chronic lung disease…
bronchitis and pulmonary emphysema (COPD)
asthma
intermittent disease
reversible airflow obstruction and wheezing
asthma
characterized by bronchospasm and dyspnea
- damage to lung is NOT reversible and increases in severity
- compensation occurs over time, ABGs altered
COPD
as COPD worsens…
- amount of O2 in blood decreases (hypoxemia)
- amount of CO2 in blood increases (hypercapnia)
worsened COPD causes…
- *chronic respiratory acidosis
- increased arterial carbon dioxide (PaCO2)
- results in kidneys retaining bicarb as compensates
if advanced emphysema….
d/t alveoli being affected
hypercarbia is a problem
how is cough and comfort facilitated in COPD pt
semi or high fowlers (lessens pressure on abdomen)
why can gastric distention occur in COPD pt
elevated diaphragm and inhibits full lung expansion
describe chronic bronchitis
- *blue bloaters
- daily productive cough for more than 3 months (at least 2 yrs)
- characterized by excess mucus secretion within bronchial tubes, inflammation leading to cough and difficulty breathing
describe s/s of chronic bronchitis
- overweight and cyanotic
- elevated hemoglobin
- peripheral edema
- rhonchi, wheezing, crackles
- blue lips, face, mucus, nail beds
- right HF
- distended neck veins
describe emphysema
- *pink puffer
- permanent enlargement and destruction of airspaces distal to the terminal bronchiole
- characterized by long term, progressive SOB d/t overinflation of alveoli (skin appears pink)
increased work to breathe in emphysema pt….
causes increased O2 consumption
what does an xray indicate in emphysema
hyperinflation with flattened diaphragm
describe s/s of emphysema
- older and thin
- severe dyspnea
- quiet chest/breath sounds
- *barrel chest
- pursed lip breathers
nursing interventions for COPD (same for bronchitis and emphysema)
- lowest FiO2 (1-2 L), prevent CO2 retention
- monitor for s/s fluid overload
- maintain paO2 55-60
- tripod position
- administer bronchodilators and anti-inflammatory
overinflation of lungs causes what
- rib cage to remain partially expanded, appears barrel chest like
- pt works harder to breathe BUT amount of O2 taken in is not adequate enough
inadequate arterial oxygenation is manifested by
- cyanosis
- slow cap refill
- clubbing of fingernails (chronic and late sign)
cells of body depend on…
O2 to carry out their functions
this occurs with insufficient oxygenation
chronic bronchitis
leads to general cyanosis and R HF
other COPD interventions
- teach to sit upright and bend forward
- teach diaphragmatic and pursed lip breathing
- administer O2 at 1-2 L by nasal cannula
- pace activity and conserve energy
- small, frequent meals (increase calories and protein)
- fluid intake 3 L a day (between meals not with them)
- smoking cessation
COPD dietary methods
- increased Mg and Ca (role in muscle contraction and relaxation)
- monitor Mg and Phos. role r/t bone mineral density
- if a smoker, may need vitamin C
because eating consumes energy…
-may need mechanical soft diets (needed as eating takes necessary energy needed for breathing)
exposure to tobacco smoke….
primary cause of COPD in US
if cyanotic and lethargic…
bad oxygenation
