Chapter 24 Management of Patients with Chronic Pulmonary Disorders Chronic Obstructive Pulmonary Disease o is a disease state characterized by airflow

w limitation that is not fully reversible. o COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or a combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma were previously classified as types of chronic obstructive lung disease. o Pathophysiology In COPD, the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. The inflammatory response occurs throughout the airways, parenchyma, and pulmonary vasculature Because of the chronic inflammation and the bodys attempts to repair it, narrowing occurs in the small peripheral airways. Over time, this injury-and-repair process causes scar tissue formation and narrowing of the airway lumen. Airflow obstruction may also be due to parenchymal destruction as seen with emphysema, a disease of the alveoli or gas exchange units. o Chronic Bronchitis a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. smoke or other environmental pollutants irritate the airways, resulting in hypersecretion of mucus and inflammation. This constant irritation causes the mucus-secreting glands and goblet cells to increase in number, ciliary function is reduced, and more mucus is produced. The bronchial walls become thickened, the bronchial lumen is narrowed, and mucus may plug the airway Alveoli adjacent to the bronchioles may become damaged and fibrosed, resulting in altered function of the alveolar macrophages. This is significant because the macrophages play an important role in destroying foreign particles, including bacteria. As a result, the patient becomes more susceptible to respiratory infection. V/Q: Perfusion Exceeds Ventilation : Shunts Characterized By: Excessive Mucus Secretion(thick gelatinous),morning cough, dyspnea, tracheobronchial tree inflammation Hypoxemia, hypercapnia, respiratory acidosis Signs of Right Heart Failure o Blue Bloaters Diagnostic Chest X-ray( Increase bronchovascular markings & Cardiomegally Pulmonary Function test ( Increased RV; Decreased VC) Arterial Blood Gasses Management Health Teaching about abstaining from smoking Increase Fluid Intake Bronchodialtors (Relieve Spasm) o Pulmonary Empysema an abnormal distention of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli. It is the end stage of a process that has progressed slowly for many years. As the walls of the alveoli are destroyed (a process accelerated by recurrent infections), the alveolar surface area in direct contact with the pulmonary capillaries continually decreases, causing an increase in dead space (lung area where no gas exchange can occur) and impaired oxygen diffusion, which leads to

hypoxemia. In the later stages of the disease, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) and causing respiratory acidosis. As the alveolar walls continue to break down, the pulmonary capillary bed is reduced. Consequently, pulmonary blood flow is increased, forcing the right ventricle to maintain a higher blood pressure in the pulmonary artery. V/Q: Ventilation Exceeds Perfusion: Dead Space Elasticity of Lungs is gone Barrel Chest due to the hyperinflation of the lungs Co2 elimination is impaired due to hypercapnia & Respiratory acidoses Tissue Hypoxia- Because of low perfusion Pink Puffers Compensatory Hyperventilation o Use of accessory muscled to compensate SOB, DOB Clinical Manifestation Dyspnea Pursed Lip Breathing Tripod Sitting position Chest is hyperresonant; wheezing head Sputum expectoration Very thin & Barrel Chest Diagnostic Studies Chest x-ray Pulmonary Function Test Arterial Blood Gas Studies Management Cessation of Smoking Bronchodilators Antibiotics Chestphysiotheraphy Low-flow Oxygen theraphy High Calorie/Protein diet Encouragre Rest Nursing Diagnosis Impaired gas exchange-low v/q ratio Ineffective airway clearance High risk of infection Bronchiectasis a chronic, irreversible dilation of the bronchi and bronchioles. Causes 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 humoralimmunodeficiency) Idiopathic causes Clinical Manifestations Purulent productive cough Hemptysis Recurrent pneumonia Weight loss, anemia

Crackles can be heard Chest X-ray o Crosward bronchial markings Management Antibiotics(7-10 days) Chest physiotheraphy Bronchodilators Nursing Management to promote bronchial drainage to clear excessive secretions from the affected portion of the lungs and to prevent or control infection. Stress good hygiene Adequate rest and diet Frequent mouth care. Chest physiotheraphy

Asthma o a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea o Reversible bronchospasm, dyspnea, cough, wheezing o Extrinsic Asthma Allergic/ Immunologic origin Atopy-genetic predisposition to manifest o Intrinsic Asthma Smokers No obvious extrinsic causes o Pathophysiology Exposure to allergens & causative factorsimmunoglobulin stimulationmast cell degranulationhistamine,leukotrienes, prostaglandin, bradykininwheezing & Narrowing of airwayAirway obstruction o Clinical Manifestation Cough, dyspnea and wheezing Nasal flaring Inability to lie flat Fast breathing; unable to speak Chest tighness o Drug Theraphy Bronchodilators rapid acting epinephrine Anticholinergics- Ipatropium Subcutaneous Epinephrine o Nursing Diagnoses Ineffective airway clearance Impaired mucocillary clearance