Nursing Management of Respiratory Diseases and

Disorders Laurie Phillips RN, MSN, PHN

Lecture Objectives Review key elements of normal respiratory

anatomy and physiology Differentiate between restrictive and obstructive

pulmonary diseases Examine relative pulmonary disease epidemiology Describe the pathophysiology, clinical

manifestations, and nursing management of acute bronchitis and Acute Respiratory Distress Syndrome (ARDS)

Lecture Objectives Discuss the pathophysiology, clinical

manifestations, and nursing management for chronic bronchitis, emphysema, and asthma

Compare the pathophysiology and clinical manifestations of secondary complications such as pulmonary edema, pulmonary hypertension, and Cor pulmonale

Apply the nursing process to plan care for patients with restrictive and obstructive pulmonary diseases

Lecture Objectives Relate the nursing process including patient

teaching to drugs commonly used for restrictive and obstructive pulmonary diseases

Learn how to correctly use a metered dose inhaler (MDI), small volume nebulizer (SVN), and oxygen

Anatomy and Physiology

Restrictive Lung Disease

VS

Obstructive Lung Disease

Acute Bronchitis

inflammation of tracheobronchial tree relationship with infection

– viral vs. bacteria frequent in winter months often mistaken for asthma

Epidemiology - Bronchitis

Internationally - top 5th reason for physician visits

Mortality - low in absence of other cardiopulmonary disease

Sex - little difference; women diagnosed more

Age - 11 out of 100 (<5yrs.) ; 4 out of 100 (>5yrs.)

Clinical Manifestations Quick Assess Bronchitis

a purulent cough fever malaise and myalgias rhinorrhea or nasal congestion sore throat wheezing dyspnea and chest pain

Diagnostics - Bronchitis

Sputum specimen Chest xray

Medication Management Acute Bronchitis

Antibiotics Analgesics/antipyretics Antitussives and expectorants Bronchodilators Antiviral agents

MDI Administration

Acute Respiratory Distress Syndrome - ARDS

sudden and progressive form of respiratory failure

alveolar capillary membranes becomes damaged

intravascular fluid fills alveoli– severe dyspnea and hypoxemia– reduced lung compliance (surfactant)– diffuse pulmonary infiltrates

Causative Factors

Direct Lung Injury

Vs.

Indirect Lung Injury

Epidemiology - ARDS

In the U.S. - reported 150,000 cases annually Internationally - unknown Mortality - 40-60% of affected persons; 70-

90% of affected persons with comorbidity of septic shock

Clinical ManifestationsQuick Assess ARDS

S/S of acute respiratory distress - tachypnea, dyspnea, accessory muscle breathing, central cyanosis

dry cough and fever fine crackles throughout all lung fields S/S of hypoxemia - confusion, agitation,

coma

Diagnostics - ARDS

Pulmonary Function Tests (PFTs) Chest xray

– bilaterally, equal interstitial and alveolar infiltrates

ABG– Hypoxemia, PO2 less than 50 mm Hg– Hypocapnia and respiratory alkalosis (early)– Hypercapnia and respiratory acidosis

Management of ARDS

Supportive Measures Oxygen Mechanical ventilation Prone positioning Maintenance of fluid balance Current research in Pharmaceutical

management

Asthma

altered immunological response increased airway resistance increased lung compliance Impaired mucociliary function altered oxygen-carbon dioxide

exchange

Epidemiology - Asthma

In the U.S. - 8% of the population affected (18-20 million persons); half of these are children

Internationally - increases with urbanization and affluence

Morbidity/Mortality - 150 million worldwide; increased 40% in last 10 yrs. 29 deaths per million per year

Clinical Manifestations Quick Assess Asthma

wheezing, crackles, diminished or absent breath sounds

breathlessness and prolonged expiration dyspnea; tachypnea with hyperventilation cough with accompanied bronchospasm thick, tenacious, white, gelatinous mucous signs of hypoxemia during attack status asthmaticus

Diagnostics - Asthma

Pulmonary Function Tests (PFTs) Peak Expiratory Flow Rates (PEFR) Chest xray ABGs and oximetry Allergy skin testing ( if applicable) Blood levels of eosinophils and IgE

Medication Management Asthma

Nonsteroidal antinflammatory drugs Corticosteroids Leukotriene inhibitors Theophylline Anticholinergic Bronchodilators

Small Volume Nebulizer Therapy

Chronic Obstructive Pulmonary Disease

COPD

expiratory airflow obstruction not completely reversible two categories

– chronic bronchitis– emphysema

Chronic Bronchitis

impaired ciliary function hypertrophy of mucous-secreting glands increased airway resistance altered oxygen-carbon dioxide exchange right ventricular decompensation

Emphysema

permanent enlargement of air spaces distal to the bronchioles

hyperinflation of alveoli destruction of alveolar capillary walls narrowed airways loss of lung compliance

Epidemiology - COPD

In the U.S. - two thirds of men and one fourth of women have emphysema at death

Internationally - the WHO estimates 2.74 million deaths worldwide in 2000 were due to COPD

Mortality - affects 32 million adult Americans Sex - Men are affected more than women Age - older than 40 yrs.

Causative Factors COPD

Cigarette smoking Infection Air pollution Heredity Aging

Clinical ManifestationsQuick Assess COPD

The Pink Puffers

VS

The Blue Bloaters

Diagnostic Testing and Monitoring

Factors Determining Severity of COPD

severity of symptoms severity of airflow limitation frequency and severity of exacerbations presence of complications of COPD presence of respiratory insufficiency number of medications needed to

manage disease

Severe Respiratory System Complications

Pulmonary edema Pulmonary hypertension Cor pulmonale

Pulmonary Edema

Pulmonary Hypertension

primary pulmonary hypertension secondary pulmonary hypertension

– increased left ventricular pressures– increased blood flow through pulmonary

circulation– obstruction or obliteration of pulmonary

vascular bed– Vasoconstriction of vascular bed

Cor Pulmonale

secondary to primary pulmonary hypertension

characterized by right ventricle enlargement

acute vs. chronic

Management of COPD

Oxygen Bronchodilators Corticosteroids Antibiotics Electrolyte supplements CPAP/BiPAP Heliox Intubation

Oxygen Therapy

Respiratory Nursing Assessment

Medical History– subjective data

Current Medications Physical Assessment

– objective data See Assessment Handout

Nursing Goals in Respiratory Management

prevent disease progression relieve symptoms improve exercise tolerance improve physical health prevent exacerbations and

complications minimize side effects from treatment

Nursing Diagnoses

Impaired Gas Exchange

Ineffective Airway Clearance

Altered Breathing Pattern

Nursing Interventions

Respiratory Care Pharmacology