasis entail?
Nursing management focuses on alleviating symptoms and helping patients clear pulmonary
secretions:
 To provide symptom relief and comfort measures
 Promote pulmonary toilet.
 To assess nutritional status and develop patient focus strategies to promote adequate
nutrition.
- Encourage the patient to have six small meals each day.
- Liquid high protein shakes fortified with vitamins and minerals, when the energy
levels are decreased.
- Weigh patient at same time of day and report a decreasing of weight of more than 2
pounds within a 24-hour duration.
- Collaborate with the doctor or a dietitian consult to help the patient or family
planning.
 To instruct the patient on smoking cessation and provide follow up on attempts to quit.
 Instruct patient and family on the best way to do postural drainage and percussion.
 Instruct patient and family on procedures to monitor vitality while advancing as dynamic
of an actual existence as could be expected under the circumstances:
- Make a rundown of exercises that should be done and organize the exercise and
figure out which exercises can be appointed to relatives.
- Take rest breaks in the middle of exercises for the duration of the day. Decide when
the most noteworthy vitality level is and do the exercises that are most significant
amid that timeframe.
- Sit at whatever point conceivable to perform exercises to moderate vitality.
- Collaborate with the doctor for an aspiratory recovery counsel
 Instruct patient and family on ways to decrease risk for an infection.
- Demonstrate appropriate strategy for hand washing and have patient and family
return the show.
- Avoid people with an upper respiratory disease or different contaminations.
- Instruct on legitimate approach to discard emissions.
 - Instruct on the signs and manifestations of a disease to answer to the doctor
immediately with the goal that early treatment might be acquired. (Fever, change in
shading or scent of sputum ought to be accounted for).

Rationale: The nurse should encourage the client to manage their symptoms, monitoring
changes in respiratory status, Teaching breathing techniques and effective coughing methods,
Proper positioning, the use of oxygen therapy, exercise conditioning and maintaining proper
hydration. Also, it is important to tell the client to cough up all secretions.

2. Sallie Thorp, a 21-year-old patient, presents to the physician’s office with an asthma action
plan form she acquired from a literature search on the World Wide Web at
http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf. She states that she
would like to develop the plan with the help of the nurse and physician and review it at each
appointment to keep it current. She has had moderate persistent asthma for 5 years, and she has
visited the emergency department several times in the past year with severe asthma attacks. She
stated that she forgets to take her medications, because the medications are at times that the
hospital provided the inhalers (12 noon and midnight), and she gets confused on which inhalers
are the long-acting ones and which inhaler is the short-acting rescue inhaler she is supposed to
use when she has an exacerbation. She stated that if she could, she would like to take the inhalers
at 8 AM and again at 8 PM. The patient stated that she has a flow meter and that a respiratory
therapist at the hospital taught her how to use it in the past, and he wrote down her personal best
peak flow, which is 400 L/sec. The nurse reviews the patient’s medical chart and discovers that
she has been prescribed the following from today’s visit:
 Use albuterol (Proventil): 2 to 4 puffs every 20 minutes for up to 1 hour as rescue
inhaler. If symptoms improve, then take the inhaler every 4 hours for 1 to 2 days. If
no improvement after 2 days, call the physician
 Salmeterol (Serevent): 50 mcg every 12 hours
 Fluticasone (Flovent): 88 mcg or 2 puffs every 12 hours
 Cromolyn sodium (Nasalcrom): one spray to each nostril once daily and before being
exposed to known asthma triggers. You may use the spray up to every 4 hours
  Measure peak flow meter every morning before using inhalers and record. Use peak
flow meter, as needed, if you develop symptoms, such as cough, shortness of breath,
wheezing, chest tightness; use of neck and chest muscles to breathe; problems talking
or walking because of extreme shortness of breath
 Follow-up in 3 months
 Have the nurse provide education on asthma self-management and fill out the action
plan that the patient brought with her today and have the physician review it and sign
it

The nurse also notes that the medications have not changed from the last visit.
(Learning Objective 8)

a. Explain the medications to the patient and practice filling in the asthma action plan.

MEDICATION/ DOSAGE AND MECHANISM/ POTENTIAL NURSING

CLASSIFICATI FREQUENCY INDICATIONS ADVERSE CONSIDERAT
ON EFFECT ON

Albuterol  2 to 4 puffs every To relax the Inhaled route is Monitor

(Proventil) 20 minutes for up bronchial smooth preferred to oral respiratory rate
to 1 hour as rescue muscle. It also route because oxygen
Beta-2 adrenergic inhaler. inhibits the release LABAs are longer saturation, an
receptors  If symptoms of immediate acting and have lungs sound
improve, then take hypersensitivity fewer side effects before and afte
the inhaler every 4 mediators from cells, than oral sustained- administration. I
hours for 1 to 2 especially mast cells. release agents. more than on
days. inhalation i
 If no improvement ordered, wait a
after 2 days, call least 2 minute
the physician between
inhalations.

Salmeterol  50 mcg every 12 Long-term Should not be used Reinforce t

(Serevent) hours prevention of to treat acute patient that thes
symptoms added to symptoms or medications
should not b
- ICS. exacerbation. used to treat acut
long-acting beta-
asthma symptom
agonists pr exacerbation.

Fluticasone  88 mcg or 2 puffs Mechanism: hoarseness,  Use

(Flovent) every 12 hours cautiously
Anti-inflammatory; throat irritation, with
blocks late reaction untreated
to allergen and headache,
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Cromolyn sodium  1 spray to each Indications: Cough and irritation. Inform patien
(Nasalcrom) nostril daily and that 4–6-wee
before being Long-term trail may b
exposed to known prevention of needed t
asthma triggers. symptoms in mild determine
-mast cell
 You may use the persistent asthma; maximum benefi
stabilizers
spray up to every 4 may modify
hours. inflammation.

 Measure peak flow meter every morning before using inhalers and record.
 Use peak flow meter, as needed, if you develop symptoms, such as cough, shortness of breath, wheezing
chest tightness; use of neck and chest muscles to breathe; problems talking or walking because of extrem
shortness of breath.
 Follow-up in 3 months
 Have the nurse provide education on asthma self-management and fill out the action plan that the patien
brought with her today and have the physician review it and sign it
 b. Explain ways to evaluate the patient’s mastery of the content?

 Have the patient explain the asthma action plan back to the you as a nurse in her/his
own words.
 Let the patient demonstrate using the spacer with the inhaler.
 Patient demonstrate using the peak flow meter and interpret the measurement.

References:
(Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th Edition ed., Vol. 1; Page 648). Julie K. Stegman.)

Johnson D. et al. 2021. Albuterol. StatPearl.

uCentral from Unbound Medicine. Nursing Pharmacology

Cunha J., 2021. Flovent HFA.

Nursing.com Team. Fluticasone.