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Week 3 Obstructive Disorder
Week 3 Obstructive Disorder
DISORDER
Prepared by: Earl John S. Amado, RN, MSN
Chronic obstructive
pulmonary disease
(COPD)
COPD is a disease characterized by airflow
limitation that is not fully reversible. The
airflow limitation is usually progressive and
associated with an abnormal inflammatory
response of the lung to noxious particles or
gases, resulting in narrowing of airways,
hypersecretion of mucus, and changes in the
pulmonary vasculature.
RISK FACTORS:
-SMOKING
-Environmental pollutants
-Occupational exposure
-Genetic predisposition(Hereditary)
CLINICAL MANIFESTATION:
-Chronic cough
-Sputum production
-Dyspnea on exertion; often worsen
over time.
MEDICAL MANAGEMENT
-Smoking cessation, if appropriate.
-Bronchodilators, corticosteroids, and
other drugs (e.g. alpha1-antitrypsin
augmentation therapy, antibiotic
agents, mucolytic agents, antitussive
agents, vasodilators, narcotics).
Vaccines may also be effective.
MEDICAL MANAGEMENT
-Oxygen therapy, including nighttime
oxygen.
TWO TYPES OBTRUCTIVE AIRWAY
DISEASE IN COPD
1. Chronic bronchitis
2. Emphysema
CHRONIC BRONCHITIS
Bradykinin(bronchoconstriction)
Histamine
Prostaglandin
Fluid/Cellular Exudation
Persistent Cough
Fibrotic Changes in the Airways
Bronchial Narrowing
Irreversible lung changes
Emphysema
Bronchiectasis
BLUE BLOATER
S/Sx:
• Overweight
• Elevated hemoglobin
• Peripheral edema
• Wheezing
DIAGNOSTICS
• Spirometry
• ABG:
mild-mod hypoxemia
Respiratory acidosis
COMPLICATION:
• RSHF(cor pulmonale)
• Pneumonia
• Pneumothorax
EMPHYSEMA
Disequilibrium between
ELASTASE & ATIELASTASE
Destruction of ELASTIC RECOIL
Overdistention of ALVEOLI
Retention of CO2(Airtrapping)
• Diet:
High Calorie – Source of energy
high Protein(CHON) – helps maintain
integrity of alveolar walls.
low Carbohydrates(CHO) – Limits CO2
production.
INTERPROFESSIONAL
COLLABORATIVE MANAGEMENT
• O2 therapy 1-3 lpm. The safest amount is
2 lpm.
Do not give high concentration of O2, The
drive for breathing may be depressed.
Consistent high CO2 in blood causes
damage in medulla oblongata.
Chemoreceptors in the carotid and aortic
bodies take up the work of breathing. The
stimulus for the peripheral chemoreceptor
is low oxygen levels in the blood.
INTERPROFESSIONAL
COLLABORATIVE MANAGEMENT
• Avoid Cigarette smoking, alcohol,
environmental pollutants, These inhibit
muco-ciliary function.
• CPT – Percussion, Vibration, Postural
drainage.
• Bronchial Hygiene measure.
Steam inhalation
Aerosol inhalation
Medimist inhalation
EMPHYSEMA/CHRONIC BRONCHITIS
MANAGEMANT
MEDICATIONS:
• Bronchodilators
Beta-2 agonists (ALBUTEROL,
SALBUTAMOL, SALMETEROL,
TERBUTALINE)
Anticholinergics (IPRATROPIUM)
Long-acting anticholinergic
(TIOTROPIUM(Spiriva))
EMPHYSEMA/CHRONIC BRONCHITIS
MANAGEMANT
MEDICATIONS:
• Steroid (BUDESONIDE, FLUTICASONE,
BECLOMETHASONE(Beclovent),
METHYLPREDNISONE(Solu-Medrol))
• Methylxanthines (THEOPHYLLINE,
AMINOPHYLLINE)
• Leukotriene antagonists(MONTELUKAST)
• Antimicrobials – if infection is present
EMPHYSEMA/CHRONIC BRONCHITIS
MANAGEMANT
COR PULMONALE
• Hypertrophy of the right side of heart, with
or without heart failure, resulting from
pulmonary hypertension,
• It is caused by diseases affecting the lungs
or pulmonary blood vessels.
Bronchiectasis
A chronic, irreversible dilation of the bronchi
and bronchioles.
