NURSING CARE OF CLIENTS WITH VENTILATION breakdown in alveolar walls/sacs resulting to

DISORDERS impaired gas exchange and transport.

OBSTRUCTIVE LUNG DISEASES • AAT- protective substance produced in the

liver that contains enzyme of WBC, which
1. COPD
helps fight inflammation.
a. Pulmonary Emphysema
b. Chronic Bronchitis
CHRONIC BRONCHITIS
2. Bronchial Asthma
• A disease of the airways is defined as the
COPD
presence of cough and sputum production
• Slow and progressive type of condition. for at least 3 months in each 2 consecutive
• Chronic Obstructive Pulmonary Disease of years
airflow obstruction involving the airways, • Blue Bloaters (cyanosis with edema)
pulmonary parenchyma or both (can be
from large airways to smaller airways).
• Is a preventable and treatable slowly
progressing respiratory disease
• Airflow limitation and obstruction is not fully
reversible

COPD Facts

• The most common form of COPD is a

combination of Chronic Bronchitis and
Pulmonary Emphysema
• Bronchial Asthma is NOT usually considered a
form of COPD because “pure” asthma
symptoms can be reversed.
• Asthma has triggers, while COPD have already
damaged the lungs.

Etiology

• Smoking – the most important predisposing In Chronic Bronchitis

factor of COPD. Too much smoking destroys
cilia that facilitates movement of debris or
unwanted particles from the air to be
expelled out.
• Occupational exposure
• Allergies
• Aging
• Air pollution
• Autoimmunity
• Infection
• Genetic disposition
Alpha 1-Antitrypsin (AAT) Deficiency
• AAT deficiency, is an inherited disorder that
can also lead to emphysema. AAT is a
protective substance produced in the liver
and transported to the lungs to help fight
inflammation. When there is an inadequate
AAT, the body is no longer protected from an
enzyme in the WBC and can cause a
• Excessive mucus excretions
• Smooth muscles contraction
(bronchospasm), airway
inflammation/bronchial wall edema
EMPHYSEMA
• Pink puffer (acyanotic with
compensatory pursed lip breathing)
• Impaired gas exchange (oxygen, carbon
dioxide) results from destruction of the
walls of overdistended alveoli
• “Emphysema” is a pathological term that
describes an abnormal distention of the
air spaces beyond the terminal
bronchioles, with destruction of the walls
of the alveoli.
 MODERATE - SOB from SOB from
moderate moderate
exertion exertion
- Coughing and
increased
sputum
- Recurrent chest
infections or
bronchitis
SEVERE - Severe SOB - Severe SOB
• 2 conditions that happen in emphysema. - Coughing and - Barrel-shaped
o Centrilobular emphysema (CLE)- excessive chest
enlargement in the alveolar ducts. amounts of
o Panlobular emphysema (PLE)- sputum
enlargement of alveolar sacs. - Wheezing
In Emphysema - Recurrent
infections
• Reduction of elastic recoil due to imbalance - Fluid buildup
between elastase & anti-elastase (swelling at the
• Loss of lung’s natural tendency to resist ankles) and blue
expansion appearance to the
• Supporting structures for the airways is skin.
decreased
Types of COPD
AAT DEFICIENCY-RELATED EMPHYSEMA
Pink Puffer Blue Bloater
• Caused by the inherited deficiency of a Feature Emphysema (Type Bronchitis (Type
protein called alpha-antitrypsin (AAT) A) B)
• Onset: between the 20’s and 40’s Age Older Younger
• S/Sx: SOB and decreased exercise capacity Stature Tall, thin More obese
Dyspnea Prominent Variable
• Dx: blood screening is used if the trait is
Cough Uncommon Prominent
suspected and can determine if a person is a
Hypoxemia Mild Prominent
carrier or AAT-deficient
(decreased
• Tx: Liver Transplant (due to this substance being oxygen in blood)
produced in the liver) Hypercapnia Late Early
(increased CO2)
Compliance Increased Normal
Hematocrit Normal Increased
Cor pulmonale Late Early
(right sided
heart failure)

