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18 Cards in this Set
- Front
- Back
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Chronic Obstructive Pulmonary Disease
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-Umbrella term for emphysema and chronic bronchitis (usually one predominates)
-Results from repeated exposure to respiratory irritants that damage structure of lungs -Irreversible airflow limitation on exhalation -Over 15 million Americans diagnose with COPD -4th leading cause of death in the US -Is not CURABLE, but it can be managed -Direct cost of care estimated at 18 billion |
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Risk Factors
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-#1 risk factor tobacco smoking
-Occupational exposure Environmental pollution -Recurrent respiratory infections -Hereditary -Alpha-antitrypsin (AAT) deficiency -Clients with asthma -Aging process |
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Emphysema
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-Airflow limitation is the result of lung tissue destruction
-Destruction of the alveolar walls > outpouring of macrophages digest alveolar tissue > decrease surface area for diffusion -Destruction of elastin > loss of elastic recoil > hyperinflation of lungs > airways collapse on expiration > air trapping in alveoli |
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S&S Emphysema
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Progressive dyspnea
Prolonged expiratory phase Barrel chest Use of accessory muscles to breathe, assumes tripod position Diminished breath sounds Weight loss/underweight Clubbing Hypoxemia/hypercapnia develop later in the disease process |
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Chronic Bronchitis
(productive cough x 3 months in 2 consecutive years) |
-Chronic inflammation of the airways with vasodilation, congestion and edema of mucosa
-Mucosal inflammation edema further narrowing of the airway -Thick & tenacious mucus in airways bacterial medium ↑ susceptibility to infection -Narrowed airways and excess secretions obstruct airflow |
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S&S Chronic Bronchitis
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Dyspnea
Persistent, productive cough (white) Bronchospasms at the end of coughing episodes Wheezing/crackles Prolonged expiration Polycythemia Ruddy appearance/Cyanosis |
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Complications of COPD
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-Cor pulmonale/right sided hear failure
-Acute exacerbations of COPD -Pneumonia -Respiratory failure -GERD/ulcers -Depression |
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Cor Pulmonale
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-hypertrophy of right side of heart
-result of pulmonary hypertension secondary to hypoxia and hypercapnia -Eventually will cause right sided heart failure |
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Clinical Manifestations of right sided heart failure
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-Peripheral edema
-Weight gain -Ascites -Hepatomegaly -Bounding pulses -JVD -Changes in heart sounds and ECG |
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Diagnostic Testing
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History
Clinical presentation Spirometry/PFT ABG’s CXR Sputum Gram stain, C&S AAT deficiency serum testing |
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Collaborative Therapy
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Cessation of smoking (wellbutrin, chantix)
Treatment of exacerbations and resp. infections Drug therapy Bronchodilators - nebulizer, inhalers, pills Cortiocsteroids- iv push/piggyback solumedrol 40-100 mg, then switched to pregnesone inhaled- know how to admin dpi vs mdi for exam! Expectorants Oxygen therapy- lowest possible level, goal of o2 sat of 90% or greater Chest phsyiotherapy Nutrition- issues w weightloss, hi cal and hi protien diets, low carbs Exercise- 20 - 30 min 3x a week Pulmonary rehabilitation Vaccinations - pneumonia and flu |
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Surgical Therapy
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Lung volume reduction surgery
-remove 30% of disease lung tissue Bullectomy -used for emphysematous COPD Lung transplantation |
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Asthma Statistics
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-Asthma affects more than 20 million adults in the US
-Asthma is the most chronic disease of childhood; most common cause of hospitalization for children under 15. Over 9 million children have asthma -Estimated that 80% of asthma deaths could be prevented with proper asthma education. Asthma is attributed to: -Nearly 2 million ER visits, -25 million lost work days annually -15 million lost school days annually -Health care costs over $16 billion a year -If 50% of asthmatic adults and children received the flu vaccine then $379 million could be saved in hospital costs. -Currently, fewer than 10% of children and 40% of adults with asthma are vaccinated. |
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Asthma
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-Chronic inflammatory disease of the airways, alveoli not involved
-Intermittent, reversible airflow limitation |
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Triggers of Asthma
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Allergens
Air Pollution Occupational Exposure Respiratory Infections Exercise Drug/Food Additives GERD Nose/Sinus Problems Stress |
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Asthma PATHOPHYSIOLOGY
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-Chronic inflammation from exposure to allergens or irritants
-The airways are hyperresponsive which lead to airway obstruction from overproduction of mucus and edema of the ariway mucosa |
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Inflammatory mediators cause
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Vascular congestion
-Edema formation -Production of thick, tenacious sputum -Bronchoconstriction -Thickening of airway walls -Increase bronchial hyperresponsiveness |
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Asthma Clinical manifestations
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-Cough
-Wheezing -Dyspnea -Chest tightness -Tachycardia with tachypnea -Prolonged expiratory phase -Anxiety/restlessness -Use of accessory muscle retractions |