CAUSES OF BRONCHIECTASIS
• Airway obstruction
• Diffuse airway injury
• Pulmonary infections and obstruction of
the bronchus or complications of long-term
pulmonary infections
• Genetic disorders such as cystic fibrosis
• Abnormal host defense (eg, ciliary
dyskinesia or humoral immunodeficiency)
• Idiopathic causes
CAUSES OF BRONCHIECTASIS
Clinical manifestation
CLINICAL MANIFESTATION
Chest X-Ray
High Resolution CT Scan(HRCTS) – Gold
standard for diagnosing bronchiectasis
Bronchoscopy
Sputum studies
Pulmonary function studies
INTERPROFESSIONAL
COLLABORATIVE MANAGEMENT
• Antibiotics
• Bronchodilator therapy(to prevent
bronchospasm)
• Beta-2 antagonist.(to stimulate muco-
ciliary clearance)
• Mucolytic agents.
• Anti-inflammatory agents.
• Pneumococcal and influenza vaccinations.
• Rest, Good nutrition, adequate hydration.
• CPT with postural drainage.
Bronchial asthma
Asthma is a chronic inflammatory disease of the
airways characterized by hyperresponsiveness,
mucosal edema, and mucus production. Allergy
is the strongest factor for the development of
asthma. The most common chronic disease of
childhood, can begin at any age.
RISK FACTORS:
-Family history
-Allergy (strongest factor)
-Chronic exposure to airway irritants or allergens
(eg, grass, weed pollens, mold, dust, or
animals).
COMMON ALLERGENS
Grass Histamine-rich
Tree foods
Weeds Eggs
Pollens Sea foods
Molds Snack foods
Dust
Roaches
Cat/Dog danders
TRIGGERS OF ACUTE ASTHMA ATTACKS
• Food additives
Sulfites
Beer, wine, dried fruits, shrimp, processed
potatoes, chip
Monosodium glutamate(MSG)
Tartrazine (Yellow dye no. 5)
TRIGGERS OF ACUTE ASTHMA ATTACKS
• Hormones, menses
• Gastroesophageal reflux disease
• Stress(Psychological/emotional)
Crying
Laughing
Anger
Fear
PATHOPHYSIOLOGY
Allergy
Inflammation
A. Bronchospasm
Bronchoconstriction
B. Edema of mucous membrane
C. Hypersecretion of mucus
Narrowing of Airways
Increase work of breath
Tends to sit up, Restlessness, Tachypnea/ dyspnea,
Tachycardia, Flaring of alae nasi, Diaphoresis, Cold
clammy skin, Wheezing, Retractions, Pallor - cyanosis
Exhaustion
Slow, shallow respiration (Hypoventilation)
Retenbtion of CO2(airtrapping)
Hypoxia Respiratory Acidosis
CLINICAL MANIFESTATION
NOTE:
Diminish or Absent breath sounds
Significant decrease in air
movement(exhaustion)
Atelectasis or pneumothorax
Severe Diminish breath sounds(“Silent
chest”)
Ominous sign, indicating severe and
impending respiratory failure.
CLINICAL MANIFESTATION
NOTE:
A severe, continuous reaction, “STATUS
ASTHMATICUS”, may occur.
Does not respond to conventional therapy.
Attack last longer than 24 hours.
Life-threatening and places the pt. at risk
for developing respiratory failure.
“The longer it last, the worse it gets, and
the worse it gets, the longer it last.
CLINICAL MANIFESTATION
NOTE:
Causes of Status asthmaticus
Viral illness
Ingestion of ASA or NSAID
Emotional stress
Environmental pollutant or other allergen
exposure.
Abrupt DC of drug therapy(Corticosteroids)
Overuse of aerosol medications.
Ingestion of beta-adrenergic blockers.
Assessment and Diagnostic Methods
• Family, environment, and occupational
history is essential.
• During acute episodes
Sputum and blood test
Pulse oximetry
ABGs
hypocapnia and respiratory alkalosis, and
pulmonary function (forced expiratory
volume [FEV] and forced vital capacity
[FVC] decreased) tests are performed.
Medical Management
Pharmacologic Therapy
There are two classes of medications
Long-acting control
Quick-relief medications(as well as
combination products).
Short-acting beta2-adrenergic agonists
Anticholinergics
Corticosteroids: metered-dose inhaler (MDI)
Leukotriene modifiers inhibitors/
antileukotrienes
Methylxanthines
Nursing Management