Comparison of Symptoms

Severity Chronic Emphysema

Bronchitis Dominating
Dominating
MILD Coughing and Possibly NO
sputum for more early signs
than 3 mos. for 2
consecutive years.
Assessment Findings
Chronic Bronchitis
• History of recurrent acute respiratory
tract infections
• Persistent productive cough
• PFT: decreased FEV & FVC, increased RV
• CXR: flattened diaphragm and dirty lung
• ABG: increased PCO2, decreased PO2
• Sputum Culture: (+) bacterial infection
Pulmonary Emphysema
• History of Chronic Bronchitis
• Progressive dyspnea – initially only in
exertion and later at rest
• Progressive cough & increased
sputum production
• Clubbing of fingers- due to hypoxemia.
• Anorexia with weight loss
• Profound weakness
• PFT: decreased FEV & FVC, increased RV
• CXR: hyperinflation, flattened diaphragm,
increased AP diameter (barrel chest, 2:1)
• ABG: increased PCO2, decreased PO2
- Orthopneic position with suprasternal,
intercostal and substernal retractions.
Collaborative Management
• Rest – to reduce O2 demand of tissues
• Increase fluid intake – to liquefy secretions
• Oral care
• Diet: High calorie, High CHON (protein), Low
CHO (carbohydrates)
- To provide source of energy
- To maintain integrity of alveolar walls
- To limit CO2 production
Management
• O2 supplement: 1-3 lpm or 2 lpm (safest)
• CPT: chest percussion, vibration and postural
drainage
• Bronchial Hygiene measures:
1. Steam inhalation
2. Aerosol inhalation
3. Medimist inhalation
Pharmacotherapy:
1. Expectorant/ Mucolytics
2. Antitussives- blocks or suppress cough reflex.
- Not recommended for COPD patients
because there are secretions that needs to
be expelled or removed. Since smoking is
the predisposing factor for COPD, these
patients have a reduced ciliary function
that helps propels these secretions. Thus,
coughing will help them to remove these
secretions.
3. Bronchodilators
4. Antihistamine
5. Steroids
6. Antimicrobials
Nursing Interventions
• Promote smoking cessation
• Improve gas exchange (w/ low flow oxygen)
- Monitor the px for dyspnea and
hypoxemia
- If bronchodilators or corticosteroids
are prescribed, the nurse must
administer the medications
- Properly and be alert for potential
side effects
• Achieve airway clearance
- Pulmonary irritants should be
eliminated or reduced, particularly
cigarette smoking
- Effective coughing
- Chest physiotherapy with postural
drainage, intermittent positive-
pressure breathing
- (intermittent positive pressure
breathing the active inflation of the
lungs during the inhalation under
positive pressure from a cycling valve
- Increased fluid intake, and bland
aerosol mists (with normal saline
solution or water)
• Improved breathing pattern
- Diaphragmatic breathing
- Pursed-lip breathing
 • Improving activity tolerance
- Pacing activities throughout the
day or using supportive devices to
decrease energy expenditure
• Avoid temperature extremes
ASTHMA
• Heterogenous disease
• Is a chronic inflammatory disease of
the airways that causes:
- Airway hyperresponsiveness
- Mucosa edema, and
- Mucus production
BRONCHIAL ASTHMA
• Usually associated with allergy
• Chest tightness
• Cough
• Wheezing: expiration more strenuous &
prolonged than inspiration
• Use of accessory muscles of respiration
• Hypoxia with cyanosis, weak pulse,
diaphoresis
• PFT: decreased FEV, increased RV, increased
TLC
• CXR: flattened diaphragm, increased AP
diameter
• ABG: increased PCO2, decreased PO2
Prevention
• Identify the substances that precipitate the
symptoms
- Possible causes are dust, dust mites,
roaches, certain types of cloth, pets,
horses, detergents, soaps, certain foods,
molds, and pollens.
• If the attacks are seasonal, pollens can be
strongly suspected
• The patient is instructed to avoid the
causative agents whenever possible
Complications
• Status asthmaticus
Is an acute exacerbation of asthma that does
not respond to standard treatments of
bronchodilators and steroids may lead to
respiratory arrest
• Respiratory failure
• Pneumonia
• Atelectasis
Medical Management
• Quick relief medication: short acting beta-
adrenergic agonists (SABA): Albuterol,
Proventil, Ventolin
• Corticosteroid
• Anticholinergics (e.g. ipratropium bromide
(Atrovent)
• Long acting beta-adrenergic agonists (LABA):
theophylline
• Antileukotrienes: Montelukast
• Immunomodulators: Omalizumab prevent
binding of IgE
• Peak flow monitoring to measure asthma
severity
Nursing Interventions
• Assess patients respiratory status by
monitoring the severity of symptoms,
breath sounds, peak flow, pulse
oximetry, and VS
• Obtain a history of allergic reactions to
medication before administering
medications and identifies the patients
current use of medications
• Administer medications as prescribed
and monitor the patients responses to
those medication
• Fluids may be administered of the
patient is dehydrated, and antibiotic
agents may be prescribed if the patient
has an underlying respiratory infection
RESTRICTIVE PULMONARY DISEASE
PNEUMOTHORAX
• Air in the pleural space
• Occurs when the parietal or visceral
pleura is breached and the pleural space
is exposed to positive atmospheric
pressure
• As a complication of severe chest
trauma injury
Types of Pneumothorax
• Simple or Spontaneous – occurs when the
air enters the pleural space through a
breach of either a parietal or visceral
pleura
• Traumatic or Open – occurs when air
escape from a laceration in the lung itself
and enters the pleural space or air enters
the pleural space through a wound in the
chest wall
• Tension Pneumothorax – is a serious
valvular type, in which air enters the
pleural space with each inspiration,
becomes trapped and is not expelled
during expiration
Clinical Manifestation
• Sudden chest pain
• Minimal respiratory distress
• Tachypnea
• Decrease lung expansion
• Diminished or absent breath sounds
• Acute respiratory distress occurs when
lung totally collapse
• Anxious
• Dyspnea and air hunger
• Uses accessory muscles
• Central cyanosis from severe hypoxemia
Medical Management
• Management depends on its cause and
severity
• The goal of treatment is to evacuate the air or
blood from the pleural space
• A pressure sterile dressing impregnated with
petrolatum
• Thoracentesis
• CTT insertion in the 2nd intercostal space
PLEURAL EFFUSION
• Abnormal accumulation of fluid in the pleural
space
• Normal pleural fluid is 5 to 15 ml
• It is rarely a primary disease, but it usually
secondary to other diseases
Etiology
• Complication of:
1. Disseminated cancer (particularly lung and
breast); lymphoma
2. Infection: tuberculosis, bacterial pneumonia,
pulmonary infection
3. Congestive Heart Failure
4. Cirrhosis
5. Kidney disease
6. Others: sarcoidosis, systemic lupus,
erythematosus, peritoneal dialysis, etc.
Clinical Manifestation
• Usually caused by the underlying disease
• Increasing dyspnea
• Dullness or flatness to percussion (over areas
of fluid) with minimal or absent breath sounds
Diagnostic Evaluation
• Chest x-ray
• Thoracentesis – biochemical, and
cytologic studies of pleural fluid
• Physical examination
• Pleuroscopy (visual exploration of
pleural space through a thoracoscope
inserted into the pleural space); pleural
biopsy
Treatment
• Thoracentesis
• Tube drainage (chest catheter)
• Radiation of the chest wall if with CA
• Pleurodesis a chemically irritating agent is
instilled to aerosolized into the pleural space
 • Surgical procedures to control malignant Treatment
effusions – parietal pleurectomy; pleural
abrasion. • There is no curative treatment
• Oxygen therapy
ATELECTASIS • Supportive treatment of symptoms includes
• Refers to closure or collapse of the alveoli respiratory physiotherapy by postural
• Is the collapse of the lung tissue at any drainage, chest percussion, and vibration
structural level (segmental, basilar or • Nebulize medications
lobar) SILICOSIS
• Maybe acute or chronic and may
cover a broad range of • Also known as Grinder’s disease and Potter’s
pathophysiologic changes, from micro rot
or macroatelectasis • Is a form of occupational lung disease caused
by inhalation of crystalline silica dust
Clinical Manifestation • Is marked by inflammation and scarring in
• Cough forms of nodular lesions in the upper lobes of
• Sputum production the lungs.
• Low grade fever
• Respiratory distress
• Dyspnea
• Tachycardia
• Tachypnea
• Pleural pain
• Central cyanosis

Nursing Management

• Frequent turning
• Early ambulation
• Deep breathing exercise
• Use of incentive spirometry
• Coughing exercise Signs and symptoms
• Suctioning secretions • Dyspnea exacerbated by exertion
• Nebulization as prescribed • Dry or severe cough, often persistent
• Postural drainage and accompanied by hoarseness of the
throat
OCCUPATIONAL LUNG DISEASE • Fatigue
PNEUMOCONIOSES • Tachypnea
• Loss of appetite
• Are group of diseases caused by inhalation of • Chest pain
certain inorganic and organic dusts • Fever
1. Asbestosis • Gradual dark shallow rifts in nails
• Is a chronic inflammatory medical condition eventually leading to cracks as protein
affecting the parenchymal tissue of the lungs fibers within nails beds are destroyed
• It occurs after long-term, heavy exposure to
asbestos, e.g. in mining In advanced cases, the following may also occur:

Signs and symptoms • Cyanosis

• Cor pulmonale
• Shortness of breath • Respiratory insufficiency
• Coughing
• Respiratory failure Treatment

• Stop further exposure to silica and other

lung irritants, including tobacco smoking
• Cough suppressants
• Antibiotics and antitubercular agents
to prevent tuberculosis
• Chest physiotherapy
• Oxygen administration
• Bronchodilators
• Lung transplantation